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Diseases of the lips.

The vermilion of the lips was conceptualized by Jean Darier as the semi-mucosa. The anatomy of the lips is transitional from skin to mucous membrane. This article emphasizes inflammatory diseases of the lips known as cheilitis. Angular cheilitis is a reactive process with several possible causes, including infections, mechanical, nutritional deficiency, and various dermatoses. Contact cheilitis may be caused by a primary irritant or a delayed hypersensitivity allergic reaction to contactants. Plasma cell cheilitis is a reactive periorificial mucositis. Exfoliative cheilitis is also a reactive process, probably secondary to factitious activity of the patient. Cheilitis glandularis is a chronic inflammatory disorder of the labial salivary glands and their ducts. There are three forms: simple, superficial suppurative, and deep suppurative. A premalignant potential is present in cheilitis glandularis. Cheilitis granulomatosa is one manifestation of orofacial granulomatosis. The granulomatous conditions of Melkersson-Rosenthal syndrome, sarcoidosis, and Crohn’s disease may be associated with cheilitis granulomatosa or it may stand alone as Miescher’s cheilitis. Actinic cheilitis is another premalignant form of cheilitis that is amenable to a variety of therapeutic modalities.

Diseases of the lips – Trauma, Fissures, Leukoplakia
Trauma. The lips, in plain sight and the center of much activity during life, usually have suffered bruising, biting, chafing and often a cut or two. Aside from scar formation and possible mild deformity which would result, trauma to the lips heals quickly and is seldom serious. Severe lacerations of the lips obviously requires surgical repair.

Cracked and Fissured Lips. Cracking of the lips, with deep fissure formation frequently results from exposure to sunlight and cold, and can be very painful and smile-preventing. It is seldom serious and heals quickly when protected with pomade or skin cream.

Cracking in the corners of the mouth in adult people often indicates ariboflavinosis, a vitamin B deficiency. When the cracking accompanies malnutrition or disease resulting from an inadequate diet, healing of the corners of the mouth usually responds readily to an adequate diet containing sufficient vitamin B.

Leukoplakia. A milky-colored coating, of a slightly thickened nature on the wet inner aspect of the lips, is the appearance of leukoplakia, considered to be a pre-cancerous condition. It can occur in other areas of the mouth, besides the lips, and is often associated with the use of tobacco in any of its forms. Leukoplakia conditions call for ceasing the use of tobacco and usually the removal of these lesions by surgery or cautery. Mouth cleanliness also becomes a matter of concern, and routine oral hygiene becomes imperative.

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Do you think your teeth are not quite as white as they should be? There are many reasons why teeth lose their “whiteness”. It happens naturally as the mineral structure of your teeth changes over time and as the enamel becomes less porous. Teeth can also become discolored by smoking, coffee drinking, and even some antibiotics.

Steps
Prevention1Avoid tobacco products.

2Stop or cut back on drinking coffee or tea.3Pass on the grape juice. And that includes red wine!4Stay away from curry.5Brush your teeth immediately if you choose to partake in any of the items just mentioned.
Whitening Toothpaste1 Find commercial toothpastes with chemical tooth-whitening agents. Look for a toothpaste with American Dental Association approval, and use it regularly.2Make your own whitening toothpaste, but see the warnings first. Mix one tablespoon of baking soda and 2 tablespoons of hydrogen peroxide to make a paste.
Whitening Kit1 A whitening kit.Use a whitening kit according to package directions. You can look for an over-the-counter whitening product with ADA approval, or you can ask your dentist about professional whitening treatments. In general, use a whitening kit as follows:
Brush and floss your teeth as usual.

Insert the whitening gel into the mouth tray. Put a teardrop-sized quantity of whitening gel in each compartment. Use the same amount in each tooth compartment for uniform whitening of all your teeth.
Don’t apply too much gel. It could squeeze out of the mouthpiece and irritate your gums, aggravating any existing condition. Avoid contact between the whitening gel and the gums. Do not use the whitening gel in any method other than the directions provided on the packaging.
Place the whitening tray in your mouth slowly and ensure it is snug to your teeth. Often whitening trays can be formed to fit your teeth by placing them in hot water for a minute or less. Follow directions for the tray if the whitening kit you purchased includes this feature.
Leave the whitening trays in your mouth for the recommended time in the kit’s directions.
Remove the trays and wash them with cool water. Store them in a clean, dry place.
Rinse out your mouth and brush your teeth again to remove all excess whitening gel

Tobacco, coffee, cavities, aging and drugs can stain teeth. Treatment for discolored teeth depends on the magnitude of the stain; remedies appear here in order of increasing intensity.
Difficulty: ModerateInstructions
Step 1Brush and floss regularly to reduce or prevent stains.

Step 2Try whitening toothpastes. Though heavily advertised, these only partially whiten teeth and don’t provide a complete remedy. Make sure the toothpaste has the American Dental Association (ADA) seal of approval and has been clinically proved to whiten teeth effectively. Very few whitening toothpastes have undergone any type of clinical trial, and ones that are too abrasive can damage teeth or make them very sensitive.

Step 3Get regular dental cleanings, which remove many food and tobacco stains. No amount of cleaning will remove the severe staining left by tetracycline or systemic disease because these pigments lie inside the tooth; you’ll have to take more aggressive measures against these.

Step 4Consider the two options, in-office and at-home treatments, for bleaching your teeth. A dentist performs in-office treatments by coating the teeth with a bleaching agent, then using periodic flashes of light to activate the solution. Treatments last 30 to 60 minutes, and the complete procedure often requires several appointments. In at-home treatments, patients wear a mouth guard fitted with bleaching gel 2 hours a day for two weeks, depending on the severity of staining.

