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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.

Porcelain crowns have been a staple in cosmetic dentistry for years. It gives the dentist and patient a much more aesthetic appearance as a final product. In the past crowns and bridges were traditionally made of porcelain fused to metal (PFM). With the development of modern porcelain, which are incredibly strong and reflect light similar to natural teeth, full porcelain crowns can be used in most areas in which porcelain fused to metal crowns were used. This is especially true in a cosmetic area of the mouth.

Porcelain crowns are very versatile and used in many ways. The cosmetic enhancement use of porcelain crowns include, changing color of teeth, closing gaps between teeth, fixing teeth that are crooked or crowded, changing shape or size of teeth. Porcelain crowns are also used to cover and protect damaged teeth, (tooth that has a root canal, broken, cracked, large fillings), and to act as a new tooth in the case of dental implants. Their versatility gives the dentist 89014 a greater flexibility in using them to fix potential issues for the patient.

cosmetic dentist emax crown

Emax Porcelain Crowns

The first step often times includes impressions for study models and photos. The patient and dentist can then discuss and plan what the end result should be. The treatment includes preparation of the tooth surface for the porcelain crowns. The outer enamel and sometimes a bit of  the dentin are removed. This allows room for the porcelain crowns to fit over the teeth and be in perfect cosmetic alignment with the others. Impressions are taken of the newly reshaped teeth and temporary crowns are made.  The porcelain crowns are custom made in the dental laboratory. The porcelain crowns are then cemented or bonded onto the teeth using an adhesive bonding material. The placement of the porcelain crown will normally take about 30 minutes (depends on amount of porcelain crowns being placed). Once completed,  the patient can eat normally and enjoy the benefits of a beautiful new porcelain crown that matches and blends perfectly with the patients existing teeth. Only you and the dentist should know anything was done.

Advantages of All Porcelain Crowns

-No PFM gray or black lines at the Gum Line of Teeth. You may have noticed a person with a dark line in the gum area along a PFM crown edge. With PFM crowns, the soft tissue around the tooth can recede over time. This allows a reveal of the metal framework underneath. This cannot happen with an all porcelain crowns because they are metal free.

-Perfect Fit. Porcelain crowns are created in state of the art facilities. Porcelain crowns will fit so well you will even forget they are present.

-Cosmetically Perfect Match. All porcelain crowns have the ability with modern porcelains to match your existing shade of tooth color as well as mimic the light reflecting properties of your natural teeth. Porcelain crowns will be undetectable to anyone but you and your dentist. Dental porcelain can be shaped custom colored and sculpted to closely copy the look of your own natural tooth enamel. All the while providing the desired strength and resilience.

Some disadvantages of an all porcelain crowns:

-Higher cost over traditional PFM crowns.

-Durability. While porcelain crowns are very durable, they do not have the flexibility of natural teeth, they can fracture. Avoiding certain foods may be necessary. For example, Biting into sandwich with a hard bread. Patients who grind and clench their teeth will need to be fitted with a mouth guard to protect the porcelain crown from unnecessary and excessive pressures.

-Porcelain crowns may need a bit more reduction of tooth structure than traditional PFM crowns.

-Sensitivity may happen for a short time, (hot, cold sensitivity), especially with bonded porcelain crowns.

Follow-up Maintenance of All Porcelain Crowns

The maintenance of porcelain crowns is actually very easy.  They require routine brushing with nonabrasive fluoride toothpaste and regular flossing as well as regular visits to the dentist. A follow-up appointment will be scheduled to evaluate the porcelain crowns about 2-4 weeks after they are placed in the mouth This allows the dentist to review the work with tissues all healed and see how your oral tissues are reacting to the crowns. Even if you think the crowns are successful, this appointment is an important part of your future oral health.
There are several types of all porcelain crowns generally used in dental offices today. They have all proven to give the best cosmetic dental results.
Zirconia Crowns or Lava Crowns (made by 3M Espe). This type of all porcelain crowns are made out of a zirconium core with porcelain pressed or layered over the crown to follow the natural contours of teeth. These crowns offer good strength and durability. Due to great strength, the material can be used to make a bridge.
Procera Crowns (made by Nobel Biocare). These are made of an Alumina core with porcelain pressed or layered over the crown to follow the natural contours of the teeth. These crowns offer great strength and durability and are esthetically quite beautiful. Often used in the back of the mouth, (premolars, molars), these are cemented in with traditional cement and have less post-placement sensitivity.
Empress II Crowns (made by Ivoclar Vivadent).These highly cosmetic porcelain crowns are used in the front of the mouth. They are used mostly for cosmetics, are very beautiful, but can fracture.
eMAX Crowns or IPS e.MAX Crowns (made by Ivoclar Vivadent). These porcelain crowns are entirely made out of porcelain without a underlying framework. The absence of this framework offers a great advantage over Zirconia crowns, Lava crowns and Procera crowns in that e.MAX crowns allow for more light transmission through the crown translating to a more superior cosmetic dental result. The strength of these porcelain crowns is such that they can be used in any area of the mouth, can be made thinner than most porcelains, and can be used for an implant without much worry of fracture.
Cosmetic Dentistry is the art and science of creating a beautiful smile. The all porcelain crowns are just one more tool that the dentist can use to give you that smile you’ve always dreamed of.
Procera Porcelain CrownsLava Crowns Ivoclar VivadentPorcelain Crowns 3M Espe



White fillings are a dental restorative material used to restore function, integrity and morphology of missing tooth structure. The missing tooth structure can occur from cavities, external trauma, and also lost intentionally via preparation of the tooth by the dentist for the dental filling. The development of tooth colored or white fillings has provided the cosmetic dentist and patients with a far more cosmetic alternative to traditional metal fillings.

