More Smiles Dental Spa Dentistry Blog | James A. Moreau, Jr., D.D.S.

Thursday, January 29, 2009

A Day in the Life of a Sick Tooth

The problem was first noticed when Brenda (not her real name ;-) was eating breakfast. A tooth in the back had become extremely sensitive when she chewed her morning bagel. She also noticed that it was sensitive to the temperature of her hot coffee. She had experienced sensitive teeth before, but usually it only lasted a minute or two and then went away. But this time the sensitivity persisted and there was a throbbing sensation as well.

So, Brenda calls our office to see what she needs to do. We encourage her to come right over so we can take an x-ray to check the nerve of the tooth. Since she's very distracted by the pain, we want her to come right over so we can work her into Dr. Moreau's schedule as soon as possible.

Once she arrives at the office, it's only a matter of minutes before we're able to seat her comfortably in an operatory that's equipped to handle emergency x-rays and possible treatment. Since we have 6 people in the office who are trained to be able to take an x-ray, we're able to get a digital image on the screen right away for Dr. Moreau to view. He greets Brenda, takes a look in her mouth to check the tooth for cracked or worn fillings, chipped cusps on the tooth's crown, and any signs of swelling or exudate around the tooth.

One look at the x-ray, though shows that the tooth has an abcess at the base of the nerve. On the computer, Brenda is able to see a tear-drop shape that appears at the bottom of the tooth's root. Dr. Moreau explains that this is infection that has developed and needs to be removed as soon as possible. The tooth is sick. Though antibiotics may help ease some of the infection, it will never get totally better by itself. The infection is bound to flare up again until the nerve is removed through root canal treatment. And furthermore, as long as a sick tooth is left to fester, there are risks of the infection spreading and causing more severe infection elsewhere in her body.

Brenda is scheduled to leave town on a business trip the next morning and is anxious about trying to travel with her sick tooth. We tell Brenda that if she can sit tight and be patient, Dr. Moreau will be able to treat her tooth that very day and have her happily on her way with a completed root canal and a new permanent crown on the tooth within a few hours. Brenda is grateful but a little nervous about the procedure since she's never had a root canal before.

Dr. Moreau gives Brenda the option of having nitrous oxide (laughing gas) to help her relax or an oral sedative. By the time she's totally relaxed, watching overhead TV's with headphones on, Dr. Moreau is ready to get started.

The root canal is done first to clear infection and sick nerve from the tooth. Then the inside of the tooth is filled with an organic, rubbery material from tropical trees (it's called gutta percha). The tooth is sealed over the top. Since Brenda wants to get as much done in one appointment as possible, Dr. Moreau prepares the tooth for a permanent crown to protect it against breakage. Much like a tree trunk, when the tooth is hollowed out, it becomes more brittle and is subject to breaking and cracking.

Using CEREC cad-cam technology, Dr. Moreau is able to design a porcelain crown on a computer screen right there in the operatory with Brenda. A digital image of the prepared tooth is used instead of bulky impressions to make sure the crown will fit perfectly over the tooth. The porcelain block is then mechanically cut in about 10 minutes while Brenda waits comfortably, still watching the overhead TV programs.

Remember that Dr. Moreau is working Brenda in on an emergency basis, so there's a slight delay while he completes a procedure on a patient who had a pre-scheduled appointment. But within a short while, the porcelain crown is ready to be seated, and Dr. Moreau returns to permanently attach the porcelain fabricated crown to Brenda's tooth. The tooth is in place and Dr. Moreau checks the bite to make sure there is no interference when she bites her teeth together.

With her new tooth in place, Brenda is ready for her trip the next day without having to worry about being bothered with a sick tooth. She is dismissed and sent on her way.

Dr. Moreau calls her at home that night to check on her and see if she has any questions that have come to mind since she got home. Brenda reports that the tooth is completely comfortable. She has required no pain medication post-op and comments on how surprised she was that she was able to get the root canal and crown delivered all in one appointment.

posted by MoreSmiles at 5:14 PM


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