My son’s front teeth are a mess!

September 29th, 2010

My 10-year-old son was jumping on the neighbor’s trampoline, and came down on his face on the frame (no safety net). Half of his left front tooth broke off, and there is a horizontal crack in the right one. We took him to the ER to make sure he did not have any other injuries, which thank God he doesn’t. This morning, I took him to our family dentist and couldn’t believe it when he told us we will have to wait nearly three weeks for his schedule to allow him to fix it! Are you kidding me?? When I asked him if he could recommend someone who could fix it right away, he said we need to wait anyway, to let the root desensitize. I’ve never heard of this before.

Is it medically necessary to wait? I want this fixed right away.

Thank you in advance,

Jennifer in Portland, OR

Dear Jennifer,

Medically, there is no reason to wait. I’m not sure why your dentist won’t recommend someone else if he is too busy to take care of this right now. Your letter kind of implies that there is not much a trusting relationship with this dentist, which is a good indicator that you may want to consider finding a new dentist.

You don’t mention whether or not you have the piece that broke off the tooth, and hopefully you do. An experienced and talented cosmetic dentist may be able to reattach the broken piece of tooth. If you do not have the missing piece of tooth, the most likely fix for a child this age is direct dental bonding. When he is older, he will likely need porcelain crowns on one or both front teeth.

Direct dental bonding is a very demanding procedure, both technically and artistically. Keep this in mind when you choose a dentist to do the repair. You should look for an expert cosmetic dentist with demonstrated skills in direct dental bonding, and one who is sensitive to self-esteem issues in kids. If you talk to a dentist and he or she seems to be dismissing the importance of the appearance of those front teeth in a child, seek another opinion.

Best of luck to you.

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White fillings OK for wisdom teeth?

September 17th, 2010

Some years ago I had three molars that required fillings, and the dentist I saw at the time talked me into white fillings. While he was at it, he also talked me into getting white fillings in my two lower wisdom teeth, to protect them against future cavities, because I guess they had very deep pits and fissures in them.

Soon after the fillings were placed in the molars with cavities, I had to have those fillings replaced by a different dentist. My teeth were so sensitive after the fillings that I could hardly stand to eat anything! The white fillings in my wisdom teeth didn’t bother me at that time, but I kind of figured that was because there were not any cavities under them. Now, though, the white filling material in my wisdom teeth has worn almost completely away. The parts of the teeth that were covered with filling material before look just awful–yellow and gross.

What kind of filling should I get to have these fixed? I don’t want a repeat of the fiasco I had before, but my current dentist does not even place the regular kind of fillings anymore. She only does white fillings, which kind of shocked me. Could it be that she does not know how to place the more traditional kind of fillings? If that is what I want for my teeth, will I have to go to a new dentist again?

Thanks for your help and advice with this,

Ryan in New Hampshire

Dear Ryan,

It wasn’t the kind of filling you had that caused your problems. It was the technique used to place those fillings.

If your dentist graduated from dental school, then she does know how to place an amalgam filling. But many dentists these days are choosing NOT to place amalgam fillings, because so few patients want them if offered the choice between white fillings and traditional amalgam fillings.

There are several disadvantages to amalgam fillings. The amalgam material is more than 50% mercury by weight, and there are ongoing concerns about safety that are currently being investigated by researchers. Many people chose to err on the side of caution and opt for white fillings. Also, the amalgam material weakens the surrounding tooth material, making the overall structure of the tooth weaker. Amalgam fillings also corrode over time and tend to make your teeth more sensitive. Finally, they are just plain ugly. There is nothing that can be done to make an amalgam filling look natural in your mouth.

By contrast, white fillings can look like a natural part of your tooth. If done properly, your teeth will be less sensitive to temperature changes, and the white composite material bonds to the tooth structure, creating a stronger end result. The disadvantages of white fillings is that they are usually more expensive, and require more skill and expertise to place.

