I really surprised by the number of patients asking this question especially that we make tooth caps to strength and support teeth. Before we start our discussion about this question we have to know first what is teeth caps and the indications of using it.

Teeth caps and dental bridges are artificial porcelain or metal  covers that covers the tooth crown. As we said it is usually made of metals or special ceramics with a thickness ranging from 0.75 mm- 2 mm. It is usually indicated in case of very extensive caries that destructing most of the tooth crown(so using fillings only won’t be enough ) or after root canal as the tooth becomes really fragile. On the other hand teeth bridges are false teeth that used to replace extracted tooth.

Before manufacturing a tooth cap or dental bridge the dentist have to grind the tooth or simply remove a thin layer from the  natural crown to allow a space for the artificial tooth cap, The tooth reduction should be exactly to the same thickness of the cap (1-2 mm as we said before) or the tooth will become very bulky and may interfere with the normal occlusion. This tooth reduction is the cause that some patients think that their natural tooth is weakened. But this is completely wrong as we will discuss later.

In case of badly destructed teeth with a very large filling the tooth is already weakened and there is a very high incidence of filling fracture or falling,  so covering the fragile tooth with a metallic cover will prevent crown fracture for sure.

In case of  root canal treated tooth the tooth usually  have a very large filling,  and also the tooth becomes very fragile after root canal treatment due to dehydration and loos of nutrition. So covering the tooth with a strong tooth cap will be a very good choice.

Also we have to say that most of the materials we use to fabricate tooth caps are usually stronger that the natural tooth material . This is not meaning that we like to grind the natural enamel for no reason but if the case is indicated and the crown in fabricated properly there will be no harm but there will be an added protection to the weakened tooth.

In case of dental bridge the decision making is a little more harder as the teeth we grind is healthy and may be completely sound,  We just want to grind it because we want to replace the neighboring extracted tooth. So the idea of grinding healthy teeth is annoying to many patients.  And as a dentist i have to say that if you can afford dental implants you should use it instead of bridges as the neighboring teeth is not affected. But the problem that many patients won’t afford the high coast of the implants . So if you left the empty space untreated you will start to avoid the side of extraction in chewing which will result tartar accumulation and gum problems that may lead to more extraction in the non-functional side. So it will be much better to restore the lost tooth with bridge rather than leaving it untreated.

My final advice :if you can afford dental implants it will be the perfect choice but if you can’t so go ahead and have a dental bridge it will be great.

Teeth whitening popularity is rising rapidly these days as every one wants a pearl white teeth.  The concept of teeth whitening is based on the oxidization effect of free oxygen on stain particles. The teeth whitener or the teeth whitening agent releases free oxygen that penetrates the tooth to reach the deep layers where internal stains present.

When the free oxygen attacks the large molecules of dental stains it breaks it to a smaller particles that is lighter in color.

There is many forms of teeth whitening  available but generally we can categories it to.

• Dentist applied (which called dentist or professional teeth whitening)
• Dentist prescribed (which called at home teeth whitening).

The home teeth whitening method start by your visit to you dentist to examine your teeth and to be sure that there is no contraindications for teeth whitening treatment  like caries or gum recession , So please don’t start applying any of the products available in the market without dentist prescription as this may be dangerous and many of these products lakes the proper testing and evaluation, So your dentist is the best one who can choose you what to use and how to use it AND sometimes you are contraindicated to use teeth bleaching at all.

Dentist or professional teeth whitening products are based usually on hydrogen peroxide as an active ingredient . Some times carbamide peroxide is used but it release half of the oxygen released by the same concentration hydrogen peroxide so many dentists prefer the hydrogen peroxide based whiteners.

The procedures of teeth whitener application is depending to the system but generally we can summarize it as follow:

1-Careful examination

2- Calculus removal and teeth polishing: This is a very important step and i think it is the cause of the failure that happens with over the counter teeth whiteners. When teeth scaling is neglected the free oxygen released by the whitening gel react with tartar, plaque and superficial stains and after this reaction there will be no oxygen left to react with the deep dark stains that cause the dark color of the teeth  which will lead to failure of the treatment.

3- Soft tissue isolation : This is the reason that makes professional teeth whitening more safe and less annoying than home teeth bleaching as the dentist will isolate the gum, cheek and lips not to come in contact with the teeth whitener gel which cause the material to be more concentrated on the teeth, This can  also diminish the burning effect of oxygen on gum and lips. There is many ways to isolate the soft tissue either by using rubber dam to cover gum and lip or painting isolating resins to gum and lips before applying of the material.

4-Application of teeth whitening gel:  Teeth whitening gel may be used directly as a painting to the labial surface of the teeth or may be loaded to a custom tray that the patient wear. Also some systems like ZOOM needs light source to be activated and others may be activated chemically with no need to light. generally light systems are a little bit expensive and supposed to be more effective although some authors stated that the efficacy  is almost the same but i see that light activated systems are a little bit more effective.

