Contrary to what you might think, a knocked out tooth doesn’t inevitably mean tooth loss. Time is of the essence — the shorter the interval between injury and replanting the tooth, the better the tooth’s long-term survival. The longer the interval, on the other hand, the less likely the tooth can survive beyond a few years. That phenomenon is due to the mouth’s natural mechanism for holding teeth in place.
The tooth root maintains its attachment with the jaw bone through an intermediary tissue known as the periodontal ligament. Tiny fibers from one side of the ligament securely attach to the tooth root, while similar fibers attach to the bone on the opposite side of the ligament. This maintains stability between the teeth and bone while still allowing incremental tooth movement in response to mouth changes like tooth wear.
While the ligament fibers will attempt to reattach to a replanted tooth’s root, the longer the tooth is out of the socket the less likely the fibers will fully reattach. An “ankylosis” may instead form, in which the root attaches directly to the jaw bone without the periodontal ligament. In this situation the body no longer “recognizes” the tooth and begins to treat it like a foreign substance. In all but the rarest cases, the tooth root will begin to resorb (dissolve); at some point (which varies from patient to patient) the attachment becomes too weak for the tooth to remain in place and is lost.
Ideally, a knocked out tooth should be replanted within 5 minutes of the injury (for step-by-step instructions, refer to The Field-Side Guide to Dental Injuries available on-line at www.deardoctor.com/dental-injuries). Even if you pass the 5-minute window, however, it’s still advisable to attempt replanting. With a subsequent root canal treatment (to remove dead tissue from the inner tooth pulp and seal it from infection), it’s possible the tooth can survive for at least a few years, plenty of time to plan for a dental implant or similar tooth replacement.
If you would like more information on treatment for a knocked out tooth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Knocked Out Tooth.”
A toothache might mean you have tooth decay—or maybe not. It could also be a sign of other problems that will take a dental exam to uncover. But we can get some initial clues about the underlying cause from how much it hurts, when and for how long it hurts and where you feel the pain most.
Let's say, for instance, you have a sharp pain while consuming something cold or hot, but only for a second or two. This could indicate isolated tooth decay or a loose filling. But it could also mean your gums have receded and exposed some of the tooth's hypersensitive root surface.
While over-aggressive brushing can be the culprit, gum recession is most often caused by periodontal (gum) disease. Untreated, this bacterial infection triggered by accumulated dental plaque could eventually cause tooth and bone loss, so the sooner it's attended to the better.
On the other hand, if the pain seems to linger after encountering hot or cold foods and liquids, or you have a continuous throbbing pain, you could have advanced tooth decay that's entered the inner pulp where infected tooth nerves are reacting painfully. If so, you may need a root canal treatment to remove the diseased pulp tissue and fill the empty pulp and root canals to prevent further infection.
If you have this kind of pain, see a dentist as soon as possible, even if the pain stops. Cessation of pain may only mean the nerves have died and can no longer transmit pain; the infection, on the other hand, is still active and will continue to advance to the roots and bone.
Tooth pain could also indicate other situations: a cracked tooth, an abscess or even a sinus problem where you're feeling the pain radiating through the teeth. So whatever kind of pain you're feeling, it's your body's alarm signal that something's wrong. Promptly seeing your dentist is the best course of action for preserving your health.
If you would like more information on treating tooth pain, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Pain? Don't Wait!”
A toothache means a tooth has a problem, right? Most of the time, yes: the pain comes from a decayed or fractured tooth, or possibly a gum infection causing tooth sensitivity.
Sometimes, though, the pain doesn't originate with your teeth and gums. They're fine and healthy—it's something outside of your tooth causing the pain. We call this referred pain—one part of your body is sending or referring pain to another part, in this instance around your mouth.
There are various conditions that can create referred pain in the mouth, and various ways to treat them. That's why you should first find out the cause, which will indicate what treatment course to take.
Here are a few common non-dental causes for tooth pain.
Trigeminal Neuralgia. The trigeminal nerves situated on either side of the face have three large branches that extend throughout the face; the branch to the jaw allows you to feel sensation as you chew. When one of the nerve branches becomes inflamed, usually from a blood vessel or muscle spasm pressing on it, it can refer the pain to the jaw and seem like a toothache.
Temporomandibular Joint Disorder (TMD). These two joints that connect the lower jaw to the skull can sometimes become dysfunctional for a variety of reasons. This can set up a cycle of spasms and pain that can radiate throughout the jaw and its associated muscles. The pain can mimic a toothache, when it actually originates in the jaw joints.
