Dental Questions: Does every tooth extraction require stitches?

Wether you've had a tooth extracted before or not, chances are that you have some idea of what is involved in this procedure. You would probably expect that every patient gets stitches (professionally called sutures) before they are allowed to leave. A dentist wouldn't let you go with a giant hole in your jaw, right? On the contrary, there are many times that sutures aren't a necessary step after extracting a tooth and do not improve the healing process. Take a look!

In the mouth, sutures can assist in the healing of gums and other soft tissues by holding them in a desired place. In complex dental extractions, such as removing wisdom teeth or impacted teeth, the bone and gums around the tooth may need to be moved or partially removed. To ensure that the gums heal cleanly around the jaws and do not create a food trap, sutures are used to approximate natural soft tissue contours. Additionally, stitches are used to help in the formation of healthy blood clots and to help keep grafts and membranes in place during critical healing periods. 

For "simple" dental extractions, sutures are not always required. When there is minimal manipulation of the gums and bones AND the patient has a healthy immune system, it is reasonable to expect that the tooth site will heal with no sutures. For most patients, a "scab" will begin to form in the mouth before they leave the dental office, and nearly all bleeding will cease within 2 hours. Research shows that sutures will not help the gums or bones heal faster or assist in preventing post extraction infection. On the contrary, the most important determining factor in extraction outcomes is following the post operative instructions given to you by your dentist!

It is often hard to tell if a patient will need sutures until after the extraction procedure is finished. Sometimes, even the most simple-seeming teeth require more manipulation and work than they initially let on. As with every procedure, we do our best to inform you of changes to your treatment plan as they arise. If you would like to know more about tooth extractions, oral surgery or other dental procedures, please give our office a call!

Dental Questions: What can I do if I have a cracked tooth?

Cracked teeth are notoriously painful and difficult to diagnose. They typically present as an ache when releasing your jaw from biting on something hard. The pressure of opening and closing the crack puts stress on the cells deep within the teeth and creates this painful sensation. You may also experience increased sensitivity to cold or a strange pushing or pinching sensation in your gums. 

If you think you have a cracked tooth, your first step is to schedule an emergency dental appointment. Here, X-rays, special lights and probes are used to identify the fracture and determine where it goes. Most often it is impossible to see the actual depth of the crack and the teeth must be treated based on their symptoms. Lowering the height of the tooth (so that the opposing tooth no longer puts pressure on it) is a typical first step. From there, a dentist may use a crown to provide extra coverage to the tooth or refer to an endodontist to take a CT scan or perform a root canal. 

If the crack goes down the length of the root and extends to one of the canals, the tooth is likely not savable. In these instances, we usually suggest an extraction to relieve pain and to prepare for an implant in the near future. For more information on emergency appointments, cracked teeth and dental pain, please give our office a call!

How Can I Soothe a Toothache?

Note: Never start taking any medication for the first time (even OTC products) without consulting a medical or dental professional first. Never exceed the prescribed dosing for a medication or use it in a method for which it was not designed. 

Toothaches always seem to spring up at the least convenient times. Often enough, they show up 6pm on a Friday before a long weekend. When you can't get to a dentist right away, what should you do about your pain? In this article, we hope to give you some direction (and comfort) in helping your dental woes.

The first thing to do with any type of dental pain is give your general dentist a call. Even after hours, every office should have a means of getting into contact with either your own dentist or one of their associates. An exception to this would be excruciating pain, possibly combined with swelling, fever and warmth around a tooth. In these instances, your first choice should be to head to an emergency room, as this can be the sign of a serious infection. 

Beyond getting into contact with a dental professional, there are a few steps you can take to reduce your symptoms. If the pain feels like it is coming from a tooth directly, we suggest taking an NSAID medication like ibuprofen (Advil). Most dental pain comes from pressure inside the tooth or bones, and is best treated by drugs (such as ibuprofen) with anti-inflammatory properties. We do not suggest taking any left over narcotics you may have on hand, as they are potentially harmful and will not stop the pain as effectively as an NSAID. 

If your pain feels like it is coming from your gums, try flossing gently to see if you can dislodge any stuck food (popcorn kernels are the worst offenders). Beyond this, we recommend rinsing with warm salt water to soothe inflamed tissue. Never try to apply Asprin, Advil or other medications directly to the gums. This will only irritate the tissue and create more pain. We also suggest staying away from topical toothache creams/gels, due to their lack of effectiveness and potentially dangerous side effects.