If your dentist ONLY places white fillings, then it is a safe bet that she is an expert in doing this procedure. If you need more reassurance, question her about where she did her training, and ask to see before and after pictures of her work. Most dentists will want you to feel safe and comfortable with the treatment plan, and if she can’t reassure you, it might be time to find a dentist you can really trust.

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Is there an optimal time to get my dental implant?

August 31st, 2010

My dentist told me I have a molar that has decayed below the gumline, and that it has to come out. She referred me to an endodontist who confirmed that diagnosis. They both say there is no way to save the tooth, and that the best course of action is to get a dental implant.

I do not have dental insurance, and a dental implant is quite expensive. How long do I have before the missing tooth starts to mess things up? Both my dentist and the endodontist said I had to get something in place “soon”, but they did not say why, specifically. I’d like some time to save up for this procedure, but I guess I could finance it if it is important to move quickly.

Sarah in New York

Dear Sarah,

You’ll definitely want to have the decaying tooth removed as soon as possible, to minimize the impact on the surrounding teeth and root structures. After removal of a tooth, the teeth surrounding the empty socket start to “drift” in just a couple of weeks. The tooth that corresponds to the missing tooth in the opposite jaw (the “opposing tooth”) will begin to grow to meet the tooth that is no longer there. This is called super-erupting. The teeth on either side of the empty socket will start to tip into the empty space.

Even though these are normal, natural teeth movements in response to a lost tooth, this motion still plays havoc with your bite and alignment. Changes in your bite and alignment can lead to headaches and TMJ issues. The longer you let the situation continue, the more time consuming and costly it will be to correct.

In the short term, your dentist should give you some kind of temporary space holder to prevent the teeth from drifting while the socket heals, and any infection clears. After the root form is placed, it will need several weeks to integrate with the bone of the jaw.

If you share your financial concerns with your dentist, she may be able to find a way to work with you to get you the care you need as expediently as possible. Certainly it is worth asking, because you do not want to delay this procedure if at all possible.

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Resistant brown spots on teeth

August 17th, 2010

I could really use a second opinion. I’ve been going to the same dentist for years, but recent developments make me wonder if I don’t need to look for someone new.

My front two teeth have been discolored ever since they came in. I’ve always taken really good care of my teeth, but my dentist said that the discoloration was caused by a very bad fever I had as a small child. Whatever the cause, the appearance of my teeth causes me a lot of embarrassment. Under the guidance of my dentist, I have tried just about every over-the-counter whitening product there is. Nothing works. In fact, I think my teeth look worse now than they did when I started trying to fix them!

At my last cleaning visit, I mentioned my frustration to my dentist. He said he could try to “experiment” and grind my teeth to try and remove the stains. I am not educated in cosmetic dentistry, but this sounds like it would leave me with an even uglier mess than I already have! Is this common treatment for stubborn stains on teeth? Would professional whitening work where the OTC treatments did not?

I need your help. I just graduated from college, and am starting to interview for my first “real” job. I can’t help feeling like my teeth are hurting me professionally. Even if someone doesn’t actually think it, my teeth create the impression that I am a slacker that can’t even be bothered to brush his teeth.

Thanks for you time,

Robert in Owasso

Dear Robert,

You are absolutely right - you need to seek a new dentist. You current dentist may be perfectly adequate for routine dental care, but for your cosmetic problem, you need to seek the services of an expert cosmetic dentist. Your current dentist does not seem to understand teeth whitening very well, and his proposed “experiment” could do serious damage to your teeth.

Professional whitening is not likely to work for you. A process called microabrasion might work, depending on the type and degree of severity of the discolored spots. A thoroughly trained and experienced cosmetic dentist should be able to determine if microabrasion is worth a try or not.

The most likely solutions would be direct dental bonding, or porcelain veneers. Both procedures should absolutely be performed by an expert. I’d hate to see you wast any more time and money on “experiments”.

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Does dental insurance ever pay for dental implants?

