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What many people don’t realize, is that a tooth has nerves and blood vessels just like the rest of our body. A tooth is “vital” or alive. There are reasons why a tooth can become non vital, or dead. ItCosmetic Dentist Marielaina Perrone DDS is not always easy to tell, and sometimes can be quite painful.

A dead tooth is simply a tooth that no longer has access to nutrients and blood flow. Our teeth are composed of three layers: the enamel, the dentin and the nerve or “pulp”. A healthy tooth has living cells and tissue inside.This living tissue plays a role in the development of the teeth. The nerve is the part of the tooth that can sense temperature, when you drink or eat something really cold or hot. It can also sense how hard you are biting into something, and feel pain.

All the blood vessels and nerve fibers are located in the pulp and this means that when the pulp is dead, then the tooth is dies as well. What can happen if a tooth becomes non vital, and why does it die?

What Causes a Tooth To Die?

The two main causes are:

Tooth Decay – Tooth decay or a bacterial infection, when left untreated, will begin to invade deeper into the tooth eventually penetrating through enamel and into the second layer, the dentin. When the decay or infection reaches deep inside the tooth, the cells of the pulp try to fight it off by triggering the inflammatory process. This includes action by the white blood cells. Pus develops when some of the white blood cells die during the battle against the infection. If the infection is not treated at this stage, all the white blood cells will die and the blood flow will stop completely.When this occurs, tooth sensitivity is usually the first sign of trouble and this sensitivity will eventually reach the pulp and results in a severe toothache.

Dental Trauma – This can occur from traumatic injuries, falls, severe grinding and clenching, biting into very hard objects, and sometimes idiopathic internal resorption (a tooth self destructs from the inside out for no apparent reason) . When dental trauma occurs, the blood supply can be severed immediately, resulting in the pulp dying off. Sometimes it is a slow progressive breakdown as teeth wear and crack from bad oral habits. Prevention is the key whenever possible. This is why sports mouth guards are recommended for all contact sports activities. Nightguards are recommended for clenchers and grinders. Extremely hard foods should be avoided such as popcorn kernels, corn nuts, and the mouth should not be used in place of tools such as scissors or a bottle opener.

Signs and Symptoms

It can be very difficult to identify a dead tooth just by looking at it and that is another reason why it’s important to visit a dentist regularly. It is possible to have no symptoms when a tooth becomes non vital. However, a non-vital tooth may exhibit some a tell tale symptom like turning darker. This discoloration is usually the dead pulp becoming visible. Another sign of a non-vital tooth is an unexplained swelling, or a raised white pimple like area. These signs are normally a result of a periodontal abscess, caused by periodontal disease or injury, which can rupture and produce an infection in the gums and mouth. A dead tooth will eventually become loose due to the destruction of surrounding bone by the infection process. It can also produce a foul odor and even more severe pain.

Cosmetic Dentist Marielaina Perrone DDSTreatment Of A Dead Tooth

Many patients will ask, “If the tooth is dead why not just leave it alone?”.Simply put, the dead tissue in the pulp chamber will become a breeding ground for bacteria. If left untreated, an abscess can occur along with pain and discomfort. There are usually two options for treatment of a non vital tooth:

Extraction – A tooth extraction can be performed if the tooth is not savable, or it can be chosen due to finances becoming an issue. A tooth extraction is usually the least expensive option but it can also can leave other issues on the long term horizon (such as tooth shifting, cosmetic and functional issues). Once extracted, tooth replacement can be done using a dental implant, a fixed bridge, or a removable denture.

Root Canal Therapy –  This procedure is performed when a patient chooses to save the tooth. Root canal therapy allows the dentist to clean out the dead tissue and infection, ridding of the decayed part of the pulp. This will allow the dentist to rebuild on the sterile tooth to return full form and function. With today’s modern technology, root canal therapy can be a painless and comfortable experience and, if done early, can save a tooth by preventing further infection and subsequent tooth loss. The procedure usually begins with anesthesia to prevent any pain, then a dentist will make an opening for the cleaning instrument to penetrate the affected inner parts of the tooth. The infection is cleaned out and the opening is then closed with a filling. The tooth can then be bleached to turn it whiter or a veneer or a crown can be placed over the tooth to make it look natural.

How To Prevent A Tooth Becoming Non-Vital

Maintaining a proper dental hygiene regimen including brushing and flossing regularly can prevent the buildup of food and bacteria that gets trapped between teeth and gums, which can cause infection and tooth decay leading to dead teeth. Regular visits to the dentist are also very important, since your dentist will be able to identify and diagnose early signs of tooth issues. There are other early signs that you can recognize on your own that include sensitivity to heat or cold, pain when chewing or biting down, slight discolorations, bad breath, gum swelling and facial swelling. Saving a dead tooth depends on early detection and early treatment. Do not ignore the signs and symptoms – get it checked out to decrease your chances of infection and tooth loss.



