• 19100 West Lake Houston Parkway #103
  • Humble, TX 77346
  • (832) 777-6056
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What is Endodontics?

Myths About Root Canal Treatments

Myth #1 — Root canal treatment is painful.
Truth—Root canal treatment doesn't cause pain, it relieves it.

The perception of root canals being painful began decades ago but with modern technologies and anesthetics, root canal treatment today is no more uncomfortable than having a filling placed. In fact, a recent survey showed that patients who have experienced root canal treatment are six times more likely to describe it as "painless" than patients who have not had root canal treatment.

Most patients see their dentist or endodontist when they have a severe toothache. The toothache can be caused by damaged tissues in the tooth. Root canal treatment removes this damaged tissue from the tooth, thereby relieving the pain you feel.


Myth #2 — Root canal treatment causes illness.

The myth: Patients searching the Internet for information on root canals may find sites claiming that teeth receiving root canal (endodontic) treatment contribute to the occurrence of illness and disease in the body. This false claim is based on long-debunked and poorly designed research performed nearly a century ago by Dr. Weston A. Price, at a time before medicine understood the causes of many diseases.

In the 1920s, Dr. Price advocated tooth extraction—the most traumatic dental procedure—over endodontic treatment. This resulted in a frightening era of tooth extraction both for treatment of systemic disease and as a prophylactic measure against future illness.

The truth: There is no valid, scientific evidence linking root canal-treated teeth and disease elsewhere in the body. A root canal is a safe and effective procedure. When a severe infection in a tooth requires endodontic treatment, that treatment is designed to eliminate bacteria from the infected root canal, prevent reinfection of the tooth and save the natural tooth.

  • The presence of bacteria in teeth and the mouth has been an accepted fact for many years. But the presence of bacteria does not constitute "infection" and is not necessarily a threat to a person's health. Bacteria are present in the mouth and teeth at all times, even in teeth that have never had a cavity or other trauma. Research shows that the healthy immune system takes care of bacteria in a matter of minutes.
  • Tooth extraction is a traumatic procedure and is known to cause a significantly higher incidence of bacteria entering the bloodstream; endodontic treatment confined to the root canal system produces much less trauma and a much lower incidence and magnitude of bacteria entering the blood stream.
  • There is no adequate replacement for the natural tooth - it should be saved whenever possible. Root canal treatment, along with appropriate restoration, is a cost effective way to treat infected teeth because it is usually less expensive than extraction and placement of an implant. In most cases, endodontic treatment allows patients to keep their natural teeth for a lifetime.

But what about Dr. Price? This is a good example of how the Internet can give new life to long-dispelled theories. Believe it or not, the misinformation about root canals that is found on the Internet is still based on Dr. Price’s century-old, discredited research. Dr. Price’s research techniques were criticized at the time they were published, and by the early 1930s, a number of well-designed studies using more modern research techniques discredited his findings. In 1951, the Journal of the American Dental Association took the extraordinary step of publishing a special edition reviewing the scientific literature and shifted the standard of practice back to endodontic treatment for teeth with non-vital pulp in instances where the tooth could be saved. The JADA reviewed Dr. Price’s research techniques from the 1920s and noted that they lacked many aspects of modern scientific research, including absence of proper control groups and induction of excessive doses of bacteria.

As recently as 2013, research published in JAMA Otolaryngology - Head & Neck Surgery found that patients with multiple endodontic treatments had a 45 percent reduced risk of cancer.


Myth #3 — A good alternative to root canal treatment is extraction (pulling the tooth).
Truth — Saving your natural teeth, if possible, is the very best option.

Nothing can completely replace your natural tooth. An artificial tooth can sometimes cause you to avoid certain foods. Keeping your own teeth is important so that you can continue to enjoy the wide variety of foods necessary to maintain the proper nutrient balance in your diet. If your dentist recommends extraction, ask whether root canal treatment is an option.

