Mouth injuries in children and teens are more common than you might think: about one out of three boys and one out of four girls will have experienced an injury before they graduate from high school. Besides contact sports, other types of accidents like car crashes or falls are high on the cause list.
Although most dental injuries aren’t considered true emergencies, there are a few where prompt action may mean the difference between ultimately saving or losing a tooth. One such situation is a knocked out tooth.
In the event of a knocked out (or avulsed) tooth, your primary goal is to place the tooth back into the empty socket as quickly as possible. Teeth that have been out of the mouth for less than five minutes have the best chance of reattachment and survival. The first step is to quickly locate the missing tooth.
Once you’ve found it, use only cold, clean water run or poured over the tooth to carefully clean off dirt or debris (no soaps or cleansers). You should also avoid touching the tooth root or scrubbing any part of it. After cleaning it of debris, gently place the tooth back in its socket, then immediately contact us or visit an emergency room. While you’re en route to our office the patient should carefully hold the tooth in place. If the tooth can’t be immediately placed into the socket (the patient is unconscious, for example), then you should place the tooth in a clean container and keep it moist with cold milk, a sterile saline solution or even the patient’s saliva.
Taking these steps increases the chances of a successful re-implantation, although the injury may ultimately affect the tooth’s lifespan. Replanted teeth can suffer from root resorption (where the root tissue dissolves) or a process known as ankylosis in which the tooth fuses directly to the jawbone with no healthy periodontal ligament in between. Either of these conditions can lead to tooth loss.
Still, it’s worthwhile to try to save the tooth, even if for a few more years. Those extra years can help you prepare for a future restoration.
If you would like more information on responding to dental injuries, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Accidental Tooth Loss.”
The March 27th game started off pretty well for NBA star Kevin Love. His team, the Cleveland Cavaliers, were coming off a 5-game winning streak as they faced the Miami Heat that night. Less than two minutes into the contest, Love charged in for a shot on Heat center Jordan Mickey—but instead of a basket, he got an elbow in the face that sent him to the floor (and out of the game) with an injury to his mouth.
In pictures from the aftermath, Love’s front tooth seemed clearly out of position. According to the Cavs’ official statement, “Love suffered a front tooth subluxation.” But what exactly does that mean, and how serious is his injury?
The dental term “subluxation” refers to one specific type of luxation injury—a situation where a tooth has become loosened or displaced from its proper location. A subluxation is an injury to tooth-supporting structures such as the periodontal ligament: a stretchy network of fibrous tissue that keeps the tooth in its socket. The affected tooth becomes abnormally loose, but as long as the nerves inside the tooth and the underlying bone have not been damaged, it generally has a favorable prognosis.
Treatment of a subluxation injury may involve correcting the tooth’s position immediately and/or stabilizing the tooth—often by temporarily splinting (joining) it to adjacent teeth—and maintaining a soft diet for a few weeks. This gives the injured tissues a chance to heal and helps the ligament regain proper attachment to the tooth. The condition of tooth’s pulp (soft inner tissue) must also be closely monitored; if it becomes infected, root canal treatment may be needed to preserve the tooth.
So while Kevin Love’s dental dilemma might have looked scary in the pictures, with proper care he has a good chance of keeping the tooth. Significantly, Love acknowledged on Twitter that the damage “…could have been so much worse if I wasn’t protected with [a] mouthguard.”
Love’s injury reminds us that whether they’re played at a big arena, a high school gym or an outdoor court, sports like basketball (as well as baseball, football and many others) have a high potential for facial injuries. That’s why all players should wear a mouthguard whenever they’re in the game. Custom-made mouthguards, available for a reasonable cost at the dental office, are the most comfortable to wear, and offer protection that’s superior to the kind available at big-box retailers.
If you have questions about dental injuries or custom-made mouthguards, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “The Field-Side Guide to Dental Injuries” and “Athletic Mouthguards.”
While most tooth loss stems from dental disease or injury, another major cause is a condition known as cracked tooth syndrome. What begins as a microscopic crack in an individual tooth’s enamel could ultimately grow to a fracture that endangers its survival.
Most often related to age-related brittleness, expansion and contraction of the enamel surface because of hot foods followed by cold foods and beverages, or grinding habits, cracked tooth syndrome usually occurs in three phases. The first phase is the emergence of miniscule cracks in the outer enamel known as craze lines. These can be very difficult to detect even with x-rays, and usually calls for specialized detection methods such as probing with a sharp instrument (an explorer) or fiber-optic lighting with dye staining to highlight enamel abnormalities. If you have pain symptoms, we may ask you to bite down on a bite stick or rubber pad to locate the area by replicating the sensation.
In the next phase, the craze line grows into a crack that penetrates below the enamel into the tooth’s dentin. Pain becomes more prominent and the risk of infection increases. Left untreated, the crack may enter the third phase, a full break (fracture) occurring deep within the inner layers of the tooth. The deeper the fracture occurs, the more serious the danger to the tooth, especially if the pulp is exposed.
The best treatment approach is to attempt to detect and treat a crack as early as possible. Craze lines and moderate cracks can usually be repaired with restorative materials like composite resins. A deeper crack extending into the pulp may require a root canal treatment and the tooth covered with a permanent, protective crown.