The application time vary from 10 min to 45 min in some systems and also the number of application vary according to the case and the system used.

5-Rinsing the gel and removal of the insulator system.

6- Applying of desensitization gel: Dentists prefer to apply desensitizers after finishing of the whitening process as this will relive the sensitivity that happens some times and also repair the tooth surface enamel and remineralize  the lost calcium from the tooth.

After all dentist applied teeth whitening is considered the best solution to have a whiter teeth if you can afford it. It is safe,  fast and have the best results the only disadvantage is the cost as it usually coast from 500- 1000 $ which is much higher than you usually pay for home teeth whitening systems available in market so forget all the faulty information on the internet and choose it, If you can’t afford it then let your dentist describe any good at home system,  It will work too.

hello,

This is my first post about dental implants (or teeth implants like patients like to call) so you can consider it as introduction till i prepare a deeper articles.

We can consider these days as the era of dental implants in dentistry. And i have to say that it really deserve it’s reputation as dental implants really offered a solution to replace extracted teeth that was beyond our imagination. As a result of the proved  success of this technology many researchers are trying to get the best from it and today it is almost used in almost all the aspects of dental treatment. Some times  it is used to support orthodontic appliances , Fix loose dentures, Replaces single  extracted tooth or even support a dental bridge .

Teeth implants in the most simple form is an porcelain  artificial or false teeth that is supported and fixed in place by a titanium post that is screwed to the jaw bones.  The word screwing may be not scientific as bone is a living tissue not just a piece of metal so it have to be integrated with the new artificial post not to refuse it which will lead to case failure. So a different materials tried to favor the bone healing and integration around the implant and titanium is proved to be the best. Also a specific surface treatment is done in order to maximize the bi compatibility, retention and mechanical load distribution over the surface.

So who can get benefit from teeth implants simply any patient who lost one or more of his teeth. Single extracted tooth, multiple neighboring extracted teeth or even completely edentulus patient as we mentioned before teeth implants can be used to fix complete dentures .

Like any medical treatment teeth implants are contraindicated in some cases. I will mention some of the relative contraindications of using dental implants here AND take care that i say relative as there is many difference in scientific research results concerning this issue and also the list of contraindication become shorter  every day as the research continue.

first thing  some times the bone diameters like height or width is not enough to host the appropriate size post usually this happens as a result of delaying for years after extraction. Also sometimes a vital structures like nasal cavity, nasal sinus ao important nerves lying in the place that suppose to carry the implant. For sure the problems we mentioned here can be corrected efficiently with surgical repair, bone grafting or sinus lifting surgery but the coast will jump here a lot.

Also any general condition that affects bone healing will diminish the success of the cases or even prevent the surgeon from even thinking in using teeth implants like osteoporosis, uncontrolled diabetes heavy smoking history of radio or chemo therapy and even very bad oral hygiene without a strong motor to change.

last thing is the coast factor as many patients can’t afford it’s high coast and try to choose more affordable  solutions .

bye bye, come later to read more

dr ahmed galal

practicing dentist

Gum boil is a very common complain that we see in our clinics every day. The case usually is a result of neglected dental abscess.

Gum boil symptoms:

The case is usually presented as small opining in the gum that drain pus or sometimes blood if you apply pressure to it. The area around the boil  is usually a little swallowed and red. The pus drainage may stop for a while and the opining may even close, but usually if the case is not treated the pus will be accumulated again in the tissue and the opining will appear again to drain the formed pus. The neighboring tooth usually is sensitive to pressure and produce pain with chewing but sometimes the pain is not obvious in chronic cases. The neighboring tooth usually have a very large cavity or severe periodontal problems. The patient usually complain of bad breath and salty bad taste as a result of the drained pus.

Some times the case  may take an acute course and here the symptoms will be generalized in the form of face swelling, fever and lymph node tenderness.

Gum boils causes and types:

Gum boil or abscess causes includes extensive caries with necrotic nerve of tooth or severe, deep periodontal pocket we will discuss both in details.

Dental pockets start with gingival inflammation due to plaque and tartar accumulation if the gingival inflammation still untreated the bacteria will start to invade the periodontal ligament that is responsible of cementing the root  surface to the gum tissue and bone. As a result of bacterial invasion into the periodontal ligament the attachment is lost between tooth and gum forming what is called dental pocket.  Later this pocket is filled with bacteria and food debris which may cause pus formation and the pus oozing  start.

The most common cause of gum boil is teeth abscess. Teeth abscess usually formed as a result of caries that reached the pulp so the caries bacteria ferment the pulp tissue and continue to invade the periodontal ligament and jaw bones over the diseased root. As a result to body reaction to bacterial invasion pus formed and the resultant pus pressure leads tissue destruction and this continue till a canal is formed to drain the pus out witch lead in the end to form gum boil that drain the pus out.

