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While the dental crown itself cannot become decayed, the underlying tooth structure can. A dental crown is placed after careful shaping and preparation of the tooth surface and then inserted over the remaining tooth structure to restore the crown to its proper form and function.

How Does The Tooth Get Decay Under A Dental Crown?

The most vulnerable part of the interface between the dental crown and the tooth is the area where the edge of the crown meets natural tooth structure. If you are not maintaining good oral hygiene (brushing and flossing) to remove the plaque that lives under the gumline, you can develop a cavity on the underlying tooth and root areas. Once decay develops, it can progress quickly into the tooth and move up and under the crown, undermining the support for the dental crown. The following things can happen if you get tooth decay on a tooth with a dental crown:

Simple Dental Filling Placed At Margin Of Dental Crown. If the tooth decay is caught early enough, there are times where a simple filling can be placed to restore the tooth. This is only done when complete removal of decay can be accessed from the area. The seal is not as strong and leakage can occur under the dental crown over time.

Root Canal Therapy. If the tooth decay gets close to or invades into the nerve of the tooth a root canal will be needed to save the tooth. If the tooth has already had a root canal performed, it will need to be rebuilt back up so that a new crown can be placed.

Crown Lengthening. A crown lengthening is a dental procedure where a portion of the bone surrounding a tooth is surgically removed to allow the dentist access to decay that might run down the side of the tooth. This gives access to restore the tooth and also allows for proper placement of a new dental crown.

New Custom Dental Crown Fabricated. In most cases, a new crown will be needed to ensure a proper seal and proper coverage over the existing tooth.

Conclusion

It is important to maintain good dental hygiene but it really becomes important once you have dental crowns. A dental crown generally lasts anywhere from 5-15 years if properly taken care of. If they are not cared for they will not last as long and could develop a bigger issue.  The big tip here is to always maintain good dental hygiene and see your dentist regularly to check the crown edges for leakage and decay.



Wisdom teeth or third molars generally erupt into the mouth between the ages of 17 and 25. These molars come in behind our 2nd molars which came in at about 12 years old. Most people develop 4 wisdom teeth, while others may develop less or even sometimes more than 4. Wisdom teeth commonly become an issue because of lack of room or odd positioning. Wisdom teeth can affect other teeth in the mouth by moving them, damaging root structure or causing tooth decay or periodontal issue. Wisdom teeth can come in sideways, horizontally, backwards, or even become impacted (partially or fully  unable to erupt into the mouth). When these complications arise, it is recommended that the wisdom teeth are removed to avoid permanent damage to other teeth.

What To Expect Following Wisdom Teeth Extraction

While most wisdom teeth extractions go quite easily with little to no pain or complications. There can always be complications no matter how minor they may seem. These can include:

Bleeding. This is quite normal following any type of oral surgery. It is not unusual to see slight bleeding or oozing into the saliva following wisdom teeth extraction. Excessive bleeding ( mouth filling with blood) is not normal and your dentist or surgeon should be contacted immediately. The general instructions given by your doctor to control this oozing or slight bleeding is to bite down on a fresh gauze pad for about 30 minutes. You can repeat if necessary. This usually does the trick but if more action is needed biting on a moist tea bag will help even further. Tea bags contain tannic acid which helps with clotting of the blood. Activity should be limited directly following surgery. If bleeding continues or you are unsure of what to do, call your dentist immediately.

Pain/Discomfort. Some minor pain following wisdom teeth removal is normal. A dull ache is expected after the local anesthesia wears off. This usually will subside on its own over 8-12 hours following surgery. Your dentist or surgeon will evaluate what may be necessary for pain management based upon your particular surgery. For more severe pain your dentist or surgeon will give you a prescription pain medicine. It is important to note that most prescription pain medication is much stronger and will make you groggy and reduce your reflexive actions. Driving as well as alcohol intake should be avoided while on these painkillers. The pain should begin to subside within 8-12 hours and be almost gone by end of 2nd day. If pain persists call your dentist immediately as you may be experiencing dry socket. A dry socket occurs when the blood clot gets dislodged prematurely from area where the tooth was extracted. Symptoms of severe and/or throbbing pain at the surgical site 3-4 days following surgery, that does not respond to pain medication, can indicate a dry socket in the area of the wisdom teeth. If this occurs call your dentist so they can relieve your pain.

