Do I Need My Wisdom Teeth Taken Out?

I have wisdom teeth that are beginning to hurt and I am worried about feeling pain and having a bad experience. Do I need them out? What do you recommend?

Wisdom teeth, often times, have to be removed for several reasons such as inability to keep clean, more prone to getting cavities, can cause shifting of teeth, can develop unusual pathology such as tumors, and can cause diffuse pain in the jaw as well as the jaw joints. Wisdom teeth can fully erupt through the gums, or partially erupt, or never erupt (called an impacted wisdom tooth). Depending on the level of eruption, a general dentist may be able to take the wisdom teeth and often times I refer to an oral surgeon who specializes in taking out more difficult teeth.

Because wisdom teeth are typically more difficult to take out, one can experience more discomfort and pain following. Again the level of eruption will determine how difficult it will be to remove which further determines how much discomfort afterwards. I typically recommend sedation for wisdom teeth in 3 different options:

1. Nitrous oxide (laughing gas during procedure)
2. Oral sedation(oral medication before procedure)
3. IV sedation (“put to sleep” with medications through an IV). Ask your dentist what is most appropriate for you.

The advantage to oral and IV sedation is also that it can cause amnesia which prevents the patient from remembering the procedure. Most patients wake up without any recollection of what happened, how long it lasted and how the procedure went. So yes I would recommend removing wisdom teeth ~85% of the time and I would recommend sedation for the procedure.

Why do I need a crown over a root canal tooth?

Almost always when a posterior (back) tooth has to receive a root canal for whatever reason (cavity, broken, infected), a crown is typically recommended following completion of root canal therapy. The reason is that the tooth is compromised from previous factors such as cavity, fracture lines, big filling, etc. The foundation of the tooth has been greatly compromised not to mention a root canal is essentially creating a hole down the middle of the tooth further weakening an already compromised tooth. A root canal also involves removing the nerve from the teeth which cuts away some of the blood and nerve supplies which can lead to desiccation or "drying out" of the tooth. Put this all together and a tooth with previous work + root canal= a tooth that will potentially fracture.

Unfortunately when these teeth fracture, they tend to do it catastrophically and sometimes to the point where they are not fixable and need to be extracted. A crown provides additional protection to the tooth as it helps splint the remaining tooth structure together and offsets some of the stresses that occur while eating, chewing, grinding, clenching etc. Depending on the situation, there are different kinds of crowns that can be used and will be discussed at a later date. Ultimately, a crown is very important following root canal therapy to minimize the changes of breaking and fracturing.

Taking child to Pediatric Dentist

Should I take my child to a pediatric dentist?

This depends on several things. If the child has severe dental problems that require substantial amount of chair time, then a pediatric dentist might be better. Certainly, if the child has a great deal of anxiety, or a history of combativeness, or unwillingness to cooperate for simple tasks such as a cleaning, then a pediatric dentist is warranted. One major advantage of a pediatric dentist is that they can sedate children at a more concentrated level than the general dentist (oral sedation or general anesthesia)--this is a great treatment modality for children that are very young, require an extensive amount of work or have a complicated medical history. I always recommend bring your child to the general dentist first and then we can make a decision together whether or not a pediatric dentist is needed. Have faith in your child as they may do better than you think!

Can you get a cavity around a crown?

Can you get a cavity around a crown?

Yes even though the tooth is "covered" by a crown, it can still get a cavity. The reason is that the interface between the crown and the tooth, which dentists refer to as "margins" has potential to get decay, or collect food. While crowns do minimize the tooth fracturing and help decrease the chances of getting another cavity, decay can still form around the edges of the crown right around the gum line. Hygiene becomes exceptionally important for brushing and flossing to prevent decay from developing.

When should my child see the dentist?

When should my child start seeing a dentist?

I recommend bring your child as soon as they get their full complement of baby teeth, which is approximately 2-3 years of age. While this age is young, and very little dentistry can often be accomplished, it establishes a couple things:

1. The dentist is able to count all the teeth to verify that all the teeth are present as well as checking for cavities. The dentist can also determine and assess for further problems such as crowding issues or potential diastemas(spaces between front teeth).
2. By establishing a routine early, the child will typically have more positive experiences and be comfortable with future visits.
3. Enables the dentist to help the parents establish a good system of oral hygiene to prevent further problems.

At ages 2-3, typically the teeth will be counted and will be checked for cavities and any other abnormalities. X-rays are not usually taken unless a problem is discovered and the child may or may not receive a cleaning depending on the child's temperament. By ages 4-5,the child will get the same treatment as an adult which involves an exam, x-rays and a cleaning. It is VERY important to have your child assessed before their permanent teeth start to come in as there could be preexisting problems that may affect the permanent teeth. An ounce of prevention provides defense against a ton of problems!

Do dentists always have to use drills/needles for dental work?

Are there ways to do dentistry with out the pain or a needle or sound of a drill?

Yes there are, but they are somewhat limited in what they can treat. For example, to not need a needle for treatment either the cavity has to be very small or the dentist uses something called “Air Abrasion” or “Laser Dentistry”. These are technologies that enable the dentist to fix cavities without using a needle or drill however they are not as effective when the cavities are deep (close to the nerve) or the tooth is sensitive.
I think an injection is much better for pain control and is better for eliminating the “what if I feel this”. An injection can almost be next to painless and the discomfort can be controlled by

1. The strength of the topical gel
2. The manner the injection is given by the dentist.

We have a special device we use sometimes called “The Magic Wand” that is very effective for getting patients numb and most patients report not feeling anything!!

I have a very simple rule…if I can't get you numb, I will not work on you that day…sometimes people just don't numb up well and it's hard to explain why but rest assured that if you are uncomfortable then I am too so I will not make you do anything that is uncomfortable. We generally have great success in getting you more than adequately numb which gives you a very comfortable, pleasant experience. Nitrous oxide(laughing gas) will often help drown out some of the sounds of the drill and also with analgesia(pain relief) during the procedure.

Regarding the sounds of the drill, we always play music while we are working..I don't like the sounds any better than my patients do? I love music from the 80s and 90s so there is always music in the background or we will play whatever music you like. We also play movies if you prefer to listen to a movie and if that's not enough…I might even sing or dance for you!

What is cracked tooth syndrome?

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.

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