Some people are more susceptible than others to having a cracked tooth. Factors that are more likely to lead to a cracked tooth are:

• Deep fillings that leave thin amounts of tooth structure.
• Sports such as hockey, football and boxing that have a high risk of facial trauma.
• People who grind their teeth or have strong chewing muscles.
• People with destructive habits like chewing ice or opening things with their teeth.

Your dentist will make recommendations to minimize your risk of a cracked tooth. Here are some things that may be recommended:

• Have crowns placed to cover weak cusps of teeth.
• Have your bite adjusted by your dentist.
• Have old silver fillings replaced.
• Do not chew ice or use teeth to open things.
• Wear a night time grinding appliance.
• Wear a sports guard.

It is likely that the crack will continue to deepen and eventually the tooth may become painful to chewing or pieces may break off it. Sometimes the tooth may crack completely in half, at which point it must be extracted. Other times, the crack goes into the nerve and root canal treatment may be necessary to save the tooth.

A filling can crack when it is old, large or it has too much biting pressure on it. It can also crack if the tooth structure under the filling has softened.

People who have previously broken teeth or fillings may be more likely to break them in the future. Other factors that can increase the risk of cracked or broken fillings are:

• The presence of older and larger fillings.
• People who grind their teeth or have strong chewing muscles.
• People who have uneven or unbalanced bites.
• People who have destructive habits, such as chewing ice or opening things with their teeth.

Your dentist will make recommendations to minimize your risk of a cracked filling. Here are some things that may be recommended:

• Replace older fillings before they break.
• Place a dental cap or “crown” over very large fillings to protect them.
• Have your bite adjusted if it is unbalanced.
• Wear a night-time grinding appliance.
• Do not chew ice or use your teeth to open things.

Bacteria can get into cracks in a filling and lead to decay under the filling material. This decay can rapidly progress into the nerve of your tooth causing a vital abscess. When this happens, the tooth requires root canal treatment or extraction to address the infection.

Discolored teeth are more common in people who have:

• Poor oral hygiene.
• Periodontal disease.
• Existing root canal treatments and old fillings.
• Bite problems.
• A smoking habit.

Consult your dentist regarding your particular situation. Some options that may be recommended are:

• Repair decayed teeth.
• Treat teeth needing root canal treatments.
• Address exposed tooth roots.
• Replace old fillings.
• Address bite problems.
• Bleach the inside of root canal treated teeth or use dental whitening products (at home or in-office).

Unless addressed, the appearance of a discolored tooth can worsen over time. In some cases, the discoloration indicates decay or a dead nerve. This can lead to a severe infection or the loss of your tooth.

Discolored fillings may be caused by leaking around the edges of a filling or staining from things we put in our mouth. When fluids leak underneath a filling, staining and decay may develop. Leakage may appear as a dark line around the edge of the filling or a dark area underneath the filling itself. White fillings may turn a darker color over time from smoking, drying out or exposure to high staining foods or drinks.

Some people are more susceptible to having a discolored filling. The risk factors for a discolored filling are:

• Older fillings.
• Open edges or gaps between the filling and tooth.
• Decay under or around the filling.
• Poor oral hygiene.
• Exposure to high staining drinks such as coffee, tea and red wine.
• Smoking.

To minimize your risk of a discolored filling, there are some important things you must do on your own. Here are some things that may be recommended:

• Carefully clean your teeth every day, as recommended by your dentist and hygienist.
• Have your dentist check your fillings regularly.
• Replace old fillings that are leaking or turning dark.
• Have your teeth professionally cleaned regularly.
• Limit high staining foods and drinks.
• Do not smoke.

If the discoloration is due to a leaking filling, dental decay will eventually develop. If left alone for too long, the tooth may need a root canal treatment or extraction. If the discolored filling is caused by staining, the filling will continue to darken and become more unsightly over time.

The presence and extent of tooth decay in your mouth depends on the balance of a number of risk factors. This balance varies between different people as well as within the same person over that person’s lifespan. For those people who are at increased risk for caries, regular brushing and flossing alone will not prevent their teeth from decaying. The risk factors for tooth decay are:

• The amount and type of tooth decay-causing bacteria in your mouth.
• The ability of your saliva to neutralize or buffer the acid produced by these bacteria.
• The mineral composition or hardness of your enamel.
• Your dental home care routine.
• Your diet.

