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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.

I need a root canal, but I have don’t have a toothache?

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Hello,

This is an example of who a porcelain crown will fit over the tooth after the root canal treatment is complete.

I am hoping that you can help give me some guidance. I had a cleaning yesterday and the dentist talked a lot about one of my front teeth. I admit that I have started noticing it was becoming a little discolored. However, it seems more like a vanity thing to me. Sure, I’d like to have it look nicer when I’m older and have the money. But, I really wasn’t that concerned because it doesn’t hurt.

Anyway, he told me that I have a tooth infection in the dark tooth and recommended that I get a root canal. Then, they would do a porcelain crown, which is supposed to cover the tooth and it will blend in again.

I am surprised to say the least, because I have not had a toothache at all! I don’t ever remember any pain associated with that tooth. I am feeling like he’s being a little presumptuous and I don’t want to be taken advantage of. Do you think I should get a second opinion? Or does a root canal sound like it is required?

Lastly, will it get worse if I decide not to move forward with any treatment?

I value your feedback because I’ve been reading your blog and it sounds like you are fair and give honest advice. Thanks for your time.

-Sherri in Virginia

Sherri,

Thank you for your question. It is understandable why you would be questioning this treatment plan, especially if you aren’t experiencing any pain. A lot of people share their dental horror stories of being in incredible pain that keeps them up at night, experience extreme sensitivity or have relentless tooth pain, facial pain or throbbing when they need a root canal. But, you may be surprised to learn that a root canal may be required even if you don’t have a toothache.

When a tooth is turning dark, it usually indicates a tooth infection. What’s happening is that the tooth is dead on the inside, which means the nerve endings aren’t working anymore and you won’t feel anything.

A root canal will heal the tooth and get rid of the infection. Ultimately, it will save the tooth in the long run. There is a good chance that this infection has been going on for a lot longer than you think. In fact, some patients have gone years before they realized what was going on with a dark tooth. In cases like that, during the procedure the infection on the inside of the tooth actually smells bad.

It’s hard to say how you got to this point. Usually, there was some trauma to the tooth. Maybe you bumped it when you were younger or ran into something and over time the nerve inside the tooth died slowly. But, the reality is that the tooth is dead now, so much so that you may not feel anything during the root canal procedure.

You had asked what would happen if you chose to do nothing to the tooth. Please don’t go this route. The infection will eventually spread to other parts of your body and if left unattended could turn into an emergency situation.

If you are concerned about money, you don’t necessarily have to do the porcelain crown at the same time as the root canal. But, it would be good to have it done in the next few months. Spreading the treatment out over time helps make it more affordable.

Hopefully, this information is helpful and will encourage you to move forward with getting the root canal done. Donald H. Currie, DMD is experienced with performing restorative services, like root canals and crowns. He is a general and cosmetic dentist located in York, PA.

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.

 

Why is my tooth turning gray after my emergency dentist visit?

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I had a toothache on and off for several months. Finally, it got so bad that I made an emergency dentist appointment. The dentist said it looked okay. But, he did notice a small crack. He decided to do a crown. So I did all the prep that day and after two weeks, I returned for the permanent crown. He did warn me that I might need a root canal if the pain didn’t improve. Even hearing that possibility has me losing sleep. So I’ve been pumping myself full of ibuprofen. It’s been  over a month now and still doesn’t feel normal. But, now the tooth next to it is turning gray! What is happening? Am I in the twilight zone? Is it possible the emergency dentist messed up the tooth next to the crown?

– Jim in North Carolina

Jim,

A gray tooth isn’t a good sign. This is an indicator that the tooth is dying or may already be dead. This can occur when the tooth has endured some sort of trauma. It isn’t likely that the emergency dentist caused it or injured it. Of course, it is possible. But, it very well could have been this tooth that was bothering you from the onset. In some cases, a toothache can refer pain to another tooth. Or it could mean that the crowned tooth and the gray tooth were both injured at the same time and both require treatment. Lastly, it could be unrelated from the crowned tooth and possibly misdiagnosed by the emergency dentist.

Whatever the case, the gray tooth needs immediate treatment. I know this isn’t what you wanted to hear. But when a tooth is dead, the inside needs to be cleaned out and a root canal treatment is required to heal it. This will clear up any bacteria inside the tooth and take care of any infection. The sooner you take action, the more economically and less painful you will experience.

