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Diagnosis

Diagnosing a Cavity

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Untreated cavities cause further damage
When a tooth has decayed and developed a cavity, it’s important to remove the decay and
restore the tooth. Treatment will stop the cavity from growing larger and weakening the tooth,
and it will also prevent bacteria from infecting the inner layers of the tooth.
 
What is a cavity?
A cavity is a hole in the tooth that forms when acids in the mouth destroy tooth structure. These acids are produced by the bacteria in plaque, which is the sticky, colorless film that forms constantly on your teeth. Unless steps are taken to prevent this decay process, the acids slowly dissolve the tooth enamel, causing a cavity.
 
Finding cavities
We locate tooth decay by performing a thorough exam, which can include visual inspection and the use of a dental explorer, xrays, and sometimes specialized equipment as well.
 
In some cases, we can see cavities easily on the biting surfaces of your teeth. To check for cavities that are less easily seen on the tops and side surfaces of your teeth, we may use a dental explorer, which sticks slightly when it touches decayed areas. We also use xrays
to find more advanced decay inside a tooth or decay between teeth. On xrays, cavities show up as dark spots.
 
During your exam, you may hear us identify the location of a cavity by using numbers and letters. They help us identify the specific surface of a particular tooth. For example, your lower left wisdom tooth is tooth number 17, and the top surface is labeled “O,” which stands for “occlusal.” This term refers to the biting surface of a tooth.
 
Treating cavities
If we find cavities in your teeth, we’ll remove the decay and place a restoration. There are several types of restorations, including fillings, inlays, onlays, and crowns, and these can be fabricated from a variety of different dental materials. We’ll talk with you about the best restoration for your situation. By treating decay as soon

Diagnosing a Cracked Tooth

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Crowning a Cracked Tooth

When a tooth is cracked, it’s often best to protect the tooth by placing a crown to protect the tooth and prevent it from breaking.

Symptoms of a cracked tooth
  • You may have a cracked tooth if you experience any of these symptoms:
  • Your tooth is sensitive to hot or cold temperatures or to sweet or sour foods.
  • You sometimes feel a sharp pain when you chew.
  • The pain is intermittent rather than constant.
Some teeth look cracked, but may not be a problem. One kind of hairline crack, called a “craze,” occurs over time in the enamel layer of the tooth, and it may not require immediate treatment.
 
Why do teeth crack?
Teeth can crack for a number of reasons. One is that they endure a tremendous amount of pressure from biting and chewing every day, and as teeth age, they may lose some of their original strength. The heavy stresses of clenching and grinding can also weaken teeth.
 
Teeth also lose strength when tooth structure is lost, as with root canal therapy or large areas of decay. Teeth can easily break off when the crack is next to large fillings. Chewing on ice, unpopped popcorn, hard candy, and other hard objects can weaken teeth, and these habits can fracture teeth that are already weak. And finally, teeth can crack or fracture because of an injury or accident.
 
Diagnosis and treatment
We recommend that you see us for an exam if you think you have a cracked tooth, even if it doesn’t hurt. The exam typically includes xrays. However, xrays don’t always reveal a crack, so we may also analyze your bite to isolate the problem.
 
There are several types of crowns, including gold, porcelain fused to metal, and porcelain. If your tooth needs a crown, we’ll talk with you about the best kind for your situation.
 
It’s important to evaluate and treat cracks as soon as possible because they can grow quickly. If a crack reaches the tooth’s nerve, bacteria can infect the tooth, and root canal therapy may be required to save it. If the crack extends to the root, the tooth may need to be extracted.
 
To prevent a cracked tooth from breaking and to seal out bacteria aqnd infetion, we often recommend placing a crown over the tooth. 

 

Diagnosing a Failing Amalgen Filling

Broken tooth and broken filling
 
Fllings are not forever
A common misconception is that a silver amalgam filling will last forever. Amalgam fillings are very durable, but eventually they will fail and need to be replaced. We consider a filling to be failing when it no longer seals out bacteria and allows them to infect the inner layers of the tooth.
 
