September 2020 | Dr. Currie's Dentistry Blog

It has been a couple years since I’ve been in for my regular dental cleaning and exam. While I was there, the dentist informed me that I have a molar underneath a crown that is broken. When he took a closer look, he didn’t feel that he would be able to get out all the decay if he did a root canal treatment. So, he recommended that I get the tooth pulled. After a few months, I am supposed to go back and get a dental bridge.

I decided to go to the endodontist anyway to see if he would be able to complete the root canal because I really want to save the tooth if there is a chance it could be saved. When I talked with my dental insurance, they told me that a crown wouldn’t be covered for a year. I am starting to wonder if the insurance will cover any part of a dental implant, but it’s worth asking. I don’t want a bridge. So, I’m trying to figure out how long I can wait if I have the tooth extracted right away. Will I start to have problems if I put it off for awhile and save up for the next treatment? If I have to wait a year to do anything for insurance, then I might as well get the dental implant if it’s covered.

I’m in my 50s so I want to get a treatment that will serve me well for years to come. I realize I should have had a root canal years ago. The dentist put a crown on and didn’t want to drill through it to do a root canal. The pain stopped eventually so I didn’t worry about it. But, apparently I should have because now it is dead I guess.

Thank you in advance for your time.

-Patricia in North Carolina

Patricia,

Dentists have varying philosophies when it comes to saving teeth. Some tend to be a bit eager to pull one. But, it is always better to save a tooth if at all possible. It seems odd that the dentist doesn’t feel confident that he can get all of the decay taken care of under the crown. It may be in your best interest to get a second opinion. It will be telling what the endodontist says.

As for a more permanent solution, a dental implant is a far superior solution to replace a missing tooth. That said, you don’t want to wait longer than a couple weeks to move forward with the dental implant process. The reason is that even though you are only in your 50s, the teeth can begin to shift around. A dental implant will stimulate the bone in the area of the missing tooth and prevent any bone loss at the site.

It is worth asking why the dentist is wanting to pull the tooth so quickly if it is not causing you any pain.

Also, a dental implant takes time to heal before it is able to complete the process with a dental crown. A temporary fixture can be placed in order to fill the empty space.

Also, you need to be prepared that a dental implant may not be covered by your dental insurance. It is possible you may get a discount, depending on what kind of coverage you have. So you may need to cover that expense out of pocket. So be prepared for that.

Generally speaking, you want to work with a dentist who prioritizes saving teeth. It may require greater skill and also may indicate a higher level of empathy and integrity by the dentist. However, there are cases where a tooth truly cannot be saved. It really would be in your best interest to get another opinion by a reputable implant dentist to see what your options are.

Lastly, it is confusing that you mentioned that you should have had a root canal treatment done years ago. If what you have explained is accurate about the the dentist not wanting to drill through the crown, then that dentist may not have done the right thing. Whenever you have decay or an infected tooth, that is when you need to take action to save the tooth. Drilling through a crown may not be ideal, but it is not a reason to leave the tooth alone. The infection or decay wasn’t going to improve once it started. It is not uncommon to drill through a crown.

I hope I’m not leaving you with more questions than answers. But hopefully this gives you a more in depth explanation as to what is going on. Getting another opinion is the best course of action at this point.

This post is sponsored by York PA dentist Donald H. Currie, DMD.

I have nine crowns that were placed many years ago. The time has come to get them replaced. They used to be bright white and now they are getting pretty dingy. I went in to the dentist and I’m mortified because he put temporaries on that look yellow. Not only that, the bite feels really off and the shape is different than before. When I bring up my concerns, he says everything looks fine and gets defensive. I think I should look into seeing a cosmetic dentist at this point. But, I want to make sure I find someone who actually cares about my opinion and how I feel in the crowns. What is the most important thing I should consider when looking for a new cosmetic dentist in my area?

Any insight you may have would be greatly appreciated.

-Steve in Texas

Steve,

Thank you for your question. First off, I’m so sorry you are having to deal with a dentist that doesn’t seem to be listening to your concerns. Ironically, that is the main root of the problem here. The dentist is not being empathetic or listening to your needs. Far too many dentists will claim to be a cosmetic dentist when they don’t have the ability, training or innate passion to create beautiful results. There is a fundamental difference that you’ll find between general dentists and cosmetic dentists. A general dentist is typically focused on solving a functional problem. In addition to functioning properly, a cosmetic dentist cares deeply about the way the final product looks and how it makes you feel.

Another thing you may not realize is that cosmetic dentistry is not a recognized specialty area within dentistry. Therefore, any dentist can call themselves one without the additional training or skills required to create stunning results. In your dentist’s response back to you he is communicating that he doesn’t care what you think. You are trying to explain that you are unhappy with it and he is getting defensive. That is a problem, and you are right to start exploring your options.

An excellent cosmetic dentist will care deeply about how you feel about your appearance. Also, an expert cosmetic dentist will want to improve and perfect their skills, which means they will likely have pursued extensive training and coursework beyond dental school. They will be proud to show you examples of cases similar to yours and ultimately, they will not be happy unless you absolutely fall in love with the way your smile looks. Many will send the restorations back to the lab if you don’t love them, until they are perfect. The bottom line is that your opinion matters. It’s your smile.

A dentist that stands their ground and communicates that they know what’s best and doesn’t take into account your input isn’t listening. It’s time to move on.

As you consider finding the best cosmetic dentist in your area, look at their credentials. The American Academy of Cosmetic Dentists (AACD) is a prestigious organization that requires rigorous requirements to ensure those that are accredited or affiliated with their organization fall into the category of an exceptionally qualified cosmetic dentist. Also, an excellent cosmetic dentist will likely offer a complimentary consultation so you can get to know them. This appointment will be a great opportunity for you to better understand if they will listen to your preferences and see if you can trust them. There is nothing wrong in seeking multiple opinions and getting multiple consultations.

It is unfortunate that you already had to go through this negative experience. However, the good news is that the porcelain crowns haven’t been permanently bonded. So, it shouldn’t be too big of a deal to switch to a new reputable cosmetic dentist that truly cares about your desires.

Thank you for reaching out. Hopefully, this gives you the confidence to move on and find the best cosmetic dentist in your area that you can.

This post is sponsored by York PA dentist Donald H. Currie, DMD.

How long can I wait to get a dental implant for a missing tooth?

What is the most important thing when selecting a cosmetic dentist?

Archives for September 2020