What is a cavity(tooth decay)?

What is a filling?

What is an abscess?

What is cracked tooth syndrome?

What is TMJ/TMD?

What is a cavity(tooth decay)?



This topic provides information on tooth decay and cavities. If you are looking for information on:

  • Gum disease, see the topic Gum Disease.
  • Toothaches, see the topic Toothache and Gum Problems.
  • Dental checkups and how to care for your teeth, see the topic Basic Dental Care.

What is tooth decay?

Tooth decay is the process that results in a cavity (dental caries). It occurs when bacteria in your mouth make acids that eat away at a tooth. If not treated, tooth decay can cause infection and tooth loss.

You can easily prevent tooth decay by brushing and flossing your teeth regularly, seeing your dentist for teeth cleaning and checkups, and avoiding foods that are high in sugar.

What causes tooth decay?

The combination of bacteria and food causes tooth decay. A clear, sticky substance called plaque that contains bacteria is always forming on your teeth and gums. As the bacteria feed on the sugars in the food you eat, they make acids. The acids attack the teeth for 20 minutes or more after eating. Over a period of time, these acids destroy tooth enamel, resulting in tooth decay.

What are the symptoms of tooth decay?

Tooth decay usually does not cause symptoms until you have a cavity or an infected tooth. When this occurs, a toothache is the most common symptom.

How is tooth decay diagnosed?

Your dentist diagnoses tooth decay by:

  • Asking questions about your past dental and medical problems and care.
  • Examining your teeth, using a pointed tool and a small mirror.
  • Taking X-rays of your teeth and mouth.

How is tooth decay treated?

Treatment for tooth decay depends on how bad it is. You may be able to reverse slight tooth decay by using fluoride. To fix cavities caused by mild tooth decay, your dentist will fill the cavities with another substance (fillings). For more severe tooth decay, you may need a crown or root canal. In extreme cases, your dentist may have to remove the tooth. 

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What is a filling?

A filling is a material that your dentist uses to fill a cavity after the tooth decay has been removed.

To fill a tooth, I will:

  • Numb your teeth, gums, tongue, and surrounding skin. I will first put a jelly substance directly on the area to start the numbing process and then inject an anesthetic to complete it. Sometimes we will give you nitrous oxide gas (laughing gas) to reduce your pain and help you relax.
  • Sometimes we use a small sheet of rubber on a metal frame (rubber dam) to target the decayed tooth and to stop liquid and tooth chips from entering your mouth and throat.
  • Drill out all the decay and replace it with a filling.

Fillings can be made from many types of material. Talk to your dentist about which type would be best for you.

  • Amalgam is the easiest material for a dentist to use. It is the fastest and least costly choice. Amalgam is a mixture of mercury, silver, tin, or other metals. I do not use this material anymore due to patient preference and because it is expensive and difficult to expose of.
  • Composite resins are tooth-colored fillings. This process is sometimes referred to as “bonding” if it is on a front tooth. This is standard nowadays for the cosmetic dentist. It is the most esthetic(cosmetic) material and the newer materials have longevity comparable to the amalgam silver fillings. Composite resin is easier than gold for a dentist to work with and generally is less expensive than gold.
  • Ceramics are costly tooth-colored fillings. They require special equipment and may require dental lab support. You may need several appointments.  These are used in much larger fillings where the tooth is in between needing a filling or a crown.

What To Expect After Treatment

After I filled the cavity, your lips and gums may remain numb for a few hours until the numbing medicine wears off. Avoid chewing on your numb lip or cheek to avoid injuring your mouth.

Why It Is Done

You need a filling when tooth decay has caused a hole (cavity) to form on a tooth surface. If you don't get a filling, the cavity will get worse and lead to more severe problems, such as bone loss.

How Well It Works

A filling repairs the tooth and stops tooth decay. Over a long period of time, you may need to replace a worn-out filling.

Your filled tooth may be sensitive to heat and cold for days to weeks after you get the filling. Talk to your dentist about toothpastes that may help you with this discomfort. Tell your dentist if your teeth are too sensitive after you get a filling, because you can usually treat this problem.

Risks

There is almost no risk involved in having a cavity filled.

Some dental work can cause bacteria in the mouth to enter the bloodstream. These bacteria can cause infections in other parts of the body. People who have difficulty fighting infections may need to take antibiotics before and after dental surgery. Such people include those who:

  • Have heart valve problems, such as endocarditis.
  • Were born with heart defects.
  • Have an impaired immune system.
  • Have liver disease (cirrhosis.
  • Have artificial joints, such as a hip that has been replaced.

What To Think About

It is important to start treatment before tooth decay becomes worse. More severe decay may cause pain and tooth loss and may require a costly crown, a root canal, or tooth removal (extraction).