Now, it’s up to you if you choose to see another dentist. If you go that route, you could request an x-ray and take it with you to another dentist to seek a second opinion of the diagnosis. If the dentist missed the fact that the gray tooth should have been treated, you may be able to request a refund from the porcelain crown work. If the x-ray doesn’t show that anything was wrong, you may be out of luck. Whatever you do, get your gray tooth treated as soon as possible. Or you may be dealing with some pain and may end up losing the tooth.

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

I think the emergency dentist screwed up my tooth extraction.

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I am so sick of dealing with this tooth. It has probably been over a year now that I’ve been fooling with it. It started as an abscessed tooth that I went to an emergency dentist to pursue treatment. He didn’t want to mess with it and sent me to a root canal specialist. I had the root canal done but the dentist gave me the impression that he wasn’t confident about it because my roots were curved. This isn’t what I wanted to hear since this was a very expensive procedure. I went back to my normal dentist to get a crown. Then, a couple months past and my face swelled up like you wouldn’t believe! When I went into the emergency dentist again, he said it was infected – again! I made the decision to let the emergency dentist pull it because I wanted to be done and move on. Lately, I keep getting this foul taste in my mouth and a lot of sinus pressure. Is it possible that the emergency dentist screwed up? I’ve never had previous sinus issues. Maybe there is a fragment of the infected tooth left behind? Any insight?

-Jo Ann in Georgia

Jo Ann,

It sounds like you haven’t had the most pleasant experiences through this ordeal. If you ever run into a similar issue again, it’s always wise to return to the root canal specialist. The tooth very well could have been successfully retreated and the tooth extraction could have been avoided altogether.

Even though the symptoms you are experiencing with your sinuses now resemble an infection, tooth infections do not linger a tooth is extracted because the source of the infection is gone. If part of the tooth was missed, it wouldn’t be causing this problem. The area should be healing after a tooth extraction and any infected material would have successfully drained from the site. However, the sinus could have been perforated during the extraction or a fragment of the tooth could have been pushed into the sinus, and that could cause the symptoms you’re experiencing.

That said, your symptoms do sound as if something isn’t right. But it likely is the fault of the emergency dentist you saw. If you aren’t in pain, then it would be good to follow up with your regular dentist. If indeed it is an infection that is lingering, although rare, a stronger does of antibiotics will be needed. If you are in pain or discover swelling, then don’t hesitate to schedule another emergency dentist appointment.

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

Help! My tooth is causing me so much pain. Can I go to the ER?

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Help! I can’t take the pain after having a root canal. It’s been a few days, but the swelling is incredible and I cannot sleep. It is the weekend so I can’t go to the dentist. When I called the emergency number, it stated that I would receive a call back in a few hours. But I don’t think I can wait around any longer. I have never been in so much pain! Will the emergency room be able to help?

– Becky in Utah

Becky,

That sounds terrible. You did the right thing by contacting your dentist when you noticed the increase in swelling and the pain. A root canal treatment isn’t always successful the first time. It sounds like you may need to be re-treated.

If you cannot stand the pain and do not think you will be able to wait for the emergency dentist line to return your call, then go to the emergency room. You will be able to seek medical care immediately. Although an emergency room isn’t set up for routine dental care, they can assist with dental emergencies. In most cases, the emergencies they see are a chipped or broken teeth. But there is a strong possibility that they have an oral surgeon available for dental emergencies. They will likely start you on a course of antibiotics and may be able to perform oral surgery if it is determined to be best for your case. Then, you need to follow-up asap with your regular dentist.

Good luck!

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

Will a loose tooth heal by itself or do I need an emergency dentist appointment?

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I’m the adult here that is usually lecturing my son on being safe while playing paintball. Well, the other day he convinced me to play with him. He somehow nailed me in the jaw. It was on after that. I didn’t think much of it in the heat of the moment. But later, I noticed that my face was pretty bruised and I feel like one of my teeth may be a little bit loose. It’s not too troublesome, but something just doesn’t feel right. I can’t visibly see movement, but I can feel it. Hopefully, this is a temporary ailment and will heal on its own. Should I wait it out or do I need to see an emergency dentist?

-Jason in Colorado

Jason,

Well, sounds like you two made some memories – that’s for sure. Although it is possible that an injury like this may heal on its own, it’s always wise to seek counsel from a dentist. So go ahead and schedule an emergency dentist appointment to put your mind at ease, or you can seek treatment right away. In these instances, the sooner you are seen, the less invasive and more economical your needs can be met.

In the meantime, stop fiddling with the injured tooth. The ligaments that keep your tooth in place may have been stretched out a bit. So they will be further irritated and bothered if you keep testing the mobility of the tooth. The emergency dentist will likely want to stabilize the tooth  to keep it from moving. There is a possibility that you may end up needing a root canal on the tooth. The dentist should be able to check out the root and figure out the right plan to get you back on the paint ball field, as soon as possible.

