Author: Adam R. Pershing, DMD

Periodontal (Gum) Disease

Written by Adam R. Pershing, DMD on April 3, 2023. Posted in Educational Videos, Periodontal Therapy. No Comments on Periodontal (Gum) Disease

While you may think that some loss of teeth is inevitable with aging, it is actually possible for all of your teeth to last a lifetime. One of the ways you can achieve this goal is to avoid periodontal disease (“peri” – around; “odont” – tooth), which is caused by bacteria that attack the tissues around the teeth. Unfortunately, you may not even realize you have gum disease as the signs and symptoms are not always as apparent to you as they are to a dental professional.

Nearly all people who do not maintain good daily oral hygiene will develop gingivitis. If left untreated, this bacterial gum infection can progress from gingivitis (“gingival” – gum; “itis” – inflammation) to periodontitis, which results in bone loss around your teeth. As the bone tissue is lost, the gum tissues detach from the teeth and form little pockets that provide an even better place for bacteria to live — where your brush and floss can’t reach. As periodontal disease advances leading to more bone loss, tooth loss can result. Part of this has to do with genetics, as periodontal disease tends to run in families. The good news is that periodontal disease can be controlled, even at more advanced stages.

Signs and Symptoms of Periodontal Disease

It’s important to understand that you can have periodontal disease with no obvious symptoms, especially if you are a smoker (nicotine reduces blood supply preventing bleeding and swelling of the gum tissues). Still, there are some important things to look for:

Bleeding gums — Some people think that when their gums bleed, it simply means they’re brushing too hard. While brushing too hard is bad for the gums, it should not cause bleeding. Any bleeding of the gums should be considered a warning sign of gum disease.
Bad breath — It’s very easy for plaque to collect in the spaces between the teeth, creating the perfect living conditions for bacteria that produce odorous, sulfur-containing compounds, resulting in bad breath.
Redness or swelling of the gums — Inflammation of the gums is usually the first visible sign of periodontal disease.
Receding gums — If you notice that your teeth look longer than they used to, it may be that your gum tissue has receded (away from the enamel), exposing some of your tooth roots.
Sensitivity — If there is gum recession, the exposed roots may become sensitive to hot or cold.
Periodontal abscess — Bacteria can become enclosed in a periodontal pocket and the area will fill with pus, becoming swollen and painful.
Loose teeth — When periodontal disease results in bone loss, teeth can become loose or migrate. Tooth loss can result and may be accelerated if you are applying excessive biting forces from clenching or grinding your teeth.

Treatment Options

All periodontal therapy starts with the evaluation of your oral hygiene techniques and instruction for improving them, followed by the mechanical removal of plaque and any calcified deposits (tartar or calculus) that are present on the root surfaces. This is accomplished with a cleaning technique known as scaling, root planing or debridement using hand instruments and/or ultrasonic (high frequency vibrational) instruments. Locally applied antimicrobial products or antibiotics might also be recommended during various parts of periodontal treatment to assist in healing and pocket-depth reduction, hopefully eliminating the need for periodontal surgery. Sometimes surgical procedures may be necessary to remove the deep pockets that form between inflamed gum tissue and teeth. There are many different types of surgery to handle a variety of problems. And many times, combinations of procedures are used to attempt to reduce the number of surgeries as well as the cost of treatment.

Periodontal Disease & Your Overall Health

Periodontal disease starts in your mouth but has actually been linked to more serious conditions, such as cardio-vascular disease (CVD), diabetes and preterm births. Research has suggested two plausible mechanisms for how gum disease and these other serious medical concerns could be related: moderate to severe periodontal disease increases the level of systemic (bodily) inflammation — a characteristic of all chronic inflammatory diseases. Also, the same bacterial strains that are commonly found in periodontal pockets surrounding diseased teeth have been found in blood vessel plaques of individuals with CVD. Therefore, it may be helpful to reduce periodontal inflammation to reduce systemic inflammation.

Preventive Strategies

The best way to prevent periodontal disease is to brush and floss your teeth effectively every day. Regular dental checkups and professional cleanings every 3 or 4 or 6 months are also an important part of maintaining periodontal health; the instruments and techniques used in these cleanings can reach into areas that your toothbrush and floss can’t.

