A crown is a replacement of the outside casing of your teeth that is permanently fixed to the tooth below. In other words, the decayed or damaged area of your tooth is removed and replaced by synthetic material, such as porcelain, to create a new ‘tooth’ with permanent results.
Crowns are often used after a root canal treatment, because the removal of a nerve causes a tooth to discolour. However, there are other reasons your dentist might crown one or more of your teeth: to restore a damaged or fracture tooth, to protect a weakened tooth so that it does not fracture under stress or to reinforce a large filling where there is not enough tooth structure left below.
Crowns are also made out of various material: gold or non-precious alloy, porcelain or ceramics, acrylic or composite resin, or even a combination of porcelain on metal. Obviously the material chosen will be in line with what will work best for your particular problem.
Currently, most dentist use porcelain fused to metal crown or full porcelain crown as both crowns produce good aesthetic result
How do we do it?
When crowning a tooth, your dentist starts by filing away away between 1mm and 2mm on every surface of your teeth, and then the entire surface is smoothed. Next, an impression is taken of the prepared tooth by syringing an impression material into the space around the tooth and holding an impression tray in position until the material has set. This gives the laboratory a perfect negative copy of your tooth, which allows them to make up the permanent crown. The dentist also ensures he sends the laboratory details of what the colour porcelain to use, to ensure the crown looks natural.
Your are then fitted with a temporary crown, which is really just a rough space-filler, while you wait for the laboratory manufacture the permanent fixture.
At the following appointment, the dentist will have taken delivery of the permanent crown. The temporary crown is then removed, and the prepared tooth below thoroughly cleaned and dried. Then the new, permanent crown is cemented onto the tooth below. Any excess cement is removed, and the treatment completed.
Picture on cases done in our clinic
Here is a example of a discolour tooth that is replaced with a full porcelain crown (E-Max)
The young gentleman dislike his front discolour right central incisor
His tooth discolouration was due to old filling and the tooth is non-vital
After the tooth is prepared, colour of the porcelain crown is chosen to match his neighbour teeth
The full porcelain crown is cemented onto the tooth
Final Result – natural looking crown!! (Treatment done by Dr. H.W.NG)
You do need to take care of your crown and not overstress it by biting or chewing very hard food. You can also floss normally around a crown. If at a later stage, your crown should break, you need to see your dentist as soon as possible, especially if the tooth inside becomes sensitive. Save the fractured piece if you can, as this can be glued back on temporarily until a new crown is made.
Primary teeth or Deciduous teeth, otherwise known as reborner teeth, baby teeth, temporary teeth and primary teeth, are the first set of teeth in the growth development of humans and many other mammals. In some Asian countries they are referred to as fall teeth as they will eventually fall out, while in almost all European languages they are called milk teeth as they exist when the child is still mainly drinking milk. They develop during the embryonic stage of development and erupt—that is, they become visible in the mouth—during infancy. They are usually lost and replaced by permanent teeth, but in the absence of permanent replacements, they can remain functional for many years.
Deciduous teeth start to form during the embryo phase of pregnancy. The development of deciduous teeth starts at the sixth week of development as the dental lamina. This process starts at the midline and then spreads back into the posterior region. By the time the embryo is eight weeks old, there are ten areas on the upper and lower arches that will eventually become the deciduous dentition. These teeth will continue to form until they erupt in the mouth. In the deciduous dentition there are a total of twenty teeth: five per quadrant and ten per arch. The eruption of these teeth begins at the age of six months and continues until twenty-five to thirty-three months of age. Usually, the first teeth seen in the mouth are the mandibular centrals and the last are the maxillary second molars.
The deciduous dentition is made up of central incisors, lateral incisors, canines, first molars, and secondary molars; there is one in each quadrant, making a total of four of each tooth. All of these are gradually replaced with a permanent counterpart except for the first and second molars; they are replaced by premolars. The replacement of deciduous teeth begins around age six. At that time, the permanent teeth start to appear in the mouth, resulting in mixed dentition. The erupting permanent teeth causes root resorption, where the permanent teeth push down on the roots of the deciduous teeth causing the roots to be dissolved and become absorbed by the forming permanent teeth. The process of shedding deciduous teeth and the replacement by permanent teeth is called exfoliation. This may last from age six to age twelve. By age twelve there usually are only permanent teeth remaining.
Teething age of deciduous teeth:
Central incisors : 6–12 months
Lateral incisors : 9–16 months
Canine teeth : 16–23 months
First molars : 13–19 months
Second molars : 22–33 months
Primary teeth care
Proper care of deciduous teeth is very important and starts at early stages even prior to their eruption. At the earliest stage, a child’s mouth and gums are to be wiped with a clean damp cloth, gauze pad, or especially designed teeth wipes. Wiping the baby’s teeth and gums after each feeding, and particularly at bedtime, helps prevent baby bottle tooth decay. This practice also helps reduce premature decay caused by harmful plaque-like film and bacteria that builds when babies ingest juices or any food containing sugar. Moreover, to reduce the possibilities to develop baby bottle tooth decay is it better to give the baby only plain water at bedtime or during the night and avoid juices, sugar water, milk or any other liquid containing sugar.