Replacing a failing amalgam filling with a new restoration can prevent more decay from developing and keep your mouth healthy.
 
What causes an amalgam filling to fail?
Many conditions in the mouth can cause an amalgam filling to fail, including:
  • time and wear.
  • moisture in the mouth.
  • temperature changes.
Fillings have to endure an incredible amount of biting force. Over time, they become worn and turn black, and their edges wear away.
 
Amalgam fillings swell when they absorb the natural moisture in your mouth. This expansion can create a wedging effect in the tooth, which can fracture or break off tooth structure. The expansion can also lift the surface of the filling slightly, creating a gap where the filling meets the tooth, and allowing bacteria into the tooth.
 
Temperature changes in the mouth can make the amalgam expand and contract, and this creates many small gaps or microfractures in the tooth or filling.
 
Replacing the filling
When we discover a failing amalgam filling, it’s important to replace it with another restoration as soon as possible to protect your tooth. There are several types of restorations, including fillings, inlays, onlays and crowns, and these can be fabricated from a variety of different dental materials. After doing a thorough exam, we’ll recommend the best restoration for your situation.

Diagnosing a Failing Filling

 
Restoring a Failed Filling
 
When we need to replace a filling, the best option is frequently to protect your tooth with a crown instead of placing a filling. Placing a crown when a filling has broken or worn out, helps to protect and strengthen your tooth.
 
Can you replace a filling with something else?
Sometimes, we can replace your filling with another filling, but this can weaken the tooth because more tooth structure must be removed to hold the new filling. This means that a larger filling must be used to replace the old one. A large filling weakens your tooth and leaves it more vulnerable to damage.
 
Replacing a filling with another filling can remove so much supporting tooth structure that the tooth can break. This is especially true if decay has formed underneath the old filling, requiring us to remove the decayed areas also.
 
Benefits of a crown
Placing a crown can prevent these problems. A crown covers and protects the tooth. It seals out plaque and bacteria and restores the strength and shape of the tooth.
 
Determining the need for a crown
When we evaluate a filling that needs replacement, we consider both the size of the filling and the amount of healthy tooth structure that remains. To determine if a crown is right for you, we perform a thorough examination. If we find that a crown is the most appropriate treatment for your situation, we talk with you about the best kind of crown to use.

Diagnosing a Failing Resin Filling

 
 
Fillings eventually fail
A common misconception is that a filling will last forever. Composite resin fillings are durable, but they eventually will fail and need to be replaced. We consider a filling to be failing when it no longer seals out bacteria and allows them to infect the inner layers of the tooth.
 
Replacing a failing resin filling with a new restoration can prevent more decay from developing and keep your mouth healthy.
 
What causes a resin filling to fail?
Resin fillings have to endure an incredible amount of biting force. Over time, they become worn, and their edges can wear away.
 
In a few cases, the resin material may shrink after it’s placed. This can open a space where the filling meets the tooth, allowing bacteria into the tooth. The shrinkage can also force the filling to pull on tooth structure as the resin shrinks, stressing the tooth.
 
Replacing the filling
When we discover a failing resin filling, it’s important to replace it with another restoration as soon as possible to protect your tooth. There are several types of restorations, including fillings, inlays, onlays, and crowns, and these can be fabricated from a variety of different dental materials.  After doing a thorough exam, we'll recommend the best restoration for your situation.

Diagnosing Abfractions

 
 
Abfractions damage teeth
Abfractions are notches in the tooth structure near, or even under, the gumline, usually on the
cheek side of the tooth.
 
Although all the causes of abfractions are not known, theories include improper forces on teeth caused by a misaligned bite or by grinding and clenching. Some evidence suggests using too much abrasive toothpaste eats into the enamel.
 