It is also possible to detect early forms of gum disease by evaluating your gingival (gum) tissues, both visually and by examining their attachment levels to the teeth. And the health of your tooth-supporting bone can be assessed by taking dental radiographs (x-rays pictures).

There are other steps you can take: Eating right, reducing stress in your life, and giving up unhealthy habits like smoking will also help ensure that you keep your teeth for a lifetime.

Common Dental Procedures

Written by Adam R. Pershing, DMD on April 3, 2023. Posted in Cosmetic & General Dentistry. No Comments on Common Dental Procedures

Your dentist is an expert in protecting your oral health. In addition to providing preventive care, they diagnose and treat the teeth, gums, mouth, and jaw. Dentists improve self-confidence with functional and cosmetic restorations. Common procedures which can restore the health and the appearance of your smile include:

Regular Exams and Cleanings

Regular checkups are one of the best ways you can maintain your oral health. The American Dental Association recommends an exam and cleaning every six months, although some dental conditions make more frequent visits advisable.

Your dentist will examine your teeth, gums, and mouth thoroughly, looking for indications of tooth decay, damaged fillings, gum disease, oral cancer, and any other oral concerns. X-rays will be taken if necessary to check the health of tooth and bone in hard-to-see locations and below the gum line.

Your hygienist will examine the surface of your teeth and your gum health. This might involve evaluating the depth of gum pockets and gum attachment to the teeth. Special tools will be used to clean the teeth and remove tartar, the hardened plaque, which can’t be removed at home. Your teeth will be polished and flossed, and fluoride might be applied.

A dental exam usually takes 30-60 minutes. After your checkup and cleaning, your dentist and hygienist will give you tips for improving and maintain your oral care.

Bonding

Dental bonding is a conservative cosmetic treatment, which uses composite resin to repair and restore the tooth surface.

Bonding is commonly used to repair chips and minor cracks, cover stained or discolored enamel, close small gaps between teeth, remodel the contours of teeth, which are undersized, crooked, or misshapen, and rebuild areas where enamel erosion has taken place.

Bridges

A bridge is a restoration that makes your smile complete again after tooth loss.

Bridges use prosthetic teeth to “bridge” the gaps caused by missing teeth. These prosthetic teeth are crafted from metal, porcelain, or porcelain fused to metal, and are matched in size, shape, and color to the teeth they’re replacing for a natural appearance. A bridge can replace up to four adjacent teeth but is typically used to replace one or two.

Traditional bridges are fixed in place and are anchored by crowns placed on the healthy teeth on each side of the gap. Bridges can also be attached to dental implants. Because a bridge requires healthy teeth, gums, and bone for a long-lasting and successful restoration, any dental problems will need to be treated beforehand.

Crowns

When a tooth has suffered structural or cosmetic damage, a dental crown can restore a tooth’s function and appearance. A crown is a custom-made “cap” which covers the entire visible surface of the tooth. Crowns are used to strengthen and protect teeth with extensive decay, breakage, or cracks, restore a tooth after a root canal procedure, cover a discolored or irregularly shaped tooth, serve as an anchor for a dental bridge, or complete a dental implant procedure.

Most crown placements require two appointments: one appointment to prepare the tooth and take an impression for crown fabrication, and one visit to fit and bond the crown to the prepared tooth. Crowns are available in several different materials. You can choose metal, porcelain, or composite resin based on factors such as durability, natural appearance, and cost.

Dentures

If you’ve lost some or all of your teeth because of trauma, periodontal infection, or decay, dentures are one option which can offer you a healthier, more attractive smile. Full or partial dentures make it easier to eat, chew, and speak clearly, support the cheeks and lips for a more youthful appearance, prevent remaining teeth from shifting out of place, and restore self-confidence.

Conventional full dentures are created and placed after the gums have healed following any extractions. Immediate dentures are placed directly after extraction, and typically require regular adjustments for fit and comfort. Partial dentures are secured to adjacent teeth, and, unlike bridges, are removable. Implant-supported full and partial dentures are also an option.

Extractions

Dentists strive to save teeth, but sometimes an extraction is necessary. Teeth might be too damaged to save due to trauma, infection, deep decay, or gum disease. Baby teeth which don’t fall out, wisdom teeth which pressure adjacent teeth, or severely overcrowded teeth might also be best treated with extraction.

