Root planing and scaling is one of the most effective ways to treat gum disease before it becomes severe. Root planing and scaling cleans between the gums and the teeth down to the roots. Your dentist may need to use a local anesthetic to numb your gums and the roots of your teeth.
Some dentists and dental hygienists will use an ultrasonic tool for the planing and scaling. This tool is not as uncomfortable as a standard scraping tool, but not all cleanings require this type of tool.
Your dentist may utilize antibiotics as an adjunct to scaling and root planing. Antibiotics can help speed healing and prevent infection.
- What Can I Expect After Treatment?
If anesthesia is used, your lips and gums may remain numb for a few hours. Planing and scaling causes little or no discomfort.
- Why It Is Done?
Root planing and scaling is done when gums have either started to pull away from the teeth or the roots of the teeth have hard mineral deposits (tartar) on them.
- How Well Does It Work?
If you maintain good dental care after the procedure, the progression of gum disease should stop. And your gums will heal and become firm and pink again.
Root planing and scaling can introduce harmful bacteria into the bloodstream. Gum tissue is also at risk of infection. You may need to take antibiotics before and after surgery if you have a condition that puts you at high risk for a severe infection or if infections are particularly dangerous for you.
- You may need to take antibiotics if you:
- Have certain heart problems that make it dangerous for you to get a heart infection called endocarditis.
- Have an impaired immune system.
- Had recent major surgeries or have man-made body parts, such as an artificial hip or heart valve.
- What To Think About
Root planing and scaling is a simple procedure that can work very well to stop gum disease. Brush and floss regularly after the procedure. Without proper dental care, your gum disease may progress. To promote healing, stop all use of tobacco. Smoking or using spit tobacco reduces your ability to fight infection of your gums and delays healing.
First, the dentist will use a local anesthetic to numb the area around the tooth to be filled. Next, a drill,
will be used to remove the decayed area.
Next, your dentist will probe or test the area to determine if all the decay has been removed. Once the decay has been removed, the dentist will prepare the space for the filling by cleaning the cavity of bacteria and debris. If the decay is near the root, your dentist may first put in a liner made of glass ionomer, composite resin, or other material to protect the nerve.
Several additional steps are required for tooth-colored fillings and are as follows. After your dentist has removed the decay and cleaned the area, the tooth-colored material is applied in layers. Next, a special light that “cures” or hardens each layer is applied. When the multi-layering process is completed, the dentist will shape the composite material to the desired result, trim off any excess material, and polish the final restoration.
Following an extraction, your dentist will send you home to recover. Recovery typically takes a few days. The following can help minimize discomfort, reduce the risk of infection, and speed recovery.
- Take painkillers as prescribed.
- Bite firmly but gently on the gauze pad placed by your dentist to reduce bleeding and allow a clot to form in the tooth socket. Change gauze pads before they become soaked with blood. Otherwise, leave the pad in place for three to four hours after the extraction.
- Apply an ice bag to the affected area immediately after the procedure to keep down swelling. Apply ice for 10 minutes at a time.
- Relax for at least 24 hours after the extraction. Limit activity for the next day or two.
- Avoid rinsing or spitting forcefully for 24 hours after the extraction to avoid dislodging the clot that forms in the socket.
- After 24 hours, rinse with your mouth with a solution made of 1/2 teaspoon salt and 8 ounces of warm water.
- Do not drink from a straw for the first 24 hours.
- Do not smoke, which can inhibit healing.
- Eat soft foods, such as soup, pudding, yogurt, or applesauce the day after the extraction. Gradually add solid foods to your diet as the extraction site heals.
- When lying down, prop your head with pillows. Lying flat may prolong bleeding.
- Continue to brush and floss your teeth, and brush your tongue, but be sure to avoid the extraction site. Doing so will help prevent infection
Dentists and oral surgeons (dentists with special training to perform surgery) perform tooth extractions. Before pulling the tooth, your dentist will give you an injection of a local anesthetic to numb the area where the tooth will be removed. If you are having more than one tooth pulled or if a tooth is impacted, your dentist may use a strong general anesthetic. This will prevent pain throughout your body and make you sleep through the procedure.
If the tooth is impacted, the dentist will cut away gum and bone tissue that cover the tooth and then, using forceps, grasp the tooth and gently rock it back and forth to loosen it from the jaw bone and ligaments that hold it in place. Sometimes, a hard-to-pull tooth must be removed in pieces.
Once the tooth has been pulled, a blood clot usually forms in the socket. The dentist will pack a gauze pad into the socket and have you bite down on it to help stop the bleeding. Sometimes the dentist will place a few stitches — usually self-dissolving — to close the gum edges over the extraction site.
Sometimes, the blood clot in the socket breaks loose, exposing the bone in the socket. This is a painful condition called dry socket. If this happens, your dentist will likely place a sedative dressing over the socket for a few days to protect it as a new clot forms.
Although permanent teeth were meant to last a lifetime, there are a number of reasons why tooth extraction may be needed. A very common reason involves a tooth that is too badly damaged, from trauma or decay, to be repaired. Other reasons include:
- A crowded mouth
Sometimes dentists pull teeth to prepare the mouth for orthodontia. The goal of orthodontia is to properly align the teeth, which may not be possible if your teeth are too big for your mouth. Likewise, if a tooth cannot break through the gum (erupt) because there is not room in the mouth for it, your dentist may recommend pulling it.
