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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.



dental care multiple sclerosis

How Multiple Sclerosis Works

Multiple Sclerosis (also just simply referred to as MS)  is an autoimmune disease in which the body attacks the nerve fibers of the  brain and spinal cord. Multiple Sclerosis is a progressive disease. This later results in demyelination of the nerve fibers and  paralysis. Demyelination is the general term for diseases of the nervous system.  Demyelination occurs when the myelin sheath (covering of nerve fibers) gets damaged. This in turn results in disorders or impairments in muscle functions, cognition and sensation. For reasons unknown, it mostly affects adults living in the northern hemisphere. Canada has one of the highest rates of Multiple sclerosis in the world.

Multiple sclerosis is just one form of demyelination and also the most common  type. Other diseases include Acute Disseminated Encephalomyelitis and Transverse Myelitis. The disorder was first described by Jean-Martin Charcot in 1868.

Specific symptoms of multiple sclerosis can include:

-Muscle spasms

-Trouble maintaining a good balancing

-Easily fatigued

-Difficulty walking

-Difficulty moving the arms or legs and tremors in the arms or legs.

Additional symptoms include constipation, the need for frequent urination, loss of bladder control, double vision, vision loss, facial pain, depression and hearing loss. These symptoms can occur intermittently and can intensify during times of stress, sun exposure, fever or when taking a hot bath.

Multiple Sclerosis Risk factors

These factors can increase your chances of developing multiple sclerosis:

-Age. multiple sclerosis can develop at any age, but generally affects people between the ages 16-55.

-Sex. Women are more than 2-3X as likely as men are to have multiple sclerosis.

-Familial history. If a parent or sibling has had multiple sclerosis, you are at an increased risk of developing the disease.

-Infections. A variety of viruses have been linked to multiple sclerosis, including Epstein-Barr (infectious mononucleosis).

-Ethnicity. White people, particularly those of Northern European descent, are at highest risk of developing multiple sclerosis. People with ethnic backgrounds of Asian, African or Native American descent have the lowest risk.

-Climate Factors. Multiple sclerosis is much more prevalent in locations with temperate climates. This includes Canada, the northern United States, New Zealand, southeastern Australia and Europe.

Vitamin D. Having low levels of vitamin D and low exposure to sunlight is associated with a greater risk of multiple sclerosis.

-Autoimmune Disease Link. A slightly higher risk of developing multiple sclerosis is possible if you have thyroid disease, type 1 diabetes or inflammatory bowel disease.

-Smoking. Smokers who experience an initial event of symptoms that may signal multiple sclerosis are more likely than nonsmokers to develop a second event that confirms multiple sclerosis.

Treatment for multiple sclerosis includes taking medications to slow the progression of the disease. These include interferon, natazalizumab, methotrexate, azathioprine, cyclophosphamide or steroids. Amantadine may be taken for fatigue, antidepressants may be taken to control mood and behavior, and cholinergic medications can soothe urinary problems. Physical therapy, relaxation and exercise may also be used to manage multiple sclerosis.

One of the parallel connections between multiple sclerosis and the patient’s oral health is loss of muscle control. A patient with MS experiences a harder time brushing their teeth depending on the muscles involved in the patients MS. Due to poor muscle control sometimes MS patients can only achieve what is considered poor brushing. Those suffering from severe multiple sclerosis symptoms will need help from family and loved ones to simply clean their teeth.

dental care in multiple sclerosisMultiple sclerosis patients may also have a difficult time simply relaxing in the dentist’s chair. This makes it very difficult for the dentist to do a thorough dental examination as well as to conduct any needed dental procedures. For this reason, it is imperative to keep Multiple Sclerosis patients in the chair for as little time as possible. Appointments should be as short as possible. Multiple breaks of 5-10 minutes per half hour of treatment should be given. It is also recommended to schedule early morning appointments as this is usually the least stressful part of the day. This is all to lessen the discomfort on the patient. Stress, fatigue, and muscle spasms may also play an important factor in chair time.

Patients suffering from multiple sclerosis are not advised to wear dentures. Muscle spasticity makes it difficult to wear dentures comfortably. The reason is due to the patients uncontrollable muscle spasms. Experiencing uncontrollable spasms could potentially result in dislodgement of the dentures or even swallowing of the denture.

Multiple sclerosis patients need regular dental care not only for reasons mentioned above but there are other factors. Tooth decay, halitosis, or periodontal disease can also occur at higher rates in these patients. All of these can easily be avoided with proper hygiene.

Multiple sclerosis may also cause pain in a specific tooth. This causes the patient to seek care on what is essentially a healthy tooth. This is caused by Trigeminal Neuralgia and is probably the most intensely painful multiple sclerosis related symptom. This can occur in the lower part of the face and is usually an intense, sharp pain. Luckily, this is rare with only about 4% of Multiple Sclerosis patients experiencing this type of pain.

There is no cure for Multiple Sclerosis. Dentists have a few set rules for management of patients with MS:

1. Maintain oral function. Allow patient to be as self sufficient as they can for as long as possible.

2. Keep patient healthy so they do not develop other disorders or diseases that could complicate their MS.

3. Maintain a person’s cosmetic appearance so they do not develop self esteem issues which will further accelerate their decline via depression.

If you have noticed, one of the primary concerns of dentists is for the patient to be able to maintain their own oral hygiene. This is achievable especially with patients whose condition has not yet reached its worst. In cases where this is not possible, family members or care givers are trained to assist the patient.

Lastly, maintaining positive attitude towards life is very important. There are a lot of people suffering from diseases and ailments worse than multiple sclerosis. If the dentist, patient, and family work together a Multiple Sclerosis patient can live free of dental worries their entire lives.