Teeth are held in place by periodontal ligaments attached to the tooth socket. After the area is numbed, your dentist will use special tools to carefully loosen the tooth and lift it from the socket. A bone graft might be placed in the socket to protect your bone density before closing the site.

You’ll be given instructions to protect the site from infection and from a painful condition called dry socket. To prevent complications such as bone loss or shifting teeth caused by a missing tooth, you should discuss tooth replacement with your dentist.

Fillings

When decay is caught early, your dentist can treat your cavity conservatively by restoring your tooth’s function and appearance with a filling.

For most small to moderate cavities, direct fillings can be bonded to the tooth immediately after removing decay and cleaning and shaping the tooth. Composite resin, dental amalgam, and glass ionomer fillings are typically used for this type of single visit restoration.

An indirect filling restores molars and premolars with larger areas of damage or decay. An inlay fills the tooth surface inside the cusps, while an onlay typically covers the center of the tooth and one or more cusps. Indirect fillings can be made of composite resin, gold, or porcelain, and are created from a mold taken after the tooth is cleaned and prepped. The finished filling is bonded to the tooth at a second visit.

Fluoride Treatments

Fluoride is a naturally occurring mineral which strengthens tooth enamel and helps prevent tooth decay. Fluoridated drinking water and over-the-counter fluoride toothpastes and rinses help maintain tooth health. For even greater protection against cavities, your dentist might recommend a professional fluoride treatment.

Fluoride treatments are straightforward and take only a small amount of time. The fluoride is administered as a gel, varnish, rinse, or foam, and applied with a swab, brush, as a mouthwash, or in a tray.

While fluoride treatments are especially important for children, adults can benefit as well. Dexterity issues that can make brushing difficult, receding gums that expose part of the roots, and conditions like dry mouth can leave the teeth more vulnerable to cavities as we age.

Implant Restorations

Dental implants are a popular and effective way to replace lost teeth.

During the implant procedure, a cylinder or screw, usually made of titanium, is surgically implanted into the jawbone. The implant fuses with the bone over several months. Once the area has healed, an abutment is connected on one end to the inside of the implant. A crown is then securely attached to the other end of the abutment, which sits above the gum line. The result is a tooth which looks and functions just like a natural tooth.

Candidates for implants need healthy bone for the implant to succeed. If there are concerns with bone size or density, a bone graft can be performed first. After three to four months of healing, the jawbone generally has enough size and density to accept an implant.

Mouthguards

A mouthguard is essential protective gear whenever you participate in any sport or activity that could lead to dental trauma. Mouthguards are designed to absorb and distribute the force of impact on teeth, jaw joints, and jaws. Mouthguards also help prevent cuts and lacerations to the gums, lips, inner cheeks, and tongue.

You can choose a one-size-fits-all stock guard, or a “boil-and-bite” model that fits a bit more closely to your teeth and mouth. But your best protection comes with a custom mouthguard. Custom guards are more effective, more comfortable, more durable, and make it easier to speak and breathe.

Nightguards

Tooth grinding, or bruxism, puts hundreds of pounds of pressure on the teeth. Grinding damages teeth, dental work, and jaw joints. One of the simplest and most effective treatments for preventing the damage caused by bruxism is a nightguard.

Nightguards fit over the teeth to prevent them from touching directly, saving tooth and enamel from injury and wear. Not only do nightguards prevent contact, they spread the biting forces of the jaw over the surface of the guard to greatly reduce their impact. And because nightguards stop the jaw muscles from clenching tightly, there’s no excess stress placed on the temporomandibular joint.

Your dentist can create a custom nightguard tailored to your teeth and mouth for the most effective protection and the most comfortable fit.

Root Canal Treatment

When bacteria infect the tooth pulp, a root canal procedure is necessary. Root canal treatment prevents more widespread infection by removing infected pulp tissue and saves your natural tooth by restoring tooth strength and structure with a crown.

Root canal procedures are straightforward. After the area around the tooth is numbed, your dentist will make an opening in the crown to allow access to the pulp inside. Delicate dental instruments will be used to clean the inner tooth and removed bacteria and dead or dying tissue. The area will be thoroughly disinfected, and the inside of the tooth shaped, filled, and sealed.

