Additional Patient Information

Pericoronitis

Pericoronitis is a common problem that occurs around a partially impacted lower wisdom tooth. The literal definition of pericoronitis is inflammation around the crown. A piece of gum tissue appears over the biting surface of the tooth, which is very difficult to clean. Debris collects under the flap and, when the debris is not removed, the gum becomes inflamed. The gum can also become inflamed if the top tooth catches the flap of tissue during chewing. In most cases pericoronitis is treated with an antibiotic for a few days and when the infection has decreased, the wisdom tooth is removed.

Wisdom Teeth

Wisdom teeth, or third molars, usually appear around age 18. Eruption may be straight, crooked, or impacted. Even if these molars come in straight, they may need to be extracted due to a lack of space and an inability to keep them cleaned and maintained. Please read and view the images below for the various types of erupting patterns and impactions.

Vertical Impactions

Vertical impactionsThe lower tooth, in the image to the right, is partially vertically impacted. This means that part of the tooth is above the bone and visible in the mouth, and part of it is submerged in the bone. This tooth could still erupt properly as the tooth next to it is not in its way.

The upper tooth is fully vertically impacted. This means that the entire tooth is submerged in the bone.

If no tooth movement is shown after a few years, then we know that the teeth are impacted and should be considered for removal. This tooth could still erupt properly as the tooth next to it is not in its way.
Mesial Impactions

Mesial impactionsThe lower tooth, in the image to the left, is partially mesially erupted. This means that part of the tooth is above the bone and visible in the mouth and part of it is submerged in the bone and is it tilted mesially, which means it is tipped toward the front of the mouth. This tooth will not likely erupt properly as the tooth next to it is in its way. These teeth typically need to be extracted because the bacteria that collects under the gum tissue are almost impossible to clean, which can cause an infection. The tooth next to the wisdom tooth can also decay due to the wisdom tooth.

The upper tooth is fully mesially impacted. This means that the entire tooth is submerged in the bone and is tipped toward the front of the mouth. These teeth can be observed for a few years but it is best if they get removed especially if other teeth need to be removed.
Distal Impactions

Distal impactionsThe lower tooth, in the image to the right, is partially distally erupted. This means that part of the tooth is above the bone and visible in the mouth, and part of it is submerged in the bone and that is it tilted distally, which means it is tipped toward the back of the mouth. This tooth will not likely erupt properly due to a lack of space toward the back of the jaw. These teeth typically need to be removed because the bacteria that gets under the gum tissue is almost impossible to clean, which then causes an infection.

The upper tooth, which is indicated by the yellow arrow, is fully distally impacted. This means that the entire tooth is submerged in bone and is tipped toward the back of the mouth. These teeth can be observed for a few years but it is best if they are removed.
Horizontal Impactions

Horizontal impactionsBoth of the teeth in the image to the left are horizontally impacted. This means that the tooth is perpendicular where they should be. This tooth will not erupt properly since there is no place for them to go and there is almost no chance that they will be guided into proper position in the mouth.

These teeth typically need to be extracted. They can be observed for a few years, but it is best if they get removed.

What is pediatric dentistry?

Pediatric dentistry is the branch of dentistry that deals with infants, children and adolescents including those patients with
special care needs.

Do you have to be a pediatric dentist to treat children?

No you don’t. However, a pediatric dentist attends a post graduate program after dental school for two to three years to learn more about the specific needs of young dental patients.

Do I need to brush my children’s teeth?

Yes because children develop plaque just like adults do and it must be removed on a daily basis so it does not lead to tooth decay. Use a soft-bristled toothbrush that will fit into the child’s mouth at least once a day to begin with when they are very young and at least twice a day by the time most of the baby teeth have erupted.

When should I take my child to the dentist for the first time?

You should schedule an appointment around the first birthday so that we can check for good oral hygiene, cavities and any developmental or congenital abnormalities.

If baby teeth eventually fall out, why are they important?

A collage of the child has lost the baby tooth.Baby teeth are very important because they serve many of the same purposes of adult teeth such as tearing and chewing food and helping the child speak properly. Additionally, they hold the place for adult teeth. If baby teeth are lost prematurely, an appliance called a space maintainer is needed to prevent the remaining teeth from shifting into the space of the lost tooth.

