Prevent Fracturing your Teeth

* Avoid grinding & clenching

* Don't use your teeth as  tools

* Avoid ice, popcorn kernels, 

   and hard candy

* Wear a mouthguard

* Have large fillings covered

   by a crown to prevent cracks

* Have regular dental exams

Endodontic Root Canal Therapy

Root canal, or endodontic therapy is the treatment of an inflamed or dying  nerve inside your tooth.  Teeth have a series of nerves and arteries that hydrate, deliver nutrients, and detect temperature changes.  When a tooth is traumatized by an accident, decay or an infection, the tooth responds by becoming inflamed, swollen or very sensitive. Root canal therapy relieves pain from the infection.

HOW DOES A TOOTH BECOME INFECTED?
At first, the tooth may be sensitive to cold, sometimes even heat, and as it worsens, the tooth becomes sensitive to biting down.  Usually at this point it means that the inflammation and infection from the bacteria present in the mouth, has gone down through the root canals, exiting at the end of the root of the tooth.  This makes the surrounding area very tender and sore to biting pressure,  especially at the end of the root.  Sometimes the infection is very aggressive and can cause the person's face, or worse the neck to become swollen.  This is a true dental emergency and should be treated with antibiotics and root canal therapy without delay. 

HOW  IS  A ROOT CANAL TREATED?
Root canal therapy removes the old, dying nerve and sterilizes the inside of the tooth.  Then it is filled with a rubbery material (gutta percha) that seals it off from the surrounding tissues.  This procedure is done under local anesthesia, or sedation if necessary.  All teeth that have had root canal therapy need to be crowned. A crown is a protective covering that distributes forces over the whole tooth and helps to prevent fracture.  Statistics show that when people delay in having the crown placed, after having a root canal, they will lose their tooth within 3-5 years.  Ideally the crown should be prepared within the first 2-4 weeks to avoid potential fracture.   The goal is to preserve & protect your tooth.

Cracked or Fractured Teeth

Habits such as clenching, grinding, and chewing on hard objects subject your teeth to incredible forces.  When you have larger fillings present, the likelihood of fracturing a cusp or part of your tooth tends to be higher.  Cracked teeth do not always show any visible signs of damage, but may present a variety of symptoms, including intermittent or spontaneous pain when chewing and sensitivity to sweets, heat and/or cold.  This erratic pain can make diagnosis a challenge.
Why Do Cracked Teeth Hurt?
When the outer hard tissues of the tooth are cracked, chewing can cause movement as the pieces flex back and forth. The pulp (nerve) can become irritated. As the biting pressure is released, the crack can close quickly, resulting in sharp pain. Irritation gum and nerve can be repeated many times while chewing. Eventually, the nerve can become damaged to the point where it can no longer heal itself. The tooth will not only hurt during chewing but may become sensitive to extreme temperatures. In time, a cracked tooth may begin to hurt all by itself. Extensive cracks will lead to infection of the pulp tissue, even spreading to the bone and gum tissue that surround the tooth or the loss of the tooth if not treated with a crown and sometimes a root canal. Fractures can extend vertically, and in such a way as to cause the tooth to be non-salvageable.  In this case, the only option is to extract the tooth.
Types of Cracked Teeth
There are many different types of cracked teeth. The treatment and outcome for your tooth depends on the type, location, and extent of the crack.

Craze linesare tiny cracks that affect only the outer enamel. These cracks are extremely common in adult teeth. Craze lines are very shallow, cause no pain, and are of no concern beyond appearance. Sometimes these can develop into larger fractures.
Fractured Cusp:  Cusps becomes weakened by large fillings or trauma.  Fractures sometimes results. The weakened cusp may break off or need to be removed. When this happens, the pain from chewing will usually be relieved. A fractured cusp sometimes damages the nerve, creating the need for a root canal. A crown is the usual treatment for a fractured cusp.
Cracked or Split Tooth
Cracked teeth will be restored with a crown to hold the pieces together and protect the cracked tooth. Sometimes these types of cracks require root canal therapy or extraction if the crack extends below the gum. Vertical root fractures are cracks that begin in the root of the tooth and extend toward the chewing surface. Often teeth that are vertically fractured need to be removed.  Early diagnosis is important. It can be challenging to determine the extent of a crack. A cracked tooth that is not treated will progressively worsen, and eventually result in the loss of the tooth. Early diagnosis and treatment are essential to saving these teeth.

