What is an avulsed tooth?

An avulsed tooth is one that has been knocked out.

A tooth can be knocked out by a blow to the mouth, or an accident involving the face. This can happen for example while playing contact sports. The tooth can be replaced in the socket successfully if you take the right action as soon as possible.

How do I stop the bleeding?

Don't panic. Get a clean handkerchief and fold it up, then hold it over the socket and bite down. Keep your jaws together to apply pressure. If you need something for the pain, don't take any medication containing aspirin as this can cause the bleeding to get worse. Do not apply clove oil to the wound.

I've still got the complete tooth, can it be replaced?

Maybe. The complete tooth needs to be replaced in the socket as soon as possible, ideally in under 30 minutes. But teeth have been successfully replaced up to 60 minutes after being knocked out.

What should I do with the tooth?

Don't touch the root. If the tooth is very dirty, rinse it with milk or tap water. Do not clean it with disinfectant or let it dry out.

How do I put the tooth back in?

Hold the tooth by the crown and put it back into the socket firmly, root first. Bite on a clean handkerchief for about 15 to 20 minutes. Visit your dentist as soon as possible.

What should I do if I can't get the tooth back in?

Your tooth has more chance of survival if you keep it in your cheek until you can get emergency dental treatment. This will keep the tooth in its most natural environment. If this is not possible, keep it in some milk.

What if I have only got part of the tooth?

It is not a good idea to try and put the tooth back into the socket if it is not complete. Contact your dental team as soon as possible and they will tell you what can be done to restore the tooth. You may need dental x-rays to see if there is any root damage.

Is there anything I should do if I haven't got the tooth?

If you cannot find the tooth, you may have swallowed it. If you think you may have swallowed or inhaled it, you may need an x-ray to be sure of this.

What if it is a baby tooth?

Most dentists would not recommend putting back a baby tooth in case an infection damaged the adult tooth underneath. Contact your dental team as soon as possible for advice. They may need to examine the child to check if any bits of tooth are still in the gum. There is no way to temporarily replace a baby tooth, so the only treatment is to wait for the adult tooth to appear.

What Should I Do After My Child Experiences a Tooth Fracture?

A chipped or broken tooth is quite common, especially among toddlers just learning to walk or preschool children engaged in vigorous play or sports. It might not even be rough play, but just a chewed piece of ice or biting into a piece of hard candy can ultimately cause some damage. There are many kinds of injuries to the tooth that can occur, from a minor chip to a fracture (a cracked or broken tooth). It might happen to one of their baby teeth or to a permanent adult tooth.

If your child’s tooth gets chipped or broken, whether it’s a baby tooth or a permanent tooth, it is very important to call their pediatric dentist right away and schedule an emergency appointment.

A child’s permanent teeth are not fully developed, so any tooth fracture to a permanent tooth needs immediate attention. The classifications of tooth fractures and common types of treatment are as follows:

• Class 1 – Fractures or chips in outer enamel layer– For smaller chips, edges are simply smoothed over. For larger chips, they might do a composite filling (bonding).
• Class 2 – Larger fractures into the dentin layer– A common type of fracture; often sensitive to cold air and liquids. To protect the dentin, composite will be used to restore the tooth. A large fracture may require a crown or porcelain veneer, though with young children, it may be advised to wait for further tooth development and an orthodontic visit.
• Class 3 – Fractures into the tooth’s pulp– Special attention is required, since there’s the danger of bacteria entering into the pulp. For adults, this often indicates the need for a root canal. Children with still-developing permanent teeth have healthier pulps with a better supply of blood, so they can often recover on their own. If a large portion of the tooth’s crown is missing, they may need a root canal to hold a dental crown in place.
• Class 4 – Fractures onto the root of the tooth– Though this isn’t common, it is very serious and may need complete removal. If your dentist is able to save the tooth, treatment might be orthodontic extrusion, a root canal, a post-and-core technique and a dental crown.

Where should I get emergency dental treatment?

It is important to get emergency dental treatment. Contact your dental practice as soon as possible and explain what has happened. You should still be able to contact your dental team for emergency treatment, even if the incident has happened outside normal dental practice hours.

What should happen at my emergency visit?

