Crowns are full coverage restorations that are used to cover a tooth that is likely to break or is too broken down to be restored with a filling. They are most commonly done after root canal treatment or when a large filling wears out. The larger the hole made by a cavity that has to be treated, the more likely a crown will be needed. Even after a filling is put in a large cavity, a tooth is more likely to break. Teeth are subjected to tremendous pressures. Crowns cover the weakened tooth, providing strength and protecting the tooth against breakage.
It takes two appointments to restore a tooth with a crown. In the first, any decay is removed from the tooth and it is shaped to accept the crown. Then an impression is made of the tooth for use in fabricating a crown. The crown is made between the two visits. It is made with either high-strength porcelain over gold alloy, all ceramic material, or gold. Also during this time, a temporary crown is worn. In the second visit, the temporary crown is removed, and the permanent crown is adjusted as needed and then cemented in place.
There are different types of dentures, but they share their common function. They replace missing teeth. When bone loss around the roots of teeth is great enough to loosen them or let them fall out, it's time for dentures. Although our goal is to preserve a complete set of teeth, it sometimes becomes necessary to remove unrestorable teeth. Dentures can be fabricated to replace all teeth in an arch or just a portion of missing teeth.
There are two ways this can be done. The first involves removing all teeth in the arch and allowing complete healing before impressions are made and dentures are fabricated and delivered. The result is the best fit at the time of delivery but requires that the patient will endure a period of time without teeth in the arch.
The second procedure allows for immediate denture delivery at the time of extractions. This technique eliminates the waiting period for the replacement teeth but requires additional procedures after healing to refit the dentures.
Follow-up is necessary in both instances including yearly exams to evaluate overall continuing oral health.
A dental implant is an option to replace a missing tooth. In this procedure, a small titanium shaft is surgically implanted into the bone and allowed to set. The bone grows around it forming a tight connection, which additionally slows or stops the bone loss that occurs when the root of a natural tooth is missing. Once the implant is firmly set in the mouth, the dentist then works to attach the replacement tooth onto the top of the shaft. This permanent solution has the advantage over bridge work that it does not stress the surrounding teeth for support, and, should the tooth wear out, another can simply be replaced on the shaft.
Implants can also be used as support as part of an implant bridge. This is an alternative to partial dentures, and has several advantages. First, there is no adjustment period to acclimate the patient who, once the work is done, only feels teeth, not metal supports intruding into the mouth. Second, this slows the bone loss occasioned by missing teeth. Third, there is no discomfort or difficulty in eating. And, best of all, of course, they are not removable.
ROOT CANAL TREATMENT
Root canal treatment (also referred to as root canal therapy or endodontic therapy) is made necessary when a cavity is allowed, through neglect, to reach all the way to the pulp. (Regular cleanings and checkups prevent and detect problems early.) Sometimes deep restorations or trauma to a tooth may cause the nerve to be damaged to the point it needs root canal therapy. Once this occurs the pulp becomes infected and can even extend through the root tip and begin to eat away at the surrounding bone (this is an abscess). By the time the pulp is infected, it must be treated and cannot heal on its own. It can even weaken the entire immune system. This is dangerous, not to mention very painful. Symptoms that the pulp has become infected may include sensitivity to hot/cold or sweets, pain, swelling, pain to biting or pressure, and a bad taste in the mouth. Sometimes, however, no symptoms are apparent and the person is unaware of any problem until a checkup.
A root canal is then performed to clean out the infected tooth pulp and to disinfect the canals of the tooth. The only other treatment would be to extract the tooth. Once the infection is resolved, the canal(s) are filled in to prevent any further infection. A core build-up and crown is usually recommended for restoring a tooth that has had root canal therapy.
This is an option for filling the space created by a missing tooth. It is formed to look like the missing tooth, and it takes its place in the mouth. The sides of a bridge use the two surrounding teeth for support, hence the name. A bridge replaces the missing tooth, both functionally and cosmetically. Bridge work is as much an art as it is an exact science. The materials used may be gold alloys, porcelain bonded to metal alloy, or all ceramic material. The choice of material depends on requirements for strength, wear, and/or esthetics.
It is important that a missing tooth be replaced as soon as possible for several reasons. If not treated the teeth surrounding the gap begin to shift inward, creating a whole chain reaction of bad things. Teeth use their neighbors for support, and, with one missing, they start to "fall." As this worsens the bite changes in response to the pressure. This can eventually result in problems with the entire jaw, e.g. TMJ. The surrounding teeth deteriorate and it is just a matter of time before they, too, are lost. Gum disease becomes a serious problem, with the difficulty of treatment increasing as the neglect continues.
TMJ stands for temporal-mandibular joint. Temporal, as in temple area of skull; mandibular as in mandible, or lower jaw; joint as in it's where the head and jaw meet. Problems in this joint may be caused by a misalignment of the teeth, trauma, or excess muscle tension. Aside from the two bones that meet there, cartilage buffers them and five muscles are involved in the area. If something goes wrong a good deal of trouble can result.
Problems in this area can cause:
- Trouble/soreness in opening and closing the mouth
- Clicking or popping of the jaw
- Pain in the jaw muscles
- Soreness in the area, sometimes extending to the face
Dental treatments for the condition can include replacing missing teeth, moving teeth, adjusting the bite, filling gaps between teeth, etc. There is no one solution that is right for all cases. Sometimes a plastic mouthpiece is used to prevent clenching or grinding that is contributing to the problem. If untreated and taken to extremes, surgery may be required to repair a badly damaged joint.