The Throat

In anatomy, the throat is the part of the neck anterior to the vertebral column. It consists of the pharynx and larynx.

The throat contains various blood vessels, various pharyngeal muscles, the trachea (windpipe) and the esophagus. The hyoid bone and the Clavicle are the only bones located in the throat of mammals.

Throat Related Problems
There are diseases that seems to affect the throat. These include

Epiglottitis

Epiglottitis is a life-threatening condition that occurs when the epiglottis — a small cartilage "lid" that covers the windpipe — swells, blocking the flow of air into the lungs.

A number of factors can cause the epiglottis to swell, including burns from hot liquids, a direct injury to the throat, and various viral and bacterial infections. The most common cause of epiglottitis is infection with Haemophilus influenzae type b (Hib), the same bacterium that causes pneumonia and meningitis.

Routine Hib vaccination for infants has made epiglottitis an uncommon condition, but it remains a valid concern. If you suspect that you or someone in your family has epiglottitis, seek emergency help immediately. Prompt treatment can prevent life-threatening complications

Signs and symptoms
Epiglottitis caused by Hib infection usually begins with a fever and severe sore throat. Other signs and symptoms may develop within a matter of hours, including:

Difficult and painful swallowing
Drooling due to severe pain when swallowing
A muffled voice
Harsh, raspy breathing
Difficulty breathing
Anxiety
Blue skin or lips

Causes
Your voice box (larynx) is a framework of cartilage, muscle and mucous membrane that forms the entrance to your windpipe (trachea), the tube that connects your mouth and throat to your lungs. The epiglottis is a small, movable "lid" just above the larynx that prevents food and drink from entering your windpipe.

It does this by dropping down when you swallow, effectively sealing off the larynx. That's why you can't swallow and breathe at the same time. When you're not eating or drinking, the epiglottis is slightly lifted so that air can flow freely into your lungs. But if the epiglottis becomes swollen — either from infection or injury — the airway narrows and may become completely blocked.

Infection
The most common cause of swelling and inflammation of the epiglottis and surrounding tissues is infection with Haemophilus influenzae type b (Hib) bacteria. Hib isn't the germ that causes the flu, but it's responsible for other serious conditions — including respiratory tract infections and meningitis.

Hib spreads through infected droplets coughed or sneezed into the air. It's possible to harbor Hib in your nose and throat without becoming sick — though you still have the potential to spread the bacteria to others.

Other bacteria and viruses also can cause inflammation of the epiglottis, including:

Streptococcus pneumoniae (pneumococcus), the most common cause of meningitis
Streptococcus A, B and C, a group of bacteria that cause diseases ranging from strep throat to blood infections

Candida albicans, the fungus responsible for vaginal yeast infections, diaper rash and oral thrush
Varicella zoster, the virus responsible for chickenpox and shingles

Injury
Physical injury, such as a direct blow to the throat, can cause epiglottitis. So can scald burns to your face or burns from drinking very hot liquids.

You also may develop signs and symptoms similar to those of epiglottitis if you:

Swallow a chemical that burns your throat
Swallow a foreign object
Smoke drugs, such as crack cocaine and heroin

Risk factors
For most of the 20th century, epiglottitis was more common in children than in adults — especially children ages 2 to 7. But since routine childhood Hib immunizations began in 1985, the number of children with epiglottitis has dropped dramatically. Today the condition affects about one of every 100,000 adults a year and even fewer children.

It's difficult to predict who might develop epiglottitis, but certain factors increase the risk.

Sex. Epiglottitis affects more men than women.

Race. In the United States, blacks and Hispanics tend to develop epiglottitis more frequently than do whites. A difference in access to medical care — including childhood immunizations — may be responsible for the higher rates of epiglottitis in underserved populations.

Crowded conditions. Hib bacteria spread rapidly when people are in close contact. Hib infections are most prevalent in child care centers, but they also spread quickly in schools, in offices and within households.

Weak immune system. If your immune system has been weakened by illness or medication, you're more susceptible to the viral and bacterial infections that may cause epiglottitis.

When to seek medical advice
Epiglottitis is a medical emergency. If someone you know suddenly has trouble breathing and swallowing, call your local emergency number or go to the nearest hospital emergency department. Don't try to examine the person's throat yourself. This can make matters worse.

Screening and diagnosis
If the medical team suspects epiglottitis, no diagnostic tests will be done until your airways are open and it's certain you're receiving enough oxygen.

Once your condition is stable, the doctor may examine your throat using a flexible fiber-optic tube. A local anesthetic can help relieve any discomfort. Sometimes you may have a chest or neck X-ray as well. Because of the danger of sudden breathing problems, children may have X-rays taken at their bedside rather than in the radiology department — again, only after the airway is protected.

You're also likely to have a blood test and throat culture. For the culture, your epiglottis is wiped with a cotton swab and the tissue sample is checked for Hib.

Complications
Epiglottitis can lead to respiratory failure — a life-threatening condition in which the level of oxygen in the blood drops dangerously low or the level of carbon dioxide becomes excessively high.

Pulmonary edema, another life-threatening condition, can develop after airway treatment for epiglottitis. It occurs when the tiny air sacs in the lungs fill with fluid, preventing them from absorbing oxygen.

Sometimes the bacteria that cause epiglottitis cause infections elsewhere in the body, such as pneumonia, meningitis or a blood infection (sepsis).

Treatment
The first priority in treating epiglottitis is ensuring that you're receiving enough air. You may wear a mask that delivers oxygen to your lungs. Or you may have a breathing tube placed into your windpipe through your nose or mouth. The tube must remain in place until the swelling in your throat has decreased — sometimes up to two or three days.

In extreme cases or if more conservative measures fail, the doctor may create an emergency airway by inserting a needle directly into an area of cartilage in your trachea. This procedure allows air into your lungs while bypassing the larynx. The needle is removed as soon as the airway is open.

If your epiglottitis is related to an infection, you'll receive intravenous antibiotics once you're breathing freely. Until your doctor knows the results of your blood and tissue cultures, you're likely to be treated with a broad-spectrum drug. You may receive a different antibiotic later, depending on what's causing your epiglottitis.

Prevention
Immunization with the Hib vaccine is the most effective way to prevent epiglottitis in children younger than age 5. In the United States, children usually receive the vaccine in four doses: at ages 2 months, 4 months, 6 months and 12 to 15 months.

The Hib vaccine is generally not given to children older than age 5 or to adults because they're less likely to develop Hib infection. But the Centers for Disease Control and Prevention recommends the vaccine for older children and adults whose immune systems have been weakened by:

Sickle cell disease
HIV/AIDS
Spleen removal
Chemotherapy
Medications to prevent rejection of organ or bone marrow transplants

The most common side effects of the Hib vaccine include redness, warmth or swelling at the injection site, and a fever. Rarely, a serious allergic reaction may cause difficulty breathing, wheezing, hives, weakness, a rapid heartbeat or dizziness within minutes or a few hours after the shot. If you have an allergic reaction to the vaccine, seek medical help immediately.

Of course, the Hib vaccine doesn't offer guarantees. Immunized children have been known to develop epiglottitis — and many other germs can cause epiglottitis, too. That's where common-sense precautions come in. Don't share personal items. Wash your hands frequently. If soap and water aren't available, use an alcohol-based hand sanitizer.

Adapted from: Mayo Foundation for Medical Education and Research

Taking care of your Teeth

Teeth for a Lifetime
Thanks to better at-home care and in-office dental treatments, more people than ever before are keeping their teeth throughout their lives. Although some diseases and conditions can make dental disease and tooth loss more likely, most of us have a good deal of control over whether we keep our teeth into old age.

The most important thing you can do to maintain good oral health is to brush and floss your teeth regularly.

Most mouth woes are caused by plaque, that sticky layer of microorganisms, food particles and other organic matter that forms on your teeth. Bacteria in plaque produce acids that cause cavities. Plaque also leads to periodontal (gum) disease, a potentially serious infection that can erode bone and destroy the tissues surrounding teeth.

The best defense is to remove plaque daily before it has a chance to build up and cause problems. Brushing removes plaque from the large surfaces of the teeth and, if done correctly, from just under the gums. Flossing removes plaque between teeth.

Brushing
Most of us learned to brush our teeth when we were children and have kept the same technique throughout our lives. Unfortunately, many of us learned the wrong way. Even if we learned the correct method, it's easy to become sloppy over the years. Brushing correctly isn't instinctive. Getting the bristles to remove plaque without damaging your gums is a little trickier than you might think.