A temporary filling or crown might be placed on the tooth to prevent bacteria and food from entering the site while a permanent crown is created. The entire process usually takes from one to three visits.

Sealants

Sealants are thin plastic coatings applied to the chewing surfaces of the back teeth, protecting them from bacteria and plaque. First, the tooth is cleaned and dried. An etching solution is brushed on the surface to roughen the area slightly, allowing the sealant to adhere more effectively. A thin coat of sealant is then painted on and hardened under a curing light.

Sealants are especially helpful for children when their permanent molars and premolars erupt because the irregular top surfaces of the molars are hard to clean thoroughly. Some children who still have their baby teeth and some adults might benefit from sealants as well. Talk to your dentist about the preventative care sealants can provide.

Veneers

A dental veneer is a thin, durable porcelain shell that is custom-fabricated to cover the front of a tooth. Veneers can restore the appearance of teeth with chips, cracks, and stains, can close small gaps between the teeth, and can reshape misshapen or slightly misaligned teeth. Because they are translucent, veneers closely match natural tooth enamel.

Applying veneers takes from two to three appointments, and, while the cost of veneers is comparable to the cost of crowns, veneers preserve more of the tooth’s underlying structure than crowns do.

Wisdom Teeth

Wisdom teeth often don’t have enough space to develop properly or to erupt without damaging your other teeth.

A fully impacted tooth never erupts, remaining inside the jawbone. The roots of neighboring teeth can be harmed by pressure from a trapped wisdom tooth, nearby teeth can be pushed out of alignment, or a cyst can develop around the impacted tooth. Even if you are symptom-free, regular exams and X-rays are necessary to monitor the condition of impacted teeth.

Partially impacted wisdom teeth never erupt completely. Food particles and bacteria are trapped by the partially exposed tooth and the gum tissue around it, making it very difficult to clean effectively. These teeth have a greater risk of decay and increase the risk of gum disease. They can also cause damage to neighboring teeth as they emerge.

For these reasons, wisdom tooth extraction is most often recommended during the teens or early twenties when the teeth begin erupting. The roots aren’t as large or as fully developed, the jawbone isn’t as dense, and recovery time is shorter.

Talk to your dentist to learn more about these procedures and to discover the further treatment options available to create and maintain a healthy, attractive smile.

Traumatic Dental Injuries

Written by Adam R. Pershing, DMD on April 3, 2023. Posted in Emergency Care. No Comments on Traumatic Dental Injuries

Traumatic dental injuries occur most often in children and teenagers, although people of all ages can experience them as well. Sports accidents, car accidents, and falls or trips are all examples of how someone can experience a traumatic dental injury. If you have experienced this type of injury, it’s important to visit your dentist as soon as possible. The longer you wait, the more severe the injury could become. Only through a dental exam can the extent of the damage and surrounding damage be assessed properly.

Types of Dental Injuries

Chipped or Fractured Teeth

Most chipped or fractured teeth can be repaired either by reattaching the broken piece or by placing a tooth-colored filling. If a significant portion of the visible portion of the tooth is broken off, an artificial crown or “cap” may be needed to restore the tooth. Injuries in the back teeth often include fractured cusps, cracked teeth, or a more serious split tooth. If cracks extend into the root, root canal treatment and a full coverage crown may be needed to restore function to the tooth. Split teeth may require extraction.

Dislodged Teeth

During an injury, a tooth may be pushed sideways out of or into its socket. Your dentist will reposition and stabilize your tooth. If the tooth root has been damaged, a root canal may also be necessary.

Knocked-Out Teeth

If a tooth is completely knocked out of your mouth, time is of the essence. The tooth should be handled very gently, avoiding touching the root surface itself. If it is dirty, quickly and gently rinse it in water. Do not use soap or any other cleaning agent, and never scrape or brush the tooth. If possible, the tooth should be placed back into its socket as soon as possible. The less time the tooth is out of its socket, the better the chance for saving it. Once the tooth has been put back in its socket, your dentist will evaluate it and will check for any other dental or facial injuries. If the tooth has not been placed back into its socket, your dentist will clean it carefully and replace it. A stabilizing splint will be placed for a few weeks. Depending on the stage of root development, your dentist may start root canal treatment a week or two later.