Your dentist will assess you and may treat any facial injury. However, treatment may be limited if there is any bruising or bleeding. They may take x-rays and will check if the tooth has been re-implanted successfully. You will probably need more appointments for follow-up treatment.Some wounds may need sutures.

What other treatment may I need?

If the tooth has been re-implanted successfully you may not need any other treatment, as long as you keep up your regular check-ups with your dentist. If the tooth becomes loose, it can be ‘splinted’ to the teeth next to it. This means it will be temporarily attached to keep it firm until your dentist can tell whether it has been re-implanted successfully.

If the tooth is lost or doesn't re-implant successfully, it can be replaced at first with a denture. Then, when the socket has healed fully, you can have a bridge or dental implant.

Is there anything that I can do to avoid getting a tooth knocked out?

If you are playing sports, particularly contact sports, you should always wear a mouthguard.

This is a rubber-like cover that fits over your teeth and protects you against a blow to the mouth. Your dental team can have one made for you by taking an impression of your teeth and sending it to a laboratory. The laboratory then makes the mouthguard so that it fits your mouth exactly.

SUMMARY

If an adult tooth is knocked out:

• Stay calm
• Handle the tooth by the crown (smooth white part), not the root (yellowish pointy part).
• If the tooth is dirty, gently rinse it in milk or saline for a few seconds. Do not rinse the tooth with water.
• Holding the clean tooth by the crown, gently put it back into the hole in the gum (socket). Make sure the pointy yellowish root(s) is the part that goes into the socket. Only do this if the person is conscious.
• Get the person to hold the tooth in place by gently biting on something soft, like a handkerchief.
• Assist the person to see a dentist immediately.

If you can’t replace the tooth yourself:

• Try not to let the tooth dry out - place it in milk or ask the person to spit into a clean container and place the tooth in their saliva. You could also seal the tooth in plastic wrap.
• Do not use water to rinse or store the knocked-out tooth.
• Seek immediate advice from a dental  professional.

• What is root canal treatment?

Root canal treatment (RCT), also known as endodontic therapy, is a dental procedure that cleans out the infected or inflamed pulp (the nerve and blood vessels) from inside a tooth to save it from extraction. The pulp is then filled with a sealant to prevent further infection. 

• When is root canal treatment necessary?

Root canal treatment is necessary when the pulp inside a tooth becomes infected, inflamed, or damaged due to deep cavities, cracked teeth, or injury. Symptoms may include lingering sensitivity to hot or cold, throbbing pain, or even a noticeable pimple on the gums. 

• How painful is root canal treatment?

Root canal treatment is generally not as painful as many people believe. Modern anesthesia and techniques can minimize discomfort during the procedure, and any post-treatment pain can usually be managed with over-the-counter pain medication. 

• Does root canal treatment save the tooth?

Yes, root canal treatment is designed to save the natural tooth by removing the infected or inflamed pulp and sealing the tooth to prevent future infection. 

• What happens if I delay root canal treatment?

Delaying root canal treatment can lead to increased pain, infection, and potentially the need for tooth extraction. In severe cases, untreated infections can spread to the jaw or bloodstream, leading to serious complications. 

Retreatment after root canals FAQS

Root canal retreatment is a procedure performed to address complications after an initial root canal treatment, such as persistent infection or new decay. It involves removing the existing filling, cleaning and disinfecting the root canal system, and sealing it again to prevent future issues. 

1.Why is retreatment necessary?

Root canal retreatment is needed when the initial treatment fails to heal properly, or if the tooth develops new problems like new decay, a cracked or loose restoration, or if bacteria re-enter the root canal. This can happen if there is no cap placed, or the patient doesn’t return for replacement of the temporary filling. It may also be because of an underfilled canal

2.What happens during retreatment?

The dentist will remove the existing filling, thoroughly clean and disinfect the root canal system, and then seal it again with new materials. 

3.What are the risks associated with retreatment?

While generally safe, retreatment can have risks like infection, nerve damage, or over-treatment of the tooth. Choosing an experienced and qualified endodontist can minimize these risks. 

4.What is the success rate of retreatment?

Retreatment has a high success rate, but it is generally slightly lower than the initial treatment because it is a more complex procedure. Retreatment is best performed by a specialist endodontist who may choose to use a microscope to view the internal aspect of the tooth clearly.

