There are several causes of tooth discoloration, including:
Foods/drinks. Coffee, tea, colas, wines, and certain fruits and vegetables (for example, apples and potatoes) can stain your teeth.
Tobacco use. Smoking or chewing tobacco can stain teeth.
Poor dental hygiene. Inadequate brushing and flossing to remove plaque and stain-producing substances like coffee and tobacco can cause tooth discoloration.
Disease. Several diseases that affect enamel (the hard surface of the teeth) and dentin (the underlying material under enamel) can lead to tooth discoloration. Treatments for certain conditions can also affect tooth color. For example, head and neck radiation and chemotherapy can cause teeth discoloration. In addition, certain infections in pregnant mothers can cause tooth discoloration in the infant by affecting enamel development.
Medications. The antibiotics tetracycline and doxycycline are known to discolor teeth when given to children whose teeth are still developing (before the age of 8). Mouth rinses and washes containing chlorhexidine and cetylpyridinium chloride can also stain teeth. Antihistamines (like Benadryl), antipsychotic drugs, and drugs for high blood pressure also cause teeth discoloration.
Dental materials. Some of the materials used in dentistry, such as amalgam restorations, especially silver sulfide-containing materials, can cast a gray-black color to teeth.
Advancing age. As you age, the outer layer of enamel on your teeth gets worn away revealing the natural yellow color of dentin.
Genetics. Some people have naturally brighter or thicker enamel than others.
Environment. Excessive fluoride either from environmental sources (naturally high fluoride levels in water) or from excessive use (fluoride applications, rinses, toothpaste, and fluoride supplements taken by mouth) can cause teeth discoloration.
Trauma. For example, damage from a fall can disturb enamel formation in young children whose teeth are still developing. Trauma can also cause discoloration to adult teeth.
Thursday, June 3, 2010
Friday, May 7, 2010
Yellowing Teeth
Yellowing Teeth
Why do my teeth have a yellow tinge, and how do I get rid of it?
By Dr. Rob for MSN Health & FitnessQ: I'm 45 years old and my teeth are no longer white. They have a yellowish tinge. What causes the color change and how can I prevent it?
A: When your teeth begin to change color, there may be a variety of reasons. If your parents have yellowish teeth, you may be headed toward that same hue. Thus, heredity may be the culprit. In addition, lifestyle issues like consumption of enamel-tinting liquids such as coffee or tea, poor dental hygiene, and older age can contribute. A visit with your family dentist will go a long way toward creating an enamel friendly treatment plan that gets your teeth back to their more "natural" color.
The anatomy of the tooth
The most visible part of our teeth is called enamel. This is an extremely hard substance, designed to withstand biting and chewing. While very durable, the enamel is also prone to chipping, cracking and thinning as one gets older. If the enamel is extremely well mineralized it will appear lighter or white in color. However, the enamel is often translucent, taking most of its light-gray/white or light yellow color from the bone-like substance underneath, known as dentin. This tissue is strong, makes up the majority of the structure of the tooth, and serves as a support for the enamel.
The core of the tooth, beneath the dentin, is known as the pulp cavity. The pulp cavity is made up of blood vessels (which supply vital nutrients that help to keep the tooth alive), tissue, and nerves that make up the pulp. The part of the pulp that lies in the root is called the root canal, through which blood vessels and nerves enter the tooth to become part of the pulp.
Reasons for the color change
While many individuals have very light or whiter shades in their teeth, others have a naturally occurring yellowish tint to their teeth. The key is in knowing what is or was the natural color of your teeth. You can then work with a dental-health professional to find the cause for the color change. Here are a few reasons to consider:
Intrinsic stains affect the color of the structures on the inside of the tooth (usually the dentin) either before or after it appeared in the mouth. Reasons for this change include hereditary conditions, illness (hyperbilirubinemia, etc.) and excessive intake of fluoride (which can cause white or brown marks), as well as certain medications (like tetracycline) ingested before eight years of age. Additionally, trauma can lead to bleeding within the pulp of the tooth and, in turn, cause a change in color. It's also possible for a tooth to darken after a root-canal procedure.
Extrinisic stains involve a color change either directly on the enamel, or through cracks and fissures on the tooth surface. Stains can be caused by the following:
Foods (blueberries, curry, soy sauce) and drinks (coffee, tea, cola, red wine, dark beer), especially those that are acidic
Tobacco smoking or chewing
Poor dental hygiene leading to the formation of tartar and plaque, which in turn makes it easier for stains to accumulate from foods, drinks or tobacco
Dental materials, such as the color of restorative material that may show through the translucent appearance of the enamel
Supplements containing iron
Overuse of prescription mouthwash containing chlorhexidine and cetylpyridinium chloride
Excessive intake of fluoride due to unusually high levels in the water, or through the consistent and intentional ingestion of fluoride from toothpaste and/or mouthwash
Medications that may include antihistamines, antipsychotics, and those used to control high blood pressure. For the best information in this category, please check with your pharmacist.
Age contributes to wear and tear of your teeth. Even though you are a relatively young 45 years of age, your teeth, over time, experience a thinning of the enamel. As a result, they will more closely reflect the natural color of the dentin inside the enamel.
Preventing discoloration
Fortunately, there's a lot you can do to halt any further discoloration. For starters, avoid as many of the extrinsic causes of stains as possible. Next, brush your teeth after meals to help remove the buildup of staining foods or drinks. Also, daily flossing can decrease bacterial buildup between teeth, while improving your overall dental health.
As for removing some of the dental stains and discoloration, it's best to visit your family dentist before using any over the counter whitening agents. These professionals have many options available, including bleaching and/or non-bleaching agents, as well as bonding and veneers.