Root Fractures

A traumatic injury to the tooth may also result in a horizontal root fracture. The location of the fracture determines the long-term health of the tooth. If the fracture is close to the root tip, the chances for success are much better. The closer the fracture is to the gum line, the poorer the long-term success rate. Stabilization with a splint is sometimes required for a period of time.

Root Resorption

Resorption occurs when your body, through its own defense mechanisms, begins to reject your own tooth in response to the traumatic injury. Following the injury, you should return to your dentist to have the tooth examined or treated at regular intervals to ensure that root resorption is not occurring and that surrounding tissues continue to heal.

Traumatic Dental Injuries in Children

Chipped baby teeth can be aesthetically restored. Dislodged baby teeth can, in rare cases, be repositioned. However, baby teeth that have been knocked out typically should not be replanted. This is because the replantation of a baby tooth may cause further and permanent damage to the underlying permanent tooth that is growing inside the bone. Children’s permanent teeth that are not fully developed at the time of the injury need special attention and careful follow-up, but not all of them will need root canal treatment. In an immature permanent tooth, the blood supply to the tooth and the presence of stem cells in the region may enable your dentist to stimulate continued root growth.

Gum Emergencies

Written by Adam R. Pershing, DMD on April 3, 2023. Posted in Emergency Care. No Comments on Gum Emergencies

The tissues of the gums, tongue, or cheek lining are vulnerable to accidents like sports injuries, bites, or scalding liquids.

If you have an injury to the soft tissue of your mouth, you should:

Rinse out your mouth with salt water
Remove any visible debris
Contain bleeding by pressing a clean, damp material to the area for about ten to 15 minutes

Injuries and infections of the soft tissue of the mouth may sometimes require immediate attention.

Seek immediate care when:

you have a gum abscess, a pus-filled sac caused by infection
You have something lodged in your gums that cannot be easily taken out, as it can cause infection

Seek emergency care if the bleeding doesn’t stop after ten to 15 minutes.

Tooth Pain

Written by Adam R. Pershing, DMD on April 3, 2023. Posted in Emergency Care. No Comments on Tooth Pain

Pain is a signal that something is wrong. Any tooth pain should be taken seriously, because ignoring this symptom can lead to more serious dental and medical consequences. Among the common causes of tooth pain are decay, erosion, infection, and trauma.

Tooth Decay

Tooth decay begins with the bacteria in plaque. These bacteria create acids that strip the minerals from tooth enamel, forming weak spots in the enamel. Without treatment, weak spots grow into cavities. When tooth decay reaches the softer dentin below the enamel, the tooth develops sensitivity to heat, cold, and sweets. Deeper cavities can reach the pulp inside the tooth, which has extremely sensitive nerve tissue. These cavities can be very painful.

See your dentist as soon as you suspect you have a cavity. Early tooth decay can sometimes be reversed. A small or medium cavity can be treated with a filling. Deep cavities might require most extensive restorations.

Tooth Erosion

Enamel erosion causes tooth sensitivity and makes teeth more vulnerable to decay. Acidic foods and drinks such as citrus juices, sodas, and energy drinks can erode enamel when they’re enjoyed too frequently. Enamel erosion can be caused by acidic backwash from gastric reflux or other medical conditions. Enamel can be damaged by brushing too aggressively, or even using a brush with hard or medium bristles.

When erosion is caught early, medical treatment or lifestyle changes can limit damage. Because enamel doesn’t grow back, more serious erosion might be treated with fillings, bonding, veneers, or crowns.

Gum Disease

Advanced gum disease is a serious infection that causes the gum tissue to pull away from the teeth. Tooth roots are covered with cementum, a softer substance than enamel, which makes them more vulnerable to tooth sensitivity and painful root cavities.

Gum disease is a progressive infection that can damage gums, teeth, and bone. Deep cleanings, antibiotics, and gum grafts are among the treatments available to restore gum health and protect tooth roots.

Pulp Infection

The pulp inside each tooth is composed of living tissue, including nerves and blood vessels. When the pulp is exposed to bacteria, whether due to deep decay, injury, or gum disease, it can become infected. Symptoms include persistent pain and sensitivity, as well as red, swollen, or tender gums.