Endodontic treatment, along with appropriate restoration, is a cost-effective way to treat teeth with damaged pulp and is usually less expensive than extraction and placement of a bridge or an implant.

Endodontic treatment also has a very high success rate. Many root canal-treated teeth last a lifetime.

Placement of a bridge or an implant will require significantly more time in treatment and may result in further procedures to adjacent teeth and supporting tissues.

Millions of healthy endodontically treated teeth serve patients all over the world, years and years after treatment. Those healthy teeth are helping patients chew efficiently, maintain the natural appearance of their smiles and enhance their enjoyment of life. Through endodontic treatment, endodontists and dentists worldwide enable patients to keep their natural teeth for a lifetime.




Reproduced with permission from the American Association of Endodontists.

Why Choose an Endodontist?

Experience
Endodontists are dental specialists with an additional two or more years of specialized training beyond dental school. The average endodontist completes 25 root canal treatments a week, while general dentists do about two root canals a week.

Efficiency
Because they limit their practice solely to endodontic treatment, endodontists are efficient and precise. This equates to positive experiences and faster healing.

Availability
Most endodontists offer tremendous flexibility in accommodating emergency cases, so delays in treatment are kept to a minimum and patients can be relieved of dental pain quickly.

Advanced Technology
Many endodontists use state-of-the-art technology such as operating microscopes, digital imaging, ultrasonic instrumentation and fiber optics, to treat their patients quickly and comfortably.

Today, getting root canal treatment is often no more uncomfortable than having a filling. Watch how root canal specialists put patients at ease with their calm and caring manner.

Reproduced with permission from the American Association of Endodontists.


Your Office Visit
A typical visit to our practice begins with completing information forms, which includes your medical history and consent forms. It is advisable to bring a list of all the medications (over-the-counter and prescription) that you regularly take or have taken within the past month. Once all forms are complete, an assistant will review and chart your chief complaint, referring dentist’s information and history of the tooth pain before taking x-rays of your teeth.

Once your first set of x-rays are complete, your the doctor will review your information forms and evaluate your symptoms prior to testing the tooth in question along with adjacent teeth. After the tests are complete, a diagnosis will be given and the doctor will discuss your treatment options. The doctor will make you aware of the benefits, options and risks involved in order for you to understand how endodontic treatment can relieve your pain and save your tooth. Possible post-treatment decisions such as a crown on the treated tooth also will be addressed.

If you decide to receive treatment, the procedure may start immediately. Before treatment begins, you will receive local anesthesia to numb any sensations you may feel during the procedure. If the procedure is unable to be completed within one visit, medicine may be placed inside the tooth between appointments.

Once your procedure is complete, more X-rays are taken to track the success of the treatment. You will be provided with review sheets that include your post-operative instructions and what to expect over the next few days.

Be sure to contact our office if you have any questions or concerns regarding your treatment.

Reproduced with permission from the American Association of Endodontists.


Treatments and Procedures

In the majority of cases, your tooth can be saved with endodontic treatment. Learn about the treatment options available to you, so that you can discuss them with the doctor and make the best choice for your oral health. Endodontic treatment helps you maintain your natural smile, continue eating the foods you love and limits the need for ongoing dental work. With proper care, most teeth that have had root canal treatment can last as long as other natural teeth and often for a lifetime.

 

Root Canal Treatment
Root Canal Treatment What is an endodontic treatment?

“Endo” is the Greek word for “inside” and “odont” is Greek for “tooth.” Endodontic treatment treats the inside of the tooth. Root canal treatment is one type of endodontic treatment.

To understand endodontic treatment, 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 a soft tissue called the pulp. The pulp contains blood vessels, nerves, and connective tissue and creates the surrounding hard tissues 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 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 tissues surrounding it.

Why would I need an endodontic procedure?
Endodontic treatment is necessary when the pulp, the soft tissue inside the root canal, becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep decay, repeated dental procedures on the tooth, or a crack or chip in the tooth. In addition, an injury 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 or lead to an abscess.