Step 5Think about getting veneers, which are custom-made shells bonded to the teeth with resins. This procedure often requires removing a small amount of tooth structure and is the most invasive, as well as the most expensive, treatment option.

Tips & Warnings

No bleaching method can permanently whiten teeth, and all require repeated treatments, especially if the factor that caused staining still exists.All of the bleaching mechanisms described here can cause tooth sensitivity, usually temporary (lasting up to several weeks).Never try to remove or scrape off stains with your fingernails or other sharp objects.The ADA and the U.S. Food and Drug Administration discourage use of over-the-counter bleaching kits, which can damage your gums.

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Summary

Baby teeth, more accurately called primary teeth or deciduous teeth, are a person’s first set of teeth. They begin to form during the first trimester of pregnancy (first 12 weeks) and begin to emerge (erupt) through an infant’s gums around 6 months of age. All twenty primary teeth are typically fully erupted by the time a child is 3 years old and are later replaced by 32 permanent teeth.

Primary teeth have several functions. They help with biting and chewing, which contributes to good nutrition, and are crucial to a child’s ability to speak. They serve as a guide for permanent teeth to erupt and grow while maintaining the space. They also make a child look more attractive by supporting the shape of the face.

Proper dental hygiene is important for primary teeth, even though they eventually will be replaced by permanent teeth. Poor maintenance of baby teeth can cause them to fall out early, which in turn can cause permanent teeth to erupt prematurely and not in correct position.

If teeth are discolored when they erupt, it might indicate an underlying medical problem. Like permanent teeth, primary teeth are also vulnerable to plaque, a clear film that sticks to teeth and attracts bacteria and sugar. This can lead to cavities. Primary teeth are vulnerable to various injuries that can cause them to chip, fracture or completely come loose.

Proper care can help avoid many of the problems that sometimes affect primary teeth. After primary teeth begin to appear, they can be brushed with a soft children’s toothbrush. According to the American Dental Association (ADA), toothpaste should not be used until the child is 2 years old. As soon as two teeth erupt next to each other, they should be flossed at least once daily. Children who take good care of their teeth form habits that help keep their teeth healthy for a lifetime. Proper maintenance and care of all teeth remains crucial to maintaining good dental health.

About baby teeth

Baby teeth, more accurately known as primary teeth or deciduous teeth, are the first of two sets of teeth that people develop during their lifetimes. They begin to form during the first trimester of pregnancy and have fully formed by the time an infant is born. However, primary teeth usually remain hidden under the gums until they begin to emerge (erupt) between 5 months and 8 months of age. This process is known as teething.

A human tooth is composed of several parts:

Crown. Part of the tooth that is visible above the gum line.

Enamel. The hard, translucent outer shell that covers the crown. The enamel is hard enough to handle the strain of a lifetime of biting, chewing and grinding. It also protects the tooth from bacteria and changes in temperature when eating hot or cold foods. Nonetheless, it is brittle and may crack or chip.

Root. Part of the tooth that pushes into the upper (maxilla) or lower (mandible) jawbone. Each root has a tiny opening at the bottom called the apical foramen. Blood vessels and nerves enter the root through this space.

Cementum. Hard shell that covers the root and attaches to fibers that fasten the root to the jawbone.

Dentin. Layer of the tooth found beneath the enamel and the cementum. It makes up most of the tooth’s structure and is responsible for the tooth’s color. It typically has a whitish to yellowish hue.

Pulp. Located beneath the dentin at the core of the tooth. It is made up of blood vessels, nerves and connective tissue. The blood supply of the pulp provides the nutrients that keep the tooth alive. The pulp is made up of two parts. The pulp chamber is found in the crown of the tooth. The root canal is the part of the pulp located in the root of the tooth, where blood vessels and nerves enter the tooth.

Twenty primary teeth – eight incisors (four front teeth on both the upper and lower jaw), four canines (located in the front of the jaw behind the incisors) and eight molars (larger teeth in the back of the mouth) – typically erupt by the time a child is 3 years old. Eruption of the lower teeth generally precedes eruption of the top teeth. Eruption times for girls are generally earlier than those for boys.

The following schedule for the top primary teeth was established by the American Dental Association (ADA):

Central incisor: 8 months to 12 months
Lateral incisor: 9 months to 13 months
Canine (cuspid): 16 months to 22 months
First molar: 13 months to 19 months
Second molar: 25 months to 33 months
Eruption of the bottom primary teeth occurs as follows:

Central incisor: 6 months to 10 months
Lateral incisor: 10 months to 16 months
Canine (cuspid): 17 months to 23 months
First molar: 14 months to 18 months
Second molar: 21 months to 31 months
The first primary teeth to emerge are usually the bottom two incisors, followed by the top four incisors and then the rest of the bottom incisors. After the incisors the rest of the primary teeth begin to fill the mouth, usually with two developing at a time. The roots of primary teeth are 50 percent formed when eruption first begins, and roots are completed by the time a child is between the ages of 18 months and 3 years.

Primary teeth have several roles. They help with biting and chewing, and are crucial to a child’s ability to speak. They may also make a child appear more attractive. Finally, primary teeth serve as a guide for permanent teeth. For this reason, primary teeth usually have more space between them to allow permanent teeth more room to erupt.

Primary teeth are smaller and whiter than permanent teeth. Some of the other ways in which primary teeth differ from permanent teeth include:

Crowns are shorter in primary teeth

Enamel depth is more consistent and thinner in primary teeth

Pulp chambers of primary teeth are larger relative to the size of the tooth

Roots are longer and more slender in primary teeth
Eventually, a child’s primary teeth begin to fall out. The middle teeth in front (incisors) typically fall out at age 6. Molars in the back are shed between the ages of 10 and 12. By age 13, children usually have their permanent teeth.