5.What kind of aftercare is needed after retreatment?

After retreatment, you will need a final restoration (filling or crown) to protect the tooth. Maintaining good oral hygiene practices like brushing and flossing is crucial to prevent future issues. 

An apicoectomy is a surgical procedure where a dentist removes the tip of a tooth root (the apex) and any infected tissue surrounding it. It's typically performed when a root canal has failed to eliminate infection or when the tooth has other issues like cysts or fractures. 

What are the reasons for an apicoectomy?

• Failed root canal treatment:

The most common reason is when a root canal, even with the correct filling material, fails to eliminate infection. 

• Persistent infection:

Even after root canal treatment, inflammation or infection may persist near the root tip. 

• Cysts or tumors:

Apicoectomy can also be used to treat cysts or tumors around the tooth's apex. 

• Fractures:

If a tooth root fractures, an apicoectomy may be necessary to remove the damaged tissue. 

• Traumatic injuries:

Injuries to the root can also warrant an apicoectomy. 

How is an apicoectomy performed?

1. X-rays: X-rays are taken to visualize the tooth and surrounding tissues. 

1. Anesthesia: Local anesthesia is used to numb the area around the tooth. 

1. Access: A small opening is made in the gum to expose the root tip. 

1. Removal: The root tip and any infected tissue are removed. 

1. Cleaning: The area is cleaned and the root canal is sealed with filling material. 
2. Stitching: The gums are stitched back together. 

What to expect after an apicoectomy?

• Swelling and discomfort: Swelling and some discomfort are normal after surgery. 
• Bleeding: Minor bleeding is common but should stop within a few hours. 
• Numbness: Numbness in the affected area may occur due to anesthesia. 
• Pain: Pain can be managed with over-the-counter or prescription pain relievers. 
• Recovery: Most patients recover within a few days to a week. 

Cost and insurance coverage:

• The cost of an apicoectomy can vary depending on the location, dentist, and complexity of the procedure.
• Dental insurance plans in India do not cover apicoectomies  unless it is due to severe dental trauma requiring hospitalization.

Are there any risks?

• Infection: While rare, infection is a potential risk after surgery.
• Nerve damage: In some cases, nerve damage can occur during the procedure, causing numbness or pain.
• Sinus problems: If the root tip is near the sinuses, sinus problems can occur. 

Is an apicoectomy painful?

• The procedure itself is typically not painful due to local anesthesia. 
• Some discomfort or pain may be experienced after the procedure, but it can be managed with pain relievers. 

How long does it take to recover?

• Recovery typically takes a few days to a week, but the bone around the root may take several months to fully heal. 

Can I return to normal activities after the procedure?

• Yes, most patients can return to normal activities shortly after the procedure. 

How to care for your mouth after an apicoectomy?

• Follow your dentist's instructions carefully.
• Avoid hard or crunchy foods for a few days.
• Brush and floss gently.
• Rinse your mouth with warm salt water.
• Apply a cold compress or ice pack to the affected area.
• Take prescribed pain medication as directed. 

Inlays and onlays are custom-made dental restorations used to replace missing tooth structure due to decay or damage. Inlays fit inside a tooth's cavity, while Onlays cover the entire biting surface and cusps, offering greater support. 

What are inlays and Onlays?

• Inlays:

These are designed to fit inside a tooth's cavity, replacing lost tooth structure due to decay or damage. 

• Onlays:

These cover the entire biting surface and cusps of a tooth, providing greater support and durability. 

How are inlays and onlays different from fillings?

• Fillings:

Fillings are used for smaller cavities and are typically placed directly into the tooth. 

• Inlays and Onlays:

These are custom-made in a dental lab and are cemented into place, providing a stronger, more durable restoration than a filling. 

What materials are inlays and onlays made from? 

• Common Materials: Gold, porcelain, and composite resin.

How long do inlays and onlays last? 

• Durability: With proper care, inlays and onlays can last 10-30 years or more.

How do I care for inlays and onlays?

• Oral Hygiene: Brush and floss your teeth regularly, as you would with your natural teeth. 
• Dietary Habits: Avoid chewing hard objects like ice, which can damage the restoration. 

How much do inlays and onlays cost? 