Left untreated, an infected tooth might need to be extracted. Infection can spread to the gums, jawbone, and other parts of the body. A root canal procedure is generally used to treat a tooth with a pulp infection. During root canal treatment, your dentist will remove any infected tissue, clean and fill the site, and often restore the tooth with a crown.

Tooth Grinding

Bruxism, or tooth grinding, puts enormous pressure on the teeth. Enamel is worn away, exposing the more sensitive dentin underneath, so teeth develop sensitivity to hot and cold. Bruxism causes toothaches, headaches, and jaw pain, and teeth can chip, crack, flatten, or loosen.

A custom nightguard is often recommended to protect your teeth from the traumatic impact of clenching and grinding. If your bruxism is caused by stress, anxiety, or any other medical condition, your doctor can suggest possible treatments.

Trauma

Dental trauma caused by a collision, a blow to the face, a sporting injury, a fall, or any other accident should be evaluated immediately. Sometimes, damage to a tooth isn’t obvious, and persistent pain could mean a hairline fracture or damage below the gum line.

Your dentist can often repair chips, cracks, and fractures in the office. For severe dental trauma, your dentist might refer you to an oral surgeon or endodontist for specialized treatment or surgery.

If you have been suffering from persistent tooth pain, see your dentist as soon as possible to discover the cause of your discomfort. Together, you can decide on a treatment plan that will give you back your healthy, pain-free smile.

Apicoectomy

Written by Adam R. Pershing, DMD on April 3, 2023. Posted in Endodontics. No Comments on Apicoectomy

Root canal therapy is often enough to treat infection in the inner tooth successfully. If pain or inflammation return, however, these symptoms can indicate a new or recurring infection. In such cases, an apicoectomy is a common surgical procedure used to save the tooth and restore the health of the surrounding bone and gum tissue.

Every tooth contains pulp tissue, both inside the crown above the gum line and in the canals within the roots. These canals are small tunnels which travel from the pulp chamber in the crown to the tip of each root.

Nerves and blood vessels connect pulp tissue to the nervous and circulatory systems in the body, entering and exiting the tooth from very small openings in the root tip. An infection in the root pulp can spread to the gum and bone tissue around it through these openings.

An apicoectomy, also known as a root-end resection, is the surgical removal of the apex, or tip, of a tooth’s root. This allows your dentist to access and remove any damaged and infected tissue within and around the root. Apicoectomies are common endodontic surgeries, performed with state-of-the-art diagnostic and surgical tools.

Often local anesthesia is all that is needed. If you are interested in sedation, discuss your options with your dentist. Once the area around the root is numb, an incision is made in the gum tissue to allow access to the root and any affected bone tissue.
Your dentist will carefully remove a few millimeters from the tip of the root, then clean the infected part of the root and remove any inflamed or infected tissue from the bone surrounding it. The root will be filled and the tip sealed.
Sutures will be used to close the incision, which will dissolve on their own or be removed at a follow-up visit.
Your dentist will let you know just how to take care of the site after surgery. You should follow post-op instructions carefully to reduce any swelling, and be sure to follow any dietary suggestions and restrictions.
Pain or sensitivity after the procedure can be treated with over-the-counter anti-inflammatory pain relief such as ibuprofen, or your dentist might prescribe prescription pain relief. Your dentist will also prescribe antibiotics as necessary to treat infection.

Most often, an apicoectomy is performed when infection occurs after a root canal procedure. (Your dentist may also recommend this procedure if you have calcium deposits in the root, if a crown or bridge makes a typical root canal impractical, or if the root of a tooth or the bone around it suffer trauma.) Common symptoms of infection include:

Pain which can be mild or very intense
Sensitivity to pressure or temperature
An abscess, pus, or discolored discharge near the tooth
Swelling, redness, or tenderness in the gums and tissues around the tooth
A foul taste in the mouth or persistent bad breath

If you have recurring or new pain or symptoms of infection after a root canal, see your dentist promptly. Left untreated, infection can destroy tooth, gum, and bone tissue. An apicoectomy can be your best option to preserve your tooth and protect your dental health.

Broken Teeth

Written by Adam R. Pershing, DMD on April 3, 2023. Posted in Endodontics. No Comments on Broken Teeth

Even though enamel is the hardest substance in the body, teeth aren’t indestructible, and chipped, cracked, and broken teeth are among the most common dental injuries. Tooth fractures might result from accidents, trauma, tooth grinding, chewing hard objects and foods, or extensive decay.

