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My cosmetic dentist wants to replace all my crowns.

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It has been many years since a cosmetic dentist put crowns on all of my front teeth. Now that I think about it, it has probably been close to 15 years ago. I’ve been pretty happy with them and haven’t had any issues overall. Then, a couple weeks ago I noticed that one of them felt like it was wiggling a little bit.

I went to see a new cosmetic dentist to see if it could be fixed. He informed me that there has been decay around the edge of the crown and that it will need to be replaced. He has recommended that I just get them all done at the same time, so they match one another. That was a surprise because the grand total feels like a stretch on my budget. It would work better for me financially to have them done one at a time. But, I really don’t want to have teeth that are mismatched.

Does having them all done at once sound like the right thing to do? Do you have any other recommendations?

-Theresa in Indiana

Theresa,

I know you mentioned that you saw a new cosmetic dentist, but I have reservations as to whether or not he truly is a cosmetic dentist. The larger issue here is that cosmetic dentistry is not a recognized specialty area within dentistry. This means that any family dentist can claim to be a cosmetic dentist without any additional training or expertise beyond dental school. Also, it turns out that less than two percent of dentists have the high level of skill required to do beautiful cosmetic dentistry. An excellent cosmetic dentist would have no problem replacing a crown on a front tooth and getting it to blend in perfectly with the surrounding teeth. Therefore, this dentist may be trying to either make some extra money or more likely, it is a testament to his ability with placing crowns on front teeth. It may be easier for him to replace them all because he may not be confident that he can get the new crown to blend in naturally with the surrounding teeth. And it needs to be done right since the front teeth show when you smile.

illustration of a dental crownNow, it is likely that the diagnosis of the margin being exposed is accurate based on the age of the crowns. This may be an indication that it’s time to take a closer look at the other crowns to see if there are starting to be issues if they are 15 years old. But, you need to know that having them blend in better isn’t a reason to get them all redone. It is absolutely possible for a skilled cosmetic dentist to do them one at a time.

As crowns age, they do need to be replaced. So, for your sake and convenience it may be worth the consideration to have the others done too, especially if there are any beginning to show any signs of decay. But, if budget is an issue for you, there is absolutely nothing wrong with spacing them out as needed.

It is also worth stating that there is nothing wrong with seeking a second opinion, especially when it comes to cosmetic dentistry. Your front teeth are highly visible when you smile, so you want them to look lifelike and natural, and for all of them to be uniform in how they look. An independent opinion would give you a better inclination and understanding to learn more about if the others are close to needing replacement, or if they look fine for the time being. That may help you to better determine the right next steps for your individual needs.

Thank you for your question. Hopefully, this information was helpful to you.

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

I had porcelain veneers and now I need root canals.

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It has been a couple years ago now that I had a full smile makeover done. It ended up being quite extensive with 12 of my upper teeth having work done and 10 on the bottom. When the permanent crowns were placed, I kept feeling a sharp pain on teeth #5 and #13. I went back in and the dentist re-adjusted the crown work. It didn’t help and I ended up going back multiple times. Finally after five adjustments, the pain subsided. But, after that I ended up getting a tooth abscess on both of those teeth in the next month. So, this time when I went back in, the dentist informed me that the nerves had died. So, it was time to get root canals done. This was very upsetting after having so much work done. I never knew root canals were a possibility. I had no idea nerve damage was a risk. I specifically remember asking the dentist about possible risks with the porcelain veneer crowns. He assured me there were was no risk. I am confused because the x-ray very clearly shows that the nerve is damaged. Can you help me better understand what has happened?