Some dentists now use a laser system to remove tooth decay and prepare the tooth for filling. The laser is quiet, does not vibrate like a drill, and is usually painless, so medicines to deaden pain often are not needed. Laser treatment is a relatively new choice for dental treatment. Two dental laser systems have been cleared by the U.S. Food and Drug Administration (FDA). These systems are under review by the American Dental Association. I do not use this type of system at this time due to it being a relatively new technology but the current research shows much promise in this innovation. Depending on the size, I can use air abrasion, which is a drill-less instrument to remove the cavity before filling. This is preferred as it is less noisy and more comfortable but only used when the filling is relatively small.

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What is an abscess?

When you have tooth decay or gum disease, you can get infection deep within the tooth or gum. This infection is an abscessed toot and can be very painful. If it is not treated, the infection can spread and you can lose your tooth or have other health problems.

What causes an abscessed tooth?

Damage to the tooth, an untreated cavity, or gum disease can cause an abscessed tooth.

If a cavity is not treated, the inside of the tooth (called the pulp) can become infected. Bacteria can spread from the tooth to the tissue around it, creating an abscess.

Gum disease causes the gums to pull away from the teeth, leaving pockets. If food builds up in one of these pockets, bacteria can grow, and an abscess can form. Over time an abscess can cause the bone around the tooth to dissolve.

What are the symptoms?

You may have:

  • Throbbing pain, especially when you chew.
  • Red, swollen gums.
  • A bad, foul smelling taste in your mouth.
  • Swelling in your jaw or face.
  • A fever.
  • A bump (gumboil) that looks like a pimple on the cheek side or tongue side of the gum near the tooth.

Over time as the infection spreads, the bone in your jaw may begin to dissolve. When this happens, you may feel less pain, but the infection will remain. If you lose too much bone, your tooth will become loose and may have to be removed.

If you have a severe toothache or notice drainage of pus, call your dentist right away. You may have an abscessed tooth. If it is not treated, the infection could spread and become dangerous.

How is it treated?

If you have an abscessed tooth, your dentist will give you antibiotics to kill the bacteria causing the infection. Antibiotics may help for a while. But to get rid of the abscess, your dentist will need to get rid off the source of infection. This is done by making hole in the tooth or gum to drain the infection. Usually this will relieve your pain.

If the inside of your tooth is infected, you will need a root canal or to have the tooth removed. A root canal tries to save your tooth by taking out the infected pulp. If you don't want a root canal or if you have one and it doesn't work, the dentist may have to remove your tooth. You and your doctor can decide the best step to take.

You may be able to reduce pain and swelling from an abscessed tooth by putting an ice pack wrapped in a towel against your cheek. You can also try over-the-counter pain medicine, including aspirin, acetaminophen (such as Tylenol) or ibuprofen (such as Advil or Motrin). But you still need to see your dentist for treatment.

How can you prevent an abscessed tooth?

You can prevent an abscessed tooth by preventing bacterial infections in your mouth. The best way to do that is to take good care of your teeth and gums:

  • Brush your teeth 2 times a day, in the morning and at night, with fluoride toothpaste approved by the American Dental Association.
  • Use dental floss to clean between your teeth every day.
  • See your dentist for regular dental cleanings and checkups.
  • Eat a healthy diet, and limit between-meal snacks.

Some people have a very dry mouth. This can cause deep dental cavities to form quickly, which can infect the pulp of a tooth and lead to an abscess. You may be able to prevent these problems by taking frequent sips of water, chewing gum, or sucking on sugarless candy. If you have severe dry mouth symptoms, you may need to take medicine to treat the problem.

Many medicines can cause a dry mouth, including some medicines used to treat depression and high blood pressure.

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What is a cracked tooth?

With more sophisticated procedures, dentists are helping people keep their teeth longer. Because people are living longer and more stressful lives, they are exposing their teeth to many more years of crack-inducing habits, such as clenching, grinding, and chewing on hard objects. These habits make our teeth more susceptible to cracks.

How do I know if my tooth is cracked?

Cracked teeth show a variety of symptoms, including erratic pain when chewing, possibly with release of biting pressure, or pain when your tooth is exposed to temperature extremes. In many cases, the pain may come and go, and your dentist may have difficulty locating which tooth is causing the discomfort.

Why does a cracked tooth hurt?

To understand why a cracked tooth hurts, it helps to know something about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is the inner soft tissue called the pulp. The loose pulp is a connective tissue that contains cells, blood vessels and nerves. When the outer hard tissues of the tooth are cracked, chewing can cause movement of the pieces, and the pulp can become irritated. When biting pressure is released, the crack can close quickly, resulting in a momentary, sharp pain. Irritation of the dental pulp can be repeated many times by chewing. Eventually, the pulp will become damaged to the point that it can no longer heal itself. The tooth will not only hurt when chewing but may also become sensitive to temperature extremes. In time, a cracked tooth may begin to hurt all by itself. Extensive cracks can lead to infection of the pulp tissue, which can spread to the bone and gum tissue surrounding the tooth.