For further information, please visit the American Academy of Cosmetic Dentistry and the American Dental Association.
Find More on MSN Health & Fitness:
What Toothpaste Do You Use?
Bad Breath: Five Causes and Five Cures
Dental Care: 22 Tips to Chew On
Conquering Canker Sores
A Bad Taste in Your Mouth?
MSN Health Centers: Oral Health
Find all articles by Dr. Rob.
Do you have a health question you'd like to ask Dr. Rob? Send e-mail to experts@microsoft.com. Please include Ask Dr. Rob in the subject line.
Each of our experts responds to one question each week and the responses are posted on Mondays on MSN Health. We regret that we cannot provide a personalized response to every submission.
Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special
Wednesday, April 21, 2010
Dental Implants
Did you know that dental implants are frequently the best treatment option for replacing missing teeth? Rather than resting on the gum line like removable dentures, or using adjacent teeth as anchors like fixed bridges, dental implants are long-term replacements that your oral and maxillofacial surgeon surgically places in the jawbone.
A Solution of Choice for Replacing Missing Teeth
Statistics show that 69% of adults ages 35 to 44 have lost at least one permanent tooth to an accident, gum disease, a failed root canal or tooth decay. Furthermore, by age 74, 26% of adults have lost all of their permanent teeth.
Twenty years ago, these patients would have had no alternative but to employ a fixed bridge or removable denture to restore their ability to eat, speak clearly and smile. Fixed bridges and removable dentures, however, are not the perfect solution and often bring with them a number of other problems. Removable dentures may slip or cause embarrassing clicking sounds while eating or speaking. Of even greater concern, fixed bridges often affect adjacent healthy teeth, and removable dentures may lead to bone loss in the area where the tooth or teeth are missing. Recurrent decay, periodontal (gum) disease and other factors often doom fixed bridgework to early failure. For these reasons, fixed bridges and removable dentures usually need to be replaced every seven to 15 years.
Before (left) and after a dental implant
Today there is another option for patients who are missing permanent teeth. Rather than resting on the gum line like removable dentures, or using adjacent teeth as anchors like fixed bridges, dental implants are long-term replacements that your oral and maxillofacial surgeon surgically places in the jawbone. Composed of titanium metal that "fuses" with the jawbone through a process called "osseointegration," dental implants never slip or make embarrassing noises that advertise the fact that you have "false teeth," and never decay like teeth anchoring fixed bridges. Because dental implants fuse with the jawbone, bone loss is generally not a problem.
After more than 20 years of service, the vast majority of dental implants first placed by oral and maxillofacial surgeons in the United States continue to still function at peak performance. More importantly, the recipients of those early dental implants are still satisfied they made the right choice. If properly cared for, dental implants can last a lifetime.
Anatomy of a Dental Implant
A dental implant designed to replace a single tooth is composed of three parts: the titanium implant that fuses with the jawbone; the abutment, which fits over the portion of the implant that protrudes from the gum line; and the crown, which is created by a prosthodontist or restorative dentist and fitted onto the abutment for a natural appearance.
Many people who are missing a single tooth opt for a fixed bridge; but a bridge may require the cutting down of healthy, adjacent teeth that may or may not need to be restored in the future. Then there is the additional cost of possibly having to replace the bridge once, twice or more over the course of a lifetime. Similarly, a removable partial denture may contribute to the loss of adjacent teeth. Studies show that within five to seven years there is a failure rate of up to 30% in teeth located next to a fixed bridge or removable partial denture.
Further, conventional dentures may contribute to the loss of bone in the area where teeth are missing. As illustration (a) indicates, the presence of natural teeth preserves the jawbone. When a tooth is missing, as in illustration (b), the bone may erode and weaken until it may be necessary for your oral and maxillofacial surgeon to graft bone to the area to strengthen it for placement of a dental implant. When a missing tooth is replaced by a dental implant, the fusion, or osseointegration, of the implant and bone provides stability, just as the natural tooth did.
If you are missing several teeth in the same area of your mouth, you may still enjoy the confidence and lifestyle benefits that come with dental implants. Your oral and maxillofacial surgeon will place two or more dental implants, depending on the number of teeth that are missing. Your replacement teeth will be attached to the implants to allow excellent function and prevent bone loss. The implants will serve as a stable support that tightly locks into your replacement teeth and dentures to prevent slipping and bone loss.
With an overall success rate of about 95% and almost 50 years of clinical research to back them up, dental implants are frequently the best treatment option for replacing missing teeth.
Dental Implants vs. Conventional Dentures
Dental Implants vs. Conventional Dentures
Orthodontics: Creating a Well-Aligned Smile
Years ago, orthodontic treatments were used only for pre-teens and teens having problems with their bite (malocclusion). Today, orthodontic treatments like dental braces are not only for pre-teens and teens, but for adults as well.
Close to 30 percent of all orthodontic patients in the United States are adults. Despite this growing trend towards adult orthodontics, it pays to start orthodontic treatment early for maximum effectiveness. The American Dental Association recommends that children receive an orthodontic evaluation by age seven.
The Restorative and Esthetic Nature of Orthodontics
Since malocclusion may interfere with eating and speaking, it is usually considered a restorative issue. Although, because a malocclusion may prevent the development of a beautiful, well-aligned smile or facial jaw lines, it may also be classified as an esthetic issue and categorized as cosmetic dentistry.
No matter what your age, orthodontics can protect your bite (occlusion), maximize your teeth's effectiveness in performing their functions and create a well-aligned smile. Today's orthodontics involves repositioning of the teeth and underlying roots, providing better support for the crown of the tooth. Orthodontic treatment is now associated with the benefits of greater esthetic appeal, increased comfort and reduced treatment time.