The dentist said that it very rarely happens to end up needing root canals and that I must be unlucky. That bothers me. I feel like he should have better prepared me for the possibility, if it was even a slight risk. Next, he sent me to an endodontist to have the root canals done. When I was in for that appointment, the endodontist performed tests on several of my other crowned teeth and found that after the cold test, I had more teeth that were problems. In total (so far) I have ended up having four teeth with root canals. That doesn’t sound rare to me. And he said I likely will need another one. My original dentist is helping cover the cost of the root canals, but it is still a lot of money. Will all of my crowned teeth go bad as time goes on? Not only is this a huge financial burden, it is stressing me out and causing me pain. Do you have any tips on moving forward?

-Ben in Texas

Ben,

There are a couple clarifications that need to be made regarding your case. You are referring to “veneer crowns” and also porcelain veneers in your original question. However, porcelain veneers and porcelain crowns are quite different. The preparation for each of these procedures varies significantly. For a porcelain veneers, a very tiny bit of the tooth enamel (surface of the tooth) is shaved down slightly. It ends up being maybe half a millimeter of the structure of the tooth that is removed. This is done so the porcelain veneer, a thin shell of porcelain about the thickness of a fingernail, can be permanently bonded to the front of your teeth. Porcelain veneers are used frequently in a complete smile makeover whenever possible to transform the look of you smile.

diagram of a dental crownIn regard to a porcelain crown, much more of the tooth structure is removed. Not much will remain of your natural tooth in this procedure and the crown (cap) fits over top of the tooth. The preparation goes much deeper into the tooth. Here is a diagram to illustrate the preparation required for a dental crown. Since so much of your natural tooth structure is removed, there is a greater risk for nerve issues because the pulp is exposed. And if the nerves are bothered too much, an infection can result.

Based on what you have described with your case, it sounds like you had porcelain crowns done and not veneers.

It is possible that your teeth had large fillings or decay that required porcelain crowns to be done and porcelain veneers weren’t an option for you. And if that is indeed the case, it is not too surprising that you ended up with several root canals that were required. When a tooth has a large area of decay or other problems, the possibility for the pulp to become infected is possible. It sounds like you had a full mouth reconstruction versus a smile makeover. Porcelain veneers are used in a smile makeover more frequently. And for a full mouth reconstruction, crowns are usually used.

Either you dentist was much more aggressive than needed, or he failed to inform you of the risks with as much work that was required. Porcelain veneers are much less invasive and are used more cosmetic purposes.

Cosmetic dentistry is like an art. Some dentists may not have the proper training or experience and decide to do crowns since they are more familiar with the procedure. Porcelain veneers are not taught in dental school and require quite a bit of extra training to make them beautiful and natural-looking.

Unfortunately, at this point, your options are limited moving forward. It sounds like the crowns have been done, which has left you with very little natural tooth structure left on the crowned teeth. If they do require root canals at this point, that really is the best thing to do in order to save the tooth.

It’s interesting that your original dentist is offering to help cover the cost of the root canal treatments. You have to wonder if he is feeling bad about the situation and speculate that he may have been in over his head with this amount of dental work.

The next few months will be telling for you. Most problems should arise sooner than later regarding the possibility of root canals. Hopefully, the others stabilize and do not require any further treatment.

Sorry you are having to go through such a painful and expensive ordeal. Thank you for your willingness to share your story. Hopefully, it is helpful to others to better understand the differences in crowns and veneers.

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

Heat is bothering my crown.

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I’ve had many crowns over the years. Some are more than 20 years old. Well, I went in for my routine cleaning and after that, I noticed that I’m starting to have some pain. And when I had my morning coffee, I’ve noticed that the pain is more severe when it’s exposed to something hot. So, I’ve been drinking warm coffee instead of hot. I contacted my dentist and he’s not in town. But I’m becoming concerned because I think it’s spreading to the neighboring crown too. Does this sound serious?

-Paul in Kansas

Paul,

Thank you for your question. Unfortunately, it sounds like you may require a root canal treatment. This means that the pulp inside the tooth is dying. The scenarios you have explained are classic symptoms. Sensitivity to heat and tooth pain are the top two signs.