If tooth decay or damage extends to the pulp — the center of the tooth containing nerves and blood vessels — bacteria in the mouth can enter the pulp, leading to infection. Often this can be corrected with root canal therapy (RCT), but if the infection is so severe that antibiotics or RCT do not cure it, extraction may be needed to prevent the spread of infection.
- Risk of infection
If your immune system is compromised (for example, if you are receiving chemotherapy or are having an organ transplant) even the risk of infection in a particular tooth may be reason enough to pull the tooth.
- Periodontal (Gum) Disease
If periodontal disease — an infection of the tissues and bones that surround and support the teeth — have caused loosening of the teeth, it may be necessary to the pull the tooth or teeth.
While a crowned tooth does not require any special care, remember that simply because a tooth is crowned does not mean the underlying tooth is protected from decay or gum disease. Therefore, continue to follow good oral hygiene practices, including brushing your teeth at least twice a day and flossing once a day — especially around the crown area where the gum meets the tooth. Antibacterial mouth rinse can also help.
On average, dental crowns last between five and 15 years. The life span of a crown depends on the amount of “wear and tear” the crown is exposed to, how well you follow good oral hygiene practices, and your personal mouth-related habits (you should avoid such habits as grinding or clenching your teeth, chewing ice, biting fingernails, and using your teeth to open packaging).
Because temporary dental crowns are just that — a temporary fix until a permanent crown is ready — most dentists suggest that a few precautions. These include:
Avoid sticky, chewy foods (for example, chewing gum, caramel), which have the potential of grabbing and pulling off the crown.
Minimize use of the side of your mouth with the temporary crown. Shift the bulk of your chewing to the other side of the mouth.
Avoid chewing hard foods (such as raw vegetables), which could dislodge or break the crown.
Slide flossing material out-rather than lifting out-when cleaning your teeth. Lifting the floss out, as you normally would, might pull off the temporary crown.
Preparing a tooth for a crown usually requires two visits to the dentist — the first step involves examining and preparing the tooth, the second visit involves placement of the permanent crown.
- First Visit: Examining and preparing the tooth.
At the first visit in preparation for a crown, your dentist may take a few X-rays to check the roots of the tooth receiving the crown and surrounding bone. If the tooth has extensive decay or if there is a risk of infection or injury to the tooth’s pulp, a root canal treatment may first be performed.
Before the process of making a crown begins, your dentist will anesthetize (numb) the tooth and the gum tissue around the tooth. Next, the tooth receiving the crown is filed down along the chewing surface and sides to make room for the crown. The amount removed depends on the type of crown used (for instance, all-metal crowns are thinner and require less tooth structure removal than all-porcelain or porcelain-fused-to-metal ones). If, on the other hand, a large area of the tooth is missing (due to decay or damage) your dentist will use filling material to “build up” the tooth to support the crown.
After reshaping the tooth, your dentist will use a paste or putty to make an impression of the tooth to receive the crown. Impressions of the teeth above and below the tooth to receive the dental crown will also be made to make sure that the crown will not affect your bite.
The impressions are sent to a dental lab where the crown will be manufactured. The crown is usually returned to your dentist’s office in two to three weeks. If the crown is made of porcelain, your dentist will also select the shade that most closely matches the color of the neighboring teeth. During this first office visit your dentist will make a temporary crown to cover and protect the prepared tooth while the crown is being made. Temporary crowns are usually made of acrylic and are held in place using temporary cement.
- Second Visit: Receiving the permanent dental crown.
At the second visit, your dentist will remove the temporary crown and check the fit and color of the permanent crown. If everything is acceptable, a local anesthetic will be used to numb the tooth and the new crown is permanently cemented in place.
Exposure to all sources of radiation — including the sun, minerals in the soil, appliances in your home, and dental X-rays — can damage the body’s tissues and cells and can lead to the development of cancer in some instances. Fortunately, the dose of radiation you are exposed to during the taking of X-rays is extremely small.
Advances in dentistry over the years have lead to the low radiation levels emitted by today’s X-rays. Some of the improvements are new digital X-ray machines that limit the radiation beam to the small area being X-rayed, higher speed X-ray films that require shorter exposure time compared with older film speeds to get the same results, and the use of film holders that keep the film in place in the mouth (which prevents the film from slipping and the need for repeat X-rays and additional radiation exposure). Also, the use of lead-lined, full-body aprons protects the body from stray radiation (though this is almost nonexistent with the modern dental X-ray machines.) In addition, federal law requires that X-ray machines be checked for accuracy and safety every two years, with some states requiring more frequent checks.
Sealants are a thin, plastic coating that is painted on the chewing surfaces of teeth — usually the back teeth (the premolars, and molars) — to prevent tooth decay. The painted on liquid sealant quickly bonds into the depressions and groves of the teeth forming a protective shield over the enamel of each tooth.