The first step in addressing tooth decay is to restore the teeth that have cavities. The decay must be removed and the missing tooth structure is replaced with a dental restoration. Your dentist may also suggest placing dental sealants or small preventive fillings on teeth with high decay risk. There are also important things that you must do on your own to decrease your risk of tooth decay. Here are some things that may be recommended for use at home:

• Special oral rinses that reduce the number of caries-causing bacteria in your mouth.
• Oral aids, such as special lollipops or chewing gum that increase salivary flow.
• Mineral applications of fluoride, calcium, and/or phosphate to your teeth to harden the enamel.
• Xylitol containing products to decrease mouth acidity.
• Customized home dental care instruction.
• Customized dietary counselling.

Discuss these options with your dentist and hygienist so that together you can make a plan that is right for you.

The bacteria in tooth decay will eventually reach the nerve and blood supply of your tooth if your cavity is left untreated. The resulting pain and infection must be addressed by either a root canal treatment or an extraction of the tooth. If the cavity is too big, the tooth may not be restoreable and may need to be extracted.

If you’ve ever searched for dental care or DIY tips online, there  are pages filled with claims that say it’s possible to reverse cavities, heal your own teeth, and avoid getting dental fillings through seemingly before-undiscovered homeopathic treatments. Is it true? Can you reverse tooth decay? The short answer is “no” but the long answer is “sort of.” Here’s why: Early tooth demineralization can be reversed Some of the popular “I reversed my tooth decay” websites don’t explain the state of damage the tooth was in (with the digital X-rays to show it) before they suddenly healed their teeth. The earliest stage of a cavity is demineralized enamel. The outer layer of enamel becomes weak and soft, due to acids and plaque biofilm coming into contact with it on an extended basis. Fortunately, demineralized enamel can — to an extent — be remineralized before a physical cavity (hole) ruptures through the surface. What are some ways to help this happen?

• Improved hygiene and plaque removal on an everyday basis.
• Protective dental sealants over deep grooves and fissures, which are some of the most cavity-prone surfaces.
• Drinking fluoridated tap water throughout the day.
• Supplementation with a prescription strength fluoride or mouthrinse, provided by your dentist.
• Use of everyday oral hygiene products that contain fluoride.
• Eating more fresh fruits and vegetables, sharp cheddar cheese, and fewer processed carbohydrates.
• Eliminating acidic beverages and those that contain natural or artificial sweeteners.

Decayed enamel can’t be “re-grown” The types of cells that make up your teeth do not re-grow or repair themselves after the tooth is fully developed. There are currently laboratory studies being conducted with stem cells to try to make this a potential reality. But as of yet, it’s physically impossible. Once a tooth has a physical cavity (opening or hole) inside of it, there is no feasible way to help the enamel grow back on your own. Instead, the cavity will gradually worsen, due to the bacterial infection inside of the tooth structure. Ideally, you would want to treat the cavity as soon as it’s diagnosed and while it’s as small as possible. When you do, your dentist can place a minimally invasive filling and preserve as much healthy tooth structure as possible. But untreated cavities will expand to the point that they require larger fillings. Or worse, they will reach into the nerve chamber and create an abscess. What could have initially been treated with a modest restoration now becomes a situation requiring a root canal and a crown.

Early diagnosis is the key to preventing your tooth decay from spreading. Sometimes, you can catch the possible cavity before it has actually broken through your tooth. Let your dentist know if you’re experiencing any sensitivity on specific teeth, feel a rough tooth surface, or notice discoloration in the surface of your enamel.