Orthodontic treatment can also rejuvenate your facial appearance by reshaping the jaw, neck and lips, especially when combined with maxillofacial surgical procedures. In addition, well-aligned teeth make oral hygiene easier to maintain.
Orthodontists
Orthodontists are the dentists who focus on the practice of orthodontics. An orthodontist is typically required to complete an additional two to three years of post-dental school education before becoming a certified practitioner of orthodontics.
The Orthodontic Evaluation
If you are a candidate for orthodontics, you will likely be referred by your general dentist to an orthodontist for evaluation of your bite. During your first orthodontic visit, your orthodontist may use several methods to develop an individualized treatment plan, including:
Oral, facial and functional evaluation (examination).
Intraoral and facial photographs.
Panoramic and cephalometric X-rays.
Impressions for models of the teeth and bite.
An orthodontist reviews your dental records, performs a clinical assessment, takes X-rays of your mouth and head and makes models of the teeth by creating an accurate impression of them. The results of this evaluation are studied in order to formulate the best orthodontic treatment plan.
Typically during the second visit, your orthodontist reviews the treatment plan and estimates the number of months for the active phase of treatment. The standard treatment phase is two years. Following treatment, you may be required to wear a retainer for a period of time.
The duration of orthodontic treatment varies based on your age, the extensiveness of the procedure (some people require more work than others) and how closely you follow your treatment plan. For example, younger patients may respond more quickly to treatment than older patients because the bones supporting young teeth are more pliable than those supporting older teeth. However, adults tend to follow treatment instructions more consistently than pre-teens.
In some cases the treatment time is longer. For example, oral surgery and recovery may be needed before or during orthodontic treatment.
[Updated May 2009]
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Close to 30 percent of all orthodontic patients in the United States are adults. Despite this growing trend towards adult orthodontics, it pays to start orthodontic treatment early for maximum effectiveness. The American Dental Association recommends that children receive an orthodontic evaluation by age seven.
The Restorative and Esthetic Nature of Orthodontics
Since malocclusion may interfere with eating and speaking, it is usually considered a restorative issue. Although, because a malocclusion may prevent the development of a beautiful, well-aligned smile or facial jaw lines, it may also be classified as an esthetic issue and categorized as cosmetic dentistry.
No matter what your age, orthodontics can protect your bite (occlusion), maximize your teeth's effectiveness in performing their functions and create a well-aligned smile. Today's orthodontics involves repositioning of the teeth and underlying roots, providing better support for the crown of the tooth. Orthodontic treatment is now associated with the benefits of greater esthetic appeal, increased comfort and reduced treatment time.
Orthodontic treatment can also rejuvenate your facial appearance by reshaping the jaw, neck and lips, especially when combined with maxillofacial surgical procedures. In addition, well-aligned teeth make oral hygiene easier to maintain.
Orthodontists
Orthodontists are the dentists who focus on the practice of orthodontics. An orthodontist is typically required to complete an additional two to three years of post-dental school education before becoming a certified practitioner of orthodontics.
The Orthodontic Evaluation
If you are a candidate for orthodontics, you will likely be referred by your general dentist to an orthodontist for evaluation of your bite. During your first orthodontic visit, your orthodontist may use several methods to develop an individualized treatment plan, including:
Oral, facial and functional evaluation (examination).
Intraoral and facial photographs.
Panoramic and cephalometric X-rays.
Impressions for models of the teeth and bite.
An orthodontist reviews your dental records, performs a clinical assessment, takes X-rays of your mouth and head and makes models of the teeth by creating an accurate impression of them. The results of this evaluation are studied in order to formulate the best orthodontic treatment plan.
Typically during the second visit, your orthodontist reviews the treatment plan and estimates the number of months for the active phase of treatment. The standard treatment phase is two years. Following treatment, you may be required to wear a retainer for a period of time.
The duration of orthodontic treatment varies based on your age, the extensiveness of the procedure (some people require more work than others) and how closely you follow your treatment plan. For example, younger patients may respond more quickly to treatment than older patients because the bones supporting young teeth are more pliable than those supporting older teeth. However, adults tend to follow treatment instructions more consistently than pre-teens.
In some cases the treatment time is longer. For example, oral surgery and recovery may be needed before or during orthodontic treatment.
[Updated May 2009]
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Cosmetic Dentistry: Treatments, Trends and Cosmetic Dentists
While traditional dentistry focuses on oral hygiene and preventing, diagnosing and treating oral disease, cosmetic dentistry focuses on improving the appearance of a person's teeth, mouth and smile. In other words restorative, general and/or family dental practices address dental problems that require necessary treatment, whereas cosmetic dentistry provides elective – or desired – treatments or services.
Cosmetic dentistry may also provide restorative benefits. For example, dental fillings are a common procedure used to treat decayed teeth. Previously, most dental fillings were composed primarily of gold, amalgam and other materials that left visible dark spots on the teeth.
Today, dental fillings may fall into the category of cosmetic dentistry, because you can select fillings made of porcelain or composite materials that closely match the color of your teeth, thus maintaining the natural appearance of your teeth and smile. Many people may choose to have their older fillings replaced with newer, tooth-colored fillings to enhance their oral appearance.
Cosmetic Dentistry Trends
Technological advancements in natural-looking, tooth-colored dental materials make today's cosmetic dental treatments more durable and predictable than in years past. Additionally, dentists are now using more conservative cosmetic dentistry techniques to preserve as much of your natural tooth structure as possible, depending upon your specific clinical situation.
