Dental question

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seaangel

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I had one of my molars crack and break in half last night during dinner. No I was not crunching ice or any thing even remotely hard. I was eating pasta with Italian Turkey sausage in it. Anyway, my question is I had a crown prep and temporary crown put on today and I have some dives planned this upcoming weekend would this be a problem?
 
I just went thru the same thing. Dentist assured me there would be no problem diving and there wasn't. However, temp crown popped off 3 times - not diving related. Just in case, HEB has 2 part crown cement (same stuff the dentist uses) for $3.00. Although it was a little tricky drying the surface with 135 psi.
 
As long as you don't have any problem removing your reg underwater so you can spit out anything that might be "unexpectedly" in your mouth...
 
Hi Seaangel,

DocVikingo gave me the heads up. My son's been hogging the computer lately.

First, I can't tell you how many people report breaking teeth on bread, pasta, crackers, etc. Unless there is a really hard crust, bread and pasta is not the culprit!. The tooth was already cracked and the sticky paste made up of the pasta and spit (uggg!) pulls the broken pieces out.

Most of the time the offending tooth has had a previous silver/amalgam filling in it since the "Big Bang". As silver fillings get older, they react chemically and begin to corrode and expand. Some appear to be squeezing out of the tooth and other expand laterally--sideways. This creates rather high stress within the cusps and a fracture usually begins within the filling preparation at the junction of the verical and horizontal walls of the preparation.

If you brux or clench your teeth, chew ice, chew a lot of gum or just TALK TOO DARNED MUCH...oops, you add to the stress and finally the tooth breaks.

Some patients report sensitivity to biting pressure, and release of biting pressure (rebound sensitivity) ONLY WHILE CHEWING FOOD. Without food between the teeth, they can squeeze as hard as they want and there is no pain. Also reported may be sensitivity to cold, sweets--especially, chocolate and rarely hot foods. For reasons that totally befuddle me, a few patients report sentivity to.....ready for this....lettuce...really. It must be something in the juice. Some patients even report that all their pain goes away after the broken piece comes out!

A cap is usually recommended because so much tooth is lost to the break and if the fracture goes deeper into the tooth, it can affect the nerve or even split the tooth in half...and that's a gonner. The cap rebuilds lost structure and can reinforce the tooth.

The temorary crowns are for both protection from stuff in the mouth AND the edges of the temporary support the soft gum tissues around the prepared margin. If you lose the temporary and leave it out even a few hours, it might not go on without first trimming the gum. So first...don't do anything to lose it and second, if it comes out try to wear it unless it follows you finger out of your mouth and get in to see your dentist.

The easiest way to lose a temporary is to eat sticky candy. If you don't know what this is, I'll enlighten you with a list I have compiled over the years. I used to say "No gum or sticky candy." and the patient would then ask, " How about gummy bears?" Duh! So here's the list....No sticky candys like gum, caramels, gummy bears, juju bees, tootsie rolls, gum drops, raisins, craisins, licorice, milk duds, coffee candy, taffy, grilled onions (they caramelize), hard candys (they start out with a sticky coat). No ice, nuts, unpopped popcorn (old maids).

If you can think of another I would love to hear it because I'm sure that someone out there will think to themselves...Hmmm...not on the list, must be ok to eat.

On to temporary cement. Awap is correct, you can buy a two part cement kit at most pharmacys. It can be used as a cement if mixed to the consistency of sour cream or as a temporary filling if mixed very stiff. Rinse your mouth out with slightly warm water and then try to blot the tooth dry. Make sure you figure out how the temporary goes on first before mixing the cement---you only get one try...mess it up and the cement is hard...bummer. I recommend and carry one when I go out of the country.

OK...now here's the really important thing to know about temporary cement....IT CAN ONLY BE USED IN TEMPORARIES FOR PERMANET CROWNS THAT WILL BE CEMENTED WITH NON-BONDING CEMENT. Many all porcelain crowns are bonded to the tooth so if you are not sure what is being used, simply slip the temporary on again and leave it alone--get to your dentist.

Any plastic resin bonding cement will fail to set properly if it come into contact with clove oil--one of the basic ingredients of OTC temporary cement. Clove oil compromises the bond, can make for a sensitive permanent tooth and lead to a cementation failure later on.