Teeth Grinding. This is an unconscious habit, often occurring at night, in which people clench or grind their teeth together. Although quite common in children who tend to grow out of it, teeth grinding can continue into adulthood. The abnormally high biting forces from this habit can cause chipped, broken or loosened teeth. But it can also cause jaw pain, headaches and tenderness in the mouth that might feel like a toothache.
These and other conditions unrelated to dental disease can seem like a tooth problem, when they're actually something else. By understanding exactly why you're feeling pain, we can then focus on the true problem to bring relief to your life.
Magician Michel Grandinetti can levitate a 500-pound motorcycle, melt into a 7-foot-tall wall of solid steel, and make borrowed rings vanish and reappear baked inside bread. Yet the master illusionist admits to being in awe of the magic that dentists perform when it comes to transforming smiles. In fact, he told an interviewer that it’s “way more important magic than walking through a steel wall because you’re affecting people’s health… people’s confidence, and you’re really allowing people to… feel good about themselves.”
Michael speaks from experience. As a teenager, his own smile was enhanced through orthodontic treatment. Considering the career path he chose for himself — performing for multitudes both live and on TV — he calls wearing an orthodontic device (braces) to align his crooked teeth “life-changing.” He relies on his welcoming, slightly mischievous smile to welcome audiences and make the initial human connection.
A beautiful smile is definitely an asset regardless of whether you’re performing for thousands, passing another individual on a sidewalk or even, research suggests, interviewing for a job. Like Michael, however, some of us need a little help creating ours. If something about your teeth or gums is making you self-conscious and preventing you from smiling as broadly as you could be, we have plenty of solutions up our sleeve. Some of the most popular include:
- Tooth Whitening. Professional whitening in the dental office achieves faster results than doing it yourself at home, but either approach can noticeably brighten your smile.
- Bonding. A tooth-colored composite resin can be bonded to a tooth to replace missing tooth structure, such a chip.
- Veneers. This is a hard, thin shell of tooth-colored material bonded to the front surface of a tooth to change its color, shape, size and/or length; mask dental imperfections like stains, cracks, or chips, and compensating for excessive gum tissue.
- Crowns. Sometimes too much of a tooth is lost due to decay or trauma to support a veneer. Instead, capping it with a natural-looking porcelain crown can achieve the same types of improvements. A crown covers the entire tooth replacing more of its natural structure than a veneer does.
If you would like more information about ways in which you can transform your smile, please contact us or schedule an appointment for a consultation. You can also learn more about the techniques mentioned above by reading the Dear Doctor magazine articles “Teeth Whitening,” “Repairing Chipped Teeth,” and “Porcelain Crowns & Veneers.”
“Don’t panic” is your first priority when faced with a sudden mouth injury. Of course, that may be easier said than done when you or a family member has just experienced a chipped, fractured or even dislodged tooth.
It helps, therefore, to have some idea beforehand on what to do and, especially, when to do it. You should think in terms of immediate, urgent and less urgent injuries: a tooth completely knocked out of its socket requires immediate action — within 5 minutes of the injury; a tooth that’s moved out of its normal position but still in the socket is an urgent matter that needs professional attention within 6 hours; and a chipped tooth is less urgent, but still needs to be seen by a dentist within 12 hours.
As you may have gathered, the most important thing you can do when a dental injury occurs is to contact our office as soon as possible. If for some reason you can’t, you should visit the nearest emergency center.
There are also some actions you should take for a knocked-out permanent tooth because there’s a chance it can be replanted in the socket if you act within 5 minutes of the injury. First, rinse the tooth with cold, clean water (bottled or tap) if it’s dirty. Be sure to handle it gently, avoiding touching the root. Grasping the crown-end with your thumb and index finger, place the tooth into the empty socket and push it firmly into place. Apply light but firm pressure with your hand or a wad of wet tissue to make sure it doesn’t come out. Don’t worry about correct alignment — we can adjust that later during examination.
If the tooth is chipped or broken, try to locate the broken pieces — it may be possible to re-bond them to the tooth. You should store them in a container with milk or the injured person’s saliva (the same can be done for a knocked out tooth if reinserting it isn’t practical). The broken pieces should then be transported with the injured person to emergency treatment.
Taking these actions may not ultimately save a traumatized tooth, but they will certainly raise its chances for survival.
If you would like more information on preventing and treating dental injuries, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “The Field-Side Guide to Dental Injuries.”
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