Treatment:

Once you discover it you should see your dentist quickly as in many cases if the boil treated quickly we may avoid tooth extraction.  The dentist will examine you carefully to discover the cause and usually an x-ray film is taken.  Once the cause is discovered the second step will be draining the pus by starting root canal treatment to let the pus get out from an opining inside the tooth crown, Sometimes making a small incision in the gum to drain the pus or even extract the tooth if your decided that the tooth is hopeless.

Then if the dentist decided that the tooth is hopeful he may perform root canal treatment or gingival surgery to treat the gum pocket.

Prognosis:

Unfortunately usually many of  the teeth that cause  gum boils should be extracted to completely relief the case. But we have to say that many teeth with gum boils may be conserved and even restore it’s normal functions after successful root canal or gingival surgery. So your dentist is the only one to decide what to do with it and your role is only to see your dentist as fast as possible as this may help to conserve the tooth and avoid extraction.

What to do at home:

As we mentioned before once you have gum boil you should see your dentist as fast as possible. Till you find a date in you dentist clinic you should try to drain the formed pus by applying light pressure on the gum around the opining and use warm saline as mouth wash to increase the blood supply to the area to help the drainage and relief the symptoms.

Dr. A. Galal

practicing dentist

Regular Teeth brushing is the most effective way to prevent caries and gum disease In adults and children. You should start brushing your kid’s teeth once the first tooth erupt around 6 months. and you should continue to supervise your child during brushing till 7 years age to avoid too much ingestion of toothpaste that contains fluoride. Remember good oral hygiene is the master key to a happy and  healthy kid.

So here are some advices that will help:

1-when to start??

some authors say that no brushing is needed in the first year you just has to wipe your baby’s teeth with a wet gauze after feeding  but many oral hygiene and pediatric dentistry text books says that  You should start brushing your kid’s teeth once the first tooth erupt around 6 months and i agree to this opinion as we saw many cases where caries start just after this first year . Also  you should continue to supervise your child during teeth washing  till 7 years age to avoid too much ingestion of toothpaste that contains fluoride.

2-child should brush twice daily with fluoride containing toothpaste (the selection of the fluoride concentration in the tooth paste will be discussed later) . Also routine kids oral hygiene should include flossing that we will discuss later on a separate post.

3-how to choose your child’s toothbrush??

first the brush should be soft brush not hard (you will find that written on the package) also the brush size must fit your child’s age as using large brush will cause discomfort to your baby and also will prevent you from brushing properly also using very small toothbrush will make the process takes much longer.

last thing you should find a toothbrush that you kid likes, usually kid’s tooth brushes have painting and decoration on it’s handle so let your kid choose what he likes as this will make it fun when he use it.

4-How to choose your child’s toothpaste??

we have two main important factors here fluoride concentration and taste.

fluoride concentration is very important  as topical use of fluoride is proved to help in the prevention of teeth decay also too many fluoride ingestion can cause fluorosis that may make the teeth pitted and discolored. so it is very important to choose the toothpaste with the appropriate fluoride concentration. For children under 6 years the tooth paste should contains 600-1000 ppm fluoride concentration according to the caries risk (children with multiple cavities and fillings or children from families that suffer from caries problems should use 1000ppm toothpaste ). children above 6 years should use toothpaste with fluoride concentration 1000-1500 ppm according to the caries risk.

You should also choose toothpaste that has a good taste and smell and let your child choose the flavor he likes as this will make it much easier to let him used to tooth brushing.

5-Choose the position that make you and your child feel comfortable during the  process i prefer to stand beside or a little behind my Childs.

6-how much toothpaste you need??

put a very small amount (smear or pea size blob < 0.3 ml ) of the toothpaste on the brush bristles. Remember using too much toothpaste can be harmful and may cause teeth discoloration and roughness as the child may swallow much fluoride containing toothpaste.

7-Duration and how to brush:

the process should take from 2.5- 3 min to assure complete plaque removal 2 thirds of the  time to the posterior teeth and one third to the interiors . a short forward and backward or circular movement should be used to clean the chewing surface of molars. To clean the tongue side and lip side of the teeth the toothbrush should be 45 degrees to gum line and use short gentle circular movement and you should concentrate not to hurt the gums or push it down.  Remember each millimeter of every tooth should be cleaned so don’t neglect un accessible hard to reach surfaces. you may also brush your kids tongue very gently.

8-After finishing the process you kid should rinse his mouth gently (not to take all the fluoride away ) and you should rinse the brush completely.

last thing you should give your kid the chance to help as this will make him happy and get  used to tooth brushing.

thanks for reading,

Dr A. Galal

Most patients with new dentures expect too much. They expect from the dentist to offer a denture that as comfortable and functional as their lost natural teeth and this is simply impossible in most cases.

Coping with new dentures :

1-You have to know that wearing new denture is difficult in the beginning and you will need time to get used to wearing it so relax we are not in a hurry and you can accommodate to it  gradually. You should also know that many patients spend a horrible time in the beginning and they think that they will never be able to wear it then gradually use their dentures perfectly.