Cosmetic dentists may also use such technologies as lasers in order to perform some procedures necessary for cosmetic treatments in their own offices – without the need for referrals to specialists. This makes cosmetic dental procedures such as smile makeovers more comfortable and convenient for patients, as well as helps to reduce recovery time.
Cosmetic Dentistry Treatments
Cosmetic dentistry treatments currently in use include:
Inlays/Onlays: Also known as indirect fillings, inlays and onlays made from porcelain or composite materials are a long-lasting yet cosmetic way to provide a “filling” to teeth with tooth decay or similar structural damage. Whereas dental fillings are molded into place within the mouth during a dental visit, inlays and onlays are created in a dental laboratory before being fitted and adhesively bonded into place by your dentist.
Composite Bonding: Chipped, broken, discolored or decayed teeth may be repaired or have their appearance corrected using a procedure called composite bonding. A dental composite material with the look of enamel and dentin is applied into the cavity or onto the surface of a tooth, where it is then sculpted into shape, contoured and hardened with a high-intensity light. The result is a restoration that blends invisibly with the remainder of the surrounding tooth structure and the rest of your natural teeth to create a healthy, bright smile.
Teeth Whitening: Teeth whitening is perhaps the most commonly recommended cosmetic dentistry procedure. Teeth are often stained from smoking, food, drink (coffee, tea or red wine) or poor oral hygiene. Bleaching the teeth can enhance the appearance of your smile.
Dental Veneers: Composite or porcelain laminates that are adhesively bonded to the surface of a tooth to correct and repair chips and cracks will improve a worn appearance or severe tooth discoloration. Veneers may also be recommended if you have gaps in your teeth or if you have not had success with teeth whitening.
Dental Implants: Dental implants are artificial tooth root replacements that are used as a part of prosthetic (artificial replacement) dentistry in order to compensate for tooth loss. Often the result is not only an enhanced smile, but also a more youthful appearance, since missing teeth cause the face to collapse, making you look older.
Smile Makeover: Smile makeovers involve a comprehensive assessment of your smile esthetics in order to improve its overall appearance. Typically one or more cosmetic dentistry procedures, such as dental veneers, dental implants, gingival sculpting and teeth whitening, will be required for several teeth in both the upper and lower arches in order to achieve the look you want.
Full mouth reconstruction: While consulting with you about a smile makeover to primarily improve the esthetic appearance of your smile, your dentist may discover that there is a need to provide necessary treatment to correct functional problems with your bite, muscles, teeth and bone structure. If you need full mouth reconstruction, the materials available today make it possible for your dentist to provide you with durable, functional and clinically sound treatments that also look natural.
Cosmetic dentistry offers many options for people who are unhappy with their smile. If you are one of these people, we encourage you to read our comprehensive cosmetic procedure articles to learn about the various treatments available to beautify your smile.
Cosmetic dentistry may also provide restorative benefits. For example, dental fillings are a common procedure used to treat decayed teeth. Previously, most dental fillings were composed primarily of gold, amalgam and other materials that left visible dark spots on the teeth.
Today, dental fillings may fall into the category of cosmetic dentistry, because you can select fillings made of porcelain or composite materials that closely match the color of your teeth, thus maintaining the natural appearance of your teeth and smile. Many people may choose to have their older fillings replaced with newer, tooth-colored fillings to enhance their oral appearance.
Cosmetic Dentistry Trends
Technological advancements in natural-looking, tooth-colored dental materials make today's cosmetic dental treatments more durable and predictable than in years past. Additionally, dentists are now using more conservative cosmetic dentistry techniques to preserve as much of your natural tooth structure as possible, depending upon your specific clinical situation.
Cosmetic dentists may also use such technologies as lasers in order to perform some procedures necessary for cosmetic treatments in their own offices – without the need for referrals to specialists. This makes cosmetic dental procedures such as smile makeovers more comfortable and convenient for patients, as well as helps to reduce recovery time.
Cosmetic Dentistry Treatments
Cosmetic dentistry treatments currently in use include:
Inlays/Onlays: Also known as indirect fillings, inlays and onlays made from porcelain or composite materials are a long-lasting yet cosmetic way to provide a “filling” to teeth with tooth decay or similar structural damage. Whereas dental fillings are molded into place within the mouth during a dental visit, inlays and onlays are created in a dental laboratory before being fitted and adhesively bonded into place by your dentist.
Composite Bonding: Chipped, broken, discolored or decayed teeth may be repaired or have their appearance corrected using a procedure called composite bonding. A dental composite material with the look of enamel and dentin is applied into the cavity or onto the surface of a tooth, where it is then sculpted into shape, contoured and hardened with a high-intensity light. The result is a restoration that blends invisibly with the remainder of the surrounding tooth structure and the rest of your natural teeth to create a healthy, bright smile.
Teeth Whitening: Teeth whitening is perhaps the most commonly recommended cosmetic dentistry procedure. Teeth are often stained from smoking, food, drink (coffee, tea or red wine) or poor oral hygiene. Bleaching the teeth can enhance the appearance of your smile.
Dental Veneers: Composite or porcelain laminates that are adhesively bonded to the surface of a tooth to correct and repair chips and cracks will improve a worn appearance or severe tooth discoloration. Veneers may also be recommended if you have gaps in your teeth or if you have not had success with teeth whitening.
Dental Implants: Dental implants are artificial tooth root replacements that are used as a part of prosthetic (artificial replacement) dentistry in order to compensate for tooth loss. Often the result is not only an enhanced smile, but also a more youthful appearance, since missing teeth cause the face to collapse, making you look older.
