Options for a badly broken tooth
As dentists we always talk about disease prevention, early detection, dealing with problems to reduce cost and improve prognosis. The reality is that a patient comes to see us when there is a problem and typically a badly broken tooth that is causing pain or discomfort. So what options do we have to solve this problem?
Broadly speaking we can (1) try to repair and restore the tooth, or (2) remove the tooth and try to replace it with something.
Whether a "slightly" chipped tooth can be dealt with polishing, we will need to examine the extent of the chip or fracture. Depending on the severity, the treatment option may vary from polishing to restorative (filling or crowning), however in more extreme situation, a root canal treatment or extraction may be necessary.
Broadly speaking we can (1) try to repair and restore the tooth, or (2) remove the tooth and try to replace it with something.
Whether a "slightly" chipped tooth can be dealt with polishing, we will need to examine the extent of the chip or fracture. Depending on the severity, the treatment option may vary from polishing to restorative (filling or crowning), however in more extreme situation, a root canal treatment or extraction may be necessary.
|
Repairing and Restoring the Tooth
All our teeth contain four different types of tissues that form the framework of a tooth. The enamel, dentin and cementum are the hard tissues of a tooth, while the soft core consist of blood vessels, lymph vessels, connective tissue and nerves called the pulp. Often referred to as the "nerve" because of the sensation (and pain) that originates from it. Small, shallow cavities may not cause pain and may go unnoticed by the patient. In a badly broken down or cracked tooth the pulp is compromised. Deep or large cavities can be painful and collect food debris. Root canal therapy is a process of removing the nerve of a tooth, disinfecting the inside of the tooth and finally filling the space with an inert material to prevent germs from leaking back into the tooth and surrounding bone. |
Enamel acts as a protective covering, forms the outermost surface of the crown of the tooth. Enamel may be weakened by acid erosion caused by plaque and wear-and-tear as a person aged.
|
When would we do this?
the most obvious time when we do this is if there is a toothache caused by the nerve
What does the process involve?
Removal of diseased/damaged tooth structure - all decayed structure is removed. This ensures that only solid tooth structure will be supporting whatever restoration we place on the tooth.
cleaning and shaping - this is usually the most time consuming part of the procedure and involves using a series of fine, flexible instruments to remove the pulp tissue and any infected material from inside the root canal(s) of the tooth.
Placing Medicament - after the initial cleaning there is almost always still some bacteria in the tooth and medicament (usually calcium hydroxide paste) is placed in the tooth. The paste has antiseptic properties and helps eliminate any residual bacteria.
Root filling - we seal the inside of the root canals usually with a combination of a specially formulated root canal cement and Gutta Percha.
Core buildup - Once the root canals have been sealed the upper half of the tooth needs to be sealed with a filling material usually a resin or Glass Ionomer Cement type material. The reason we do not seal the upper half of the tooth with the same Gutta Percha and cement as the root canals is that these materials are actually relatively soft and also some of the cements are known to discolour the tooth structure.
A crown is often necessary after a root canal therapy to protect the tooth against cracking and to improve the protection of the visible part of the tooth and prevent bacteria from infiltrating the tooth. We refer to this as 'coronal seal' and it plays a vital part in the success of root canal therapy.
Removing the tooth
A tooth may be extracted if a tooth is badly decayed or the root of the tooth is fractured. I would only choose this option if the tooth was truly beyond repair or if maintaining it would cause even more problems to the patient (for example if the tooth is very badly positioned and will cause problems with restoring other teeth).
Sometimes this option is chosen by the patient for financial or personal reasons not directly related to the treatment itself. It is a great pity that this situation still does arise quite frequently despite the increasing affluence of our society but the patient is the ultimate decision maker and we as professionals respect that decision.
If the patient seeks to replace the lost tooth, the options are
1) a dental implant supporting a crown
2) a dental bridge (of which there are various designs)
3) a removable denture
Read more Denture After care
the most obvious time when we do this is if there is a toothache caused by the nerve
What does the process involve?
Removal of diseased/damaged tooth structure - all decayed structure is removed. This ensures that only solid tooth structure will be supporting whatever restoration we place on the tooth.
cleaning and shaping - this is usually the most time consuming part of the procedure and involves using a series of fine, flexible instruments to remove the pulp tissue and any infected material from inside the root canal(s) of the tooth.
Placing Medicament - after the initial cleaning there is almost always still some bacteria in the tooth and medicament (usually calcium hydroxide paste) is placed in the tooth. The paste has antiseptic properties and helps eliminate any residual bacteria.
Root filling - we seal the inside of the root canals usually with a combination of a specially formulated root canal cement and Gutta Percha.
Core buildup - Once the root canals have been sealed the upper half of the tooth needs to be sealed with a filling material usually a resin or Glass Ionomer Cement type material. The reason we do not seal the upper half of the tooth with the same Gutta Percha and cement as the root canals is that these materials are actually relatively soft and also some of the cements are known to discolour the tooth structure.
A crown is often necessary after a root canal therapy to protect the tooth against cracking and to improve the protection of the visible part of the tooth and prevent bacteria from infiltrating the tooth. We refer to this as 'coronal seal' and it plays a vital part in the success of root canal therapy.
Removing the tooth
A tooth may be extracted if a tooth is badly decayed or the root of the tooth is fractured. I would only choose this option if the tooth was truly beyond repair or if maintaining it would cause even more problems to the patient (for example if the tooth is very badly positioned and will cause problems with restoring other teeth).
Sometimes this option is chosen by the patient for financial or personal reasons not directly related to the treatment itself. It is a great pity that this situation still does arise quite frequently despite the increasing affluence of our society but the patient is the ultimate decision maker and we as professionals respect that decision.
If the patient seeks to replace the lost tooth, the options are
1) a dental implant supporting a crown
2) a dental bridge (of which there are various designs)
3) a removable denture
Read more Denture After care