A total of 32 permanent teeth replace the original 20 primary teeth. Meanwhile, permanent first and second premolars (bicuspids) replace the primary first and second molars and permanent incisors and canines replace primary incisors and canines. The permanent molars which grow towards the back of the mouth do not replace baby teeth. This is why there are more teeth in permanent dentition.

Potential problems with baby teeth

Although a child’s baby teeth, or primary teeth, eventually will be replaced by permanent teeth, it is important to care for these initial teeth. When primary teeth emerge, they should be off-white or ivory in color. Teeth that erupt with a black tint or another color usually indicate an underlying problem. Most often, this is the result of plaque growing on the teeth due to a build-up of bacteria in the child’s mouth. Liquid medications containing iron, some antibiotics and certain supplemental vitamins also can cause this effect. Other potential causes of discoloration include:

Chronic illness or recurrent fevers

Excessive fluoride, which may cause bright white spots (fluorosis)

Injury to the teeth, which may cause pink or grayish discoloration

Jaundice in newborns, which may cause yellowish or greenish tint

Use of the antibiotic tetracycline by the mother during pregnancy
Poor maintenance of primary teeth can result in premature loss either naturally or by extraction. This can cause a change in the eruption schedule of the permanent teeth, which may lead to space problems for proper eruption. The permanent teeth may erupt crooked and misaligned.

Primary teeth are also vulnerable to dental plaque, a clear film that sticks to teeth and attracts bacteria and sugar. As the bacteria feed on the sugar, they are broken down into acids that eat into the enamel of the teeth. This causes cavities in the teeth, which can be painful. In addition, plaque can cause gums to become red, swollen and sore. This condition is known as gingivitis, or gum disease.

The first risk to a child’s primary teeth often comes in the form of baby bottle tooth decay (baby bottle syndrome or bottle mouth). This condition results from leaving a bottle in a baby’s mouth for long periods of time while the baby sleeps. Sugars from milk or juices that bathe and remain on the teeth for hours at a time begin to eat away at the enamel. Pocked, pitted or discolored front teeth are signs of the condition. In its most extreme form, this condition can lead to a need to pull a baby’s front teeth until permanent teeth grow in. As a rule, parents or caregivers should only allow a baby to have a bottle during meals, and to fill the bottle only with water if it is used at night.

As children grow older, the primary teeth remain at high risk for cavities. Cavities are one of the most common chronic conditions among children in the United States, according to the American Academy of Pediatrics. Among 3-year-olds, 18.7 percent have at least one tooth with a cavity that has yet to be treated. By the time a child is 8 years old, 51.6 percent have an unfilled cavity or at least one filling. Children who were born prematurely or who had a low birth weight are at increased risk for cavities. Other factors that increase the risk of cavities include:

History of ongoing health care needs
White spots or brown areas on teeth
Failure to regularly see the dentist
Inadequate brushing and flossing regimen
Poor socioeconomic status
Diet that includes too many sugary foods and drinks
Primary teeth are also vulnerable to injuries that can cause them to chip, fracture or completely come loose. Usually, an injury causes baby teeth to loosen rather than fracture. These injuries often occur as the result of falls, mishaps during play or accidents during athletics. If a child suffers an injury to the gums or a baby tooth that causes bleeding, parents may be advised to run cold water over a piece of gauze and apply pressure gently to the injury site. Sucking on an ice pop may be recommended to reduce swelling until the child can see a dentist.

Baby teeth that are knocked out do not require special care after they come loose, unlike permanent teeth, because they cannot be reimplanted. Reimplanting a baby tooth can damage developing permanent teeth and often results in death of the pulp.

Nonetheless, a child’s tooth injury usually requires a visit to a healthcare professional. In many cases, consulting the dentist is the best option. However, a visit to a hospital emergency room may be necessary if the child has suffered a blow to the head, which can be life-threatening, or an injury to another body part. In some cases of primary tooth loss, a dentist may use a space maintainer to keep the area open until the permanent tooth erupts.

Caring for your child’s teeth
Published by Bupa’s health information team, March 2009.

This factsheet is for people who would like information about caring for their child’s teeth.

Caring for a child’s teeth from an early age will help him/her to grow up with healthy teeth and gums. Diet, oral hygiene and visits to the dentist are all important in helping to care for a child’s teeth.

About your child’s teethWhat can damage my child’s teeth?How can I protect my child’s teeth?Further informationQuestions and answersRelated topicsSourcesAbout your child’s teeth
Children’s teeth start to develop before birth. There are two sets of teeth: “milk” teeth and permanent teeth.

Milk teeth
Children usually have 20 milk teeth. They start to push through the gums (erupt) at about six months. Most children have all 20 teeth by the age of two or three. The last milk tooth will fall out at around the age of 12.

Your child’s milk teeth are important for his/her eating, speech, smile and confidence. They are also important for the development of his/her permanent teeth, so it’s very important to look after them.

Permanent teeth
Permanent teeth usually start to erupt at the age of six. Adults have up to 32 permanent teeth.

Most of these will erupt by the age of 13. However, wisdom teeth (those at the very back of the mouth) often don’t erupt until the early- to mid-twenties, if at all.

If your child’s permanent teeth are damaged or need to be removed, there won’t be another set of natural teeth to replace them.

What can damage my child’s teeth?
Many children fall over and bump their teeth accidentally. If this happens to your child, take him/her, and the tooth if it has been knocked out, to the nearest dentist for advice.

Tooth decay and dental erosion are two preventable causes of damage to children’s teeth.

