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Dry socket (also called medically as alveolar osteitis) is a very painful dental condition that can sometimes happen following removal of a permanent adult tooth. Dry socket occurs when the blood clot at the area of tooth removal fails to develop, or it dislodges or dissolves before the wound has fully healed. Having a tooth removed by your dentist comes with certain expectations. This includes discomfort following the tooth removal. However, this discomfort should last a day or 2 at the most and be fairly mild. Dry socket pain can become very intense quickly and last for almost a week in some cases. Dry socket is actually the most common complication of a tooth extraction. Even with that fact it still only occurs a little less than 2% of the time (about 200,000 cases in US each year) and most often following removal of wisdom teeth. It is also prevalent in those with poor blood flow, smokers, and diabetics. Dry socket generally occurs 2-3 days following tooth removal procedure.

When a tooth is removed, a blood clot forms to protect the opening in your gums as it heals. If the blood clot does not form properly or becomes dislodged, it can create a dry socket. A dry socket leaves the nerves and underlying bones exposed, so it is important to see your dentist immediately. If left untreated, this can lead to dental infection and other complications. Dry socket most often occurs in those  who smoke, are on oral contraceptives (estrogen can interfere with clotting mechanisms), or do not follow post care instructions properly.  Interesting for women, the oral contraceptives also tend to lower pain tolerance which will lead to increased pain sensation if dry socket occurs.

What Is A Dry Socket? Symptoms

Dry Socket Las Vegas Marielaina Perrone DDSSigns and symptoms of dry socket may include:

-Sharp, aching pain usually starting 2-3 days after removal of a tooth or teeth

-Blood Clot Missing. If you peek into your mouth you would see an opening where tooth was and if there is no blood clot present then you probably have a dry socket. In a normal situation a blood clot forms and covers the exposed opening.

-Visible Bone Present. Bone that can be seen upon visual examination in the socket.

-Radiating Pain. Radiating from the tooth socket to your ear, eye, temple or neck on the same side of your face as the tooth removal.

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

-Swollen Lymph Nodes. If you have swollen lymph nodes around your jaw or neck, this is a sign of dental infection and you need to be seen by your dentist immediately as this can be a serious medical emergency if untreated. Signs of a dental infection can include fever, swelling, redness, and pus discharge from extraction site.

-Over The Counter Pain Medications Do Not Work. Generally, tylenol, aleve and advil will not be strong enough of a pain reliever to be able to control dry socket pain.

How Can A Dry Socket Be Treated?

Your dentist will relieve the area of pain using a local anesthetic. If the infection has spread this may not relieve all pain and discomfort at this time but it will help. Your dentist will need to inspect the tooth removal site and clean it of any debris or food particles. Once the area is cleaned sufficiently, your dentist will probably place a medicated dressing over the area to promote healing and soothe the dry socket symptoms. These medicated dressings usually need to be changed daily until dry socket symptoms subside. Use of a warm cloth on outside of face can also aid in healing by promoting increased blood flow to the area. If there is infection present or your dentist suspects one is forming an antibiotic may be prescribed. You will also be given detailed instructions on at home care. Usually includes rinsing with warm, salt water and just being careful with area while it heals. Healing of a dry socket at this point will take between 1 and 2 weeks.

Possible Home Help Remedies For Dry Socket

Home remedies to help with dry socket pain can include:
-Rinsing with Warm salt water. Rinsing can help eliminate bacteria and reduce or prevent further infection.
-Cold and heat therapy. This can promote blood flow to area of dry socket. For the first 24 hours or so following a tooth extraction, use cold against your face for 15 minutes at a time to reduce swelling. After 1st day you can use heat in the form of warm cloth to help manage pain.
-Clove oil. This contains eugenol (this is traditional dental office smell), which has anesthetic, anti-inflammatory, and antibacterial properties. It can help to soothe pain and help prevent infections. Some people have reactions to clove oil so speak to your dentist before using. You can place clove oil on a sterile gauze and place it over dry socket area for 15 minutes or so to help relieve dry socket symptoms.
-Honey. Honey has anti-inflammatory and analgesic properties. Clinical studies have found that honey when used for dry socket applications resulted in a significant reduction in inflammation, swelling, pain, and discomfort. There was also evidence honey possibly prevents further dental infection. Honey can be applied similar to the clove oil. Place a small amount of honey on a sterile gauze and place over dry socket wound.
-Black tea. Contains tannic acid. Tannic acid can act as a natural antibacterial agent while also having the ability to reduce both swelling and pain.
-Tea tree oil. Also has antiseptic, antibacterial, and analgesic properties.
-Oregano oil.  Has antibacterial benefits and studies have shown it may even be effective against some drug-resistant strains of bacteria.
-Chamomile tea. Chamomile has anti oxidant properties. This can promote wound healing.

What Is A Dry Socket? Conclusion

It is important to follow your dentist’s instructions especially following a tooth removal. Communicate concerns and questions immediately so they can be addressed immediately to avoid unforeseen complications. A dry socket can be quite painful and can have serious consequences if ignored. See your dentist regularly to maintain a healthy smile for a lifetime.



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.