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Is Needing a Root Canal a Dental Emergency?

If a tooth needs a root canal treatment but doesn’t have any pain, is it a dental emergency or can it wait? On that note, if it can wait, how long can it wait?

Tyson

Dear Tyson,

Root Canal Treatment

This is kind of tricky to answer because I have not examined your tooth. I think, however, I can give you some general guidelines. If the tooth is hurting in any way (which you say yours is not) then, I would consider it a dental emergency and you would need to get treatment as soon as possible. You would not necessarily need to schedule it for that day, but as soon as they can.

I would say that if it starts hurting again, go in fairly soon as well. Both of those scenarios indicate that you have an active tooth infection that needs to be treated. Dental infections spread and can blow up pretty quickly. You do not want it spreading to your heart, lungs, or brain, all of which are close to your jaw.

If it is not hurting and has not for a while, you should be able to wait. I had a colleague who had a patient with a tooth that needed a root canal that waited several years. This was only possible because the infection was not active.

What was interesting to me about this case is that apparently, even though the infection wasn’t active, the fact that it had been infected was having an impact on his health. The patient felt unexplainably worn down all the time, even though he was getting enough sleep and his thyroid levels were good. The cause turned out to be the tooth. After he had his root canal treatment, he told my colleague that he felt better than he had in a while.

This blog is brought to you by Lafayette, LA dentists Drs. Foreman and Thimmesch.

Should My Husband Get All-On-Four Dental Implants?

My husband needs to replace his bottom teeth. His upper teeth have been gone for a while and he has dentures there. We were told that you shouldn’t do dentures on bottom teeth because they won’t stay in the way the top ones do. Our dentist said he needs to get all-on-4 dental implants. I just want to explore if there are other options before we make a decision?

Pricilla

Dear Pricilla,

All-on-4 Dental Implants

I am curious why that is the only option he gave your husband. A dentist is ethically obligated to give his or her patients all of their options. He is correct that dentures are a bad idea on bottom teeth. While it is true that dentures will struggle to stay in on the lower arch, that does not happen right away. This is an issue because of bone resorption.

When his teeth are removed, his body recognizes that and begins to resorb the minerals in his jawbone in an effort to be as efficient as possible with his body’s resources. The big problem with that is after ten or so years, he will no longer have enough jawbone left to retain his dentures. This is known as facial collapse.

This bone structure is important no matter what tooth replacement option he chooses.

All-on-4 Dental implants (pictured above) are what dentists will sometimes offer to patients who have lost some jawbone structure but still want dental implants. However, there are other options.

Implant-supported denture

The first thing to find out is whether or not he has lost bone structure. If he hasn’t, then his best option is to get an implant overdenture. This uses between for and six dental implants and then anchors a denture to them.

If he is missing bone, depending on the amount, he has two choices. First, he can have the all-on-4 procedure his dentist suggested, as long as he hasn’t lost too much bone. The one downside to this procedure, however, is that if one implant fails, the entire unit has to be redone. A second option, no matter how much bone he’s lost, is to have a bone grafting procedure done to build it back up. Then, he can do implant overdentures if he wants. He could get a denture too, but bear in mind he will end up with facial collapse. Having dental implants in the jaw bone, prevents that from happening.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Tooth Mousse & Zoom Whitening

I have some white spot lesions on my teeth. My dentist prescribed tooth mousse for me. It is a nine week treatment. After that, if the white spots are not gone, then we will finish it up with Zoom Whitening because it is fast. However, we are hoping the mousse will take care of it on its own. Is there a chance that both those things together won’t work and I’ll need a third treatment?

Eve

Dear Eve,

someone getting zoom whitening
Zoom Whitening

I’m glad you wrote. Your dentist is sort of close on this, but not close enough for me to not give you some warnings. First, tooth mousse is a decent treatment option. However, I’m concerned he doesn’t understand the point of the treatment. It is designed to treat white spots, but mostly to remineralize the area.

White spots are precursors to decay. Using the tooth mousse will repair the demineralization that occurred to cause the spots in the first place. The company makes no claim that it will change the aesthetics of the tooth.

As for the Zoom Whitening finishing that up, it will actually make things worse. Teeth whitening, no matter what method you choose, will whiten your teeth evenly. This means the white spots will get whiter along with the rest of your teeth.

While the remineralization is a great idea. The thing that will make the teeth even in color is dental bonding. However, I would not ask your dentist to do the bonding himself. This is an advanced cosmetic procedure. If he did not understand how teeth whitening works, he will not be able to do the bonding well.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Is a Crack in a Dental Crown an Emergency?

I have had six porcelain crowns for close to twelve years. One of them, on a front tooth, has always had a slight defect. It never really bothered me because you couldn’t really see it. If I rubbed my tongue against it, there would be a slight depression but that is all. Now, it feels like there is a crack and I can see a horizontal line. I am afraid the crown will break. Would this be considered a dental emergency?