There will be a lot of bleeding Your mouth is full of blood vessels. During an emergency, such as a blow to the mouth, you’ll see a lot of bleeding as a result. While the bleeding can be scary, it’s a good thing. It means that there’s plenty of opportunities to help save your knocked out tooth if you act fast. It’s your body’s way of making sure you don’t develop an infection and that the wound heals quickly. Your first step is to apply a firm amount of pressure to your mouth, using a clean gauze or washcloth. If bleeding does not subside (such as in instances of clotting disorders or if you take certain anti-coagulation medication) then head to the nearest emergency room. Act fast Locate your tooth. If it appears to be completely whole, you’re in luck! Gently rinse the tooth under a slow stream of water to remove any visible debris. Do not touch the tooth root, as this will displace the tiny fibers across the surface that will help to aid in reattachment. Handle it only by the crown (the part that you normally see above the gums). Reinsert your tooth As unnatural as it may sound, the ideal situation is to place your tooth immediately back into the socket that it came out of. Do not force it. Either your tooth will go back in, or possible bone damage will prevent it from doing so. If you’re successful at reinserting the tooth, bite down on a gauze or clean cloth and head to your dentist’s office immediately. Store your tooth properly If you can’t reinsert your tooth, then the right kind of storage will make a difference in if your tooth is salvageable when you get to the dentist’s office. It also prevents you from accidentally losing your tooth. Put your tooth in a sealed container if possible (one with a lid, such as what you would keep food in.) Your tooth needs to be completely submerged in liquid and kept moist. The best liquids to use are milk, contact solution, or some type of saline. Tap water should only be used as a last resort; if used, add a pinch of table salt. Another option is to tuck your tooth inside of your cheek, keeping it completely moist with your body’s own saliva. Depending on where you are when your avulsed tooth emergency takes place, the first aid kit may have a tooth kit that contains a special formula and bottle for your knocked-out tooth to be kept in. See a dentist immediately For the best success in re-implanting a knocked out tooth, you need to see a dentist within 1-2 hours. Waiting longer will significantly lower your chances of being able to save it. Most dentists will be able to accommodate such dental emergencies as quickly as possible, even if it’s after hours. The key is to have a provider on hand that you know and trust; hopefully, one you’ve already been seeing for years!

Dietary habits which include very hard or fibrous foods. In moderation, this is not a concern, but an excessive habit of eating particularly abrasive foods can lead to tooth abrasion. Examples of this would be sunflower seeds, or certain grains and nuts. Dental products come in a wide range of abrasiveness. Because exposure to abrasive toothpastes occurs on a daily basis, it is important to select products that will minimize the abrasive risk to your teeth. Examples include toothbrushes with excessively hard bristles and some toothpastes that contain highly abrasive particles.

Abrasion most commonly occurs as a shiny V shaped groove at the gum line of the teeth contributing to a notching appearance. Abrasion associated with a destructive diet will cause a flattening appearance of the chewing surfaces of the back teeth.

Prevention is the most important part of managing tooth abrasion. Choose a low abrasion toothpaste as some toothpastes play a significant role in causing tooth abrasion. The RDA value (Relative Dentin Abrasivity) ranges from 0-250. RDA values of 150-250 are considered the harmful. Additionally, use a soft toothbrush and a correct brushing technique using moderate force.

Continual abrasion will affect the appearance or structural integrity of the teeth and may lead to sensitivity, decay and eventual tooth loss in very severe cases.

We can evaluate your individual risk factors and customize a Dry Mouth Management Protocol for you. Once you have your protocol, it is up to you to carry out its important steps on your own. Here are some things you can do at home:

• Apply special water-based lubricants to protect your teeth and tissues.
• Use sugar free mints or chewing gum to stimulate salivary flow.
• Use a humidifier while sleeping to prevent your mouth from drying out.
• Use oral medication to stimulate salivary flow.
• Learn more about the intake of caffeine and alcohol as well as the intake of water and other re-hydrating fluids.

If your oral imbalance is left unaddressed, continuing dry mouth will put you at a much higher risk for many oral diseases. Severe tooth decay often results in infection requiring either root canal treatment or tooth extraction. Even with adequate tooth brushing, patients with dry mouth may experience bad breath. The risk of mouth sores and loss of tooth structure due to wear and acid erosion also increases.

Stomach acid is the most destructive cause of erosion on teeth. It is associated with gastroesophageal reflux disease, [GERD] and chronic vomiting due to causes such as chemotherapy or bulimia nervosa. A less severe form of erosion is caused by acids associated with diet, particularly citric acid, sport drinks, and other acidic drinks and fruits. An occupational risk associated with long term exposure to acidic fumes through galvanizing and battery production, professional wine tasting, and a recreational risk associated with competitive swimming have all been identified as possible causes of erosion.

Your dentist may suggest the following:

• A thorough review of your medications and medical and dental history.
• A discussion of possible destructive acids in your diet.
• Measurement of the severity and location of the areas of erosion.
• Measurement of the amount of saliva in your mouth to determine the possibility of dry mouth.
• A review of home care including brushing technique and using an appropriate toothpaste.
• An evaluation of possible occupational risks.