Once the first primary teeth come in, brushing starts. Warm water is normally used in these cases or a non fluoride toothpaste. The market offers special toothbrushes or finger toothbrushes for babies that help protect tender gums and gently clean baby teeth and gums. Other toothbrushes are specially designed for toddlers to easily grip them. They also come in catchy designs that encourage toddlers to use them. Toothbrush designs vary according to age, therefore, it is better to check the age recommendation on the package to obtain the most convenient one. Toothbrushes should be replaced every two to three months. It is also important to brush children’s teeth after giving them medicine as their acids may affect the tooth enamel. Early brushing helps reduce harmful bacteria, remove plaque, sugar, or any other kind of food that may cause tooth decay.
Parents are advised to take their children to the first dentist visit when they are 12 months old. During this visit, the dentist can define dental care plan. Two possible ways to prevent tooth decay are the use of fluoride and sealants.
Fluoride makes teeth stronger over time which then prevents the initiation of dental caries and tooth decay. Also, it re-mineralizes those areas of the teeth which have been weakened by acid. Fluoride can be included in one’s diet. Other ways of obtaining fluoride are in toothpastes and mouth rinses that are normally used at homes. The dentist can provide it through gels and foams he applies during dental visits.
To add to the benefits of the fluoride, dentists also apply sealant in order to preserve the teeth even more. Sealant is applied in some locations of the teeth that smooth their surface. Therefore, food and plaque are less likely to get trapped in those areas.
Children can start flossing when they are about 3-4 years old. However, at this age they might still need help and will be able to floss by themselves when they are 8-10 years old.
Some ladies may feel that their gums are uncomfortable than usual during pregnancy. Their gums are sore or tender, or if they bleed when brushing or flossing, they may have a condition called pregnancy gingivitis. Pregnancy gingivitis is a very common occurrence during pregnancy however; if it is not treated it can lead to complications with their pregnancy. If you are pregnant and notice any of the symptoms of pregnancy gingivitis it is important that you visit with your dentist in order to get appropriate treatment.
Pregnancy gingivitis is an hyperplastic reaction to microbial plaque. Elevated estrogen or progesterone levels resulting from hormonal shifts enhance tissue vascularity, which permits an exaggerated inflammatory reaction to plaque.
What is Gingivitis?
Gingivitis is more commonly referred to as gum disease, and it will affect over 90% of Americans at some point in their lives. Caused by the sticky plaque that accumulates on our teeth and gums, it can leave your gums swollen and tender, and even cause them to bleed. Gingivitis can also make brushing and flossing extremely painful. Gingivitis is one of the earliest stages of a more severe type of gum disease, called periodontal disease. Untreated gum diseases will progress into periodontal disease, which can cause irreversible damage to your gums and teeth. (More info on gingivitis)
What is Pregnancy Gingivitis?
Pregnancy gingivitis is simply gingivitis that occurs during pregnancy. More than 50% of all pregnant women experience some form of pregnancy gingivitis. Though gingivitis disease is annoying, it is usually harmless, unless it is left untreated. Pregnancy gingivitis is an hyperplastic reaction to microbial plaque. Elevated estrogen or progesterone levels resulting from hormonal shifts enhance tissue vascularity, which permits an exaggerated inflammatory reaction to plaque. Pregnancy gingivitis produces fiery red, swollen and tender marginal gingiva and compressible and swollen interdental papilla. If pregnancy gingivitis progresses to periodontal disease, it can increase your risk of going into preterm labor.
Causes of Gum Disease in Pregnancy
There are a number of causes of gum disease in pregnancy. One such reason is increased blood flow. During pregnancy, your blood flow actually increases by between 30% and 50%. This is to ensure that your baby is provided with the appropriate nutrients to grow and develop. Unfortunately, this increased blood flow can also cause you gums to swell and become very tender. It may even cause your gums to bleed, leaving them at increased risk for gingivitis.
The rise in your hormones can also play a role in you developing pregnancy gingivitis. These higher levels of hormones leave your gums and teeth more sensitive to the bacteria that hide in plaque. This is one reason why gingivitis is so common in pregnancy.
Morning sickness may also play a small role in contributing to pregnancy gingivitis. Many women find that they can no longer stand the smell or taste of toothpaste, making it difficult to maintain good oral hygiene. Increased vomiting during pregnancy can also take its toll on your gums. Vomit contains stomach acid which can eat away at your gums and teeth, making your mouth very sensitive.
Symptoms of Pregnancy Gingivitis
There are a few symptoms of gum disease to keep an eye out for. If you notice any of these symptoms, it is important to seek treatment as soon as possible.
tender, swollen gums
red or purple-red gums
gums that look shiny
bleeding gums after brushing or flossing
persistent bad breath
a bad taste in the mouth that won’t go away
Complications of Pregnancy Gingivitis
Generally speaking, pregnancy gingivitis is nothing to worry about. However, if your gingivitis is left untreated it could cause potential health problems for both you and your baby.
Sometimes, gum disease can cause sores to form on your gums. These sores are often called pregnancy tumors. These tumors can grow up to three-quarters of an inch in size and may cause discomfort or even pain. If ruptured, pregnancy tumors can become infected. Most tumors can be easily removed though, before they cause any complications.