Smile Makeover: Smile makeovers involve a comprehensive assessment of your smile esthetics in order to improve its overall appearance. Typically one or more cosmetic dentistry procedures, such as dental veneers, dental implants, gingival sculpting and teeth whitening, will be required for several teeth in both the upper and lower arches in order to achieve the look you want.
Full mouth reconstruction: While consulting with you about a smile makeover to primarily improve the esthetic appearance of your smile, your dentist may discover that there is a need to provide necessary treatment to correct functional problems with your bite, muscles, teeth and bone structure. If you need full mouth reconstruction, the materials available today make it possible for your dentist to provide you with durable, functional and clinically sound treatments that also look natural.
Cosmetic dentistry offers many options for people who are unhappy with their smile. If you are one of these people, we encourage you to read our comprehensive cosmetic procedure articles to learn about the various treatments available to beautify your smile.
Dental Health and Wisdom Teeth
Wisdom teeth are the third and final set of molars that most people get in their late teens or early twenties. Sometimes these teeth can be a valuable asset to the mouth when healthy and properly aligned, but more often, they are misaligned and require removal.
Wisdom teeth present potential problems when they are misaligned - they can position themselves horizontally, be angled toward or away from the second molars or be angled inward or outward. Poor alignment of wisdom teeth can crowd or damage adjacent teeth, the jawbone, or nerves. Wisdom teeth that lean toward the second molars make those teeth more vulnerable to decay by entrapping plaque and debris. In addition, wisdom teeth can be entrapped completely within the soft tissue and/or the jawbone or only partially break through or erupt through the gum. Teeth that remain partially or completely entrapped within the soft tissue and /or the jawbone are termed "impacted." Wisdom teeth that only partially erupt allows for an opening for bacteria to enter around the tooth and cause an infection, which results in pain, swelling, jaw stiffness, and general illness. Partially erupted teeth are also more prone to tooth decay and gum disease because their hard-to-reach location and awkward positioning makes brushing and flossing difficult
How Do I Know if I Have Wisdom Teeth?
Wisdom teeth present potential problems when they are misaligned - they can position themselves horizontally, be angled toward or away from the second molars or be angled inward or outward. Ask your dentist about the positioning of your wisdom teeth. He or she may take an X-ray periodically to evaluate for the presence and alignment of your wisdom teeth. Your dentist may also decide to send you to an oral surgeon for further evaluation.
Your dentist or oral surgeon may recommend that your wisdom teeth be extracted even before problems develop. This is done to avoid a more painful or more complicated extraction that might have to be done a few years later. Removal is easier in young people, when the wisdom teeth roots are not yet fully developed and the bone is less dense. In older people, recovery and healing time tend to be longer.
How Are Wisdom Teeth Removed?
The relative ease at which your dentist or oral surgeon can extract your wisdom teeth depends on their position. Your oral health care provider will be able to give you an idea of what to expect during your pre-extraction exam. A wisdom tooth that is fully erupted through the gum can be extracted as easily as any other tooth. However, a wisdom tooth that is underneath the gums and embedded in the jawbone will require an incision into the gums and then removal of the portion of bone that lies over the tooth. Oftentimes, for a tooth in this situation, the tooth will be extracted in small sections rather than removed in one piece to minimize the amount of bone that needs to be removed to get the tooth out.
What Happens During Wisdom Teeth Removal?
Before your wisdom teeth are pulled, the teeth and the surrounding tissue will be numbed with a local anesthetic - the same injection with the same medication you would receive to numb a tooth prior to having a cavity filled. In addition to the local anesthetic to numb the pain, you and your dentist or oral surgeon may decide that a sedative is desired to control any anxiety. Sedating medications that could be selected include: nitrous oxide (otherwise known as "laughing gas"), an oral sedative (for example, Valium), or an intravenous sedative (administered via an injection into your veins). If nitrous oxide is given, you will be able to drive yourself home. If any of the other medications is selected, you will need someone to drive you both to and from the appointment.
What Does Recovery Involve After Wisdom Teeth Are Pulled?
After having your wisdom teeth removed, the speed of your recovery depends on the degree of difficulty of the extraction (a simple extraction of a fully erupted tooth versus a tooth impacted into the jawbone). In general, here's what to expect.
During the first 24 hours
Bleeding may occur for several hours after tooth extraction. To control it, position a piece of clean moist gauze over the empty tooth socket and bite down firmly. Apply constant pressure for about 45 minutes. A moistened tea bag is an effective alternative. The tannic acid in tea helps healing blood clots to form (blood clots function similarly to scab over an open wound). Repeat this process if a small degree of bleeding continues; if heavy bleeding continues to occur, contact your dentist or oral surgeon. Avoid rinsing or spitting for 24 hours after tooth extraction, avoid "sucking" actions (for example, don't drink beverages through straws or smoke) and avoid hot liquids (such as coffee or soup). These activities can dislodge the clot, causing a dry socket (see below) to develop.
Facial swelling in the area where the tooth was extracted typically occurs. To minimize swelling, place a piece of ice, wrapped in a cloth, on that area of your face on a schedule of 10-minutes on, followed by 20-minutes off. Repeat as necessary during this first 24-hour period.
Pain medications, such as acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) can be taken for minor pain. Your dentist or oral surgeon may prescribe more potent pain relievers, such as narcotics, if necessary.
Antibiotics that may have been prescribed prior to tooth extraction (to treat any active infection around the wisdom tooth to be extracted) should continue to be taken until the full prescription is gone.
Foods should be restricted to a liquid diet until all the numbness from anesthesia has worn off. Eat soft foods for a few days. Also avoid alcohol if you're also taking narcotic pain medication.
