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Why do I have tooth pain?

Toothache happens when the outermost protective layer of enamel has been compromised exposing the second layer dentin or the core/ third layer of the tooth pulp. Enamel does not have extensive nerve supply, so healthy teeth with no decay, chips, wear or cracks do not hurt. When the protective enamel is compromised and the inner layers of tooth with nerve supply are exposed, you will have sensitive teeth or a toothache.

Tooth pain usually suggests some infection in your teeth, gums or jaw bone.

What are different types of toothaches?

Toothaches can be described in various ways. The severity and intensity usually depends on the cause of the pain:

  • Sharp pain
  • Throbbing pain that radiates to the ear and causes headaches
  • Dull ache
  • Constant pain that doesn’t improve with OTC medications
  • Sensitivity to hot and cold that lingers
  • Swollen gums

Why should I call the dentist when I have a toothache?

In most situations toothache does not resolve itself completely without an intervention from a dentist. If your tooth pain is due to a dental cavity or an abscess the OTC medications may give you only a temporary relief. Our body does not have the capability to heal the teeth naturally in case of gum infection, abscess or decay. If you have discomfort or pain in your mouth, it is important to schedule a visit with our dentist. The longer you wait the more severe the infection will be and more expensive the treatment will be. If you are experiencing swelling or fever, it may be an indication that the dental infection is affecting your body.

What are the treatment options for a toothache?

Depending on the cause of the toothache, one or more of the following options may be the choice of treatment for you:

  • Extraction and bone grafting
  • Root canal treatment
  • Crowns
  • Scaling and root planing/ deep cleaning

Extraction and bone grafting

The only dentist I’ve ever gone to that had recommended grafts after extractions. I’ve never been offered this and didn’t even know it was a thing. Dr and staff were very nice and professional. Procedure went smoothly and clearly very carefully done. I would recommend them if you’re looking for a new dentist. – MH

What are Tooth Extractions?

Dentist showing a patient an extracted tooth.Extractions are often performed when there is no other way to save a tooth or when a tooth is compromising your oral health. They are simple procedures that are done in-office regularly, so they are safe and effective for most patients. Extractions may be done as a way to help improve oral health or prevent problems. A dental extraction is a procedure during which your dentist removes the painful tooth from the jaw bone.

Who needs a tooth extraction?

Dr. Bhandaru recommends saving your natural teeth as long as possible with various treatment options available to you. In situations where Root canal treatment, composite fillings, Dental crowns are not a treatment of choice due to the extent of damage, removing the tooth maybe the choice of treatment.

You may need a tooth extraction if you have one or more of the following conditions:

  • Cracked/fractured tooth
  • Extensive decay compromises the strength of the tooth
  • Loose teeth due to advanced periodontal disease/gum disease
  • Impacted wisdom teeth causing pain or damage to adjacent teeth
  • Infected teeth causing pain
  • Primary teeth/ Baby teeth that are not exfoliating
  • Teeth broken or dislocated due to accident or trauma

How do I know if my dentist will recommend a dental extraction?

Dr. Bhandaru performs a thorough exam, gets a digital x-ray, or a 3-D image of the painful area and if none of the available treatment options benefit you, she recommends an extraction. It is important to give a complete list of all of your health conditions and medications including supplements to avoid any unnecessary complications after the procedure is completed.

What is the process of a dental extraction?

After a comprehensive exam is completed and if extraction of the tooth is selected as the ideal treatment, Dr. Bhandaru may offer nitrous oxide (laughing gas) as an option to reduce the anxiety during the procedure.

Topical and local anesthesia will be administered to the affected area. Once the area is numb, specialized dental instruments are used to remove the tool carefully without damaging the adjacent teeth. If the tooth is severely decayed, broken down or impacted, Dr. Bhandaru may need to surgically remove the tooth.

What happens after the tooth extraction?

When the tooth extraction procedure is complete, the socket is disinfected with saline and laser. Dr. Bhandaru strongly recommends a socket preservation procedure with a bone graft to prepare the site for a future dental implant placement.

Will there be a hole in my mouth after a dental extraction?