Flossing is one of those tasks in life that we know we should do, we know the benefits of it, and we know how little time it takes but most of us, just do not do it regularly.

Flossing your teeth every night can be a hard habit to develop and maintain, but it’s one that comes with great benefits.  Simply having a cleaner feeling mouth, avoiding bad breath , preventing tooth cavities or even avoiding loss of teeth can be accomplished with flossing. Regular tooth brushing cannot reach all the areas of our mouth. Brushing supposedly is only able to clean about 60% of the mouth whereas flossing is able to get to the other 40%. Flossing is able to reach those areas if done properly. Flossing is able to remove plaque, bacteria, and food debris between teeth.

It is recommended by the American Dental Association that we floss at least once a day. Proper oral hygiene maintenance is important to stave off periodontal disease and also to keep our entire body healthy. Studies have shown less than half of Americans admit to flossing daily. In reality, that number is probably much lower.

What if there was an easier way to floss daily to maintain our teeth and gums?

 

Alternatives to Flossing

These alternatives will never be as good old fashioned flossing but they will make an improvement to your oral health versus not using them.

Flossing with Waterpik Flosser Marielaina Perrone DDS

Flossing with Waterpik

Waterpik Oral Irrigator. As the name suggests the waterpik is able to do its job by using a stream of pulsating water to remove plaque, bacteria,  and food debris between teeth and above and below the gum line, to stimulate blood flow, and to improve overall oral health. Studies have shown when used correctly that the waterpik is actually superior  in reducing bleeding of gum tissue and is as effective in reducing plaque buildup. The beauty of the waterpik is its ability to mix antibacterial rinses or a rinse like Periogen into the irrigating chamber. This adds the benefit of being an antibacterial or anti tartar rinse as well, making it doubly effective.

Oral-B Hummingbird Electric Flosser. The hummingbird flosser is an electric flossing tool that is able to gently vibrate to massage your gums while it is cleaning between your teeth. This is an excellent flossing tool for those lacking dexterity since it can be used with one hand vs two with traditional flossing.

Tooth Pick, stimudents, soft piks. Yes, a good old fashioned tooth pick can be useful for cleaning in between your teeth. While it doesn’t do the best job, it is definitely  easy to use, can remove large food particles, and stimulate blood flow. Just be careful not to poke your gums and injure yourself.

Sonicare AirFloss. This product makes it easier to keep our teeth clean between dental visits. The Sonicare AirFloss was specially

Flossing with Sonicare AirFloss Marielaina Perrone DDS

Flossing with Sonicare AirFloss

designed to give you an easy and simple, effective way to clean in between your teeth. The Sonicare AirFloss works using patented micro burst technology. This technology delivers micro droplets of air and water to remove plaque, bacteria, and food debris between teeth. Studies have proven the Sonicare Airfloss to be safe and effective as well as gentle on teeth and gum tissue.The Sonicare Airfloss is very easy to use. It features a single button and a guidance tip that allows the user to target cleaning in between teeth. Patients can complete their flossing in as little as 60 seconds. And with the narrow tip, patients are able to reach the back of their mouth very easily. This allows all the teeth in the mouth to be cleaned. The reservoir holds two teaspoons of water, mouthwash, or other oral rinse. This is enough for two uses and makes the Sonicare AirFloss doubly effective as it has an anti bacterial component as well.

Alternative Flossing Conclusion

As you can see above there are a few alternatives to flossing. Bottom line is nothing beats using a simple piece of floss and flossing like many have been for decades. But if you are unable to or unwilling, the products listed above will help improve your oral hygiene.  Use what works best for you and use it as often as you can. Keeping your teeth clean between dentist visits is very important in having your teeth last a lifetime and preventing the development and advancement of periodontal disease. So, maintain a regular schedule of complete dental examinations as well as professional cleanings along with continued at home care and you will see great results in your smile and your health.

 

 

 

Teeth whitening has become one of the most requested and performed procedures in dental offices across America and the world. According to the American

Academy of Cosmetic Dentistry, teeth whitening is the number one requested cosmetic dentistry procedure requested by patients to improve their smile. We have long known that the importance of feeling good about our smile increases our self esteem and confidence. It alters how others look at us and interact with us. So it is no surprise that people want a whiter smile. But did you know teeth whitening can occur using natural ingredients?

The first step is the maintenance of good dental hygiene. Our Health and beauty are one and the same. Start with clean, healthy teeth and gums.Removing plaque, and stains will help give your smile the sparkle you need and the  confidence to smile. Teeth covered in plaque, tartar and debris, and red, swollen puffy gums are never beautiful. Maintaining a regimen of brushing and flossing as well as regular visits to dentist and hygienist are the first step in any improvement to our smiles.