There are different ways to brush teeth, and your dentist or dental hygienist can show you the method that he or she feels would be best for you. The modified Bass technique is among the most popular for adults and is very effective in removing plaque above and just below the gum line. Children, however, may find it difficult to move the toothbrush this way. A dentist or dental hygienist can explain to your child the best way to brush. Parents should supervise their children's oral hygiene until age 9 or 10.

Here are a few general pointers about brushing:

Brush at least twice a day — Many oral health professionals recommend brushing just before going to bed. When you sleep, saliva decreases, leaving the teeth more vulnerable to bacterial acids. Teeth should also be brushed in the morning, either before or after breakfast, depending on your schedule. After breakfast is ideal so food particles are removed. But if you eat in your car, at work or skip breakfast entirely, make sure you brush in the morning to get rid of the plaque that built up overnight.

Brush no more than three times a day — Brushing after lunch will give you a good mid-day cleaning. Remember, though, that brushing too often can cause gums to recede over time.

Brush lightly — Brushing too hard can cause gums to recede. Plaque attaches to teeth like jam sticks to a wooden spoon. It can't be totally removed by rinsing, but just a light brushing will do the trick. Once plaque has hardened into calculus (tartar), brushing can't remove it, so brushing harder won't help. Try holding your toothbrush the same way you hold a pen. This encourages a lighter stroke.


Brush for at least two minutes — Set a timer if you have to, but don't skimp on brushing time. Longer is fine, but two minutes is the minimum time needed to adequately clean all your teeth. Many people brush for the length of a song on the radio. That acts as a good reminder to brush each tooth thoroughly.

Have a standard routine for brushing — Try to brush your teeth in the same order every day. Some oral health professionals feel that this helps patients remember to brush all areas of their mouths. If you do this routinely, it eventually will become second nature. For example, brush the outer sides of your teeth from left to right across the top then move to the inside and brush rights to left. Repeat the pattern for your lower teeth.

Always use a toothbrush with "soft" or "extra soft" bristles — The harder the brush, the greater the risk of harming gum tissue.

Change your toothbrush regularly — As soon as the bristles begin to splay, the toothbrush loses its ability to clean properly. Throw away your old toothbrush after three months or when the bristles flare, whichever comes first. If you find your bristles flaring much sooner than three months, you may be brushing too hard. Try easing up.

Electric is fine, but not always necessary — Electric or power-assisted toothbrushes are a fine alternative to manual brushes. They are especially useful for people who are less than diligent about proper brushing technique or for people with physical limitations that make brushing difficult. As with manual brushes, choose soft bristles, brush for at least two minutes and don't press too hard or you'll damage your gums.

Choose the right toothpaste for you — It can be overwhelming to face the huge number of toothpaste choices in the average supermarket. Remember, the best toothpaste for you may not be the best toothpaste for someone else.

Toothpastes don't merely clean teeth anymore. Different types have special ingredients for preventing decay, plaque control, tartar control, whitening, gum care or desensitizing teeth.

Most toothpastes on the market today contain fluoride, which has been proven to prevent, stop or even reverse the decay process. Tartar-control toothpastes are useful for people who tend to build up tartar quickly, while someone who gets tooth stains may want a whitening toothpaste. Whitening toothpastes will remove only surface stains, such as those caused by smoking, tea or coffee. To whiten teeth that are stained at a deeper level, talk with your dentist.

Some people find that some toothpaste ingredients irritate their teeth, cheeks or lips. If your teeth have become more sensitive or your mouth is irritated after brushing, try changing toothpastes. If the problem continues, see your dentist.

How To Brush
Modified Bass brushing technique:
Hold the head of the toothbrush horizontally against your teeth with the bristles part way on the gums.

Tilt the brush head to about a 45-degree angle, so the bristles are pointing under the gum line.

Move the toothbrush in very short horizontal strokes so the tips of the bristles stay in one place, but the head of the brush waggles back and forth. Or use tiny circular motions. This allows the bristles to slide gently under the gum. Do this for about 20 strokes. This assures that adequate time will be spent cleaning away as much plaque as possible. Note: this is a very gentle motion. In healthy gums, this should cause no pain. Brushing too vigorously or with large strokes can damage gum tissue.

Roll or flick the brush so that the bristles move out from under the gum toward the biting edge of the tooth. This helps move the plaque out from under the gum line.

Repeat for every tooth, so that all tooth surfaces and gum lines are cleaned.

For the insides of your front teeth, where the horizontal brush position is cumbersome, hold the brush vertically instead. Again, use gentle back and forth brushing action and finish with a roll or flick of the brush toward the biting edge.

To clean the biting or chewing surfaces of the teeth, hold the brush so the bristles are straight down on the flat surface of the molars.

Gently move the brush back and forth or in tiny circles to clean the entire surface. Move to a new tooth or area until all teeth are cleaned.

Rinse with water to clear the mouth of food residue and removed plaque.

You can clear even more bacteria out of your mouth by brushing your tongue. With your toothbrush, brush firmly but gently from back to front. Do not go so far back in your mouth that you gag. Rinse again.

Flossing
Many people never learned to floss as children. But flossing is critical to healthy gums and it's never too late to start. A common rule of thumb says that any difficult new habit becomes second nature after only three weeks. If you have difficulty figuring out what to do, ask your dentist or dental hygienist to give you a personal lesson.

Here are a few general pointers about flossing:

Floss once a day — Although there is no research to recommend an optimum number of times to floss, most dentists recommend a thorough flossing at least once a day. If you tend to get food trapped between teeth, flossing more often can help remove it.

Take your time — Flossing requires a certain amount of dexterity and thought. Don't rush.

Choose your own time — Although most people find that just before bed is an ideal time, many oral health professionals recommend flossing any time that is most convenient to ensure that you will continue to floss regularly. Choose a time during the day when you can floss without haste.

Don't skimp on the floss — Use as much as you need to clean both sides of every tooth with a fresh section of floss. In fact, you may need to floss one tooth several times (using fresh sections of floss) to remove all the food debris. Although there has been no research, some professionals think reusing sections of floss may redistribute bacteria pulled off one tooth onto another tooth.

Choose the type that works best for you — There are many different types of floss: waxed and unwaxed, flavored and unflavored, ribbon and thread. Try different varieties before settling on one. People with teeth that are closely spaced will find that waxed floss slides more easily into the tight space. There are tougher shred-resistant varieties that work well for people with rough edges that tend to catch and rip floss.

How To Floss
How you hold the floss is a matter of personal preference. The most common method is to wind the floss around the middle fingers then pull it taut and guide it with your index fingers. You also can wind it around your index fingers and guide it with your thumb and middle fingers or simply hold the ends of the floss or use a floss-guiding tool. (If you have a fixed bridge, a bridge threader can help guide floss under the bridge for better cleaning.) How you hold the thread is not as important as what you do with it. If you can't settle in on a good method, ask your dentist or hygienist for suggestions.

Hold the floss so that a short segment is ready to work with.

Guide the floss gently between two teeth. If the fit is tight, use a back-and-forth motion to work the floss through the narrow spot. Do not snap the floss in or you could cut your gums.

Hold the floss around the front and back of one tooth, making it into a "C" shape. This will wrap the floss around the side edge of that tooth.

Gently move the floss toward the base of the tooth and up into the space between the tooth and gum.

Move the floss up and down with light to firm pressure to skim off plaque in that area. Do not press so hard that you injure the gum.

Repeat for all sides of the tooth, including the outermost side of the last tooth. Advance the floss to a clean segment for each tooth edge.

Other Ways To Clean Between the Teeth
Many people have larger spaces between their teeth and need additional tools, called interdental cleaners, to remove food particles and bacterial plaque adequately. You may have larger spaces that need extra care if you have had gum surgery or if you have teeth that are missing or out of alignment.

Small interdental brushes are tiny bristle or filament brushes that can fit between teeth and come in a variety of sizes and handle designs. These brushes clean better than floss when the gum tissue does not completely fill the space between your teeth. These little brushes also can help people with orthodontic bands on their teeth to remove bacterial plaque from around the wires and brackets.

Another tool for cleaning between teeth is wooden interdental cleaners. These long, triangular strips of wood can be softened and used to clean between teeth.

