Art of restoring a badly decayed/fractured teeth

A post and core is a prosthetic device that is recommended when there is inadequate tooth structure remaining to support a traditional restoration or an artificial crown.

Post and core procedure is painless and does not even require local anesthesia as the tooth has long been dead after the root canal treatment. A post and core can only be made for a tooth that has had root canal treatment.

Some posts are ready made, whereas others are made in the laboratory especially to fit the tooth.

Why are post and cores needed ?

A great deal of dental crown stability depends on the amount of tooth structure that extends into its interior. If very little tooth structure occupies this space, the crown will be easily dislodged, especially by forces directed at its side.

Basically, the core is rebuilding the tooth so it is closer to its original dimensions. Hence, the crown's stability will greatly increase, and therefore its long-term chances for success are maximized.

                                              

Is a post always needed ?

A dental post is generally recognized as just an aid in helping to anchor a dental core to a tooth.

As a rule of thumb, if more than half of a tooth's original crown portion has been lost, a post is needed to assist in anchoring the core to the tooth. If more than half still remains, a core by itself (which basically means a direct build up with composite materials) will probably suffice.

Factors to be considered in making the decision to use a post

Many have stated that the main reason for placing a post is to strengthen the connection between the coronal build-up material and remaining tooth structure to the root portion of the tooth. In my opinion, that is only partially true. Additionally, the following potentially negative or positive factors should be considered in the decision to use a post. All of these factors should be observed before making the decision:

• Quantity of remaining tooth structure

• Quality of remaining tooth structure

• Remaining adjacent teeth

• Occlusion

• Planned restoration to be placed on the tooth

When is a post and core not indicated ?

There are certain conditions that make the use of a post and core device inadvisable :

·         Intense pain, gingival bleeding, suppuration, advance infections, tooth abscesses etc. These situations will be evaluated on a case-by-case basis and the post and core should be placed with the greatest caution.

·         Tooth shows advance mobility. Mobility is an indicator of bone loss around the tooth and it should be evaluated on a dental X-ray as well.

·         When the tooth crown is severely damaged (especially when the tooth is fractured bellow the gumline) and the remaining part of the tooth is not strong enough to support the post.

                                              

Structure

A post and core consists of two parts :

·         The post

The post is a small rod, usually metal/carbon fiber, which is inserted into the root space of the tooth and protrudes from the root a couple of millimetres. The post is then used to hold the core, or a filling in place.

Because the post is inserted into the root canal, a post and core can only be made for a tooth that has had root canal treatment.

·         The core

The core replaces missing tooth structure in preparation for making a new dental crown. Normally, a dental core can be directly built up from composite materials without a post to hold it in place.

However, a dental post can be used to help to anchor the core to the tooth. In this case, the core is generally made off metal alloys and the device is called post and core.

The core is then utilized to hold a dental crown in place. The crown can be a single unit crown or a retainer crown for a dental bridge.

Success rates

The procedure is successful in over 90% of cases.

Potential risks

·         Tooth fracture

·         Root fracture

·         Root canal failure (it is difficult to repeat root canal treatment once the post is in place)

·         Post coming out

·         Post protruding through the side of the root (this is a particular risk if the root is curved)

After Dental Post And Core

Post procedure care                                                       

Patients should avoid eating on the crown, following a post and core procedure. Certain foods, such as hard or chewy sweets, should be avoided as the crown could become loose.

Possible discomfort

Some minor discomfort to be expected after this procedure, but this can be easily controlled with normal painkillers.

Dental Crown a ..life line...for root canal treated teeth

Root canal is one of the advanced and revolutionary treatments in dentistry to save infected and badly decayed natural tooth. The term “root canal” comes from cleaning of the canals inside the tooth’s root after the removal of infected pulp and followed by disinfecting and filling tooth roots. Once the dentist has an access to the tooth’s roots, the infected dental pulp is removed and the roots are treated with antibiotics.

Why crowns are advised

To better understand the need for dental crowns, it’s necessary to understand why root canal therapy results in large tissue loss

Similar to a cavity filling procedure, tissue is removed from the tooth. This requires the removal of any diseased tissue within and around the cavity. Once a cavity has reached the roots of a tooth, it has usually compromised a relatively large portion of the tooth.

As there is no blood supply, over the time this causes tooth to become brittle and likely to fracture. Permanent fillings after root canals protect the treated teeth from bacteria and to strengthen them in the process but, without the extra protection, which crown provides, there are chances of tooth fracture. Another advantage of crowns is that they restore the natural appearance of your teeth.

Benefits of dental crown

Dental fillings are effective ways of replacing lost tooth tissue. However, they can only fill gaps in a tooth that is otherwise healthy and relatively strong. Root canal therapy tends to weaken a tooth to the point where it shouldn’t be just filled, but also protected on the exterior. More importantly, the dental pulp has been removed, which is responsible for generating new, healthy tissues within a tooth. Consequently, dental crowns are needed for superior restoration.

o    Structural support: Crowns simultaneously fill lost tissue while serving as the tooth’s outer layer. In this way, crowns restore strength to a tooth that would be too weak to function on its own.

o    Protection: By capping the natural crown of a tooth, dental crowns protect a tooth from injury, stress, and abrasion.

o    Preservation: Without a crown, the alternative for many teeth would be extraction and replacement. A crown allows patients to preserve a natural tooth, rather than replace it with a dental implant or bridge.

o     Durability: By using porcelain, dental crowns can easily last 15 years or longer without wear or damage. With the right care, porcelain crowns are effective permanent restorations.  

o    Realistic appearance: Porcelain is the most effective dental material for mimicking the shape and color of natural teeth. And because it’s stain resistant, your porcelain crown will continue to shine for years.

