Frequently Asked Questions for the Dentist
A root canal infection can become serious and spread to other areas of the face and skull. It is not uncommon for teeth to die and get infected. Since the tooth is dead, blood can’t enter the tooth and bring protective immune cells to kill the infection, so the problem grows. In most cases the infection spreads to the surrounding bone. This causes increases the pressure and the tooth is pushed up out of its socket. The tooth feels high when biting.
The body attacks the root canal infection surrounding the tooth and the area around the tooth becomes inflamed. The inflammation leads to tooth pain. Antibiotics alone do not cure the problem. The dead nerve inside the tooth must be removed and the canals cleaned, otherwise the remaining dead tissue can feed infection. This is why many patients go to the dentist for an emergency appointment, get antibiotic and in a week feel great. Because they feel well, they don’t return. Three months later the problem returns and is much more serious and sometimes life threatening.
Sometimes the body and the root canal infection come to a stalemate and a dental abscess forms. This dental abscess can remain inside a patient’s jaw bone for years and constantly feed live and dead bacteria into this patient’s bloodstream. Keeping the dead tooth is not an option and taking herbs, vitamins, or even prescription antibiotics will not solve the problem. The correct treatment is to perform root canal therapy or a dental extraction.
The root canal infection must be treated with the correct antibiotics to kill the bacteria causing the dental infection. With the constant use of antibiotics over many years, super resistant bacteria have developed that can not be easily killed. This is especially why this problem should be treated soon and treated aggressively.
Your appearance is one reason. Another is that the gap left by a missing tooth can mean greater strain is put on the teeth on each side. A gap can also mean your “bite” is affected, because the teeth next to the space can lean into the gap and alter the way the upper and lower teeth bite together. This can then lead to food getting packed into the gap, which causes both tooth decay and gum disease.
This depends on the number of teeth missing and on where they are in the mouth. The condition of the other teeth also affects the decision.
There are two main ways to replace the missing teeth. The first is with a removable false tooth or teeth — a partial denture. The second is with a fixed dental bridge. A bridge is usually used where there are fewer teeth to replace, or when the missing teeth are only on one side of the mouth.
This is a plate with a number of false teeth on it. It may be all plastic or a mixture of metal and plastic. Both types may have retaining clips (clasps), to help keep the denture in place in the mouth. Depending on where they are, some of these clips may be visible when you smile or open your mouth.
Usually plastic, and occasionally porcelain. Each replacement tooth is made specially to get the right shape, color and size for you.
Plastic partial dentures are less expensive to make, but unless they are designed very carefully, they can damage the teeth they fit against.
Metal partial dentures are usually made from an alloy of cobalt and chromium and they are much stronger. They are lighter to wear and can be supported by the remaining teeth. Although the base is metal, they have gum-colored plastic and natural-looking teeth fixed to them. They are more expensive than the plastic ones.
Be guided by your dentist. He or she will know the condition of your remaining teeth. In most cases a metal-based partial denture gives the best result, but the higher cost may make you decide against it.
You should remove the denture from your mouth for cleaning. You’ll be shown how to clean it by your dentist or hygienist, probably with a small toothbrush and toothpaste, or by soaking it in cleansing solution. If you have a metal-based denture, you’ll need to choose a cleansing solution that’s suitable for metal.
The main alternative is a fixed bridge. This is made by constructing crowns on the teeth at either side of the space, and then joining these two crowns together by placing a false tooth in the space. This is all made in the laboratory and then the pieces are cemented into place with special adhesives. The bridge can’t be removed.
Providing you have enough strong teeth with good bone support, yes, you can usually have a bridge. Your dentist will help you decide which is the best way of replacing the teeth within your budget.
Although a bridge may seem expensive, it will give many years of use. It will also improve your appearance and bite. A bridge uses the considerable skill of the dentist and technician, and in this way, it’s similar to ordering a piece of hand-made jewelry. The materials are also expensive so it’s fair to say a bridge will not be the cheapest treatment you have ever had.