The causes of abfraction and their treatments
Abfractions could be caused by the following:
  • Improper forces on teeth from a misalined bite. When your bite is slightly off, one tooth may hit sooner than the rest. This causes undue stress on the involved teeth, and they begin to flex. Over time, this continual flexing and stress causes the enamel to separate from the inner dentin layer of the tooth, forming a notch at the gumline. If your bite is off, we may smooth areas down so that chewing forces are evenly distributed among all your teeth.
  • Grinding and clenching
    Tooth grinding and clenching also place extra stress on teeth. If tooth grinding or clenching is the problem, we may prescribe a nightguard to absorb those stresses and protect your teeth.
  • Toothpaste abrasion
    The way you brush your teeth could be the problem. The abrasive ingredients in toothpaste, often combined with aggressive brushing action, gouges out a Vshaped
    indentation in the tooth’s enamel. If we suspect you might be using too much toothpaste or are brushing too hard, we recommend that you brush using only fluoridated mouthwash, and only use a soft toothbrush.
 
Treatment
Once the cause of the abfraction is addressed, we may restore the notch in the tooth by bonding a filling in place, or, we may cover the notch with gum tissue to help stop sensitivity.
 
Tooth-colored fillings can restore the tooth to nearly its original color and shape.
 
Dealing with abfractions early can prevent further damage and restore your teeth to beautiful good health.

 

Diagnosing Ankylosis

 
Causes of ankylosis
Ankylosis is a condition in which a tooth fuses to the bone, preventing normal tooth growth. This condition can happen to a primary or permanent tooth and can be caused by trauma or heredity.
 
In a child’s mouth, the roots of a child’s primary teeth naturally dissolve, which allows the permanent teeth to move into place. If the roots of a tooth don’t dissolve properly, they can ankylose, or fuse, to the jawbone.
 
Fusing to the jawbone could happen if the periodontal membrane is compromised. This is a thin ligament that holds a tooth in place and forms a barrier between the tooth and the jawbone. If the ligament is gone, the roots and bone can grow together, cementing the tooth in place.
 
Ankylosis damages more than teeth
Ankylosis can cause problems including:
  • affecting the way your child chews, breathes and speaks,
  • delaying or stopping normal tooth growth,
  • changing the shape of your child’s jaw,
  • causing an open bite and
  • causing the opposing tooth to extrude out of its socket.
Diagnosis
We use three ways to diagnose ankylosis:
  • We first do a visual exam because an ankylosed tooth may appear shorter than neighboring teeth.
  • We will lightly tap on your child’s tooth because an ankylosed tooth sounds different than a normal tooth.
  • We will take Xrays to monitor the development of permanent teeth blocked by the primary tooth’s roots.
Treatment options
To treat ankylosis we may take a “wait and see” approach with very young children. Later, we could recommend removing the tooth, and we may need to send you to a specialist to perform the procedure. Once the tooth is removed, your child might need to wear a space maintainer to give the permanent tooth the proper space in which to grow.
 
Addressing ankylosis early can help prevent future problems and help your child’s teeth grow in straight and strong.

Diagnosing Bruxism

Tooth problems while sleeping
Bruxism is the clenching or grinding of the teeth that often occurs while a person is sleeping.
 
There are many causes of bruxism. Whatever the cause, it Is important to treat bruxism early to prevent damage and restore harmony to your mouth.
 
Symptoms of bruxism
The symptoms of bruxism include:
  • a sore, tired jaw.
  • difficulty in opening and closing your mouth.
  • sensitive teeth.
  • headaches or earaches.
  • pain in your jaw joints.
It Is also possible that you clench and grind your teeth, and yet notice no symptoms at all.
 
Dental problems caused by bruxism
When you brux, the force on your teeth is many times greater than during normal chewing. These forces can cause:
  • flattened or worn-down teeth.
  • loss of tooth enamel near the gumline.
  • fractured or loose teeth.
  • damage to the jawbone or jaw joints.
Diagnosis and treatment
Though all of the causes of bruxism are not known, stress is often a factor. If this is the case, a variety of stress reduction techniques may be recommended.
 
We may also recommend medication to temporarily reduce stress and relieve pain.
 
