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Cracked Tooth

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Cracked and fractured teeth are common dental problems. As people retain their natural teeth longer (due to advances in dental technology), the likelihood of cracked teeth increases. There are many reasons why teeth may crack, for example, biting on hard objects, trauma, grinding and clenching of teeth. All of these behaviours place the teeth under extra strain and render them more susceptible to cracking.

When tooth enamel is cracked, pain can become momentarily debilitating. When no pressure is exerted on the crack there may be no discomfort. However, as the cracked tooth performs a biting action, the crack widens. The pulp and inner workings of the tooth then become exposed, and painful irritation occurs. As pressure is released again, the two parts of the crack close back together, and pain subsides.

If left untreated, the pulp becomes irreversibly damaged and constantly painful. The resulting pulp infection can affect the bone and soft tissue surrounding the tooth. Other risks of non-treatment include extension of the crack resulting in eventual fracture of the tooth. The future prognosis of a fractured tooth is determined by the extent and location of the fracture.

Symptoms of a cracked tooth may include:

  • Unexplained pain when eating.
  • Sensitivity to warm and cold foods.
  • Pain with no obvious cause.
  • Difficulty pinpointing the location of the pain.

 

What kind of cracks can affect the teeth?

There are many ways in which a tooth can be cracked. The specific type of crack will determine what type of treatment is viable. In many cases, if the crack is not too deep, root canal therapy and a crown can be performed and the natural tooth can remain in the mouth. In other situations, the tooth is too badly damaged and requires extraction.

Here is a brief overview of some of the most common types of cracks:

Crazes – These are generally tiny vertical cracks that do not place the teeth in danger. These scratches on the surface of the teeth are considered by most dentists to be a normal part of the tooth anatomy. A craze rarely requires treatment for health reasons, but a wide variety of cosmetic treatments can be performed to reduce the negative aesthetic impact.

Oblique supra-gingival cracks – These cracks only affect the crown of the tooth and do not extend below the gum line. Usually, the affected part of the tooth will eventually break off. Little pain will result, because the tooth pulp (that contains the nerves and vessels) will usually remain unaffected.

Oblique sub-gingival cracks – These cracks extend beyond the gum line, and often beyond where the jawbone begins. When a piece breaks off, it will usually remain attached until the dentist removes it. Oblique subgingival cracks are painful and may require a combination of periodontal surgery (to expose the crown), and endodontic treatment to place a crown or other restorative device.

Vertical furcation cracks – These cracks occur when the roots of the tooth separate. This type of crack almost always affects the nerve of the tooth. Because the tooth will not generally separate completely, root canal therapy and a crown can often save the tooth.

Oblique root cracks – These cracks tend not to affect the surface of the tooth at all. In fact, the damage is only apparent below the gum line and usually below the jawbone. Root canal therapy may be possible; depending on how close the fracture is to the tooth surface. However, extraction is almost always the only option after sustaining this classification of fracture.

Vertical apical root cracks – These cracks occur at the apex (tip of the root). Though the tooth does not require extraction from a dental perspective, many patients request an extraction because of the high degree of pain. Root canal therapy alleviates the discomfort for a while, but most often, teeth affected by such cracks are eventually extracted.

How are cracks in the teeth treated?

There are many different types of cracked teeth. Some can only be seen using X-rays, while others are clearly visible to the naked eye. Some cracks cannot be detected on X-ray or visually and are diagnosed from the clinical symptoms.

In cases where the tooth root is affected, root canal therapy is the most viable treatment option. The pulp, nerves and vessels of the tooth will be removed, and the resulting space will be filled with gutta-percha. A crown or filling will be added to stabilize the tooth and it will continue to function as normal. Some teeth will need specialist referral to determine if they can be reasonably restored.

As a general rule, it is better to treat identified cracks at an early stage as their tendancy to extend often results in a need for more extensive treatment.

When the crack is too severe for the tooth to be saved, the dentist will perform an extraction. There are a number of restorative options in this case, such as bridges, dental implants and partial dentures. All of these structures can restore biting, chewing and speaking functions.

If you have any questions or concerns about cracked teeth, please ask us.

 

What’s your happy meal?

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Today’s nutritional approaches to oral health go beyond “don’t eat sugar.”

Good nutrition

“Adequate nutrition is important in disease prevention, and nutritional counseling is becoming an increasingly important tactic in preventive dentistry,” said Kevin Sheu, DDS, senior dental consultant at Delta Dental. “The quality and consistency of foods, their nutritional composition and the combinations in which they are eaten can affect oral health, including the likelihood of tooth decay.”

