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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.

A dental abscess is an infection of the mouth, face, throat, or jaw that begins as a tooth infection or cavity. Generally these infections are caused by poor dental health and can be the result of lack of proper and timely dental care. A Dental abscess may also occur in people with medical conditions such as autoimmune disorders (Sjögren’s syndrome and similar conditions)  or conditions that weaken the immune system (diabetes, following radiation or chemo from cancer). A dental abscess can also be triggered by minor trauma in the oral cavity…such as a fractured tooth. Openings in the tooth enamel allow bacteria to infect the nerve tissue (the pulp) in the center of the tooth. Infection may spread out from the root of the tooth and out to the surrounding bones supporting the tooth.

A dental abscess occurs when there is an infection to a small area of tissue and the body is able to seal off the infection and keep it from spreading further. White blood cells (the body’s defense mechanism against certain infections) travel through the walls of the blood vessels in the area of the infection and collect within the damaged tissue. When this happens pus forms (A generally viscous, yellowish-white fluid  formed in infected tissue, consisting of white blood cells, cellular debris, and necrotic tissue). This pus pocket is the dental abscess, which is represented by inflammation, redness, and pain.

Dental Abscess

X-ray showing Dental Abscess

The inflamed area can burst, allowing the pus to drain out, but it will come back if the cause of infection is not removed. The bacteria and host cells cause quick destruction of connective tissues around the tooth and into the jawbones as the dental abscess develops. The pain is constant and may be described as gnawing, sharp, shooting, or throbbing. Putting pressure or something warm on the tooth may induce extreme pain. There may be a swelling present at either the base of the tooth, the gum, and/or the cheek, which can be alleviated by applying an ice pack. A Dental abscess can be acute or chronic. Acute abscess are the most painful. A chronic dental abscess may produce a dull pain with intermittent swelling, but can develop into an acute abscess at any point. Sometimes the infection can progress to the point where swelling threatens to block the airway, causing difficulty breathing. A dental abscess can also make you feel ill, with nausea, vomiting, fevers, chills, and sweats.

In some patients, a dental abscess may penetrate the bone and start draining into the surrounding tissues creating a localized facial swelling. it is also possible for the lymph glands in the neck will become swollen and tender in response to the infection. It may even feel like a headache as the pain can shift from the infected location. Generally, the pain does not travel across the face, only up or down as the nerves that serve each side of the face are separate.

A dentist can determine by a thorough examination, if you have a drainable dental abscess. X-rays of the teeth are usually necessary to show smaller abscesses that may be at the deepest part of the tooth. The objective of any treatment is to remove the infection, save the tooth (if possible), and prevent further complications.

The most frequently seen types of a dental abscess are:

1) Periapical abscess. These are located at the apex of an infected tooth surrounding the roots. This type of dental abscess can occur on any tooth that has severe decay or is broken or chipped.

Dental Abscess

Dental Abscess

2) Periodontal abscess. These are located in the periodontal ligament (PDL) surrounding the tooth. This type of dentalabscess will commonly involve the mandibular and maxillary first molars, maxillary incisors, and cuspids, followed by maxillary second molars.

Treatment of a dental abscess can include:

-A Regimen of antibiotics may be given to fight the infection. Along with drainage of the infected area (if it has not already begun to drain).

-Endodontic or Root Canal Therapy (RCT) can be performed if the dentist feels the tooth can be saved. Even after the root canal therapy is completed, the dentist may want to see the patient periodically to ensure the area is healing properly.

-Teeth that cannot be restored must be extracted, followed by curettage of all apical soft tissue to remove necrotic infected tissue..

An untreated dental abscess can be life threatening and should not be taken lightly. Timely treatment usually allows the dentist to be able to cure the infection. The tooth can usually be saved in many cases but not all. Prompt treatment of dental cavities reduces the risk of a dental abscess. Teeth that have been subject to trauma should be examined immediately by the dentist.

 

Diabetes affects almost 26 million people in the United States and is a growing problem due to the obesity epidemic.  The relationship between a person’s oral health and his/her diabetes is of utmost concern to health care professionals but especially dentists.

Patients with Diabetes have an increased risk of oral health issues due to poorly controlled blood sugars. Diabetes impairs white blood cells, which are the body’s main defense against bacterial infections.  These bacterial infections can affect everything in the mouth as well as the rest of the body.

A number of oral disorders are associated with Diabetes. The association between periodontal disease and diabetes has been studied at length with a definite correlation between the two.

The common oral health issues facing Diabetic patients include:

*Increased Dental Caries. There has been no study to effectively correlate this relationship. But anecdotal evidence leads me to believe this is a real problem for Diabetic patients withBioteneout good control over their blood glucose levels. Patients who are type 2 diabetics(meaning that it is not genetically caused but caused by diet) tend to eat more carbohydrates and sugary foods enhancing the possibility of increased caries rate. Also some patients experience xerostomia, which is more commonly referred to as “dry” mouth. I usually recommend Biotene for patients.Biotene  has the added benefit of containing a bio-active salivary enzyme protein system that actively combats bacteria, reducing bad breath, improving oral hygiene and relieving oral dryness.Some of the salivary dysfunction is caused by medications and age as well.

*Oral Mucosal Disease and other infections. Different types of oral disease are found, including lichen planus and recurrent aphthous stomatitis. People with diabetes that are often taking antibiotics to fight off infections are prone to developing Oral candidiasis(a fungal infection of the mouth and tongue). Oral candidiasis is found more frequently in patients with diabetes. Candidiasis occurs due to a patient being in a weakened immune state as well as a secondary response to the “dry” mouth mentioned above. This particular fungus thrives on the high levels of sugar in the saliva of people with uncontrolled diabetes.  This fungus results in a burning sensation in areas of the mouth and sometimes a loss or change in taste.

*Periodontal Disease (gingivitis and periodontitis) have been shown to have a direct link to Diabetes. It has been noted that elevated levels of Periodontal disease also lead to complications in management of blood glucose levels. This disease tends to be more prevalent and more severe in diabetic patients than in the general population. This is mainly due to the fact that diabetics have decreased wound healing and infection fighting ability.

Diabetics who smoke are at a much higher risk of disease.  Their risk factor can be as much as 20x more likely than non-smokers to develop thrush and periodontal disease. Smoking does seem to reduce blood flow to the gums and this can also affect healing in the tissue area.

Because people who suffer from diabetes can be more prone to symptoms that may harm their oral health, it’s very important to follow dental home care instructions and to note any changes in your oral health. Promptly schedule a dental consultation if you notice any changes.

Dental Hygiene for Diabetics

We always recommend visiting the dentist and hygienist at least twice a year but it is doubly important in patients with diabetes. They need to strive to keep their mouths as bacteria free as they can. In conjunction with proper brushing we also recommend that patients floss after every meal if possible. A daily mouthwash can be beneficial as well.