Root Canal Treatment

What are the signs of needing endodontic treatment?
Signs to look for include pain, prolonged sensitivity to heat or cold, tenderness to touch and chewing, discoloration of the tooth, and swelling, drainage and tenderness in the lymph nodes as well as nearby bone and gum tissues. Sometimes, however, there are no symptoms.

How does endodontic treatment save the tooth?
The endodontist removes the inflamed or infected pulp, carefully cleans and shapes the inside of the root canal, then fills and seals the space. Afterwards, you will return to your dentist, who will place a crown or other restoration on the tooth to protect and restore it to full function. After restoration, the tooth continues to function like any other tooth.

Will I feel pain during or after the procedure?
Many endodontic procedures are performed to relieve the pain of toothaches caused by pulp inflammation or infection. With modern techniques and anesthetics, most patients report that they are comfortable during the procedure.

For the first few days after treatment, your tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with over-the-counter or prescription medications. Follow your endodontist’s instructions carefully.

Your tooth may continue to feel slightly different from your other teeth for some time after your endodontic treatment is completed. However, if you have severe pain or pressure or pain that lasts more than a few days, call your endodontist.

Step-by-Step Endodontic Procedure
Endodontic treatment can often be performed in one or two visits and involves the following steps:

Endodontic treatment

1. The endodontist examines and x-rays the tooth, then administers local anesthetic. After the tooth is numb, the endodontist places a small protective sheet called a “dental dam” over the area to isolate the tooth and keep it clean and free of saliva during the procedure.

2. The endodontist makes an opening in the crown of the tooth. Very small instruments are used to clean the pulp from the pulp chamber and root canals and to shape the space for filling.

Endodontic treatment

3. After the space is cleaned and shaped, the endodontist fills the root canals with a biocompatible material, usually a rubber-like material called gutta-percha. The gutta-percha is placed with an adhesive cement to ensure complete sealing of the root canals. In most cases, a temporary filling is placed to close the opening. The temporary filling will be removed by your dentist before the tooth is restored.

Endodontic treatment

4. After the final visit with your endodontist, you must return to your dentist to have a crown or other restoration placed on the tooth to protect and restore it to full function.

Endodontic treatment

If the tooth lacks sufficient structure to hold the restoration in place, your dentist or endodontist may place a post inside the tooth. Ask your dentist or endodontist for more details about the specific restoration planned for your tooth.

Endodontic treatment

Will the tooth need any special care or additional treatment after endodontic treatment?
You should not chew or bite on the treated tooth until you have had it restored by your dentist. The unrestored tooth is susceptible to fracture, so you should see your dentist for a full restoration as soon as possible. Otherwise, you need only practice good oral hygiene, including brushing, flossing, and regular checkups and cleanings.

Most endodontically treated teeth last as long as other natural teeth. In a few cases, a tooth that has undergone endodontic treatment does not heal or the pain continues. Occasionally, the tooth may become painful or diseased months or even years after successful treatment. Often when this occurs, redoing the endodontic procedure can save the tooth.


What causes an endodontically treated tooth to need additional treatment?
New trauma, deep decay, or a loose, cracked or broken filling can cause new infection in your tooth. In some cases, the endodontist may discover additional very narrow or curved canals that could not be treated during the initial procedure.


Can all teeth be treated endodontically?
Most teeth can be treated. Occasionally, a tooth can’t be saved because the root canals are not accessible, the root is severely fractured, the tooth doesn’t have adequate bone support, or the tooth cannot be restored. However, advances in endodontics are making it possible to save teeth that even a few years ago would have been lost. When endodontic treatment is not effective, endodontic surgery may be able to save the tooth.




Reproduced with permission from the American Association of Endodontists.


Root Canal Retreatment

 

What is Endodontic Retreatment?

With proper care, even teeth that have had root canal treatment can last a lifetime. But sometimes, a tooth that has been treated doesn't heal properly and can become painful or diseased months or even years after treatment. If your tooth failed to heal or develops new problems, you have a second chance. An additional procedure may be able to support healing and save your tooth. If you have pain or discomfort in a previously treated tooth, talk to an endodontist about retreatment.