If, however, the fracture is too deep, the tooth may be beyond repair and will need to be extracted and replaced with a dental implant or permanent bridge. In any event, the sooner a cracked tooth is discovered and treated, the greater your chance of avoiding pain, discomfort, and, ultimately, tooth loss.
If you would like more information on cracked tooth syndrome, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Cracked Tooth Syndrome.”
National Fresh Breath Day is celebrated in August, but who doesn’t want fresh breath every day? Everyone has bad breath once in a while, so here are some tips to fight it.
1. Step up your oral hygiene routine.
Good oral hygiene is the first line of defense against bad breath. Brush your teeth morning and night and floss daily to remove much of the tiny food debris and plaque (colonies of oral bacteria) that can cause bad breath.
2. Don’t neglect your tongue.
A coated tongue can be a source of bad breath, so brush your tongue as well as your teeth or use a tongue scraper, which can be purchased in the oral health aisle of your local pharmacy.
3. Clean around your braces.
If you have braces, use an interdental brush or a water flosser to free trapped food particles.
4. Pay attention to your oral appliances.
If you wear dentures, be sure to clean them thoroughly every day, and brush your gums and the inside of your mouth as well. Bridgework also needs special attention: Clean carefully around the bridge and under the false tooth, as food can get stuck there.
5. Tackle dry mouth.
Dry mouth, a major cause of bad breath, can result from numerous medications, salivary gland problems, or breathing through the mouth instead of the nose due to sinus problems, sleep apnea, or other conditions. If your mouth is chronically dry, chew sugarless gum to stimulate saliva production, or ask about an over-the-counter or prescription saliva substitute.
6. Avoid extreme dieting.
Weight loss diets that advocate a stringent reduction in carbohydrates can lead to “keto breath.” This foul-smelling breath happens when the body burns fat instead of glucose for fuel.
7. Quit smoking.
In addition to smelling like cigarettes, people who smoke have less—as well as lower quality—saliva, which contributes to bad breath and poor oral health. If you need help quitting, talk with us or call (800) QUIT-NOW.
8. Be aware that some foods and beverages can leave stinky breath.
These include garlic, onions, strong spices, coffee, alcohol, cheese, and canned fish.
9. Keep up with regular dental visits.
Professional dental cleanings are necessary to get rid of hardened plaque (tartar) that can’t be removed by your brushing and flossing routine at home. We also check for gum disease, another cause of bad breath.
10. See your doctor.
Certain medical conditions like acid reflux, diabetes, and respiratory infections can cause bad breath. If you have an untreated health condition, make an appointment with your medical doctor.
If you are concerned about bad breath, please contact our office or schedule a consultation. You can learn more in the Dear Doctor magazine article “Bad Breath: More Than Just Embarrassing.”
Your neighbor says she just had a root canal. You expect nasty details regarding a painful dental procedure. Instead, she tells you that Dr. Samuel Kim, her dentist in Apple Valley and serving Helendale, CA, performed a comfortable restorative treatment which relieved pain and other symptoms. She says her tooth feels and looks great. What is root canal therapy, and what signs tell your dentist at Apple Valley Dental that you may need it?
What is root canal therapy?
Some people call it torture, but in reality, root canal therapy is practically painless and salvages teeth destined for extraction. Also termed endodontic therapy, a root canal performed by your highly skilled Apple Valley and Helendale dentist removes the causes of tooth infection, inflammation, and breakdown.
Also, it preserves remaining viable tooth structure and covers it with a porcelain crown. The American Dental Association (ADA) states that most teeth treated with endodontic therapy last for many years--even the rest of the patient's life.
How does it work? Dr. Kim carefully examines the tooth in question, looking at its roots and surrounding bone with digital X-rays. If he confirms the need for a root canal, he'll prepare the patient with a local anesthetic. He'll place a protective dam around the tooth to keep infectious material from invading the mouth and throat.
Next, the dentist creates small access openings in the tooth. Each hole allows him to enter the root canals, the pulp-filled chambers which run down each tooth root (there can be four canals in all). He cleans each canal with metal files of ascending size and disinfects the chambers with special medication. Finally, he seals the canals with gutta-percha, a natural putty which supports the tooth and keeps out bacteria.
After placement of a temporary crown, the patient goes home to heal, treating the tooth gently over the next week or so. A soft diet and analgesics help with any discomfort.
At the next visit to Apple Valley Dental, Dr. Kim retrieves the temporary restoration and puts a new crown over the tooth. This completes the root canal.
Signs you need root canal therapy
If you ever have a tooth that just does not look or feel right, please call Apple Valley Dental right away. Signs that a tooth may be in trouble and require endodontics include:
- Sensitivity to cold, heat, or the pressure of chewing
- Reddened, swollen gums
- Jaw swelling
- A noticeable crack, chip, or discoloration of the enamel
- A pimple on the gums
- Drainage that tastes bad
If you think you have a sick tooth, or if Dr. Kim definitively says a root canal treatment would help you, please schedule your appointment at Apple Valley Dental in Apple Valley, CA, and serving Helendale. You can trust the skill, experience and gentle attitude of this patient-centered team. Call (760) 247-6007.
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