You need to clean your bridge every day to prevent problems such as bad breath and gum disease. You also have to clean under the false tooth every day. Your dentist or hygienist will show you how to use a bridge needle or special floss, as a normal toothbrush cannot reach the area.
There are other methods such as using a combination of crowns and partial dentures that can keep the retaining clips out of sight. These are quite specialized dentures, so you should ask your dentist about them.
This is possible with the use of implants. The success of this technique means you may be able to replace missing teeth without crowning other teeth.
Remember that it’s as important to care for your remaining teeth as it is to replace the missing ones.
Foods/drinks. Coffee, tea, colas, wines, and certain fruits and vegetables (for example, apples and potatoes) can stain your teeth.
Tobacco use. Smoking or chewing tobacco can stain teeth.
Poor dental hygiene. Inadequate brushing and flossing to remove plaque and stain-producing substances like coffee and tobacco can cause tooth discoloration.
Disease. Several diseases that affect enamel (the hard surface of the teeth) and dentin (the underlying material under enamel) can lead to tooth discoloration. Treatments for certain conditions can also affect tooth color. For example, head and neck radiation and chemotherapy can cause teeth discoloration. In addition, certain infections in pregnant mothers can cause tooth discoloration in the infant by affecting enamel development.
Medications. The antibiotics tetracycline and doxycycline are known to discolor teeth when given to children whose teeth are still developing (before the age of 8). Mouth rinses and washes containing chlorhexidine and cetylpyridinium chloride can also stain teeth. Antihistamines (like Benadryl), antipsychotic drugs, and drugs for high blood pressure also cause teeth discoloration.
Dental materials. Some of the materials used in dentistry, such as amalgam restorations, especially silver sulfide-containing materials, can cast a gray-black color to teeth.
Advancing age. As you age, the outer layer of enamel on your teeth gets worn away revealing the natural yellow color of dentin.
Genetics. Some people have naturally brighter or thicker enamel than others.
Environment. Excessive fluoride either from environmental sources (naturally high fluoride levels in water) or from excessive use (fluoride applications, rinses, toothpaste, and fluoride supplements taken by mouth) can cause teeth discoloration.
Trauma. For example, damage from a fall can disturb enamel formation in young children whose teeth are still developing. Trauma can also cause discoloration to adult teeth.
By making a few simple lifestyle changes, you may be able to prevent teeth discoloration. For example, if you are a coffee drinker and/or smoker, consider cutting back or quitting all together. Also, improve your dental hygiene by brushing and flossing regularly and getting your teeth cleaned by a dental hygienist every 6 months.
If your teeth appear to be an abnormal color without ready explanation and, if other symptoms are also present, make an appointment to see your dentist.
Treatment options to whiten teeth can vary depending on the cause of the discoloration and may include.
- Using proper tooth brushing and flossing techniques
- Avoidance of the foods and beverages that cause stains
- Using over-the-counter whitening agents
- In-home whitening agents purchased from your dentist
- In-office whitening procedures
While traditional dentistry focuses on oral hygiene and preventing, diagnosing and treating oral disease, cosmetic dentistry focuses on improving the appearance of a person’s teeth, mouth and smile. In other words restorative, general and/or family dental practices address dental problems that require necessary treatment, whereas cosmetic dentistry provides elective — or desired — treatments or services.
Cosmetic dentistry may also provide restorative benefits. For example, dental fillings are a common procedure used to treat decayed teeth. Previously, most dental fillings were composed primarily of gold, amalgam and other materials that left visible dark spots on the teeth.
Today, dental fillings may fall into the category of cosmetic dentistry, because you can select fillings made of porcelain or composite materials that closely match the color of your teeth, thus maintaining the natural appearance of your teeth and smile. Many people may choose to have their older fillings replaced with newer, tooth-colored fillings to enhance their oral appearance.