Tooth decay
Our mouths are full of bacteria that build up on the teeth in a sticky layer called plaque. These bacteria digest some of the sugar in our food and drinks, making acids that can weaken the tooth enamel (the hard outer layer of teeth). If acid remains on the tooth surface for a long time, it can cause those areas of the tooth to decay. This can happen if children often have sugary foods or drinks, or don’t clean their teeth properly.

If your child has tooth decay that isn’t treated by a dentist, it will eventually reach the centre of the tooth and can cause an infection or toothache.

Dental erosion
Dental erosion is the gradual wearing away of the enamel on the whole surface of the tooth. It’s caused by acid attacking the surfaces of the teeth. These acids usually come from drinks such as fruit juices, fizzy drinks and squashes – even the sugar-free varieties. These drinks are so popular that over half of all five-year-olds in the UK have some dental erosion. Acids can also be produced if your child vomits or has stomach problems.

Dental erosion can cause sensitivity and pain. Although enamel doesn’t grow back, it doesn’t usually need treatment. If your child has a seriously eroded tooth, his/her dentist may protect the tooth with a filling.

How can I protect my child’s teeth?
To reduce your child’s risk of tooth decay and dental erosion:

take your child to the dentist regularly
don’t give him/her too many sugary or acidic foods and drinks
encourage your child to brush his/her teeth twice a day with at least 1,000ppm fluoride toothpaste
encourage your child to spit out toothpaste and not rinse with water, as this reduces the effect of the fluoride
take advice from your dentist about protective treatments such as fluoride supplements and fissure sealants (see Fissure sealants)
Going to the dentist
It’s a good idea to take your child when you go for your routine dental check-ups, even when he/she is too young to have teeth. This helps your child get familiar with the people and the surroundings at the dental surgery. Your dentist will look in your child’s mouth in an informal way, and may count how many teeth have erupted and spot any early signs of decay. Quick check-ups like this help to encourage good cooperation with the dentist when your child is older.

Your dentist will recommend check-ups at intervals suitable for your child. He/she may take X-ray images to check for decay. Children usually need dental visits more often than adults. Milk teeth are smaller and have thinner enamel than permanent teeth, so decay can spread very quickly. Regular check-ups help your dentist to help you prevent and treat decay before it causes toothache.

Diet
Reducing sugar in your child’s diet is the best way to prevent tooth decay. However, it’s how often your child eats sugar (rather than how much) that is important. Similarly, it’s how often your child has acidic food and drinks (rather than the amount) that affects dental erosion.

Keep squashes, fizzy drinks, natural fruit juices, sweets and cakes to a minimum. Don’t give your child sugary foods and drinks as snacks between meals or before bedtime. Watch out for hidden sugars in sauces, breakfast cereals, etc.

Fruit, vegetables, cheese and milk are all healthier snacks because they contain natural sugars. Remember, however, that as well as natural sugars, fruit contains acids, which can cause decay if eaten in large amounts. You can help to protect your child’s teeth against erosion by finishing a meal with an alkaline food such as milk or cheese. This will neutralise the acid in your child’s mouth.

Older children can chew sugar-free gum after meals, especially containing Xylitol, as this helps prevent tooth decay.

Plain water and plain milk doesn’t cause tooth decay or erosion. Your child may find it hard to drink plain water or milk if he/she usually has sweet drinks, but most children get used to it over time.

Toothbrushing
You should start cleaning your child’s teeth as soon as they come through the gums. There are special toothbrushes for babies.

Make toothbrushing a regular activity, after breakfast and before bedtime, so that it becomes part of your child’s daily routine. Don’t brush for one hour after eating or drinking anything acidic.

When your child is about seven years old, teach him/her how to brush his/her own teeth, using a gentle, circular motion and fluoride toothpaste. You should supervise your child while he/she is learning to brush his/her teeth. Give your child plenty of encouragement and praise. It’s a good idea to check how well he/she is getting on every few days.

Disclosing tablets are small pills that, if chewed for 30 seconds, turn plaque a bright colour – usually pink. This can help you show your child any areas that have been missed when brushing.

Toothpaste
Most toothpaste contains a mineral called fluoride, which strengthens the tooth enamel making it more resistant to decay. Fluoride is also added to the water supply in some parts of the country. In these areas, there has been much less tooth decay.

However, too much fluoride in young children can result in a spotted appearance on their permanent teeth (dental fluorosis).

The amount of fluoride in different brands of toothpaste varies. Children aged up to three years should use toothpaste that contains 1,000ppm fluoride. Children over three years should use toothpaste that contains between 1,350 and 1,500ppm fluoride. Ask your dentist which is the best toothpaste for your child.

If your child is less than two years old, only use a smear of toothpaste. After that, use an amount about the size of a small pea.

Fluoride supplements
If you live somewhere where there is no fluoride in the water or if your child’s teeth are particularly at risk of decay, your dentist may recommend extra fluoride in the form of tablets, drops or mouthwashes.

Fissure sealants
Some children have very deep fissures (crevices) in their permanent back teeth, which can be difficult to keep clean. These fissures can be sealed with a resin film to protect the surface from decay.

Fissure sealants are quick and painless to apply. The dentist cleans the tooth with a special acid, then washes and dries it. The resin is then painted on to the tooth and hardened with a bright, blue light.

Fissure sealants can last for several years but regular visits to the dentist are needed to check that they haven’t worn through. Children with fissure sealants still need to brush their teeth with fluoride toothpaste.

