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Dental Emergency

Many of us never think of the possibility of a dental emergency until it is upon us. One of the most critical aspects when choosing a dentist should be their emergency dentistry policy. Will the dentist be available after hours to answer questions or phone calls or even to open the office? Will my family be prepared in case of a dental emergency? Do we know what number to call or who to contact?

Fortunately, many dentists choose to offer their patients 24/7 access via cell phone to at least give advice or prescribe medicine after hours if not open the office after hours. There are also, many who choose to use an answering service or not be available at all for an after hours dental emergency.

Most Common Dental Emergency

-Chipped or broken teeth. This dental emergency may or may not be a painful event or it may be only cosmetic depending on the severity of the chip or break. Teeth can fracture or crack in all manner of ways and can create a true dental emergency. Your emergency dentist will be available to relieve pain and also restore your tooth to its natural form and function.

-Knocked-Out Tooth (also called a tooth avulsion). This occurs from direct trauma. Timing is everything!  The key here is to re-implant the tooth as soon as possible to give it the best chance for success over the long term. If it hasn’t fallen out completely, try pushing it immediately back in, your dentist can do any necessary tweaking. Retrieve the tooth, hold it by the crown or head (the part that is usually exposed in the mouth), do not touch the root. Rinse off the tooth root with water if it’s dirty. Do not scrub it or remove any attached tissue fragments. If possible, try to put the tooth back in place. Make sure it’s facing the right way. Never force it into the socket. If it’s not possible to reinsert the tooth in the socket, put the tooth in a small container of milk (or cup of water that contains a pinch of table salt, if milk is not available) or a product containing cell growth medium, such as Save-a-Tooth. Leave the rest to your emergency dentist.

-Toothaches/Infection. This can happen when tooth decay invades the nerve of the tooth, trauma causes the tooth to die, or periodontal disease is left untreated. The bacteria in the mouth invade the tooth and surrounding bone. This causes the body to respond, which leads to the swelling, pain, and infection. If left untreated this can be a life threatening situation. Call your dentist immediately for this dental emergency.

-Objects caught between teeth. This dental emergency may seem minor but it can be quite uncomfortable and scary. A dentist has the proper tools to remove any and all foreign objects in between teeth.

-Lost Dental Restoration. This dental emergency usually occurs when there is tooth decay present in or around the restoration. The bond between dental material and the tooth will break down causing the restoration to break loose. Depending on how large the restoration is this can cause quite a bit of pain and discomfort.

-Broken Braces And Wires. This may seem like a minor dental emergency but a broken bracket or wire can be very uncomfortable and can even cause trauma to the oral tissues. Contact your dentist for advice in your particular situation.

Dental Emergency Conclusion

dental emergency is an issue that involves the teeth and any oral tissues tissues that is of high importance to be treated by the relevant professional. All dental emergencies should be treated under the supervision or guidance of a dental health professional in order to preserve the teeth for as long as possible.

An emergency dentist that is available 24/7 is an important asset to have for you and your family. You never know when a dental emergency will arise and don’t you want the peace of mind to know your family is protected? Not all dentists make themselves available after hours for a dental emergency so it is important to ask your dentist if they will come to your rescue in the event of a dental emergency.

Osteoporosis…What Is It?

Osteoporosis is a disease of bones that leads to a decreased density of bone and subsequent increase in risk of fracture. In osteoporosis, the bone mineral density (BMD) is reduced, bone micro architecture deteriorates, and the amount and variety of proteins in bone are altered.

Osteoporosis is a bone weakening disease that has affected millions of people worldwide. The National Osteoporosis Foundation estimates that osteoporosis is a health threat for about 44 million people in the United States alone. The disease is far more prevalent in women than men. According to The National Osteoporosis Foundation, women are four times more likely than men to develop osteoporosis.

Because of these numbers, it is important for women to maintain a healthy lifestyle and diet even in their youth. Exercise and a proper diet for young women can help build strong bone mass for the future to avoid issues (like osteoporosis) later in life. There are recent studies showing that women who drink wine in moderation tend to have higher bone density than those who abstain from alcohol.