Yes. The root of the tooth is anchored in the jaw bone. Most teeth have long roots which give stability to the tooth. When the tooth is removed, the space occupied by the tooth root leaves a hole in the bone. If not taken care of properly immediately after extraction, the blood clot can be lost causing a dry socket. Food cab be caught in the socket and may cause infection. To avoid complications, Dr. Sirisha Bhandaru recommends bone grafting to help with reducing the pain and aid in faster healing.

The Do’s and Don’ts for Tooth Extractions Carrollton TX

What to do after a dental extraction

  • Follow all the instructions given to you by your dental surgeon.
  • Rest for the first 24 hours.
  • Take the antibiotics and pain medications as prescribed to you. It is important to take all of the medications prescribed to you.
  • If your dentist does not recommend pain medication, over the counter, ibuprofen or acetaminophen can be taken.
  • If you are experiencing pain, ice packs can help with pain and swelling.
  • Your dentist will place a piece of gauze at the extraction site. Apply pressure on it for 30 minutes and take it out.

If you are prone to allergies or frequent sinus infections, Dr. Bhandaru may recommend the use of decongestant spray or tablets to avoid sneezing to prevent dislodgement of blood clots.

Eat soft, cold, warm food for 24-48 hours following the dental extractions.

If you are having continuous oozing of blood due to your medication or other health conditions, bite on a tea bag and the tannins in the tea will have clotting potential.
Please call the provider: if you develop fever over 101, have difficulty breathing or have continuous bright red blood oozing out of the extraction socket or liver clots.

What not to do after a dental extraction

  • Do not smoke for the first 72 hours after the dental extraction.
  • Do not suck on a straw for the first 72 hours after the dental extraction.
  • Do not consume alcohol for the first 72 hours after the dental extraction.
  • Do not spit forcefully after brushing or vigorously brush the extraction site for the first 72 hours after the dental extraction.
  • Do not eat hard, hot or crunchy foods for the first 72 hours after the dental extraction.
  • Do not put your finger to check the extraction site as it may transfer infective agents to the site and cause secondary infection.
  • Do not place hot packs to alleviate discomfort near the extraction site for the first 72 hours after the dental extraction as it may cause swelling.
  • Do not lift weights or do strenuous physical exercise for the first 72 hours after the dental extraction.

What can I eat after a tooth extraction?

Dr. Bhandaru recommends you to avoid hard, crunchy, chewy, sticky foods for the first72 hours after the dental extraction.
Soft warm, lukewarm, cold foods like yogurt, smoothies, mashed potatoes, pasta, warm soup, ice-cream, Jell-O, applesauce are recommended to avoid the sutures being interrupted and the food being caught in the area.

What are the complications of dental Extractions?

As with any procedure, post-processive complications are rare but not uncommon after dental extraction. Pain and swelling are the most common complications after a dental extraction.

Depending on the complexity of the extraction, the following complication may occur in a very rare situations:

  • Dry socket
  • Nerve injury
  • Perforation of maxillary sinus
  • Delayed healing

To avoid unnecessary complications, follow all of the post-operative instructions and contact Carrollton Smiles if you are experiencing any of the above conditions.

How long will it take for me to heal after a dental extraction?

Most people are able to resume normal activities 48-72 hours after the procedure. You may need extra time to heal if the tooth removal was complicated. If a socket preservation procedure was done, the gum will heal over the socket in 2-3 weeks. The bone will fill in about 4-5 months. Dr. Bhandaru will recommend another 3-D image with CBCT at 5 month post extraction to evaluate the quality of healing and plan the Dental implant placement.

What is socket preservation /bone graft?

Socket preservation / dental bone graft

Jawbone loss is detrimental to your oral health and can cause a domino effect of problems, including mobility and tooth loss. Dental bone grafts may help reduce the complications. when a tooth is removed, there will be a hole in the jaw where the root of the tooth would be present.

The bone graft material fills the extraction socket adding volume and density to the bone. The bone graft acts as a space holder/scaffolding and prevents the collapsing of the extraction site.

Who is a candidate for bone graft?

At Carrollton Smiles, Dr. Sirisha Bhandaru recommends socket preservation for all the patients needing a tooth removal. Grafting the extraction socket is a very common procedure with many benefits and a very few complications. Most patients with uncomplicated health histories are candidates for bone graft/ socket preservation procedure.