July 31st, 2010

My dentist just told me that I should get dental implants. I had all of my upper teeth pulled years ago, and it is getting really difficult to wear a denture. My dentist says I am running out of options, and that dental implants would be the best way to go, but they are so expensive! There is just no way I can pay for a full upper set of dental implants without some kind of help.

Is there a dental insurance company you recommend that would help pay for the cost of dental implants?

Thanks for your help,

Melissa in Oregon

Dear Melissa,

I’m afraid you are in a tough position. You will not find a dental insurance company that will pay for dental implants. If you think about it from the dental insurance company’s point of view, it makes sense. They would be out of business pretty quickly if they had to routinely pay for dental implants, which are many times the cost of a policy. Most dental insurance companies will pay a portion of the least expensive treatment, and most also have a yearly cap of $50o to $1000, which as you now know does not go a long ways towards paying for an entire set of dental implants.

Dental insurance is usually of the most benefit when it is supplied through an employer, where the dental care is part of the benefit package for employees, and paid for with pre-tax dollars. That way the insurance company passes on the costs of all the dental care they pay for on to the employer, along with a little profit for the insurance company.

The unfortunate thing is that you probably did not anticipate this kind of problem when you had all your upper teeth removed. Most people are not aware that the bone of your jaw is reabsorbed at the point of a lost tooth. If you have lost ALL your teeth, you can wind up with a condition called facial collapse. Over time, the bones of the jaws deteriorate to the point that no denture can be worn, and the face seems to “fold in” on itself.

Dental implants halt the process of bone loss. If you can not afford a full set of implants, see if your doctor does “mini dental implants”, which are used to anchor a denture. These mini dental implants will also work to stop some of the bone loss in your jaw, and are a less expensive option than a full set of upper dental implants.

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Why are my teeth so sensitive after my braces came off?

July 17th, 2010

I had braces for more than two years. Six weeks ago, I finally got them taken off. I was so excited to finally get rid of those braces, but now it seems like I have a whole new set of problems with my teeth.

For one thing, they are getting darker every day. I almost never drink any kind of dark pop or coffee, but it seems like my teeth are getting more and more stained. I can’t hardly stand to eat anything that is really hot or really cold, because it REALLY hurts. And it feels like there are “dips” in the front of my teeth now, spots where the tooth feels rougher than the areas around it.

What happened? Did my orthodontist damage my teeth when he removed the cement holding the brackets in place? What can I do about this?

Thanks for your help,

Eddie in Mishawaka

Dear Eddie -

It is highly unlikely that your orthodontist caused damage removing the brackets. That is a very routine procedure and almost never results in the kinds of problems you describe. More likely, you are suffering from the effects of less than stellar dental care while you were wearing your braces.

If you noticed white patches on your teeth where the brackets used to be, those are probably areas of decalcification. Those may also be the areas that are now staining, and that feel rougher than the surrounding tooth surfaces. What often happens is that patients–especially teens–are not as careful as they should be about brushing while they are wearing braces. Food that would normally just slide off your teeth becomes caught in the brackets, and if the patient does not brush immediately and thoroughly after eating, the acid-producing bacteria of the mouth work away at that food AND at the surface of the tooth for hours.

The damage is obvious when the braces come off. Those pitted spots may continue to chip and stain, eventually turning quite brown. Soft spots of decay may even be present underneath some of the spots. The extreme sensitivity of your teeth indicates that you are probably missing some enamel.

Teeth whitening services (over the counter or in-office) will not help. Dental bonding can be used to treat the damage if it is confined to just a few spots that are relatively small. If the damage is more significant, you may need porcelain veneers.

Situations like these are only one of the reasons that Invisalign braces can be such a great choice for teens. The aligners are removed to eat and brush/floss, then replaced.

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How do you treat baby teeth that are badly decayed?

June 30th, 2010

I’ve been trying to find information about my 5 year old son’s dental problems. He has at least four teeth that need to be treated, and I have not yet located a dentist that can talk my son into getting a look in his mouth.