Continue to brush your teeth, but avoid the teeth directly neighboring the extracted tooth during the first 24 hours. On day two, resume the gentle brushing of your teeth. Do not use commercial mouth rinses -- these can irritate the extraction site.
What Does Recovery Involve After Wisdom Teeth Are Pulled? continued...
After 24 hours
Facial swelling in the area of the tooth extraction should be treated with heat after the first 24 hours of ice. Apply a moist warm towel to the area on a 20-minute on, 20-minute off schedule. Repeat as necessary.
Rinse your mouth with warm salt water (1/2 teaspoon of salt in a cup of warm water) after meals and before bed. Do not use commercial mouth rinses.
Stitches, if used and if not of the self-dissolving type, need to be removed by your oral health care provider in about 1 week. If you do require stitches, ask what type you have been given.
Watch for signs of dry socket (described below). This condition requires treatment by your oral health care provider.
Complete healing doesn't occur for a few weeks to a few months following the extraction. However, usually within the first week or two, enough healing has taken place for use of your mouth to be reasonably comfortable in the area of the extraction. Your dentist will explain what to expect in your specific case.
What Are Potential Complications of Wisdom Tooth Removal?
Two of the more important complications after having your wisdom teeth removed include:
Dry socket. Dry socket is a common complication that occurs when either a blood clot has failed to form in the extracted tooth socket or else the blood clot that did form has been dislodged. Without clot formation, healing will be delayed. When it happens, dry socket typically occurs 3 or 4 days following the extraction and is accompanied by pain (ranging from "dull" to moderate to severe) and a foul mouth odor. Your dentist or oral surgeon will treat the dry socket by placing medication in the socket.
Paresthesia. Paresthesia is a less frequently occurring complication. Wisdom teeth entrapped in the jawbone are often close to nerves. Sometimes these nerves can be bruised or damaged during the tooth removal process. The result is a numbness (called a paresthesia) of the tongue, lip, or chin that can last a few days, weeks, months, or may even be permanent.
How Much Does Wisdom Teeth Extraction Cost?
Simple extraction of a wisdom tooth can cost as little as $99 per tooth. The cost of wisdom teeth that are impacted can cost between $230 and $340 and even more. Because costs vary in different areas of the country, contact your dentist or oral surgeon for their charges. Also check with both your dental insurance carrier and medical insurance provider. One or the other type of insurance may cover a portion of the cost of wisdom teeth removal.
Wisdom teeth present potential problems when they are misaligned - they can position themselves horizontally, be angled toward or away from the second molars or be angled inward or outward. Poor alignment of wisdom teeth can crowd or damage adjacent teeth, the jawbone, or nerves. Wisdom teeth that lean toward the second molars make those teeth more vulnerable to decay by entrapping plaque and debris. In addition, wisdom teeth can be entrapped completely within the soft tissue and/or the jawbone or only partially break through or erupt through the gum. Teeth that remain partially or completely entrapped within the soft tissue and /or the jawbone are termed "impacted." Wisdom teeth that only partially erupt allows for an opening for bacteria to enter around the tooth and cause an infection, which results in pain, swelling, jaw stiffness, and general illness. Partially erupted teeth are also more prone to tooth decay and gum disease because their hard-to-reach location and awkward positioning makes brushing and flossing difficult
How Do I Know if I Have Wisdom Teeth?
Wisdom teeth present potential problems when they are misaligned - they can position themselves horizontally, be angled toward or away from the second molars or be angled inward or outward. Ask your dentist about the positioning of your wisdom teeth. He or she may take an X-ray periodically to evaluate for the presence and alignment of your wisdom teeth. Your dentist may also decide to send you to an oral surgeon for further evaluation.
Your dentist or oral surgeon may recommend that your wisdom teeth be extracted even before problems develop. This is done to avoid a more painful or more complicated extraction that might have to be done a few years later. Removal is easier in young people, when the wisdom teeth roots are not yet fully developed and the bone is less dense. In older people, recovery and healing time tend to be longer.
How Are Wisdom Teeth Removed?
The relative ease at which your dentist or oral surgeon can extract your wisdom teeth depends on their position. Your oral health care provider will be able to give you an idea of what to expect during your pre-extraction exam. A wisdom tooth that is fully erupted through the gum can be extracted as easily as any other tooth. However, a wisdom tooth that is underneath the gums and embedded in the jawbone will require an incision into the gums and then removal of the portion of bone that lies over the tooth. Oftentimes, for a tooth in this situation, the tooth will be extracted in small sections rather than removed in one piece to minimize the amount of bone that needs to be removed to get the tooth out.
What Happens During Wisdom Teeth Removal?
Before your wisdom teeth are pulled, the teeth and the surrounding tissue will be numbed with a local anesthetic - the same injection with the same medication you would receive to numb a tooth prior to having a cavity filled. In addition to the local anesthetic to numb the pain, you and your dentist or oral surgeon may decide that a sedative is desired to control any anxiety. Sedating medications that could be selected include: nitrous oxide (otherwise known as "laughing gas"), an oral sedative (for example, Valium), or an intravenous sedative (administered via an injection into your veins). If nitrous oxide is given, you will be able to drive yourself home. If any of the other medications is selected, you will need someone to drive you both to and from the appointment.
What Does Recovery Involve After Wisdom Teeth Are Pulled?
After having your wisdom teeth removed, the speed of your recovery depends on the degree of difficulty of the extraction (a simple extraction of a fully erupted tooth versus a tooth impacted into the jawbone). In general, here's what to expect.