When is the bone graft material placed?

Graft procedure is highly successful when done immediately after the extraction. This helps the freshly formed clot form a stable scaffold for the body to replace with healthy natural bone. Occasionally additional bone volume and density may be needed during the placement of dental implant. Additional graft or a second augmentation procedure may be needed.

What are the complications of dental bone graft?

As with any surgical procedure, pain is a common postoperative complication. If the tooth removal process was difficult, requiring surgery, or if the infection was extensive prior to the tooth removal, infection of the graft material could occur.

To increase the success of the socket preservation procedure, Dr. Bhandaru disinfects the extraction socket with Periolase dental laser. This helps formation of the blood clot, decreases the amount of infection, decreases the postoperative pain and aids in faster healing.

How is the Bone graft/ Socket preservation procedure done?

When a tooth is removed, there will be an empty socket in the jaw which used to house the root of the tooth. When a graft is not placed to fill the extraction site, food and plaque will accumulate in the area. This will cause delayed healing, possible infection and tissue loss.

After the tooth is removed, the socket is cleaned and disinfected. Dr.Bhandaru will place the bone graft material in the socket and place a membrane on top of it. This is sutured in place. You will return to the office 2 weeks post appointment for evaluation of the healing and suture removal.

What is the healing process after dental bone graft placement?

It is important to follow all the post-operative instructions given by Dr. Bhandaru to have an uneventful healing. The body replaces the graft material and membrane with your natural bone. The time required for this varies and is dependent on the amount of infection prior to the dental extraction, difficulty of the tooth removal, your general health and the medications you are taking. Generally at 4-6 months healing period is ideal for the planning and placement of the dental implant.

Root Canal Treatment

What is a Root Canal Treatment?

Root canal treatment is a process where the general dentist or the root canal specialist will remove the infected pulp (the innermost layer of the tooth which contains nerves and blood vessels) and disinfect the area. The chamber is filled with inert material called Gutta-Percha and sealed. It is very important to have a crown placed after the root canal treatment is completed to protect the tooth.

Who needs a Root Canal Treatment?

When the pulp of the tooth is compromised either due to bacterial infection secondary to decay or due to an accident or trauma, root canal treatment will help you save and keep the tooth longer.

You may need a root canal treatment or endodontic treatment if you have one or more of the following conditions:

  • If you have a large cavity compromising enamel and encroaching on the pulp.
  • If you are experiencing spontaneous pain in your tooth/teeth that recurs and does not get better with OTC Advil, Aleve or Motrin.
  • Radiating pain to ear, eye or head and neck area from the tooth.
  • If you are experiencing hot and cold sensitivity on tooth/teeth that lingers for more than few seconds after consuming foods or drinks with extreme temperature.
  • If you have discolored teeth which may have suffered trauma either due to an accident or sports injury. The pulp of the tooth may be discolored and undergoing necrosis causing discoloration.
  • Swelling of the gum with either a pimple that is draining pus or just a swelling with throbbing or aching pain.
  • Pain on biting or chewing.
  • Accident or trauma causing chips or cracks on the teeth/tooth.

What happens during a root canal treatment?

When you make an appointment at Carrollton Smiles, we take a digital x-ray or a 3D image to evaluate the tooth and determine the extent of infection.
Depending on the complexity of the treatment and severity of infection, you may be prescribed antibiotics or referred to an endodontist.

If Dr.Bhandaru determines that treatment can be provided the day of consultation, you will be offered optional nitrous oxide (laughing gas) to reduce anxiety. Local anesthetic will be administered and the root canal treatment will be completed. During the procedure, the infected pulp will be removed using specialized tolls and the chamber is disinfected. The disinfected and cleaned root canals will then be filled with a binding agent and inert Gutta-Percha and sealed with a filling. Sometimes, in cases of extensive infection, the procedure may require more than one appointment.

What can I expect after Root Canal Therapy?

As with any procedure some pain and discomfort is to be expected after the root canal treatment.

If you have moderate to severe infection associated with pain prior to the procedure, your dentist may prescribe antibiotics and pain medicine for pain and infection.
It is important to take all the prescribed medication to decrease the pain and discomfort and increase the success of the root canal treatment.