2-If you have no problems in wearing your new denture you should wear it as much as possible, but if you have problems like gagging you can start first with one jaw only until you used to it  then wear the two jaws  and increase the wearing time day after day.

3-You shouldn’t wear your denture at night keep it in a water glass or denture storing solutions.

4-How to eat with your new denture:

• At the beginning you should cut food into small pieces.
• Also you should chew your food on both sides in the same time this will help you to stabilize the denture in the beginning.
• Try to avoid hard food that needs an effort to chew till you get used to your denture.
• also sticky food food should be avoided till you become an expert.

5-Looseness of new dentures:

at first dentures can be loose a little until the patient adapt it. Also dentures usually need 10-30 minutes to become fixed when first inserted. Normally looseness will be disappeared gradually if the denture is manufactured properly

6-Cleaning new dentures: food debris sometimes accumulated under the denture or even if no food debris is accumulated the denture should be cleaned at least twice daily to be sure that there is no plaque or bacteria is adhering to the denture.

there is so many denture cleaners available and we will discuss this subject later in a separate post but at least dental brush and tooth paste should be used till you buy denture cleaner.

7-Discomfort, pain or ulcers:

it is quite normal that patient will feel discomfort in the few days after wearing new dentures . If the symptoms don’t relieve in a few days you should see your dentist.if you have ulcers or wounds stop wearing your denture and see your dentist directly.

Hello ,

We decided to make another step forward, We will answer your questions about dental care completely for free, within 24 h and prof. dentists will answer you.

How to send you question??

All you have to do is to add your question  as a comment down  this page and we well send you the answer by mail within 24 hours.

Questions we apologize not to ask :

Questions about dental care fees,  dental insurance or dentist recommendation will need someone in your country to answer you  as answerers will vary from place to another, So we apologize not to answer such questions as we want the visitors questions section to be helpful for visitors from all countries not specific location.

NOTE:

ALL THE ANSWERS WILL BE PUBLISHED FOR PUBLIC IN THE VISITORS QUESTIONS SECTION .

Every body dreams of fantastic smile but this smile can turn to horrible one if accompanied with bad breath. it is not necessary that bad breath is a sign of oral or general disease condition, it also can present in healthy people. it is like any other body odor  caused by bacteria. These bad odors is the result of bacterial fermentation of food debris and beverages which produce volatile sulfur compounds which is the main cause of bad odor.

But also bad breath can be the first significant sign of some general diseases like diabetes for example so such complain should be taken seriously and carefully investigated.

Causes of halitosis or bad breath:

oral and dental causes:

A- Medical illness or diseases:

1-bad oral hygiene: persons with bad oral hygiene tend to have bad breath due to decompositions of food debris by oral bacteria.

2-Gum disease: persons with gingival or periodontal diseases like pockets or gingival inflammation tend to produce bad breath.

3-pus formation due to dental or gum abscess also are a main cause of halitosis.

4-teeth cavities hold food debris for long time which helps bacteria to ferment food and produce sulfur compounds that cause the bad smell.

5-false teeth if not well fitted can also cause bad odors also removable dentures can cause bad odors if not kept clean.

6-Tongue is usually covered by thousands of small papillae that help in taste recognition and protect the tongue from friction with food, sometimes these papillae become longer than usual so the tongue surface become rough and hold easily bacteria, food debris and the resultant sulfur compounds for long periods.

7-blood oozing from inflamed gums can also fermented and cause unpleasant odor.

B- Morning breath:

upon waking up in the morning  due to less saliva production and lack of normal cleansing mechanisms of the mouth  like swallowing or ventilation.

C-smoker’s breath:

heavy smokers develop unpleasant mouth odor .

D-mouth breathing due to nasal or sinus problems can cause mouth dryness that lead to bad breath.

E-some types of food, drinks or medications can be excreted in saliva or excreted from the lung causing a bad odor like onion and garlic.

Non oral causes:

1-Infection of nose,nasal sinuses or throat can cause bad breath due to bacterial growth.

2-infection in the lungs,bronchi or lung abscess especially with production of pus is also a major cause.

3-kidney diseases: especially in renal failure the mouth becomes dry and the breath may have a urine like smell as the excretion of urea is from salivary glands .

4-advanced liver diseases can cause also a sulfur odor.

5-uncontrolled diabetes can cause acetone like odor.

6-stomach and digestion problems is also very common in producing bad breath.

7-psychological factors may be a cause of less oral care so bad breath.

Treatment:

• routine dental service which covers oral hygiene, caries treatment and tartar removal.
• fix the causes of food impaction like bad dentures, bridges.
• using tooth brush and interdental floss is mandatory.
• tongue brushing can really surprise you.
• periodic dentist visits.
• proper cleaning of the removable dentures with tooth brush or denture cleaners.
• chewing sugarless gum which stimulate the salivary flow and a cleaning action.
• treatment of any general medical conditions that mentioned before.

at the end we wish you wonderful smile with pleasant odor’.