Why do I need another endodontic procedure?
Endodontic re-treatment As occasionally happens with any dental or medical procedure, a tooth may not heal as expected after initial treatment for a variety of reasons:
• Narrow or curved canals were not treated during the initial procedure.
• Complicated canal anatomy went undetected in the first procedure.
• The placement of the crown or other restoration was delayed following the
  endodontic treatment.
• The restoration did not prevent salivary contamination to the inside of the tooth.
• In other cases, a new problem can jeopardize a tooth that was successfully treated.
  For example:
• New decay can expose the root canal filling material to bacteria, causing a new infection
  in the tooth.
Endodontic re-treatment • The placement of the crown or other restoration was delayed following the
  endodontic treatment.
• The restoration did not prevent salivary contamination to the inside of the tooth.
• In other cases, a new problem can jeopardize a tooth that was successfully treated.
  For example:
• New decay can expose the root canal filling material to bacteria, causing a new infection
  in the tooth.
• A loose, cracked or broken crown or filling can expose the tooth to new infection.
• A tooth sustains a fracture.

Endodontic re-treatment

What will happen during retreatment?
First, the endodontist will discuss your treatment options. If you and your endodontist choose retreatment, the endodontist will reopen your tooth to gain access to the root canal filling material. In many cases, complex restorative materials—crown, post and core material—must be disassembled and removed to permit access to the root canals.

Endodontic re-treatment After removing the canal filling, the endodontist can clean the canals and carefully examine the inside of your tooth using magnification and illumination, searching for any additional canals or unusual anatomy that requires treatment.

Endodontic re-treatmentAfter cleaning the canals, the endodontist will fill and seal the canals and place a temporary filling in the tooth. If the canals are unusually narrow or blocked, your endodontist may recommend endodontic surgery. This surgery involves making an incision to allow the other end of the root to be sealed.

Endodontic re-treatmentAfter your endodontist completes retreatment, you will need to return to your dentist as soon as possible to have a new crown or other restoration placed on the tooth to protect and restore it to its full function.

Is retreatment the best choice for me?
Whenever possible, it is best to save your natural tooth. Retreated teeth can function well for years, even for a lifetime.

Advances in technology are constantly changing the way root canal treatment is performed, so your endodontist may use new techniques that were not available when you had your first procedure. Your endodontist may be able to resolve your problem with retreatment.

As with any dental or medical procedure, there are no guarantees. Your endodontist will discuss your options and the chances of success before beginning retreatment.

What are the alternatives to retreatment?
If nonsurgical retreatment is not an option, then endodontic surgery should be considered. This surgery involves making an incision to allow access to the tip of the root. Endodontic surgery may also be recommended in conjunction with retreatment or as an alternative. Your endodontist will discuss your options and recommend appropriate treatment.

What are the alternatives to endodontic retreatment and/or endodontic surgery?
The only other alternative is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these options require extensive surgery or dental procedures on adjacent healthy teeth, they can be far more costly and time consuming than retreatment and restoration of the natural tooth.

No matter how effective tooth replacements are—nothing is as good as your own natural tooth. You’ve already made an investment in saving your tooth. The payoff for choosing retreatment could be a healthy, functioning natural tooth for many years to come.



Reproduced with permission from the American Association of Endodontists.


 

Endodontic Surgery

Occasionally, a nonsurgical root canal procedure alone cannot save your tooth and your endodontist will recommend surgery. Read on to learn why you might need endodontic surgery and view a step-by-step explanation of the most common surgical procedure, an apicoectomy.