If a permanent crown is recommended post root canal treatment, it is very important to get it done within the first 2 weeks of root canal treatment.
You may be recommended a soft diet for the first 72 hours post treatment.

DO’S and Don’ts after Root Canal Treatment

Do’s of Root Canal Treatment:

  • Call your dentist as soon as you have a toothache.
  • Take over the counter pain medication like Advil, Aleve, Motrin or Tylenol to help decrease the pain.
  • Take all the medications prescribed to you by your dentist.
  • Use cold compresses if recommended to decrease the pain and swelling.
  • Have the crown procedure completed as soon as possible after the root canal treatment is completed.

Don’ts before and after Root Canal Treatment

  • Do not put warm compresses to the affected area as it will increase the swelling.
  • Do not put clove oil or aspirin directly on the painful tooth or gums as this may cause chemical burn and cause unnecessary complications.
  • Do not discontinue the prescribed medication before completion of the course.
  • Do not eat hard and crunchy foods before getting a permanent crown as it may cause fracture of the root canal treated tooth.

What is the recovery after Root Canal Treatment?

  1. Some pain and discomfort is to be expected as with any dental procedure.
  2. The post procedural pain and discomfort is directly related to the amount of infection and the cause of pre-procedural pain.
  3. You may be prescribed some antibiotics and pain medication either before or after the root canal treatment. It is very important to take all medication as prescribed.
  4. Most people are able to return to regular activities 48-72 hours after the procedure.
  5. It is important to contact Dr.Bhandaru if you have persistent for more than a week or develop a fever of over 101 deg F.
  6. What are the complications of Root Canal Treatment?

    Most common complication of root canal treatment is reinfection. If a permanent crown is not placed after the root canal treatment, there is a chance of root and crown fracture of the treated tooth. Very rarely allergic reactions may occur to the filling material used in the procedure.

    Infrequently nerve damage may occur as a postoperative complication.

    How do I know if my Root Canal Treatment is failing?

    If you are experiencing one or more of the following symptoms after the completion of root canal treatment, it may be an indication that your procedure could be failing:

    • Spontaneous pain
    • Pain on chewing
    • Abscess visible on x-ray or 3D images even when the tooth is not painful
    • Sinus congestion in case of upper teeth root canal treatment
    • Fractured root , this happens usually in instances of failure to get a permanent crown
    • Swelling in the affected area with or without drainage

    What are my options if the Root Canal Treatment is failing?

    If your dentist has diagnosed that the root canal treatment has failed, they may offer you different options to address the situation.

    Retreatment of Root Canal Therapy

    Extraction of the tooth with socket preservation technique

    If you and Dr. Bhandaru has elected to extract the tooth, it is important to discuss all the tooth replacement options like Partial dentures, Bridge and dental implants.

    Why is it important to get a permanent crown after the completion of Root Canal Treatment?

    Access is made to remove the infected nerve to do a root canal treatment, the pulp is then removed. This process weakens the tooth. If you need the root canal treatment due to a large cavity or decayed tooth, a significant portion of the tooth may be missing and this compromises the integrity of the tooth. Dental Crown is necessary to protect the weakened tooth from further breaking down.

    Dental crowns

    What are dental crowns?

    Dental crowns are also called a dental cap. The dental crowns are used to restore the weakened or missing tooth structure. The crowns are similar in shape, color and size to your natural teeth.

    Who needs a dental crown?

    If more than half of your tooth is missing due to a large cavity, your dentist will recommend you a crown.
    Crowns are recommended after a root canal treatment.

    Porcelain dental crowns are a part of cosmetic smile makeover procedure

    If the tooth/teeth cracked due to an accident resulting in a portion of the tooth missing, crown will be recommended to replace the missing portion of the tooth.

    If you have sensitive painful teeth due to wearing down of the enamel due to grinding of the tooth, dental crown will help protect the tooth.

    What are different types of crown?

    All-metal crowns

    The metal crowns are made with precious or non-precious metals. Dr.Bhandaru may recommend gold crowns if you grind your teeth. Gold is a malleable metal so is less likely to break with excessive grinding forces. Gold has bacteriostatic properties and can prevent cavities
    forming at the margin of the crown.

