If there is periodontal bone loss over 50%, it may be better to extract the tooth, especially if there is active infection or the person isn’t coming in regularly for their periodontal recare. If there is deep decay near the bone or extensively throughout the tooth, it may not be worth the additional surgical procedures and loss of bone to do crown lengthening procedures or root canal  procedures with posts and cores, etc.

If there are cracks that are located within the confines of the tooth, then many times a crown and build up can be placed and will solve the problem or a root canal if there are symptoms. But, if the crack extends down onto the root, then the prognosis is generally hopeless and it will be better to extract the tooth as it cannot be saved no matter what we do. This is the main criteria for removing a tooth with a crack and it is sometimes a difficult diagnosis and a hard decision to explain to our patients. Many of these also have the telltale sign of active infection along the crack extending down the root, but some do not.

Our 3D cone beam X-rays can help in the diagnosis and decision making. We are seeing many more of these “cracked tooth syndromes” in our practice as people are under a lot of stress and tend to bruxism, the clenching and grinding, of their teeth. The best approach is prevention and trying not to place any fillings in the tooth if possible so as to weaken it.

Regular preventative maintenance hygiene visits, check ups and dental X-rays go a long way to accomplishing this. When the decision arises of whether to save or not to save a tooth, many times the decision will be obvious (and many times it won’t) and a discussion with your dentist as to the short and long term prognosis, advantages, disadvantages, cost, labor and time will go a long way to help in this difficult decision making process. If you would like to schedule a consultation with Dr. Vaughn at Two Rivers Dentistry in Vancouver, Washington, we welcome you to call us today at 360-256-1202. Your smile will thank you!

The post TO SAVE (A TOOTH) OR NOT TO SAVE…THAT IS THE QUESTION first appeared on Two Rivers Dentistry.

To assist you in protecting your restorations (especially if you have dental implants) and prevent further wear on your teeth, we may recommend a nightguard or bite splint.  All of ours are digitally designed and manufactured with the ideal fit and comfort.  My favorite appliance is the comfort H/S bite splint which stands for hard/soft.  There is a hard outer flat layer which trains your subconscious not to grind and absorbs all the forces of your teeth and a soft inner layer for maximum comfort.  We also can provide a thermal splint which is hard, but softens as you warm it up in warm water prior to placing it in the mouth.  It then cools and becomes hard again.  This is also very popular.

For those people who clench and suffer from headaches and migraines most of the time, the NTI-TSS deprogramming appliance is the best, reducing the need for drugs with harmful side effects.  This appliance fits on the front teeth and opens up the posterior teeth, reducing the muscular forces by up to 70 percent and drastically reducing tension headache and migraine severity.

The success of these therapies depends on the person following through and wearing the appliance.  Fabrication is simple, a full arch scan and bite of the teeth is captured and sent to the lab, a completely digital process.  Most of the time no adjustments to the appliance are needed.

Many of our family of patients are benefited so much from nightguard and splint therapy.  The teeth should only touch during eating and if they come together during the day or night, then the appliance is warranted.  If the stress of nighttime grinding or harmful habits is wearing down the teeth or causing problems, these appliances are the best, conservative short and long-term way to go before a very expensive surgery or full mouth reconstruction is needed.  What was it somebody said? “An ounce of prevention is worth a pound of cure”. We wholeheartedly agree!

The post IT’S A STRESSFUL WORLD OUT THERE first appeared on Two Rivers Dentistry.