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Dental Implants

Diabetes and Dental Implants

I have type 1 diabetes and need to replace a tooth. I was hoping to get a dental implant. Is that possible for me or is my condiation a contra-indication?

Aubrey

Dear Aubrey,

Diabetes is not a contraindication for dental implants, but you do need to be aware that it is a risk factor. A significant one. You will need careful diagnostics ahead of time. Don’t skimp on them. Make sure you get a CT scan.

You will also want a dentist who has done a LOT of dental implants successfully. Ask how many dental implant procedures they’ve done and what their percentage of successful cases is. It shouldn’t be less than 98%.

Ideally, the dentist will do the surgery and the placement. However, if they refer you to an oral surgeon, make certain your dentist makes the decisions about the placement and there is close coordination between the two of them.

Cosmetic Considerations

You did not mention where the implant was being placed. If it is on a visible part of your smile, you will want to think long term. If you are considering teeth whitening, you will want to do it before you get the porcelain crown that will go on the implant.

This is because, while the color of the crown can be made any color, the color is permanent. If you whiten later, your natural teeth will brighten, but the crown will remain the same color. If you want it to match your teeth, you will have to replace it. Getting the whitening done ahead of time means you will save money.

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

Emergency Dentist

Antibiotics for Tooth Infection

I had a severe toothache and went to see a new dentist. My regular one closed permanently shortly after the quarantine started. He was close to retirement anyway. This dentist gave me an antibiotic that I was taking three times a day. My tooth started to get better, but now has gotten worse. What do I do now? I have never had this happen before.

Alice

Dear Alice,

Woman grabbing her jaw in pain needing an emergency dentist

I hope your new dentist didn’t think giving you an antibiotic was enough. He should have scheduled a follow-up appointment with you to have a root canal treatment. If he didn’t, that is a real problem.

An antibiotic is useful to hold off an infection until you are able to have the treatment you need. However, it does not heal the tooth. The only way to do that is for the dentist to get in there and physically remove the infected pulp.

If the tooth can be saved, you would do that with a root canal treatment and many times a dental crown will need to be placed as well. If the tooth can’t be saved, then you’d need a tooth extraction.

It is a bad sign that the infection started to get better and then progressed again. This is a dental emergency and needs to be seen right away.

If You Lose the Tooth

My guess is you will still be able to save the tooth. If, however, you get back in and it isn’t possible, then the tooth will have to be extracted to keep the infection from spreading. Dental infections can turn life-threatening.

When a tooth is extracted, it is important to replace it. If you don’t, the other teeth will shift and tip into the open space, which will throw off your bite. In some cases, it can lead to TMJ Disorder and daily jaw pain and migraines.

Hopefully, this dentist didn’t cost you a tooth.

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

Invisalign

Dealing with Congenitally Missing Lateral Incisors

My daughter never received one of her adult lateral incisors. When the baby one fell out, our dentist said not to worry about it because the adjacent teeth would shift to fill in the spot. While they did, it left a bit of a gap, which leaves my daughter feeling embarrassed by her smile. This is her senior year and I’d like her to be able to go off to college feeling good about her smile. I spoke to another dentist and they recommended we open up the space and then place a dental implant there. I don’t think she’d be too keen with a mouth full of braces during her senior year of high school. Is there another option?

Laurie

Dear Laurie,

a smile with missing lateral incisors
A smile with canine teeth where the lateral incisors would normally be.

The above image shows a smile with missing lateral incisors. In the place of them are her canine teeth. As you can see, the smile doesn’t look normal. Instead, it is almost vampiric. Your daughter’s smile would look even stranger with one canine tooth. The advice her childhood dentist gave you was horribly bad.

The second dentist’s advice is sound. Your daughter has other choices aside from a full mouth of metal. Her first option is Six-Month Smiles which will allow her to fix her front teeth quickly. A second option is for her to get Invisalign. These use clear aligners instead of wires and brackets. Most responsible teenagers do very well with these. Then, when that is ready, a dental implant will be a fantastic idea.