Sometimes, missing teeth, worn teeth, spaces between teeth, or teeth that are out of alignment may cause grinding and clenching. In this case, bridges, crowns, equilibration, orthodontics, or other dental treatments can often restore your bite and eliminate grinding and clenching.
 
A common and effective treatment for stopping the damage caused by bruxism is the use of a nightguard. This is a plastic device that fits over your top or bottom teeth and protects your teeth by absorbing the forces caused by grinding. A custom nightguard, made from models of your teeth, usually offers the most effective and comfortable protection.

Diagnosing Dry Socket

Dry socket
 
Dry socket is an inflammation that occurs when the blood clot that forms in the socket after a tooth extraction becomes dislodged or does not form properly.
 
The clot is necessary to protect the socket, stop bleeding, promote the development of new bone and gum tissues, and prevent pain.
 
However, when the clot is lost prematurely, the inflamed socket and underlying nerves and bone are exposed.
 
Symptoms
The symptoms of dry socket are a severe throbbing pain that does not respond to normal pain
medications. It starts one to four days following an extraction, and the pain may radiate into your ear. You may also notice a foul odor or taste in your mouth.
 
Causes and prevention of dry socket
After your tooth has been extracted, we’ll give you complete instructions about caring for your mouth. Following them exactly will help you avoid dry socket. It’s especially important to avoid certain behaviors that can cause the premature loss of a blood clot, particularly within the first 24 hours after an extraction.
  • Do not touch the extraction site with your fingers or tongue.
  • Do not rinse the area during the first 24 hours after extraction. After that time, follow our instructions for when and how to rinse.
  • Do not smoke or use tobacco.
  • Do not suck through a straw.
  • Avoid sneezing or coughing when possible.
  • Avoid carbonated, hot, or alcoholic drinks.
Diagnosis and treatment
Call our office right away if you notice any symptoms of dry socket. To confirm the diagnosis, we’ll talk with you about your symptoms and perform a thorough examination. The exam may include an xray of the extraction site.
 
Treatment for dry socket often includes a gentle rinsing of the socket with a medicated solution. We may also pack the site with a gauze dressing that contains a soothing anesthetic. You’ll probably need to return to our office several times over the next week or two, so we can change the dressing and monitor the effectiveness of your pain medications.
 
Prompt diagnosis and treatment will allow the blood clot to fill back in, and the area will begin to heal normally once again.

Diagnosing Gingivitis

Symptoms of gingivitis
Gingivitis, also known as gum disease, is inflammation of the gums. It is often the first stage
of periodontal disease.
 
Some of the warning symptoms of gingivitis
include:
  • bleeding when brushing or flossing.
  • redness where the gums and tooth meet.
  • swollen gums.
  • bad breath.
Causes of gum disease
Gingivitis usually begins when plaque, the sticky, colorless film of bacteria and food particles that constantly forms on your teeth, is not cleaned away every day.
 
It is hard to see plaque, but in the image below, a harmless dye stains it red. When plaque stays on your teeth for two or three days, it can harden into tartar. Tartar, which is stained blue in the image, can irritate your gums and lead to gingivitis.
 
Gum disease can also be caused by certain medical conditions, some medications, trauma, smoking or chewing tobacco. During pregnancy, hormonal changes can contribute to gum disease.
 
Examination
To determine if you have gingivitis, we examine your mouth and look for red, swollen, or bleeding gums.
 
Because gingivitis can advance to periodontal disease, we may take xrays to check your bone levels.
 
We may also check the depth of the sulcus around each tooth. A sulcus is the tiny groove between the base of the visible part of your tooth and the gum.
 
Treatment
If you have gingivitis, we thoroughly clean your teeth and may schedule you for more frequent cleanings. We may also suggest a special mouthwash or rinse and discuss your homecare technique.
 
The good news is that gingivitis is reversible. The sooner we catch it, the better chance you have of keeping your smile for a lifetime.

Diagnosing Neuromuscular Problems

Advanced technology
When diagnosing problems with your bite, we use advanced technology to measure the path of your jaw and movement of your jaw joints. We track the way your jaw performs in motion and at rest, evaluate the health and positioning of your jaw joint, and measure
the muscle function.
 