What are the repercussions of waiting?

o    Nothing will happen.

o    The tooth could chip- simple repair. Or it could crack and would need a crown.

o    In rare cases waiting could cause a RE- root canal to be needed.

o    The tooth could split, which could require crown lengthening or extraction.

o    These are things that your dentist should be prepared to talk over with you.

What are the options?

In some cases, while a crown is one option, there can be others. You might opt for a filling instead. Keep in mind, however, that a filling does not prevent you from needing a crown later on. Also, if a substantial portion of your tooth needs filling, a better solution is usually the crown because fillings do not give you the same kind of protection as crowns do. Also, if the filling is extremely large, it can cause the tooth to break, making it irreparable.

Relation between Dental issues and General health………..Fact/Myth????

Yes, teeth infection can really turn out to be serious issues. It’s hard to imagine how a toothache could turn deadly—but it can. Even mild or moderate dental discomfort quickly turns into a serious condition, known as an abscess - a pus-filled infection inside the tooth or between a tooth and the gum. 

No one has a precise explanation for the trend, but some experts speculate that the high cost, pain phobia, lack of awareness of dental treatment prevent many people from seeking routine dental care and perhaps delaying treatment when a dental problem occurs/arises.

Dr. Erin Sutton, a Fort Walton Beach dentist, pointed out the infection could either move to bone marrow or the bloodstream, causing sepsis and affecting major organs.

“Toothache leads to multi-organ dysfunction” Ms Mala, 26 yrs, lands in ICU, unable to drink, eat or speak. Never had she, imagined that lack of oral hygiene could prove so disastrous. What started as a simple toothache landed with multi-organ dysfunction. Mala survived three mild cardiac attacks and was on ventilator for two months before recovery.

When a toothache and swelling in her right jaw bothered, she, like any other youngster, thought pain killers would be the cure. However, those didn't help her in fact, the ache led to dental cellulitis and the swelling made its way to her throat, blocking the passage. An examination revealed the infection had spread to her vital organs and she was diagnosed with multiple organ dysfunction syndrome. There was a shower of bacteria on her lungs and fluids in the lungs started accumulating around her heart. Besides, there was a clot in a vein that connects the heart, head and the neck region. Oral hygiene was compromised, leading to the spreading of anaerobic bacteria,"

“Ms Mala had a lot of cavities and didn’t bother to take care of them. It hit her only when she lost speech, couldn’t lie down and wasn’t even able to swallow water. It’s a rebirth for him.”

(http://www.thequint.com/health-fitness/2016/07/19/bengaluru-womans-ignored-dental-problem-toothache-led-to-multi-organ-dysfunction)

Abscessed tooth—A big Headache

Concise View

Dental abscess in a swelling filled with pus, the swelling in your body is result of body’s protective mechanism. It's the mechanism of arresting/preventing debris entering in blood stream from mouth via tooth or gums, a type of protective mechanism. Ideally abscess is caused by body trying to rid its self of harmful bacteria. If you are not suffering from this condition currently, probably you are lucky, still it’s good to be aware of potential consequences so as to keep yourself safe and healthy.

Potential causes of dental abscess 

• Neglected oral hygiene
• Decayed tooth
• Trauma
• Tooth fracture
• Left over roots only 

Abscessed tooth- affecting general health

Body infection in general is the cause for alarm, as abscess has the tendency to not only locally damage the area but also spread and make condition potentially severe. Reason why tooth infection is different from general body infection:-

·        Jaw bone already has compromised blood supply so it limits healing potential by itself.

·        With increase in age, healing potential gets delayed.

·      If debris from oral cavity is entering gums/carious teeth, then it’s a unilateral entry so chances of abscess being drained down by itself is very limited.

·        Presence of abscess will make treatment more time consuming and eventful.

·     Treatment line depends on severity of abscess. In extremely severe condition to get an early relief one may have to sacrifice tooth/teeth, which could have been saved if approached to your dentist timely.

a.      Other most important symptoms present along are

1.      Fever

2.      Bitter taste in mouth

3.      Swollen jaw

4.      Reddened gums

5.      Bad breath

6.      Sleepless nights

7.      Loosening of tooth

b.      To be on a serious note, abscessed tooth may lead to heart issues (bacterial endocarditis), full face infection there by restricting airways (Ludwig’s angina), transfer of infection to brain. 

Treatment alternatives

a.    Conservative approach – if patient’s condition permits, ROOT CANAL THERAPY, preferably the ideal choice followed by tooth crown/cap.

b.       Extraction – if tooth is non- restorable or condition becomes severe.

** Emergency dental procedure can be costly, but preventative treatment is not