Foods To Eat for Teeth Whitening

-Crunchy, crispy fruits and vegetables have an abrasiveness that can help remove stains from the teeth and give the illusion they are whiter. Consider these like nature’s toothbrush. Apples, fresh green beans, cauliflower, carrots, celery and other crunchy fruits and vegetables help whiten by gently scrubbing the teeth. These abrasive vegetables and fruits have enough abrasiveness for teeth whitening without causing any harm to the enamel. A great snack for teeth whitening are crudités (sliced, fresh, raw veggies). Fibrous fruits and vegetables are low in calories, high in nutrients and massage gums and promote blood flow to help keep oral tissues healthy. They also help to increase salivary flow. Good salivary flow is an important key to help protect our oral health.

-Strawberries. This delicious fruit contains an enzyme called malic acid that helps with teeth whitening.

-Eating tart fruits such as oranges and pineapples. These may cause the mouth to produce more saliva, which washes

teeth clean naturally. Beware of using these very acidic directly on teeth, because too much acid can cause damage to the teeth.

-Cheese and other dairy products (like yogurt and milk). These products contain a type of lactic acid that helps prevent decay. Hard cheeses also scrub teeth similar to the crunchy fruits and vegetables to help with teeth whitening by removing stain build up.

-Ginger Root. This help is owed to the anti inflammatory and antibacterial ingredients of the fruit. Patients with periodontitis will receive some benefit by introducing ginger into their diet.

-Basil. This is known as a strong natural antibiotic. Basil can reduce the amount of harmful bacteria in the oral cavity. Basil also acts as a defense mechanism deterring the bacteria from multiplying.

Sesame seeds. Nature’s scrubbing toothbrush. These will help in reduction of plaque deposits. Just take a few teaspoons of sesame seeds a few times per week, and you will begin to note a change in how clean your teeth are. You will probably see reduced plaque deposits.

Teeth Whitening with Crest Baking Soda

Teeth Whitening with Crest Baking Soda Toothpaste

-Baking Soda. Studies have found that toothpastes that contain baking soda do a better job of removing plaque than toothpastes without the ingredient. To try it, your best bet is brushing with a commercial paste (like Crest Baking soda teeth whitening toothpaste) that contains the mild abrasive. This will happen with teeth whitening due to removal of stains by the abrasive paste

Foods to Avoid for teeth whitening

I am sure most people can rattle off the worst offenders pretty quickly. Tea, coffee, red wine, and sodas. But there are a few foods that might surprise you. They include:

White wine. This can promote staining because it contains tannins and acids that can actually etch tooth surfaces. Alcoholic drinks are generally not acidic unless mixed with acidic beverages in cocktails. These can include drinks such as screwdrivers (vodka and orange juice) or cosmopolitans (vodka with cranberry and lime juice).

Sports drinks. These drinks tend to have a higher acidic content regardless of whether they are regular or sugar free.

teeth whitening - epic xylitol gum

xylitol gum – teeth whitening

Most people won’t give up staining foods. So they must maintain regular visits to the dentist as well as adding the next two to their diet on a regular basis.

Water works to reduce staining. Drink water with meals and rinse your mouth with water after eating. Just sip and give a final swish (and swallow) after a meal.

Sugar-free gum can also help clean teeth. This is helpful when you won’t be able to brush for a while. Xylitol (artificial sweetener) in some sugar-free gums also helps prevent decay by stimulating salivary flow.

 

Following some of the steps above will probably not get you the results of professional teeth whitening but they will help maintain a healthy, vibrant smile for many years to come. Teeth Whitening comes in many forms!

 

 

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Avulsed Tooth is the complete displacement of a tooth from its socket in alveolar bone from trauma.

Dentists generally refer to a tooth that has been knocked out as an avulsed tooth. The accidental loss of a tooth through trauma ( avulsed tooth ) is considered a very serious dental emergency for a permanent tooth (occurs in about 1/10th of the population). For an avulsed primary tooth re-implantation is generally not successful, and is usually left alone. For a permanent tooth if you act quickly enough there is a chance the avulsed tooth can be saved and maintained for many years. Even the best techniques and intentions do not always lead to a successful outcome for an avulsed tooth.

The usual cause of an avulsed tooth is a  force sufficient to break the bond between the tooth and the connection (periodontal ligament ) to the bone. An avulsed tooth has no oxygen or blood flow and will die quickly if not re implanted. The primary goal of quick reimplementation is to maintain the periodontal ligament, so that the tooth is not rejected. The avulsed tooth will always need to be splinted to the other teeth, and usually, but not always, require a root canal. The speed in which the tooth is re implanted, the cleanliness of it, and how hydrated or wet it has been all play key roles in whether or not re-implantation of the avulsed tooth will be successful.