Whatever you do, don’t put off seeing the dentist thought. If it is left alone but really does require intervention, you could end up losing the tooth.

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

Is a gum injury an emergency?

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My son has been complaining about a spot on his gums that is irritated. It has been a few days now and he says he must have cut it on a hard piece of food or something. As a mom, I’m worried about it of course. When I took a closer look at it, I think I saw some junk ooze out of it. He told me it’s no big deal, but he also says he had to drain it a couple times today. Does this sounds like any kind of dental emergency or should I give it some time?

– Sandra in Washington

Sandra,

Any kind of irritation or sore in the mouth that is oozing is a dental emergency. Based on the what you described it sounds like your son has an abscess which is an infection. If it was a cut or irritated spot then it would heal up without oozing.

The pus is a result of an infection inside of his tooth. If indeed this is what is going on, you need to schedule an emergency dentist appointment for him to be seen right away. He may end up requiring a root canal treatment where the infection is properly cleaned out. If you don’t act soon, the infection has the potential to spread and he will be in danger of losing the tooth. In severe cases, infections can become life threatening. So it’s best to have this checked out as soon as possible. Swelling, pus, and soreness are all signs of an infection.

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

 

Do I have to tell the emergency dentist how this happenned?

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Do you know if I have to tell the emergency dentist how I ended up with the trauma to my face? See I was beaten up a couple days ago and mugged. It was horrific, to say the least. Anyway, I may have been in possession of some illegal goods so I really don’t want to have to explain any further how this happened to me. I don’t want to get the police involved or anything or I may be in greater trouble, if you hear what I’m saying. When I was punched in the face, I didn’t think it was that bad. But my face and front teeth are really painful. Is the dentist going to inquire how this happened to me? It he or she required by law to report something like this?

-Anonymous

Dear Anonymous,

This is a difficult situation and likely up to the particular opinion of the emergency dentist that you end up seeing. The law doesn’t clearly state one way or the other. So if the dentist feels it is in your best interest to keep quiet, then he or she may honor your confidentiality request. That said, if the dentist feels there may be some legal recourse upon him for your treatment, then the confidentiality may be breached to protect his license and practice. But if there is no threat to you or anyone else, it is completely up to the discretion of the dentist whether the incident is officially reported to the authorities.

You can expect some questions. Especially if you call in acting suspicious. The emergency dentist will want to know how it happened, when it happened, and where. But you can always say that you would rather not answer.

The bottom line is that if you are in pain, it’s time to be seen.
You don’t want to risk losing the tooth, have possible jaw damage or be at risk of infection. The tooth may require a root canal to save it.

This post is sponsored by York PA dentist Donald H. Currie, DMD General & Restorative Dentistry.

Will an antibiotic take care of my tooth infection?

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I went to the dentist and was told that my tooth is infected. I didn’t get the impression it was an emergency. I am wondering if taking the antibiotic will clear it up so I don’t have to get work done on the tooth?

– Jerry in Louisiana

Jerry,

No, an antibiotic alone will not take care of the problem. And if that is the only thing you do, you could end up with a pretty serious dental emergency on your hands.

The antibiotic that is given when your tooth is infected helps to control the bacteria, it doesn’t kill them. Then, the body produces the antibodies needed to combat the infection.

When the dentist tells you that you have a tooth infection, the typical treatment is a root canal together with an antibiotic. In some cases a tooth extraction is necessary if the tooth is not salvageable. But when the tooth gets infected, it doesn’t have anywhere else to go since swelling cannot take place. The pulp inside the tooth dies and the bacteria multiply. Then, the infection will spread into the bone and even other parts of the body if this situation is not remedied.

Even if your tooth begins to feel better after taking the antibiotics, you are not in the clear. The infection cannot be addressed since it has originated inside the tooth.

Another factor that is worrisome if you only take antibiotics and do not have the tooth treated, is that you are actually helping the bacteria to become resistant to the medication. So when the infection resurfaces (because it will if it is not treated properly) it will be more difficult to beat. Sadly, we have seen patients that continually put off taking care of the tooth that the infection spreads into the bone and jaw infections are very dangerous. In other cases, the bacteria move the throat, cause swelling, and then can inhibit breathing. Still other times, the infections spreads to the brain.

Word to the wise, don’t ignore a tooth infection. Do yourself a favor, listen to your dentist and get the tooth taken care of in conjunction with the antibiotic.

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