Doctors Blog
April 14th, 2014 - Why does my tooth hurt after a root canal?
A common misconception when that I hear when treating patient's is that a Root Canal treatment is the answer to all of your tooth pain. That is only partly true.
There are a number of possible causes of pain after the completion of a root canal. After a root canal is completed no living pulp tissue remains inside the tooth, but nerve endings remain in the ligaments that attach the tooth to the surrounding bone. These ligaments have nerve fiber associated with them that can feel pain. They are the source of any post root canal pain.
One possible cause of pain are numerous and include inflammation of the periapical tissues post root canal. This inflammation may be due to extruded sealer or 'over instrumentation during the endodontic procedure. Sometimes the root canal files go past the apical terminus and can either inject some debris periapically or just damage the ligaments. This inflammation usually resolves by itself given enough time.
Another source of post root canal discomfort is a high bite and this can easily be corrected by a dentist. If a patient bites down, with no food in their mouth and their root canaled tooth hurts, then the bite should be adjusted. Teeth undergoing root canals should be not be in a heavy occlusion.
Other possible causes of pain are a persistent infection or a root fracture. If a root canal is completed, but an infection still is present around the periapical area then a retreatment may be indicated especially if significant time has gone by without a resolution of the infection. Sometimes an infection can be caused by a fracture of the tooth in question and in that case the tooth usually has a hopeless prognosis and requires extraction.
It is also possible, but not as common that persistent pain exists due to a sensitization of a nerve ganglion We have all heard of 'phantom limb pain'. This a similar phenomenon. Some of these patients can have pain even after the offending tooth is removed.
April 7th, 2014 - Cosmetic Composite Bonding vs Porcelain Veneers
One of the most common questions I get in my office is 'What is the differece between Veneers and Bonding?'
I'll start with what each procedure is exactly and then I'll get into the Pros and Cons of each.
Porcelain veneers are thin pieces of porcelain used to recreate the natural look of teeth, while also providing strength and resilience comparable to natural tooth enamel.
Veneers are routinely used to fix:
- Teeth that are discolored -- either because of root canal treatment; stains from tetracycline or other drugs, excessive fluoride or other causes; or the presence of large resin fillings that have discolored the tooth
- Teeth that are worn down
- Teeth that are chipped or broken
- Teeth that are misaligned, uneven, or irregularly shaped (for example, have craters or bulges in them)
- Teeth with gaps between them (to close the space between these teeth)
What's the Procedure for Getting a Dental Veneer?
- Getting a dental veneer usually requires three trips to the dentist – one for a consultation and two to make and apply the veneers. One tooth or many teeth can simultaneously undergo the veneering process described below.
o Diagnosis and treatment planning: This first step involves your active participation. Explain to your dentist the result that you are trying to achieve. During this appointment, your dentist will examine your teeth to make sure dental veneers are appropriate for you and discuss what the procedure will involve and some of its limitations. He or she also may take X-rays and possibly make impressions of your mouth and teeth.
o Preparation: To prepare a tooth for a veneer, your dentist typically will remove about 1/2 millimeter of enamel from the tooth surface, which is an amount nearly equal to the thickness of the veneer to be added to the tooth surface. Before trimming off the enamel, you and your dentist will decide the need for a local anesthetic to numb the area. Next, your dentist will make a model or impression of your tooth. This model is sent out to a dental laboratory, which in turn constructs your veneer. It usually takes 1-2 weeks for your dentist to receive the veneers back from the laboratory. During this time you will given temporary veneers.
o Bonding: Before the dental veneer is permanently cemented to your tooth, your dentist will temporarily place it on your tooth to examine its fit and color. He or she will repeatedly remove and trim the veneer as needed to achieve the proper fit; the veneer color can be adjusted with the shade of cement to be used. Next, to prepare your tooth to receive the veneer, your tooth will be cleaned, polished, and etched -- which roughens the tooth to allow for a strong bonding process. A special cement is applied to the veneer and the veneer is then placed on your tooth. Once properly position on the tooth, your dentist will apply a special light beam to the dental veneer, which activates chemicals in the cement, causing it to harden or cure very quickly. The final steps involve removing any excess cement, evaluating your bite and making any final adjustments in the veneer as necessary. Your dentist may ask you to return for a follow-up visit in a couple of weeks to check how your gums are responding to the presence of your veneer and to once again examine the veneer's placement.
Cosmetic Composite Bonding is a procedure in which a tooth-colored resin material (a durable plastic material) is applied and hardened with a special light, which ultimately "bonds" the material to the tooth to restore or improve person's smile.
Bonding is among the easiest and least expensive of cosmetic dental procedures. The composite resin used in bonding can be shaped and polished to match the surrounding teeth. Most often, bonding is used for cosmetic purposes to improve the appearance of a discolored or chipped tooth. It also can be used to close spaces between teeth, to make teeth look longer or to change the shape or color of teeth.
What’s the Procedure for Getting a Cosmetic Bonding?
Your dentist will use a shade guide to select the composite resin color that will match the color of the tooth most closely.
Once your dentist has chosen the color, he or she will slightly abrade or etch the surface of the tooth to roughen it. The tooth will be coated lightly with a conditioning liquid, which helps the bonding material adhere.
When the tooth is prepared, your dentist will apply the tooth-colored, putty-like resin. The resin is molded and smoothed until it's the proper shape. Then the material is hardened with an ultraviolet light or laser.
After the bonding material hardens, your dentist will further trim and shape it. Then he or she will polish the material until it matches the sheen of the rest of the tooth surface.
It usually takes about 30 minutes to an hour to complete the procedure. If you're having more than one tooth done, you may need to schedule several visits.
Tea, coffee, cigarette smoke and other substances can stain the resin. To prevent or minimize stains, it's essential to avoid eating or drinking foods that can stain for the first 48 hours after any composite procedure. In addition, brush your teeth often and have them cleaned regularly by a dental hygienist.
Pros and Cons:
Veneers are a great way to improve your smile, especially if your teeth are chipped, malformed, very discolored or will not and cannot be whitened. The pros of veneers are that they can be done in only two visits, the color easily changes, and the porcelain has the real look of teeth and will not stain. The main con is that the teeth sometimes have to be shaped so it’s generally not a reversible procedure. But veneers will give you the smile everyone wants.
Veneers are typically more costly than Cosmetic Bonding and they don’t typically need to be replaced for 15-20 years.
Dental Bonding Advantages include:
- Cost: The average cost of dental bonding ranges from $300 to $600 per tooth. “But many dental insurance plans cover most of the cost of bonding, particularly when it is done for structural reasons or to fill a cavity,” says Harms.
- Speed: Dental bonding typically requires only one office visit. The entire process can be accomplished in 30 to 60 minutes per tooth.
- Ease: Anesthesia is usually not necessary, unless bonding is being used to fill a decayed tooth. Compared to veneers and crowns, dental bonding also requires the least amount of enamel removal.
Disadvantages of dental bonding include:
- Staining: Unlike crowns and porcelain veneers, dental bonding has a tendency to become discolored over time. Coffee, tea, red wine, and cigarette smoke can stain the material used in dental bonding, making it stand out from the rest of your teeth. To minimize staining, you’ll need to avoid these substances for 24 to 48 hours after bonding is first performed. If you’re a smoker, you’ll want to choose a different cosmetic dentistry treatment. Because bonding material is porous, it will yellow from exposure to cigarette smoke.
- Less durable: Additionally, the material used in dental bonding isn’t as strong and long-lasting as porcelain veneers and crowns. It can easily chip. With proper care though, dental bonding can last three to seven years.