It is important to take pregnancy gingivitis seriously because, if untreated, it will lead to periodontal disease. Periodontal gum disease is an advanced form of gingivitis that attacks the bones and tissues supporting the teeth. This disease can cause permanent damage to your mouth, and can cause you to lose both your gums and teeth. Periodontal disease has also been linked to a higher risk of premature birth – in fact, women with periodontal disease are seven times more likely to give birth prematurely.
Treating Gingivitis in Pregnancy
There are no cures for gum disease although its damage can sometimes be reversed or halted. All pregnant women should receive at least two thorough dental cleanings during pregnancy. This should help to reduce your chances of developing pregnancy gingivitis or periodontal disease.
If you already have gingivitis, the best gum disease treatment is to have a complete cleaning at your dentist’s office. Your dentist will scale your teeth using a variety of instruments. This will remove excess plaque from your teeth and around your gum line. Serious gingivitis may also require root planning, a process during which the roots of your teeth are cleaned of plaque completely.
As always, the best treatment for gingivitis is prevention. Maintaining a good oral hygiene routine will ensure that you have healthy gums and teeth for a long time to come. Try following these tips:
brush twice a day for at least five minutes
use a soft bristle brush – this will prevent you from irritating your gums
floss once a day or use an anti-bacterial mouthwash to get rid of plaque from between your teeth
avoid eating large amounts of refined sugar – this will cut down on plaque and tartar buildup
Having to deal with a dental emergency is not something people think about. However, being prepared can make the difference between saving or losing a tooth. And in the case of a toothache, if it involves a bacterial infection, it can be a life-threatening situation.
Here are a couple of common dental emergencies and what to do about them.
A lost filling
Rinse out the cavity with warm water. Apply a temporary filling product such as Dentemp® which can be made into a ball and pressed firmly into the cavity. This can alleviate immediate pain, but it is important that you call your emergency dentist and arrange to have your filling replaced before the situation worsens.
Lost Crown / Cap
Even though a missing crown is not immediately painful, it can become painful in a short period of time as food and other debris gather in the cavity. Unless the cavity is sealed up again, decay and infection can cause the tooth to ache. It is important that you visit your emergency dentist within a few days of losing your crown or cap.
You’re suffering with a toothache
Toothaches can be more dangerous than any physical trauma to a tooth. Rinse your mouth out with warm water and place some kind of cold compress against your cheek for twenty minutes to reduce the swelling. Then let it warm up for 20 minutes and then back to the cold compress.
Don’t put any kind of pain medication against the gum. The pain medication could burn the gum and cause more problems. The greatest risk comes if the toothache is from a bacterial infection. If left untreated, this could become life threatening. See an emergency dentist ASAP.
White filling or composite resin is getting more and more popular currently as it produces a nice aesthetic result. Previously silver filling (amalgam) is preferred due to low cost, easy to handle and it has a good mechanical properties (amalgam is strong and durable). However, current composite resin is as strong and durable as amalgam and on top of that, it produce a ‘hard to see restoration’ on the tooth making it a preferred choice for dentist and patient. Anyway, Nobody wants their filling to be seen!!
Composition of composite resin
Composite resins are composed of:
Bis-GMA monomers or some Bis-GMA analog
a filler material such as silica and in most current applications,
Dimethacrylates are also commonly added to achieve certain physical properties such as flowability.
Further tailoring of physical properties is achieved by formulating unique concentrations of each constituent.Unlike Amalgam which essentially just fills a hole, composite cavity restorations when used with dentin and enamel bonding techniques restore the tooth back to near its original physical integrity.
Dental composite resin
In our clinic, we have multiple shade (or colour) to choose to mimic the original colour of the tooth in the mouth. For every restoration, we use different shade for each ‘layer’ during restoration.
Below are some of the cases done in our clinic.
Restoring Composite Resin
(Illustration in great depth)
An old amalgam was removed from a upper right molar and the tooth was ready for filling placement
Firstly, the enamel surface of the molar was treated with phosphoric acid 35%
Then, it was followed by the dentine which was located at the center of the tooth
Next, the cavity was cleaned and dried. A thin layer of adhensive solution was applied over the cavity
Light cure unit was used to activated the adhesive which was photo-sensitive
A metal band was used to wrapped around the molar
The metal band was checked to ensure that there was no gap between the tooth and the metal band. This was to prevent the filling material from overflow out from the cavity.
‘Dentine shade’ composite resin was placed at the center of the cavity to cover the darkish stain in the dentine area.
The composite was light-cured to make it harden
Next, ‘enamel shade’ composite was placed over the ‘dentine shade’ composite (layering technique) to get the translucency effect.
‘Enamel shade’ composite was placed at the side-wall of the molar and was cured (with light-cure unit)
The metal band was removed and more composite was placed at the side-wall of the molar so to achieve a nice contour and bulbosity.