You can find these interdental cleaners at most drugstores and grocery stores. Your dentist or dental hygienist can show you how to use these cleaners to remove plaque between your teeth.


Other Cleaning Tools
To supplement your at-home brushing and flossing, your dentist or hygienist may suggest one or more of the following:

Oral irrigators — These electrical devices pump water out in a slim steady or pulsating stream. Although they do not seem to remove plaque that is attached to the tooth well, they are very effective at flushing out food and bacteria byproducts in periodontal pockets or that get caught in orthodontic appliances. They are particularly useful for delivering medication to hard-to-reach areas. For example, prescription antibacterial rinses can be sprayed into gum pockets with an oral irrigator. Irrigators should be used in addition to brushing and flossing, not as an alternative.

Interdental tip — These soft, flexible rubber nibs are used to clean between the teeth and just below the gum line. Plaque and food debris can be removed by gently running the tip along the gum line. ====>>

Mouthwashes and rinses — As with toothpaste, your choice of mouthwashes or rinses will be guided by your personal mouth care needs. Over-the-counter rinses are available to freshen the breath, add fluoride or kill plaque bacteria that cause gingivitis. Some mouthwashes are designed to help loosen plaque before you brush. Ask your dentist or hygienist to recommend the type of rinse that would be best for you. If you need to avoid alcohol, read ingredient labels carefully. Many over-the-counter mouthwashes contain significant amounts of alcohol. In some cases, the dentist might prescribe a stronger fluoride or antibacterial rinse.

Adapted from: Columbia University Medical Center, School of Dental & Oral Surgery

Implant

Implants are devices that replace the roots of missing teeth, and are used to support crowns, bridges or dentures. Implants are placed in your jawbone surgically. Most of the time, implants feel more natural and secure than other methods of replacing missing teeth, such as dentures.
There are many reasons why it's important to replace missing teeth:

Having all of your teeth can make you more self-confident. You don't worry that people notice that you have teeth missing.

When teeth are lost, the area of the jawbone that held those teeth starts to erode. Over time, you can lose so much bone that your jaw will need a bone graft to build up the bone in your jaw before your dentist can place implants or make a denture that fits properly.

Tooth loss affects how well you chew and what foods you are able to eat. Many people who have missing teeth have poor nutrition, which can affect overall health.

The loss of teeth can change your bite, that is the way your teeth come together. Changes in your bite can lead to problems with your jaw joint, called the temporomandibular joint.
Losing teeth can lead to changes in your speech, which also can affect your self-confidence.
There are several types of implants, including root form, blade form, Ramus frame and subperiosteal implants.

Root-form implants are the most common type used today. A root-form implant looks like a small cylinder or screw and is made of titanium. After an implant is placed in the jawbone, a metal collar called an abutment eventually is attached to it. The abutment serves as a base for a crown, denture or bridge.

The key to the success of all implants is a process called osseointegration, in which the bone in the jaw bonds with the implant. Titanium is a special material that the jawbone accepts as part of the body.

The ability of titanium to fuse with bone was discovered accidentally. In 1952, a scientist named Per-Ingvar Brånemark was using titanium chambers screwed into bones as part of his research to discover how bone healed after an injury. When he tried to remove the titanium chambers, he found they had become bonded to the bone.

This discovery led Dr. Brånemark to do further research into how titanium implants might work. In 1965, the first root-form implants were placed in people. Other types of implants also have been used for the past 30 to 40 years. There are many implant systems available, made by various dental manufacturers.

Success
Available studies indicate that surgical placement of root-form implants is successful more than 90% of the time. When these implants fail, the problems usually occur within the first year after surgery. After that, only about 1% of all implants fail each year.

Implants have become increasingly popular since the American Dental Association (ADA) endorsed them in 1986. Between 1986 and 1999, the number of implant procedures tripled. An ADA survey found that the average number of implants placed by a dentist who does the procedure was 56 per year in 1999, compared with 18 in 1986. According to the survey, in 1999, 90% of oral surgeons, 68% of periodontists, 10% of prosthodontists and 8% of general dentists had performed implant procedures.

It is now estimated that between 300,000 and 400,000 implants are placed every year in the United States.

Implants Versus Alternatives
Depending on your particular problem, implants can be more expensive than the alternatives (denture or bridge). An implant plus a crown costs between $1,500 and $4,000. The fees will depend on many factors. Insurance companies generally do not cover this cost, although you should always check with your insurer.

While the upfront cost for implants can be more than for other types of restorations, the investment can pay off in the long run. You do not necessarily need an implant for every missing tooth. Your dentist can discuss how many implants you will need.
Other benefits of implants include:

Feel — Because implants are imbedded in your bone, they feel more like your natural teeth than bridges or dentures.

Convenience — You will not need to worry about denture adhesives or having your dentures slip, click or fall out when you speak.

Nutrition — You will be able to chew better with implants. Chewing can be difficult with regular dentures, especially ones that don't fit perfectly. A regular upper denture also covers your palate, which can reduce your sense of taste.

Self-esteem — Because implants are so much like your natural teeth, you will think about them less. Your self-esteem and confidence will be improved because you will not have to worry about denture problems or people noticing that you have missing teeth. Regular dentures also can affect your speech, which can make you less self-confident when talking with others.

Types of Implant

Today, most dental implants are made of titanium, a metal that has special qualities that make it useful for this purpose.

Titanium develops a thin film on its surface that protects it from corrosion. It is resistant to acids, salt solutions and oxygen, among other things. Titanium also is almost completely nonmagnetic and is extremely strong for its weight.

Perhaps most important, the body does not reject titanium implants as foreign objects. When implants are placed in bone, the bone grows around the implant in a process called osseointegration.

Titanium implants come with many types of surfaces, including acid etched, plasma sprayed, acid etched and grit blasted, and hydroxyapatite coated. Hydroxyapatite is a part of what bone is made from. It bonds with bone in a process called biointegration.
There are several types of implants.

Root-Form Implant
These are the most popular type of implant. Root-form implants are called endosseous or endosteal implants, meaning they are placed in the bone. They look like screws, thick nails or cones, and come in various widths and lengths. For root-form implants to be successful, the bone needs to be deep enough and wide enough to provide a secure foundation.

Your dentist decides which type of implant to use based on the quality of the bone in your jaw and the type of crown, bridge or denture that will be placed on the implant.

Root-form implants can be inserted in a two-stage process — the traditional way of placing them — or in a single-stage procedure. In the two-stage procedure, the implant is “buried” under the gum tissue for three to four months and then exposed during a second surgical procedure. In a single-stage procedure, the implant is placed in the bone and remains exposed in the mouth.

Ramus-Frame Implant
This type of implant can be used if the lower jawbone is too thin for a root-form or subperiosteal implant. A Ramus-frame implant is embedded in the jawbone in the back corners of the mouth (near the wisdom teeth) and near the chin. Once it is inserted and the tissue heals, a thin metal bar is visible around the top of the gum. Dentures are made that can fit onto this bar. Ramus-frame implants also can stabilize weak jaws and help to prevent them from fracturing.

Transosseous Implant
Transosseous implants originally were designed to be used in people who had very little bone in their lower jaws and who had no bottom teeth. However, they are rarely used today because placing them requires extensive surgery, general anesthesia and hospitalization. Also, their use is limited to the lower jaw. Placing transosseous implants involves inserting two metal rods from below the chin, through the chin bone, until they are exposed inside the mouth. The rods that can be seen inside the mouth are used to attach a denture. Most clinicians today prefer to use bone grafts and one of the other endosseous implant methods described earlier instead of the transosseous method because they are equally effective and do not require the level of surgery needed when placing transosseous implants.

Blade-Form Implant
This type of implant also is known as a plate-form implant. It is a type of endosseous implant (placed in the bone), but it is used less frequently than a root-form implant. Blade-form implants are flat rectangles of metal with one or two metal prongs on one long side. A blade implant is placed in the jaw so that the prong(s) stick out into the mouth where they will support crowns or bridges.

Adapted from: Columbia University Medical Center, School of Dental & Oral Surgery

Crowns

A crown is a tooth-shaped cover placed over a tooth that is badly damaged or decayed. A crown, which many people call a cap, is made to look like your tooth.

Crowns may be placed for several reasons, but generally the tooth has been extensively damaged by decay or breakage and filling material can't replace the missing tooth structure and make the tooth strong enough. A crown may hold together parts of a cracked tooth and can be used to hold a bridge in place. Crowns also are used for cosmetic purposes to cover misshapen or badly discolored teeth.

