Dentalnews (en)

Actually a toothache is never really the fault of the tooth, but rather the fault of the dentist or the patient!

Generally we speak of infections or cysts, and specifically infections in the bone.

Cysts in the mouth, or to be more precise, the jaw, are usually caused by infections in the bone – more on this tomorrow.

What causes infections in bones?
It starts when the dental nerve is damaged, e.g. by cavities or bad brushing habits (the patient’s fault). Or the dentist may inadvertently damage the nerve while drilling, either by drilling too deep or not providing sufficient cooling for the tooth, which leads to overheating – basically the nerve gets cooked).

Some other causes could be the chemicals used by the dentist, or white fillings – called composites – all this being the patient’s fault: more on this topic here.
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Once the nerve is damaged, you get a toothache lasting for several days!

Some of you may go to a dentist, while others do not, since the pain goes away after a while. What you may not know is that this is simply because the nerve is dead. But now the nerve begins to rot, just like meat which has been lying out in the sun. This rotting leads to an infection in the bone – and then you again have a toothache. This process can last days, weeks, months or even years. Once the infection is acute, you feel pain when you put pressure on your teeth, like when you chew. Chronic infections don’t tend to hurt, though.
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If your nerve damage has become acute, and you go to the dentist , then you still face the luck of the draw!
Root treatment – the lucky ones!
If the root is treated properly, using sterile root canal instruments, and using a coffer dam, then the damage caused by the nerve can be repaired, and you will soon be smiling again: to the left you can see a tooth after proper treatment, and to the right one which wasn’t treated properly.
The losers
Poorly performed treatment can lead to another infection days, weeks or even years later. And now we’re back to square one!

Root inflammations can have many causes, the most common one being cavities!

Some other possible causes are plastic fillings, excessive drilling when setting crowns, or after an accident – more details here.

If root treatment is not performed correctly, or complications arise, or if necessary treatment is not performed at all, then the dental nerve causes an inflammation in the bone, leading to a cyst in the root. This need not always be accompanied by pain, however. More on this topic here.

At some point the inflammation will make itself felt through the mucous membrane, leading to a fistula at the dental root. If the problem is not too big, root treatment may help to reverse the process, otherwise a root tip resection will have to be performed.

It is not uncommon to feel pain after root treatment!

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This may happen if not all of the dental nerve is removed. Or if the hollowed out part of the tooth is not completely filled up, then pain may appear after root treatment.

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Here you can see what causes root problems and what you can do to prevent them.
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When is root treatment necessary and what is the right way to do it?
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A filler called Epiphany Sealer and Resilon Sticks ® have been developed which seal the canal much more tightly than the Guttapercha used until now.
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Sometimes root treatment is performed properly, but if dental fillings start to come loose over the years, bacteria get into the canal by way of the dental crown and start to multiply inside the canal – especially if the Guttapercha used did not seal up the canal 100%.
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Animal experiments have shown that the new filler system works much better than Guttapercha. Ask your dentist about Epiphany Sealer and Resilon sticks!

Root pivots are one way to get crowns attached to the roots of teeth!

Yesterday you read all about pivot teeth and how they are made, today we’ll show you some examples of pivot operations gone wrong – except of course the first picture, which shows how it should be done!

Root pivot x-ray Pic 1
This is what a pivot tooth should look like, the roots are thick, evenly filled to the tips. The root pivot is located in the back root (black arrow) and fills more than 1/3 of the root!
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Pic 2
The pivot is too short and the rest of the root has not been filled up with enough of the root-filling compound
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Pic 3
The pivot is too short and the rest of the root has not been filled up with enough of the root-filling compound, moreover the canal was drilled crooked, so the pivot is not actually in the canal
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Pic 4
The pivots are too short and the rest of the roots have not been filled up with enough of the root-filling compound

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Videos on the topics of root treatment, root pivots and dentistry can be found here!

The terms pivot tooth, pivot crown, stump reconstruction or pivot reconstruction all refer to a tooth reinforced by a pivot.

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If a tooth has suffered extreme cavity damage (1)

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that practically only the root is left (2),

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a pivot (3) can be inserted into the root to

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provide retention for affixing a dental crown (4).

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To succeed, this procedure requires

• proper treatment of whatever is left of the root (the pink area in picture 2)
• the root itself to be in good condition

Nowadays, it is common to use fiber-glass pivots, earlier they were made of metal. More on the topic of pivot teeth here!

The cost of a pivot tooth ranges from 100€- 350€ in Europe, depending on the materials and manufacturing methods used. Monday we will show you some examples of badly performed pivot tooth insertions. An x-ray  will show you the status of your pivot teeth – more on the topic of x-rays here.