This was the result after the composite harden
The composite excess was removed with a rotary white stone
The restoration was checked to look of any interference with the lower teeth during biting and chewing (with a bite registration tape)
And the red markings from bite registration tape was removed
Finally, for aesthetic reason, grooves and fissures was make on the tooth surface
And ‘stain’ composite was placed on the fissure to make it looked like the neighboor teeth
Lastly, light-cure unit used to harden the rest of the composite
The restoration was polished to make is glossy and shining
The Final Result!!
Before and after picture.
Another case: Replacing old silver (amalgam) restorations with composite restorations
This young gentleman came complaining of sensitive to hot and cold at his bottom right molars. On examination, he had a few siler fillings which cracked and had gaps noted at the margin fo the fillings.
The silver fillings were removed and replaced with white fillings. The fillings match with the colour of the tooth very well as if there was no filling done!!
A dental implant is a small “anchor” made of titanium. It is inserted into the jawbone to take the place of your missing tooth root. After Osseointegration, or when the surrounding bone has attached to the implant, a replacement tooth is secured to the top of the implant. The new tooth looks, feels, and performs just like your natural teeth.
Dental implants can be used in a variety of situations, whether you need to replace a single missing tooth or many teeth. They can even be used to replace a full denture. As anchor points, implants can also securely attach a partial denture or bridge.
What are the benifits of dental implant?
Choosing implants offers you a number of significant advantages including:
More healthful and beautiful: When teeth are missing, the surrounding bone begins to shrink. This unhealthy bone loss can make your jawline recede. Dental implants can help prevent deterioration of the jawbone caused by loss of teeth, so your face retains its natural shape.
As an alternative to bridgework, dental implants eliminate the need to grind down healthy teeth when replacing one or more adjacent teeth.
More comfortable: Because dental implants are securely anchored, there is no slipping or movement as there is with dentures. This eliminates some of the key worries of dentures, including poor fit, gum irritation, and pain from exposed nerves.
More confident: With dental implants, you will never need to cover your mouth when laughing, smiling, or speaking. You can eat your favorite foods without pain or fear of embarrassment – and taste every bite. You will look better, feel better, and live more confidently.
Are you the candidate for dental implants?
If you’re healthy enough to have a tooth extracted, you’re probably healthy enough to have an implant – whether your missing teeth are the result of injury, disease, or decay. General good health and adequate bone in the jaw are the key requirements. Your doctor can tell you if implants are right for you.
What is involved in implant procedure?
The dental implant process involves several steps that take place over a time period that averages from four to nine months. The typical process will include:
Initial implant placement:This procedure is typically performed in your dentist’s office under either a local or a general anesthesia. Your doctor places the implant into your jaw. Over the next several months, bone will attach to the surface of the implant anchoring it into position. Depending on your particular case, an additional minor procedure creates an opening through which your artificial tooth will emerge.
Implant prosthetic attachment: During this phase, your dentist painlessly attaches a prosthetic “post” from Zimmer Dental to the implant. A simple impression will be taken and over the next few days an artificial tooth will be created for a functional natural restoration.
Implants can improve your appearance, confidence and freedom
Since dental implants look and feel like natural teeth, they naturally enhance your appearance. More importantly, the securely attached implant gives you the confidence of eating what you like, speaking easily and clearly, and freedom from embarrassment. And, by following a regular routine of careful oral hygiene and regular checkups, your implants can last for many years.
To find out if implants are a solution for you, ask your doctor to evaluate you today.
Are Some People at More Risk for Developing Cavities?
How Can I Prevent Cavities?
What should I do if I have tooth decay?
What is Tooth Decay?
Dental cavities are an infection caused by a combination of carbohydrate-containing foods and bacteria that live in our mouths. The bacteria are contained in a film that continuously forms on and around our teeth. We call this film plaque. Although there are many different types of bacteria in our mouths, only a few are associated with cavities. Some of the most common include Streptococcus mutans, Lactobacillus casei and acidophilus, and Actinomyces naeslundii.
When these bacteria find carbohydrates, they eat them and produce acid. The exposure to acid causes the pH on the tooth surface to drop. Before eating, the pH in the mouth is about 6.2 to 7.0, slightly more acidic than water. As “sugary foods” and other carbohydrates are eaten, the pH drops. At a pH of 5.2 to 5.5 or below, the acid begins to dissolve the hard enamel that forms the outer coating of our teeth.
As the cavity progresses, it invades the softer dentin directly beneath the enamel, and encroaches on the nerve and blood supply of the tooth contained within the pulp.
Cavities attack the teeth in three ways:
1. Pit & Fissure
2. Smooth surface
3. Root surface
The first is through the pits and fissures, which are grooves that are visible on the top biting surfaces of the back teeth (molars and premolars). The pits and fissures are thin areas of enamel that contain recesses that can trap food and plaque to form a cavity. The cavity starts from a small point of attack, and spreads widely to invade the underlying dentin.
The second route of acid attack is from a smooth surface, which is between, or on the front or back of teeth. In a smooth-surface cavity, the acid must travel through the entire thickness of the enamel. The area of attack is generally wide, and comes to a point or converges as it enters the deeper layers of the tooth.
The third is the attack started at the root surface of the tooth after it was exposed to the oral cavity. The root is usually exposed due gum recession as a result of periodontitis (gum disease)
Recipe for tooth decay formation?