How do thumb sucking and pacifier habits harm teeth?

There is not much difference between the two habits and they only become a problem if the baby teeth start to get displaced or if the habit continues after the adult teeth have erupted. Read more here about thumb sucking and pacifiers.

I did not give my baby candy but he still has decay. How did that happen?

Decay is not only caused by candy; it can be caused by most foods or liquids other than water that do not get removed from the surface of teeth. Infants and children are at the mercy of their parents. If a toddler is continuously given a bottle with almost anything other than water at bedtime, they will probably develop baby bottle caries, which are cavities on the front teeth. Do not give a bottle with anything other than water at bedtime and get in the habit of brushing your child’s teeth on a regular basis.

How often do children need to visit the dentist?

Children should visit a dentist every six months. We like to catch anything when it is small and seeing the child every six months gives us the best chance to keep an eye out for any signs of early decay. Additionally, since teeth start coming and going, we like to have a history of each patient’s dental development.

Is toothpaste good or bad for children?

Fluoridated toothpaste should not be used for children under age 2. After that time, parents should be in charge of dispensing the toothpaste and the amount to be used each time should not be bigger than the size of a pea. Make sure the children spit the toothpaste out instead of swallowing it. It is not dangerous if they swallow it once or twice but do not let it become a habit.

Should baby teeth be sealed?

Baby teeth should be sealed if they have deep pits and fissures that may be prone to decay without a sealant. Read more about sealants.

What should I do if my child has an accident and knocks out a tooth?

Please read how to save a knocked out tooth.

Pulpotomy (Child Root Canal)

Close up of boy having his teeth examined by a dentistThe build up of decay can reach the nerve/pulp of the baby tooth and cause pain. In order to relieve the pain, we need to remove the nerve from the nerve chamber of the particular tooth. This is similar to an adult root canal but does not take as long since only the pulp has to be removed. The other difference is that here is no filling placed in the canal for a child’s tooth.

The procedure works well to relieve your child of the pain that caused the problem. Moreover, pulpotomy prevents further deterioration of the tooth and allows it to develop fully until it falls out. Yet, there is a chance that the damage to the nerve is beyond repair and the whole tooth might have to be extracted.

If the tooth does have to be removed, the placement of a space maintainer would likely be needed since it is important to maintain the space that the removed tooth had occupied. Saving the baby tooth is a better option, which can be done only through pulpotomy if the decay has reached the nerve.

Sealants

sealantSealants are thin plastic coatings applied in the dental office on the chewing surfaces of back teeth, which are prime spots for cavities. Sealants act as a barrier to prevent bacteria and food from collecting and sitting on the grooves and pits of teeth.
Sealants are best suited for permanent first molars which erupt around the age of 6 and second molars that erupt around the age of 12. It is important to have the sealant applied as soon as the tooth has fully come in. They are also indicated on the pre-molars if there are deep pits and fissures present.
Before the sealant material is applied, the tooth surface is prepared by cleaning with a dental solution that helps the sealant stick to the tooth by penetrating the enamel.
Sealants may last for several years once applied, but should always be examined at the child’s regular checkup. Even if the sealant becomes lost, the material that has penetrated the enamel will still provide protection. Sealants are easily replaced if lost.
Sealants are nearly 100% effective in preventing decay in the chewing surfaces of the back teeth. Fluoride helps fight decay on the smooth surfaces of the teeth.

Endodontics (Root Canal Therapy)

The term endodontic is a combination of the Greek words endo, which means “inside” and odont, which means “tooth.” Endodontic treatment involves treating the inside of the tooth and is also referred to as root canal therapy because it is focused on the root part of the tooth, specifically in the canal portion of the root where the nerve, blood vessels, and connective tissue of the tooth reside.

Inside of a tooth, under the white enamel and a layer called the dentin, is soft tissue called the pulp. The pulp contains blood vessels, nerves, and connective tissue and creates the surrounding hard tissue of the tooth during development.