Dr R. Nagaty

my lovely wife

complete dentures are a complete set of false teeth that made to replace the extracted natural teeth. Denture is the first requirement needed for the patient to be satisfied, no one want to wear a denture that is not fixed in place or fall during speaking or eating food.

Naturally the dentures don’t need adhesives if it is constructed properly , patient have a enough remaining jaw bones height  and healthy salivation . But sometimes the patient spend much time with no denture which may cause jaw bones height  loss  or have any other problems that prevent the denture stability in this cases maybe you will need the assistance of adhesives.

Denture adhesives types and forms :

It is a biocompatible glow that used to bond the denture in place during functions. There are many types and forms  like powder, paste and stripes. Powders comes usually in a small package that has a small opining that helps to distribute the powder regularly, Paste usually comes in a tube resembling the tooth paste tube and stripes looks like the adhesive tape  that comes in a few centimeters long.

So what is the best type for you??

Lets say that we cannot favor one of the previous forms for every one it depends on the case. Some people like the paste form as it gives a good retention other hate it because the excess paste is spilled in the mouth and the over head of cleaning it after denture removal. Others like the powder because the excess powder is not a major problem here but others say that it has a poor adhesion. Even some patients has allergy to one of the adhesives available so they have to avoid it.

So you should try every available type till you reach the one that has the best fit to your needs, sure consulting your dentist will shorten the road.

Do i need denture adhesives:

First we have to concentrate on a very important point ”Adhesives is not the solution for ill fitted rocking denture ”. It is very important for you to know that adhesives should only be used with properly manufactured, fitting, and not rocking denture. If you made a new denture and it is not fitting or rocking or cause sores and ulcers go straight forward to your dentist to repair it. If you neglected the problem and tried to use adhesives the jaw bones will shrink  which will make it very hard for the dentist to repair and may be you will need to make a new denture that can be worse than the first one.

What if you have an old denture that used to be fixed and stable then after a while (A year or so) it becomes un-stable, fall or move during speaking and eating or cause sores and ulcers. Unfortunately denture adhesives are not the answer here this denture needs what we call “relining”. Relining is needed when the dimension of the jaw bones under the denture  changes over time by resorbtion as a response to the mastication force falling on it.  In this case you have to check your dentist to take a new impression with your denture and the dentist then send it to the lap to add a thin layer to compensate the lost bone.

So it is indicated to use adhesives only when you have a properly manufactured denture ,that accurately fit your gums but has a bad retention due to insufficient height of jaw bones that may caused by spending much time edentulous without denture  or insufficient salivation that can be caused by the chronic use of some drugs or any other medical condition.

Some times the denture is ok and fixed in place but you need more confidence that it will not fall during speaking to the public. This fear is common among new denture wearers so it is ok to use it but you have to concentrate more in training your self to stabilize the denture in place as muscles has a great role in denture fixation.

How to use denture adhesives:

1-First clean your denture with tooth paste carefully especially the fitting surface that towards the gums.

2- If you will use powder adhesives keep the fitting surface a little wet then shake the powder container lightly to spread the powder regularly to the fitting surface then put it in your mouth and wait minutes before eating or speaking to let the powder set.

in case of paste adhesives put a separate points from the tube to the fitting surface and keep the adhesive away from the denture base periphery not  to expel the excess in your mouth. Then put the denture in place.

with the stripes adhesive you will just adheres the tape to the denture base and put it in your mouth.

generally use the least amount of the adhesive first then gradually increase the amount every day till you reach the best sufficient amount needed to stabilize your denture.

3-You shouldn’t wear your denture over night, every night you have to take of your denture, clean it from the adhesive and store it in water or denture storing solution till the next morning to keep you gums healthy and clean.

Some adhesives may cause some kind of allergy that is usually presented as gums burning or rudeness in that case stop using it and call your dentist to change the type for you.

There are many denture adhesive preparations in the market like cushion grip, Equate Firm grip, Super poli grip, fixodent, sea bond and ends lip. the selection is yours you can use any of them according to your preference i usually describe corega powder in the beginning till the patient try the available products and see what is good for him. The prices range from 3$ to 25&.

The human body is one unit so you have to help your dentist to record carefully a full medical history for you. Liver problems are of the medical conditions that needs special care in dental clinic. liver diseases has many types but the most common are liver fibrosis as a result of viral infection or parasitic infection (belharizeases in some countries).

Dentist usually give extra care to liver patients because Liver is responsible of producing most of the factors that are essential for blood clotting. So viral hepatitis or any other distructive liver diseases can impair the normal coagulation mechanism and the patient of the uncontrolled liver disease tend to bleed more after surgery or tooth extraction. There is also an crossinfection risk if viral hepatitis(The most common liver problem) is present.

bleeding tendency: The diagnosis should be confirmed by a physician and the severity of liver affection should be taken into consideration by arranging for a coagulation screen tests  before any surgical treatment like extraction. Patients may need vitamin K or freshfrozen plasma to gain enough coagulation and, therefore, should be managed in hospital and the dentist also will concentrate on local methods of reducing post extraction bleeding like stitching or mesh supported dressing.

