A dentist’s goal is to save teeth, however, if there is too much decay or gum disease or the financial situation is not good enough to properly restore the teeth, then the fateful decision must be made to remove the remaining teeth. There are two ways of handling the construction of the first set of dentures. One method is to wait for one full month to allow the gums to heal and shrink. At this point, an impression (or mold) is made of the gums and denture construction begins. The other method is an immediate denture. An immediate denture is constructed before the teeth are removed. The advantage of that is that the denture is inserted on the day of the surgery. This way the patient never has to go around without teeth. Unfortunately, there are compromises. There is no way to do a try-in to check the cosmetic arrangement of the teeth, the function, or phonetics (ability to speak with the dentures). It’s possible that the resulting pre-made denture could be far enough off that it may have to be remade. The other issue is that the gums will shrink after surgery, so the denture will have to be relined after about six months. This way the inner part of the plastic of the denture will match the new healed gums. An immediate denture would at least save one from the embarrassment of being without teeth for any length of time.
When a child receives a blow to the mouth and injures a front tooth, there is always a chance that the blood supply to the dental pulp (or nerve) will be severed, causing the nerve to die. In this case, root canal treatment would be indicated. However, if the child is of a younger elementary school age, the end of the root has probably not matured yet.
This is a situation called an open apex. The apex is the tip of a tooth root. In a normal root canal, an inert filling material is packed against the apex to seal the end of the root. With an open apex, there is nothing to pack against so there is no way to get a good seal. Fortunately, there is a procedure called apexification that will stimulate the body to close the apex. After the root canal has been thoroughly cleansed of debris, a calcium hydroxide paste is inserted at the root end. The calcium hydroxide is very alkaline. The body reacts to this high pH by depositing hydroxylapatite crystals (the basic building blocks of teeth) at the site. It takes a few visits spaced out over a year’s time and then the canal can be properly sealed. Using this procedure will allow a front tooth to be retained, saving the child from years of embarrassment and numerous tooth replacements.