How Will I Know if I Have a Cavity?
The large majority of cavities are completely painless. This is because the outer enamel has no nerves. It is only when the cavity enters the underlying dentin that the cavity may begin to feel sensitive (Teeth sensitive). The most common cavity symptoms are an increased sensation to cold, sweet foods or beverages. A cavity is often responsible for a broken tooth. The cavity weakens the tooth, especially when it forms under a tooth filling or a tooth cusp, and can easily cause a fracture when biting down.
Patients are sometimes taken off guard when they learn that they have a few cavities but they don’t have any symptoms. It is far better to treat a small cavity than to wait until they have symptoms; such as pain. By the time there are symptoms, the cavity may have spread to infect the dental pulp, necessitating a root canalprocedure or a tooth extraction to eliminate the infection. Always remember that most dental problems are insidious — that is, they sneak up on you. Regular dental exams, at least twice a year, will greatly reduce the likelihood that a dental cavity will go undetected and spread, causing toothache pain and infecting the dental pulp.
How Do Dentists Detect Cavities?
Cavities are detected a number of ways. The most common are clinical (hands-on) and radiographic (X-ray) examinations. During a clinical exam, the dentist uses a handheld instrument called an explorer to probe the tooth surface for cavities. If the explorer “catches,” it means the instrument has found a weak, acid damaged part of the tooth — a dental cavity. Dentists can also use a visual examination to detect cavities. Teeth that are discolored (usually brown or black), can sometimes indicate a dental cavity.
Dental X-rays, especially check-up or bitewing X-rays, are very useful in finding cavities that are wedged between teeth, or under the gum line. These “hidden” cavities are difficult or impossible to detect visually or with the explorer. In some cases, none of these methods are adequate, and a dentist must use a special disclosing solution to diagnose a suspicious area on a tooth.
Are Some People at More Risk for Developing Cavities?
People who have reduced saliva flow due to diseases such a Sjogren Syndrome; dysfunction of their salivary glands; have undergone chemotherapy or radiation; and who smoke are more likely to develop cavities. Saliva is important in fighting cavities because it can rinse away plaque and food debris, and help neutralize acid. People who have limited manual dexterity and have difficulty removing plaque from their teeth may also have a higher risk of forming cavities. Some people have naturally lower oral pH, which makes them more likely to have cavities.
How Can I Prevent Cavities?
The easiest way to prevent cavities is by brushing your teeth and removing plaque at least three times a day, especially after eating and before bed. Flossing at least once a day is important to remove plaque between your teeth. You should brush with a soft-bristled toothbrush, and angle the bristles about 45 degrees toward the gum line. Brush for about the length of one song on the radio (three minutes). It’s a good idea to ask your dentist or hygienist to help you with proper brushing methods.
Blushing and Flossing teeth are to do it daily to stop caries
Reducing the amount and frequency of eating sugary foods can reduce the risk of forming cavities. If you are going to drink a can of sweetened soda, for instance, it is better to drink it in one sitting, than sip it throughout the day. Better yet, drink it through a straw in one sitting, to bypass the teeth altogether. Getting to the dentist at least twice a year is critical for examinations and professional dental cleanings.
Reduce high sugar food can reduce dental cavity significantly
To reduce the incidence of cavities, use toothpaste and mouthwash that contains fluoride. Fluoride is a compound that is added to most tap water supplies, toothpastes, and mouth rinses to reduce cavities. Fluoride becomes incorporated into our teeth as they develop and makes them more resistant to decay. After our teeth are formed, fluoride can reverse the progress of early cavities, and sometimes prevent the need for corrective dental treatments.
Mouthwash with fluoride
The recent drop in the number of cavities is largely due to the addition of fluoride to our drinking water. Mass water fluoridation is the most cost-effective measure available to reduce the incidence of tooth decay. The Environmental Protection Agency has determined that the acceptable tap water concentration for fluoride is 0.7 to 1.2 parts per million.
A dental procedure called sealants can also help reduce cavities on the top and sides of back teeth (occlusal, buccal and lingual surfaces). A sealant is a white resin material that blankets the tooth, protecting the vulnerable pits and fissures of the tooth. Sealants are routinely placed on children’s teeth to prevent cavities on their newly developing molars. The use of sealants to prevent cavities is also a cost-effective way to reduce the incidence of cavities on adults as well. Sealants are generally not used on teeth that already have fillings.
People who have a dry mouth are at risk for developing cavities, and can have their dentist prescribe artificial saliva and mouth moisturizers, as well as recommend chewing sugarless gum to stimulate saliva production. Finally, an antiseptic mouthwash containing chlorhexidine gluconate such as Chlohexxa or Oradex can also be useful in killing bacteria associated with dental caries.
What should I do if I have tooth decay?
You should go the to dental clinic as soon as possible. Early or small decay is easily to treat. Usually a small filling will do. However if it is large cavity, then a larger filling is required provided there is no pain. In cases where the tooth is painful (eg. pain on biting, disturb sleep), then root canal treatment or extraction is required to stop the infection.
Filling can be silver (amalgam) or white (composite).
