Thursday, July 4, 2013


I have been coming across cracked teeth cases very frequently. When a patient presents with a vertical crack line in a otherwise healthy tooth, it is an unfortunate situation because he or she is very likely to lose the tooth.

< Image courtesy of

Some teeth have cracks that are too small to show up on Xrays. Sometimes the cracks are under the gum. These small cracks are known as "cracked tooth syndrome."
Cracked tooth syndrome is most common in lower back teeth (molars). That's because these teeth absorb most of the forces of chewing.
Some people grind or clench their teeth. These people may be more likely to have cracked tooth syndrome. Sometimes, the way a person's teeth come together can put too much pressure on one tooth. This can cause the teeth to crack.
Teeth with large fillings may be more likely to crack. Teeth that have undergone root canal treatment are weaker than other teeth and also may be more likely to crack. People with one cracked tooth are more likely to have others, either at the same time or in the future.

The tooth may hurt sometimes when you bite or chew. The sensitivity or pain can be mild or intense. It may be painful only when you eat certain foods or when you bite in a specific way. You will not feel a constant ache, as you would if you had a cavity or abscess. The tooth may be more sensitive to cold temperatures.
If the crack gets bigger, a piece of the tooth can break. You many also develop an infection. This can happen in the gum around the fractured tooth. You may notice a pimple-like bump on the gum near the tooth. This is known as a fistula.
Many people with cracked tooth syndrome have symptoms for months. It is hard to diagnose cracked tooth syndrome because the pain is not predictable.
Your mouth and teeth will be examined focusing on the tooth in question. A sharp instrument called an explorer may be used to feel for cracks in the tooth. . You may have X-rays taken. But X-rays often do not show the crack.
A bright light or special stains may be used to detect cracks. Existing restorations may need to be removed to check on crack lines.

How long symptoms last depends on how quickly a cracked tooth can be diagnosed. Even after a crack is found, treatment may not completely relieve the symptoms.

If you grind or clench your teeth it can increase your risk of cracked tooth syndrome.

Treatments for cracked tooth syndrome do not always relieve the symptoms.
Treatment depends on:

  • Where the crack is
  • How deep it is
  • How large it is

Sometimes a crack affects one or more cusps of a tooth. These are the highest points of the tooth. In this case, the tooth may be fixed with a crown. Some cracks affect the pulp: the center of the tooth, where the nerves and blood vessels are. In that case, the tooth will need root canal treatment.
About 20% of teeth with cracked tooth syndrome will need root canals. After a root canal, the tooth will no longer be sensitive to temperature, but it still will respond to pressure. If you felt pain before the root canal, you may still feel some pain afterward. It probably will not be as intense or as frequent, but it may still occur.
In some cases, the tooth may need to be removed. Some cracks affect the root of the tooth in the jaw. There's no way to fix this type of crack. If your tooth is removed, you can have it replaced with an implant or a bridge.
A night guard (a plastic bite piece) can be made to prevent you from grinding your teeth. This will relieve the pain from grinding. For some people it can stop tooth sensitivity. The night guard can be worn during sleep. It also can be work at other times if clenching or grinding happens during waking hours as well.

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Treatment of cracked tooth syndrome is not always successful. We talk with patients about what might happen. In some people, a crown will fix the problem. In others, root canal treatment solves the problem. Some people continue to have occasional symptoms after treatment. They may need to have the tooth taken out.

Wednesday, August 5, 2009

Back to blogging!

It has been hectic the past few months. Thus, the long absence from cyberspace! Very often I meet anxious parents who are so worried about their little ones' dental and oral condition. They seek treatment hoping that the problems will solved in one visit and no further episodes of pain and discomfort will occur. Parents need to understand that each child is born with his/her own genetic make and the risk factors for dental decay and gum problems differ accordingly. Maintaining balanced diet and good oral hygiene regime are important factors in combating these problems.

Parents often have questions about how to take care of their children's teeth. When should you start brushing? What kind of toothpaste is best? When should you go to the dentist? Knowing the answers to these questions can help you keep your kids' teeth healthy and cavity free.

Although you don't necessarily need to brush them yet, you should start cleaning your infant's teeth as soon as he gets his first tooth. At first, you can just use a wash cloth to clean your infant's teeth. As he gets more, you can use a soft children's toothbrush.

Because there is some danger if your child gets too much fluoride, your choice of toothpaste is important. Keep in mind that most brands of kids' toothpaste are fluoridated. They just have different flavors and popular characters on them to make them more fun for children, but that doesn't make it safe for your children to swallow too much of the toothpaste.

