It’s a scenario that can surprise even the most diligent dental patient: your dentist removes an old crown, and beneath it lies a significant amount of decay. This decay, often hidden from view and undetectable through regular dental X-rays, can pose a serious threat to the tooth’s structure and health. When this happens, several treatment options must be considered based on the extent of the decay, the location of the tooth, and various patient-specific factors.
The Discovery of Hidden Decay
The discovery of hidden decay under an old crown typically occurs during the removal of the crown for replacement or due to discomfort reported by the patient. The decay might have developed due to a poor fit of the old crown, inadequate oral hygiene, or other factors. When a dentist uncovers extensive decay, immediate steps must be taken to address the damage and decide on the best course of action.
Evaluating the Extent of Decay
Upon discovering the decay, the dentist will assess the extent of the damage. This evaluation is crucial to determine if the tooth can be saved or if extraction is the most viable option. Factors that influence this decision include:
Amount of Remaining Tooth Structure: If there is insufficient healthy tooth structure left, saving the tooth might not be possible.
Location of the Tooth: The position of the tooth in the mouth can influence the treatment choice. Front teeth have different functional and aesthetic considerations compared to molars.
Patient Preferences and Health: Patient’s overall health, preferences, and age also play a significant role in deciding the treatment plan.
Treatment Options for Extensive Decay
Crown Lengthening:
Crown lengthening is a procedure that involves reshaping the gum and bone tissue to expose more of the tooth’s structure, providing a stable base for a new crown. This can be a viable option if there is enough tooth structure to support the procedure.
Case Example: Recently, a patient with extensive decay under an old crown on tooth #31 opted for crown lengthening. The old post was removed, a new post was placed, and a new buildup was done. The use of a CO2 laser facilitated the process, making it efficient and precise. The tooth, being out of the esthetic zone, allowed for a focus on functionality over aesthetics.
Extraction and Replacement Options:
If the decay is too extensive, the tooth may need to be extracted. Post-extraction, several replacement options are available:
Ridge Preservation and Guided Tissue Regeneration (GTR): These procedures help maintain the bone structure and prepare the site for an implant. Ridge preservation involves placing bone graft material into the socket immediately after extraction to prevent bone loss. GTR may involve the use of membranes to guide the bone regeneration process.
Dental Implant: Implants are a popular and effective solution for replacing a missing tooth. They provide a permanent, stable replacement that looks and functions like a natural tooth. The success of implants depends on the amount of available bone and the patient’s overall health.
Dental Bridge: A bridge is another fixed option for replacing a missing tooth. It involves placing crowns on adjacent teeth and a false tooth in between. Bridges can be a good alternative if implants are not feasible.
Removable Partial Denture: Although typically less popular, removable partial dentures are a cost-effective solution. They can be taken out and cleaned easily but may not offer the same comfort and stability as fixed options.
Why Address Hidden Decay Even If Asymptomatic
Many patients might wonder why they need to address decay if they don’t feel any pain or see visible problems. Here are some crucial reasons:
Prevent Further Damage: Untreated decay can continue to progress, leading to more severe damage that can compromise the entire tooth or even adjacent teeth.
Avoid Infections: Decay can lead to infections, which might require more intensive treatments like root canals or extractions.
Maintain Oral Health: Treating decay early helps maintain overall oral health, preventing more complex and costly dental issues down the line.
Aesthetic and Functional Integrity: Even if a tooth is out of the esthetic zone, maintaining its functional integrity is vital for chewing and overall dental alignment.
Long-Term Savings: Addressing dental issues promptly can save money in the long run by avoiding more extensive procedures.
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Discovering extensive decay under an old crown is a challenging situation, but modern dentistry offers several viable solutions. The chosen treatment depends on the extent of the decay, the location of the tooth, and patient-specific factors such as health, preferences, and financial considerations. By evaluating all options, your dentist can help you make an informed decision that ensures the best possible outcome for your dental health and overall well-being.
If you suspect any issues with your old crowns or have concerns about your dental health, consult your dentist. Addressing problems early, even if asymptomatic, is key to maintaining a healthy and functional smile.
A painful bump or ulcer in your mouth can be frustrating and concerning. While canker sores and cold sores are common culprits, it’s important to remember that mouth sores can have various causes. This post will shed light on the key differences between canker sores and cold sores, helping you navigate the discomfort and seek appropriate solutions.
The Difference Between Canker Sores and Cold Sores: It’s Not All Blisters and Bites
While both canker sores and cold sores bring discomfort, they have distinct characteristics:
Feature
Canker Sore (Aphthous Ulcer)
Cold Sore (Fever Blister)
Location
Inside the mouth: cheeks, tongue, gums
Outside the mouth: lips, around the mouth
Appearance
Round, white or gray ulcer with a red border
Cluster of small, fluid-filled blisters
Size
Smaller (usually under 1 cm)
Larger (can grow up to 1 cm)
Pain
More painful, especially when touched
Tingling, burning, itching before blistering
Contagious
No
Yes, highly contagious through contact
Cause
Unknown, linked to stress, diet, injury
Herpes simplex virus (HSV-1)
Remember: This is a general comparison. If you experience a mouth sore with unusual characteristics or prolonged healing time, consult your dentist for a diagnosis. Early diagnosis can ensure proper treatment and rule out any other potential causes.