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Cracked and Fractured Teeth

Because people are living longer and dentists are helping keep teeth longer, teeth are being exposed to years of crack inducing habits. Particularly, clenching, grinding, and chewing hard things such as ice can result in cracks and fractures in teeth. Typically teeth with cracks/fractures do not show on radiographs (x-rays). Hence, cracked and fractured teeth can especially be difficult to locate. When the outer hard tissues of a tooth are fractured or cracked, chewing can cause movement of the pieces and the pulp becomes irritated. Often this results in a momentary, sharp pain which eventually progresses to include thermal sensitivity. In time the cracked or fractured tooth, similar to other teeth with pulp degeneration, can begin to hurt on it’s own.

How do I know if my tooth is Cracked or Fractured?

Does your tooth feel like it “zaps” you when bite on it? Well, that’s not enough to know it’s cracked or fractured. Unfortuantely, cracked and fractured teeth exhibit a variety of symptoms. If your tooth is cracked/fractured, you might feel occasional pain when chewing, particularly between bites as you release the pressure on your teeth. You might also feel pain when you eat or drink something hot or cold. Cracks and fractures are fairly difficult to diagnose because the pain comes and goes, and cracks/fractures only rarely show up on x-rays. Because of this, you may see your dentist several times before the crack is diagnosed.

Don’t all Cracked/Fractured teeth hurt?

Not all cracked and fractured teeth hurt. It really depends on the severity of the crack and the pulps response to the irritants allowed into the tooth. Commonly it’s not until they become symptomatic that we get involved. A crack/fracture can make the tooth sensitive due to movement of the fractured tooth pieces and/or leaking irritants into the pulp and even allow bacteria to come right in causing eventual infection of the tooth. Let’s take a closer look at a normal healthy tooth.

Inside the tooth, under the white enamel is a hard layer called the dentin, and there is the inner soft tissue called the pulp. The pulp contains blood vessels, nerves, and connective tissue. The pulp is a vestige of what originally formed your tooth when you were a kid!

When the outer hard tissues of the tooth are cracked, the chewing can cause movement of the pieces, and the pulp can become irritated. When biting pressure is released, the crack can close quickly, resulting in a momentary, sharp pain. Irritation of the dental pulp can be repeated many times by chewing. Eventually, the pulp will become damaged to the point that it can no longer heal itself. The tooth will not only hurt when chewing but may also become sensitive to temperature extremes. In time, a cracked tooth may begin to hurt all by itself. Extensive cracks can lead to infection of the pulp tissue, which can spread to the bone and gum tissue surrounding the tooth.

How can you check to see if my tooth

has a crack and/or fracture?

No single test or technique provides the correct diagnosis 100% of the time. In fact, if a restoration is present, it can become quite difficult to diagnose without removing the restoration or drilling a hole into the tooth. Most of the time we use a transilluminating light and see if the light transmits from one side of the tooth to the other. Of course, fillings don’t transmit the light the same so it’s even harder to tell when cracks or fractures are present in teeth with restorations. A trained eye can spot the difference.

Normal tooth
Probable cuspal fracture
A biting test can be performed. We concentrate the biting forces commonly using an instrument as seen below. This can isolate specific areas of the tooth that might be sensitive to bite, but does not tell us the underlying cause of the discomfort.

Tooth Slooth Biting Test on each Cusp
Sometimes some dye might be used to temporarily stain the tooth, and check to see if a tooth is fractured. It is then washed off and evaluated. This is most commonly done once access to root canals is obtained.

Stained Cracked Tooth

(Blue Stain Can be fully removed after diagnosis)

Are All Cracks and Fractures

seen on the outside of teeth Bad?

Craze lines are tiny cracks that affect only the outer enamel of the tooth. They are common in all adult teeth and cause no pain. Craze lines need no treatment. They do NOT extend into dentin. Hence, these cracks are observed in most teeth and are considered normal. They are the result of “wear and tear” on teeth.
Hence, the answer is no, not all cracks seen on the outside of teeth are bad.

Does my Cracked or Fractured tooth need to be Treated?

That depends. If the crack/fracture is caught early enough, often times only a restoration that holds the tooth together will be needed. Once the pulp begins to degenerate and/or becomes infected, it must be treated endodontically if the tooth is going to be maintained. Like cracks in a windshield, cracks in teeth can often remain small or progress slowly over time. I believe that the sooner a crack or fracture is detected and appropriate treatment delivered, the better the chance of maintaining your tooth.

How will my cracked/fractured tooth be treated?

The treatment of your cracked tooth depends on the

type, location, and severity of the crack.

All of the common cracks and fractures of the crown region start on the surface and work there way into the tooth toward the end of the root.

Common Cracks and Fractures of the Crown region

(Top Part of the tooth above the gumline)

Cuspal Fracture
Cracked Tooth Split Tooth

Cuspal Fracture: When a cusp or the pointed part of the chewing surface of your tooth becomes weakened, the cusp will fracture. Part of the cusp may break off or may need to be removed by your dentist. Depending upon the extent of the fracture, the pulp may also become damaged. Endodontic therapy is needed when the pulp is damaged beyond repair and a crown will be placed to help protect the tooth and replace the fractured tooth structure.

Cracked Tooth: This type of crack extends from the chewing surface of the tooth vertically towards the root and sometimes below the gum line. A cracked tooth is not completely split into two distinct movable segments. If caught early enough, the tooth is usually crowned but endodontic therapy may be needed at a later date (typically in the first 6 months). Nonsurgical endodontic therapy (root canal) will be needed when the pulp becomes substantially injured or exposed. During endodontic therapy the inside crown portion of the tooth is stained with a temporary dye and viewed microscopically for the extent of the fracture. Prognosis depends on the severity of the crack. A full crown is needed to hold the tooth together.