Why would I need endodontic surgery?
Endodontic re-treatment • Surgery can help save your tooth in a variety of situations.
• Surgery may be used in diagnosis. If you have persistent symptoms but no problems appear on your x-ray, your tooth may have a tiny
  fracture or canal that could not be detected during nonsurgical treatment. In such a case, surgery allows your endodontist to examine the entire
  root of your tooth, find the problem, and provide treatment.
• Sometimes calcium deposits make a canal too narrow for the instruments used in nonsurgical root canal treatment to reach the end of the root. If your tooth
  has this “calcification,” your endodontist may perform endodontic surgery to clean and seal the remainder of the canal.
• Usually, a tooth that has undergone a root canal can last the rest of your life and never need further endodontic treatment. However, in a few cases, a tooth
  may not heal or become infected. A tooth may become painful or diseased months or even years after successful treatment. If this is true for you, surgery
  may help save your tooth.
• Surgery may also be performed to treat damaged root surfaces or surrounding bone.

Although there are many surgical procedures that can be performed to save a tooth, the most common is called apicoectomy or root-end resection. When inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure, your endodontist may have to perform an apicoectomy.

Endodontic re-treatment

What is an apicoectomy?

In this procedure, the endodontist opens the gum tissue near the tooth to see the underlying bone and to remove any inflamed or infected tissue. The very end of the root is also removed.

A small filling may be placed in the root to seal the end of the root canal, and a few stitches or sutures are placed in the gingiva to help the tissue heal properly.

Over a period of months, the bone heals around the end of the root.

Are there other types of endodontic surgery?
Other surgeries endodontists might perform include dividing a tooth in half, repairing an injured root, or even removing one or more roots. Your endodontist will be happy to discuss the specific type of surgery your tooth requires.

In certain cases, a procedure called intentional replantation may be performed. In this procedure, a tooth is extracted, treated with an endodontic procedure while it is out of the mouth, and then replaced in its socket.

These procedures are designed to help you save your tooth.

Will the procedure hurt?
Local anesthetics make the procedure comfortable. Of course, you may feel some discomfort or experience slight swelling while the incision heals. This is normal for any surgical procedure. Your endodontist will recommend appropriate pain medication to alleviate your discomfort.

Your endodontist will give you specific postoperative instructions to follow. If you have questions after your procedure, or if you have pain that does not respond to medication, call your endodontist.

Can I drive myself home?
Often you can, but you should ask your endodontist before your appointment so that you can make transportation arrangements if necessary.

When can I return to my normal activities?
Most patients return to work or other routine activities the next day. Your endodontist will be happy to discuss your expected recovery time with you.

Does insurance cover endodontic surgery?
Each insurance plan is different. Check with your employer or insurance company prior to treatment.

How do I know the surgery will be successful?
Your dentist or endodontist is suggesting endodontic surgery because he or she believes it is the best option for saving your own natural tooth. Of course, there are no guarantees with any surgical procedure. Your endodontist will discuss your chances for success so that you can make an informed decision.

What are the alternatives to endodontic surgery?
Often, the only alternative to surgery is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge, or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these alternatives require surgery or dental procedures on adjacent healthy teeth, endodontic surgery is usually the most biologic and cost-effective option for maintaining your oral health.

No matter how effective modern artificial tooth replacements are—and they can be very effective—nothing is as good as a natural tooth. You’ve already made an investment in saving your tooth. The pay-off for choosing endodontic surgery could be a healthy, functioning natural tooth for the rest of your life.



Reproduced with permission from the American Association of Endodontists.


Traumatic Dental Injuries

Traumatic dental injuries often occur in accidents or sports-related injuries. Chipped teeth account for the majority of all dental injuries. Dislodged or knocked-out teeth are examples of less frequent, but more severe injuries. Treatment depends on the type, location and severity of each injury. Any dental injury, even if apparently mild, requires examination by a dentist or an endodontist immediately. Sometimes, neighboring teeth suffer an additional, unnoticed injury that will only be detected by a thorough dental exam. Endodontists specialize in treating traumatic dental injuries. With their advanced skills, techniques and technologies they can often save injured teeth.