Your customized management protocol may include:

• Treatment of the eroded teeth and regular dental checkups.
• Medical referral where indicated.
• Reduction of acid exposure by reducing the frequency and contact of acids.
• Protective mouth-guards or a spacer device to deliver inhaled drugs.
• A soft toothbrush and low-abrasion toothpaste.
• The use of chewing gum to reduce acid reflux.

Continual erosion will affect the appearance of the teeth and may lead to sensitivity and possibly tooth loss.

There are several ways that dentin can become exposed leading to tooth sensitivity. Here are a few common causes of sensitive teeth resulting from dentin exposure:

• Gum recession due to gum disease.
• Overaggressive brushing or brushing with a hard bristled toothbrush.
• Too many acidic foods and beverages.
• Teeth grinding.
• Tooth decay or physical injury to the tooth.
• Recent dental procedure.

Always see your dental professional for tooth pain that is severe or consistent and lasts for more than a day or two, but if you have the sharp, shooting pains commonly felt with tooth sensitivity, use products that are designed to block the tubules and relieve the pain including toothpaste for sensitive teeth and gums.

With the many recent advancements in oral health technology, you might not have to accept sensitive teeth as a fact of life. There are a number of options for treatment of sensitive teeth:

• Brush and floss your teeth twice a day to prevent gum disease.
• Be sure to clean all parts of your mouth, including between teeth and along the gum line.
• Brush gently and use a soft bristled electric toothbrush. This will help prevent overaggressive brushing and protect your enamel from being worn away.
• Avoid acidic foods and drinks.
• Use a toothpaste designed to help protect your teeth against sensitivity.

Tooth wear is not normal. Three causes for tooth wear have been identified: Acid erosion which appears as grooving or dishing of the biting surface of your teeth. The risk factors for acid erosion are:

• Chronic dry mouth.
• Chronic vomiting or “GERD” (Gastroesophageal Reflux Disease).
• Diet – sports drinks, soft drinks, candies, citrus fruits.
• Environment – certain acidic work places, swimming pools.

Bite wear which appears as shortening or thinning of your teeth. The risk factors for bite wear are:

• An unbalanced bite – your teeth should contact evenly on both sides.
• Grinding your teeth.
• An overly abrasive diet.

Tooth cleaning abrasion which appears as notching near the gum line of your teeth. The risk factors for tooth cleaning abrasion are:

• Abrasive dental home care aids such as some toothpastes and toothbrushes.
• Using too much pressure on your toothbrush or toothpicks when cleaning your teeth.

The first step in addressing tooth wear is to have your dentist evaluate your individual risk factors and customize an appropriate management protocol for you. Your tooth wear management protocol may include:

• Diagnosing and managing chronic dry mouth.
• Diagnosing and treating conditions related to chronic vomiting and GERD.
• Customized dietary counseling.
• Diagnosing and treating an unbalanced bite.
• Making a mouthguard to protect your teeth from grinding.
• Mineral applications to your teeth such as fluoride to harden the notched surfaces.
• Customized home dental care instruction.

Other than impacting the way you look, untreated tooth wear may lead to the nerve of your tooth being exposed. When this occurs, the affected tooth will require root canal treatment to save it. If tooth wear remains untreated, it can lead to the tooth becoming damaged to the extent it must be removed.

A loose tooth can be caused by the loss of bone around the tooth (“periodontal disease”), a broken root of the tooth (trauma) or a widened space between the root and the bone that the tooth sits in (infection or long-term stress).

Some people are more susceptible than others to having a loose tooth. The people at high risk for having a loose tooth are those with:

• Advanced periodontal disease.
• An unbalanced bite.
• Excessive bite forces.
• Traumatic injuries to teeth.
• Infections around teeth.

Your dentist will make recommendations to manage the specific loose tooth risk factors that apply to you. Here are some things that may be recommended:

• Periodontal management procedures.
• “Equilibrating” or balancing your bite.
• Wearing a night guard.
• Wearing a sports guard.
• Treating any infections associated with your teeth.

Most often, a loose tooth will become progressively looser and eventually fall out. This process is frequently accompanied by pain and infection.