Finding Relief: Exploring Remedies for Mouth Sore Discomfort
While the cause of canker sores remains elusive, several remedies can help manage discomfort and promote healing:
Over-the-counter pain relievers: Options like ibuprofen or acetaminophen can help manage pain and inflammation.
Topical ointments: Look for gels or ointments containing lidocaine for numbing or zine oxide to protect the sore.
Mouth rinses: Use a gentle, alcohol-free mouthwash to maintain oral hygiene without irritation.
Dietary adjustments: Avoid acidic or spicy foods that can worsen discomfort. Focus on soft, bland foods.
Lysine: This amino acid is a popular over-the-counter option for cold sores. While research results are mixed, some studies suggest it may reduce outbreak frequency or shorten healing time.
Natural Remedies: While research is ongoing, some natural options may offer relief, but be sure to consult your dentist before using any new product:
Honey: A natural antibacterial and anti-inflammatory agent, honey can promote healing. Apply a small amount directly to the sore (not recommended for young children).
Licorice root: This herb possesses anti-inflammatory properties. Look for licorice root extracts in lozenges or gels (consult your dentist before using licorice root if you have high blood pressure).
Aloe vera: The gel from this plant has soothing and healing properties. Apply a small amount to the sore.
Important Note: The effectiveness can vary with these natural remedies. Consult your dentist before using any new product, especially if you have underlying health conditions.
A Promising Option: Laser Therapy
Another area that has shown promise is with the use of a diode laser to treat the affected region of the mouth.
Cold Sores: Diode laser therapy, particularly during the prodromal stage (tingling, itching before blisters appear), can potentially prevent a cold sore from fully erupting. Additionally, some patients report a reduced frequency of outbreaks with repeated laser treatments.
Canker Sores: Many patients have reported almost immediate relief from painful canker sores after in-office treatment with a diode laser.
Pain relief: Laser therapy can alleviate discomfort associated with both canker sores and cold sores.
Reduced risk of infection: Lasers may have a disinfecting effect, minimizing the risk of secondary infections.
Disclaimer: It’s important to note that laser therapy is not a one-size-fits-all solution, and further research is needed to solidify its effectiveness for canker sores
When in Doubt, Consult Your Dentist
While this post provides a general overview, a definitive diagnosis is crucial for proper treatment. Your dentist can examine the sore, determine its cause (canker sore, cold sore, or something else), and recommend the most effective course of action.
By understanding the differences between canker sores and cold sores, exploring potential remedies, and prioritizing a dentist’s diagnosis, you can navigate mouth sore discomfort with more clarity and confidence. Remember, early diagnosis and proper care are key to a speedy recovery and a more comfortable smile.
Lasers are familiar to many of us from science fiction (think of the Star Wars light saber) to comedy (remember Austin Powers’ Dr. Evil?). The fact is that lasers surround us in every-day life. For example, in the home you will find them in CD players, while industry uses them for high-speed metal cutting machines and measuring devices. Hair replacement, tattoo removal, dermatologists, eye surgeons — they all use lasers.
So do dentists. And so does our office.
This begs the question, just what is a laser? How is it different from any other kind of light? “If Dr. Evil planned to destroy the world with one, why won’t it hurt me when you use it on my gums?!” Actually, that’s three questions . . . .
Anyway, let’s try take them in order:
The word “LASER” itself is an acronym that stands for light amplification by stimulated emission of radiation. This concisely describes exactly how a laser works. The laser is a device which controls the way that energized atoms release photons (a quantum of electromagnetic energy). When we say “radiation” however, we are not talking about ionizing radiation — such as would be produced by an x-ray.
Laser light is very different from normal light or radiation emitted by an x-ray. Laser light has the following properties:
The light released is monochromatic. It contains one specific wavelength of light (one specific color). The wavelength of light is determined by the amount of energy released when the electron drops to a lower orbit.
The light released is coherent. It is “organized” — each photon moves in step with the others. This means that all of the photons have wave fronts that launch in unison.
The light is very directional. A laser light has a collimated (very tight) beam. This makes it stronger and concentrated. A flashlight, on the other hand, releases light in many directions, and the light is very weak and diffuse.
Why won’t it burn you to a crisp when we use it on your gums? Clearly, we’re using a controlled power setting (in our office we use a diode laser) — in fact, most patients tell us they don’t feel anything when we use it in conjunction with their dental cleanings. But that doesn’t mean it isn’t effective!
Watch the video below for a demonstration and explanation of how a dental laser is being used during a routine cleaning.
If you would like to read more about how we use a dental laser in our office and how it can benefit your health, check out the following article posted in the Services section of our website:
Dr. Richard Walicki is a dentist practicing general and cosmetic dentistry. While we hope you find the information contained herein interesting and useful, this blog is for informational purposes and is not intended to diagnose any oral disease. Dental conditions should be evaluated by your dental health professional or a qualified specialist.
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