Drugs & medications: Drugs prescription is really dilemma as liver is responsible for the breakage and excretion of many toxic chemical materials including many drugs. Also there is some drugs that considered liver toxic and can really hurt the liver in compromised patients. so many drugs should be used with caution or avoided completely in severe liver disease. Paracetamol, NSAIDs, sedatives that usually prescribed after extraction or surgery  are the most common. Any drug prescribing should include reference to a drug formulary.  As some drugs even with normal dose can be txic to liver patient because he fails to break and excrete the drug so it accumulate in the body.  It is difficult to estimate the impairment of drug metabolism even with liver function tests so adjusting the doses of drugs can be very hard even for the experienced physician .

Cross viral infection:The most common form of liver disease is the A,B and C viral hepatitis caused by HAV, HBV AND HCV  so the routine precautions for infection control is essential which  means that all patients who needs extraction or any other oral surgery treatment, whether known high risk or not, should be managed in the same strict way to eliminate the risk of transmission of infectious agents like viruses and bacteria.

Many dental patients asking about the cheapest type of false teeth to replace an extracted teeth. Lets say that the good academic replacements available are porcelain bridges, Metal + porcelain tooth caps, Full metallic bridges, metal based partial denture and acrylic based temporarily partial dentures. I ordered the solutions available from expensive to cheap.

So the cheapest type of false teeth is full acrylic partial denture. This type is considered temporary academically and in many countries it is un legal to introduce it to the patient as permanent solution. But many patients allover the world even in developed countries use it as permanent prosthetic because it is far cheaper than bridges or metal based partials.

This type of dentures can be functional and perform well on the short term (year or two) but on the long run after years the troubles begin. The problem in this type of false teeth that it concentrate all the force of mastication on the gums covering the place of the extracted tooth and the underlying jaw bone. In case of the more expensive metal based partial dentures the force of mastication is distributed between the gums and the remaining neighboring natural teeth. Something called occlusal rest is used to support or hang the denture partially on teeth during function.

This distribution of force is very important to the long run durability of the partial denture. When the mastication force fall on the jaw bone the bone shrink or resorp as response to stress, By the time after two or three years the bone in the extracted tooth place become concave which will make the construction of bridge very hard because the false teeth will be very long to accommodate the bone concavity.

So it will be better if can pay to more money to avoid this poor type of partial dentures. But if you cant afford the expensive alternatives like metal based partial denture then it will be a good decision to make a cheap temporally full acrylic denture to conserve the lost tooth space till you can pay for permanent solution.

Many patients suffering from impacted wisdom molars. Molar wisdoms are the last molars in each arch side if you didn’t extracted any molars wisdom should be after the LAST  two permanent molars. Many patients ask if the wisdoms or 3rd molars are erupted in their mouth and i will give you a simple way to know, If you can count three large molars in the end of jaw side then it is erupted if you only find two large molars then it is not erupted. I use the word large molars to distinguish between the small premolars that is located just after the canines and the larger molars that present near the end of the jaw .

So why wisdoms get impacted?

There is many theories explaining this phenomena but it will be overkill to go deep here so we will keep the explanation simple a possible. The wisdoms impacted simply because there is no jaw enough space for them to erupt . This space problem is explained in many ways some authors say that the western soft cooked food is not grinding the teeth from its sides, this grinding was enough to offer space for the wisdoms. Others saying that if the jaw size is small (inherited from one parent ) and the teeth sizes are large (inherited from the other parent  ) this may cause this problem. Any way it just happened

Impaction can be full when the molar is completely under jaw gums or partially  impacted if a small part of it is out in the mouth. The symptoms vary according to the impaction type.

Symptoms of impacted 3rd molars or wisdoms:

Lets say that most of people won’t have any problems with their wisdoms they just erupt in place with no problems and even you won’t notice it. Sometimes the 3rd molars are impacted and not erupted and also not causing any problems and may still silent for years.

some times impacted wisdoms start to make troubles and symptoms this problems includes

1- Pain : pain that is related to the end of the jaw or even sometimes not localized and may extend to the whole face side. The pain type change according to the the case, presence of infection and impaction type .

2-gums swelling, tenderness and redness :

Some times especially in partial impaction  Gums around the area become swollen , red ,tender and hot as a result of infection. Some times in partially impaction a small gum piece (flap) remain over the molar crown and the opposing molar if present bite on this flap causing severe pain on chewing and more inflammation.

3-Face swelling:

some times the inflammation spread and cause swelling in the side of impacted wisdom even the swelling may extend to the eyes which become almost closed(don’t panic we see this every day, but you should see your dentist in the moment) .

4-Food impaction or wedging:

Some times especially in partial impaction when the wisdom is erupt in a anterior angulation food may become impacted between impacted 3rd & second molar which may cause severe pain and gum pocket.