Dental sealants are most commonly placed on the permanent molars of children. Ideally, this is done shortly after these teeth fully erupt. The first permanent molars erupt around age six and the second permanent molars erupt around age 12. Dental sealants can also protect vulnerable pits or grooves on adult teeth.

The pits and grooves on the back teeth may be too narrow for a toothbrush bristle to reach the base. This allows plaque and bacteria to accumulate, which increases the risk of tooth decay. Dental sealants fill those pits and grooves, thus decreasing the risk of tooth decay by preventing the accumulation of plaque and bacteria.

Placing dental sealants requires no anesthetic or drilling. The teeth must be kept isolated during the procedure. The tooth surface is cleaned and prepared then the sealant material is spread into the pits and grooves. The material either sets by itself or is cured with a light. Your dental professional will check to ensure the sealant does not interfere with chewing.

There is very little risk in having dental sealants placed. Rarely, a sealant will leak, and decay will form beneath it. Regular examinations by your dentist allow sealants to be repaired or replaced as needed.

Without dental sealants, the risk of tooth decay increases significantly in teeth with deep grooves and pits. Once a tooth is decayed, it requires a filling and often becomes weaker due to the loss of sound tooth structure.

Function: This surgical procedure is recommended if there is not enough healthy tooth structure above the gum. By changing the bone level and exposing more of the tooth structure, a tooth can be properly restored with a crown or other restoration. Aesthetics: This procedure can improve a gummy smile of the front teeth. By changing the bone level around the teeth in question and subsequently changing the levels of the gums, an aesthetic improvement is achieved.

Risks associated with local anesthetic, bleeding, bruising, swelling and infection are all possible complications. Tooth sensitivity, exposure of adjacent tooth structure and exposure of restoration margins may also occur.

You may elect to remove the tooth that cannot be properly restored without crown lengthening. The tooth will then likely need to be replaced. An alternative to crown lengthening might be to orthodontically move the tooth into the mouth.

If you elect not to have crown lengthening for functional reasons, the result may be premature loss of the tooth. This procedure may be necessary to achieve your aesthetic objectives if the goal is to improve a gummy smile.

Fluoride helps protect teeth from decay and cavities. Teeth with fluoride in the enamel simply resist acids better than teeth that have not. When bacteria in the mouth combine with sugars, acid is produced that can dissolve tooth structure and cause cavities or erode away the enamel. It protects teeth from demineralization caused by the acid. It can also help with repairing enamel that has been mildly damaged by acids. Studies have shown water fluoridation continues to be effective in reducing tooth decay by 20- 40%, even with widespread availability of fluoride from other sources.

Both children and adults can benefit from fluoride use. Especially helpful for those with a history of tooth decay, poor dental hygiene, a high acid/sugar diet and those who experience dry mouth.

As with any medical treatment, toxic effects can occur with extreme doses. Overdose is possible, for example, if a small child consumes an entire tube of toothpaste or ingests multiple supplement tablets. Fluoride can cause discoloration of enamel if excess amounts are used over long periods of time while the teeth are developing.

There are no known alternatives that provide equal benefit for the health and strength of tooth enamel.

Generally, there is a significantly increased risk of developing cavities.

Until recently, most professional fluoride treatments that you received after a dental cleaning were in the form of a foam or gel inside of a squishy tray that fit over your teeth. You wore the tray for a few minutes, then any remaining fluoride was suctioned away, and you were advised to not eat or drink for a half hour or more. This prevented any surface fluoride from being washed or wiped away, allowing the porous tooth enamel to soak in as much as possible. But with a varnish, the tacky-like texture immediately adheres to the tooth and stays there for several hours. It’s applied with a small brush just one tooth at a time and in most cases, there are no dietary restrictions. Just avoid brushing your teeth until the end of the day, so that the fluoride can be absorbed as much as possible.

With a sodium fluoride varnish, you can enjoy: • Maximum mineral uptake into your teeth. • No need to wait to eat or drink after your dental appointment. • Relief for tooth sensitivity. • Reversal of enamel demineralization (early tooth decay). • Greater resistance against cavities.

Fluoride varnish is an effective option for managing chronic tooth sensitivity. If your teeth are healthy but tend to be hypersensitive to temperature changes (as when you’re eating) or just breathing in through your mouth, then you may want to request a varnish treatment. Applying fluoride varnish usually provides relief for sensitive teeth on the very same day, with results lasting up to three or four months. You can stop by your dentist’s office at any time to have another treatment. Even if it’s not covered by your dental insurance, the affordable procedure is worth the minimal investment!