Pamela

Dear Pamela,

Porcelain crown being placed on a tooth

While I would not say that you have a dental emergency on your hands that you have to try and get in today, I would schedule an appointment with an excellent cosmetic dentist and have them look at it. Based on your description, there has been a substantial change on the structure of your tooth. It is likely to break at some point in the near future.

You have a couple of options. Your porcelain crowns are aging. Because of that more of them may start failing. You can either replace all of them at once or one at a time as they fail.

What to beware of is a dentist who says that you have to replace all of them to get them to match. A single crown can be matched to the other teeth. However, it takes a highly skilled cosmetic dentist to do it.

Whichever dentist you end up with, make certain they are willing to do a temporary try-in and allow you to approve the crown before it is permanently bonded on. They need to be willing to re-do the crown if you are not 100% satisfied with it.

This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Twelve Shots to Get Numb?

I recently had a lower second molar extracted. The appointment was a nightmare. First, it took twelve shots for him to get me numb. How he could miss the area that many times is beyond me. Then, I had a bone spur in the area that took the dentist over thirty minutes to get. Now, I seem to have a sharp edge on the extraction site. I’ve sort of lost confidence in this dentist. Can you tell me if this is normal or if I need to have another procedure done to deal with this?

Cassidy

Dear Cassidy,

Woman holding her jaw in pain

I would find it hard to think any dentist would actually miss the spot that many times. The more likely scenario is that you had some dental anxiety going in and, as a result, your body was fighting the local anesthetic.

Unfortunately, not enough dentists currently understand the connection between dental anxiety and the inability to get numb. I am going to recommend for your next appointment where you need any work done you see a sedation dentist. Even just some nitrous oxide will help relax you, which in turn enables the anesthetic to do its work.

For those with a more severe level of anxiety, I recommend oral conscious sedation. While it is administered by a pill, it is so strong that you will need someone to drive you to and from your dental appointment as well as stay with you for a few hours afterward until you are lucid and steady on your feet again. Most people who use oral conscious sedation sleep through their appointment.

As for the bony ridge. sharp edges do show up during the healing process. You don’t notice them at first because your gums are swollen. As the swelling goes down the ridges appear. If it stays a problem, your dentist can clip it.

One thing I want to make sure your dentist addressed is the need to replace that second molar. If you leave the space open, your other teeth can drift or tip into the space, which will throw off your bite. That can lead to painful TMJ Disorder.

If you want the best tooth replacement, I’d look into a dental implant. However, you do have other options.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Should She Finish This Smile REconstruction?

I have worn teeth because of teeth grinding. I didn’t realize I was doing it and my last dentist never mentioned it. However, when I moved I switched dentists because of the location and this dentist pointed out a whole bunch of things I didn’t know about. The grinding makes sense and does explain why my teeth have become more sensitive in recent years. She mentioned that I would need a mouth guard to protect my teeth from nighttime grinding and to repair the teeth, most of them would need crowns. We did the lowers first and it was a bit traumatic for me. I tend to have trouble with change. Plus, I have had some gum inflammation. My dentist wants to finish the procedure, but I am hesitant. My teeth aren’t hurting as much anymore and I miss my old smile. It wasn’t perfect, but it had a quirky nature I enjoyed and fit my personality. Do I really need to finish? Could I just whiten the tops?

Patty

Dear Patty,

Woman Smiling.

I have not seen your case, so it would be tricky to give you a definitive answer, but I can give some general guidelines.

First, change is hard for some. I know. Though in my experience, when a case is done by a skilled cosmetic dentist patients are thrilled when the results are finished and grateful they went through the trouble. It’s a bit like remodeling a house. It’s inconvenient, but when it is done you have the home of your dreams. This leads me to the quirkiness issue.

These are your teeth. If you want quirky in your smile, by golly, your dentist and their ceramist can put it there. In fact, because most patients want a perfect, flawless smile, my guess is they’d be thrilled at the chance to put some character in a smile.

Finally, while you could just whiten the upper teeth, dental ceramics will be harder on your upper teeth than your natural tooth structure was. If you have structural loss from teeth grinding, that would include the upper teeth. I am afraid only doing half the fix will actually make things worse for you in the long run.

This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Will Invisalign Correct Misalignment?

I have some misaligned teeth but feel too old for traditional braces. I asked my dentist about Invisalign and he said it does not correct misaligned teeth. I sort of have my doubts and felt like he just wanted to refer me to an orthodontist friend of his. So, I thought I would double-check with you guys whether it would be possible for me to use Invisalign.

Karen

Dear Karen,

Invisalign aligners
Invisalign Aligner

It sounds to me like either your theory is correct or possibly your dentist is just not open to new treatment options. As such, he may be completely unaware of what Invisalign is capable of.

My suggestion is that you get a second opinion from a dentist who has experience with Invisalign and let them look at your case. When Invisalign first came out, many years ago, it was only able to do the more ideal cases. These days, however, they can fix all but the most complicated cases.