Technological advancements in natural-looking, tooth-colored dental materials make today’s cosmetic dental treatments more durable and predictable than in years past. Additionally, dentists are now using more conservative cosmetic dentistry techniques to preserve as much of your natural tooth structure as possible, depending upon your specific clinical situation.
Cosmetic dentists may also use such technologies as lasers in order to perform some procedures necessary for cosmetic treatments in their own offices — without the need for referrals to specialists. This makes cosmetic dental procedures such as smile makeovers more comfortable and convenient for patients, as well as helps to reduce recovery time.
Cosmetic dentistry treatments currently in use include:
- Inlays/Onlays: Also known as indirect fillings, inlays and onlays made from porcelain or composite materials are a long-lasting yet cosmetic way to provide a “filling” to teeth with tooth decay or similar structural damage. Whereas dental fillings are molded into place within the mouth during a dental visit, inlays and onlays are created in a dental laboratory before being fitted and adhesively bonded into place by your dentist.
- Composite Bonding: Chipped, broken, discolored or decayed teeth may be repaired or have their appearance corrected using a procedure called composite bonding. A dental composite material with the look of enamel and dentin is applied into the cavity or onto the surface of a tooth, where it is then sculpted into shape, contoured and hardened with a high-intensity light. The result is a restoration that blends invisibly with the remainder of the surrounding tooth structure and the rest of your natural teeth to create a healthy, bright smile.
- Teeth Whitening: Teeth whitening is perhaps the most commonly recommended cosmetic dentistry procedure. Teeth are often stained from smoking, food, drink (coffee, tea or red wine) or poor oral hygiene. Bleaching the teeth can enhance the appearance of your smile.
- Dental Veneers: Composite or porcelain laminates that are adhesively bonded to the surface of a tooth to correct and repair chips and cracks will improve a worn appearance or severe tooth discoloration. Veneers may also be recommended if you have gaps in your teeth or if you have not had success with teeth whitening.
- Dental Implants: Dental implants are artificial tooth root replacements that are used as a part of prosthetic (artificial replacement) dentistry in order to compensate for tooth loss. Often the result is not only an enhanced smile, but also a more youthful appearance, since missing teeth cause the face to collapse, making you look older.
- Smile Makeover: Smile makeovers involve a comprehensive assessment of your smile esthetics in order to improve its overall appearance. Typically one or more cosmetic dentistry procedures, such as dental veneers, dental implants, gingival sculpting and teeth whitening, will be required for several teeth in both the upper and lower arches in order to achieve the look you want.
- Full mouth reconstruction: While consulting with you about a smile makeover to primarily improve the esthetic appearance of your smile, your dentist may discover that there is a need to provide necessary treatment to correct functional problems with your bite, muscles, teeth and bone structure. If you need full mouth reconstruction, the materials available today make it possible for your dentist to provide you with durable, functional and clinically sound treatments that also look natural.
Cosmetic dentistry offers many options for people who are unhappy with their smile. If you are one of these people, we encourage you to read our comprehensive cosmetic procedure articles to learn about the various treatments available to beautify your smile.
There are several important differences between the two types, it’s not just a matter of appearance.
As a patient, your dentist should inform you of the availability of the white composite fillings. If you have had amalgam fillings placed in your mouth without being offered the option of having white fillings instead, the dentist has not performed his or her legal duty.
Given the opportunity to make a fully informed choice, my experience is that the vast majority of today’s dental patients will choose the white fillings. There are several reasons for this: In the view of many, the mercury in amalgam is viewed as potentially toxic. (Traditional dentists like to use the term “silver fillings,” but they have more mercury in them than silver.) Also, the feeling is that the white composite represents a more advanced technology. Additionally, composite is more esthetic. For all these reasons, the public is demanding white. And, with today’s technology, composite fillings can easily withstand the stress required to serve in a back tooth.
