Tooth decay is a disease process caused by the by-product of bacteria in the mouth. Unfortunately, the only treatment once the disease has progressed is restoration of the tooth with fillings, such as amalgams (silver) or composite resins (tooth-colored) or if the decay is more advanced, then crowns (caps), root canal therapy, or extraction may be the only course of treatment.
Process of Tooth Decay
Tooth decay or caries occurs when the bacteria found in the plaque that forms on teeth after eating and drinking is not removed quickly enough by brushing and flossing. These bacteria give off an acidic by-product that given enough time, will eat a hole through the enamel, or outside layer, of the tooth and leave a “soft spot” in the tooth. This hole will continue to get larger and deeper until the tooth is properly treated.
Treatment of Tooth Decay
Treatment involves numbing the tooth so the dentist can use a handpiece to remove all of the soft diseased tooth and all the bacteria, and then using a restorative filling material such as amalgam or composite resin to seal the hole left behind. If the decay has removed too much tooth for the tooth to adequately support a filling, a crown may be needed to hold the tooth together. Likewise, if the decay has reached the nerves and blood vessels in the center of the tooth, a root canal may be needed as well to remove the nerves to prevent future tooth pain.
Prevention of Tooth Decay
Tooth decay can be prevented using a combination of two things. The first is fluoride. The National Institute of Health found that fluoride in the water system was the # 1 most important health advancement made in the 20th century. It has been proven to decrease the depth of the pits and grooves in the teeth which are prone to trapping bacteria and leading to decay and helps expose the tooth enamel to fluoride molecules. Also, using fluoridated toothpaste exposes the enamel to the fluoride molecules which leads to a chemical change in the tooth enamel that actually leaves the enamel stronger and more resistant to the bacterial acids. The second form of prevention is the mechanical removal of the bacteria through brushing and flossing your teeth. The less bacteria on the teeth, the less the chance the bacterial by-products can cause irreversible damage.
Guide to Root Canal Therapy
Endodontic or root canal treatment must be performed on a tooth once the tooth nerve has been compromised. This happens whenever the bacteria associated with tooth decay has reached the nerve area called the pulp or when the nerve and blood vessels have died due to deep decay, restorations, or tooth fracture. All of these senarios have led to or will lead to a tooth abscess and pain if treatment is not received.
Root Canal Procedure
To perform root canal treatment, a dentist will numb the tooth and use a handpiece to make a hole in the biting surface of the tooth until they reach the pulp chamber in the center of the tooth. This area is the largest part of the tooth containing the nerves and blood vessels. The dentist then proceeds to remove all remnants of nerve, blood vessel, and infection from the chamber and down the roots of tooth. They then open up the canals running down the roots in order to get a filling material called gutta purcha, a rubbery plastic material, down to the tips of the root. They will use this material to seal the inside of the canals so the bacteria and infection cannot reenter the tooth. After this, an amalgam (silver) or composite resin (tooth-colored) material will be used to seal the hole in the biting surface of the tooth and most commonly a crown will be needed to hold the tooth together as teeth tend to get brittle and break after the blood supply is removed.
Root Canal Success Rate
Generally speaking, the 5 year success rate of endodontic treatment runs between 90-95%. The most common cause of failure is not properly restoring the tooth with a crown after the root canal treatment, Decay getting back into the root canal space either under the existing crown or restoration, or root fracture due to the overall brittleness of the tooth.
Alternatives to a Root Canal
The only alternative when an infection has fully taken hold is tooth extraction. If this path is chosen, the tooth can be replaced by either a partial denture, fixed bridge, or a dental implant. However, if the tooth is asymptomatic, it might be possible to remove 2-3 mm of nerve tissue and place a bio-ceramic and/or MTA material to see if the tooth can heal, instead of completing the full root canal treatment. The dentist will need to assess the tooth to see if this treatment is possible.
Guide to Removable Appliance Options for Missing Teeth
Dentures, partial dentures and oral surgery are a necessary part of dentistry. Dentures and partials are removable appliances designed to replace missing teeth. They improve chewing ability which is the beginning of the digestive process, and they enhance facial appearance, thus restoring the patient’s smile and self-confidence.