Crowns can be prefabricated or made in a laboratory. Prefabricated crowns are made of plastic or stainless steel and can be used as a temporary restoration until a permanent crown is manufactured. In some cases, prefabricated crowns can be used as a permanent restoration.
Crowns can be all metal, porcelain fused to metal (PFM), or all ceramic. Metals include gold alloy, other alloys (palladium) or a base-metal alloy (nickel or chromium). The all-metal or PFM crowns are stronger and are better choices for back teeth. PFM and all-ceramic crowns look just like normal teeth.

Usually, crowns last at least 7 years, but in many cases they last much longer, up to 40 years or so.

Preparing the Tooth
If you need a crown, you may also need endodontic or root canal treatment on the tooth, due to extensive decay or the risk of infection or injury to the tooth's pulp. Not everyone who needs a crown will also need a root canal.

Besides the crown, your dentist may need to build up a foundation to support the crown. A foundation is needed if large areas of the natural tooth structure are decayed, damaged or missing. If you are receiving the crown after root canal treatment, your dentist may insert a post-and-core foundation.

To place a crown, your dentist must file down the tooth to make room for it. If you are receiving an all-metal crown, less tooth structure will be removed because these crowns are thinner than PFM or all-porcelain ones.

After filing down the tooth, your dentist will use a piece of thread or cord to push the gum down around the tooth, and then make an impression of the tooth. The impression material sets in five or six minutes and is removed. Your dentist will also take an impression of the teeth above or below the tooth that will receive the crown, to make sure the crown will not affect your bite.
The impressions are sent to the lab, where the crown is made. During that time, you will have a temporary crown. These crowns are usually made of plastic and are made in your dentist's office on the day of your visit. They are not meant to last. If a temporary crown is left in the mouth, the cement eventually washes out and the tooth can decay.

At a second visit, your dentist will remove the temporary crown and test the permanent one. Sometimes crowns need additional polishing or glaze or some other adjustment before they are placed. Once the crown is ready, it's cemented to your tooth.

After a Crown
You shouldn't feel any discomfort or sensitivity after a crown is placed, though if your tooth still has the nerve in it, you may have some hot/cold sensitivity. If you notice pain or sensitivity when you bite down, you should contact your dentist. Usually this means that the crown is too high on the tooth. This can be fixed easily.

You may notice a dark line next to the gumline on your crowned tooth, particularly if you have a PFM crown. This dark line is the metal of the crown showing through and is normal. A crowned tooth is not protected from decay or gum disease. You should continue practicing good oral hygiene.

Crowns, especially all-porcelain ones, can chip. This can sometimes be repaired in the mouth. Your dentist will etch the porcelain with acid and bond composite resin to it to fix the chip. If the chipping is extensive, you may need a replacement crown.

It's also possible that the cement could wash out from under the crown, but the crown does not fall out. Under these conditions, bacteria can leak in and cause decay. If your crown seems loose, contact your dental office.

Your crown may fall out, due to a lack of cement or an improper fit. If this happens, clean the crown and the tooth. You can replace the crown temporarily using denture adhesive or temporary cement sold for this purpose. Contact your dental office immediately and try to schedule a visit for the next day. If you are away from home, seek a dentist in the area who can evaluate the problem. You may need a new crown or it may be possible to re-cement the old one on the tooth.

Adapted from: Columbia University Medical Center, School of Dental & Oral Surgery

Teeth Treatment Options - Apicoectomy

Your teeth are held in place by roots that extend into your jawbone. Front teeth usually have one root. Other teeth, such as your premolars and molars, have two or more roots. The tip of each root is called the apex. Nerves and blood vessels enter the tooth through the apex, travel through a canal inside the root, and into the pulp chamber, which is inside the crown (the part of the tooth visible in the mouth).

An apicoectomy may be needed when an infection develops or persists after root canal treatment or retreatment. During root canal treatment, the canals are cleaned, and inflamed or infected tissue is removed. Root canals are very complex, with many small branches off the main canal. Sometimes, even after root canal treatment, infected debris can remain in these branches and possibly prevent healing or cause re-infection later. In an apicoectomy, the root tip, or apex, is removed along with the infected tissue. A filling is then placed to seal the end of the root.

An apicoectomy is sometimes called endodontic microsurgery because the procedure is done under an operating microscope.

What It's Used For
If a root canal becomes infected again after a root canal has been done, it's often because of a problem near the apex of the root. Your dentist can do an apicoectomy to fix the problem so the tooth doesn't need to be extracted. An apicoectomy is done only after a tooth has had at least one root canal procedure.

In many cases, a second root canal treatment is considered before an apicoectomy. With advances in technology, dentists often can detect additional canals that were not adequately treated and can clear up the infection by doing a second root canal procedure, thus avoiding the need for an apicoectomy.

An apicoectomy is not the same as a root resection. In a root resection, an entire root is removed, rather than just the tip.

Preparation
Before the procedure, you will have a consultation with your dentist. Your general dentist can do the apicoectomy, but, with the advances in endodontic microsurgery, it is best to be referred to an endodontist.

Your dentist may take X-rays and you may be given an antimicrobial mouth rinse, anti-inflammatory medication and/or antibiotics before the surgery.
If you have high blood pressure or know that you have problems with the epinephrine in local anesthetics, let your dentist know at the consultation. The local anesthetic used for an apicoectomy has about twice as much epinephrine (similar to adrenaline) as the anesthetics used when you get a filling. The extra epinephrine constricts your blood vessels to reduce bleeding near the surgical site so the endodontist can see the root. You may feel your heart rate speed up after you receive the local anesthetic, but this will subside after a few minutes.

How It's Done
The endodontist will cut and lift the gum away from the tooth so the root is easily accessible. The infected tissue will be removed along with the last few millimeters of the root tip. He or she will use a dye that highlights cracks and fractures in the tooth. If the tooth is cracked or fractured, it may have to be extracted, and the apicoectomy will not continue.

To complete the apicoectomy, 3 to 4 millimeters of the tooth's canal are cleaned and sealed. The cleaning usually is done under a microscope using ultrasonic instruments. Use of a surgical microscope increases the chances for success because the light and magnification allow the endodontist to see the area better. Your endodontist then will take an X-ray of the area before suturing the tissue back in place.

Most apicoectomies take between 30 to 90 minutes, depending on the location of the tooth and the complexity of the root structure. Procedures on front teeth are generally the shortest. Those on lower molars generally take the longest.

Follow-Up
You will receive instructions from your endodontist about which medications to take and what you can eat or drink. You should ice the area for 10 to 12 hours after the surgery, and rest during that time.

The area may bruise and swell. It may be more swollen the second day after the procedure than the first day. Any pain usually can be controlled with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofem (Advil, Motrin and others) or prescription medication.

To allow for healing, you should avoid brushing the area, rinsing vigorously, smoking or eating crunchy or hard foods. Do not lift your lip to examine the area, because this can disrupt blood-clot formation and loosen the sutures.

You may have some numbness in the area for days or weeks from the trauma of the surgery. This does not mean that nerves have been damaged. Tell your dentist about any numbness you experience.

Your stitches will be removed 2 to 7 days after the procedure, and all soreness and swelling are usually gone by 14 days after the procedure.

Even though an apicoectomy is considered surgery, many people say that recovering from an apicoectomy is easier than recovering from the original root-canal treatment.

Risks
The endodontist will review the risks of the procedure at the consultation appointment. The main risk is that the surgery may not work and the tooth may need to be extracted.
Depending on where the tooth is located, there may be other risks. If the tooth is in the back of your upper jaw, the infection can involve your sinuses, and your dentist may suggest antibiotics and decongestants. The roots of the back teeth in the lower jaw are close to some major nerves, so surgery on one of these teeth carries a slight risk of nerve damage. However, your endodontist will use your X-rays to see how close the roots are to the nerves, and the chances of anything happening are extremely small.

An apicoectomy is usually a permanent solution, and should last for the life of the tooth.

When To Call a Professional
If you're having any pain or swelling from a tooth that has had root-canal treatment, contact your dentist, who will take X-rays and do an exam. If your dentist feels you need an apicoectomy, you will need to set up an appointment for a consultation.