Typically, children should get sealants on their permanent molars and premolars as soon as these teeth come in. In this way, the dental sealants can protect the teeth through the cavity-prone years of ages 6 to 14. However, adults without decay or fillings in their molars can also benefit from sealants.
Sealants can protect the teeth from decay for up to 10 years, but they need to be checked for chipping or wear at regular dental check-ups.
Several different options are available to change the shape of teeth, make teeth look longer, close spaces between teeth or repair chipped or cracked teeth. Among the options are bonding, crowns, veneers, and re-contouring.
Dental bonding is a procedure in which a tooth-colored resin material (a durable plastic material) is applied to the tooth surface and hardened with a special light, which ultimately “bonds” the material to the tooth.
Dental crowns are tooth-shaped “caps” that are placed over teeth. The crowns, when cemented into place, fully encase the entire visible portion of a tooth that lies at and above the gum line.
Veneers (also sometimes called porcelain veneers or dental porcelain laminates) are wafer-thin, custom-made shells of tooth-colored materials that are designed to cover the front surface of teeth. These shells are bonded to the front of the teeth.
Re-contouring or reshaping of the teeth (also called odontoplasty, enameloplasty, stripping, or slenderizing) is a procedure in which small amounts of tooth enamel are removed to change a tooth’s length, shape or surface.
Each of these options differ with regard to cost, durability, “chair time” necessary to complete the procedure, stain resistant qualities, and best cosmetic approach to resolving a specific problem. Talk to your dentist to see if one is right for you.
If you fear going to the dentist, you are not alone. Between 9% and 15% of Americans state they avoid going to the dentist because of anxiety or fear. The first thing you should do is talk with your dentist. In fact, if your dentist doesn’t take your fear seriously, find another dentist. The key to coping with dental anxiety is to discuss your fears with your dentist. Once your dentist knows what your fears are, he or she will be better able to work with you to determine the best ways to make you less anxious and more comfortable.
The good news is that today there are a number of strategies that can be used to help reduce fear, anxiety, and pain. These strategies include use of medications (to either numb the treatment area or sedatives or anesthesia to help you relax).
A dental crown may be needed in the following situations:
- To protect a weak tooth (for instance, from decay) from breaking or to hold together parts of a cracked tooth
- To restore an already broken tooth or a tooth that has been severely worn down
- To cover and support a tooth with a large filling when there isn’t a lot of tooth left
- To hold a dental bridge in place
- To cover misshaped or severely discolored teeth
- To cover a dental implant
- To make a cosmetic modification
For children, a crown may be used on primary (baby) teeth in order to:
- Save a tooth that has been so damaged by decay that it can’t support a filling.
- Protect the teeth of a child at high risk for tooth decay, especially when a child has difficulty keeping up with daily oral hygiene.
- Decrease the frequency of sedation and general anesthesia for children unable because of age, behavior, or medical history to fully cooperate with the requirements of proper dental care.
In such cases, a pediatric dentist is likely to recommend a stainless steel crown.
Permanent crowns can be made from stainless steel, all metal (such as gold or another alloy), porcelain-fused-to-metal, or all ceramic.
Stainless steel crowns are prefabricated crowns that are used on permanent teeth primarily as a temporary measure. The crown protects the tooth or filling while a permanent crown is made from another material. For children, a stainless steel crown is commonly used to fit over a primary tooth that’s been prepared to fit it. The crown covers the entire tooth and protects it from further decay. When the primary tooth comes out to make room for the permanent tooth, the crown comes out naturally with it. In general, stainless steel crowns are used for children’s teeth because they don’t require multiple dental visits to put in place and so are more cost- effective than custom-made crowns and prophylactic dental care needed to protect a tooth without a crown.
Metals used in crowns include gold alloy, other alloys (for example, palladium), or a base-metal alloy (for example, nickel or chromium). Compared with other crown types, less tooth structure needs to be removed with metal crowns, and tooth wear to opposing teeth is kept to a minimum. Metal crowns withstand biting and chewing forces well and probably last the longest in terms of wear down. Also, metal crowns rarely chip or break. The metallic color is the main drawback. Metal crowns are a good choice for out-of-sight molars.
Porcelain-fused-to-metal dental crowns can be color matched to your adjacent teeth (unlike the metallic crowns). However, more wearing to the opposing teeth occurs with this crown type compared with metal or resin crowns. The crown’s porcelain portion can also chip or break off. Next to all-ceramic crowns, porcelain-fused-to-metal crowns look most like normal teeth. However, sometimes the metal underlying the crown’s porcelain can show through as a dark line, especially at the gum line and even more so if your gums recede. These crowns can be a good choice for front or back teeth.
All-ceramic or all-porcelain dental crowns provide better natural color match than any other crown type and may be more suitable for people with metal allergies. However, they are not as strong as porcelain-fused-to-metal crowns and they wear down opposing teeth a little more than metal or resin crowns. All-ceramic crowns are a good choice for front teeth.
Temporary versus permanent. Temporary crowns can be made in your dentist’s office, whereas permanent crowns are made in a dental laboratory. Temporary crowns are made of acrylic or stainless steel and can be used as a temporary restoration until a permanent crown is constructed by a lab