If your pain has a specific trigger, make note of it and try to avoid using your teeth in that manner. Knowing what causes the tooth to flare up can be an important factor in diagnosing the exact problem. If you would like to know more about toothaches, dental pain or gum pain, please give our office a call! 

Dental Questions: Why does my tooth hurt after a filling/crown?

If you've ever had dental pain after a filling or crown, you know how frustrating this situation can be. Did something go wrong? Is it normal? Rest assured, "post operative sensitivity" is one of the most common complaints after dental work. Depending on the type, timing and severity of pain, it can indicate a few potential problems. Read on to catch a glimpse into how we interpret and treat patients with after-treatment pain!

Any time a dentist uses an instrument to modify the structure of a tooth, there is a chance that this procedure will irritate the dental nerve. Typically, this pain is reversible and is a response of the tooth cells being transiently injured during treatment. It is usually described as weak or dull and resolves on it's own in about two weeks. If we are working near the pulp of the tooth (such as with deep cavities and certain fractures) there is a higher likelihood of causing irreversible irritation of the dental nerve. In this scenario, the tooth becomes hyper-sensitive as the inner tissue becomes necrotic. Patients usually describe this pain as a sharp, prolonged sensitivity to hot/cold foods. Over time, it transitions to a spontaneous pain and sensitivity to taping and chewing. In these instances, the best solution is to perform a root canal to clean out the dead tissue and relieve any infection that may be present. 

Beyond these types of nerve irritation, some fillings become sensitive due to the nature of the materials we use in dentistry. Many types of fillings and crown cements are physically bonded to the tooth. This process involves painting on a resin "glue" and using a light to cure it to the tooth. The chemical change causes a small amount of shrinkage that can put pressure on the microscopic tubes in the tooth's dentin layer. Patients usually feel this pain as sharp and sensitive to biting and chewing. To solve this, we may change the material used to fill your tooth or remove the old filling and place a temporary "sedative" filling and see if the nerve calms down. Interestingly, we usually see this type of pain on smaller fillings, as they tend to have more walls made of natural teeth, and thus more surface area to place tension on. 

A final (and probably most common) source of post-operative pain is the filling/crown simply being too high. We check every single restoration we place with marking paper to make sure it doesn't change the way your teeth together. However, the ligaments in your teeth can feel changes on a microscopic level and can be difficult to account for. This problem is easily detected and fixed- we simply need to remove the area of the filling/crown that is interfering with your opposing teeth. 

Any patient complaint of pain after a procedure is taken very seriously and typically handled the same way. We will have you come in for an emergency appointment where we will take an X-ray (to see where the nerve is) and check the bite (to rule out a "high" restoration). We use this information to perform other tests to narrow down the possibilities to a correct diagnosis. Our ultimate goal at this visit is to get you out of pain and make a plan to protect the tooth long-term. If you would like to know more about the fillings we place and the risks/benefits of these procedures, please give our office a call. 

Replacing A Lost Crown

Imagine you are enjoying a nice meal when you suddenly notice a strange space open up in the front of your mouth. To your horror, a crown on one of your front teeth has fallen off! Every dental office sees two to three cases like this yearly- as with this patient today. Fortunately, we were able to replace the missing space with a cosmetic Emax lithium disilicate crown. The end result was fabulous- we saved the tooth and improved on the esthetics of the previous crown!

Dental crowns can come loose for a number of reasons. Most commonly, cavities start at the margin between the tooth and the crown and undermine the seal. Once this seal is broken, the crown quickly loses the adhesive and retentive properties that bond it on the tooth. Other common causes of crown loss include trauma, chewing sticky foods and post/core failure. 

If you ever lose a crown, do NOT try to re-cement it (even using temporary crown cement from the drug store). You run the risk of creating a bond so strong that the dentist cannot remove it without damaging the tooth or a bond so weak that it causes the crown to become a choking hazard. Rather, call our office as soon as possible and let us know what happened. Depending on how the crown fell off, what was underneath the crown and if there was any damage to the tooth we may be able to recement it with little modification.

Unfortunately, there is no way for us to determine if the crown or tooth is savable over the phone. Your best bet is to schedule an emergency appointment at your earliest convenience. The longer your tooth stays exposed without a crown, the more likely it is to become damaged through daily use. If you would like to know more about lost crowns and how to protect your teeth, please give our office a call!