Showing posts with label fractured cusp. Show all posts
Showing posts with label fractured cusp. Show all posts

Monday, November 14, 2016

Dental Detectives: What Fossil Teeth Reveal About Ancestral Human Diets


When scientists want to know what our ancient ancestors ate, they can look at a few things: fossilized animal bones with marks from tools used to butcher and cut them; fossilized poop; and teeth. The first two can tell us a lot, but they're hard to come by in the fossil record. Thankfully, there are a lot of teeth to fill in the gaps.
"They preserve really well," explains Debbie Guatelli-Steinberg, a dental anthropologist at Ohio State University. "It's kind of convenient because teeth hold so much information."
The structure of a tooth and even the amount of enamel, for example, hint at what the teeth are adapted to eat.
Look at molars: Thick enamel on a molar is good for crushing foods. It suggests an animal used its teeth to grind seeds or crush the marrow out of bones. Thin enamel on a molar, while delicate, causes sharp edges — perfect for slicing and tearing foods like leaves and fruits.
However, these are just clues to some of the things the animal could have been eating, not what it ate every day, says Peter Ungar, an anthropologist at the University of Arkansas.
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"If you eat Jell-O almost every day of the year, but sometimes you need to eat rocks ... you want teeth that can eat rocks," he explains. So, teeth are usually adapted for the toughest component of an animal's diet, not what it eats on a daily basis.
To see what an animal was actually eating, Ungar studies something called dental microwear, the marks left behind by food on teeth. As we chew on say, a celery stick, hard particles — either bits of silica from the plants' cells or sand and grit from the surrounding environment — are dragged across and pressed into our teeth. When we chomp down on something hard, like a nut, the crushing force leaves microscopic pits behind. When we tear through tough grasses — which may not sound appetizing now, but it's likely some of our ancestors did eat them — by moving our teeth side-to-side, the teeth get tiny, microscopic scratches.
"I call it a foodprint," Ungar says.
These foodprints can paint a pretty good picture of what an animal ate in the weeks leading up to its death — a sort of last meal. A study of such microwear revealed that Australopithecus afarensis, our 4 million-year-old ancestor best known by the famous fossil of Lucy, probably ate tough grasses and leaves. And it looks like early members of our genus, Homo — like Homo habilis, which lived 2.4 million years ago or Homo erectus, which even overlapped with humans about 100,000 years ago — were omnivores like us. They ate a variety of foods like meat, plants, fruits, "Anything they wanted!" says Ungar.
So we can tell what an animal was adapted to eat and what it ate shortly before it died. But to know what it ate for longer periods, scientists have to look deeper — to just below the surface of a tooth — for certain molecular signatures left behind from daily meals.
As our teeth grow in early childhood and adolescence, they incorporate certain molecules from the food we eat. The same was true for our ancestors. Paleoanthropologists studying ancient diets are especially interested in carbon molecules in our ancestors' teeth, because they come from plants and stick around for a long time.
Some groups of plants use mostly one form, or isotope, of carbon. Plants with C3 isotopes are usually found in fruits and leaves — things that grow in forests. Plants with C4 isotopes, like grasses and sedges, grow in savannas.
Data from isotopes confirmed that Lucy's species switched from forest foods to savanna foods about 3.5 million years ago. That transition from forests to grasslands may have played a key role in human evolution, explains Matt Sponheimer, a paleoanthropologist at the University of Colorado, Boulder. Some researchers even think that adding more grass to our diets gave our ancestors more foods to eat and places to live as the early climate changed causing Africa's forests to shrink.
Our understanding of what our ancestors ate has become more complex and richer with time, as scientists have applied newer, more advanced techniques to study teeth. When Mary Leakey dug the 2 million-year-old human ancestor Paranthropus boisei out of Olduvai Gorge in Tanzania in 1959 year, she noticed the fossil's wide, thick molars. The skull had huge cheekbones to accommodate strong chewing muscles and powerful jaws, suggesting the species was well-suited for crushing nuts. So, Paranthropus boisei was nicknamed Nutcracker Man.
But when Peter Ungar and others examined Nutcracker Man's teeth, they barely found any foodprints, so they decided he likely ate soft foods like fruits.

An analysis of Nutcracker Man's tooth isotopes revealed C4 carbon, which comes from savannas, not fruit-filled forests.
Today, researchers think that Paranthropus boisei ate a varied diet with lots of different foods, but he mostly ate tough grasses and sedges.