The first molars on the bottom both have cavities that look to be quite deep, and the second molars are worse. They have both lost tooth structure from decay. I’m pretty sure we are going to have to sedate him to get work done on these teeth, and I want to thoroughly understand all the options before I send him to a pediatric dentist.

When teeth have begun to literally rot out, do they have to be removed? Is there any sense in doing porcelain onlays or dental bonding on such a young child, or could white fillings be used to protect what is left of his teeth until they are replaced by his adult teeth?

Thanks very much for your help,

Michelle from Columbus

Dear Michelle,

You are right to be concerned about keeping those baby teeth intact. They are necessary, not only to help him eat, of course, but to hold the proper spaces for his adult teeth. If he loses those teeth, his permanent molars will drift forward, and cause crowding. This would likely cause a cascade of problems that could result in a lot of time, money and discomfort. If your son does need to have those teeth pulled, space maintainers should be used to keep his teeth aligned.

Perhaps a more difficult topic to address is the pattern of eating that probably produced this issue. Young children generally get a lot of cavities because they eat too frequently. The level of decay you describe makes it very likely that your son is a “grazer”–that he likes to eat small amounts pretty much constantly. This pattern of eating is almost always the culprit in severe tooth decay in young children.

Habits surrounding food are very challenging to break, but you would be doing your child and yourself a favor by nipping this kind of eating habit in the bud as soon as possible. If you don’t, you will continue to see issues with tooth decay which will become more serious when permanent teeth are involved.

Most dental work on baby teeth is considered a short-term solution, as those teeth will fall out when the permanent teeth begin to come in. For molars, that usually happens around age 11 or 12. A dentist will likely place a dental crown on the decayed molars, but not the same kind of crown that is used for adult teeth. Generally, a dentist will use a crown that is not as expensive, like a stainless steel or some other kind of prefabricated crown.

Look for a pediatric dentist who is experienced with sedation techniques, if that is what it will take to get this work done.

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Is there a quicker fix than braces for my crooked smile?

June 3rd, 2010

When I viewed the proofs of my engagement pictures, I had a harsh reality check. My wedding is only a little over a year away, and I don’t want to look at my crooked, crowded teeth in all those pictures! I had a consultation with an orthodontist today, and he said it would take two years–at least–to straighten out my teeth with braces. I don’t have that kind of time, and I sure don’t want to look at a mouth full of metal in my wedding pictures!

Is there a quicker way to get my smile straightened out it time for the wedding?

Dakota in South Haven, MI

Dear Dakota,

You have two outstanding choices that will give you a wedding-perfect smile in just a few months, but you need to talk to an expert cosmetic dentist, not an orthodontist.

Invisaligninvisible braces could be an option for you. The severity of your teeth’s crowding and crookedness will obviously affect treatment time, but some Invisalign treatments can be completed in as little as 6-9 months. An additional positive point for Invisalign braces is that even if your treatment is not complete in time for the wedding, you could always remove the aligners for the day of the ceremony and the pictures. After months of treatment, your teeth would certainly look much better, even if they are not perfectly straight by the day of the ceremony.

An even faster alternative is porcelain veneers. Porcelain veneers do not truly straighten your teeth, but they create the appearance of perfectly straight teeth. Be extremely cautious about the dentist you chose to do your porcelain veneers. A dentist without the proper training and artistic sense could cost you a lot of time and money.

The best option for you is to have a consultation with an expert cosmetic dentist who is also certified to do Invisalign braces. This way, he or she can offer you a truly informed opinion on which solution would be best for your individual situation.

Congratulations on your upcoming wedding.

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Welcome to our blog!

February 15th, 2010

We have joined the blogosphere to help provide quality answers and advice for your dentistry questions and concerns.

If you have a problem you would like to ask us about, simply send us an email through our website. If we feel that your question might be of interest to people looking for dental information, we might post an edited version of your question in this blog.

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