The tooth is actually dealing with an infection inside the pulp. Normally swelling occurs if this would happen elsewhere in they body. But in the tooth, the swelling has nowhere to go. So, it will end up dying and when this happens. When you mention sensitivity to heat, the dying tooth is releasing gases  and the heat increases pressure, resulting in pain.

It sounds like you did the right thing by calling your dentist. But if it will be awhile before his return, you may want to consider seeing an emergency dentist to see if you can get in right away. An infected tooth needs to be addressed sooner than later. Does your dentist have an after-hours or dental emergency line?

When you go in for treatment, the root canal treatment can be done on a tooth that is already crowned. That said, your dentist may want to replace the old porcelain crown if it is over 20 years old. Also, he may want to investigate further and look into the tooth next to it, if you feel like the pain is spreading.

It’s difficult to say precisely what happened with your situation. The decay may have crept underneath the crown to the natural tooth. Or it may be a result of what we call a leaky margin that a routine cleaning may have overlooked. Lastly, the root may be irritated or exposed. Over time, sometimes a tooth will die unexpectedly too, so it is difficult to say exactly what the cause was.

But, it’s time to get it taken care of. So, don’t put it off or you may be a risk for losing the tooth altogether. The sooner you get in, the more economically your need may be met and the pain resolved.

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

 

Is a cracked crown a dental emergency?

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I have had porcelain crowns on my front teeth for over 15 years. They’ve been great, but one of them must be cracked. It’s next to impossible to see it, but I can feel it. Do you think it’s at risk for breaking? My fear is that it will crack in half at an embarrassing time. It’s something that I’m starting to think about more and more. It is toward the biting edge of the crown and it is horizontal. I can see it if I look very closely. Do you think this is a dental emergency? Does it need replaced?

-Pam in Missouri

Pam,

Since it isn’t causing you discomfort or pain, a cracked porcelain crown isn’t necessarily a dental emergency. That said, it’s time to get it replaced. Once you detect a crack, it is only a matter of time. And if it’s already weighing on your mind, you should move forward with replacement. Finding a reputable cosmetic dentist in your area is the first step. You’re probably right, it would be embarrassing it broke off in a public setting.

Crowns and porcelain restorations have tiny lines that dentists refer to as craze lines. They are generally not concerning. But, since you can see it and feel it, it means there is some movement taking place with the crack. If you can see it, then it is a concern. The craze lines are not visible with the naked eye. Since you can see it, replacement is the way to go.

After consulting with your cosmetic dentist, it may be suggested that you get all of the front crowns replaced. It sounds like they are getting old. Although, if they are in good shape it isn’t absolutely imperative that all of them are replaced. If only the cracked crown is replaced, it will take a highly-skilled cosmetic dentist to ensure a perfect, seamless look. Cosmetic dentistry is like an art. Be careful in selecting a cosmetic dentist that has experience in replacing front crowns. Ask to see his or her portfolio of work. For example, if they automatically say you need to replace more than one, it may be an indication that they are not confident in their ability to match the surrounding teeth. It might be wise to talk to multiple cosmetic dentists to find the right one. Your front teeth are highly visible when you talk or eat and you deserve a beautiful restoration that you are confident in.

This post is sponsored by Flower Mound dentist Donald H. Currie, DMD.

 

Do you know what will work better porcelain veneers or crowns?

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I just moved out of state and was planning to get porcelain veneers done. My dentist mentioned some little cavities that probably needed to be treated before the veneers, but he didn’t seem to think it would be a big deal. He basically said that the area would end up being removed in the preparation of the teeth for porcelain veneers. Well, now my new dentist is telling me I need crowns. How could this be? Does something sound fishy to you? I really don’t want crowns, I want veneers. I really don’t want metal in my mouth!