Complete dentures are designed for the patient who is missing all the teeth in a single arch, whether upper or lower. The soft and hard tissues of the mouth support these appliances. Some patients may opt for dentures that snap into dental implants. This supplies additional stability for the denture and is especially helpful with lower dentures in patients who may have insufficient ridge structure. Generally, adapting to a maxillary (upper) denture is easier then a lower denture, beacuase there is a full palate to rest against. The mandibular (lower) denture can be a difficult appliance for the patient to learn to wear since the toung does not allow for the stability you get with the upper arch. Our dentists will work with our patients as they progress through this learning curve and adjustment period.
Partial dentures are constructed to replace teeth missing in an arch when other, natural teeth, are still present. The natural teeth provide support to these appliances. There are three general types of partial dentures:
- Resin based: similar to the base of a full denture but contains wires that attach to the remaining teeth to hold it in place. These tend to be more temporary and last upto 2 years.
- Duraflex: has a flexible base and a pink clasp to attach to the remaining teeth. These are light and comfotable but do not las as long. Expect a 2-5 year life span.
- Cast partial: has a metal base and metal clasps to attach to the remaining teeth. These have a longer life span and are more rigid.
Guide to Titanium Dental Implants
A dental implant is an artificial tooth root made out of titanium that is placed in the bone to replace a missing tooth. After placement and healing, a single implant can have an abutment screwed into the implant and a crown attached to replace the missing tooth, or if an entire arch of teeth is missing, multiple implants can be fitted to attachments that allow a denture to snap onto the implants or they can be connected to form a bar the a denture can attach on to or to screw into the final prosthesis its self.
Pros and Cons of Implants
The nice thing about a dental implant is it is just like having your natural tooth back only it can never get decay. You can floss between it, unlike a bridge, and you can chew pretty much whatever you want. The negatives are the time it takes to complete after extraction range from 4 months to close to a year due to healing rates. Implants do tend to have the highest satisfaction rate of any missing tooth replacement.
Implant Success Rate
90-95% of dental implants are successful. However, as with all forms of man-made implanted items there is a small percentage of rejection that occurs. Generally speaking, when this occurs, the implant is removed and bone healing of the socket is allowed to occur before placing another implant in the site. The risk factors are relatively low with implant surgery.
Alternatives to Implants
Alternative treatment for single tooth replacement would be a bridge or removable partial. For multiple teeth, alternatives include a partial or denture.
Cosmetic Dentistry offers ways to improve your appearance and self-confidence through your smile. From tooth whitening to complete smile makeovers, cosmetic dentistry can change the color, shape and even the alignment of your teeth to give you the smile you have always wanted. Cosmetic dentistry can include whitening (or bleaching), porcelain veneers, orthodontics, and even more common dental work such as fillings and crowns. As is true for all dental work, home-care with your brush and floss is essential for the success of cosmetic dentistry.
Teeth darken with age and also as a result of the food and drink we consume. Although excellent home care with over the counter products like whitening tooth paste and regular visits to the hygienist can help, sometimes a stronger bleaching agent is needed to remove those stubborn stains. With take home bleaching and heat activated in-office bleaching, your teeth can be 2 to 4 shades whiter in a few hours to a few weeks. A strong hydrogen peroxide solution is placed in trays which cover the teeth and allowed to whiten for 30 minutes to 1 hour. This process is safe and effective and can repeated often to achieve the desired color. Some patients experience some minor sensitivity during the bleaching process which resolves after the bleaching is discontinued keep in mind, bleaching is like colouring your hair, teeth will darken again over time. On average 3 years after bleaching, your teeth will return to the same color if additional treatment has not occured. For teeth that have had root canal treatment but have turned dark internal bleaching can be used when the other whitening options are not effective, but there are risks of tooth absorption in this practice.
Porcelain veneers are very thin porcelain which are cemented to your teeth. The process often requires little or no need for preparation and can be placed without anesthesia in some cases. Using veneers we can change the shape and color of your teeth creating a more beautiful smile. Veneers are an effective way to treat teeth that are resistant to bleaching such as with tetracycline stains. Veneers can also be used in some cases to treat worn or chipped teeth without the need for a crown.
Esthetic Restorative Materials
Often by simply replacing older fillings and crowns with newer more esthetic materials, you can restore your smile. Newer materials are more translucent allowing the transmission of light in a way more like natural teeth. In addition, materials stain over time causing them to become darker than the surrounding tooth structure. Composite materials are now available in many shades to match teeth. Older crowns can show dark lines around the gums where the metal substructure shows over time. With new all porcelain crowns or zirconia crowns these dark lines can be eliminated while providing the strength needed for normal chewing function. New crowns can also be used in conjunction with porcelain veneers to completely change your smile.