Teeth from more recent fossils reveal more because they have more isotopes preserved in them. For example, the nitrogen in the teeth of Neanderthals can reveal whether the protein they ate came from plants or animals. It's one of many reasons researchers think Neanderthals hunted large mammals, though scientists have also found fossilized plants stuck in Neanderthal teeth.
Researchers were even able to use isotopes to find out when one Neanderthal started weaning her baby. As teeth grow, they lay down layers of enamel. And barium, a molecule children get from breast feeding mothers, builds up in baby teeth until the mother stops nursing. By comparing barium in a Neanderthal tooth with levels in donated present day baby teeth, the scientists were able to find out that the Neanderthal baby had been weaned at about seven months.
We can even use teeth to tell if someone moved between places with dramatically different foods or soils. Since wisdom teeth are the last adult teeth to come in, comparing them to an early emerging canine tooth can give scientists a dietary snapshot across time. Say someone was born in Africa and moved to a new continent as a preteen, while wisdom teeth were still growing. A comparison of the isotopes in the teeth would reveal the story of that migration.
There's still a lot to learn from teeth, and a lot of fossil teeth still being discovered, says Sponheimer. And as the tools to study them get more sophisticated, teeth are providing a richer picture of "who we are and how we came to be," he says.

By: Erin Ross, NPR
http://www.npr.org/sections/thesalt/2016/10/25/497094756/dental-detectives-what-fossil-teeth-reveal-about-ancestral-human-diets

If you have questions or would like to schedule an appointment, please contact Omni Dental Group at one of our three office locations listed below:

North Austin on Hymeadow Drive: (512) 250-5012
Central Austin on Jollyville Road: (512) 346-8424
South Austin on William Cannon: (512) 445-5811

Thursday, July 10, 2014

Cracked Tooth Syndrome (CTS)

What is CTS?
Minuscule cracks can form on your teeth, threatening your dental health. Why? 
  • Age plays a factor - as we get older, our teeth tend to weaken, making them susceptible to tiny hairline fractures that are not visible to the naked eye. 
  • We increase our chances of developing cracked teeth by exposing them to trauma, such as bruxism and chewing on hard objects.
  • When teeth have been heavily filled, it is not unusual that they develop cracked (or split) tooth syndrome (CTS). 
Symptoms include a sharp pain when you bite down into something hard. When you open your mouth and the teeth are no longer touching, the pain goes away. The pain does not usually linger after the biting action is finished. The fact that you feel pain when pressure is applied to the tooth means that the nerve is being affected. If the problem is not solved quickly, the nerve may die and the tooth will then require endodontic treatment (root canal).

Why does it hurt when I eat?
Pressing an object against the tooth opens the crack, causing the underlying dentin to move and irritating the pulp chamber (which contains the tooth's nerves). When the pressure is released, the crack immediately closes, causing a sharp pain. If left untreated, the pulp will eventually become damaged, and you will start to feel sensitivity to hot and cold or prolonged pain.

Common sites of cracked teeth
  • Premolars and molars, the back teeth that grind and crush food 
  • A tooth that has recently been drilled and a great amount of tooth structure has been lost
  • A tooth that has an extensive filling (usually silver amalgam) that has been in place for a long time 
  • Or a tooth that only has a small silver filling  
    • The filling has weakened the tooth just enough so that when you chew or bite, the tooth and filling separate slightly (flex), causing immediate and sometimes severe pain.
Types of cracked teeth:
  • Fractured Cusp: When the cusp (the raised section of the biting surface of your tooth) becomes fractured. If a fractured cusp does not break off on its own, it will need to be removed by a dentist and replaced by a dental crown.
  • Cracked Tooth: Run vertically, originating from the top part of the crown and working their way down. Treatment typically entails a root canal followed by a dental crown. If the crack has extended below the gum line, the tooth may require a tooth extraction. 
  • Split Tooth: When a cracked tooth is not treated, the crack can extend beyond the root, causing the tooth to split. Although these teeth are difficult to save, they can sometimes be treated with a root canal. 
  • Vertical Root Fracture: Sometimes the crack starts at the bottom of the root and works its way up. If caught early, endodontic dental surgery may correct the situation. 
Treatment
Vertical Fracture

