Archive for August, 2010

Is there an optimal time to get my dental implant?

Tuesday, 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

Tuesday, 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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