Ongoing research indicates that antioxidants and other nutrients found in fruits, vegetables, legumes and nuts may strengthen immunity and improve the body’s ability to fight bacteria and inflammation, all of which can help protect the teeth and gums. And some foods and dietary habits even have distinct effects on the mouth’s ability to handle cavity-causing bacteria attacks.

For example:

  • Calcium-fortified juices, milk and other dairy products are rich in calcium and vitamin D and help promote healthy teeth and bones, reducing the risk for tooth loss. Adding powdered milk to cooked dishes helps those who don’t like milk or cheese to get some of the calcium needed to protect teeth and jawbones.
  • Cheese unleashes a burst of calcium that mixes with plaque and sticks to the teeth, protecting them from the acid that causes decay and helping to rebuild tooth enamel on the spot.
  • Crisp fruits and raw vegetables, like apples, carrots and celery, help clean plaque from teeth and freshen breath.
  • Antioxidant vitamins, such as vitamin C, and other nutrients from fruits and vegetables help protect gums and other tissues from cell damage and bacterial infection.
  • Recent studies indicate that fresh cranberries interrupt the bonding of oral bacteria before they can form damaging plaque.
  • Folic acid promotes a healthy mouth and supports cell growth throughout the entire body. This member of the B vitamin family is found in green leafy vegetables and brewer’s yeast.

You may already know that cavity-causing organisms feed on the sugar in foods such as soda, chocolate milk and candies and convert it to acid, which attacks tooth enamel and causes tooth decay.

  • But did you know that acidic foods and drinks can wear away your enamel, leaving your teeth sensitive, cracked and discolored?

Timing is everything

A diet that promotes good oral health is not just about the foods you eat or avoid — when and how you eat them is equally important.

  • Foods that take a long time to chew or that you hold in your mouth (such as cough drops) can damage teeth as they retain sugar in the mouth longer than do other foods.
  • Instead of snacking on sugary, carbohydrate-rich or acidic foods throughout the day, eat these foods just during meal times in order to minimize the amount of time teeth are exposed to acid. In addition, the body produces more saliva to help digest larger meals, which washes away more food and helps neutralize harmful acids before they can attack teeth.

Information courtesy of the Academy of General Dentistry.

Controlling your biofilm (cleaning the kitchen)

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This is the third in a series of posts about biofilms and how they relate to you.

We have learned that biofilm (plaque) builds up on your teeth, or oral appliances, and the net effect is to cause disease, either decay or gum disease. The most common way of removing biofilm in an oral health context is by regular brushing and flossing. You can equate this to the necessity to regularly clean your kitchen surfaces, shower or bath in order to maintain a healthy environment in which to live.

The more regularly this happens, the less opportunity those bacteria have to develop into those teeming cities of goo we described earlier.

Antibiotic Control of Biofilm

Although gum disease can be controlled by proper oral hygiene (toothbrushing, flossing, rinsing), gingivitis (the mildest form) is still experienced by most of the population at some point in life; a smaller proportion (30% to 40%) experience periodontitis (the severe form). Treatment of oral infections such as gum disease and decay requires removal of the biofilm and calculus (tartar) from the teeth and gums by surgical or nonsurgical procedures, sometimes followed by antibiotic therapy. This means that the biofilm needs to be regularly removed by your hygienist or dentist if you want to try to prevent the progress of the disease process. Unfortunately, these infections are not completely responsive to antibiotics. For this reason, oral infections are chronic diseases that require ongoing treatment and daily care by proper oral hygiene measures. Prevention is certainly the best strategy.

Chemical Control of Biofilm

When good oral hygiene practices fail to prevent the development of biofilms, toothpastes and mouthwashes with chemotherapeutic agents can be used. These agents can kill microorganisms in the biofilm. Chlorhexidine, triclosan, and essential oils and minerals–agents proven to kill the harmful bacteria–can reduce the degree of plaque and gingivitis, while not allowing disease-causing microorganisms to colonize.

How do biofilms form?

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This is part 2 in a series of posts about Biofilms.

Where Biofilms Form

Biofilms happily colonize many household surfaces in the bath and kitchen, including toilets, sinks, countertops, and cutting boards. Poor disinfection practices and ineffective cleaning products may increase the incidence of illnesses associated with pathogenic organisms encountered during normal household activity.

Basically, they can form on any damp surface which has not been properly cleaned. From an oral health point of view, they form on the tooth surface, both root and crown.