If using a fluoride toothpaste, use a small, pea-size amount of toothpaste, so that there is little danger of your child getting too much fluoride if he swallows it. And begin to encourage your child to spit out the toothpaste at a young age. The other alternative for younger children is to use a non-fluoridated toothpaste.

The timing of the first visit to the dentist is a little controversial. The American Academy of Pediatric Dentistry states that children should see a dentist when they get their first tooth and not later than 1 year of age. In contrast, according to the American Academy of Pediatrics, unless your child has risk factors for having problems with his teeth, such as sleeping with a cup or bottle, teeth staining, thumb sucking, etc., the first visit to the dentist should be by around the third birthday.

However, an early visit to the dentist is a good way to learn proper oral hygiene at an early age, including avoiding nighttime bottles or cups of formula or juice, proper toothbrushing, and a diet that promotes good dental health. You may also want to see a Pediatric dentist early if your child has a medical condition that puts him at risk of having dental problems, such as Down Syndrome.

Sunday, April 19, 2009

Root canal treatment

Saw a nice picture and writeup on rootcanal in Wikipedia. Thought it will be nice to share the info:

A root canal is the space within the root of a tooth. It is part of a naturally occurring space within a tooth that consists of the pulp chamber (within the coronal part of the tooth), the main canal(s), and more intricate anatomical branches that may connect the root canals to each other or to the surface of the root.

The smaller branches are most frequently found near the root end (apex) but may be encountered anywhere along the root length. There may be one or two main canals within each root. Some teeth have more variable internal anatomy than others. This space is filled with a highly vascularized, loose connective tissue, the dental pulp. The dental pulp is the tissue which forms the dentin portion of the tooth.

The formation of secondary teeth (adult teeth) is completed by 1-2 years after eruption into the mouth. Once the tooth has reached its final size and shape, the dental pulp's original function ceases for all practical purposes. It takes on a secondary role as a sensory organ.

Root canal is also a colloquial term for a dental operation, endodontic therapy, wherein the pulp is cleaned out, the space disinfected and then filled.

Tuesday, March 10, 2009

Wow ... absent for so long!!

I have been away from my cyberspace for so long!! Just realised it is almost 1 year and need to celbrate my anniversary of absence!!

Methods of tooth whitening

Also take from Wikipedia:

There are two main methods of gel bleaching--one performed with high-concentration gel, and another with low-concentration agents. High-concentration bleaching can be accomplished either in the dental office, or at home. Performing the procedure at home is accomplished using high-concentration carbamide peroxide which is readily available online or in dental stores, and therefore is more cost-effective than the in-office procedure by many orders of magnitude. Whitening is performed by applying a high concentration of oxidizing agent to the teeth with thin plastic trays, for a short period of time, which produces quick results. The application trays ideally should be well-fitted to retain the bleaching gel, ensuring even and full tooth exposure to the gel. Trays will typically stay on the teeth for about 15-20 minutes. Trays are then removed and the procedure is repeated up to two more times. Most in-office bleaching procedures use a light-cured protective layer that is carefully painted on the gums and papilla (the tips of the gums between the teeth) in order to reduce the risk of chemical burns to the soft tissues. The bleaching agent is either carbamide peroxide, which breaks down in the mouth to form hydrogen peroxide, or hydrogen peroxide itself. The bleaching gel typically contains between 10-30% carbamide peroxide (15% is recommended) which is roughly equivalent to 3-10% hydrogen peroxide concentration.

Low-concentration whitening is far less effective, and is generally only performed at home. Low-concentration whitening involves purchasing a thin mouthguard or strip that holds a relatively low concentration of oxidizing agent next to the teeth for as long as several hours a day for a period of 5 to 14 days. Results can vary, depending on which application is chosen, with some people achieving whiter teeth in a few days, and others seeing very little results or no results at all. Whitening is potentially better at a dentist because the strip or mouth-guard does not completely conform to the shape of the teeth, sometimes leaving the tips of the teeth (near the gumline) unbleached. The bleaching agent is typically less than 10% hydrogen peroxide equivalent so irritation to the soft tissue around teeth is minimized. Dentists as well as some dental laboratories can fabricate custom fitted whitening trays that will greatly improve the results achieved with an over-the-counter whitening method.