Tooth injuries can cause self-consciousness, sensitivity, and pain. More serious fractures can lead to infection and further damage to the tooth and its surrounding tissues. Depending on the extent of the injury to your tooth, there are several options available for restoring its appearance and function.

Options for Restoring Broken Teeth

Reattachment

It may be possible to reattach a broken tooth fragment if the damage is not too severe and you act promptly. Call your dentist for instructions on how to preserve the tooth fragment and make an appointment for treatment as soon as possible.

Contouring

Contouring is used to repair minor cosmetic damage caused by small chips. The jagged or uneven edge of the enamel is gently reshaped with a drill or laser, and then the edge is polished for a smooth, even appearance.

Bonding

A tooth with a small chip or crack could be a good candidate for bonding. A tooth-colored composite resin is applied to the damaged area with an adhesive, molded to shape, and then hardened with a curing light.

Veneer

Veneers are popular options for restoring front teeth with chips and minor cracks. A veneer is a thin, tooth-colored shell made of porcelain or composite resin. The damaged tooth is shaped to accommodate the veneer at a first appointment, and an impression of the tooth is taken. A veneer is custom fabricated from this impression. At a second appointment, the tooth’s front surface is prepped and the veneer is bonded to the tooth.

Onlay

An onlay restores a molar or premolar when one or more cusps have cracked or broken. Because an onlay is placed only on the center and any damaged cusps of the tooth, it preserves more of the natural tooth than a crown. The injured tooth is cleaned and shaped, and an impression is made which will be used to fabricate the onlay at a dental lab. The onlay will be bonded to the tooth at a second appointment.

Crown

If too much of the tooth structure is damaged or missing, a crown can restore the tooth’s appearance and function. The injured tooth is shaped and prepared, an impression is made, and a crown is custom fabricated to cover and protect the remaining tooth structure. If the pulp is damaged, a root canal is usually necessary to save the tooth before the crown’s final application.

Extraction

If the tooth has lost too much structure, if a crack extends below the gum line, or if a root is broken, extraction might be necessary. A dental implant after extraction is often the best treatment for long-term dental health. Implants can prevent shifting in the surrounding teeth, difficulties with eating and speaking, and loss of bone beneath the missing tooth.

Any injury to a tooth should be treated promptly to prevent possible infection and further damage to the tooth and the tissues around it. If you suffer any kind of dental trauma, call your dentist right away to discover the best options for restoring the health and appearance of your smile.

Root Canal Retreatment

Written by Adam R. Pershing, DMD on April 3, 2023. Posted in Endodontics. No Comments on Root Canal Retreatment

If your tooth does not heal correctly after a root canal procedure, endodontic retreatment may be necessary to save it. With any dental procedure, it is better to save your natural tooth if the possibility is there. A “retreated” tooth can last a very long time, even a lifetime.

A few instances that require the need for endodontic retreatment:

The infection in your tooth did not heal properly
Placement of your crown or other restoration was delayed
New decay has formed

If your endodontist thinks you need retreatment, you both will discuss treatment options and choose the one that best suits your situation. Your endodontist will begin by reopening your tooth to gain access to the root canal filling material. Removal of restoration and filling material allows access to blocked canals. After removing the canal filling, the endodontist will clean the canals and carefully examine the inside of your tooth using magnification and illumination, searching for any additional canals or unusual anatomy that requires treatment. Your endodontist will then clean the canals, seal them, and place a temporary filling in the tooth. After your endodontist completes retreatment, you will need to return to your dentist as soon as possible to have a new crown or other restoration placed on the tooth to protect and restore it to its full function.

Combined Root and Gum Problems

Written by Adam R. Pershing, DMD on April 3, 2023. Posted in Endodontics. No Comments on Combined Root and Gum Problems

Sometimes it can be difficult to detect exactly where pain in your mouth is coming from. And with the combination of symptoms you’re experiencing, it may be even harder to decipher which oral complication could be happening. Typically, when an infection is taking place, it has either started in the pulp of the tooth or in the gum tissue. The infection spreads from one location to the other, or vice versa, making it complicated to pinpoint from where the infection originated.