Comparison within big and small filling:
Small Filling vs. Large filling
Less pain during filling More pain (because lager & deeper cavity)
More aesthetic Less aesthetic
More lasting and durable Less durable
Cheaper More expensive (more filling material)
Or tooth capping of is a procedure to created back function, aesthetic as well as protection to a severely damaged tooth. It is usually made of porcelain fused with metal or a full porcelain material. Crown is durable and more lasting compared to a large filling.
Root canal treatment (RCT)
RCT is required when infection from caries has spread to the pulp of a tooth. The tooth is usually painful on chewing and sometimes disturb sleep. The purpose of this treatment is to preserve the tooth by removing the dead and infected pulp leaving the tooth bacteria free.
After RCT, the tooth can be restored with filling or a corwn. If there is a lot of tooth structure loss, the tooth should be protected with a crown.
Tooth extraction in another way to stop infection. However, this method is commenced if patient don’t want to keep the tooth anymore. Patient have to understand the consequent of removing the tooth
Dental filling is a dental restorative material used to restore the function, integrity and morphology of missing tooth structure. Basically… material used to fill up cavity in the tooth after the decay was removed from the tooth.
Most cavities discovered during a dental examination will need to be treated. In general, if a cavity has broken through the enamel and is into the underlying dentin, or is able to be probed with an explorer, it has undergone cavitation and requires treatment. Early dental cavities that have not spread to the dentin or have undergone cavitation should not be treated, as they can be healed or re-mineralized with fluoride.
The goal of treating cavities involves two basic principals:
1. Removing the decayed portion of the tooth
2. Rebuilding the missing tooth structure with a filling material.
The dentist usually begins the procedure with an injection of local anesthetic if the decay is deep and very sensitive. A high-speed dental drill is needed to remove the decay and prepare the tooth for the filling. Depending on which material is used, the dentist will vary the tooth preparation accordingly.
After the tooth has been prepared, a liner (Dycal®)is often used to reduce tooth sensitivity.Dycal is a compound containing calcium hydroxide, and is used in deep cavities to stimulate the dentin to regenerate and protect the dental pulp. In deeper fillings, a base is used in addition to the liner. Common bases used under dental fillings are glass ionomer cement and zinc phosphate cement. The main purpose of the base is to insulate the tooth from temperature changes in the mouth.
The dentist and patient can then choose a number of different materials to fill the tooth, but the most common are silver (amalgam), white (resin), porcelain or gold. These materials are layered on top of the liner or base to finish the process of rebuilding the tooth.
After a tooth has been filled, it is not unusual for the tooth to be sensitive for a day or two. In general, the deeper the filling, the more likely the tooth will have prolonged sensitivity, especially to cold food or beverages. Most fillings should be completely comfortable within two weeks. In some cases, the filling will be built up too high, and a second appointment is needed to shave down the filling to a comfortable level. If sensitivity lasts more than two weeks, it may indicate that there is a void under the filling. Prolonged discomfort may also indicate a tooth that has an infected pulp, and requires root canal therapy.
What Dental Material is Best for My Teeth?
Every dental material used to rebuild teeth has advantages and disadvantages. Dental amalgam or silver fillings have been around for over 150 years. Amalgam is composed of silver, tin, copper, mercury and zinc. Amalgam fillings are relatively inexpensive, durable and time-tested. On the flip side, they are considered unaesthetic because they blacken over time and can give teeth a gray appearance, and they do not strengthen the tooth. Some people worry about the potential for mercury in dental amalgam to leak out and cause a wide variety of ailments, but research does not bear this fear out.
Not aesthetic (Silver colour)
Blacken over time and can give the teeth a gray appearance
Required deeper cavity to retain amalgam
No chemical bonding to tooth structure
Composite Resin/White Filling
Composite resin, or white fillings have been around for about two decades. Composite fillings are composed of an organic polymer known as bisphenol-A-glycidyl methacrylate (BIS-GMA), and inorganic particles such as quartz, borosilicate glass and lithium aluminum silicate. They have the advantage of requiring a more conservative tooth preparation (less drilling required), can have a strengthening effect on the tooth and are very aesthetic, virtually blending in with the tooth. Composite fillings are the material of choice for repairing the front teeth. On the down side, they are more technique-sensitive for the dentist to place, and are highly susceptible to decay in the future if placed improperly. They usually cost more than an amalgam. Despite this research composite fillings are considered safe, and like the other dental filling materials, they are approved by the American Dental Association.
Highly aesthetic – it can be used to improve aesthetic
Can be used for shallow cavities
Chemically bond to tooth structure
Technique sensitive (required dry surface for filling adhesion)
Can result in tooth sensitivity (due to shrinkage of the composite)
The strength of composite is lesser than amalgam
Required replacement or repair due to staining, chipping, wear and tear
Porcelain is sometimes used for dental fillings called onlays or inlays. Porcelain is a non-crystalline glass composed of silicon and oxygen. It has the advantage of being highly aesthetic, and is the restoration of choice for people who place the highest value in the appearance of their teeth. Porcelain has the disadvantage of being brittle, and, therefore, susceptible to breakage. It is also even more technique-sensitive to use than composite; requires two dental visits to place the filling; and costs significantly more than amalgam or composite fillings. Porcelain can also cause accelerated wear of the opposing tooth when biting.