Swelling. Another very normal complication of wisdom teeth removal. Swelling can usually be found around the mouth and sides of the face. The swelling can be controlled or minimized by the use of ice packs. After 36 hours, ice has little beneficial effect and can be replaced with the application of moist heat to the sides of the face. Moist heat has been found to be helpful in reducing the swelling and increasing the range of motion of your jaws. Most swelling will subside over the course of 3-4 days.

Dietary Restrictions. Initial nutritional intake should be in liquid form or very soft foods. It is best to avoid chewing on side where wisdom teeth were extracted. Drinking fluids is especially important to avoid dehydration. Stay away from sharp, crunchy foods that can lodge themselves into the extraction site. You need to eat and drink so that you will heal and the stronger you will feel, but not too much if you are experiencing nausea. Do not use a straw when drinking as you may dislodge the clot and cause a dry socket or increased bleeding.

Nausea/Vomiting. Developing nausea is a real possibility especially if general anesthesia was used. Limit food intake until nausea subsides and try to drink a carbonated beverage (coke or ginger ale) it will help ease your upset stomach.

Maintain Dental Hygiene. Keeping the mouth clean is important. Rinsing should not be performed the day of surgery. The day after surgery you can rinse 5-6 times a day using a saltwater mix (cup of warm water with a teaspoon of salt). Your doctor will let you know when brushing in the area can resume.

Bruising/Discoloration. In some cases, this can happen and is very normal. Occurs when blood forms beneath the tissues causing black, green, blue, or even yellow discolorations on the skin. Usually occurs 2-3 days after surgery. Application of moist heat to the area may speed up the healing process.

Infection. Your dentist may place you on a course of antibiotics if there is an infection present. The Antibiotic prescription should be completed as directed by your dentist and pharmaceutical instructions.

Jaw Stiffness. This can occur from the jaws being open and stretched for an extended period of time. Normally goes away within a day or two.

Less Likely Wisdom Teeth Complications

Numbness. This can happen and is generally temporary. Be aware that you can bite your lip or tongue while you are numb so be careful. If the numbness persists call your dentist immediately.

Fever. Development of a fever is a rare occurence following wisdom teeth removal but it can happen. If the temperature lasts more than a few hours or does not go back down after taking Tylenol or Advil call your dentist.

Dry, Cracked Lips. This can occur from your lips and mouth being stretched during surgery. Most dentists can minimize this by using vaseline on your lips and skin before surgery to keep them moist.

Irregular Bony Projections. In some cases, patients may feel bony projections with their tongue. This is the bony walls that housed your wisdom teeth. These projections may need to be removed by the dentist if they persist.

Wisdom Teeth Conclusion

It is important to remember that we are all individuals and our bodies will react differently to different events such as wisdom teeth surgery. Many of us will have no complications beyond pain and slight swelling, but for others, bigger complications may arise. It is important to maintain an open line of communication with your dentist in case an issue arises.



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.

Dry socket (also called alveolar osteitis) is an extremely painful dental condition that can occur after removal (extraction) of a permanent adult tooth.

Having a tooth removed is generally not something anyone looks forward to. Most people understand there will be some level of discomfort following the procedure.  Many are given a prescription for pain medication before leaving their dentist. Most people in fact do not even need to get the prescription filled. However, when a patient experiences what is called a dry socket the pain can become quite intense and linger for days.

Very few people are affected by dry socket. The development of Dry socket after a tooth extraction occurs in only about 2-3% of patients. For those who experience dry socket it can be a very scary experience. Fortunately dry socket is treatable.