– Allison in Nevada

Allison,

Decay is such a tricky thing, so it is difficult to give you and specific recommendations without having seen your case in person. You didn’t mention how much time has passed. In some cases, decay can spread very rapidly. It also depends on the new dentist’s treatment philosophy. He may feel  crowns are needed instead of veneers to avoid having to do more work down the road. Other dentists take a less invasive approach from the beginning. It’s hard to say if your previous dentist’s recommendations were accurate and if this dentist is being a bit more aggressive.

The more important matter here is that you mention the use of metal, which likely means that the new dentist is recommending porcelain-fused-to-metal crowns be used instead of all porcelain crowns. This may mean that this dentist doesn’t necessarily take the most aesthetically-pleasing approach and may not have the cosmetic dentistry training necessary to create a beautiful smile. Porcelain-fused-to-metal crowns on the front teeth will inevitably appear to have a gray line near the gumline as time goes by. This is because the gums recede and the metal shows through. If for some reason decay is dictating that crowns be done instead of porcelain veneers, you will want to get all porcelain crowns done for teeth that show when you smile. Most excellent cosmetic dentists always use porcelain crowns because they look much nicer and have proven to be strong enough to hold up on back teeth.

Just remember, you can always seek a second opinion on the matter from another cosmetic dentist. Find one in your area that is experienced in cosmetic dentistry to see what their opinion is of the decay and whether or not you are a porcelain veneers candidate.

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

My temporary crown came off. Is it a dental emergency?

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I am in the process of getting my first crown done on a top tooth. Well, when I was flossing before bed, it popped right off. It freaked me out. I know I wasn’t supposed to floss, I just completely forgot and did it completely out of habit. Now I look silly because it is a little nub since it was shaved down. In fact, I have a toothless smile at the moment. It looks very embarrassing, but doesn’t hurt too terribly or anything. Is this a dental emergency? When I called and left a message, it doesn’t sound like they can get me in until late in the afternoon. Even if it is only cosmetic, I feel like I should get emergency treatment. What do you think?

– Ben in New Jersey

Ben,

When something like this occurs, your dentist will likely do everything possible to work you into the schedule at their earliest convenience. But since you are not in pain, there is likely some emergency dentist appointment(s) that are more urgent than your need. I’m sure it is annoying and probably a little embarrassing that you look like you’re missing a tooth, but a true dental emergency is typically involving pain and swelling. You are dealing with a cosmetic dentistry issue, more than anything.

Unfortunately, it is not uncommon for a temporary crown to come off. This especially holds true when a front tooth is prepared for a dental crown. The temporary crowns are not very durable, As you were probably told, you are supposed to be careful biting and chewing, as well as flossing. Sometimes dentists will recommend pulling the floss all the way through, versus popping it back through the teeth.

Hang tight and the dentist will work you into their schedule as soon as possible. Dental emergencies generally take priority. Imagine if you were in great pain, you would want to be seen immediately.

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

Acid reflux and teeth

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I suffer from acid reflux. For some reason when that happens, it makes my back fillings hurt. Do you know why that is?

Brent W.- Little Rock, AR

Brent,

I don’t think that it is your fillings that are sensitive, but your teeth being damaged.  It is important you get your acid refux under control. I hope you’ve been to a doctor. The reflux is very acidic and wears away the enamel on your teeth. You see this often in bulimics. If you are able to get your reflux under control, your dentist may be able to give you fluoride treatments to strengthen your teeth.

However, if the damage is already too severe, you’ll need to have porcelain crowns put on your teeth. Even then, there is always some exposure to your teeth through a thin strip.

No matter what, anytime you vomit or have reflux rinse out your mouth with water without delay. They will help forestall some of the damage done by the acid.

This blog is brought to you by York, PA Cosmetic dentist Dr. Donald Currie.

Crowns for chipped teeth

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I have chipped my two front teeth, which makes them shorter than my other teeth. I had bonding done, but they’ve since chipped as well. My dentist wants to do four crowns on my front teeth. I’m concerned that crowns are too drastic a move for something that is merely cosmetic. Wouldn’t bonding be a better choice?