What Her Original Dentist Should Have Done

Ideally, when her baby tooth came out and there was no adult lateral incisor, her dentist should have provided her with a dental flipper. This would have held the spot open so when she was old enough you could have just placed the dental implant. Now, because of his bad advice, you are having to add orthodontics to the mix.

I say this as a cautionary measure to others reading this post in two ways. First, in giving them the correct way to handle this situation. Second, in knowing that anytime you have a major dental decision to make, there is never any harm in getting a second opinion before moving forward.

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

Teeth Whitening

Luster Premium Teeth Whitening

I want to get my teeth whitened, but don’t have a ton of money. I saw an advertisement for Luster Premium Teeth Whitening. It’s at least half of what my dentist charges for teeth whitening. Before I get it I want to know if it is safe or not.

Laura

Dear Laura,

teeth whitening trays

Two Problems with Luster Premium

If what you are asking is if it will harm you, then the answer is it is safe as far as that aspect goes. However, I will say it is a waste of your money. I looked at this and see two big problems. I’ll begin with the light. It isn’t nearly strong enough to have any real effect on the teeth whitening process. The only purpose I see in it is for purely psychological reasons. In that case, they would better serve their patients by not having it there and lowering the cost even further.

A second issue is it doesn’t really whiten your teeth the way professional teeth whitening does. The whitening effect it has is actually a pigment in the ingredients (zinc oxide). This makes your teeth look whiter, but the effect fades. My guess is the positive reviews they received were written before the fading took place.

To keep your teeth the whiter shade it provides, you would have to continue to purchase it every time it wore off. Because of that, you’d actually be spending way more money than you would if you just had the bleaching done through your dentist.

Affording Teeth Whitening

Many dentists are willing to work with their patients on affordability. I’d start by talking to your dentist to see if he or she would let you pay it out. If they absolutely won’t work with you, there are some dentists who offer free teeth whitening to new patients. However, they may require you to have your cleaning and check-ups done with them first. If you decide to go that route, I’d wait until it was time to get your check-up and cleaning done anyway so you don’t pay for that twice.

Fast Teeth Whitening

If cost isn’t the factor and you liked the idea of the light that makes it “work” faster, a method like that which will actually work is Zoom Whitening. You can see if your dentist offers that option. If not, there are many who do.

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

Porcelain Veneers

Root Canal with a Porcelain Veneer

I have eight porcelain veneers that I love. I recently found out that one of the teeth needs a root canal treatment. I am a bit worried the procedure will damage my porcelain veneer. Is this safe or will I need to replace the veneer?

Maggie

Dear Maggie,

A single porcelain veneer being placed on a tooth

If your tooth needs a root canal treatment, you don’t want to leave the infection untreated. That would be quite dangerous. Dental emergencies have a way of turning into life-threatening medical emergencies when you don’t get timely care.

To put your mind at ease about your porcelain veneer, though, it shouldn’t have any impact on the porcelain veneer itself. One thing that does become an issue is the underlying tooth turning dark, which in turn will cause your porcelain veneer to turn dark. There is a way to forestall this, however.

Have your dentist carefully follow these instructions if they don’t already know this procedure.

The most important step is to make sure they get all the underlying material out of the canals from the root tip all the way to the crown of the tooth.

Once that is done, your dentist will want to put in a white fiberglass post. From there, he or she will fill the remainder of space with white composite material.

Doing this will keep the tooth white much longer than would otherwise be possible. It works even better when the tooth has a porcelain veneer, as yours does.

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

Zoom Whitening

Zoom Whitening & White Spots

When my daughter’s braces were finally removed, she ended up with white spots on her teeth. Her orthodontist said her dentist could help us with that. The dentist recommended Zoom Whitening to even the teeth up, but for some reason, they now look worse than ever instead. Did something go wrong? Where do we go from here?

Amanda

Dear Amanda,

Zoom Whitening Logo

While Zoom Whitening is an amazing and powerful teeth whitening system, your dentist doesn’t understand teeth whitening principles. When your teeth are whitened, they whiten evenly. That means the white spots they had will still be different from the remainder of her teeth. The difference between Zoom and take-home whitening systems is that Zoom is faster, whitening her teeth in just one appointment, rather than over several weeks.

