Everyone loves a concert where there's plenty of audience participation… until it starts to get out of hand. Recently, the platinum-selling band Fifth Harmony was playing to a packed house in Atlanta when things went awry for vocalist Camila Cabello. Fans were batting around a big plastic ball, and one unfortunate swing sent the ball hurtling toward the stage — and directly into Cabello's face. Pushing the microphone into her mouth, it left the “Worth It” singer with a chipped front tooth.

Ouch! Cabello finished the show nevertheless, and didn't seem too upset. “Atlanta… u wild… love u,” she tweeted later that night. “Gotta get it fixed now tho lol.” Fortunately, dentistry offers a number of ways to make that chipped tooth look as good as new.

A small chip at the edge of the tooth can sometimes be polished with dental instruments to remove the sharp edges. If it's a little bigger, a procedure called dental bonding may be recommended. Here, the missing part is filled in with a mixture of plastic resin and glass fillers, which are then cured (hardened) with a special light. The tooth-colored bonding material provides a tough, lifelike restoration that's hard to tell apart from your natural teeth. While bonding can be performed in just one office visit, the material can stain over time and may eventually need to be replaced.

Porcelain veneers are a more long-lasting solution. These wafer-thin coverings go over the entire front surface of the tooth, and can resolve a number of defects — including chips, discoloration, and even minor size or spacing irregularities. You can get a single veneer or have your whole smile redone, in shades ranging from a pearly luster to an ultra-bright white; that's why veneers are a favorite of Hollywood stars. Getting veneers is a procedure that takes several office visits, but the beautiful results can last for many years.

If a chip or crack extends into the inner part of a tooth, you'll probably need a crown (or cap) to restore the tooth's function and appearance. As long as the roots are healthy, the entire part of the tooth above the gum line can be replaced with a natural-looking restoration. You may also need a root canal to remove the damaged pulp material and prevent infection if the fracture went too far. While small chips or cracks aren't usually an emergency (unless accompanied by pain), damage to the tooth's pulp requires prompt attention.

If you have questions about smile restoration, please contact us and schedule an appointment. You can read more in the Dear Doctor magazine articles “Porcelain Veneers: Strength & Beauty As Never Before” and “Porcelain Crowns & Veneers.”

Your tooth is in peril if its innermost layer, the pulp, becomes infected and inflamed. Deep tooth decay, repeated dental procedures or fractures can all expose the pulp and ultimately the roots to infection and lead to tooth loss.

But that scenario isn't inevitable — we can often save the tooth with a root canal treatment. By accessing the tooth's interior through a prepared hole, we're able to clean out the infected tissue in the pulp chamber and root canals, and fill the empty space with a special filling. We then cap the tooth with a custom crown to protect it from a re-infection.

Root canal treatments have a very high success rate — chances are good your tooth will survive for many years afterward. But there's a slight chance the tooth may become re-infected; in that case, a second root canal treatment may be in order.

In a few cases, though, a second root canal may not be advisable, and could even accelerate damage to the tooth. For example, if past dental work resulted in an extensive crown restoration, accessing the root canals the conventional way will require disassembling that restoration. This could weaken the tooth significantly.

We can approach the problem from a different route: instead of accessing the tooth's interior through the crown (the visible part of the tooth), we instead perform a surgical procedure called an apicoectomy, which accesses the tooth at the root end through the gums.

In this procedure we numb the area with local anesthesia and then make a small incision through the gums at the level of the affected root. After access, we remove any diseased tissue around the root and a few millimeters of the root tip itself. We then insert a small filling in its place to seal the canal and prevent further infection. In some cases we may also insert a graft to encourage bone growth and aid in healing.

Over time, the affected area will heal and return to normal function. Even if a traditional root canal treatment can't be used, an apicoectomy could be another option for saving your tooth.

If you would like more information on your options for preserving a problem tooth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Apicoectomy.”

There’s one sure thing about tooth decay: you can’t ignore it. In fact, the best outcomes result from finding it early and treating it before it enters the pulp in the center of the tooth, often a filling or similar treatment.

If it does advance to the pulp, you may need a root canal treatment to save the tooth. This is a moderately invasive procedure where we access the pulp and root canals, tiny passageways leading to the root and supporting bone. We then remove all the diseased tissue and fill the empty pulp chamber and root canals with a special filling. Later we’ll crown the tooth for added protection against future infection or fracture of the tooth.

But there’s also another less-invasive method than a root canal called pulp capping. It’s only appropriate to use, however, if the pulp has become exposed or almost exposed by decay, but hasn’t yet shown signs of disease.

Pulp capping can be either direct or indirect. We use direct pulp capping if the healthy pulp has been exposed by the disease process. We first isolate the tooth from the rest of the mouth to prevent contamination and then proceed to remove all of the tooth’s decayed dentin structure. We then apply a biocompatible material directly over the pulp to protect it from further decay and to facilitate healing. We then restore the tooth, usually with a filling, to its proper function and life-like appearance.

When the pulp is threatened by decay but not yet exposed, we may then use the indirect method. In this approach we first remove most of the decayed dentin, but leave a small amount next to the pulp to keep it covered. We then treat this remaining dentin with a material to help it heal and re-mineralize, followed by a temporary filling of the tooth. A few months later we’ll remove this filling and inspect the treated dentin. If it has regenerated sufficiently, we remove any remaining decay and permanently restore the tooth.

As we said, pulp capping is only used with patients with deep decay whose pulp tissue is healthy. But when we can use it we can avoid some of the permanent alterations that often come with a root canal treatment and still save the tooth.

If you would like more information on treatments for tooth decay, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Pulp Capping: A Procedure that May Save a Decayed Tooth.”