Required to scarified more tooth structure for retention
The retention of the porcelain is depends on the cement used to ‘glue’ the porcelain to the tooth
Porcelain is brittle and susceptible to breakage
Required two visits
Can cause accelerated wear of the opposing tooth when biting
Gold is sometimes used for dental fillings, most commonly as an inlay. Gold is not used in its pure form, but as an alloy containing 75 percent gold, as well as copper, silver, platinum, palladium and zinc. Gold is extremely durable; fairly aesthetic, it does not damage the opposing tooth when biting, and is very well tolerated by the gums and other intraoral tissues. A well-done gold filling can last two to four times longer than any other dental material and might be considered the “gold standard” for dental fillings. Gold inlays, like porcelain inlays, take two dental visits to complete and are also much more costly than amalgam or composite. They are also not nearly as aesthetic as composite or porcelain. In addition, gold inlays are fairly difficult to prepare and place.
Very well tolerated by the gums and other intraoral tissues (bio compatibility)
Does not damage the opposing tooth when biting (as compared to porcelain)
Difficult to prepare
Required to scarified more tooth structure for retention
They are the last molar (or third molar) that usually erupt at the age of 18 to 25 years old (and sometimes older). The eruption of the tooth may cause pain in some of the cases. There are usually 4 wisdom teeth in each person. However, in some cases not every tooth will erupt into the oral cavity.
Impacted Wisdom Teeth
When a wisdom tooth cannot erupted properly either it tilt to the front or back or half-way jammed it is consider as impacted. The impaction cause severe pain especially when the tooth is erupting. This prevents the patient from open his mouth wide or eat properly. Sometimes it interferes with his daily activities. Impaction of wisdom tooth also will cause food trap easily (between the second last molar and wisdom teeth) which will result in decay at the second molar.
Impacted wisdom teeth can be divided into one of several categories. Mesioangular impaction is the most common form (44%), and means the tooth is angled forward, towards the front of the mouth. Vertical impaction (38%) occurs when the formed tooth does not erupt fully through the gum line. Distoangular impaction (6%) means the tooth is angled backward, towards the rear of the mouth. And finally, Horizontal impaction (3%) is the least common form, which occurs when the tooth is angled fully ninety degrees sideways, growing into the roots of the second molar.
Impacted wisdom teeth may also be categorized on whether they are still completely encased in the jawbone. If it is completely encased in the jawbone, it is a bony impaction. If the wisdom tooth has erupted out of the jawbone but not through the gumline, it is called a soft tissue impaction. Sometimes the wisdom tooth fails to erupt completely through the gum bed and the gum at the back of the wisdom tooth extends over the biting surface, forming a soft tissue flap or lid around the tooth called an operculum. Teeth covered by an operculum can be difficult to clean with a toothbrush.
Signs and Symptoms of Impacted Wisdom Tooth
Usually impacted wisdom teeth are presented with:
pain (may disturb sleep and may extend to the back, neck and head)
unable to open the mouth big due to pain
infection of the gum around the wisdom tooth
swelling on the gum
swelling on the cheek of the affected side
Consequence of impacted wisdom teeth
Impacted wisdom tooth can lead to:
Acute gum infection or pericoronitis that happens around the wisdom tooth (Most common).
Infection on the pulp or pulpitis in the wisdom teeth due to decay
Infection on the pulp or pulpitis in the second molar due to prolong food trap that causes dental caries.
Infection on the bone or osteomylitis which occur if infection spread into the bone.
Infection around the facial tissue or cellulitis. This happens when the infection spread into the soft tissue around the facial region (Below).
Gum abcess – if pus present in the gum or facial abcess if it’s in the face region
Gum problem or periodontitis around wisdom tooth and second molar.
1. Leave it – If the symptoms are very mild, usually with some mouth rinse and the pain will subside. However, sometimes the pain may come back due to re-infection.
2. Take antibiotic and pain killer – Again the symptoms will subside however re-infection still can occur.
3. Incisional and Drainage – Removing of the pus accumulated either in the gum or facial region then followed by removing of the wisdom tooth.
4. Operculectomy – Removing the gum that cover the wisdom tooth for easy cleaning. However, sometimes the gum might grow back and infection can re-occur
5. Extraction – Removing the wisdom tooth (surgery or without surgery)
6. Root canal treatment – On the second molar if the pulp is infected and the wisdom tooth required to be removed.
Indication of Wisdom teeth Extraction
Wisdom teeth are extracted for two general reasons: either the wisdom teeth have already become impacted, or the wisdom teeth could potentially become problematic if not extracted. Potential problems caused by the presence of properly grown-in wisdom teeth include infections caused by food particles easily trapped in the jaw area behind the wisdom teeth where regular brushing and flossing is difficult and ineffective. Such infections may be frequent, and cause considerable pain and medical danger.
According to NICE (The National Institute for Clinical Excellence – UK), the routine practice of prophylactic removal of pathology-free impacted third molar should be discontinued. Third molar should be removed if there is evidence of pathology includes unrestorable caries, non-treatable pulpal and/or periapical pathology, cellulitis, abcess and osteomyelitis, internal/external resorption of the tooth or adjacent teeth, fracture of tooth, disease of follicle including cyst/tumour, tooth/teeth impeding surgery or reconstructive jaw surgery, and when a tooth is involved in or within the field of tumour resection.