     13017 W. Linebaugh Avenue

     Tampa, FL 33626

     813-891-1212

     info@DesigningSmilesTampa.com

     Located in Westchase Commons Office Park

Vertical impactions sometimes may erupt normally, but if the process is slow, it can be painful, become inflamed and infected, or may potentially damage the adjacent teeth.

Extractions

An extraction may be necessary when a tooth cannot be saved by a root canal, filling or crown.  Teeth which have cracked or are too extensively decayed may fall in this category.  Wisdom teeth are commonly removed.  We prefer to try to save teeth with endodontic therapy, crowns, or a filling, if at all possible, because extraction is an irreversible procedure. Occasionally we may need to refer you to a specialist (oral surgeon), if the extraction or your medical history is complicated. 

Wisdom Tooth Extractions
Wisdom teeth, commonly referred to as third molars, are the last teeth to erupt in the mouth.  Most people get their wisdom teeth in their late teens or early twenties.  Because they are often difficult to keep clean, decay easily and can create crowding in the mouth, wisdom teeth are often removed. Wisdom teeth can become trapped under the gum, or impacted.  Sometimes the impaction is at an angle or horizontally impacted.  Depending on the condition, certain impactions can cause damage to the adjacent teeth.  It is important for you to have your wisdom teeth evaluated, to determine your risk, and decide whether or not you should have them removed.  Below are a few examples of conditions that can occur. 

Parents:  Plan ahead for your high school and college students.  Most wisdom tooth extractions are performed over Christmas and summer breaks, and in between school semesters.    

Horizontal impaction is a severe condition that prevents the tooth from uprighting and erupting properly.  Root resorption (or the dissolving of the tooth next to the wisdom tooth) is a potential complication of delaying extraction. 

Distal impactions are when the wisdom tooth is angled back towards the back of the mouth (distal).  As thejaw grows, sometimes these impactions will work their way out.  If the jaw doesn't continue to grow, the tooth will be only partially erupted, which causes decay, pocketing, gum disease, and bad breath.              

Emergency Care

813-891-1212

If you have a toothache, a dental emergency such as a broken tooth, swelling or pain that keeps you up at night, please contact our office. Relief is just a call away! 

If it is the weekend or the office isn't open, please contact Dr. Hilton-Foley by calling the office for instructions. You can also go to the emergency room, a walk in clinic, or you may contact your physician if you have swelling, chills, fever, or you feel your situation is getting worse quickly. There is a Dental Walk In clinic here in Tampa, on Kennedy Ave, which is open for extended hours during holidays and evenings.

For crowns or temporaries that have come off, please contact the office as soon as possible for instructions.  It is best not to leave a temporary or a permanent crown off your tooth.  If you cannot come in, the best thing to do is get some denture adhesive and cement it back on with the adhesive.  This will hold the space between the teeth and prevent the crown from needing to be remade or adjusted significantly. 

If you have a problem that is not an emergency, or a scheduling conflict, please contact Designing Smiles during normal business hours at 813-891-1212.  

Mesial impactions are the most common type of impaction, and usually require extraction.  If not caught early enough, this type of impaction, just like the horizontal impaction situation, can cause the roots of the teeth next to the wisdom teeth, to resorb or eat away, which damages the tooth which has already erupted.

Bone Grafting
If an extraction is our only choice, and the lost tooth is not a wisdom tooth, we recommend to place a bone graft in the area of the extraction, to build up and preserve the bone, for the future.  By doing so, you can prevent the severe bone loss that occurs following an extraction.  Within the first two years after an extraction, more than 50% of the bone height and contour is lost.  Without a graft, placing an implant may be difficult down the road.  Even if you plan to place a porcelain bridge or a partial denture to fill in the space, by placing a bone graft, you prevent the bone loss that occurs.  Bone grafts allow your body to build bone back into the area where the tooth was lost.  The graft provides the framework.  It is also important to note that following an extraction, the healthy teeth adjacent to the extraction site may lose bone, because of the loss of bone from the extraction. Bone grafting protects the teeth next to the extraction site. Aside from accidents or trauma, preventative dentistry, regular checkups, and good home care can eliminate or at least minimize the need for extractions. 

Cosmetic & Family Dentistry

​​Angela Hilton-Foley, DMD

(813) 891-1212