Medications Used for Osteoporosis and their Dental Link

Certain osteoporosis medications (also called bisphosphonates) have possibly been linked to osteonecrosis

Osteoporosis - Marielaina Perrone DDS

Normal Bone Vs. Osteoporosis Bone

(or “death of bone”) of the jaw. Osteonecrosis is bone death caused by poor blood supply to the area. It is most common in the hip and shoulder, but can affect other large joints such as knee, elbow, wrist, ankle, and jaw. Osteonecrosis is a rare and serious disease that can causes destruction of the jawbone. a condition marked by pain, swelling, infection and exposed bone. The majority of cases of osteonecrosis of the jaw involve people with cancer who have been treated with intravenous bisphosphonates. A  number of cases of osteonecrosis of the jaw have been reported in people taking oral bisphosphonates for osteoporosis. These have been primarily associated with active dental disease or a recent dental procedure, such as a tooth extraction.

Osteonecrosis can occur at any age range and can affect a wide range of ethnicity’s. Osteoporosis is considered a very serious disease and is responsible for well over 1.5 million bone fractures per year.

According to the American Dental Association (ADA), osteonecrosis of the jaw linked with osteoporosis medications has mainly been seen in cancer patients who are receiving the bisphosphonates intravenously. In fact, 94% of the cases reported are linked to intravenously-administered bisphosphonates while only 6% are linked with the oral medications.

How Do Bisphosphonates Cause These Bone Issues?

Bisphosphonates are very effective in slowing down the breakdown of bone by targeting the cells which breakdown bone (osteoclasts). An unfortunate side effect is, that they also slow down the bone cells which create new bone (osteoblasts). In areas of the body where the bones do not change much after development, (leg, hip, arm bones), this is not very disruptive. In areas such as the jaw, where bone is constantly reforming and reshaping, the lack of strong bone rebuilding cells is inhibitive to forming new bone after an extraction.

Common Bisphosphonates for Osteoporosis Treatment

Osteoporosis Fosamax Marielaina Perrone DDS

Osteoporosis Medication – Fosamax

-Fosamax

-Boniva

-Actonel

-Didronel

-Skelid

What causes Osteonecrosis?

Osteonecrosis occurs when part of the bone does not get blood and dies. After a while the bone can collapse. If this condition is not treated, the joint will deteriorate and this will become severe arthritis.

Osteonecrosis can be caused by disease, or a severe trauma, that affects the blood supply directly to the bone. Many times, no trauma or disease is present. This is called “idiopathic osteonecrosis” (which means it occurs with no known cause).

Direct Causes of Osteonecrosis:

-Long term use of steroids.

-Abuse of alcohol.

-Sickle Cell Disease.

-Radiation therapy.

-Gaucher Disease. This is a genetic disease in which a fatty substance (lipid) accumulates in cells and certain organs.

-Decompression sickness from a lot of deep sea diving

-Break, Dislocation, fractures around a joint.

Diseases Associated with Osteonecrosis:

-Gout.

-Atherosclerosis.

-Diabetes.

Osteonecrosis Symptoms

-Loosening of teeth.

-Pain in the Jawbone.

-Swelling in the area affected.

-Bone becoming exposed.

-Reoccurring Infection.

Osteoporosis Conclusion

It is good to remember that osteonecrosis of the jaw bone from bisphosphonate medication use is quite rare. The drugs being used to counteract osteoporosis have proven benefits to counteract a very serious disease and reduce bone loss. If you are taking any of the bisphosphonate drugs for osteoporosis call your physician before stopping them. It is also very important to inform your dentist that you are taking such medications so they can have it in their medical history in case something arises during your course of treatment.

Maintain a proper diet, exercise regimen, along with regular visits to your dentist and physician to keep your osteoporosis under control.

 

 

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.

 



Root Canal Therapy (also called root canal treatment or endodontic treatment)  is a dental procedure in which the diseased or damaged nerve (pulp) of a tooth is removed and the inside areas (the nerve or pulp chamber and root canals) are cleaned, filled and sealed permanently to avoid dental infection. Without treatment, the surrounding tissues of the tooth (including the gums and bone) will become infected and a dental abscess can form.

A tooth’s nerve and blood vessel provide nutrients and hydration to a tooth as well as the ability to sense temperature. It provides the sensation of hot or cold. The presence or absence of a nerve will affect the routine functioning of a tooth. Over time, the tooth with the root canal dehydrates which makes the tooth brittle and more susceptible to fracture. Most often, a crown is placed following root canal treatment is completed to protect the tooth and restore full function to the patient.

Root canal therapy is considered by many to be the most feared dental procedure. Does that surprise you?  Surveys completed by the American Association of Endodontists reveals that most people with a fear of the dentist are based on others’ experience and not on their own.

The inaccurate information they receive about root canal therapy prevents patients from making a properly informed decision regarding their teeth.  Many patients will ask that a tooth be extracted rather than experience a root canal procedure simply fearing the unknown.

