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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.

 

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 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 sense of 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 after root canal treatment is completed to protect the tooth and restore full function.

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 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.

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 pain. Most people who have root canal therapy admit they did not experience any pain during the appointment and felt better 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 exhibited.

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.

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 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.

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. 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 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 medications or an antibiotic if an infection was present. Follow directions given to you very carefully.

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 if you have any pains or discomfort.

Radiograph of RCT

Xray of completed root canal

Have you ever caught yourself staring at the perfect smiles seen on TV, in the movies, and in magazines . . . the smiles of  Hollywood actors and actresses, and models? Have you ever wondered, “How did they get that perfect, white smile? Odds are, those celebrities were not born with pearly white smiles. These smiles were likely designed and created just for them with the help of a cosmetic dentist. The good news? Anyone can enjoy the perfect Hollywood smile, with the assistance of a cosmetic dentist and porcelain veneers.

Porcelain veneers (also referred to as porcelain laminates) are super thin, custom fabricated shells of tooth colored porcelain designed to cover the front surface of teeth to improve your smile’s overall aesthetic appearance. These shells are adhesively bonded to the front of the teeth changing their color, shape, width, and/or length. Versatile and very strong, porcelain veneers are used in a variety of ways to transform your smile, from complete smile makeovers to repairing a chipped tooth.

Porcelain veneers are custom made from a high quality dental porcelain that has similar light reflecting properties as our natural teeth. Porcelain veneers are excellent at resisting stains and they mimic our natural teeth’s light reflecting properties. They are the cosmetic dentist’s greatest tool for elevating a normal smile to a Hollywood smile.

Porcelain Veneers arecosmetic dentist regularly used to fix the following issues:

-Teeth that are stained or discolored. Teeth can become stained or discolored from root canal treatment, from tetracycline or other drugs, excessive fluoride, or the presence of large resin fillings that have discolored over time.

-Teeth that are worn down from use or grinding of teeth.

-Teeth that are broken or chipped.

-Teeth that are misaligned, uneven, or irregularly shaped. Porcelain veneers are sometimes referred to as “Instant Orthodontics”.

-Teeth with gaps or spaces between them. Porcelain Veneers are able to cosmetically close those spaces.

Making the decision to have porcelain veneers is the first step. The entire process usually takes 3-4 visits, one for a consultation and two to make and apply the porcelain veneers. There is sometimes an added appointment following the consultation where the dentist will show the patient a mock up model. This model will be of your teeth where the dentist has waxed onto those teeth what the porcelain veneers will look like on your smile. It is a great visual reference for you to decide the course of treatment for you. This can also be done via software on a computer. One tooth or many teeth can simultaneously undergo the treatment described in the following paragraphs.

Consultation/Diagnosis and Treatment Planning. This first step involves your aCosmetic Dentistctive input. Explain to your dentist what you want in the final result. During this appointment, your cosmetic dentist will examine your teeth to make sure porcelain veneers are appropriate for you and explain to you what the procedure involves and some of its drawbacks. They may take X-rays and possibly make impressions of your teeth as study models. These models will be used by the dentist to do a mock up of the final result. The dentist will prepare the teeth on the model and sculpt wax over them to give you a visual representation of the final product. This is an important step.

Preparing the Teeth for Porcelain Veneers. A dentist must remove  about 1/2 millimeter of enamel from the tooth surface, which is an amount nearly equal to the thickness of the porcelain veneers to be added back to the tooth.  Before beginning, you and your dentist will decide the need for a local anesthetic to numb the area. Next, your dentist will take an impression of your teeth. This model is sent out to a dental laboratory, which in turn constructs your custom porcelain veneer. It takes about 1-2 weeks for the laboratory technicians to complete the process. Temporary veneers are placed using a resin material until the final veneers are ready.

Dental Bonding. Before the porcelain veneers are permanently bonded to your tooth, the dentist will check for fit and color by temporarily placing it onporcelain veneers the tooth. If they fit properly and the color shade is correct the dentist will go on to prepare your tooth, your tooth will be cleaned, polished, and etched (this is a process whereby your tooth surface is roughened up chemically at the microscopic level).  A special adhesive is applied to the porcelain veneers and the veneer or veneers are methodically placed on your tooth. When the they are in the right position, your dentist will apply a special light to the porcelain veneers. This activates chemicals in the adhesive, causing it to cure. The final steps involve removing any excess adhesive, evaluating your bite and making any final adjustments in the porcelain veneers as needed. Your dentist may ask you to return for a follow-up visit in a couple of weeks. This is to ensure you are happy with the final result as well as checking the gum tissue surrounding the new porcelain veneers.

There are some disadvantages to porcelain veneers:

-The procedure is not reversible.

-Porcelain Veneers are not repairable. If they break, a new one will need to be custom  fabricated in the laboratory.

-The color cannot be changed once the porcelain veneers are in place. So both dentist and patient must be sure they are happy with color prior to final placement of the porcelain veneers. It does happen on occasion that the color is not what is desired from the laboratory and they are sent back to be remade. It is of the utmost importance for the patient to be ahppy and satisfied with the final result.

-Porcelain veneers can fall off or chip. The material is very strong but patients who grind their teeth, bite their nails or chew on pencils will be more susceptible to this occurring.

-The teeth under the porcelain veneers are still susceptible to tooth decay. Patients need to be made aware of maintaining proper oral hygiene.

Porcelain veneers can be brushed, and flossed just like your own teeth. You should not even know they are in your mouth as they are bonded to your natural tooth sstructure.

Imagine. In just a few short visits, you can have an amazing Hollywood smile . . . a smile that has been custom designed just for you. A smile that is straighter and whiter than you could have imagined. You’ll be looking younger and feeling more confident. And it’s all possible with your cosmetic dentist and porcelain veneers.