What is the difference between a temporary and permanent crown.

Temporary crowns are usually made from acrylic, composite or aluminum and can be made and fitted to a tooth rapidly, in 6-15 minutes. These crowns are usually cemented in with temporary cement and must last until a permanent crown can be fabricated for a prepared tooth. Although some temporary crowns can be made as 'interim ' restorations and can function for up to a year or more, they do tend to experience more rapid wear and breakage than permanent crowns.

A permanent Crown is custom made to fit your prepared teeth and the fit is verified in your mouth. It is often made from porcelain fused to a metal substructure . Other types of Permanent crowns can be made from gold, all porcelain, or porcelain bonded to zirconium.

Some dentists, using emerging technology, are preparing teeth for crowns, taking optical impressions and using cad cam technology to mill crowns from Zirconium blocks. These crowns can be fabricated while the patient is in the chair . Teeth can be prepared for a crown and it can be inserted in the same visit and no temporary is even necessary!

All permanent crowns are made from durable materials that wear well and when made well can last between 10 an 30 years when cemented with a permanent cement.

What is an indirect pulp cap?

When a dentist performs an indirect pulp cap on a tooth with a deep cavity, he does not expose the 'nerve' . Instead he leaves a small amount of 'suspect' tooth structure called affected dentin in between the nerve and the cavity preparation. He usually places a medication over the affected dental such as calcium hydroxide that dries out the dentin and stimulates the formation of sound secondary dentin.

If in the process of cleaning out 'decay' the nerve is exposed, it sustains and injury that it may not be able to recover from. The thinking behind this procedure is that by not exposing the pulp directly, a root canal may be avoided, and the tooth will be OK with a final restoration, assuming the tooth remains asymptomatic.

Some dentists advocate leaving a sedative filling in the tooth as an interim restoration and after a long period of time taking it out and completely removing any soft dentin that remains. It is my observation that the Calcium hydroxide has the effect of desiccating the affected dentin and I do not usually have to go back to remove the affected dentin does not actually need to be removed at a later time.

Why do my upper back teeth hurt and feel too big for my mouth?

This is a complaint often heard from patients with a sinusitis. It can be one sided or bilateral, though usually it is one sided. Allergies or a sinus infection can cause inflammation of the maxillary sinuses, which contain the roots of multiple maxillary back teeth.

Apparently this can cause an irritation in the nerves that go to these teeth and also can cause them to shift slightly so that the patient's bite is affected. Usually when the patient's sinus condition is treated the related teeth symptoms go away.

I often ask patients to go into a hot shower and stay for a while to see if that make them feel better. Also, a decongestant can help. If the patient has a sinus infection, then an antibiotic is usually prescribed by their physician.

What is an ovate pontic?

When a dentist fabricates a fixed bridge, the part that replaces a missing tooth is called a pontic. An ovate pontic is egg shaped on the part that contacts the gum, so that it is more easily clean with dental floss. Also it can be designed to slightly depresss the gum, so that the illusion is created that it is an actual tooth emerging from the gum. In my opinion, this is almost always the best design for pontics on anterior fixed bridges.

Traditionally, most pontics were designed with a modified ridge lap design. The part of the pontic resting on the gum was concave so that the pontic hugged the alveolar ridge. This design works, but it can pose a problem when a patient wants to clean under the pontic since it is difficult to use floss to clean this concavity, even with a floss threader.

Unfortunately, most dental laboratories still use modified ridgelap designs when fabricating fixed bridges, possibly because this is the design they were taught to use and it can be easier for them to create, than the ovate design. If you are in the process of having a fixed bridge made , it would be a good idea to ask your dentist about whether you can have an ovate pontic.

Is a Translucent Crown or Porcelain Veneer always a good idea?

Although translucent crowns or porcelain veneers can look extremely natural, sometimes they can allow a dark tooth surface to influence the final shade. If the underlying tooth color is not very different than the final shade than often no opaquer needs to be used by the ceramicist. If on the other hand the underlying tooth structure is more than one shade darker than opaquer should be blended with the porcelain.

When I am doing an anterior crown or veneer, I often photograph the prepared tooth surface and give the technician a 'stump' shade. This allows the ceramicist to guesstimate how much opacity should be added to the porcelain to mask out any darker colored underlying tooth structure.

Are you closed for Passover?

Yes, the office will be closed Thursday, April 9th and Friday April 10th in observance of Passover. The office will reopen on Monday April 13. Hag Sameach! I will be eating a lot of Matzoh and probably way too many chocolate easter eggs as well!

If I have pain from a tooth, does that mean I have a cavity?

Patients often report that the reason they have made an appointment is that they have pain from a tooth and they think that they may have a cavity. Although they percieve that tooth pain may indicate a possible cavity, more often this symptom has a different origin. Dentists must perform a thorough examination in order to accurately diagnose patients problems. Large cavities do often cause pain, but small ones usually provide few symptoms. Tooth pain can be caused by a number of possible causes including, cracks in the teeth, high bites, gum infections, herpetic infections, and sinusitis. If you are experiencing tooth pain a trip to the dentist is in order both to diagnose the problem and to suggest possible treatments!

Why do I have pain after eating candy?

Usually this indicates that a patient either has a 'leaky' or cracked filling, a cavity, a large abfraction or a cracked tooth. Probably what is happening is the sucrose in the candy is being rapidly consumed by bacteria in or around a tooth and a by product of this 'metabolism' is lactic acid which causes pain.

Obviously the larger the cavity, crack or gap between a filling and a tooth, the more bacteria will tend to be present. The amount of pain that a person experiences may be proportional to the relative numbers of bacteria that are hiding out in a defect in their tooth.