    Porcelain-metal crowns

    These crowns have 2 materials. There is a metal substructure made of either precious or non-precious metal with a porcelain overlay. Dr. Bhandaru recommends this type of crowns when you need a long dental bridge and dental implant is not the recommended treatment. Porcelain fused to metal crowns may be recommended if the cavity is below the gum-line and gold crown is not referred due to esthetic concerns but an all-porcelain crown cannot be done due to location of the crown margin.

    All-porcelain crowns

    These crowns are strong, durable, and aesthetic. These are preferred by many patients due to life-like appearance.

    What happens during the placement of a dental crown?

    At Carrollton Smiles, Dr.Bhandaru performs an exam and based on the findings she will recommend either a 3D image or an x-ray to evaluate the options for you. If a crown is the option for the treatment, you will be given an explanation of the process.

    The area of the mouth that the crown needs to be placed will be anesthetized with local anesthetic. If you are anxious, nitrous oxide / Laughing gas will be provided to alleviate the anxiety and make you comfortable during the procedure.

    The decayed or the fractured portion of the tooth will be removed. The tooth will the built up to ensure the final crown will have ideal dimensions.
    The tooth/ buildup will be reduced to create the room for the permanent crown.

    An impression/mold of the tooth, adjacent teeth and the opposing teeth are made. This will be sent to the lab and the technician uses this to make the permanent crown fit your bite in shape, color and size.

    A temporary crown will be placed to protect the prepared tooth while the technician is fabricating your custom crown.

    As a patient at Carrollton Smiles, you will receive a call as soon as the crown is received by our office. Sometimes this waiting period may take 2-3 weeks.
    At the second appointment, the temporary crown will be removed and the permanent crown will be cemented in place.

    Dr.Bhandaru disinfects the tooth with ozone prior to cementing the permanent crown. This disinfects the tooth and reduces the chances of sensitivity post procedure.

    The color, shape and fit will be confirmed and the crown is cemented in place.

    What happens after the crown cementation?

    In some instances, patients may need to be anesthetized with local anesthetic before the removal of temporary crown and placement of permanent crown. It is important not to chew on the numb lip or cheek. Doing so will cause significant discomfort. Dr. Bhandaru recommends patients not to eat anything hard on crunchy till the anesthetic wears down to avoid the complication.

    It is not uncommon for the bite not to feel normal after the anesthetic wears off. This is due to the area not being able to feel the bite pressure adequately during the crown placement as a result of anesthetic. If you feel that the bite does not feel normal within 48 hours of the crown placement, it is important to call Carrollton Smiles for an adjustment.

    If you are known to grind your teeth, Dr.Bhandaru may recommend a mouth guard to reduce the stresses on the crown due to the parafunctional habits.

    Do’s and don’ts after crown procedure

    Do’s after a crown procedure

    • It is very important to brush your teeth adequately during the temporary crown phase and after the placement of permanent crown.
    • Brush, floss, waterpik and mouthwash the dental crown area like the rest of your teeth.
    • It is important to keep up with your dental cleaning appointment to make sure the crown is healthy.

    Don’ts after a crown procedure

    • Do not avoid brushing and flossing the area.
    • Do not chew on extremely sticky foods as it may cause the crown to debond.
    • Do not chew on ice cubes.
    • Avoid extremely hard, crunchy, and chewy foods.

    How long do crowns last?

    Dental crowns can last 10-30 years with good oral hygiene and keeping up with your dental appointments.

    What are the complications of dental crowns?

    Debonding or falling out of the crown is a common complication. The cement/ adhesive sometimes washes out due to wear and tear and makes the crown become loose. Bring the crown to your dentist and they will be able to recement it at a minimal cost to you.

    If the crown is placed due to extensive loss of tooth structure as a result of dental caries, the nerve of the tooth also called pulp may get inflamed requiring a root canal treatment.

    Very rarely, the tooth under the crown may have recurrent dental caries if you are unable to brush / floss / waterpik / mouthwash as recommended.

    When do I call my dentist after a crown placement?

    Call your dentist immediately if the bite feels off. Call your dentist if the crown is loose. It is important to call your general dentist if the crown chips or cracks and is sharp to your cheek or tongue.


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