The degree to which the severity or recurrence rate of pericoronitis should influence the decision for surgical removal of a third molar remains unclear. The evidence suggests that a first episode of pericoronitis, unless particularly severe, should not be considered an indication for surgery. Second or subsequent episodes should be considered the appropriate indication for surgery.
Surgery or Not Surgery?
When a wisdom tooth erupts vertically just like the second molar and the access is easily, then extraction of the tooth will be straight forward case. Usually the surgeon will loosen the tooth and grip the tooth with a forceps to remove it.
However, most of the impacted wisdom tooth is embedded in the bone, tilted either forward or backward. Sometimes the tooth is in a horizontal position instead of vertical. This will make extraction with forceps impossible. Therefore, surgery is required.
Surgical Removal of Wisdom Tooth
Usually done by a oral surgeon (Specialist) or an experience dentist and it should be done in a sterile manner. After injections are given, a small cut will be made on the gum to expose the wisdom tooth and bone surrounding it. Then some bone near to the tooth will be removed to allow instrument to engage with the tooth. Next, the tooth will be sectioned into half or more and the fragment of tooth will be removed.
After the whole tooth was removed completely, the socket will be cleaned and the surgeon will inspect the wound to make it is clean and bleeding stop. Finally, the gum will be held together by stitches and the patient will be allowed to go home with gauze, pain killer and antibiotic. Usually the whole process takes about an hour or less.
For Anxiety Patient…
If in a case of an anxious patient come for wisdom tooth surgery, usually, we will prescribe some medication of reduce anxiety before the surgery or patient will have to inhale nitrous oxide during the procedure so that he/she will feel relax and calm all the time during surgery. If the patient is extremely phobia of surgery, then he can opt for surgery done under general anaesthesia which required hospitalization.
What Do I Need to Do During Recovery?
After your wisdom teeth are removed you may experience some swelling and mild discomfort, which are normal symptoms and are part of the healing process. Here is what to expect after the procedure.
1) The First 24 Hours:
Bleeding: This may occur for several hours after your wisdom teeth are removed. To control it, place a piece of clean moist gauze or moistened tea bag over the empty tooth socket and bite down firmly. This needs to be done for about 45 minutes. You should avoid rinsing, spitting or sucking actions for 24 hours after your wisdom teeth are removed. For example, don’t drink beverages through straws or smoke, and avoid hot liquids (such as soup or tea). You should also avoid carbonated and alcoholic drinks. These activities can cause the clot to dislodge, which will cause dry socket.
Facial Swelling: This can occur where the wisdom tooth was extracted. You can apply a cold compress to ease the swelling and pain. Cold compress(ice packs) should be used 20 minutes on 20 minutes off. Repeat as necessary during this first 24-hour period. Avoid taking aspirin, ibuprofen (e.g. Motrin, Advil, etc.) if you have a stomach ulcer.
Pain: Medications such as Mefenamic Acid (Ponstan) or Etoricoxib (Arcoxia) can be taken to manage your pain. We may prescribe more potent pain relievers, such as narcotics, if necessary.
Antibiotics: Antibiotics may be prescribed post-treatment and should be taken until you have finished the prescription.
Food: Avoid hot liquids and alcoholic beverages for at least 24 hours. When the extraction is more difficult, you will need to consume a soft or liquid diet for at least 24 hours after removal of your wisdom teeth.
Brush your Teeth: You need to continue to brush your teeth, but avoid the teeth adjacent to the extracted tooth during the first 24 hours. On day two, you can resume the gentle brushing of your teeth. However, do not use commercial mouth rinses because these can irritate the area of extraction.
2) After 24 Hours:
Facial Swelling: Facial Swelling in the area of your wisdom tooth extraction needs to be man aged with heat after the first 24 hours of ice. Use a moist warm towel and apply it to the area on a 20-minute on, 20-minute off schedule. Repeat as necessary.
Rinse Your Mouth with Warm Salt Water: Use 1/2 teaspoon of salt in a cup of warm water after before bed and after meals. Do not use commercial mouth rinses.
Complete Healing: This will not occur for a few weeks to a few months following the removal of your wisdom teeth. However, usually within the first week or two, you will feel reasonably comfortable because enough healing has taken place. We will explain what to expect regarding your healing process.
Complication of Wisdom Tooth Surgery
1) The usual problem the patient will experience after surgery
Pain on surgical site
Limited mouth opening
Swelling around the cheek
Bruise over the cheek (not usual)
2) Complication (Rare!!)
Infection on surgical site (Higher risk for smoker and diabetic patient)
Lower jaw fracture (Will only happens in very thin jaw or a rough surgery)
Bleeding (Can be from arteries which usually can be controlled with compression)
Injury to nerve (Damage to the nerve will happens when the wisdom tooth is very near to the nerve and the event of removing it cause injury to the nerve. This will result in numbness on the lower lipand usually it takes 6-12 months to recover.)