How will my injury be treated?
Chipped or Fractured Teeth

Endodontic re-treatment

Most chipped or fractured tooth crowns can be repaired either by reattaching the broken piece or by placing a tooth-colored filling. If a significant portion of the tooth crown is broken off, an artificial crown or “cap” may be needed to restore the tooth.

If the pulp is exposed or damaged after a crown fracture, root canal treatment may be needed. These injuries require special attention. If breathing through your mouth or drinking cold fluids is painful, bite on clean, moist gauze or cloth to help relieve symptoms until reaching your dentist’s office. Never use topical oral pain medications (such as Anbesol®) or ointments, or place aspirin on the affected areas to eliminate pain symptoms.

Injuries in the back teeth often include fractured cusps, cracked teeth and the more serious split tooth. If cracks extend into the root, root canal treatment and a full coverage crown may be needed to restore function to the tooth. Split teeth may require extraction.

Dislodged (Luxated) Teeth
Endodontic re-treatment During an injury, a tooth may be pushed sideways, out of or into its socket. Your endodontist or general dentist will reposition and stabilize your tooth. Root canal treatment is usually needed for permanent teeth that have been dislodged and should be started a few days following the injury. Medication such as calcium hydroxide may be put inside the tooth as part of the root canal treatment. A permanent root canal filling will be placed at a later date.

Children between seven and 12 years old may not need root canal treatment since their teeth are still developing. For those patients, an endodontist or dentist will monitor the healing carefully and intervene immediately if any unfavorable changes appear. Therefore, multiple follow-up appointments are likely to be needed. New research indicates that stem cells present in the pulps of young people can be stimulated to complete root growth and heal the pulp following injuries or infection.

Knocked-Out (Avulsed) Teeth
If a tooth is completely knocked out of your mouth, time is of the essence. See an endodontist or dentist immediately! Handled the knocked-out tooth very gently, Endodontic re-treatment avoiding touching the root surface and follow these steps to protect the tooth.

Your endodontist or dentist will carefully evaluate the tooth, place it back in its socket and examine you for any other dental and facial injuries. A stabilizing splint will be placed for a few weeks. Depending on the stage of root development, your dentist or endodontist may start root canal treatment a week or two later. A medication may be placed inside the tooth followed by a permanent root canal filling at a later date.

Endodontic re-treatment

The length of time the tooth was out of the mouth and the way the tooth was stored before reaching the dentist influence the chances of saving the tooth. Again, immediate treatment is essential. Taking all these factors into account, your dentist or endodontist may discuss other treatment options with you.

Root Fractures
Endodontic re-treatment A traumatic injury to the tooth may also result in a horizontal root fracture. The location of the fracture determines the long-term health of the tooth. If the fracture is close to the root tip, the chances for success are much better. However, the closer the fracture is to the gum line, the poorer the long-term success rate. Sometimes, stabilization with a splint is required for a period of time.

Do traumatic dental injuries differ in children?
Chipped primary (baby) teeth can be esthetically restored. Dislodged primary teeth can, in rare cases, be repositioned. However, primary teeth that have been knocked out typically should not be replanted. This is because the replantation of a knocked-out primary tooth may cause further and permanent damage to the underlying permanent tooth that is growing inside the bone.

Children’s permanent teeth that are not fully developed at the time of the injury need special attention and careful follow up, but not all of them will need root canal treatment. In an immature permanent tooth, the blood supply to the tooth and the presence of stem cells in the region may enable your dentist or endodontist to stimulate continued root growth.

Endodontists have the knowledge and skill to treat incompletely formed roots in children so that, in some instances, the roots can continue to develop. Endodontists will do all that is possible to save the natural tooth. These specialists are the logical source of information and expertise for children who are victims of dental trauma.

Will the tooth need any special care or additional treatment?
The nature of the injury, the length of time from injury to treatment, how your tooth was cared for after the injury and your body’s response all affect the long-term health of the tooth. Timely treatment is particularly important with dislodged or knocked-out teeth in order to prevent root resorption.

