Wednesday , 1 October 2014
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Word of Mouth: Oral Health Advice

I did not see a dentist for a while and recently found out that an upper front tooth has large decay under a capped tooth. My dentist said it was below my gum. I have been given some options but I am confused with these choices. I could use some guidance.

Your situation is not uncommon. Many patients have crowns that were placed years ago and were never a concern until the restoration fails. There are several factors to be considered when addressing this issue.

First, cosmetics should be the foremost consideration; then practicality. To save what remains of the tooth structure, you need what is called “crown lengthening.” This procedure involves raising the gum and underlying bone up and away from the decay to expose healthy root of the tooth so your dentist can clean out the decay and prep the tooth for a new crown. Bear in mind that if this procedure is performed, this tooth will be longer than the other teeth as the gum line will be uneven, causing the tooth to look like a “vampire tooth” when you smile.

Another option would be to remove the tooth and make a bridge to replace it. However, this presents a couple of issues, which are not advocated:

1) Two of the adjacent healthy, non-compromised teeth would have to be cut down, and

2) If you are prone to decay, you run the risk of this happening again.

Since this is an upper front tooth, the best long-term esthetic solution would be to remove the tooth and immediately place a dental implant. You may think this is extreme, but stop and think of the many advantages of this option:

• A dental implant does not decay.

• A dental implant will never need a root canal.

• A dental implant is easy to maintain. Flossing and brushing are simple and a healthy oral environment is intact.

My wife is under a lot of stress – work, family and just everyday issues. If the pain does not interrupt her sleep, she wakes up in the morning with severe discomfort. It is difficult for her to open her mouth wide to brush her teeth or eat, for example. Should we seek medical help?

This is probably one of the most misdiagnosed problems that cross between dental and medical professionals. For many reasons, proper attention should be given, hopefully ruling out invasive treatment.

Let’s begin with mechanics. At night, subconsciously, our jaw muscles contract and grinding habits are formed. Over time, this dysfunction will throw off the bite as the teeth are no longer aligned, resulting in earaches and headaches. In dental terminology this is referred to as TMJ (temporomandibular joint) syndrome. To break this cycle, initially, certain foods should be avoided and warm compresses can be applied to relieve the throbbing. It is recommended that impressions for an acrylic night guard appliance be taken and a series of occlusal adjustments be completed. Depending on the severity of the condition, success of this treatment should be realized quickly.

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