Split Tooth: A split tooth is a cracked tooth in which the crack has progressed so there are 2 distinct segments that can be separated from one another. Unfortunately, with today’s technology, a split tooth can never be saved intact. The extent and position of the crack will determine if any portion can be maintained but most of these teeth will be extracted. In rare instances, endodontic treatment, possibly some gum surgery, and a crown may be used to retain a portion of the tooth.

After treatment for a cracked tooth, will my tooth completely heal?

Unlike a broken bone, the fracture in a cracked tooth will never completely heal. In fact, even after treatment, it is possible that a crack may continue to worsen and separate, resulting in the loss of the tooth.

The treatment you receive for your cracked tooth is important because it will relieve pain and reduce the likelihood that the crack will worsen. Once treated, most cracked teeth continue to function and provide years of comfortable chewing. Talk to your dentist and/or endodontist about your particular diagnosis and treatment recommendations. They will advise you on how to keep your natural teeth and achieve optimum dental health.

How long will a cracked or fractured tooth last?

Good question. I don’t have a really good answer though. It seems somewhat related to if the crack/fracture extends below the gum line alot. The problem is it’s like a crack in a windshield, it can stay the same or spread. This means it’s difficult to predict how long a fractured/cracked tooth will be maintained in your mouth. I’ve got one and have had the tooth for 13 years without any problems, but I can’t say if that’s what will happen in your case. The good news is they have good success rates, typically 70% I believe.

What can I do to prevent my teeth from cracking?

While cracked teeth are not completely preventable, you can take some steps to make your teeth less susceptible to cracks.

Don’t chew on hard objects such as ice, unpopped popcorn kernels or pens.

Don’t clench or grind your teeth.

If you clench or grind your teeth while you sleep, talk to your dentist about getting a retainer or other mouthguard to protect your teeth.

Wear a mouthguard or a mask when playing contact sports.

If you experience symptoms of a fractured or cracked tooth, see your dentist immediately. If detected early, a cracked/fractured tooth can often be more likely to be maintained.

Fractures of the Root which start below the Gumline

Vertical Root Fractures or ‘Split Root’

VRF

Signs & Symptoms Typically symptoms are associated with a tooth that has had endodontic therapy. If you have persistent symptoms which do not appear on a radiograph or x-ray, you tooth may have a tiny fracture in the root but keep in mind other causes can produce the same symptom. Also these teeth commonly present with bone loss around an entire root in more advanced fractures and often go unnoticed until surrounding bone and gums become infected.

Causes Commonly a complication from endodontic therapy. Sometimes believed to exacerbated by large post placement.

Diagnosis In many cases, endodontic micro surgery allows the visualization of your root to determine the problem. The gums are reflected to expose the root and a stain or dye used to make the fracture more noticeable. Sometimes during the retreatment process, the use of a microscope can detect the fracture as long as it’s not around a curve. If a fiberscope can be placed, that may also be used for diagnosis of this type of fracture.
Direction of Fracture Vertical root fractures begin in the root typically near the end and extend toward the chewing surface.
Treatment Treatment for a single rooted teeth is usually extraction. Multirooted teeth may have the affected root removed in some cases.

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Craze lines

Most adults have have craze lines and they cause little concern. They are tiny cracks that only affect the outer enamel of the tooth, are painless and may affect the cosmetic appearance of the tooth. These lines allow light to pass through them to light up the whole crown of the tooth. If there is a crack, light will not pass through.

Fractured Cusp

When a cusp becomes weakened, a fracture may result. A fractured cusp rarely damages the pulp. This tooth will need to be restored with a full crown.

Cracked Tooth

This type of crack extends from the chewing surface of the tooth and vertically migrates towards the root. Damage to the pulp is common. A root canal treatment is usually necessary. A cracked tooth that is not treated will worsen, resulting in the loss of the tooth.

Split Tooth

A split tooth is usually the result of an untreated cracked tooth. It can be identified by a crack with distinct segments. The position and extent of the problem will dictate whether any portion of the tooth can be saved.

Vertical Root Fracture

A vertical root fracture begins at the root and extends towards the chewing surface of the tooth. Treatment may involve root surgery if a portion of the tooth can be saved extracted.

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Cracked Tooth Syndrome

Cracked tooth syndrome is a very common problem that affects teeth that have large fillings in them. Decay and large fillings causes a weakening in the remaining tooth structure over time. A hairline fracture often develops at the bottom corner of the filling.

Grinding your teeth will cause massive increase in the stress and stain on your premolars and molars increasing the risk of this condition. Also, having worn down fillings or canines will increase your risk factors toward this condition.

The reason it hurts to bite when you have a cracked tooth is the fact that your tooth is flexing which microscopically stimulates the nerve in the tooth. These hairline cracks open and close which applies pressure on tubules that run down the nerve of the tooth causing fluid to push and pull on the tooth’s nerve resulting in pain. The nerve in the cracked tooth is also being exposed to bacterial toxins that become inflamed making it sensitive allowing infection to spread to the nerve and bone tissue underneath resulting in an abscess. If the crack goes untreated it will spread and deepen like a crack in glass and a part of the tooth may break off causing a need for a root canal or extraction.

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Symptoms:

Sensitive to hot and cold
Pain upon release of biting pressure which may come and go when you release from biting because the crack will close quickly causing pain.

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Clinical Test To Check Diagnosis

The only way to diagnose a fracture is through interpreting a tooth’s response to temperature and touch.

