Prevention & Oral Health Services
Our mouths are full of bacteria. Hundreds of different types live on our teeth, gums, tongue and other places in our mouths. Some bacteria are helpful. But some can be harmful such as those that play a role in the tooth decay process.
Tooth decay is the result of an infection with certain types of bacteria that use sugars in food to make acids. Over time, these acids can make a cavity in the tooth.
On one team are dental plaque—a sticky, colorless film of bacteria—plus foods and drinks that contain sugar or starch (such as milk, bread, cookies, candy, soda, juice, and many others). Whenever we eat or drink something that contains sugar or starch, the bacteria use them to produce acids. These acids begin to eat away at the tooth’s hard outer surface, or enamel.
On the other team are the minerals in our saliva (such as calcium and phosphate) plus fluoride from toothpaste, water, and other sources. This team helps enamel repair itself by replacing minerals lost during an “acid attack.”
Our teeth go through this natural process of losing minerals and regaining minerals all day long.
When a tooth is exposed to acid frequently — for example, if you eat or drink often, especially foods or drinks containing sugar and starches — the repeated cycles of acid attacks cause the enamel to continue to lose minerals. A white spot may appear where minerals have been lost. This is a sign of early decay.
How can we help teeth win the tug of war and avoid a cavity?
Using flouride. Fluoride is a mineral that can prevent tooth decay from progressing. It can even reverse, or stop, early tooth decay.
Fluoride works to protect teeth. It . . .
- prevents mineral loss in tooth enamel and replaces lost minerals
- reduces the ability of bacteria to make acid
You can get fluoride by:
- Drinking fluoridated water from a community water supply; about 74 percent of Americans served by a community water supply system receive fluoridated water.
- Brushing with a fluoride toothpaste
You may need to apply additional fluoride by:
- Apply a fluoride gel or varnish to tooth surfaces
- Prescribe fluoride tablets
- Recommend using a fluoride mouth rinse
Tooth decay can be stopped or reversed at this point. Enamel can repair itself by using minerals from saliva, and fluoride from toothpaste or other sources.
But if the tooth decay process continues, more minerals are lost. Over time, the enamel is weakened and destroyed, forming a cavity. A cavity is permanent damage that a dentist has to repair with a filling.
A dental extraction (also referred to as exodontia) is the removal of a tooth from the mouth. Extractions are performed for a wide variety of reasons, including tooth decay that has destroyed enough tooth structure to prevent restoration. Extractions of impacted or problematic wisdom teeth are routinely performed, as are extractions of some permanent teeth to make space for orthodontic treatment.
Types of extraction
Simple extractions are performed on teeth that are visible in the mouth, usually under local anesthetic, and require only the use of instruments to elevate and/or grasp the visible portion of the tooth. Typically the tooth is lifted using an elevator, and using dental forceps, rocked back and forth until the Periodontal ligament has been sufficiently broken and the supporting alveolar bone has been adequately widened to make the tooth loose enough to remove. Typically, when teeth are removed with forceps, slow, steady pressure is applied with controlled force.
Surgical extractions involve the removal of teeth that cannot be easily accessed, either because they have broken under the gum line or because they have not erupted fully. Surgical extractions almost always require an incision. In a surgical extraction the doctor may elevate the soft tissues covering the tooth and bone and may also remove some of the overlying and/or surrounding bone tissue with a drill or osteotome. Frequently, the tooth may be split into multiple pieces to facilitate its removal. Surgical extractions are usually performed under a general anesthetic.
Wisdom Tooth Extraction
A wisdom tooth, in humans, is any of the usually four third molars, including mandibular third molar and maxillary third molar. Wisdom teeth usually appear between the ages of 17 and 21. Most adults have four wisdom teeth, but it is possible to have more, in which case they are called supernumerary teeth. Wisdom teeth commonly affect other teeth as they develop, becoming impacted or “coming in sideways”. They are often extracted when this occurs.
Wisdom teeth are extracted for two general reasons: either the wisdom teeth have already become impacted, or the wisdom teeth could potentially become problematic if not extracted. Potential problems caused by the presence of properly grown-in wisdom teeth include infections caused by food particles easily trapped in the jaw area behind the wisdom teeth where regular brushing and flossing is difficult and ineffective. Such infections may be frequent, and cause considerable pain and medical danger. Other reasons wisdom teeth are removed include misalignment which rubs up against the tongue or cheek causing pain, potential crowding or malocclusion of the remaining teeth (a result of there being not enough room on the jaw/ in the mouth), as well as orthodontics.
A root canal is the space within the root of a tooth. It is part of a naturally occurring space within a tooth that consists of the pulp chamber (within the coronal part of the tooth), the main canal(s), and more intricate anatomical branches that may connect the root canals to each other or to the surface of the root.
The smaller branches, referred to as accessory canals, are most frequently found near the root end (apex) but may be encountered anywhere along the root length. There may be one or two main canals within each root. Some teeth have more variable internal anatomy than others. This space is filled with a highly vascularized, loose connective tissue, the dental pulp.
The dental pulp is the tissue of which the dentin portion of the tooth is composed. The formation of secondary teeth (adult teeth) is completed by 1-2 years after eruption into the mouth. Once the tooth has reached its final size and shape, the dental pulp’s original function ceases for all practical purposes. It takes on a secondary role as a sensory organ.
Root canal is also a colloquial term for a dental operation, endodontic therapy, wherein the pulp is cleaned out, the space disinfected and then filled.
A bridge, also known as a fixed partial denture, is a dental restoration used to replace a missing tooth by joining permanently to adjacent teeth ordental implants.
There are different types of bridges, depending on how they are fabricated and the way they anchor to the adjacent teeth. Conventionally, bridges are made using the indirect method of restoration however, bridges can be fabricated directly in the mouth using such materials as composite resin.
A bridge is fabricated by reducing the teeth on either side of the missing tooth or teeth by a preparation pattern determined by the location of the teeth and by the material from which the bridge is fabricated. In other words, the abutment teeth are reduced in size to accommodate the material to be used to restore the size and shape of the original teeth in a correct alignment and contact with the opposing teeth. The dimensions of the bridge are defined by Ante’s Law: “The root surface area of the abutment teeth has to equal or surpass that of the teeth being replaced with pontics” .
The materials used for the bridges include gold, porcelain fused to metal, or in the correct situation porcelain alone. The amount and type of reduction done to the abutment teeth varies slightly with the different materials used. The recipient of such a bridge must be careful to clean well under this prosthesis.
When restoring an edentulous space with a fixed partial denture that will crown the teeth adjacent to the space and bridge the gap with a pontic, or “dummy tooth”, the restoration is referred to as a bridge. Besides all of the preceding information that concerns single-unit crowns, bridges possess a few additional considerations when it comes to case selection and treatment planning, tooth preparation and restoration fabrication.
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