As with any type of vitamin or mineral, ingesting too much of a good thing isn’t good. But in appropriate doses, fluoride is vital to having a healthy smile that lasts through life. Not only do regular fluoride exposures or varnish treatments help you keep your teeth strong, they significantly lower the risk of decay due to the gradual erosion process from our foods and drinks. Most professionals suggest an application every six months for preventative purposes.

Most people are familiar with traditional dental fillings and crowns (“caps”.) But not many individuals have heard of an alternative to these treatments, known as a dental inlays and onlays.

Larger than a filling, smaller than a crown Fillings are ideal when a tooth has a small cavity. But when tooth decay or fractures extend deeper into teeth, trying to patch it up with a filling only places the tooth at a higher risk of fracturing and cracking during everyday use. At this point, the majority of general and cosmetic dentists progress to a full coverage dental crown that protects the entire tooth, even if there is significant healthy structure remaining. Sometimes fillings are not effective, but crowns are too aggressive than what’s truly necessary. It’s at this point where dental inlays and onlays come into play. An inlay or onlay offers greater protection and durability than a large filling but is significantly less invasive than a full coverage “cap” which requires reshaping of the tooth entirely. Yet, many dentists do not offer inlays and onlays in their practice. Filling in the fissures/valleys and grooves Inlays are sometimes called “lab made fillings” because of their purpose and design process. An inlay essentially fills in the valleys and hollows inside of a tooth, as long as the cusps around it are still intact. It’s almost like a large filling, except more durable than a standard composite or amalgam (metal) restoration. Because inlays restore such a large portion of teeth, they’re made in a lab like a crown. First, the compromised tooth structure is removed, then an impression or digital scan is taken. The impression/scan is transferred to the lab, where a technician designs it by hand or has it milled electronically. Because it’s made from a solid piece of ceramic or zirconia, the inlay is extremely durable and acts to strengthen the tooth, rather than pose a risk to the enamel that’s left. Covering the cusps and biting edges Onlays cover the cusps and ridges (or biting edges) of teeth, rebuilding enamel that’s been chipped or broken off. When it comes to recreating the shape of compromised teeth, an onlay is more like a traditional crown, except it does not cover the full tooth surface. Onlays are sometimes called “three-quarter crowns” because of their ability to cover such a large area, without encompassing the entire tooth. As such, they’re more conservative than traditional crowns, allowing you to preserve as much healthy, natural tooth structure as possible.

Just like any other routine dental procedure, the tooth being restored will be fully anesthetized. Local anesthetic is applied to the area around it, preventing any discomfort once the treatment starts.

Depending on which tooth is being treated, it may have anywhere from 1-3 roots. This is a big factor when it comes to the length of your appointment (treating fewer roots takes less time.) Additionally, some teeth have unique root anatomy, making them more challenging to treat. For example, a root may be curved or hooked at the end, requiring special resources to clean out the nerve canal and fill it. Your dentist or endodontist will use a soft mouth prop to help you relax your jaws and facial muscles throughout the process.

If you’re slightly sore the next day, it’s usually where the local anesthetic was injected or due to some joint irritation. Plan to massage your face, jaw, and take an anti-inflammatory to prevent any potential discomfort before it starts. The goal of endodontic therapy — aside from preserving your tooth — is to alleviate the risk of pain. Treating your tooth with a root canal is meant to help you avoid any potential discomfort from an infection. Today’s resources and technology can make getting a root canal essentially pain free.

The root canal procedure itself will remove the infected nerve tissues from inside your tooth. If left in place, the tooth will reabsorb and abscess, ultimately requiring an extraction. After the chamber is cleaned and decontaminated, a filling material will be placed down into the hollow canals to prevent the risk of reinfection. The remaining tooth structure will now be disease-free, but more brittle as it is no longer vital. Your dentist will place a protective ceramic crown over the tooth, allowing it to function normally without wearing down due to everyday use.

Now that your tooth is restored both inside and out, you’ll want to continue caring for it as if nothing had happened. Daily brushing and flossing are essential, to prevent any gum disease or decay from affecting the outer surfaces along the gum lines.