5-fever :

in some severe cases of infection the body temperature may raise as a reaction to infection.

6-bad breath and bad taste :

impacted food, pus formation and some anaerobic bacterial products can cause a salty bad taste and also the breath smell may change.

7-sometimes pus or blood oozing from gums.

8-Inability to open the mouth widely:

Muscles that is responsible of mouth opining lies close to the end of the jaw so any infection in this area can cause muscle stiffness.

9-lymph node tenderness and pain with swallowing food:

the lymph nodes under the lower jaw react to infection and become enlarged and tender which may cause pain with swallowing.

after all once you feel any of the previous symptoms you should visit your dentist quickly to start the treatment early because if you delay the infection may become very annoying and dangerous. till you go to your dentist you may take over the counter pain killers to decrease pain also peroxide mouth wash may help in removal of impacted food  and killing anaerobic bacteria that cause the infection.

choosing between extraction and filling or conservation is a very common decision that both dentists and patients have to take every day. With adults the decision making is much more easier, if the tooth is restorable and the patient can pay for the treatment then we simply conserve the tooth. If the patient is a child then the process of decision making is much more harder as many factors affect the selection of the treatment plan that the dentist have to follow.

1-Child’s age:

This factor is very important as it well judge the cooperation of the child during treatment process so the cooperative patient is giving more chance to the success of lengthy treatments like filling or even root canal when uncooperative patient may drive the dentist to extraction.

2- The time left for the tooth to come out or shedding:

The dentist here estimate the time left for the milk tooth in the mouth by considering the normal eruption time averages and also the eruption time variations of your kid. Some kids tend to change their teeth earlier of later than normal and this should be taken in consideration when the dentist calculate the estimated of the milk tooth left.

if the dentist estimated that the permanent tooth needs only 6 months or less to come out then it would be better not to waste money and time in filling or root canal.

We have to know that premature extraction of the milk teeth will result in less effective chewing also may cause malalignment or crowding in the permanent teeth which will need an expensive orthodontic treatment after that.

3-General medical state of the child:

If the child suffer from generalized medical illness this may change the treatment plan dramatically. For example if the kid suffers from cardiac disease or the immunity of the child is compromised for any reason like uncontrolled diabetes etc. The recurrence of infection here should be avoided so extracting the affected tooth with a antibiotic coverage may be better than performing deep filling or root canal treatment that may fail and cause recurrence of infection.

In other cases if the child suffers from diseases that affect blood coagulation (like hemophilia ) then the extraction should be avoided and we should try to conserve the tooth till it fall out or shedd normally to avoid the risk of bleeding after extraction.

4-Parents insistence:

Most of the parents of our patients have a good knowledge about problems of early extraction of milk teeth but sometimes we meet parents who insist in extraction and keep saying “the tooth will fall naturally any way in a year or two why should i spend money on it ” In many of this cases the dentist will just pull the tooth as he feels that the patient is not believing what he say about early extraction.

5-Number of decayed milk teeth:

If the child has only one carious tooth then we should conserve this tooth and his mouth clean. But if we have extensive caries allover the mouth sometimes we have to sacrifice some teeth to keep the treatment plan affordable and realistic. The very common decision here is to extract the first milk molar and conserve the second milk molar as the first milk molars tend to cause less problems when extracted early.

6-The degree of tooth destruction:

simply some teeth are too late to be fixed

7-position of the tooth:

Although loss of first incisor will have less effect on permanents alignment, loss of canines or molars will lead to more problems especially in patient with a crowding susceptibility .

8-orthodontic consecrations:

Many times the orthodontist can give an order of early extraction or insist on keeping a tooth that may require lengthy treatment to avoid serious orthodontic problems in the future.

last thing we have to say that early extraction of deciduous teeth can cause really bad problems in permanents alignment or even affect the child’s chewing and psychology. so take your time to think before pulling the tooth

Before you take the decision you fist have to know what will happen after you extract this tooth:

1-Less chewing capability:

when you extract a tooth (especially molars)  your mastication force is affected badly because you are not only losing the tooth you extracted only but the opposing tooth in the other jaw become nonfunctional because it is biting on air so it can’t chew. also when you chew food the food must fall under pressure to be chewed. The tongue from inside, the check from outside and the upper and lower teeth above and below when you extract a tooth food escape to the empty space.

2- Appearance or Aesthetics:

when you get your tooth pulled and especially if the tooth is in your smile area it gives a really bad looking smile even the teeth after the canines will be apparent from the side profile.

Also extraction of posterior molars will affect you face symmetry and make you look older ??now you are asking  why doc.

Teeth act as a support for your lip and check if you removed one or more molars the check and lip will be depressed which can give a aging look. Also as long as the teeth in place it stabilize the face bone in place once you extract many teeth the face bone may start to shrink which also give a older look.