  • Treatment will involve at least one x-ray to assist in the diagnosis and to rule out other causes. We will try to find the section of the tooth that is causing the problem by pushing on the various sections of the tooth or having you bite on a hard object.  
  • When the section of the tooth that is cracked is found, it makes treatment easier. First, the tooth is anesthetized and the old filling is removed. 
  • Then we carefully inspect the area to determine whether the cracked section can be seen. Very often it is visible at this point. 
  • The next step is to see whether the split area can be fixed with a direct filling (bonded). This is the ideal situation if the crack is small.  If the crack is small enough, it may be removed by replacing the filling. Bonded white fillings and bonded amalgam filling will hold the tooth together making it less likely to crack
    • Crown
    • Your dentist may first place an orthodontic band around the tooth to keep it together. If the pain settles, the band is replaced with a filling that covers the fractured portion of tooth (or the whole biting surface).
  • Unfortunately, this rarely occurs. If the crack goes too far vertically, there is a possibility the tooth may need to be removed and replaced with an artificial one (bridge, denture, or implant). More often (over 95% of the time), the biting surfaces of the tooth must be entirely covered and protected first with a provisional (temporary) onlay or crown. 
  • If this is successful in eliminating the pain (we usually wait for a few weeks to be sure the problem is resolved), an impression for a laboratory-fabricated casting - either a porcelain or resin onlay or a crown - is made. If adequate tooth structure remains, a partial coverage restoration - an onlay - is preferred. If the tooth has been badly cracked or if not much tooth remains, then a crown will be necessary. The purpose of either type of cast restoration is to unite all sections of the tooth so it cannot move or separate under normal biting forces. If the provisional restoration is successful in eliminating the pain, we expect that the final cast crown or onlay will correct the problem. 
  • The nerve may sometimes be affected so badly that it dies. Root canal treatment will be required if the tooth is to be saved.
The earlier a split tooth is diagnosed and treated, the better success there is in treating it. If the split is severe, a root canal may be necessary to save the tooth. Depending on the symptoms you describe, we may choose to treat it as a bite adjustment, small filling, or larger preparation for an onlay or  crown. If these do not work, the treatment plan will be modified. If left untreated, the tooth may eventually be lost. It is also possible that the initial split of the tooth may be such that it cannot be saved, despite our best efforts.

Delaying Treatment
What happens if CTS is not treated quickly? The best you can hope for is that the tooth continues to hurt only when you chew or bite. This does not often happen. Usually, the broken section of tooth gets weaker and weaker until it fractures off. Additionally, if the crack gets deeper into the tooth, the nerve will die and the tooth will need endodontic treatment before the crown or onlay is placed. Sometimes the nerve is immediately affected by the initial split and dies. This may occur quickly or may take years before it is evident. Every case of CTS is unique. If it is any consolation, the cracked tooth is not your fault. It is a result of your teeth being drilled and filled with big silver fillings when you were younger. We see this particular dental problem mostly in patients who are between 25 and 45 years old.

Unfortunately, cracked teeth do not go away. Many times, they only hurt when you bite on them from one particular angle. If the fractured segment is not stressed, the tooth feels normal. You might also be able to "train" yourself to chew on different teeth and avoid the cracked tooth. At best, you only postpone necessary treatment while the nerve may be slowly dying.

After Treatment
If treated by adjusting your occlusion (bite) on the tooth
This will lessen the symptoms. If the discomfort you feel when you bite is not eliminated within one week of treatment, please call our office and let us know. If the split is still present, a different approach will have to be tried. Give the tooth a few days to "calm down" before you try to bite down on hard foods.

If treated by removing the old restoration and placing a bonded filling in its place 
If the split is small, this may eliminate the problem. Do not bite down hard on the tooth for a few days, then gradually place more pressure on the tooth. Call our office in one week and let us know how it feels. If the split is still causing a problem, a different approach must be tried. If left untreated, the tooth may split further and you may need endodontic treatment and a crown. If the tooth splits severely, it may have to be extracted.

If treated by cementing a temporary crown onto the cracked tooth with temporary cement 
Because the crack was so severe, this procedure was used to determine whether or not the tooth can be treated without performing a root canal. Please give the tooth several days of rest before you try biting down on hard foods. Expect the tooth to be sensitive for a few days after the temporary is placed. This is normal. Gradually apply more force when you bite into foods, and gradually try to eat harder foods. Expect the temporary crown to remain in place for several weeks, until it can be determined whether or not the problem is solved.

If you have any questions about cracked tooth syndrome, please feel free to ask us.