How will my cracked tooth be treated?

There are many different types of cracked teeth. The treatment and outcome for your tooth depends on the type, location, and extent of the crack.

Craze Lines

Craze lines are tiny cracks that affect only the outer enamel. These cracks are extremely common in adult teeth. Craze lines are very shallow, cause no pain, and are of no concern beyond appearances.

Fractured Cusp



When a cusp (the pointed part of the chewing surface) becomes weakened, a fracture sometimes results. The weakened cusp may break off by itself or may have to be removed by the dentist. When this happens, the pain will usually be relieved. A fractured cusp rarely damages the pulp, so root canal treatment is seldom needed. Your tooth will usually be restored with a full crown by your dentist.

Cracked Tooth



This crack extends from the chewing surface of the tooth vertically towards the root. A cracked tooth is not completely separated into two distinct segments. Because of the position of the crack, damage to the pulp is common. Root canal treatment is frequently needed to treat the injured pulp. Your dentist will then restore your tooth with a crown to hold the pieces together and protect the cracked tooth. At times, the crack may extend below the gingival tissue line, requiring extraction. Even with high magnification and special lighting, it is sometimes difficult to determine the extent of a crack. A cracked tooth that is not treated will progressively worsen, eventually resulting in the loss of the tooth. Early diagnosis and treatment are essential in saving these teeth.

Split Tooth
 
Vertical Root Fracture
 

A split tooth is often the result of the long term progression of a cracked tooth. The split tooth is identified by a crack with distinct segments that can be separated. A split tooth cannot be saved intact. The position and extent of the crack, however, will determine whether any portion of the tooth can be saved. In rare instances, endodontic treatment and a crown or other restoration by your dentist may be used to save a portion of the tooth. Vertical root fractures are cracks that begin in the root of the tooth and extend toward the chewing surface. They often show minimal signs and symptoms and may therefore go unnoticed for some time. Vertical root fractures are often discovered when the surrounding bone and gum become infected. Treatment may involve extraction of the tooth. However, endodontic surgery is sometimes appropriate if a portion of the tooth can be saved by removal of the fractured root.

After treatment for a cracked tooth, will my tooth completely heal?

Unlike a broken bone, the fracture in a cracked tooth will not heal. In spite of treatment, some cracks may continue to progress and separate, resulting in loss of the tooth. Placement of a crown on a cracked tooth provides maximum protection but does not guarantee success in all cases. The treatment you receive for your cracked tooth is important because it will relieve pain and reduce the likelihood that the crack will worsen. Once treated, most cracked teeth continue to function and provide years of comfortable chewing. Talk to your Dr. Crumpton about your particular diagnosis and treatment recommendations. He will advise you on how to keep your natural teeth and achieve optimum dental health.

 

What can I do to prevent my teeth from cracking?

While cracked teeth are not completely preventable, you can take some steps to make your teeth less susceptible to cracks.

  • Don't chew on hard objects such as ice, unpopped popcorn kernels or pens.
  • Don't clench or grind your teeth.
  • If you clench or grind your teeth while you sleep, talk to your dentist about getting a retainer or other mouthguard to protect your teeth.
  • Wear a mouthguard or protective mask when playing contact sports.

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What is TMJ/TMD?

 

According to the American Dental Association, more than fifteen percent of American adults suffer from chronic facial pain. Some common symptoms include pain in or around the ear, tenderness of the jaw, clicking or popping noises when opening the mouth, or even headaches and neck aches.

Two joints and several jaw muscles make it possible to open and close the mouth. They work together when you chew, speak, and swallow. These structures include muscles and ligaments, as well as the jaw bone, the mandible (lower jaw) with two joints, the TMJ's.

 

Diagnosis And Treatment

A dentist can help identify the source of the pain with a thorough exam and appropriate X-rays. Often, it's a sinus, toothache or an early stage of periodontal disease. But for some pain, the cause is not so easily diagnosed. The pain could be related to the facial muscles, the jaw ortemporomandibular joint, located in the front of the ear. Treatments for this pain may include stress reducing exercises, muscle relaxants, or wearing a mouth protector to prevent teeth grinding. They've been successful for many and your dentist can recommend which is best for you.

 

The most common treatment prescribed is a nightguard which is an appliance that is placed over the teeth to keep the teeth physically separated during grinding and clenching events. Depending on the level of grinding, severity of symptoms, and whether or not the presence of headaches will determine what type of nightguard is right for you. There are soft nightguards, hard nightguards and others such as an "NTi" appliance which has just been approved for treatment of migraine headaches.

 

Request an appointment or call our office to schedule a personal consultation during your next visit.

 

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