Tour de Dental - For a healthy smile

When the degradation products of the decay causing bacteria have been lifted enough tooth material to the various heat stimulation bring s easier stimulated the pulp innervations, our tooth easily become sensitive when consuming hot, cold possibly acidic foods and beverages. In this case our tooth is still alive, so if we go to our dentist by the first such signal, the tooth can be saved usually with one filling.

Many patients come to our surgery when they feel continuous or periodic, but without stimulus occurring pain in their teeth. In this case the pulp is inflamed. The tooth is special anatomical featured organ, because the closed space limited with the hard tissue does not allow the completion of the inflammatory process successful “self-healing”. This special circumstance is which is in the case of the tooth inflammation necessitates the intervention of the dentist, which is synonymous with the root canal treatment.

If the tooth during the biting shows sensitivity, it is the signal that the pathogens get through the pulp and the root canal, and they get stuck somewhere in the bone and in the border of the root apex. If the dentist can clean properly the root canal and can care it with well closing apex filling, then from the mouth the open road ended for the bacteria and the organism is be able to overcome the pathogens in surrounding space of the root apex.

If the inflammatory process finds itself another way, it is often involves with bone fracturing the abscess formation. In this case coupled with typical strain feeling swelling is evolve on the palate or on the outside of the teeth in the area of submammarial folds of the mouth’s mucous membrane. The opening of these depends on the size and the location; it can happen through the tooth or with an incision from the mucous membrane.

It can cause frequent pain the pierce or the forming so called Pericoronitis around the crown of the blocked fracturing wisdom teeth. In this case between the wisdom tooth’ crown and the gum a pocket is formed, which inflamed because of the difficult cleanability. Rinse this area in a daily basis; probably treat it with medication strip. After the inflammation receded it is worth to remove the underlying cause. This means that after the evaluation of the X-ray picture, in the right direction we help the wisdom tooth to pierce with the intersection of the above gum or we remove the abnormal positioned wisdom tooth.

Toothache is often considered as the pain caused the diseases of the supporting structure of the tooth. At this point the teeth show sensitivity for the typical lateral forces (percussion). Less frequently, but during such diseases can also formed abscess formation next to the teeth.

On the following radiograph we can see the formed cyst in the lower left 6 tooth’s root.

Tooth decay

Few people know, but the most common teeth disease is the dental caries, which is the result of the bacterial infection. The mouth is the home of hundreds of species of bacteria, some of these plays huge role in the creation of the tooth decay, most of these have important role in the gingivitis and in the progress of the periodontal diseases.

The dental caries is chronic process associated with the damage of the tooth’s hard tissues. The caries occurs in the following way:

• The bacteria settle in the deposited pellicles on the tooth. We picked up these bacteria usually in our childhood from our parents or friends.
• They consumed the carbohydrates entered into the mouth, so the bacteria metabolize.
• The degradation products have already formed an acidic environment, which is able to dissolve the minerals in the stock of the hard tissues.
• Dissolved minerals replace from the intake fluoride in a certain extent. The fluoride can be replaced from the toothpastes, from mouthwashes, from fluoridated salts, from mineral waters. The fluoride can overdose; the unlimited consumption can causes pathological changes in our organism’s tissues.
• If the balance of the dissolution and the replacement is disrupted, the dental caries wins.

The previous sections show the frequent intake of the carbohydrates is much more harmful to our teeth, than eating many sweets at the same time. In this case there is no time for the replacement. The dentist’s main task is when preparing a filling remove all of the softened bacteria filled tooth material and replace it in such a way that completely balk the bacteria.

Under filling decay, this started from the uncleaned area between the two teeth, which is very close to the pulp.

Reasons for periodontal diseases, gum atrophy formation

The second most common cause of the tooth loss after the tooth decay is the formation of the periodontal disease. In most cases the periodontal disease occurs as a chronic inflammation, whose main cause is the accumulating pellicle and dental calculus on the teeth. With the growth of the dental calculus will be more, difficult cleanable surface in the mouth. As a consequence between the teeth and the gum the number of the bacteria will increase in the formulating pockets due to the inflammation. With this the inflammation is strengthening and the process strengthen itself with the increasingly more difficult cleanable surfaces and pockets, until around the teeth do not destroy completely the tooth’s supporting structure, including the surrounding bone. Then the tooth slowly starts to move and fall out.

On the picture below you can see that deep pockets were formed due to the regularly not removed tooth calculus. The gum separates from the root, the gum recedes, and the bone is decomposition. When treating the pockets it is not enough to remove the dental calculus from the teeth surface. In this case it is necessary to curetting under local anesthesia after registering the pockets. So the periodontal diseases can be stopped and symptom-free status can be achieved.

Risk factors

The bad oral hygiene, the smoking, the diabetes, and some genetic factors greatly increase the risk of the formulation of the periodontal diseases. The periodontal disease has mainly genetic formed type, but the accumulated dental calculus exacerbates it.

Treatment

Above can be seen the importance of maintaining the good oral hygiene. This includes the regular dental calculus removal at the dentist. If the pockets have already formed, from these the inflamed tissues must be removed with special tools (closed curettage), or if the pockets are very deep (more than 5-6 mm) the surgical cleaning (open curettage) is also considered.

Registration of the pockets with periodontal probe:

These changes may be form not only around the teeth, but around implanted artificial roots in neglected cases. The therapy is similar, there shouldn’t use special materials made tools for cleaning to don’t hurt the surface of the implants.

We often splint wiring the mobile teeth in order to increase their stability. The mentioned methods are only aimed at stopping the process. The lost connection between the tooth and the bone they can’t be restored. For this much more expensive membranes guided tissues regeneration survey is necessary, combined with bone replacement materials. These unfortunately can be applied always; furthermore if we can’t change the oral hygiene habits, or the patient doesn’t give up the smoking, their use is almost useless.

The surgical attend of the gingival retractions (recessions) are the specialists’ task. Their size and location greatly influenced the success of the surgery.

Surgical images:

Digital panoramic X-ray picture of the serious periodontal disease: