Dear Dr. Mady: My dentist is recommending that I get crowns placed on a couple of my teeth. What exactly are crowns and what is the reason why some people need them?-Sylvio in Puce

Dear Sylvio: A crown is a tooth shaped covering or? Cap? That is placed over a tooth to restore it to its original size and shape, to strengthen it and to improve its appearance. When completed and cemented in place, a crown completely covers the entire visible portion of your tooth that is above the gum line.
There are many reasons why crowns are needed on teeth and why your dentist may recommend them. Sometimes crowns are used to strengthen a weak tooth or one that is cracked. This tooth may already even be broken or moderately worn. Crowns are also extremely beneficial when a tooth has a very large filling in it, not a lot of natural tooth structure remaining and when it is structurally compromised.
You may have a need for a crown if your teeth are misshaped or severely discolored, or to be placed on top of an dental implant. The most common need for a crown that even outweighs cosmetics is when a tooth has had a root canal (endodontic treatment), especially on posterior or back teeth. Endodontic ally treated teeth become brittle over time due to the loss of nerve and blood supply and are very susceptible to fracture. When a crown is placed it can actually strengthen the tooth and is an excellent preventative measure.
Preparing your tooth or teeth for a crown usually requires two dental visits. At the first appointment, your crown prep will be completed using a local anesthetic, a final impression or mould will be taken and a temporary crown will be placed. The second appointment is when you will get your crown(s) delivered or placed. They are usually cemented permanently with a dental cement.
While waiting for your permanent crown to be fabricated, you have to be cautious with the temporary crown. Avoid sticky foods that can pull the crown off and try not to floss aggressively around the temporary. These are usually fabricated from acrylic and are not meant to be on ?too tight?. If the temporary crown does come off, you must notify your dentist immediately because if it stays off, the prepped tooth can move or hyper-erupt and then there is risk that the permanent crown will not fit. Also avoid hard foods with your temporary and try to chew in other areas of your mouth.
Permanent crowns can be made of metal, all porcelain ceramic, or a combination of porcelain fused to metal. The strongest ones are the metal and porcelain fused to metal, but the all-ceramic type is the most esthetically pleasing. The metal crowns are usually made from gold but the porcelain crowns can be color matched to the adjacent teeth. Metal crowns require removal of less tooth structure as opposed to the other types. Porcelain can wear the opposing teeth more than metal, and fracture easier, but most patients shy away from metal due to the ?look? of it.
All-ceramic crowns are the best choice for anterior or front tooth restorations because they provide the best natural color match of all crown types. They are also more suitable for individuals with metal allergies.
The newly crowned tooth may be sensitive immediately after the anesthetic wears out. This may occur after the prep and even after the permanent cementation. If the tooth in question still contains a live nerve, you may experience some hot and cold sensitivity. This usually subsides quickly but if it does not or if it worsens, let your dentist know.
Dental crowns usually last between five and fifteen years, but may last longer. The life span depends on several variables including but not limited to oral hygiene practices, oral habits (like chewing on things), bruise (grinding) and clenching.
Crowned teeth do not require any special care, but many believe that a crowned tooth cannot get a cavity. This is completely false and if good oral hygiene is not practiced, the tooth structure that supports the crown can decay and often without you knowing it before it is too late. Therefore, after your crowns are placed, continue brushing at least twice a day, flossing once a day and keep your regular check-up and cleaning appointments with your dentist.
If you need any other information or have any dental questions, please e-mail Dr. Mady at drmady@drmady.com

Dear Dr. Mady: I have been wearing dentures since the age of twenty-eight. I am now fifty years old and over time my lower denture has become more and more uncomfortable and loose. I have had new ones made with no luck and now I even feel electric shocks sometimes underneath when I chew. My lower dentures just don’t seem to fit as well as they used to and chewing has become a problem. What should I do? – Ronny in Morphett

Dear Ronny: The story you are explaining to me is not an uncommon one. I hear or see similar situations at least once a week in my own dental practice. Even though you feel helpless in this situation, there is some hope for a possible solution that may improve your quality of life.
Whenever teeth are lost and for whatever reason, loss of bone from shrinkage after extractions and over time is an inevitable consequence. A decrease in supporting bone under dentures can cause many problems, especially with lower dentures. It is important for you to understand that this is a natural process and not just specific to you. The fact that you lost your teeth at such a young age is only compounding the problem. Your jaw has had a lot of years of wear and tear and this promotes bone restoration also.
If any of your past dentures have contained porcelain teeth, this kind will increase the rate of bone shrinkage and make it worse. The reason for this is that the porcelain is structurally harder than your bone and with chewing over the years, something has got to give. This is why dentures with porcelain teeth sometimes look like new after many years of use as opposed to dentures with acrylic teeth that are more commonly used today.
Many individuals in your position get to a point where they cannot chew without some sort of pain and discomfort. I realize also that there is no pleasure in living on a mashed potato-type diet, but the fact that you have been wearing dentures for a number of years is actually part of the reason why they slip, jump and slide. There is even a nerve in the lower jaw and when it is near the surface, it can get pinched while chewing and cause the electric-like shock that you are experiencing and an inability to exert pressure. If you are a steak eater like I am, this is not fun.
As the bone in your lower jaw resorts, it may become very narrow and even sharp in areas, which can add to your discomfort. Often getting new denture(s) fabricated does not help the situation or makes it worse. Patients will get frustrated with their dentist because the new denture is not helping and they are still having problems. The real problem is not the dentist, but the underlying bone support and some even think that getting dentures is just like buying another set of teeth. They are so wrong.
Fortunately, you may be a candidate for dental implants. These are the best solution to the problem as long as you have enough bone left to support them. Ideally if some implants can be placed in your lower jaw and attached by a bar or some similar device, a denture can be fabricated that can snap on this bar. This will help retain it and slow down the bone shrinkage problem because there will not be as much pressure on the tissues like before. Most of the chewing forces will then be transferred to the bone, sort of like a natural tooth root. If this can be done, you will be able to eat things that you haven’t been able to eat in years.
With a lower implant-retained prosthesis your denture won’t move around when you chew and talk, pain will be decreased or may even disappear, and you should be able to eat like a human being again. Upper dentures are never as big a problem as lower dentures because the roof of the mouth can assist with suction and retention even if there is some bone shrinkage. A lower conventional lower denture even has the tongue to deal with and that does not help the situation.
The largest limiting factor you are facing now is the reduction in chewing force. The amount of force that you can use is limited to the amount of pressure that you can handle. Dental implants have been in use for over twenty-five years and techniques and materials have been constantly studied and refined. Have your dentist refer you to specialist like an oral surgeon, periodontist or prosthodontist for a consultation to see if you are in fact eligible for this modality of treatment. If you are, it can change your life.

Dear Dr.: My gums are bleeding a lot when I brush my teeth and I’ve heard people talking quite a bit about gum disease. How do I know if I have it, and if I do what can be done about it?-James in Tecumseh

Dear James: If your gums are bleeding when you brush, there is a good chance that you are at some stage of gum (periodontal) disease. It does affect approximately nine out of ten adults at some point in their lives and it may not even hurt or you may not even be aware that you have it until a more advanced stage. If you notice any of the following warning signs, see your dentist ASAP:
*Bleeding gums
*Red or swollen gums
*Gums that look like they have pulled away from the teeth
*Pus between the gums and teeth
*loose teeth or ones that have changed position (can make your bite feel different)
*constant bad breath

In terms of treatment, it depends on the severity of the problem. The first step after a comprehensive exam is usually to remove plaque and tartar (calculus) deposits from above and below the gum line (scaling). The root surfaces may also be smoothed (planning) to decrease the chance of future plaque attachment and also to facilitate healing and reattachment of gum tissue to the teeth. In more advanced stages of the disease deep pockets can form between your teeth and gums that may even make it difficult for your dentist to do a thorough job. In this case, and possibly before, you may be referred to a Periodontist (gum specialist) for evaluation. If you have had any of the warning signs, don’t let it go any further. Allow your dentist to treat it, educate you about it and how to control it, and put you on a proper maintenance schedule. The longer you wait, the worse it will get!

Dear Dr Mady: I have so many unanswered questions when it comes to choosing oral care products like toothbrushes and toothpaste. What do you think?-a faithful reader.
Dear faithful reader: When shopping for oral care products it is extremely common for one to become confused with the great variety available on the market today. A good place to start is with recognition of a dental association seal such as ADA, ODA or CDA, on packages. Products that carry one or more of these seals include toothbrushes, toothpastes, mouthwashes, flosses, inter-dental cleaners and the list can go on.
With respect to your tooth brush, it should be replaced approximately every 3 months or sooner if the bristles appear frayed or severely worn. Always purchase a soft or ultra-soft bristle brush as the medium or hard bristle type may cause unnecessary damage or wear to both your teeth and gums. The bristles on your brush should be polished when they are made so that they are gentle on tissues. Use a size and shape that allows you to clean all surfaces of your teeth comfortably. Children may wear out their toothbrushes quicker than adults.
Shopping for floss and other related items can be even more frustrating. When it comes to floss, choose a type, whether waxed or un-waxed, that adapts the best to your teeth and gums. Waxed flosses seem to be more gentle for the most part and they are available now in thick or thin versions. As far as mouthwashes go, ones that contain antibacterial qualities are best for rinsing and gargling. Other oral cleaning devices and stimulators may be prescribed by your own dentist specifically to suit your own dental needs. Ask your dentist or hygienist what they think.

If you need any other information or have any dental questions, please e-mail Dr. Mady at drmady@drmady.com

Dear Dr. Mady: I have been experiencing problems with extremely bad breath for the past four months. My dentist said my teeth are not the cause of the problem. As a matter of fact, he said that my oral hygiene is superb. Can bad breath come from somewhere other than my teeth?-Joe B. in Moncton

Dear Joe: Items like mouthwashes, toothpastes, breath mints, breath strips and gum are a multi-billion-dollar a year business, especially in North America. This is mainly because bad breath is bad news for business, relationships and self-confidence. The first impression is often an important one and bad breath leaves a bad impression. What does concern me is the fact that bad breath can also be a sign of poor health.
Bad breath can be a sign of problems in the mouth, sinuses, lungs, airways, stomach or even kidneys. If someone has persistent bad breath, their physician should entertain the fact that there may be other causative factors. I have seen infections in the lungs that cause halitosis (bad breath).
The reason bad breath is so devastating, is due to the embarrassment that it causes. In ancient times it was known as a disease and sometimes evens a curse. For many, it just means it is time to floss and brush your teeth. For others it is a chronic problem caused by an underlying sickness or for no known reason.
It is a common belief that someone with halitosis does not brush their teeth and that they have poor oral health. This is actually false. Most individuals with bad breath have impeccable oral hygiene. The culprits of bad breath are bacteria that function in an oxygen-deprived environment in our mouths. These bacteria ingest protein particles and metabolize them and in the process they produce sulfur gases. These sulfur gases have a rotten egg-like smell that causes halitosis.
Gum disease starts with a plaque build-up on teeth and gums. These bacteria are oxygen-loving and they too create sulfur gases. This is why people with periodontal disease have bad breath. For those with a chronic problem unrelated to oral bacteria, they must seek the help of their physician to ?dig a little deeper? to try and diagnose the real underlying cause.
The fact is that low-crab diets do cause bad breath, because the large protein intake is very desirable to anaerobic bacteria that cause bad breath. As the body burns fat, ketenes are released b through the breath and the urine and these ketenes smell. So if you are on a low-crab diet, drink lots of water and this will lessen the chances of bead breath.
Another fact is that your tongue is a rug-like haven for bacteria to metabolize into sulfur gases. Tongue scraping is one of the absolute best ways to decrease bad breath in addition to brushing your tongue when brushing your teeth.
It is a myth that if you have a bad taste in your mouth, that you will have halitosis. You could have a bad taste in your mouth and no odor whatsoever in your breath. On the other hand, if you have no taste in your mouth, you could have very bad breath. Sometimes you can even get used to the smell and not even notice it yourself, but others surely can.
While performing oral hygiene at home, always include flossing, because floss gets in between teeth where your brush can not and removes food debris and bacteria that fester into halitosis. The bottom line is that if you understand all these facts and are performing good and proper home dental care and are still experiencing long-lasting bad breath, you need to act now. Ask your dentist or hygienist to review your hygiene practices and ask if they have a toothpaste and mouth rinse containing chlorine dioxide. If that doesn’t help, call your physician and I am sure that with warranted diagnostic testing that you will increase your chances of a cure for this ?disease?

Dear Dr. Mady: The first time I went to my dentist for an examination, five years ago, he had x-rays taken of all of my teeth. I go now about every six months for cleanings and check-ups and he has the hygienist take a couple of x-rays about every second visit. Sometimes they find cavities and other times they do not. What are the benefits of dental x-rays, how do they work and how often should they be taken?-Heather from Naples, Florida via e-mail

Dear Heather: Every time you go to visit your dentist and he looks in your mouth, many diseases that may exist in the teeth and in the tissues around them cannot be seen. However a dental x-ray is an excellent aid with respect to diagnosis of any anomalies or of good oral health.
Individuals who do not floss often get cavities in between their teeth just below where the teeth contact each other. A visual exam often is not sufficient to correctly diagnose these inter proximal cavities, along with recurrent decay that may be growing underneath existing restorations that you have. Failing to diagnose these may ultimately lead to the need for root canal treatment or even extraction.
Also infections, abscesses or cysts in the jaw bone surrounding teeth can be easily seen on dental radiography. These often exist for various reasons and you may not even be aware of them. There may also be other dental abnormalities existing that cannot be visualized with the naked eye.
Gum disease or periodontal disease ultimately destroys the supporting structures of your teeth, including bone. Loss of this bone and the extent in all areas can easily be seen with x-rays and gives your dentist a better idea of which direction to go in as far as your dental treatment plan goes.
Basically the way that dental x-rays work is that a small amount of radiation passes through a selected area of your mouth and conveys an image of this area on a small dental film (intra-oral). There are larger films that are used to take an x-ray of a larger area and these films are used outside of the mouth (exta-oral). Examples of these are the anorexia and the cephelogram.
In the process, more of the rays are absorbed by the denser tissues like teeth and bone than by the gums and cheeks, before these rays reach and hit the film. This is how the image is created. The reason that the teeth seem lighter is because fewer rays penetrate (are not absorbed as much). Infections, bone changes, ligaments that surround teeth and cavities appear darker on the x-ray because more rays penetrate these less dense areas. Existing fillings will show lighter or darker depending on the dental restorative material that was used in their placement.
Frequency of x-ray taking on dental patients is situation-specific. In simple terms, this means that it depends on the oral health needs of each individual patient. Every patient is different and the need for radiographs will be different and individualized for each. Your dentist will decide whether they are warranted and when, based on present signs and symptoms oral conditions, previous history of decay, age and risk of dental disease.
If it is your first visit and complete exam, your dentist usually will want more x-rays so that everything can be completely examined at that starting point. If there is no disease present or a possible problem starting, these radiographs can later be used as a vehicle to compare future changes with past conditions. If you have recently had x-rays taken at another dental office, forwarding these to your dentist or new dentist is a common practice. On the other hand if a referral to a dental specialist is later required for you, your dentist can simply send the radiographs there and omit the need for new ones to be taken.
Children may require dental x-rays more often than adults because their teeth and jaws are constantly developing and they are more likely to be affected by tooth decay than adults. Also the tracking of exiting baby teeth and entering permanent teeth is important. If you are an individual that has new cavities diagnosed every time you visit your dentist, x-rays will be taken more often so nothing gets missed.
Finding and treating dental problems at an early stage can save money, time, pain and unnecessary aggravation later on. They can detect damage to structures that are not evident during a visual oral exam and ones that exist but are asymptomatic. If you have a hidden tumor, dental x-rays may even help save your life!

Dear Dr. Madly: I have two small, hard bumps on my gums on the inside of my lower jaw right below my teeth. They feel abnormal but they are painless. I have been told that they are called tori. What causes them and should they be removed? Paula in Tilbury

Dear Paula: A torus or tori (plural) is a benign growth of new bone that usually occurs in the mouth. In general, they are slow-growing and limited in size for the most part. Tori most commonly develop on the palate (roof of the mouth) or on the inside (tongue side) of the mandible (lower jaw).
Palatal tori are far more common and a single growth is named ?torus palatines.? Race and sex tend to play a role in the development of these. Twenty to twenty-five per cent of our population possesses tori and twice as many females get them.
Also, Canadian/American Indians and Inuit more commonly develop tori. Tori can form at different ages but more often begin at the onset of puberty or before 30 years of age. They can be of genetic nature (inherited) and can have occasional growth spurts and halts but generally don’t shrink.
Size and shape of these varies and so does the thickness of the gums that cover them. Although thinner over these areas, the tissue is still normal. If you have tori, there is no need for removal unless they get too large or unless they are interfering with the fabrication of upper or lower dentures, partial dentures or any other dental/oral prosthesis.
Also removal is indicated if they interfere with speech swallowing or normal oral hygiene. If you are experiencing any problems related to them, ask your dentist for a referral to see an oral surgeon for a consultation about removal.

Dear Dr. Mady: The other day I had a tooth extracted by my dentist. Although the appointment was very quick and simple I ended up with one whole week of agonizing pain that was worse than the toothache I had previously. My dentist said that it was from smoking. How is this possible?-Denise in Belle River

Dear Denise: It sounds like you experienced a case of classic ?dry socket? (alveolar posterities). This painful situation occurs when the bone has been exposed at the extraction site after a tooth has been removed or extracted. Under normal circumstances a blood clot forms in the hole where the tooth roots were (socket) and healing occurs without difficulty. The clot is an extremely important part of the healing process after extraction. If this clot is partially or completely lost prematurely, the exposed bone causes moderate to severe pain that can last a long time and throb worse than any toothache.
One usually has a foul taste in their mouth from this condition. The pain, which often radiates up and down the head and neck, can be extremely unpleasant. Like the child who “picks at a scab” the area heals in time but is painful for far longer than if the “scab” had been left alone. Dry socket is painful but otherwise a relatively harmless situation. There has been some talk in the past about women taking oral contraceptives being more susceptible to this.
Instructions known as ?post-op instructions? are usually given by your dentist or oral surgeon after an extraction and they must be followed closely in order to escape the possibility of dry socket. These include 24 hrs of no sucking through a straw, no drinking out of a bottle, no rinsing and no smoking for 48-72 hours after. Basically, any action that can cause a negative pressure in your mouth after your surgery can cause the clot to be dislodged from the socket and you now know what can result. The most common cause of dry socket is smoking and it can also increase the length of time for healing.
Treatment by your dentist may include application of medicated dressings into the socket every day or other day for up to a week, after gentle flushing with a saline solution. These dressings usually give immediate relief due to the main ingredient, eugenic (similar to oil of cloves). Your dentist may also prescribe you pain medication and a mouth rinse containing chlorhexidine to use twice a day, temporarily. After the pain has subsided the dressing will not be placed anymore so that the soft tissue around the socket can heal from inside out and over.
In many cases pain medication does not help and the only relief accessible is from medicated dressing. A dry socket is not an infection, and is not directly associated with swelling because it occurs entirely within bone ? it is a phenomenon of inflammation within the bony lining of an empty tooth socket. Because dry socket is not an infection, the use of antibiotics has no effect on its rate of occurrence. Each situation may be different so if you are having constant discomfort when you thought it would all be gone, then you most likely have dry socket. It is very important to remember that Cigarette smoking or other tobacco use can delay healing with or without dry socket and should be avoided with any kind of surgery.

Dear Dr. Madly: I lost my back upper teeth years ago and now I can finally afford dental implants. When I went to discuss it with my dentist, he said that I probably don’t have enough bone to support implants. He is now referring me to an oral surgeon to see if anything can be done. What options do I have if I don’t have enough bone? -June in Markham

Dear June: As you probably now realize, over time the jawbone in the areas of missing teeth is resorted or shrinks naturally. This often results in a situation in which there is poor quality and amount of bone remaining to support dental implant placement. In this specific situation, you would not be a candidate for dental implants.
In this day and age, however, there is a procedure known as bone grafting that can make these previous extraction sites suitable for dental implants. If successful, this will not only allow your oral surgeon to place implants of suitable width and length, but will also allow your dentist to restore proper dental function and esthetics.

Bone shrinkage is not always caused by extractions. There are other factors and conditions that promote restoration. These may include gum disease, genetics, previous oral or maxillofacial surgery, or trauma. Bone grafting procedures can repair inadequate implant sites. They involve surgical placement of bone from another area or source into the site with the restoration and then allowing it to heal.

The bone used in grafts can be obtained by various means, but the most common method is to use the patient’s own bone. This bone usually is taken from the patient’s own hip, jaw or tibia just below the knee. The removal of bone for grafting is usually accomplished by an orthopedic surgeon and then they transfer it to an oral surgeon immediately in the operating room so it can be placed in a prepared site where it is needed. Some specially trained oral surgeons today complete the entire process on their own without the help of an orthopedic surgeon.

If your surgeon feels that your own bone will not be adequate or if you decide together that the post operative pain is not desired, then you have other options. Freeze-dried cadaver bone is accessible and some surgeons even use artificial bone. The most common graft that I have seen is a hip graft from the patient’s own hip. This may require a short hospital stay. The only negative side effect is a sore hip for a short period of time which usually causes temporary limping. However, this does not always occur and I have witnessed some patients who experienced absolutely no hip symptoms after this type of graft.

Also, special membranes may be utilized that dissolve under the gums and protect the bone graft and promote bone regeneration. This procedure is called guided bone regeneration or guided tissue regeneration.
Some patients have very low sinuses in their upper jaw area where molars are or used to be. Often after upper molar extractions, there is merely a thin layer of bone separating the maxillary sinuses from the oral cavity. In a case where a routine graft is not a good option or where the membrane in extremely low, a procedure called a sinus lift graft can be performed.

The technique involves an oral surgeon entering the sinus from where the upper teeth used to be. The sinus membrane is then raised or lifted upward and donor bone is then placed into the floor of the sinus. After months of healing, this bone becomes part of the patient’s upper jaw and should then be thick enough for implants to be inserted. If just enough bone is available between the upper jaw ridge and the floor of the sinus pre-operatively, to stabilize the implant, then the implant(s) can be placed at the time of the sinus lift graft and overall treatment can be shortened by several months.

These surgical procedures are great when there is no other option than to wear dentures or partial dentures. Cost may be a factor in your decision, but as the old saying goes, ?you get what you pay for?!

I have been unhappy with my smile for most of my life and now I am forty years old and wish to do something about it. When I smile, I show more gums than teeth, the gum heights are also uneven and it looks terrible to point where I don’t like to smile. My dentist said that I can have jaw surgery or a more simple a procedure called a gingivectomy to help improve my gummy smile. What exactly is involved with these procedures and which one would be best for me? – Dawn in Orillia

An uneven, gummy smile is not usually attractive but an experienced cosmetic dentist or periodontist (gum specialist) can treat the gingival to make a vast improvement in your smile and self esteem.
As your teeth erupted during childhood, they were naturally covered by gums. With age these gums automatically receded to show the crowns of your teeth when you smile. This does not occur in all individuals and then the gums hide the smile. A gingivectomy is a form of minor gum surgery that can give you more of a smile that you desire.
The gingivectomy is best described as the surgical removal of a certain amount of pink gum tissue. It can be performed using anesthesia and a scalpel, an electrosurgical knife or machine, a dental rotary instrument and most recently by laser. It is usually quick and relatively painless. The most common method is using a scalpel to make a small incision around the involved teeth and then immediately removing the tissue using a dental instrument. A periodontal, putty-like dressing is then placed over those teeth to assist in healing. Your dentist or periodontist will later remove the dressing and check the healing. Total healing usually takes a few weeks.
Sometimes excess gum tissue growth is the culprit. There are other things that can cause this tissue growth. They include but are not limited to certain medications (especially heart and anti-seizure meds), and certain medical conditions. This may not be the situation in your case, but if it is, the results of gum surgery and the maintenance of the results could be modified.
Also, a gummy smile can be from having naturally short crowns on your teeth, or ones that have been worn down from bruise (grinding) of your teeth. This makes the ratio of gum to clinical crown size change in a negative direction. Sometimes people are just born with a short upper lip and an injection of botox (to partially paralyze the nerve) can help to stop the upper lip from raising high when smiling and revealing the gummy smile. However, this could decrease the effectiveness of your smile.
If you have a long upper jaw (maxilla), the bone heights above your teeth in the front can be excessive. In a case like this, a procedure called crown lengthening can be performed where not only gingival is removed, but some of the bone around the necks of the teeth also, for an improved appearance. If the height of the bone is moderate to severe, then the patient may require orthographic surgery by an oral surgeon. This is a more complicated surgery performed under general anesthesia, where a complete section of bone is removed from your upper jaw and the jaw is repositioned and wired in a new, more appealing position. After healing, the results can be phenomenal.
If perfection is sought in a severe case of a gummy smile, several clinicians may be involved including a cosmetic dentist, an oral surgeon, a periodontist and even an orthodontist. The type of treatment and cost will be determined after you have had a complete and comprehensive oral examination and a study of your smile and personal expectations. A gorgeous smile is created by the union of several different elements. Everything, not just the teeth should be beautifully arranged for maximum esthetics!

If you want more information about cosmetic dental procedures, periodontics, oral surgery or orthodontics, go to www.drmady.com and click?articles? and then type a search topic in the search box on the left and simply select ?go?. There is an abundance of interesting and educational information in all of these articles. You can also e-mail Dr. Madly any questions at drmady@drmady.com

I went to see my dentist last week and from a routine x-ray he diagnosed one of my teeth with restoration. He said I will need a root canal but could not guarantee me that the tooth would last. Please give me some information about tooth restoration that may help me better understand what it is and what may happen to my tooth.-Karen L.

Tooth? Resorption? is when the body’s own cells attack and destroy actual tooth structure. The restoration can be either external or internal.
?External tooth restoration? Occurs when the cells on the outside of a tooth attack and eat away at the outside surface of the tooth or its root. Logically, internal restoration? is when the tooth is attacked from the inside out. In reality, these are exactly the same situation, but they happen in different areas. No matter where tooth restoration is taking place, it is not a good situation.
The external type causes restoration of calcified dental tissue, beginning on the external surface of the root and extending through the cementum (outside root covering), dentin (layer under both the cementum and enamel), and eventually into the pulp chamber and root canal which houses the nerve and blood supply for a vital tooth. This kind is much worse and has a much poorer prognosis than internal restoration. As a matter of fact, most cases of external restoration result in tooth extraction.
If the destruction is limited only to the root of a tooth, then this is known as ?root restoration?. One type is ?external root restoration?. This is most commonly seen as a situation arising from unintentional, rapid orthodontic treatment but can occur for other unknown reasons. External root restoration is easily diagnosed by dental x-rays because the root of the tooth or teeth in question appears much shorter than normal or the sides of the root may appear eaten away. If the root pathology is too severe, then extraction is indicated.
If the damage is from inside the root, then it is called ?internal root restoration?. It can be difficult to treat because it can create round, hollow areas inside the root that cannot be derided properly, even with the most current root canal instrumentation.
The most treatable restoration overall is internal restoration. Here the cells are eating their way from the inside of the tooth out. This is often difficult to diagnose because it is usually asymptomatic and often not noticed until the tooth becomes so weak that it crumbles while chewing. Every tooth has a chamber within its crown that houses the majority of the nerves and blood vessels that supply the root canals for that tooth. This is called the pulp chamber and the problem usually starts at the top of the root canal and spreads into the chamber.
Internal restoration is generally painless and moves at a slow rate. If it is caught early enough, these damaging cells can be removed with standard root canal therapy and the restoration may cease.
We are not exactly sure what causes tooth restoration, but we do know that there is a relationship between restoration and trauma from tooth decay or a physical assault on the tooth. A cracked tooth’s cells can occasionally malfunction and resort tooth structure and an unfinished or inadequate root canal therapy can cause internal tooth restoration. Regular dental exams and necessary dental x-rays are the best way to diagnose and treat dental disease, including restoration.