Because the white fillings can be blended and mixed, a skilled cosmetic dentist is able to precisely match the tooth color of the fillings with the natural color of your teeth. Thus, they are able to place fillings that are virtually undetectable. This means only you and your dentist will know you have these fillings. These fillings are commonly called composite resins after their ingredients. These resins are metal free and are composed of a variety of materials. The most popular ingredients include acrylic resin and powdered particles similar to glass.

Tooth colored white fillings are done in one visit, in a procedure much like that for metal amalgam fillings, except that a high intensity curing light is used to bond the composite material to the tooth. Most patients will select tooth-colored composite fillings when they have a new cavity. As the availability of white fillings has increased more and more patients are having their cavities filled with cosmetic tooth colored fillings.

Metal fillings do not bond with the tooth structure. They merely rested on it and provided a degree of protection but over time the margins will open causing bacteria to leak inside. This causes a new cavity to form. Decades of research has led us to know so much more about the interface Tooth Colored Fillingsbetween dentin and enamel. This has led scientists to discover new ways of bonding fillings to teeth to create a stronger, more sealed connection between filling and tooth and also to be more aesthetic.

Composite resins allow us to keep more of your natural tooth structure intact than amalgams. Most dentists believe in being as conservative as possible. The more natural tooth structure we maintain, the better teeth you will likely have in the future.

Mild sensitivity is felt by some patients following the placement of composite resin fillings. This is usually temporary in nature and resolves on its own, usually in a few days. The only caution that is usually mentioned is that coffee, tea, and other staining foods and beverages may discolor your white fillings over time. These restorations have been shown to last an average of 7-10 years. It is vital to see your dentist regularly so they can be evaluated at every visit for possible breakdown of the material or further cavity formation.

Dental bonding can provide dramatic, aesthetic results in a very short period of time, usually in one appointment. With dental bonding, we can:

-Close gaps or spaces between teeth.

-Restore decayed teeth.

-Change the contours of small, misshapen teeth.

-Repair chipped or cracked teeth.

-Cosmetic tooth color fillings.

-Replace old metal amalgam fillings with a cosmetic alternative.

-To protect an exposed root surface following recession of gums.dental bonding

Cosmetic dentists can shape and color a single tooth, or they can change your entire smile.

 

 



Is the sipping of hot coffee or the eating of cold ice cream sometimes a painful experience for you? If your answer is YES, you may have a common problem called sensitive teeth.

Tooth sensitivity is tooth or teeth discomfort that is provoked by hot, cold, sweet, or acidic foods and drinks, or breathing in cold air. The pain can be sudden, sharp, and shoot deep into the nerve endings of your teeth.

There are two very different types of sensitivity:

Dentinal Sensitivity. This occurs when the middle layer (dentin) of a tooth is exposed to the outside. Dentin is usually covered by enamel above the gum line and by cementum (bone like connective tissue covering the root of a tooth) below the gum line. There are tiny openings called tubules in the dentin. Inside each tubule there is a nerve branch that comes from the tooth’s pulp (the nerve center of the tooth). When the dentin is exposed, these nerve branches can be affected by hot, cold, or certain foods. This causes tooth sensitivity.

When the outer protective layers of enamel or cementum wear away the dentin becomes exposed to the outside. This can affect one tooth or multiple teeth. Dentin exposure can be be caused in a variety of ways. These can include:

1. Aggressive brushing. The enamel layer can be worn away from brushing too hard.

2. Plaque build up. The presence of plaque on the root surfaces can cause sensitivity.

3. Tooth wear that occurs over time from chewing and brushing.

4. Untreated dental cavities.

5. Gingival recession. When the gums recede they expose the tooth’s roots. Receding gums often are caused by periodontal diseases or by aggressive brushing. Receded gums are very common and up to four fifths of people have gum recession by the time they are 65.

6. Periodontal surgery (gum surgery) that exposes the tooth’s roots.

7.  Tooth whitening.

8. Frequently eating acidic foods or liquids.

Pulpal sensitivity. This is a reaction of the tooth’s pulp. The pulp consists of a mass of blood vessels and nerves in the center of each tooth. Sensitivity of the pulpal tissue tends to affect only one tooth. Causes of this type of sensitivity can include:

1. Dental cavities or infection.

2. Placement of a recent filling.

3. Excessive pressure from grinding or clenching your teeth.

4. A cracked or broken tooth.

If you feel a sharp pain upon biting, you may have a broken or cracked filling. Pain when you release your bite is a sign of a cracked tooth.

sensitive teeth

toothpaste for sensitive teeth

You dentist will be able to diagnose the type of sensitivity you have. You want to rule out pulpal sensitivity as that requires more extensive treatment. If it is decided you have dentinal sensitivity then we will suggest a few options for you. The most conservative way is by use of a sensitivity toothpaste. I recommend Colgate Sensitive Pro-Relief which I believe to be the best on the market today. I have found it to be the most effective in eliminating or limiting the symptoms of tooth sensitivity. Other options include use of a fluoride varnish or a bonded desensitizing agent that we would apply in office. As well as use of an at home fluoride rinse.

In severe cases of hypersensitivity that is persistent and cannot be treated by other ways, your dentist may recommend endodontic (root canal therapy) treatment to eliminate the sensitive teeth issue.

If you or a loved one is experiencing either type of sensitivity, the best approach would be to schedule a dental appointment for further evaluation.