Symptoms

If you are experiencing any of these symptoms, they should never be ignored:

Dull or intermittent discomfort
Tooth sensitivity due to temperature
Tooth sensitivity due to pressure
An ache from a group of teeth or single tooth
An ache from your sinuses

These symptoms can suggest a variety of dental issues, including root canal and gum problems. Disregard the pain and it sometimes will go away on its own. However, this usually signifies that the pulp in your tooth has died. With the nerve no longer functioning properly, there will be the absence of pain. If your condition has gotten this far, it can become far more serious.

How Infection Occurs

Once the pulp inside your tooth has become severely infected, these stages of infection occur:

The disease moves through the end of the root and outside the tooth.
Infection then spreads to the periodontal ligament, which is vital for anchoring the tooth to the surrounding bone and gum tissue.
Gum tissue is infected and can cause periodontal disease or a gum abscess.

In reverse, the infection begins in the gums and goes through these stages:

The gums have developed periodontal disease due to plaque buildup.
Infection travels through passageways in between tooth roots.
Infection then spreads to the pulp inside your tooth.

Prognosis of Saving Your Natural Teeth

Your dentist will want to do everything they can to save your natural tooth or teeth. But sometimes, this can be challenging due to the progression of infection. An infection that begins in the tooth root has a better chance to be treated than an infection that began in the gums. If the gums are infected severely enough with periodontal disease, it is likely that most of the bone has been eroded away. In this case, saving the tooth may not be possible.

It’s important to note that root canal and gum problems do not get better as time passes. Immediate care is essential for stopping the infection in its early stages.

Root Canal Treatment for Children

Written by Adam R. Pershing, DMD on April 3, 2023. Posted in Endodontics. No Comments on Root Canal Treatment for Children

If your child’s baby tooth suffers extensive decay, infection, or trauma, damage to the tooth’s pulp can occur. Pain, visible decay, darkened enamel, sensitivity, redness, pus, or a pimple-like spot on the gums can be symptoms of pulp injury or infection, and should be evaluated by a dentist immediately.

Pulp is living tissue containing nerves and blood vessels. It’s found in the pulp chamber and in the root canals inside each tooth. Infection and inflammation in the tooth pulp can cause premature tooth loss. Infection can spread to the surrounding gums and bone. In some cases, the development of the permanent tooth beneath the injured primary tooth is disrupted.

With prompt endodontic treatment, a primary tooth can be saved. Pulpotomy and pulpectomy are the most common procedures used to treat pulp injuries:

Pulpotomy

A pulpotomy procedure, also called a baby root canal, is recommended when the pulp in or near the crown of the tooth has been affected by decay, infection, or trauma while the root pulp remains healthy. After numbing the area, the inflamed or infected pulp inside the crown of the tooth is removed, leaving the root canals intact. The healthy remaining pulp will be covered with a special material to protect and help heal the tooth.

Pulpectomy

When the pulp inflammation or infection has spread to the root canals as well as the pulp chamber, a traditional root canal procedure is often the best option. After numbing the area around the tooth, all of the pulp tissue will be removed from inside the crown and the roots. The pulp chamber and root canals will then be cleaned, disinfected, shaped, and filled.

Crowns

A crown is typically placed over the tooth after root canal treatment. When a baby tooth is treated with a pulpotomy or a pulpectomy, the tooth becomes more fragile and prone to fracture. A crown covers the entire visible surface of the tooth, protecting it from further damage. Stainless steel crowns are usually used for children’s teeth, especially for molars, but there are tooth-colored options available.

Even though baby teeth will be replaced by adult teeth, premature loss of a primary tooth can have both short and long-term effects on a child’s health:

A broken, decayed, or infected tooth can be very painful.
A healthy set of baby teeth helps a child develop proper chewing and eating habits and encourages pronunciation and speech development.
Each baby tooth serves as a place holder for the adult tooth which will replace it. If a primary tooth is lost too early, the remaining baby teeth can shift out of place, disrupting the alignment of permanent teeth.
Missing teeth can affect self-confidence.

There can be good reasons for extracting a seriously damaged baby tooth, and there are situations where root canal treatment is the best and healthiest option for your child’s smile. Whenever tooth pulp has been compromised, visit your child’s dentist immediately for safe, gentle, and effective treatment.