Adapted from: Columbia University Medical Center, School of Dental & Oral Surgery

Oral Changes with Age

Isn’t tooth loss inevitable in the later years?
No! Today, older adults are keeping their natural teeth longer because of scientific developments and the preventive emphasis in dentistry. This improvement was seen in the results of a survey released by the National Institute of Dental and Craniofacial Research. They showed that among persons aged 55 to 64, the rate of toothlessness dropped 60 percent since 1960.
Good oral hygiene and regular dental care are important throughout your life, whatever your age. By practicing good oral hygiene at home and visiting your dentist regularly, you will prevent dental problems and save time and money as well. In the process, you can save your teeth and gums.

At my age, why should I bother with oral hygiene, such as brushing and flossing?
Thorough daily brushing and flossing of your natural teeth are essential to keep them in good condition—especially as you age. Plaque, the sticky, colorless layer of bacteria that causes tooth decay and periodontal (gum) disease, can build up quickly on the teeth of older adults, particularly when they neglect oral hygiene. This can increase your risk for tooth decay and periodontal disease.

A few simple steps can help you maintain good oral health throughout your life. Brush your teeth twice a day with a fluoride toothpaste, and clean between your teeth daily with floss or interdental cleaners. Choose products that carry the ADA Seal of Acceptance, your assurance that the products have met the ADA’s standards for safety and effectiveness. Be sure to see your dentist regularly for exams and professional teeth cleaning.

Should adults be concerned about cavities?
Tooth decay is not just a child’s problem. Adults of all ages can have cavities, too. The causes for tooth decay are the same for everyone, regardless of age. Decay results when the bacteria in plaque feed on the carbohydrates (sugar and starch) in our diet to produce acids that can cause cavities.

Yet, the nature of the decay problem does change somewhat as people grow older. Adults are more likely to have decay around older fillings, and because many adults grew up without the benefits of fluoride, they may have many more fillings. Decay of the tooth root is also common among older adults. Root caries (decay) occur when the gums recede, exposing the softer root surface, which decays more easily than tooth enamel.

Tooth decay is also promoted by dry mouth. This condition—called xerostomia—occurs when the supply of saliva is greatly reduced. It can be caused by many types of medications (such as anti-histamines, anti-hypertensives, and anti-depressants) or radiation therapy to the head or neck. Saliva is needed to lubricate the mouth, wash foods away and neutralize the acids produced by plaque. Allowed to continue, dry mouth can lead to rampant tooth decay. If you think you have this problem, be sure to discuss it with your dentist or physician. They may recommend an artificial saliva and fluoride products to help prevent decay.

I understand that periodontal disease is a major cause of tooth loss in adults, but is there anything I can do about it?
Gum disease—periodontal disease—often progresses slowly, without pain, over a long period of time. This is one reason why it is common among older adults. The longer the disease goes undetected and uncontrolled, the more damage it causes to gums and other supporting tissues. Although periodontal disease is caused by plaque, other factors can increase the risk or severity of the condition. These include food left between the teeth, smoking, smokeless (spit) tobacco use, badly aligned teeth, ill-fitting bridges or partial dentures, poor diets and systemic diseases such as anemia.
Although periodontal disease is common, it can be controlled or arrested. In its early stages, it can be reversed. Treatment of advanced cases may require surgery. Look for these warning signs and see your dentist if you notice any of them: bleeding gums when you brush; red, tender or swollen gums; gums that have pulled away from the teeth; pus between your teeth and gums when the gums are pressed; loose teeth or teeth that are moving apart; any change in your bite; any change in the fit of your partial dentures; constant bad breath or bad taste.

My dentures don’t feel as comfortable as they once did. Before I see the dentist, should I try some different products myself to try to improve them?
Your dentures were made to fit precisely. If they are cared for properly, they do not change shape. They can become loose due to natural changes in the gums and bone supporting them. As the jawbone begins to shrink, so do the gums. When your dentures do not fit properly, see your dentist as soon as possible so adjustments can be made. Do not try to change the fit of your dentures yourself. This can damage them and make them unrepairable. This could be a costly experiment! Ill-fitting dentures repaired at home can irritate the gums, tongue and cheeks. In emergencies, denture adhesives can be used to keep the dentures stable until you see the dentist. If your denture is loose, have your dentist check it.

Now that I have full dentures, do I really need to see the dentist as often as before?
Even if you no longer have your natural teeth, you should see your dentist regularly for an oral examination. The dentist will examine your mouth to check for any problem with the gum ridges, the tongue and the joints of the jaw, as well as screen for oral cancer. For a variety of reasons, many older adults are more susceptible to oral diseases, including oral cancer. About 95 percent of all cancers are found in people over age 40. However, many of these cancers are treatable if detected early. Oral tissues are also checked for signs of other diseases that can first manifest themselves in the mouth.

I find that some foods have become difficult to chew and swallow. Do I really need to eat the same amount or variety of food that I did when I was younger?
Maintaining proper nutrition is important for everyone, young or old. Many older adults do not eat balanced diets and avoid meats, raw vegetables and fresh fruits because they have trouble chewing or swallowing. These problems can be caused by painful teeth, ill-fitting dentures, dry mouth or changes in facial muscles. Others find their sense of taste has changed, sometimes due to a disease or certain medications. Because of these and other factors, the diets of older adults are often lacking in calcium, protein and other nutrients essential to dental and overall health. You need a balanced diet based on the five food groups—milk and dairy products; breads and cereals; meats and dried beans; fruits; vegetables. You may need a multi-vitamin or mineral supplement, but do not be your own doctor. Use these supplements only after discussion with your physician.

I am anxious about dental visits. I know I should go, but I can’t. What can I do?
Anxiety over dental treatment is not unusual. People of any age can experience it. Older patients may be less able to cope with the stress due to certain physical conditions such as vision or hearing loss. Communication between you and your dentist is an important aspect of a comfortable dental visit. You should share your feelings with your dentist and the staff. Let them know that you are anxious so that they can adjust their treatment and their pace to meet your needs. Advances in pain and anxiety control, including many behavioral therapy techniques borrowed from psychology, have made dental visits relatively anxiety- and pain-free.

I am currently taking medication that my physician prescribed for me. Can this affect my dental treatment?
When your dentist asks for your medical history, be sure to provide complete, up-to-date information on your health. Inform your dentist if you have experienced recent hospitalization or surgery, or if you have recently been ill. Also tell the dentist the names, doses and frequency of any medications you are taking—whether prescription or over-the-counter products—and the name of your physician. Inform the dentist of any changes in your health or medications. This information will help the dentist to select the most safe and effective method of treatment for you.

I’ve heard about implants as an alternative to dentures. What should I know about implants?
Dental implants may offer solutions for patients who cannot function adequately with conventional dentures. However, not every patient is a candidate for implants. The decision can be made only after a careful examination by your dentist and discussion of the relative benefits and risks and what the procedure involves. Ask your dentist if implants may be an option for you.

I’ve heard of some new cosmetic techniques that can improve smiles. Are they appropriate for older adults?
Older adults can benefit from many of the options available today for improving the look of a smile. Your dentist can describe and discuss with you the range of treatments that would be right for you. Part of older adulthood is the acceptance of aging and the development of realistic expectations for appearance. In that context, dental treatment for older adults can be a healthy and adaptive way of maintaining dental health and emotional well-being. Our teeth and mouth play a critical role in psychological development and well-being throughout our lives. Modern dentistry has expanded esthetic options for people of all ages. Coupled with good oral hygiene and regular dental visits, cosmetic techniques can help improve the appearance of your smile.

I’m on a limited, fixed income and can’t really afford regular dental treatment. Are there any resources available to help me?
Even if you cannot pay for dental care, you don’t need to live without it. Thousands of dentists across the country assist the elderly on fixed incomes by offering their services at reduced fees through dental society-sponsored assistance programs. The availability of such aid varies from one community to another, so call your local dental society for information about where you can find the nearest assistance programs and low-cost dental care locations, such as public health and dental school clinics. Other sources of such information are local social service organizations.