Thorough dental history.
Check for a history of trauma, clenching or bruxism and chewing habits like, ice
History of bite adjustments
Examine the teeth with an explorer
Check hot and cold sensitivity. If a sharp pain is felt with temperature, and the pain rapidly diminishes with removal of the stimulus, then a fracture is more likely.
Probe the gum tissue for pocketing
Check for a cracked filling
Using a cotton roll, rubber wheel or bite stick, you will be asked to bite down liken on chewing gum to help isolate each tooth
X-ray films.
A filling might need to be removal to help visualize the crack and assess nerve involvement.

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Solution

A fracture will probably not improve and will eventually need to be treated. Teeth do have a limited ability to heal themselves. Unfortunately, fractured teeth do not heal themselves like other bones in your body. The only real solution to hold the tooth together and to prevent the tooth from breaking is with a crown. A crown will allow chewing forces to move the whole tooth rather than splitting it apart. This full crown is bonded over the entire tooth to seal all the small cracks and prevent bacterial leakage thus allowing the nerve to recover and stabilize.

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Considerations

About 10% of cracked teeth have nerves that can still die and need root canal treatment. Early treatment can help to minimize this from happening. If you decide to refuse treatment for this condition remember that that tooth is like a ticking time bomb that will suddenly flare up and cause sever pain, swelling, pus and possible bone loss that will put stress on your immune system and may affect your overall health.

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Broken Tooth What causes teeth to break?

One factor is silver fillings. These fillings have been found to enlarge as they age which may cause some outward pressure as you chew or bite. Over time this can cause a broken tooth. A more common type of fracture is when the inside area of the tooth breaks off, this fracture can usually be easily repaired. Bruxism is one of the most common causes of teeth breaking.

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The dental aesthetic care

A bright smile rhyme often with confidence, beauty and health. The dental aesthetic care is, for simplest of them, with the range of all. Then why to deprive itself some? All that it is necessary to know before jumping the step and posting your more beautiful smile.

Principal dental aesthetic treatments

To find a bright smile, your dentist can transform himself into true magician. If you don’t support the spectacle of ageing on your teeth, discover the keys of the aesthetic treatments.

The bleaching of the teeth

You dreamed of a luminous smile, underlined by an enamel with marked whiteness? The current methods and products don’t cease progressing while respecting your teeth. Care in professional cabinet with the kit of bleaching in residence, turn of horizon of the techniques which go. ?

Beautiful well aligned teeth

Difficult to accept a treatment orthodontic for young people as for the adults. And yet if the port of the rings is neither aesthetic nor pleasant, the utility of these dental apparatuses is not any more to show and the results are generally impressive.

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Broken teeth: good reflexes

A dental traumatism, that the tooth is or not broken, is always an urgency. Indeed more the assumption of responsibility is fast, plus the chances to recover the tooth in good state of operation are large. In practice, when the tooth was expelled under the effect of the shock, it must be reimplanted in the 20 minutes. The child can keep it in his mouth, in contact with his saliva, while waiting for the intervention of the dentist.

It must of course pay attention not to swallow it. For this purpose, one can wrap it in a gauze for example. Another medium favorable to the transport of the tooth, the milk or the physiological salt solution, which makes it possible to gain a few additional minutes.

To react quickly

If the tooth is broken and that only a fragment can be restuck, it is appropriate, there still, to preserve the piece ” in mouth”. The circumstances are then ideal and quasi-immediate repair, especially if the fracture interests pulp. There exist now adhesives and composites making it possible to restick the fragment or to reconstitute the tooth if the piece were lost.
Radiographies are in any event necessary to make sure of the integrity of the close teeth. We can thus eliminate the possibility from a fracture of the root even if the teeth are apparently not broken. It isn’t question of awaiting the end of the day to occupy itself some if the accident occurred in the morning: no dentist you will want some to upset his program for this reason.

Good reflexes

When the tooth was expelled, it is positioned back after disinfection then an application (i.e. an immobilization) is carried out with a small wire maintained by composites, operation close to the application of an articulation. If the teeth must necrose, to die, they in general make it in the six-month period following the shock. That justifies visits of monitoring to regular interval, up to two to three years after the traumatism. A change of color isn’t a good sign.

Finally a dental traumatism is never banal, whether it affects the teeth baby or the teeth permanent. The final tooth bud can suffer from the expulsion or the intrusion of a baby tooth. If, in addition, nothing were done on this baby tooth and if an abscess occurs, the germ becomes also vulnerable.

The dental traumatism is public health problems; it relates to a great number of children and the prevention of the complications is possible… on the condition of being informed. In these some figures testify: 20 to 30% of the 12 year old children present a traumatism of the permanent teeth and a third of the preschool childs already underwent a traumatism of the temporary teeth, or teeth baby, often related on the training of walk, the accidents in the home or the plays of playground… The teeth most often broken are the incisors and the canines of the upper jaw.

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To prevent the dental caries
As of more the young age, we learns how to fear the decay. Rather than to apprehend the dental care, we may find it very beneficial to warn these unpleasant intruders suitably? In finishing with the decays isn’t impossible.

Preserve the smile of your child

Your child must face a frightening enemy: the dental carie. To avoid useless sufferings and expensive care, best protection remains the prevention. With Doctissimo, discover all the councils to preserve the smile of your small child.

The decay: rather to prevent that to suffer

This is the chronic disease of man most common. It touches the baby teeth as well as the final teeth and as well the man as the children.

Dental carie and food

Formerly, sugar was regarded as an exceptional food and was reserved to the patients or soup at the time of the festivals. For a long time, the dental carie touched only the adults, and it started to parallel to reach the children the development of sugar industry.

End of the decays in Europe?

The strident noise of the strawberry… this memory still freezes you blood! But this technique is about definitively to fall into the oubliettes! The prospect for living with healthy teeth and finishing its life with an impeccable smile could become a reality in Europe.