If your dentist isn’t willing to keep up with the latest technologies in his field, he may not be the best dentist for you. You want the top treatment possible. Let’s say you lose a tooth and need to replace it. Will your dentist only offer removable partial dentures or does he know about dental implants, which give you a permanent, secure tooth?

I’m not telling you to switch dentists. However, I would advise you to take a good look at what your dentist offers and see if he is keeping up in his field.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Is My Husband Reacting to His Dental Implants?

I am quite sensitive to smells and I’m wondering if my husband is having a reaction to his dental implants. His mouth and breath smell awful. He’s had the implants placed and his dentist has given him temporary, acrylic dentures. Eventually, he’ll have porcelain dentures. However, I’m wondering if we need to switch his dental implants before that happens. His dentist gave him the metal implants. I’m wondering if he is reacting to the metal and that is what is causing the horrible odor I keep smelling. I mentioned to his dentist the possibility of switching him to the zirconia implants but he acted like that was a ridiculous idea. Is it?

Kaitlyn,

Dear Kaitlyn,

Metal and Zirconia Dental Implants

I wouldn’t say you were being ridiculous. It sounds to me more like you are trying to make sure your husband is okay. Even if he doesn’t think that the dental implants are an issue, he should have been more respectful of your care and concern for your husband. I am sorry you were treated that way.

That being said, your husband’s metal implants are made from titanium, which is not only one of the most biocompatible materials around, it is also inert. The inert part will tell you the metal doesn’t really have a smell. The biocompatible part means it is highly unlikely he is having any type of reaction to it. It would be foolish for me to say that no one is allergic to titanium. Each person’s body is unique. However, I would look at more common issues first.

The first thing I would check is to see if food or other debris is getting caught in his temporary dentures. This is fairly common and can cause a putrid odor. Using something like a WaterPik, will clean things out. A second possibility is an infection. However, that almost always has other symptoms such as pain or fever. You did not mention either of those.

Switching Dental Implants

Without an extremely good reason that cannot be solved any other way, I do not recommend switching his dental implants. I am not opposed to zirconia implants. They do a fine job. The problem is what would be involved in switching them out.

First, he would need his implants removed. This takes bone structure with it. Because of that, he will no longer have enough bone to retain the new dental implants you want to place. Now, your husband needs a bone grafting procedure done to provide him with the missing structure. Once that has healed, he is onto another surgery to place his new implants. If that is succesful, he will be back to where he is now.

Each of those additional procedures has a risk of failure. If he has successful implants. Keep them.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Wisdom Teeth and Dental Sedation

I have a daughter who is nineteen years old. She needs her wisdom teeth extracted but has terrible dental anxiety. My dentist has always had trouble working with her and is suggesting we take her somewhere that can do the procedure with general anesthesia. That scares me. Is there an alternative for her?

Penny

Dear Penny,

Unless there is some highly unusual complication with your daughter’s case, which I doubt, then there will be no need for your daughter to have to do this procedure under general anesthesia.

You mentioned your daughter has always had trouble at the dentist. Many dentists don’t realize the connection between dental anxiety and the inability to stay numb. It causes too many patients distressing dental appointments. The good news is there is a solution.

You need to have her wisdom teeth extracted by a sedation dentist. Specifically, you will want one who offers oral conscious sedation. This is administered by a pill, but is so strong that you will need to drive her to and from her dental appointment as well as stay with her for a few hours until she is lucid and steady on her feet again. With this, she will be so relaxed that she will likely completely sleep through her procedure.

Some more good news for you and her is that she is at the perfect age to have her wisdom teeth removed. The bone is still pliable. Plus, there has not been time for cementum to have accumulated on the roots of the teeth. It should be a fairly easy procedure.

This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Fixing My Teeth Without Porcelain Veneers

I have some crooked teeth. All of my teeth are discolored from age. I want to improve my smile. My dentist is very keen on me getting porcelain veneers and even showed me his brag book. I hope it doesn’t sound ugly to say I was not impressed. I don’t want to hurt his feelings, so I am looking for alternatives.

Callie

Dear Callie,

Zoom Whitening

Don’t feel bad about having a high standard for your cosmetic work. These are expensive procedures that affect your appearance. Your smile is one of the first things people notice about you.

If you do not want porcelain veneers, that is okay. There are options. The first thing I would suggest is to deal with the discoloration. Having brighter, whiter teeth can make you look years younger. One quick way to do that is with Zoom Whitening. It can deeply whiten your teeth in just one appointment.

side by side compairison of braces
Braces versus Invisalign

Then, to straighten them, you can either get braces or Invisalign. I recommend Invisalign for several reasons.

  • They are more comfortable
  • They are invisible even at a conversational distance
  • They work faster
  • They make it easy to keep up with your oral hygiene

Both of these procedures together are less expensive than porcelain veneers. While porcelain veneers require extensive post-doctoral training for a dentist to do them well, teeth whitening and Invisalign can be done by just about any dentist.

This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.