What is dentistry doing to better serve older adults?
Dentists are experiencing a quiet revolution in their offices as the number of older patients increases steadily and their treatment centers more on natural teeth. The profession knows that this burgeoning population group is wearing fewer dentures and is keeping natural teeth longer. Also, we know that some patients in this group require special consideration because reduced mobility and dexterity may make daily oral hygiene difficult. In addition, medical conditions and impairment are factors that dentists take into account for certain patients. Sometimes, lack of awareness about available treatments and techniques leads older patients to make false assumptions about their dental health and tolerate conditions such as toothaches, bleeding gums and clicking dentures. Dentists are gaining practical information on how to effectively manage the treatment needs of older patients. Many dental societies have set up access programs to assist older adults, individuals with physical or mental disabilities or indigent persons to receive care.
Dentists are increasingly sensitive to the special needs of and the importance of dental health in the older patient. Older adults are more health conscious as a group than ever before. Their oral health is an important part of their overall health and the dental profession is committed to providing the treatment and guidance older adults need to maintain it.

Why do my teeth seem darker?
One of the changes you may notice as you grow older is that it's harder to keep your teeth clean and white. This is because the sticky, colorless layer of bacteria, called plaque, can build up faster and in greater amounts as we age. Changes in dentin, the bone-like tissue that is under your enamel, may also cause your teeth to appear slightly darker.

Why does my mouth feel dry?
Reduced saliva flow that results in a dry mouth is a common problem among older adults. It is caused by certain medical disorders and is often a side effect of medications such as antihistamines, decongestants, pain killers and diuretics. Some of the common problems associated with dry mouth include a constant sore throat, burning sensation, problems speaking, difficulty swallowing, hoarseness or dry nasal passages. Left untreated, dry mouth can damage your teeth. Without adequate saliva to lubricate your mouth, wash away food, and neutralize the acids produced by plaque, extensive cavities can form.
Your dentist can recommend various methods to restore moisture. Sugar-free candy or gum stimulates saliva flow, and moisture can be replaced by using artificial saliva and oral rinses.

Why am I losing my sense of taste?
You may find that you are losing your appetite due to a change in your sense of taste. Several factors can cause this change. Besides an age-related decrease in the sense of taste and smell, certain diseases, medications and dentures can contribute to a decrease in your sense of taste.

Adapted from: American Dental Association

Menstruation, Pregnancy and your Teeth

With all the changes taking place in a woman's body during stages like puberty, pregnancy, lactation, menstruation, and menopause, women can expect some oral health changes as well, reports the Academy of General Dentistry, an international organization of 34,000 general dentists dedicated to continuing dental education to ensure the best possible dental care for the patient. Elevated levels in sex hormones can also jump start oral health problems.

Early on, menstruation may cause swollen gums, herpes-type lesions and ulcers. Later in life, women going through menopause may experience oral problems like pain, burning sensation, bad taste, and dry mouth, as well as bone loss due to osteoporosis, a condition characterized by a decrease in bone mass with decreased density and enlargement of bone spaces.

Pregnant women frequently experience increased oral sensitivity and often suffer inflammation of the gums, or gingivitis, due to hormonal changes. Along with a strict oral hygiene routine, the patient should begin a personal and professional plaque control regimen to treat or prevent gingivitis. Periodontal therapy, if necessary, should begin after the woman gives birth.

"During pregnancy, women can expect to see changes in their mouth. Gingivitis is common, partly due to hormonal changes," says Barbara J. Steinberg, DDS, spokesdentist for the Academy.

Dr. Steinberg says women may need more frequent dental exams during pregnancy, and recommends that women "even contemplating pregnancy," get an oral exam.

When the dentist asks a woman whether she has recently given birth, might possibly be pregnant, is breast feeding, or is going through menopause, the dentist isn't just nosy. This information is crucial to a dentist planning to administer medication because if a woman is pregnant or lactating, the medication could affect the fetus or newborn child.

Adapted from: Academy of General Dentistry

Dental Emergencies & Injuries

There are a number of simple precautions you can take to avoid accident and injury to your teeth. One way to reduce the chances of damage to your teeth, lips, cheek and tongue is to wear a mouthguard when participating in sports or recreational activities that may pose a risk. Avoid chewing ice, popcorn kernels and hard candy, all of which can crack a tooth. Cut tape using scissors rather than your teeth.

Accidents do happen, and knowing what to do when one occurs can mean the difference between saving and losing a tooth.

Bitten Lip or Tongue
Clean the area gently with a cloth and apply cold compresses to reduce any swelling. If the bleeding doesn’t stop, go to a hospital emergency room immediately.


Broken Tooth
Rinse your mouth with warm water to clean the area. Use cold compresses on the area to keep any swelling down. Call your dentist immediately.


Jaw-Possibly Broken
Apply cold compresses to control swelling. Go to your dentist or a hospital emergency department immediately.


Knocked Out Tooth
Hold the tooth by the crown and rinse off the root of the tooth in water if it’s dirty. Do not scrub it or remove any attached tissue fragments. If possible, gently insert and hold the tooth in its socket. If that isn’t possible, put the tooth in a cup of milk and get to the dentist as quickly as possible. Remember to take the tooth with you!


Objects Caught Between Teeth
Try to gently remove the object with dental floss; avoid cutting the gums. Never use a sharp instrument to remove any object that is stuck between your teeth. If you can’t dislodge the object using dental floss, contact your dentist.


Toothache
Rinse your mouth with warm water to clean it out. Gently use dental floss or an interdental cleaner to ensure that there is no food or other debris caught between the teeth. Never put aspirin or any other painkiller against the gums near the aching tooth because it may burn the gum tissue. If the pain persists, contact your dentist.


Adapted from: American Dental Association

Tooth Discoloration

Your teeth can become discolored by stains on the surface or by changes in the tooth material. Dentists divide discoloration into three main categories:

Extrinsic discoloration — This occurs when the outer layer of the tooth (the enamel) is stained by coffee, wine, cola or other drinks or foods. Smoking also causes extrinsic stains.


Intrinsic discoloration — This is when the inner structure of the tooth (the dentin) darkens or gets a yellow tint. Causes include excessive exposure to fluoride during early childhood, the maternal use of tetracycline antibiotics during the second half of pregnancy and the use of tetracycline antibiotics in children 8 years old or younger.


Age-related discoloration — This is a combination of extrinsic and intrinsic factors. In addition to stains caused by foods or smoking, the dentin naturally yellows over time. The enamel that covers the teeth gets thinner with age, which allows the dentin to show through. Chips or other injuries to a tooth can also cause discoloration, especially when the pulp has been damaged.
In rare cases, children with a condition called dentinogenesis imperfecta are born with gray, amber or purple discolorations.


Symptoms
Symptoms include stains on the enamel or a yellow tint in the dentin.

Diagnosis
No special tests are needed. A dentist can diagnose tooth discoloration by looking at the teeth.

Expected Duration
Some tooth discoloration can be removed with professional cleaning, but many stains are permanent unless the teeth are treated (whitened) with a bleaching gel.

Prevention
Brushing your teeth after every meal will help to prevent some stains. Dentists recommend that you rinse your mouth with water after having wine, coffee or other drinks or foods that can stain your teeth. Regular cleanings by a dental hygienist also will help to prevent surface stains.
Intrinsic stains that are caused by damage to a nerve or blood vessel in the inner part (the pulp) of a tooth sometimes can be prevented by having root canal treatment, which removes organic material before it has a chance to decay and darken. However, teeth that undergo root canal treatment may darken anyway. To prevent intrinsic stains in children, avoid water that contains a high fluoride concentration. You can check the concentration of fluoride in your drinking water supply by calling the public health department. Then consult your dentist.


Treatment
Discoloration often can be removed by applying a bleaching agent to the enamel of the teeth. With a technique called "power bleaching," the dentist applies a light-activated bleaching gel that causes the teeth to get significantly whiter in about 30 to 45 minutes. Several follow-up treatments may be needed.

It's also possible to remove discoloration with an at-home bleaching gel and a mouth guard given to you by your dentist. The bleaching gels designed for use at home aren't as strong as those applied by your dentist, so the process takes longer — usually two to four weeks. Whitening toothpastes may remove minor stains, but they aren't very effective in most cases.

If you've had a root canal and the tooth has darkened, your dentist may apply a bleaching material to the inside of the tooth.

When a tooth has been chipped or badly damaged or when stains don't respond to bleaching, your dentist may recommend covering the discolored areas. This can be done with a composite bonding material that's color-matched to the surrounding tooth. Another option is to get veneers, which are thin shells of ceramic that cover the outer surfaces of the teeth.


When To Call a Professional
Tooth discoloration is mainly a cosmetic problem. Call a dentist if you're unhappy with the appearance of your teeth. Any change in a child's normal tooth color should be evaluated by a dentist.