There is a controversy over the potential adverse health effects of silver fillings, which are close to 50% mercury and generally have less than 40% silver in them. Although mercury is toxic, it has been thought that it was not released to the body during use as a filling material. Recent research, however, seems to show that these fillings release a very small amount of mercury vapor during chewing. Whether or not this amount of mercury is harmful to the body is a subject of controversy. Most people have some silver amalgam fillings in their teeth with no apparent adverse effects. No harm from the mercury in amalgam fillings has ever been absolutely proven. However, it has never been proved that it is not harmful, either. Many people are preferring the mercury-free fillings because of this health issue.
This is another question that is loaded and highly controversial in the profession. The direct answer to this from me is yes, the mercury-free fillings or composite fillings are weaker than amalgam. However, if you take the total result—the filling plus the tooth—the composites are stronger because they bond to the tooth, making the tooth more resistant to fracture.
My personal advice is not to ever be assertive with your dentist in telling him or her how you want your tooth restored. Listen to the options presented to you. Ask what your choices are and what the dentist recommends. If your dentist is not offering the white fillings to you as an option, there is probably a good reason. Many dentists do not feel comfortable using these composites on back teeth—they require special training to place. But if you press the dentist, he or she may say yes, they will place whatever restoration you want, in order for you to be happy, even though he or she feels uncomfortable with the procedure.
Their early history goes back to the 70s, well before the technology was available to do them well. In the mid-80s, technology was developed to bond to dentin and the materials were improved. While I was practicing, we had been placing these restorations since 1984. While it is true that in the 80’s, these composite restorations were functionally inferior to the old silver amalgam restorations, that is no longer the case, provided that they are placed with proper technique by an experienced practitioner.
You can still graduate from most American dental schools without doing any white composites on back teeth. The reason the dental schools give for not including these techniques in their curriculum is that they are too busy preparing students for the board examinations and have no space in their curriculum for topics that aren’t required by those board examinations. So, in short, the answer is that the board exams don’t require them, so dentists have to go out, often after graduation, and learn these techniques from seminars, and dentists who are equipped with only the essentials from dental school don’t feel comfortable with the white fillings.
Normally, the mercury-free fillings should have practically no sensitivity afterward – this is one of their chief advantages. There are several reasons they could be sensitive.
You need to understand that your insurance company is not a non-profit benevolent society. They are in business to make money. Composite is more expensive to place, and the policy of many insurance companies is to cover the cost of the least expensive treatment, as long as that treatment is reasonably appropriate according to their definition. I don’t think they’re being entirely unreasonable in this. My experience has been that most patients who want the nicer fillings are willing to pay the difference, and I think it’s appropriate that they do. See our page of explanation of the costs of white fillings to learn more. You can also visit our page on the costs of cosmetic dentistry.
Dental hygienists are registered and certified health professionals who specialize in preventing oral health problems and diseases. They work with individual clients or communities to prevent tooth, gum and mouth diseases and injuries that can affect overall health.
Dental hygiene services are provided to individuals across the age spectrum. Dental hygienists work with patients ranging from parents in pre-natal classes to the elderly in long-term care centres. A work day could involve assessment, planning, implementing and evaluating oral health data and include:
- teaching an elementary class about oral health care
- counseling a family about oral health
- providing fluoride treatments to patients during a dental visit
- administering local anaesthetic for dental hygiene or dental treatment
- teaching long-term care staff about mouthcare for their clients
- working with nurses to prevent sports and playground injuries
- screening seniors for signs of oral cancer
- performing head, neck and oral examinations
- applying pit and fissure sealants to teeth
- reviewing literature and conducting research
- scaling and rootplaning, and so on
The dental hygiene profession focuses on preventive health care. As a result, many dental hygienists deliver health promotion programs in their community to parent and special needs groups, schools, day cares and long-term seniors’ care facilities. Among the programs provided are:
- Tobacco Cessation
- Sports/Mouthguard Clinics
- Well Baby Seminars