Now, you're wondering "How about Superglue?" Don't you dare. First, it won't work long except when you want to get the darned thing off. It's adhesion fails in a moist environment. It may be toxic to the pulp tissue--which is Ok if you really want a root canal.

Finally, temporary crowns stay on because of a snug fit. The temporary cement is there to prevent PULLING it off. So biting on the temporary usually won't loosen it...the operative word is, USUALLY. A properly cemented temporary crown won't have any bubbles under it nor are those bubbles the real problem in barodontalgias. About the only thing a bubble might do under a temporary crown while diving is create a potential space into which the plastic may be compressed--this could loosen the crown.

Oh, yeah...Flossing temporaries...slip the floss through to clean and then let go of one end and slip the floss out. Both sides. If you pop it out, it might go ballistic.

All this being said, diving with a temporary, while possible, poses an aspiration risk. Even more so if it is already loose and you've put it back into your mouth. Also, barodontalgias seem to be associated more with a dead or dying nerve than with a simple bubble. The tooth preparation for the cap may set up those conditions. The temporary cap probably does NOT add any liablility.

My professional advice it to avoid the dive with a temporary crown. If you inhale it, it won't show on an x-ray and it poses both a choking hazard and a real pain in the a** to remove from your lungs. If you're lucky and swallow it, most times it will pass...but one never knows, do one?

Lastly, just in case you take me seriously:

Disclaimer
(No representations are made that in any way offer a diagnosis, treatment or cure for any illness or condition, either discussed or implied. Answers to questions are offered as information only and should always be used in conjunction with advice from your personal diving physician/dentist. I take no responsibility for any conceivable consequence, which might be related to any visit to this site.)


Safe diving,

Larry Stein
:doctor:
 
Cindy:
We have some very smart doctors on here, don't ya think?
((((( reaching for my M&M's since they were not on the list )))))
 
I forgot and left something out.

If a temporary comes out and your desperate, get some denture paste--in a tube--powder is too hard to use. Clean out the temporary, put in a really small dab and it wil stay on by sheer stickness. Too bad you can't use candy on the inside--huh?

You've got to remove the sticky mess periodically, otherwise it kind of hardens and builds up the bite, not to mention food and germy stuff. Remove the denture paste with hot water and a toothpic.

Hey Natasha--I can't figure out if M & M's are chocolate or sticky candy. I can't think of a patient who lost a temporary to chocolate--as opposed to chocolate taffy or tootsie rolls.

BTW, I absolutely no idea why candy sticks to temporary plastic like it does. It doesn't stick to teeth or porcelain the same way. It's got to do with the chemical/physical properties of the plastic and candy. Freedent gum DOES stick to temporaries--so let's not use that excuse to get me into the office on a Saturday when I supposed to be in the water.

Some really rich guy (probably) named Richwil came up with a special way to remove permanently cemented crowns without breaking them. The Richwil Crown Remover. It's a little rectangular piece of what looks like....candy. You warm it up in hot water, press it over the crown, chill it with water and then grab the glob with a hemostat--the crown comes with it. You can also have a patient bite down on it and then quickly open--sometimes you get the crown out and sometimes you get the opposite filling out! Then it takes about 15 minutes to get the damn gummy stuff off the crown (if you did it right).

Larry Stein
 
Thanks, that was much more than my dentist even attempted to tell me. I have a really good dentist and I told him that I dive, but he made no comment about if I could or not.

I also, noticed you mentioned plastic temporary, mine is or looks like a steel or metal cap. Is there some differences?

I guess I have to decide what I want to do, about diving that is. This is the last weekend that I will have the opportunity to do my deep dive certification until next spring. It is the last of my dives to earn my Master Diver Certification. I have been looking forward to this for several weeks now.

Again, thanks for the informative response.
 
Laurence Stein DDS once bubbled...
Most of the time the offending tooth has had a previous silver/amalgam filling in it since the "Big Bang". As silver fillings get older, they react chemically and begin to corrode and expand. Some appear to be squeezing out of the tooth and other expand laterally--sideways. This creates rather high stress within the cusps and a fracture usually begins within the filling preparation at the junction of the verical and horizontal walls of the preparation.