Adapted from: Columbia University Medical Center, School of Dental & Oral Surgery

Impacted Wisdom Teeth

Introduction
What's so smart about wisdom teeth if it seems like they're nothing but trouble in the long run?

Indeed, impacted wisdom teeth can cause a variety of problems, from nuisance pain to serious dental disorders. They often must be surgically removed.

Wisdom teeth are your third molars, stuck way in the back of your mouth. Most people have four wisdom teeth, one in each corner of the mouth — two on top, two on bottom. Wisdom teeth are the last of your teeth to come in, or erupt through the gums. They normally emerge between ages 17 and 21.

Oftentimes, wisdom teeth aren't able to emerge normally and instead become impacted, or trapped within your jaw. Understanding more about impacted wisdom teeth can help you decide how and when to treat them and how to prevent related complications.

Signs and symptoms
Some people never experience problems with their wisdom teeth. Your wisdom teeth may emerge normally and be trouble-free for the rest of your life. Or, you may have impacted wisdom teeth but remain blissfully unaware, since they don't always cause signs and symptoms.

Common signs and symptoms of impacted wisdom teeth include:

Pain or tenderness around your gums
Swelling around your jaw
Red or swollen gums around the impacted tooth
Jaw pain
Bad breath
Unpleasant taste when biting down on or near the area
Prolonged headache or jaw ache

Causes
Early humans needed wisdom teeth and larger jaws to handle a tougher diet. Today's humans typically have smaller jaws and little use for wisdom teeth. And that often means people wind up experiencing problems. Having pesky wisdom teeth surgically extracted seems almost a rite of passage — and something to swap stories about later.

Wisdom teeth develop like your other teeth. But they take the longest to develop and are the last teeth to emerge. Any tooth can become impacted. Because wisdom teeth must fight for space with teeth that have already emerged, they're the teeth most likely to become impacted.

At about age 9, the crown of a wisdom tooth begins to form in a small sac inside your jaw. Over time, the tooth grows and the roots become more firmly planted in the jawbone. By your early 20s, the crown of a wisdom tooth should fully emerge from your gum. By your 40s, the roots of your wisdom teeth are solidly planted within the dense bone of the jaw.

For many people, wisdom teeth don't follow this normal development pattern. Today's smaller jaws simply may not have room for this last set of molars to grow properly. So the wisdom teeth become impacted.

The cramped wisdom teeth struggle for a path to grow and emerge. They grow at various angles in the jaw, sometimes even horizontally. Sometimes, a wisdom tooth partially emerges through the gums. Other times, it remains completely hidden

Risk factors
Having a small jawbone may make you more prone to having impacted wisdom teeth. But otherwise, there are no particular biological or environmental risk factors that make you more likely than someone else to have impacted wisdom teeth

When to seek medical advice
If you notice pain or swelling in your mouth, teeth, gums or jaw, contact your dentist right away. Also contact your dentist if you notice any changes in your teeth, such as shifting of position, discoloration or changes in sensitivity.

Screening and diagnosis
Your dentist can evaluate your teeth and mouth to determine if you have impacted wisdom teeth or if another condition is causing your problems. Such evaluations typically include:

Your dental and medical history
A dental exam
Dental X-rays

Complications
Impacted wisdom teeth that aren't removed can cause numerous problems. These problems include:

Gum disease. Bacteria and food can get trapped under a flap of gum that can grow over wisdom teeth, creating infections. Gum disease may be initially mild (gingivitis) or progress to a more severe form (periodontitis).
Crowding. A wisdom tooth can push on other teeth, damaging them or moving them out of position.

Decay. Because they're hard to reach, wisdom teeth may not get fully cleaned during brushing, making them vulnerable to decay and cavities.
Cysts. The crown of a wisdom tooth grows in a sac. If the sac remains in the jawbone, it can fill with fluid, forming a cyst that can damage the jawbone, teeth and nerves. Very rarely a tumor, usually benign, also may develop, which may require removal of tissue and bone.

Treatment
Impacted wisdom teeth don't automatically need to be surgically removed. You have two main treatment options, depending on the severity of your situation and other factors. They are:

Conservative treatment
Surgical extraction

Conservative treatment
If impacted widsom teeth aren't causing problems, you and your dentist may choose to simply monitor them. People who can't have their teeth removed because of certain health problems may also need to choose conservative treatment.

Under guidance from your dentist or oral surgeon, you may be able to care for your impacted wisdom teeth and minor problems using mouthwashes, saltwater rinses and over-the-counter pain relievers. If complications arise or worsen, surgery might become an option.


Surgical extraction
Experts agree that when an impacted wisdom tooth causes complications, it should be extracted to prevent further problems.

Some experts say that impacted wisdom teeth should always be removed, even if they aren't causing problems. The belief is that the impacted tooth will probably eventually cause problems, and that it's better to remove it when someone is younger and more likely to recover better and faster from surgery. This is why many high-school children or young adults have their wisdom teeth extracted even before the teeth start causing problems. In addition, if a child might require braces, his or her dentist may recommend extraction of the wisdom teeth first.

There's no scientific evidence to recommend for or against extracting impacted wisdom teeth in adults or adolescents if the teeth aren't causing complications. You and your dentist can evaluate your situation to see which treatment option is best for you or your child.

Extracting an impacted wisdom tooth
Extraction of impacted wisdom teeth often can be done in your dentist's office with local anesthesia. However, if the tooth is deeply impacted or if the extraction may be difficult, your dentist may suggest that you consult with an oral surgeon. Sometimes extractions are done in the hospital. You may need general anesthesia for more complicated extractions.

To reach the impacted tooth, an incision is made in your gum. The incision creates a flap of gum, which can be peeled back to expose the impacted tooth and jawbone.

An impacted wisdom tooth that has partially emerged may be removed with forceps. But if the tooth is fully impacted or if the roots reach deep into the jawbone, the tooth may have to be broken into pieces for removal. In more severe cases, portions of jawbone may need to be removed.

You may need stitches to close the gap in your gum. The socket where your tooth was located is packed with gauze to control bleeding and to help a clot form, which promotes healing.

Care after surgery
Your dentist or oral surgeon gives you specific instructions about caring for your mouth after extraction of an impacted wisdom tooth. Here are general tips about care after oral surgery:

Activity. Plan to rest for the remainder of the day after surgery. Don't engage in rough play or ride a bike. Don't smoke for at least the first day after surgery, as doing this may disrupt the blood clot in the socket.

Diet. Drink lots of clear liquids and eat only soft foods for the first 12 hours. If you had several teeth removed, stick to a diet of soft foods for the first few days. Don't use straws, as doing so can dislodge the clot that forms in the tooth socket. Avoid hard or crunchy foods, such as popcorn, for two weeks after surgery.

Pain management. Some people may need prescription pain medication during the first few days after surgery. Others may be able to manage their pain with over-the-counter pain relievers. Applying ice packs — a bag of frozen peas or corn works nicely —also may help control pain, as well as swelling.

Bleeding. Some oozing of blood is normal for the first day after removal of your impacted wisdom tooth. Swallow blood-tinged saliva instead of spitting it out, to avoid dislodging the socket clot. Get instructions from your dentist or surgeon about replacing the gauze packing. Remember that when blood mixes with saliva, the amount of blood loss can look worse than it actually is.

Swelling and bruising. Swelling of your cheeks and jaw is normal after surgery. You can use ice packs to help control swelling. Swelling normally begins to subside by the third day. Some dentists give an injection of a steroid during the surgery to help minimize swelling. Swelling may make it a bit difficult to open your mouth fully, but this normally improves on its own. You may also have some bruising around your jaw or upper neck.

Cleaning your mouth. The day after surgery, rinse your mouth gently with warm salt water at least six times a day. Mix 1/2 teaspoon of table salt in an 8-ounce glass of water. Brush your teeth, but be very gentle in the area around your surgery.

Complications of extraction
Most people recover quickly and without problems after removal of an impacted wisdom tooth. However, complications can arise. Your dentist or surgeon advises you about signs and symptoms to watch for, such as fever and increasing pain.