A dry socket occurs when the blood clot at the site of the tooth extraction has never fully formed, has broken free, or has dissolved before the wound has had a chance to fully heal. The blood clot is the protective layer for the underlying bone and nerves, it begins the process of healing so that gum tissue and bone can refill the area. When the clot is gone the bone and nerves are now exposed to the outside air, food, fluid, and anything else that enters the mouth. This can lead to a dry socket with sharp, aching pain that can last for 5-6 days, and in the case of a patient taking fosamax type drugs the pain can last for weeks.

A dry socket is considered the most common complication following tooth extractions. It happens more frequently with extraction of impacted wisdom teeth, in patients with poor blood flow to the socket, (smokers, patients taking fosamax), delayed healing (diabetics ).  The pain begins to build and develop about 2-4 days following the procedure.

Signs and Symptoms of Dry Socket

Signs and symptoms of dry socket may include:

-Sharp, aching pain within 2-4 days after a tooth removal.

explanation of dry socket

Graphic explanation of dry socket…image courtesy of Dental Care Matters

-Partial or total loss of the blood clot at the tooth extraction site. You would be able to visually notice a deep hole or space where tooth used to be, that weeps fluid when pressed vs a blood clot overlaying the site.

-Bone that is visible upon visual examination in the socket

-Pain that radiates from the socket to your ear, eye, temple or neck on the same side of your face as the extraction

-Abnormally bad breath or a foul odor emanating from your mouth. This will coincide with having a bad taste in your mouth as well.

-If you have swollen lymph nodes around your jaw or neck, this is a sign of infection and you need to be seen by your dentist immediately.

Over the counter medications by themselves will not control the symptoms. Your dentist or oral surgeon will need to begin treatments to lessen pain and allow for healing to take place.

Treatment of Dry Socket

Taking a nonsteroidal anti inflammatory drug (NSAID – aspirin or ibuprofen) can help to ease the pain but probably will not be enough to take it away completely. When the pain persists you should call your dentist immediately. The dentist may prescribe you a stronger pain medication to allow the pain to subside for you or give you anesthesia in the office to relieve some of the symptoms for a little while anyway.

paste for dry socket

Paste for Dry Socket

What will your dentist need to do for the dry socket? Your dentist will need to numb and clean the tooth socket. This will allow for  removal of any debris from the space where the tooth once was, and allow for rebleeding into the site. The dentist may then fill the socket with a medicated dressing or a special paste to promote healing and soothe the symptoms. Patients with dry socket dressings generally need to come back to be seen by the dentist every day until the pain subsides. The dressing needs to be changed daily. Warm cloth on the outside of the face also helps promote blood flow.

An antibiotic may also be prescribed at this point to prevent an infection from forming. At home care will include rinsing with salt water and being careful what you eat and how you eat it, ( avoiding the side where the dry socket is ).

The site will usually heal completely following treatment in 1-2 weeks.

Who is most likely to get a Dry Socket?

Some patients will be more likely than others to get a dry socket after a tooth extraction. These include the following:

Smokers. Patients who smoke have twice the chance of developing dry socket over those who do not. Smoking also is believed to slow the healing process.

Poor Oral Hygiene. Those with poor oral hygiene will have an increased risk due to the amount of bacteria in the mouth. Will be difficult to maintain a sterile field when removing tooth.

Having wisdom teeth (3rd molars) extracted. Increased trauma to area during procedure is one of the indicators for increasing the possibility for the development of dry socket. 3rd molars tend to be more difficult to remove especially if they are fully or partially impacted.

Previous history of dry socket. If you have had dry socket previously, you are more likely to develop it after another extraction.

Use of birth control pills. Contraceptives which contain estrogen effect the blood clotting system of the body. So we see an increased incidence in dry socket in patients on oral contraceptives.

Rinsing and spitting a lot or smoking after having a tooth extracted also can increase your risk of getting dry socket. These activities will increase chances of the blood clot becoming dislodged.

Following the removal of a tooth it is very important to follow all instructions given to you by your dentist. If you are unsure of anything you must ask or call back. At first sign of pain or discomfort call your dentist to be sure it is not something more serious. As always, maintain a regular schedule visiting your dentist, as well as keeping an open communication with your dentist. This will make you feel comfortable asking questions and knowing you are getting the proper information to care for your oral health.