My Tooth Hurts

November 22, 2012 by ·

A cracked tooth, broken tooth, tooth hurts when biting, tooth sensitive but no cavity present are dental conditions that require immediate attention .

Cracked Tooth Molar

A cracked tooth may not always be visable.

One of the most common problems with teeth today is a cracked back tooth. Typically the further back in the mouth, the occurrence of a tooth problem increases. The uncomfortable tooth often is not broken.  Broken back teeth are often less painful than a cracked tooth before it breaks.

The signs and symptoms of a cracked tooth are:

  • Temperature sensitivity especially noticeable when pressure is placed on the tooth
  • The tooth location is far back in the mouth. The last molar is most likely and with each tooth forward the risk decreases some.
  • The problem tooth often shows signs of significant wear, indicating more than normal function against the tooth it bites against.
  • When checked with inked paper called articulating paper there are extensive areas of ink left on the tooth rather than a more normal point to point contact between the teeth.
  • Teeth with large dental fillings are weaker and therefore more susceptible to cracking and breaking.
  • The tips of the canine teeth (eye teeth) are worn off.

Why do teeth crack?

To understand this you must first understand what is normal. In a normal situation the upper and lower back teeth touch each other with point contacts. When a person chews the back teeth do not touch when the jaw moves from side to side. The four canine teeth (two upper and two lower) guide the jaws apart sending a signal to the brain to open the mouth when the jaw slides left or right. The back teeth only contact when the jaws are fully together. The at risk back teeth ideally only receive vertical force down the center of the tooth where they where designed to best receive heavy force.  Side forces on back teeth are not well tolerated and places the tooth at risk for developing a crack(s). If there is a filling in the tooth and especially if it is a large filling that is also a silver/mercury amalgam, the tooth crack risk is greatly increased. People who grind their teeth have increased risk of developing a cracked tooth..

What to do to prevent or treat cracked back teeth.

If the tips of the four canine teeth are worn down allowing the back teeth to contact heavily in side to side movements the individual should consider the value of placing dental restoration on the canines to improve jaw guidance by eliminating or lessening side to side forces on the back teeth.

If the individual grinds their teeth at night they should consider wearing a protective night guard over either the upper or lower teeth to lessen the stress on the teeth and the jaw muscles.

Tooth grinding and heavy tooth wearing can be an indication of tooth interference to normal jaw closure. The dentist may feel the individual could benefit from adjusting the bite.

If on routine examination the dentist notices a darkened crack line in a tooth, thought should be given to place a protective crown or onlay restoration to contain the walls of the tooth on either side of the crack preventing the crack from propagating through the tooth.

If left untreated the crack potentially could extend through the tooth to the nerve (pulp) area requiring root canal treatment. If the crack extends through the nerve area to the middle of the tooth where it meets the jaw bone, the tooth would need to be removed.

If the cracked portion ultimately breaks off the tooth, it frequently breaks down to where the tooth emerges from the bone requiring a surgical procedure called crown lengthening before the tooth can be restored with a crown.

For more information please see: Smiles by Design, the Lexington Dentist Smile Makeover Artist.

Dr. David Brother, DMD, FAGD Lexington Dentist ,  Smiles By Design 57 Bedford Street, Ste 110, Lexington, MA 02420

Filed Under: Endodontics, General Dentistry ·

Root Canal – Something You Should Know

July 14, 2010 by ·

Tooth and Gumline

At the center of each of your teeth is a hollow space occupied by nerve and blood vessel tissue called the dental pulp.  This tissue was important to the tooth while it was forming providing nutriment to the developing tooth.  Once the tooth was formed, however, the pulp is not a necessary part of a functioning tooth. 

SOURCES OF TOOTH DAMAGE

If a tooth is subjected to trauma, damage can occur to the pulp.  The sources of damage include the following:

  • Severe tooth decay.
  • Trauma to the tooth or its supporting bone.  The tooth may be fractured or broken.  Even if the tooth is not visibly damaged, the shock of trauma is often enough to injure the pulp.
  • Severe wear of tooth surface through attrition, abrasion or erosion.
  • Advanced periodontal disease.

Severely damaged pulp will die.  The dead cells provide what is commonly called a pulpal abscess.  Often times it will be accompanied by pain.  A damaged pulp can also be sensitive or painful.  Discomfort is not always immediate and symptoms differ for a live injured pulp or dead pulp.  Information you provide us in conjunction with an examination and x-ray will provide the diagnosis in most cases. 

Except when a fracture of the affected tooth makes it unrestorable, these injured teeth can be saved potentially for the rest of your life.  To do this, the damaged pulp is removed from the tooth in a process call endodontics therapy or root canal therapy.  When it is deemed necessary in order to preserve a tooth, this can be accomplished with little or no discomfort to you. 

ROOT CANAL THERAPY

To treat a tooth with root canal therapy, a hole is made in the center of the tooth to allow the dentist access to the damaged pulp.  Small instruments, called files, and a solution used to dissolve tissue is used through this access cavity to clean out the pulpal tissue that could provide nourishment to germs.  Once the pulp has been removed to the tip of the root, the space previously occupied by the pulp is filled with cement, an inert material designed to prevent germs from accessing the tooth, which could cause future infection.  In some instances, these steps may be carried out in a single office visit.  Often, though, two, three, or more visits are required.

FEES FOR ROOT CANAL

Fees for root canal are determined by the number of roots in the tooth.  This fee only covers the root canal therapy and does not cover the cost of restoring the tooth.

RESTORING THE TOOTH

Endodontically treated teeth all need to be restored following treatment.  In some instances, this will be limited to a bonded filling in the access cavity.  Often, the damaged tooth will require an inlay or crown to restore it to normal appearance and function.  The American Dental Association recommends that all endodontically treated back teeth be protected with a crown or inlay because of the high incidence of fracture.  In all cases, the restoring of the tooth is a separate and distinct portion of treatment from the endodontic therapy provided. 

Dr. David Brother, DMD, FAGD
Lexington Dentist ,  Smiles By Design
57 Bedford Street, Ste 110,
Lexington, MA 02420 

Filed Under: Endodontics ·