• Cost Factors: The material used, the size of the restoration, and the dentist's fees can all impact the cost.

Is insurance coverage available? 

• Insurance Coverage: In India, dental insurance plans do not cover the cost of dental care in general. However, it would be prudent to ask your insurer about coverage.

What are the benefits of inlays and onlays?

• Durability: They are more durable than fillings and can last longer. 
• Strength: They strengthen the tooth and prevent further decay. 
• Aesthetics: They can be made to match the natural color of your teeth, improving the appearance of your smile. 

Are inlays and onlays painful? 

• Pain: The procedure is not painful, as local anesthesia is used.

What is the inlay/onlay  procedure?

Preparation: The dentist numbs the area and removes decay.

Impression or scan : An impression or scan  of the prepared tooth is made.

Lab work: The inlay/onlay  is custom-made by a dental lab.

Placement: The dentist cements the custom made restoration into place. 

Dental crowns are caps placed over damaged or weakened teeth to restore their shape, size, and strength. They come in various materials, including ceramic, gold, metal alloy, or porcelain fused to metal. Crowns can last anywhere from 5-15 years or even longer with good oral hygiene and care. 

Why do I need a crown?

• A crown is needed to protect a tooth that has undergone a root canal or has a large cavity. 
• It can also be used to restore the strength and shape of a tooth that has been weakened by decay, injury, or other issues. 

What are crowns made of?

• Crowns are typically made from ceramic, gold alloy, metal alloy, or porcelain fused to metal. 
• Ceramic crowns are often preferred for their natural appearance. 

How long do crowns last? 

• The lifespan of a crown can vary, but generally, they can last between 5-15 years or even longer.
• Factors like your oral hygiene habits, the material of the crown, and your bite forces can affect how long it lasts.

How do I care for my crown?

• Treat your crown like you would a natural tooth: brush twice a day and floss daily. 
• Avoid hard, sticky, or chewy foods that could damage the crown. 
• Regular dental checkups are also important for monitoring the crown's condition. 

Will the crown be noticeable?

• The crown should be well-matched to your natural teeth, so it should not be overly noticeable. 
• Ceramic crowns are particularly good at matching the natural tooth color and shape. 

How painful is getting a crown? 

• Getting a crown is generally not painful, as the area is typically numbed with a local anesthetic.
• You might experience some discomfort during the procedure, but it's usually manageable.

Can I get a crown in one day? 

• In some cases, it's possible to get a same-day crown with the help of CEREC technology.
• However, for some crowns, it may take a few appointments.
• If the gum margin around the prepared tooth is inflamed, it may alter the fit of the crown as the scan and impression will change.It is better to follow the advice of the treating doctor and discuss regarding temporary crowns in the interim.

What if my crown breaks or falls out? 

• If your crown breaks or falls out, it's essential to contact your dentist promptly.
• They can assess the damage and determine the best course of action, which might involve repairing or replacing the crown.

Do teeth need special care after getting a crown?

• While you don't need special care beyond regular oral hygiene, it's crucial to avoid hard or sticky foods immediately after getting the crown to prevent damage. 
• You may also be advised to rinse your mouth with warm salt water to help reduce inflammation and promote healing.

What can cause dental crowns to yellow? 

• Dental crowns themselves don't yellow over time, but if they're made of porcelain, the tooth underneath can darken, making the crown appear lighter in comparison.
• Gum recession can also expose the margin of the crown, which can look grey.

Why might teeth protected with dental crowns sometimes rot? 

• Although the crown protects the tooth from decay, the area where the crown and tooth meet can still be vulnerable.
• Poor oral hygiene can lead to decay developing at the margin of the crown, which can then spread to other parts of the tooth.

Do crowns have a warranty like other electronics and gadgets that we use?

Crowns typically last atleast 5-15 years with good maintenance. Yes, many dental laboratories offer warranties on dental crowns, typically ranging from 5 to 15 years. These warranties often cover one free repair or replacement within the warranty period if issues arise from the crown itself or its fit, but not typically from accidental damage or poor oral hygiene. After one repair or replacement , the warranty is null and void. Oral hygiene, habits, and overall oral health can influence the longevity of a crown. Replacement and repair required the original warranty card and receipt to be produced.