Acid attacks

The acids weaken the teeth by causing a demineralization of enamel. This demineralization is the first stage of the decay or disease of the tooth.

Decays: The adults aren’t saved!
” Stop the sugar refineries and brushes the teeth! “. These advised councils of your childhood allow to prevent the decays. Will know that they are still valid with adulthood, because the decays attack without understanding. With Doctissimo, preserve your smile!

Treatment of the dental caries
Decay, a word which often makes quiver because it leads inevitably to a visit in the dentist. No panic, first the prevention avoids good number; enter they. Lastly, the dentists are better and better armed for good to look after you, without pain!

M’ T teeth: the Health insurance takes care of the teeth of your child

Since 2007, the Health insurance offers to the children and teenagers of 6,9,12,15 and 18 years of the free consultations of prevention. So that your children
don’t haven’t toothaches and that they can take care day of it after day, don’t miss these go prevention offered.

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Stop with squeakings of teeth! The bruxism defines any squeaking or squeezing of the teeth ” with vide” , this is to be said apart from the phases of chewing and swallowing. The consequences are minor when the phenomenon remains occasional. But it if persists, the damage can be irreversible.
Used, sensitive teeth? Muscular pains and crispations of the jaw to the alarm clock? Perhaps you suffer from bruxism. Characterized by an inopportune squeaking of the teeth, the day or the night, this pathology often related to the stress would touch nearly 6% of the French.
The squeaking of teeth
The bruxism concerns the children as much as the adults. It can appear the day or the night. when it is diurnal, the person is conscious of the pressure that she exerts on her teeth. The will is thus enough to slacken the jaw. But in 80% of the cases, the bruxism is night and that poses more problems. Indeed, the ” bruxomane” doesn’t have conscience of its crispation mandibulaire.
During the night, ” a person reached of bruxism can rub her teeth during 6 to 8 minutes; sharpened! ” entrust Professor François Unger of the French dental association (ADF). We distinguishes two types of bruxism. When the person exerts a pressure without frictions, the bruxism is known as ” centered”. If the pressures of the jaw are accompanied by squeakings of teeth, one speaks about bruxism ” excentered”.
How to know if we suffers from bruxism?
Majority of the ” bruxomanes” squeak of the teeth during their sleep. When frictions make noise, this is often the spouse who detects the disorder. If the tension exerted by the jaw isn’t accompanied by noises, characteristic symptoms can alert. The alarm clock is often doubled pains with the jaw and migraines.
Any suspected bruxism must be confirmed by a visit in the dentist who will measure the dental wear. But the pr. Unger specifies that ” the bruxism isn’t a disease and that its intensity can vary in time for same a individu”.
Stress with the origin of the bruxism
Two causes can explain the cases of bruxism: the deterioration of the closing of the teeth and the stress. When the teeth are badly aligned or that some are absent, the contact between the teeth is unstable and the patient says ” obstructed”. By reflex, it tends to rub and tighten its teeth to use the teeth which disturb it .

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Phobia of the dentists in the children
The parents play a big role in the preparation of their child to return the first visit in the dentist a pleasant experiment. Any form of anxiety expressed by a relative will be perceived by the child.

The Councils for a pleasant first visit
- To speak with child of the visit in the dentist, by limiting the details. To answer any question by simple answers. To leave the dentist or the pedodontist (specialist for the children) to answer the more complex questions. These professionals are involved to describe the instruments with the children of a way less threatening and in a more comprehensible language.
- Never not to say to child that something will cause pain or will hurt.
- Never not to tell at child an unpleasant experiment that the relative had in a dentist.
- To put emphase on importance of dental hygiene of child at the house, and to explain that the dentist is a friendly person which ensure that the methods of hygiene are good.
- Not to promise a reward after the visit in the dentist. You should be remembered; it is normal that a child either more or less apprehensive, or because that he is separated from the relative, that is to say by fear of unknown. A dentist who treats the children knows how to react with those who are apprehensive, and has the abilities to put them at ease.

Methods to calm the child

Fears of the children can be expressed in several ways. Some cry, of others launch objects. The dentist could use several techniques to calm child:
- Control voice. The dentist can use a soft and friendly voice, making it if necessary firm.
- Simple instructions. The dentist uses simple words, and can show an example on an object or a mannequin before treating the child.
- Distraction. The dentist can tell a history to divert attention of child.
- Sedation. The dentist or the pedodontist can use sedation to help to calm a child more agitated. Sedation can be in gas form (Protoxide of nitrogenize) or medicamentous (Ativan or Valium).

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What is the mouth ulcers? The mouth ulcers are ulcers d’ approximately 1 to 2 mms in diameter which develops on the oral mucous membranes (stops, language, lips, gums). They appear separately or in dispersed group. Each ulcer forms a small yellowish crater surrounded d’ a red halation. The mouth ulcers are not dangerous for health but can be very painful. They are not contagious nor infectious
Which are the causes?
The origin of the mouth ulcers remains unknown but there exist starting factors:
§ stress and physical tiredness
§ allergy or food sensitivity. The food most often accused is the acid spices, food, the dry citrus fruits, pineapples, fruits and particularly the nuts, the tomatos, alcohol, chewings-gum, meats, dairy products and gluten.
§ some food deficiencies. Studies associate the aphthous stomatitis with Iron deficiencies, folic acid, B1 vitamins, B2, B6 and B12.
§ hormonal changes related to the menstrual cycle. The woman is elsewhere more prone to the mouth ulcers than man.
§ dental prostheses evil adapted or limproper use of the brush with tooth.
§ the use of a toothpaste containing of the lauryl sulphate of soda as detergent agent (all the studies are not concordant on this subject).
§ some drugs