Resorption occurs when your body, through its own defense mechanisms, begins to reject your own tooth in response to the traumatic injury. Following the injury, you should return to your dentist or endodontist to have the tooth examined and/or treated at regular intervals for up to five years to ensure that root resorption is not occurring and that surrounding tissues continue to heal. It has to be noted that some types of resorption are untreatable.

Reproduced with permission from the American Association of Endodontists.


 

Cracked Teeth

Our smiles are built to last. In fact, tooth enamel — the outer surface of our teeth — is the hardest substance in the human body, stronger even than our bones. That tooth enamel can withstand a lot of wear and tear. But as we live longer, and expose our teeth to stresses like clenching, grinding or chewing on hard objects, we can put our smiles at risk. If you think you have a cracked tooth, it's important to seek treatment quickly, before the problem gets worse.

How do I know if my tooth is cracked?
Endodontic re-treatment 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 pulp contains the tooth's nerves and blood vessels.

When the outer hard tissues of the tooth are cracked, chewing can cause movement of the pieces, and the pulp can become irritated. 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 surrounding the tooth.

What if my tooth is chipped?
Chipped teeth account for the majority of dental injuries. Most chipped teeth can be repaired either by reattaching the broken piece of tooth enamel or by bonding a tooth-colored filling or crown in place. See your dentist as soon as possible after the injury to treat your chipped tooth and keep it from worsening.

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
Endodontic re-treatment When a piece of a tooth’s chewing surface breaks off, often around a filling, it’s called a fractured cusp. A fractured cusp rarely damages the pulp, and usually doesn’t cause much pain. Your dentist can place a new filling or crown over the damaged tooth to protect it.

If you've cracked a tooth and breathing through your mouth or drinking cold fluids is painful, bite on clean, moist gauze or cloth to help relieve symptoms until reaching your dentist’s office. Never use topical oral pain medications (such as Anbesol®) or ointments, or place aspirin on the affected areas to eliminate pain symptoms.

Cracked Tooth
A cracked tooth means a crack extends from the chewing surface of your tooth vertically toward the root. The tooth is not yet separated into pieces, though the crack may gradually spread. Early diagnosis is important in order to save the tooth. If the crack has extended into the pulp, the tooth can be treated with a root canal procedure and a crown to protect the crack from spreading.

However, if the crack extends below the gum line, it is no longer treatable, and the tooth cannot be saved and will need to be extracted. That’s why early treatment is so important. 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
Endodontic re-treatment 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 some cases, endodontic treatment may be performed to save a portion of the tooth.

Vertical Root Fracture
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 tooth can be saved by removal of the fractured portion.

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 endodontist about your particular diagnosis and treatment recommendations.

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.



Reproduced with permission from the American Association of Endodontists.


Sedation

Sedation in dentistry is used to help patients relax during dental procedures. We offer 3 types of sedation:

Inhaled Sedation:
With inhaled sedation, our patient breathes nitrous oxide, also known as "laughing gas", combined with oxygen through a mask placed over their nose. The gas helps you relax while being awake and tends to wear off quickly. With this form of sedation, most patients are able to drive themselves after the procedure.

Oral Sedation:
With oral sedation, our patient takes a pill at a predetermined time prior to procedure. Typically, the pill is Halcion or Valium, both members of the same drug family. The pill will make you drowsy and sleepy but still responsive if needed. Patients with this type of sedation will need adult supervision for 24 hours starting at the time they take the pill. Patients should not attempt to drive or operate machinery during that time frame.

Intravenous (IV) Sedation:
With IV sedation, our patient receives the sedative drug through a vein. This type of sedation is used for cases of extreme dental anxiety or complex dental procedures that require an extended period of time. You will still be conscious and responsive if needed. IV sedation is performed by a Dental Anesthesiologist. Patients with this type of sedation will need adult supervision for 24 hours starting at the time they receive sedation. Patients should not attempt to drive or operate machinery during that time frame.

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