The pulp extends from the crown of the tooth to the tip of the roots where it connects to the tissues surrounding the root. The pulp is very important during a tooth’s growth and development. However, once a tooth is fully mature, it can survive without the pulp because the tooth continues to be nourished by the tissue surrounding it.
Why Endodontic Treatment is Necessary

Decaying tooth

Root canal therapy is necessary when the pulp becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep decay due to bacteria, multiple dental procedures on the tooth, or a crack or chip in the tooth. In addition, trauma to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain, and/or lead to an abscess.

Signs of pulp damage may include pain, prolonged sensitivity to heat or cold, discoloration of the tooth, and swelling and tenderness in the nearby gums. Sometimes there are no symptoms at all.

Treating the Tooth

Root canal treatmentA traditional root canal involves removing the inflamed or infected pulp, carefully cleaning and shaping the canals inside of the tooth, then filling and sealing the space inside the canal. A crown holds the tooth together and reduces the likelihood of the tooth fracturing in the future. Back teeth often need crowns since a great amount of tooth structure may be lost from decay, which makes them more susceptible to fracture. Front teeth occasionally need crowns and are restored with a crown on a case-by-case basis.
Root Canal Procedures Explained

Endodontic treatment can often be performed in one or two visits, depending upon the source of the problem and the complexity of the tooth. The first step is to examine, test, and x-ray the tooth. The area is then numbed with local anesthetic to reduce or eliminate pain. Next, a rubber dam is placed to isolate the tooth from the rest of the oral cavity, creating a barrier to prevent bacteria and saliva from entering the tooth during the procedure. We then use a handpiece to open access into the pulp chamber and root canals. Very small instruments are used to clean and shape the pulp chamber and root canals to remove the nerve, blood vessels and connective tissue, and to prepare the canals for the root canal filling material.
Filling the Canals

Filling the canals

After the space is cleaned and shaped, we fill the root canals with a biocompatible material which is placed with an adhesive cement to ensure the complete sealing of the root canals. The goal of the filling material is to create a barrier so that no cells, fluids, or other matter enters the tooth at the tip of the root. In some cases, a temporary filling is placed to prevent anything from entering the tooth from your mouth. It is important that this temporary is replaced by a final restoration in a short amount of time as it is not meant for long term wear.

Restoring the Tooth

Root canal tooth restorationIf the tooth lacks sufficient structure to hold a restoration after the root canal, a core build-up or post will need to be added inside of the tooth. This provides a solid foundation for a crown and fills the hollow space that was created to access the pulp and canals of the tooth. A crown or other restoration is then placed on the tooth to protect and restore it to its full function.
How A Tooth With A Simple Cavity Can Require a Root Canal

Root canal animationThe animation on the right depicts the process of a tooth requiring a root canal from an untreated cavity to the subsequent steps that occur to restore the tooth.

The first few images show the tooth with a cavity. If the decay was removed at this point, the tooth would merely need a filling. As the cavity progresses, it breaks through the enamel, which is the hard outer layer of tooth, and it enters the dentin, which is the layer of tooth beneath the enamel. The dentin is much softer and once the decay enters this layer, it spreads much faster as it progresses its way to the pulp.

Once the decay enters the pulp, you now have bacteria from your mouth that invade the root canal system and cause destruction of the surrounding bone, which can be a very serious situation and can cause both serious pain throbbing within the tooth. At this point, you either need to have a root canal or have the tooth extracted. It is also possible for the infection to cause death due to a condition called bacterial endocarditis. It can, however, take years for the cavity to burrow its way into the pulp but it is best to treat the cavity as soon as it is detected.

The first step in the therapy is to remove the blood vessels, nerve and connective tissue inside the pulp and root canals. The walls of the canal are smoothed with either a hand or rotary file. The canals are then sealed with a filling material and a temporary might be placed if the tooth is not restored at that appointment. The last step is to restore function to the tooth with a core build-up material and possibly a post and either a filling or a crown.

Almost all back teeth will need a crown since teeth that have had a root canal have lost a significant amount of tooth structure and a crown not only restores full function but it also helps prevent a future fracture. Front teeth are crowned on a case-by-case basis depending upon how much healthy tooth structure remains after the endodontic therapy. If a crown is not indicated on a front tooth, it will be restored with a tooth colored filling material.

Please also refer to our glossary