How Biofilms Form

  • Free-swimming bacterial cells land on a surface, arrange themselves in clusters, and attach.
  • The cells begin producing a gooey matrix.
  • The cells signal one another to multiply and form a microcolony.
  • The microcolony promotes the coexistence of diverse bacterial species and metabolic states.
  • Some cells return to their freeliving form and escape, perhaps to form new biofilms.

In this way, biofilms can spread over large areas of surface if given enough time. In an oral health setting, it is possible to detect biofilm (plaque) formation just 20 minutes after you have cleaned your teeth.

Next time, we will write about the effects of uncontrolled biofilm and how to control it.

What is biofilm?

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This will be the first in a number of posts about biofilms. This is not about cinematic experiences involving Richard Attenborough and lovely furry animals but about something you encounter every day of your life.

What Is Biofilm?

You may not be familiar with the term biofilm, but it is something that you come into contact with every day. The plaque that forms on your teeth and causes tooth decay and periodontal disease is a type of biofilm. Clogged drains also are caused by biofilm, and you may have encountered biofilm-coated rocks when walking into a river or stream.

Biofilms form when bacteria stick to surfaces in some form of watery environment and begin to excrete a slimy, gluelike substance that can stick to all kinds of materials–metals, plastics, soil particles, medical implant materials, biological tissues.

Biofilms can be formed by a single bacterial species, but biofilms more often consist of many species of bacteria, as well as fungi, algae, protozoa, debris, and corrosion products. Essentially, a biofilm may form on any surface exposed to bacteria and some amount of water.1

Dental plaque is a yellowish biofilm that builds up on the teeth. Biofilms contain communities of disease-causing bacteria and their uncontrolled accumulation is associated with cavities and gum disease (both gingivitis and periodontitis).

In the past, scientists studied bacteria by looking through a microscope at cells suspended in a water droplet. Today, scientists believe that the disease-causing bacteria do not exist as isolated cells, such as in the water droplet, but rather they stick to various wetted surfaces in organized colonies that form diverse communities–biofilms.

Think of biofilm as a teeming city of bacteria, the foods they live on, the waste products they create and a glue which sticks the whole mess to a surface.

Next time we will look at how biofilms are created.

QI facts in dentistry

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If you’re in the mood to expand your knowledge when it comes to teeth and oral health, we’ve got some interesting bits of trivia for you!

  1. Did you know that tooth decay in children is a new concept? Kids in prehistoric times didn’t have to worry about it because their diets were free of sugar!
  2.  The only organ that’s fully developed at birth in a human baby is the tongue
  3.  Women smile an average of 62 times a day
  4.  Before modern toothbrushes, humans in ancient history would clean their teeth with twigs and roots.
  5.  Of every 2,000 babies born, one will have a tooth already in their mouth.
  6.  The strongest substance in the human body is tooth enamel
  7.  The Chinese celebrate a holiday called ‘Love your Teeth’ day
  8.  Snails have thousands of teeth all lined up in rows
  9.  Some people in medieval Germany believed kissing a donkey would cure a toothache
  10.  The ancient Romans used to make toothpaste out of honey and eggshells
  11.  Much like a fingerprint, everyone’s tongue print is unique too

My oral health routine

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Maintaining healthy habits when it comes to taking care of your teeth is absolutely necessary. We often only think about the short-term consequences of our actions, which leads to poor dental health from accumulated lack of care in the long run. Therefore, greater awareness of the long-term disadvantages of poor oral health can help people make smarter choices in the present and avoid costly visits to the dentist.

Bad oral hygiene leads to plaque, which accumulates around your teeth and gums, leading to inflammation of the gums. This can be very painful. Another effect of plaque is tooth decay, which can worsen over time and result in the need for dentures.

You can evaluate your dental health by a number of methods. Although it is difficult to be certain about your symptoms, a visit a dentist for a dental health check is key. For instance, you should make sure your gums are pink, which indicates that they are healthy. Furthermore, they should not bleed when you floss or brush your teeth. You should not be suffering from bad breath at all times. Finally, your teeth should not only feel, but look clean as well.

Having preventive oral care measures takes time to begin feeling natural to you. Therefore, follow these steps without hurrying through them, and remain committed to the whole process keeping the long-term benefits in mind.