Wow, I had no idea. What is this lifetime of a typical filling? If that is happening can you have those fillings replaced with another material?

-K
 
Hi Seaangel,

Just when I thought I had said everything about temporary crowns......You're describing what sounds like a steel or aluminum shell crown. They are prefabricated out of metal, usually trimmed with a special scissors and then filled with cement and pressed over the prepared tooth.

It's a matter of preference. I prefer to custom fabricate a temorary crown out of plastic. In my hands I feel the fit and hygiene is better. Some guys though get pretty slick with them and they can be made pretty fast. Their anatomy is not as natural and sometimes they (and any temporary) can irritate the gums.

I prefer the plastic because it conforms much closer to the prepared tooth. I feel I have more control over the contours affecting the contacts between the teeth and the contours of the tooth which translates--for me--to better tissue conditions for permanent crown cementation.


Ok, now for you Scubakat. To date, there is no "perfect" direct filling material. A direct material is one that is placed and shaped into the cavity preparation in a single visit.

Dentists basically have three materials to choose from. Amalgam, a mixture of silver, mercury, tin, copper, zinc. I know that there is a great deal of controversy about the mercury component in it. Elemental mercury is toxic. So is fluoride, vitamin A, D, E and K. So something toxic is not necessarily something that will hurt you if used in an appropriate way.

The mercury component in the silver amalgam forms a new alloy of metal. The mercury is essentially bound within the mass. You get more mercury in the air each day than from the fillings in your mouth and let's not get into tuna.

The next material is "porcelain" composite. Actually, a plastic. This is "bonding". It is made up a plastic resin into which is packed tiny particles of quartz, glass, ceramic--whatever the chemists can think of to enhance the physical properties. Now, even fluoride is mixed in. The plastic by itself, shrinks a lot during setting (polymerization). To reduce the shrinkage, the particulates or aggregates are added. They are hard and don't shrink so the entire mass tends to shrink less. The move particles, also know as filler present within the plastic, the less the shrinkage. Unfortunately, there is an upper limit to how many particles can be incorporated into a plastic resin and still be usable as a filling.

Composite can be polymerized either chemically, or by light curing or both. Usually, a blue colored light is used to cure the plastic in about 20-30 seconds. To further reduce shrinkage, small increments are added and cured. Each addition shrinks but by layering, the shrinkage occurs within the mass before it is completely attached to the all the surfaces of the tooth. This way, less stress is applied by bonded, shrunken resin, which can cause sensitivity.

Composite is much more technique sensitive than amalgam and higher sensitivity may be experienced unless you take special steps to reduce moisture, shrinkage and increase the penetration of the plastic into the tooth. The actual bond is very strong.

Finally, there is something called glass ionomer cements or resin ionomers. These are cement like. They have high fluoride content and can be used in decay prone people like children or the elderly and infirmed. They wear the most.

Currently, amalgams and composites are supposed to wear at approximately the same rate. In reality, I find that composite still wears faster. The published life times for both is 7-14 years. This is for ideal, unchipped, unbroken fillings.

When a composite fails, it is usually easier to see the discoloration and become suspicious. Amalgams seem to stay "servicable" for many years more but in fact, there may be a failure underneath that is not detectable. Also, like I mentioned earlier, amalgams corrode and can lead to fractured teeth.

Amalgams do have some good properties. They are usually better in high stress areas like the molars. They can be placed over clove oil cements which reduce sensitivity. They take about 1/3 to 1/2 the time to place.

Composites, are certainly more cosmetic and I feel better about doing a nice job after placing one. I prefer to do them in the bicuspids and forward. Sometimes, on request I will do them anywhere with the warning that they may not last as long. BTW, an estrogen like substance has been found to leach out of composites. What does this mean? I don't know. Probably about as much as there is mercury in amalgam.

It is considered unethical to remove amalgam for health reasons posed by the dentist. The patient can have whatever they want for cosmetic reasons. They just have to know that you give up something to get something.

Hope this answered your question. Oh, yeah, the glass ionomes wears the fastest and has the least amount of recurrent decay during it's useful lifetime. I use it for bases and cores under crowns and temporary fillings.

Regards,

Larry Stein
 

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