3-Phonetics or speaking  affected, You even can have a lisp:

Tooth pulling can really affect your phonetics especially if the removed tooth is on the anterior part of the jaws  and it is very challenging to you dentist to restore the normal phonetics even with a good false tooth.

4-Tooth gaps may formed in the extraction side of the jaw:

sometimes the teeth in the same side  rotate or slide in the empty space which may cause teeth gaps which can be very annoying as food get impacted inside it and sometimes cause gingival problems and even caries.

5- the opposing tooth in the other jaw may need to be extracted also:

when a tooth is extracted the opposing tooth in the other jaw start to over erupt or going out from the gums which may cause looseness and sensitivity to clod the looseness may increase with the time till the tooth need removal.

6- Stop pulling save your money :

This may look wear as extraction is usually cheaper than filling and root canal but this is the true PULLING COAST MORE MONEY. I can say that we “the dentists” are rich because of people who like extraction. Once you start to eat after tooth removal you will start to think in making false teeth to fill the space you just will feel bad and start to look for a treatment for the empty space. You go to your dentist and ask him to solve your problem. You will just find that all the options available are really really expensive (implant, bridges or even removable denture)

after all just stop the nonsense and keep your teeth where it should be and don’t start to think about pulling unless your dentist say that there is no other solution if root canal or simple filling treatment can be done in your case do it don’t hesitate.

root canal is a thin canal that run inside tooth roots and crown that contains blood vessels, nerves and connective tissue. when the tooth pulp is diseased due to bacteria invasion from caries or deep gingival pocket pulp may become irreversibly inflamed or even completely dead witch will cause severe pain, abscess formation and discoloration.  In this case the only available treatment other than extraction is root canal treatment.

Root canal is considered in many cases the last solution before we think of extracting the tooth. Extracting teeth will cause a very significant drop in mastication, appearance and even phonetics as the extracted tooth will leave an empty space that will cause the food to escape from being chewed also extracting the tooth will cause the opposing tooth in the other jaw to be non functional as it will bite on air also the neighboring teeth to move in the empty space which may cause over eruption of the opposing tooth and drifting of the teeth in the same jaw to the empty space which can cause gaps that the food will be impacted into. Sure you should ask your dentist if the option of root canal treatment is available before thinking in extraction.

Root canal treatment procedures is simply started by removing the dead tissue from the tooth pulp then irrigating the empty canal with a disinfectant then widening of the canal to the needed diameter using what is called root canal file instrument. After that the empty canal is filled with natural resin and the tooth crown is restored using any filling material.

We have to say that root canal treatment don’t deserve it’s bad reputation as the process now is very traditional with success rate about 95%. Also the treatment is not painful as you expect as long as the dentist work under anesthesia. But like any other medical procedure root canal have some problems and complications that sometimes annoy the patients which we will discuss here.

Root canal problems during the process of cleaning and filling:

1-pain:

pain is the biggest fear when we speak about this kind of dental treatment. You don’t have to worry about this any more most of patients admit that they almost have no pain during root canal treatment. Some patients are very sensitive to pain and will need more than one injection and this is ok as the dental anesthesia is safe even at 4-5 injections so just inform your patient that you have pain and  he will manage it with no problems.

sometimes infection may prevent the anesthesia from working properly so the dentist have to manage the infection first before start of the treatment.

also it is normal to have some discomfort or affordable pain between visits that is normal and respond well to over the counter pain killers but if the pain is beyond the limit call your dentist.

2-Fracture of instruments during instrumentation:

This is a  problem that happen during root canal treatment and usually happen when the root is curved or obliterated.  It is ok if the file break after canal disinfection and reaching the end of the root but if the file break before canal cleaning or not reaching the end of the root this may cause the tooth to be extracted or require endodontic surgery to fix the situation

3-Tmj (The jaw joint) pain due to lengthy wide opening the mouth especially if the tooth to be treated is not accessible enough like posterior molars. all you have to do is to inform your dentist and he will manage this easily or will give you a brief rest period.

4-root fracture sometimes the root fracture during condensation of the root canal filling material the fracture usually cause the tooth to be extracted.

5-any other problems that can prevent cleaning or filling the root canals like pulp stones ,missed canal problems etc.

Problems and complications after finishing the treatment:

1-pain:

It is normal to feel little discomfort or affordable  pain  with biting on the treated tooth for few days after treatment and usually this pain respond well to analgesics if the pain continue more than few days you should call your dentist as this may be a bad sign.

2-swelling and redness or bus oozing in the gums above tooth.

This can happen because of infection, The dentist failed to properly clean and disinfect the root canal due to the presence of excess canals that don’t appear on xray or too short or too long root canal filling sometimes the infection happen with no apparent reason. Generally root canal retreatment  have a very high success rate especially if started early.

3-The tooth crown become really brittle after rct and may fracture even under normal masticatory force so you should cover the tooth with a tooth caps or crown after rct.

last thing don’t panic this problems happen only in about 3% of the cases and most of it can be managed and retreated easily with no problems