Other complications can include:

Numbness, usually temporary, of your teeth, gums, tongue and chin
Dry socket when the socket clot dislodges, exposing underlying bone
Infection from bacteria or trapped food particles
Sinus problems if teeth near the sinuses were removed
Weakening of the jawbone from bone removal or damage

Coping skills
For some people, a visit to the dentist causes so much anxiety they can't get themselves to go, even if they're in pain. The thought of having a tooth extracted may be overwhelming. But if you're having problems related to an impacted wisdom tooth, delaying care could lead to serious and permanent problems.

Make sure you have a dentist who is sympathetic and willing to help relieve your fears. Talk to your dentist about your concerns. Don't be embarrassed about your anxiety — it's common, especially when you must have a dental procedure that can be uncomfortable.

Many dentists offer ways to ease your anxiety, such as listening to music or watching videos. You may be able to bring along a supportive family member or friend. You can also learn relaxation techniques, such as deep breathing and imagery. If you have severe anxiety, talk to your doctor about medications that may help. And of course, you may be able to opt for full sedation during the procedure itself, so you're asleep through it all.

Adapted from: Mayo Foundation for Medical Education and Research

Tooth Abfraction Lesions

Abfraction lesions are small cracks or notches in your teeth caused by chewing. Each time you clench your teeth, chew or bite down on something, pressure is put on your teeth. Eventually, this pressure can cause the enamel to crack and split.

Abfraction lesions can show up as notches on the chewing points (cusps) of a back tooth. They also show up as lines or cracks in the enamel of a tooth. They can be seen if you shine a flashlight or bright light on your teeth and look in a mirror. The lines usually run up and down (vertical) for the length of a tooth. You also can have cracks in the neck of a tooth (the part closest to, or just under, your gums).

People who grind their teeth are more likely to get abfraction lesions because their teeth are subjected to repeated pressure when grinding.

Abfraction lesions are relatively common in adults, especially older adults. They occur more often in premolars and molars, but they can occur on any tooth.

Teeth with abfraction lesions are not more likely to decay, but they can weaken over time and be at a higher risk of fracture.


Symptoms
Abfraction lesions are not painful. They affect only the enamel (outermost) layer of the tooth, although sometimes the dentin (middle layer) can be exposed, which can cause tooth sensitivity. Otherwise, the lesions do not cause symptoms.


Diagnosis
Your dentist can see abfraction lesions during a regular dental exam.


Expected Duration
Abfraction lesions do not heal over time. Some may worsen, but in most cases they do not need to be treated.


Prevention
Abfraction lesions happen due to the natural wear of your teeth. There usually is no way to prevent them. If you grind your teeth, you can wear a night guard to reduce the pressure on your teeth.


Treatment
Many abfraction lesions do not need treatment. Whether to treat the lesions depends on where they are, how many there are and other factors. If your dentist notices that your bite (the way your teeth come together) puts increased pressure on certain teeth, he or she will correct your bite to reduce this pressure.
Treated lesions are filled with composite material or glass ionomer cement. This procedure sometimes is similar to filling a cavity. In other cases, the tooth does not need to be drilled first.

Sometimes abfraction lesions increase the risk of tooth fracture, and treatment will strengthen the teeth. Some people may think the lesions are unattractive and ask their dentists to cover them. However, in most cases the lesions do not cause problems, and it is up to you and your dentist whether they should be treated.


When To Call a Professional
If you notice abfraction lesions, you do not need to call your dentist right away. You can point them out at your next appointment. However, if the lesions are causing tooth sensitivity, or if they are obvious enough to make you feel self-conscious, you can make a special appointment to have them examined.

A cracked tooth is a more serious situation than a tooth with abfraction lesions. Deep cracks that affect the pulp of the tooth are painful, and these teeth need immediate treatment.

Adapted from: Columbia University Medical Center, School of Dental & Oral Surgery

Enamel Fluorosis

Q: What is enamel fluorosis?

A: A child may face the condition called enamel fluorosis if he or she gets too much fluoride during the years of tooth development. Too much fluoride can result in defects in tooth enamel.

Q: Why is enamel fluorosis a concern?

A: In severe cases of enamel fluorosis, the appearance of the teeth is marred by discoloration or brown markings. The enamel may be pitted, rough, and hard to clean. In mild cases of fluorosis, the tiny white specks or streaks are often unnoticeable.

Q: How does a child get enamel fluorosis?

A: By swallowing too much fluoride for the child's size and weight during the years of tooth development. This can happen in several different ways. First, a child may take more of a fluoride supplement than the amount prescribed. Second, the child may take a fluoride supplement when there is already an optimal amount of fluoride in the drinking water. Third, some children simply like the taste of fluoridated toothpaste. They may use too much toothpaste, then swallow it instead of spitting it out.

Q: How can enamel fluorosis be prevented?

A: Talk to your pediatric dentist as the first step. He or she can tell you how much fluoride is in your drinking water. (Your local water treatment plant is another source of this information.) If you drink well water or bottled water, your pediatric dentist can assist you in getting an analysis of its fluoride content. After you know how much fluoride your child receives, you and your pediatric dentist can decide together whether your child needs a fluoride supplement.

Watch your child's use of fluoridated toothpaste as the second step. A pea-sized amount on the brush is plenty for fluoride protection. Teach your child to spit out the toothpaste, not swallow it, after brushing.

Q: Should I just avoid fluorides for my child altogether?

A: No! Fluoride prevents tooth decay. It is an important part of helping your child keep a healthy smile for a lifetime. Getting enough -- but not too much -- fluoride can be easily accomplished with the help of your pediatric dentist.

Q: Can enamel fluorosis be treated?

A: Once fluoride is part of the tooth enamel, it can't be taken out. But the appearance of teeth affected by fluorosis can be greatly improved by a variety of treatments in esthetic dentistry. If your child suffers from severe enamel fluorosis, your pediatric dentist can tell you about dental techniques that enhance your child's smile and self-confidence.


Adapted from: American Academy of Pediatric Dentistry

Dry Socket (Alveolar Osteitis)

Dry socket is a complication of having a tooth extracted. Usually, after a tooth is extracted, a blood clot forms in the socket, or hole, and protects the area while it heals. When the blood clot gets washed away, the bone is exposed to air and food.

This is called a dry socket, and it can be extremely painful.
Dry socket is more common in people with diabetes, smokers and women who take oral contraceptives. It occurs following 3% to 20% of extractions and is more common after the removal of premolar or molar teeth in the lower jaw.

Symptoms
Dry socket causes pain in and around the site where the tooth was extracted. The pain usually starts on the third or fourth day after surgery and can radiate out from the site. Many people who have lower back teeth extracted feel pain in the ear on that side. The pain is severe and usually not relieved by over-the-counter painkillers. Dry socket can also cause bad breath and a bad taste in the mouth.

Diagnosis
Your dentist will examine the socket to see if it is sensitive to touch. He or she will also look to see if the bone in the socket is exposed. Your dentist will check to see if you have bad breath or spasms of the muscles around your mouth. You may need to have an X-ray to determine whether fragments of the tooth or bone are in the socket.


Expected Duration
A dry socket can last from one to several weeks, although treatment can eliminate or significantly reduce the pain during this time. A tooth socket that does not heal after a few weeks of treatment may be caused by other medical conditions.


Prevention
Several procedures can help to decrease your risk of dry socket:

Practice good oral hygiene.
Have your teeth cleaned before an extraction.
Do not drink through a straw or spit frequently after an extraction because this can cause the blood clot to dislodge.
If you smoke, try to stop before surgery and for at least two weeks afterward since smoking can slow healing.
If you are using oral contraceptives, try to schedule the surgery during days 23 to 28 of your tablet cycle.

Avoid vigorously rinsing your mouth for the first 24 hours after the surgery and brush and rinse gently for the next week. Your dentist may prescribe an antibacterial rinse to be used before and after surgery.

Treatment
Your dentist will rinse the socket with a saline solution or an antiseptic and dislodge all debris. You may receive anesthesia during this procedure to minimize discomfort. Then the socket will be packed with a medicated dressing or paste, which will be replaced daily or as necessary until the socket heals and the pain goes away. You may also be prescribed pain relievers or told to take over-the-counter medication for pain relief. Some dentists use a dissolvable sponge soaked with an antibiotic solution.

Once your dentist decides that dressings are no longer required, he or she will instruct you in how to irrigate the socket.

When To Call A Professional
Call your dentist if you experience severe pain that starts a few days after you have a tooth pulled and that seems to originate from that site

Adapted from: Columbia University Medical Center, School of Dental & Oral Surgery