A typical course of bleaching can produce dramatic improvements in the cosmetic appearance of most stained teeth however, some stains do not respond to bleaching. Tetracycline staining may require prolonged bleaching, as it takes longer for the bleach to reach the dentine layer. White-spot decalcifications may also be highlighted and become more noticeable. Bleaching is least effective if teeth have white spots, decay or infected gums. It is also least effective when the original tooth color is grayish. Bleaching is most effective with yellow discolored teeth.

Laser bleaching, also known as power bleaching, utilizes light energy to accelerate the process of bleaching in a dental office. Different types of energy can be used in this procedure. The ideal source of energy should be high energy to excite the peroxide molecules without overheating the pulp of the tooth, creating an inflammatory response.[2] The use of an argon laser to safely and effectively speed up the whitening process is ideal for laser bleaching. The use of an argon laser is preferred over the use of an arc lamp (the traditional dental method of light-activated bleaching) or infrared laser because it does not exhibit any of the heat or UV ray emissions of the arc lamp.[2] Chemical burns, which are occasionally a side-effect of gel bleaching, or heat-induced sensitivity, are not a factor with argon laser whitening.[2] Most laser teeth whitening treatments can be done in approximately 1 hour, in a single visit to a dental physician, (depending on the condition of a person’s teeth).

Whitening ... your million dollar smile!

Teeth whitening is becoming an increasingly popular cosmetic "treatment". Who doesn't want a winning smile? ... here is an interesting article for your reading (taken from Wikipedia):


Dental bleaching, also known as tooth whitening, is a common procedure in general dentistry but most especially in the field of cosmetic dentistry. A child's deciduous teeth are generally whiter than the adult teeth that follow. As a person ages the adult teeth often become darker due to changes in the mineral structure of the tooth, as the enamel becomes less porous. Teeth can also become stained by bacterial pigments, foodstuffs and tobacco. Certain antibiotic medications (like tetracycline) can also lead to teeth stains or a reduction in the brilliance of the enamel.

There are two methods to whiten teeth: bleaching gel and laser bleaching. Traditionally, at-home whitening is done with bleaching gel which is applied to the teeth using thin guard trays. Oxidizing agents such as hydrogen peroxide or carbamide peroxide are utilized to lighten the shade of the tooth. The oxidizing agent penetrates the porosities in the rod-like crystal structure of enamel and oxidizes interprismatic stain deposits; over a period of time, the dentin layer, lying underneath the enamel, is also bleached. Laser bleaching utilizes light energy to accelerate the process of bleaching in a dental office. The effects of bleaching can last for several months, but may vary depending on the lifestyle of the patient. Factors which will decrease whitening include smoking and the ingestion of dark colored liquids like coffee, tea and red wine.

Internal staining of dentin can discolor the teeth from inside out. Internal bleaching can remedy this. If heavy staining or tetracycline damage is present on a patient's teeth, and whitening is ineffective, there are other methods of whitening teeth. Bonding, when a thin coating of composite material is applied to the front of a person's teeth and then cured with a laser can be performed to mask the staining. A veneer can also mask tooth discoloration

Saturday, April 26, 2008

Your fear of dentists!

Many people fear going to the dentist, and this is an absolutely real syndrome with many adults let alone kids!

If we examine our past experiences, we remember on those painful visits we had to the dental clinic as a child and that phobia remains alive for a long time. As we can't see the treatment being done inside our mouth it makes the fear even more "justified".


Firstly, remember that time has changed. We are now in the 21st century with numerous progress in the dental field. Secondly, we have different equipments, treatment methods and also a wide choice of dentists compared to the 1950s when a "Doktor Gigi" down the street may be the only choice.

  • Equipment today are more sofisticated. For example, even before you start treatment you can view your intra oral image shown on a large tv screen. This gives you a good look and mentally prepare yourself to what is recommended.
  • Time taken to do a filling has been shortened due to more efficient cutting tools that don;t really "cut" your teeth instead just grind away the decay.
  • Local anasthesia is always available if you need to eliminate the little discomfort that you feel.


  1. Take time to see at least a few dentists in your area and select one whom you find most comoftable to talk to and to trust your teeth with!
  2. Use the FREE Dental Checkup months (usually every April) to visit several dentists so that you can evaluate your choices.
  3. When treatment is necessary allocate time to visit a dentist and DO NOT rush between your appointments.
  4. Ask for inofrmation on potential pain and discomfort.
  5. Understand the available options before making your chouce of treatment.


Bring kids for check ups at an early age before they develop serious decay that requires treatment. Do not wait until there is a serious need. Simple check ups give kids an understanding of oral hygiene.

Early visits also gives them a better perspective during the young age thus preventing unecessary fear when they grow old.