You must brush your teeth for two minutes, twice a day. Make sure your brush reaches all sides of all teeth, in a gentle circular manner. At night, after brushing, you must floss your teeth properly, at least once a day. The floss string should reach all your teeth, and it should follow the tooth line so that your gums are not harmed. The space between the teeth and the gum should also be gently reached by the floss.

Additionally, after brushing and flossing, you can use a mouthwash and swish it in your mouth for at least thirty seconds before spitting it out. It is also very important to clean your tongue to prevent mucus and bacteria from building up and being detrimental to your teeth. To do so, you can put a little bit of toothpaste on your toothbrush and gently clean the tongue, or you can use dental floss to scrape bits off your tongue. You can also simply invest in a tongue cleaner and use it at least once a day, preferably before bedtime.

As a final piece of advice, even if you include the steps above into your daily oral health regimen, make sure you visit us at the intervals we recommend for a dental health check. For more information on the wide range of best available dental services at Quirke Dental Surgeons, please contact our friendly team at (051) 421453.

What is an inlay?

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Inlays and onlays are dental restorations that are used by dentists in order to repair the back teeth that are suffering from mild to moderate decay. They can also be used to repair fractured or cracked teeth that are decaying, but are not damaged enough to warrant a crown.

Inlays and onlays are usually used for patients suffering from enough damage in their oral cavity that the tooth structure cannot be treated using a filling, but have enough healthy tooth remaining that there is no need for a crown. In essence, inlays and onlays can be used for patients suffering from a midlevel of tooth decay. Inlays and onlays allow us to conserve more of the original tooth structure of the patient.

While some people consider inlays and onlays to be more of a cosmetic procedure, this cannot be further from the truth. There are several different types of benefits of using inlays and onlays compared to using metal fillings including:

  • Inlays and onlays help to strengthen the damaged teeth by nearly up to 75 percent. In case of traditional metal fillings, they are known to reduce the strength of the teeth by nearly up to 50 percent.
  • Inlays and onlays are known to prolong the life of the tooth and therefore help to prevent the need for further dental treatment somewhere in the future.
  • Inlays and onlays are known to be more durable as they are made up of hard-wearing and tough materials that are known to last up to 20 years in some cases.

Much like fillings, dental inlays and onlays require local anaesthesia as well. However, this is mainly to remove the old fillings. Basically, inlays and onlays will be used in cases where old fillings are no longer useful and need to be replaced or removed. Much like a filling, dental inlay will fit inside the top edges, or the cusp tips of the teeth, while fitting dental onlays is an extensive procedure that needs to extend over the cusp of the tooth that has been treated.

For both inlays and onlays, once the filling has been removed, we will take an scan of the tooth with our CEREC scanner.  The new Inlay and onlay can be made from this scan and porcelain or composite resin materials can be used in the final restoration. Then, the new Inlay or onlay is cemented into place and it blends with the treated tooth in order to give the patient a more natural and uniform appearance.  For more information on the wide range of dental services at Quirke Dental Surgeons, please contact our friendly team at (051) 421453.

Caring for your denture

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If you’ve recently started wearing dentures, you know how important they are for maintaining your facial structure and helping you enjoy your favorite meals. Wearing dentures shouldn’t cause you extra work, in fact, they should be taken care of similarly to your original teeth! Teeth in a denture can be made of porcelain or acrylic, but they build up plaque and tartar just like natural teeth. To keep great oral health with your new dentures, it starts by making sure they’re clean and properly fitted. Here are some helpful hints:

  • Thoroughly clean your dentures every day.
  • Remove and rinse your dentures after eating.
  • Soak them in a cleaning solution for about 30 minutes before brushing to loosen tartar and plaque.
  • Rinse your dentures before putting them back in your mouth, especially after using a denture-soaking solution.
  • Brush your dentures every day with a denture brush and liquid soap or foam cleaner.
  • Use non abrasive products to prevent scratching.
  • Leave your dentures out overnight to let your gums rest and to prevent inflammation.
  • Soak your dentures overnight.
  • Clean the cup you store your dentures in at least once a week.
  • Replace your denture brush on a yearly basis.
  • Avoid contact with abrasive cleaning materials, whitening toothpastes, products with bleach, and hot water.

Each day you should remove your dentures and brush your mouth, tongue, cheeks, and palate. You should also inspect your denture for any broken or cracked areas that may attract a buildup of plaque. At Quirke Dental Surgeons, we’ll monitor your dentures for fit and comfort and will also replace them over time for proper jaw alignment. We will want to see you regularly to monitor your oral tissues and overall health for any changes. To learn more about how to properly care for your dentures, contact us today!