The technology we use may include:
  • tomography
  • Sonography or joint vibration analysis
  • jaw tracking
  • and a TENS unit.
Tomographs are specialized xrays that give us a 3D view of the jaw joints. This allows us to check the health and position of the bones of your jaw joints.
 
The sonograph, or joint vibration analysis equipment, measures the sounds in your jaw joints as you open and close your mouth. These measurements can help us identify joint problems. With electromyography, we can measure the tension in your chewing muscles.
 
When muscles are tense or strained, they give off tiny electrical currents. To track your jaw movements, we’ll place a tiny magnet just below your lower front teeth. The sensor then records the movement of the magnet when you move your jaw open and closed, side to side, and forward and backward.
A bad bite is the cause of many problems
Once we know how your muscles and jaw presently work, we’ll need to compare those measurements to some taken after your jaw muscles are relaxed and comfortable. If we discover a difference, a bad bite is more likely to be the cause of your problems.
 
The TENS unit sends a mild, ultralow frequency pulse into your chewing muscles to relax your jaw and reduce muscle pain. We’ll have you wear the unit for about 45 minutes. When the TENS treatment is complete, we’ll repeat the electromyography to determine if your muscles are more relaxed. If they are more relaxed, we’ll then use the TENS unit and jaw tracking equipment together.
 
The TENS will make your jaw move slightly along its most relaxed path of closure, and the jaw tracking equipment draws a line that displays that path. This shows us the jaw position that will allow your jaw joint and muscles to be the most stable and comfortable at rest, and when chewing, talking, and swallowing. After the workup

Diagnosing Oral Habits

Harmful oral habits
Children can develop a variety of oral habits that can affect the normal development of their teeth and jaws.
 
These habits can include:
  • sucking a thumb or finger,
  • sucking a pacifier,
  • tongue thrusting and
  • grinding teeth, which is called bruxism.
Oral habits: their effects and treatments
It is natural for babies and toddlers to suck their thumbs, fingers, or pacifiers. Most children stop on their own by age three or four. 
 
If the child is still sucking after the permanent teeth start to come in, the sucking motion could distort the normal growth of the jaw; the upper teeth can protrude; it can cause an open bite and can force the developing teeth out of alignment. If sucking continues for many years, it is likely that orthodontia will be necessary.
 
Helping your child to stop sucking should not be a struggle. Becoming frustrated can make the problem worse. Many children respond to a reward system.
 
Encouraging your child to stop sucking could be as easy as having an authority figure who is not the parent, talk to the child about it.
 
If it is proving to be very difficult, your child might be willing to wear a thumb guard to help break the habit. This works best if the child is not forced to wear it.
 
Another option is to temporarily cement a device in their mouth that will make it difficult to suck.
 
Bruxism is another oral habit that could require intervention. A child can grind their teeth together while awake or asleep. This can cause the teeth to wear down.
 
If we diagnose this as a problem, we may make a special mouthguard for your child to wear.
 
Tongue thrusting, also called a reverse swallow, is the improper placement of the tongue during swallowing. It can result in speech difficulties that may require further professional evaluation. We can temporarily affix a device to the backs of the teeth to help break the habit.
 
For any of these devices to work well, your child must want to break the habit. None of these methods should be forced upon your child or used as a punishment.
 
Children and adults should remember teeth are for chewing food, not for holding pens, pencils, keys, glasses, opening packages or chewing fingernails or ice.
 
Correct harmful oral habits when your children are young, and they can have a lifetime of healthy smiles.

Diagnosing Pediatric Cavities

Cavities hide
Cavities can be hard to see, especially when they are first starting. That is why we use a variety of technologies to help find a cavity, no matter how small or hidden away it is, so your child’s smile can be free of decay.
 
Diagnostic tool options
On large, smooth tooth surfaces, we might use a common dental explorer to gently touch each tooth’s surfaces. If the explorer catches on a soft spot, we know that spot could be the beginning of a cavity.
 