Painless DentistryRoot canal treatment is needed when the nerve or pulp tissue becomes inflamed or infected. The inflammation or infection can occur from a number of ways: Decay that extends into the pulp chamber, repeated dental procedures on the tooth, or a fracture or chip in the tooth that allows bacteria to spread into the pulp chamber. Also, a traumatic injury to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain or lead to a dental abscess.

Root canal therapy is almost always recommended because a tooth is causing pain from a condition that is irreversible. Pulpitis (inflammation of the pulp), an infected pulp, broken teeth, or a slowly dying nerve are all common reasons for root canal therapy.

Root canal therapy is used to alleviate that dental pain. Most people who have root canal therapy admit they did not experience any pain during the appointment and felt better almost immediately afterward.

Signs that a root canal may be necessary include pain, prolonged sensitivity to temperature (hot or cold), tenPainless Dentistryderness to touch and chewing, darkening or discoloration of the tooth, and swelling, drainage and tenderness in the lymph nodes, bone and surrounding gingival tissues. Sometimes, no symptoms are shown at all

Root Canal Therapy generally requires one or more visits to the dentist and can be performed by either a dentist or a specialist called an endodontist. An endodontist is a dentist who specializes in the causes, diagnosis, prevention, and treatment of diseases and injuries of the human dental pulp or the nerve of the tooth. The choice is generally up to the dentist on who will perform the root canal. The reasons the dentist may send you to the endodontist include: degree of difficulty of the tooth involved and need for a microscope, re treatment of a Painless Dentistryprevious root canal, and the patients preference. You and your dentist will discuss who is best suited to complete this treatment for you and make the best decision for your treatment.

The first step is to take an X-ray (if one has not been already taken during the diagnosis) to see the shape of the root canals and determine if there are any indications of dental infection in the surrounding bone tissues. Your dentist or endodontist will then use a local anesthetic to numb the area surrounding the tooth. Anesthesia is not always necessary but generally preferred by patient to make the procedure more comfortable.

Once numb, the pulpal tissue along with bacteria, the decayed nerve tissue and related debris are cleaned out from the inside of the tooth and roots. Tiny instruments called dental files are used to measure the length of the root canal and to shape and clean the inside of each root. Sterile water, peroxide, or sodium hypochlorite are used periodically to flush away the debris and kill bacteria..

Once the tooth is thoroughly cleaned, each root canal is filled to the end with a rubbery compound called gutta percha and sealed . The process essentially is like a cork to prevent bacteria and fluid from re-entering the tooth, and keep it sterile. Some dentists like to wait a week before sealing the tooth. This will give the Painless Dentistryinflammation a chance to settle down back to normal. Some prefer to seal the tooth the same day it is cleaned out. If the root canal is not completed on the same day, a temporary filling is placed to keep out contaminants like saliva and food until the next appointment.

The final step may involve a more extensive restoration of the tooth. Generally a tooth that needs a root canal often is one that has a large filling or extensive decay. Even when decay was not a factor, the root canaled tooth is weaker than a ”live” tooth. Therefore, a crown, crown and post, or other restoration often needs to be placed on the tooth to protect it, prevent it from breaking, and restore it back to full function again. After restoration, you will not notice any difference in its function or form. You and your dentist will discuss this need further and decide together the best course of action for you.

Root canal therapy is highly successful and has more than a 95% success rate. Many teeth repaired with a root canal can last a lifetime.

Most root canals are performed to relieve the pain of toothaches caused by pulpal inflammation or infection. With modern techniques, materials, and anesthetics, most patients report that they do not feel any pain once the procedure is underway. Root canal procedures have the reputation of being painful. Usually most patients report that the procedure itself is no more painful than having a routine filling placed.

For a few days following treatment, your tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with over the counter or prescription pain medications or an antibiotic may be necessary if an infection was present. Follow directions given to you very carefully and feel free to ask questions if an issue arises.

Your tooth may continue to feel slightly different from your other teeth for some time after your root canal treatment is completed. However, if you have severe pain or pressure or pain that lasts more than a few days, call your dentist.

As noted above, the pain from root canals in modern dentistry is from the infection that presents to the dentist and the actual procedure should be pain and worry free. Best defense against developing a toothache is to see your dentist regularly, maintain proper oral hygiene, and call your dentist at the earliest signs if you have any pains or discomfort.

Radiograph of RCT

Xray of completed root canal