During the first 24 hours
Bleeding may occur for several hours after tooth extraction. To control it, position a piece of clean moist gauze over the empty tooth socket and bite down firmly. Apply constant pressure for about 45 minutes. A moistened tea bag is an effective alternative. The tannic acid in tea helps healing blood clots to form (blood clots function similarly to scab over an open wound). Repeat this process if a small degree of bleeding continues; if heavy bleeding continues to occur, contact your dentist or oral surgeon. Avoid rinsing or spitting for 24 hours after tooth extraction, avoid "sucking" actions (for example, don't drink beverages through straws or smoke) and avoid hot liquids (such as coffee or soup). These activities can dislodge the clot, causing a dry socket (see below) to develop.
Facial swelling in the area where the tooth was extracted typically occurs. To minimize swelling, place a piece of ice, wrapped in a cloth, on that area of your face on a schedule of 10-minutes on, followed by 20-minutes off. Repeat as necessary during this first 24-hour period.
Pain medications, such as acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) can be taken for minor pain. Your dentist or oral surgeon may prescribe more potent pain relievers, such as narcotics, if necessary.
Antibiotics that may have been prescribed prior to tooth extraction (to treat any active infection around the wisdom tooth to be extracted) should continue to be taken until the full prescription is gone.
Foods should be restricted to a liquid diet until all the numbness from anesthesia has worn off. Eat soft foods for a few days. Also avoid alcohol if you're also taking narcotic pain medication.
Continue to brush your teeth, but avoid the teeth directly neighboring the extracted tooth during the first 24 hours. On day two, resume the gentle brushing of your teeth. Do not use commercial mouth rinses -- these can irritate the extraction site.
What Does Recovery Involve After Wisdom Teeth Are Pulled? continued...
After 24 hours
Facial swelling in the area of the tooth extraction should be treated with heat after the first 24 hours of ice. Apply a moist warm towel to the area on a 20-minute on, 20-minute off schedule. Repeat as necessary.
Rinse your mouth with warm salt water (1/2 teaspoon of salt in a cup of warm water) after meals and before bed. Do not use commercial mouth rinses.
Stitches, if used and if not of the self-dissolving type, need to be removed by your oral health care provider in about 1 week. If you do require stitches, ask what type you have been given.
Watch for signs of dry socket (described below). This condition requires treatment by your oral health care provider.
Complete healing doesn't occur for a few weeks to a few months following the extraction. However, usually within the first week or two, enough healing has taken place for use of your mouth to be reasonably comfortable in the area of the extraction. Your dentist will explain what to expect in your specific case.
What Are Potential Complications of Wisdom Tooth Removal?
Two of the more important complications after having your wisdom teeth removed include:
Dry socket. Dry socket is a common complication that occurs when either a blood clot has failed to form in the extracted tooth socket or else the blood clot that did form has been dislodged. Without clot formation, healing will be delayed. When it happens, dry socket typically occurs 3 or 4 days following the extraction and is accompanied by pain (ranging from "dull" to moderate to severe) and a foul mouth odor. Your dentist or oral surgeon will treat the dry socket by placing medication in the socket.
Paresthesia. Paresthesia is a less frequently occurring complication. Wisdom teeth entrapped in the jawbone are often close to nerves. Sometimes these nerves can be bruised or damaged during the tooth removal process. The result is a numbness (called a paresthesia) of the tongue, lip, or chin that can last a few days, weeks, months, or may even be permanent.
How Much Does Wisdom Teeth Extraction Cost?
Simple extraction of a wisdom tooth can cost as little as $99 per tooth. The cost of wisdom teeth that are impacted can cost between $230 and $340 and even more. Because costs vary in different areas of the country, contact your dentist or oral surgeon for their charges. Also check with both your dental insurance carrier and medical insurance provider. One or the other type of insurance may cover a portion of the cost of wisdom teeth removal.
The Teething Process
Teething can begin as early as 3 months and continue until a child's third birthday.
Between the ages of 4 and 7 months, you'll notice your baby's first tooth pushing through the gum line. The first teeth to appear usually are the two bottom front teeth, also known as the central incisors. These are usually followed 4 to 8 weeks later by the four front upper teeth (central and lateral incisors). About a month later, the lower lateral incisors (the two teeth flanking the bottom front teeth) will appear.
Next to break through the gum line are the first molars (the back teeth used for grinding food), then finally the eyeteeth (the pointy teeth in the upper jaw). Most kids have all 20 of their primary teeth by their third birthday. (If your child experiences significant delay, speak to your doctor.)
In some rare cases, kids are born with one or two teeth or have a tooth emerge within the first few weeks of life. Unless the teeth interfere with feeding or are loose enough to pose a choking risk, this is usually not a cause for concern.
As kids begin teething, they might drool more and want to chew on things. For some babies, teething is painless. Others may experience brief periods of irritability, and some may seem cranky for weeks, with crying jags and disrupted sleeping and eating patterns. Teething can be uncomfortable, but if your baby seems very irritable, talk to your doctor.
Although tender and swollen gums could cause your baby's temperature to be a little higher than normal, teething doesn't usually cause high fever or diarrhea. If your baby does develop a fever during the teething phase, it's probably due to something else and you should contact your doctor.
Easing Teething
Here are some tips to keep in mind when your baby is teething:
Wipe your baby's face often with a cloth to remove the drool and prevent rashes from developing.
Give your baby something to chew on. Make sure it's big enough so that it can't be swallowed and that it can't break into small pieces. A wet washcloth placed in the freezer for 30 minutes makes a handy teething aid — just be sure to wash it after each use. Rubber teething rings are also good, but avoid ones with liquid inside because they may break or leak. If you use a teething ring, be sure to take it out of the freezer before it becomes rock hard — you don't want to bruise those already swollen gums!