The Xray is an excellent diagnostic tool to search for cavities between teeth or under the gums. But Xrays can show only a side view of a tooth.
 
The biting surfaces of teeth can have deep pits and fissures where cavities can be very difficult to find. We can use a special light that detects cavities that are hiding between teeth, in deep grooves and under the enamel. This light can also notice changes in tooth structure that signal the start of a cavity. In that case we may be able to strengthen the tooth’s surface and reverse the damage.
 
Treatment options
If we find a suspicious area, we have several treatment options:
  • Early stages of decay may need only a fluoride treatment in the office.
  • We may recommend a remineralizing toothpaste or home fluoride treatments.
  • We might use air abrasion to clean out minor surface decay.
  • A more advanced cavity could need a restoration or a root canal procedure.
Our goals are to find a cavity early to avoid complicated restoration procedures and to prevent
further decay so your child can have a healthy, beautiful smile.

Diagnosing Periodontal Disease

 
What is periodontal disease?
Periodontal disease is a serious infection and the number one reason adults lose teeth. As periodontal disease advances, the infection can destroy the ligaments and bone that support your teeth.
 
What are the symptoms?
If you have periodontal disease:
  • your gums may bleed when your brush or floss
  • your gums baybe soft, swollen or tender
  • your gums may start to pull away from you teeth
  • your teeth may become loose
  • you may have persistent bad breadth
 
What causes periodontal disease?
The main cause of periodontal disease is the long term buildup of plaque, the sticky, colorless film of food and bacteria that constantly forms on your teeth.
 
It is hard to see plaque, but plaque can clearly be seen after it is stained with a disclosing tablet. When plaque stays on your teeth for two or three days, it hardens into calculus, or tartar.
 
The bacteria in plaque invade the spaces between your teeth and gums and produce toxins. These toxins, combined with your body’s reaction to them, destroy the bone around your teeth. And once lost, bone never grows back on its own.
 
If there is not enough support for the teeth and they become loose, they might have to be removed.
 
Diagnosis and treatment
To determine if you have periodontal disease, we perform a thorough examination which includes taking xrays to determine how much bone has been lost.
 
We measure the depth of the sulcus (a tiny groove between the tooth and gum) with a probe. A reading of more than 3 millimeters could be a sign of periodontal disease, and we pay careful attention to those areas.
 
If we find periodontal disease, we discuss your treatment options and proper homecare. We want to help you maintain the health of your teeth, gums and bone and restore your healthy smile.

Diagnosing Periodontitis

Considering Extraction due to Periodontitis
 
When an extraction is necessary
When too much bone around a tooth has been lost due to severe periodontal disease (also
called periodontitis), sometimes the best treatment is to remove the tooth to maintain the
health of your mouth.
 
Periodontal disease causes bone loss
Teeth are held in place by the height and shape of the jawbone, but when teeth and gums are
infected by the bacteria that cause periodontal disease, the disease process begins to destroy
the bone that surrounds the teeth.
 
Left untreated, periodontal disease destroys so much bone that there is not enough support for the teeth. In severe cases, the teeth become very loose and cannot be saved.
 
Diagnosis and treatment
To determine if an extraction is right for your situation, we’ll do a thorough examination, which typically includes xrays. In advanced gum disease, sometimes called periodontitis, xrays show us low and uneven bone levels around the teeth. The condition is especially obvious when compared to xrays of a healthy mouth, in which the bone comes up high around the necks of the teeth.
 
Many times we can save teeth. Aggressive periodontal therapy, frequent periodontal maintenance appointments in our office, and consistent homecare can halt the progression of periodontal disease and stop the bone loss. Sometimes we also recommend periodontal surgery to save teeth.
 
However, if your teeth continue to loosen and the destruction persists, our only option will be to remove the affected tooth. It’s important to extract a tooth that cannot be saved as soon as possible to prevent the spread of infection.
 
We often recommend replacing an extracted tooth to preserve remaining jawbone and stabilize your bite, so we’ll talk with you about your replacement options.