Sylvia D.- Pennsylvania

Sylvia,

Sylvia,

I’m curious as to why your dentist wants to do four crowns when you only have two chipped teeth? I do think crowns would be a little too drastic for a cosmetic issue. I’m also concerned that your dentist would try to do porcelain fused to metal crowns, which would not be a good choice for front teeth.

You’ve had dental bonding and that didn’t last. Truthfully, even if you got it again it would not last as long as you’d want. I think you’re a good candidate for porcelain veneers. It doesn’t require much shaving of the tooth and will be a permanent solution.

This blog is brought to you by York PA dentist Dr. Donald Currie.

Could an infection in my tooth actually be dangerous?

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Last Friday I was eating some peanuts and one of my back molars just broke in half. It is the tooth that is right before where my wisdom tooth used to be before I had them taken out. I don’t have any dental insurance right now, so I didn’t go in right away to get it looked at, but I have been in a lot of pain, and it isn’t getting any better. It is not just located where the tooth was. The pain feels like it is all over my face—in my sinuses, my nose, and now even in my temple and down my neck.

I don’t have any money for a dentist right now. I got some antibiotics and have been taking them, but as I mentioned things seem to be getting worse. Is there any kind of home remedy I can try? I started Goggling for information, but that is kind of freaking me out. One article said an infection in a tooth can actually be dangerous, and can spread to the brain. Is that true?

Thanks for your help,

Zane in Big Rapids, MI

Dear Zane,

You have reason to worry. An infection in your tooth can be very dangerous indeed, and from what you describe the infection is spreading. This is very serious and you need to get it taken care of right away.

And you should discontinue use of the antibiotics until you see a dental professional. The reason the infection is spreading is that oral antibiotics transmitted by the blood stream cannot address the source of the infection, which is inside your tooth where there is no blood supply. All you are doing by taking an antibiotic without addressing the source of the infection is make the bacteria that remain stronger and more resistant to treatment.

Call your local hospital and see if they have an emergency service that is free or reduced cost. From your signature, it appears that you live in a college town. If you are a student, go to the university’s health service and explain the situation. They should have some way to get you treated in a way you can afford.

You will almost certainly need a root canal treatment, and the broken tooth should really be covered with a porcelain crown. If the tooth is too far gone to be salvaged, it may have to be extracted. Ideally, you would replace that missing tooth with a dental implant, but that is quite expensive and will likely have to wait. You may want to consider a dental bridge.

This blog has been posted as a courtesy of the dental office of York PA cosmetic dentist Dr. Currie.

Could a recent filling be the source of this pain?

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I’ve been experiencing shooting pains along my jaw, and down my neck. The only thing I can think of that might be causing this is some recent dental work I had done. My  dentist recently did a composite filling on one of my molars, then capped it with a ceramic crown. Shortly after that happened, I started having intense pain. I asked my dentist about it, and he said that I might have a teeth grinding issue. I bought a night guard, but that hasn’t helped at all.

I called my dentist again, and he said maybe he will have to grind down my teeth to change my bite. How did all this go so wrong so fast?

Toni in Detroit

Dear Toni,

Your instinct that it has something to do with the filling is probably accurate. Your description of the original work is a little concerning. You mention both a filling and a ceramic cap, which would not be used together on the same tooth. Did the tooth crack while the filling was being placed? That would be one reason for the cap over a filling.

The kind of pain you are experiencing will help your dentist diagnose what is going on. Severe pain that is constant usually means that there is an infection in the tooth.  You don’t mention whether the pain is constant, or if it comes and goes, and that information will help your dentist. You also don’t mention whether or not the pain is exacerbated by heat or cold, which will also help your dentist determine whether or not the tooth is just irritated.

Something you may want to consider at this point is a second opinion. The fact that your dentist did both a white filling and a porcelain crown is worrisome, as is the over the phone speculation that led you to buy a useless appliance.

This post created for York PA cosmetic dentist Dr. Currie.