Rub your baby's gums with a clean finger.
Never tie a teething ring around a baby's neck — it could get caught on something and strangle the baby.
If your baby seems irritable, acetaminophen may help — but always consult your doctor first. Never place an aspirin against the tooth, and don't rub alcohol on your baby's gums.
Baby Teeth Hygiene
The care and cleaning of your baby's teeth is important for long-term dental health. Even though the first set of teeth will fall out, tooth decay can hasten this process and leave gaps before the permanent teeth are ready to come in. The remaining primary teeth may then crowd together to attempt to fill in the gaps, which may cause the permanent teeth to come in crooked and out of place.
Daily dental care should begin even before your baby's first tooth emerges. Wipe your baby's gums daily with a clean, damp washcloth or gauze, or brush them gently with a soft, infant-sized toothbrush and water (no toothpaste!). As soon as the first tooth appears, brush it with water.
Toothpaste is OK to use once a child is old enough to spit it out — usually around age 3. Choose one with fluoride and use only a pea-sized amount or less in younger kids. Don't let your child swallow the toothpaste or eat it out of the tube because an overdose of fluoride can be harmful to kids.
By the time all your baby's teeth are in, try to brush them at least twice a day and especially after meals. It's also important to get kids used to flossing early on. A good time to start flossing is when two teeth start to touch. Talk to your dentist for advice on flossing those tiny teeth. You can also get toddlers interested in the routine by letting them watch and imitate you as you brush and floss.
Another important tip for preventing tooth decay: Don't let your baby fall asleep with a bottle. The milk or juice can pool in a baby's mouth and cause tooth decay and plaque.
The American Dental Association (ADA) recommends that kids see a dentist by age 1, when six to eight teeth are in place, to spot any potential problems and advise parents about preventive care.
Reviewed by: Lisa A. Goss, RDH, BS, and Charlie J. Inga, DDS
Date reviewed: October 2008
Between the ages of 4 and 7 months, you'll notice your baby's first tooth pushing through the gum line. The first teeth to appear usually are the two bottom front teeth, also known as the central incisors. These are usually followed 4 to 8 weeks later by the four front upper teeth (central and lateral incisors). About a month later, the lower lateral incisors (the two teeth flanking the bottom front teeth) will appear.
Next to break through the gum line are the first molars (the back teeth used for grinding food), then finally the eyeteeth (the pointy teeth in the upper jaw). Most kids have all 20 of their primary teeth by their third birthday. (If your child experiences significant delay, speak to your doctor.)
In some rare cases, kids are born with one or two teeth or have a tooth emerge within the first few weeks of life. Unless the teeth interfere with feeding or are loose enough to pose a choking risk, this is usually not a cause for concern.
As kids begin teething, they might drool more and want to chew on things. For some babies, teething is painless. Others may experience brief periods of irritability, and some may seem cranky for weeks, with crying jags and disrupted sleeping and eating patterns. Teething can be uncomfortable, but if your baby seems very irritable, talk to your doctor.
Although tender and swollen gums could cause your baby's temperature to be a little higher than normal, teething doesn't usually cause high fever or diarrhea. If your baby does develop a fever during the teething phase, it's probably due to something else and you should contact your doctor.
Easing Teething
Here are some tips to keep in mind when your baby is teething:
Wipe your baby's face often with a cloth to remove the drool and prevent rashes from developing.
Give your baby something to chew on. Make sure it's big enough so that it can't be swallowed and that it can't break into small pieces. A wet washcloth placed in the freezer for 30 minutes makes a handy teething aid — just be sure to wash it after each use. Rubber teething rings are also good, but avoid ones with liquid inside because they may break or leak. If you use a teething ring, be sure to take it out of the freezer before it becomes rock hard — you don't want to bruise those already swollen gums!
Rub your baby's gums with a clean finger.
Never tie a teething ring around a baby's neck — it could get caught on something and strangle the baby.
If your baby seems irritable, acetaminophen may help — but always consult your doctor first. Never place an aspirin against the tooth, and don't rub alcohol on your baby's gums.
Baby Teeth Hygiene
The care and cleaning of your baby's teeth is important for long-term dental health. Even though the first set of teeth will fall out, tooth decay can hasten this process and leave gaps before the permanent teeth are ready to come in. The remaining primary teeth may then crowd together to attempt to fill in the gaps, which may cause the permanent teeth to come in crooked and out of place.
Daily dental care should begin even before your baby's first tooth emerges. Wipe your baby's gums daily with a clean, damp washcloth or gauze, or brush them gently with a soft, infant-sized toothbrush and water (no toothpaste!). As soon as the first tooth appears, brush it with water.
Toothpaste is OK to use once a child is old enough to spit it out — usually around age 3. Choose one with fluoride and use only a pea-sized amount or less in younger kids. Don't let your child swallow the toothpaste or eat it out of the tube because an overdose of fluoride can be harmful to kids.
By the time all your baby's teeth are in, try to brush them at least twice a day and especially after meals. It's also important to get kids used to flossing early on. A good time to start flossing is when two teeth start to touch. Talk to your dentist for advice on flossing those tiny teeth. You can also get toddlers interested in the routine by letting them watch and imitate you as you brush and floss.
Another important tip for preventing tooth decay: Don't let your baby fall asleep with a bottle. The milk or juice can pool in a baby's mouth and cause tooth decay and plaque.
The American Dental Association (ADA) recommends that kids see a dentist by age 1, when six to eight teeth are in place, to spot any potential problems and advise parents about preventive care.
Reviewed by: Lisa A. Goss, RDH, BS, and Charlie J. Inga, DDS
Date reviewed: October 2008
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