Instructions for an Avulsed Tooth

If a tooth has avulsed due to trauma it must be re implanted in its socket within 60 minutes (or sooner if possible) of the accident for the best chance of a positive result (i.e. tooth remains in position). It is important to keep the root surface of the avulsed tooth moist. This is the reason for the need for speed when re implanting the tooth.

An avulsed tooth, whose structure is maintained without any major fracture, must be re-implanted in its socket within an hour after the accident for best chances for it to remain in position. The best option is to attempt re-implantation within the first few minutes at the site where the accident occurred. The avulsed tooth should be attempted to be cleaned and placed back into the socket ( hole in jaw ) by an adult. This can be either the person who lost his or her tooth or by an adult if a child has suffered the trauma. If the avulsed tooth goes back into its socket where it was originally then it would be considered to be a successful re-implantation.

smileIf the avulsed tooth is dirty, it is vitally important that it is cleaned, the best way is with the patient’s own saliva by putting it in their mouth. Once the avulsed tooth is cleaned in this manner the patient should spit out any blood and dirt in mouth. While spitting, you probably will remove the blood clot forming in the avulsed tooth socket. This will allow an easier re-implantation of the avulsed tooth into the socket. the tooth can also be rinsed with cold water or milk. When the avulsed tooth is as clean as you can get it, it should be placed back in the socket as soon as possible. The quicker it is done, the better the chance for success. There are also “tooth saver” kits made to hold and keep the avulsed tooth wet for transport to a dentist.

If the avulsed tooth cannot be repositioned in its socket for any reason, then it should be brought to the dentist as soon as possible. There are a few ways to accomplish this:

1) The avulsed tooth should be rinsed and cleaned as explained above. The person who had the accident must then keep the avulsed tooth in their mouth. They should keep the avulsed tooth under the tongue or between the cheek and back teeth or lip and front teeth. If the trauma happened to a young child the previous advice should be disregarded as they can swallow the tooth. In such a case, the avulsed tooth should be rinsed and placed in milk, or in water with salt. Go to your dentist as soon as possible.

2) After cleaning with saliva, the avulsed tooth can be put in a solution of water and salt. A half a teaspoon of salt should be mixed in a cup of water. It is best to use bottled water if it is  available, but tap water can also be used in a pinch.

3) The avulsed tooth can also be placed in fresh room temperature milk. The patient and avulsed tooth in solution should be brought to the dentist as soon as possibleSave-a-tooth avulsed tooth kit

4) There is a commercial product available for the storage of an avulsed tooth. It is called Save-A-Tooth. This is a small container containing fluid to help preserve the avulsed tooth  for easy transport and re-implantation.

Exceptions to the Rule

The instructions above are recommended for adult teeth only. If a primary tooth (also called baby tooth) has avulsed following an accident, the re-implantation will not really work.

-If the adult avulsed tooth is broken or has visible fractures following the trauma, and or its root remained in the socket, the re-implantation will not be successful. This is because the tooth will not reattach to its root, and a fractured tooth will continue to break down.

Prognosis of Avulsed Tooth following Re-Implantation

It should be remembered that even if you follow all of these recommendations precisely, the tooth in question may eventually need to be extracted. If the instructions are followed correctly, chances are better that the tooth may remain in position.  An immediate splinting to the other teeth is optimal to take stress off the tooth and allow for healing. It may eventually need root canal treatment and possibly a crown to restore the avulsed tooth to its full form and function.

The re implanted  tooth can also seem to be fine for a few months or even a few years before it eventually becomes a problem.

At the Dentist Office

Putting the avulsed tooth back in its socket sometimes can be quite easy. And sometimes it can be very complicated, such as when the tooth or bone is fractured or broken. Your dentist may use water to flush debris from the socket. Then they will attempt to slide the avulsed tooth back into place. As mentioned earlier, it is most important to re implant the tooth as soon as possible. Ideally, this should occur within the hour of the accident.

The best course to take will depend upon how long the tooth was out of the mouth and amount of trauma. In either case, the dentist will splint the avulsed tooth to the teeth on either side with a soft wire and/or a resin material. This will be used to maintain the tooth in place for days-weeks.

If the bone around the tooth was not fractured, the root usually will reattach firmly to the bone in about three to four weeks. More extensive damage to the area may need 6-8 weeks of healing time.

Your dentist should examine the tooth again in three to six months to ensure the tooth is doing fine with no evidence of infection occurring. If there are no signs of infection, the next visit will be at your yearly dental examination. The dentist will then continue to monitor the tooth for the next 2-3 years to ensure that the tooth re implanted successfully.