When there are white spots after braces, it is generally a sign of decalcification. It’s difficult to brush efficiently with all those metal wires and brackets on her teeth. That’s one reason we often recommend Invisalign for teens and adults. Because these use aligners, you can simply remove them to brush and floss and then put them back on.

As for the decalcification, you do want to address that before it turns into actual decay. There is a product on the market called Tooth Mousse which is specifically designed to recalcify teeth.

Another option is to have the decalcified spots gently removed and then have composite bonding placed on top to match the remainder of the tooth.

One caveat here. Your current dentist likely isn’t qualified to do the dental bonding. Teeth whitening principles are quite basic and she missed the boat with that. Bonding is more advanced and takes some post-doctoral cosmetic dentistry training.

Best of luck to you and your daughter!

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

Teeth Whitening

Brightening My Smile After Quarantine

My state is beginning to open up again and that includes our dentists. Now that I get to be in public I want to brighten up my smile. What recommendations do you have?

Melanie

Dear Melanie,

I have two suggestions for you, depending on your budget and what your ultimate goal is in regard to your smile.

Brightening Your Smile With Teeth Whitening

Woman placing teeth whitening trays on her teeth
At-home teeth whitening with custom fit trays.

This is probably the least expensive way to brighten your smile. Just by whitening your teeth, you can take years off your appearance. Most dental offices will offer at-home whitening which allows you to whiten at home at your convenience. This also has the benefit of just going to the level of whiteness you want on your teeth.

Additionally, if you’re in a hurry and just want them to get as white as they can, some offices office an in-office solution with Zoom Whitening. This will allow you to you whiten your teeth in just one appointment.

Getting a Total Smile Makeover

A single porcelain veneer being placed on a tooth
Porcelain Veneers

If you are looking to get that Hollywood type of smile, then the go-to procedure for a full-mouth reconstruction is to have porcelain veneers placed. While any dentist can do teeth whitening, it does take someone with some expertise and post-doctoral training in cosmetic work to make this work well.

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

Uncategorized

Can I Switch Dentists During Invisalign treatment?

I love my Invisalign treatment, but I don’t really enjoy the dentist. He makes suggestive comments that make me uncomfortable. If I say something about it he gets prickly and starts to get short with me. Even his assistant has looked at me sympathetically, which tells me this is a pattern. I’ve gotten to the point that I can’t deal with him any more. Is it possible to switch dentists in the middle of treatment?

Kathy

Dear Kathy,

Invisalign aligner
Invisalign aligner

You can switch dentists at any time, even in the middle of treatments. Your dentist is ethically obligated to provide all the information to the new dentist including diagnostics and labs. He should provide everything where your new dentist can take over right from where you left off.

If for some reason, your dentist doesn’t live up to his ethical obligations, you can contact the dental board to get help. Just don’t stop wearing the Invisalign aligners that you have so that your teeth don’t shift out of place.

If you are in a holding pattern while he provides everything, ask your new dentist for some professional teeth whitening gel. Your Invisalign aligners can double as teeth whitening trays. This is an inexpensive way to get both treatments done at once and you won’t feel like you aren’t getting anything done.

I’m sorry about your experience with this dentist. You should not have to deal with that. I would consider writing a review to warn other patients.

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

Invisalign

A Serious Problem with smile care club

During a YouTube binge, an acquaintance come across this video by a young woman called Rosie Posie. She’s been documenting her experience and treatment with Smile Care Club. In one of her videos, posted directly below, you see her struggling to get her aligners in. It takes quite a while.

Eventually, after twenty mintues of trying to put them in, she gives up. In a follow-up video, the problem was discovered and resolved. Smile Direct Club inadvertantly mixed up her aligners giving her ones that were a month ahead of where she really was in her treatment.

To give you an idea of how serious this is from a medical standpoint, it would be like a surgeon accidentally doing surgery on the wrong body part.

The stress put on her teeth from being a month ahead and then going back to an earlier treatment often leads to root resorption. This can lead to premature tooth loss. It would be interesting to look at before and after x-rays of her teeth roots as a result of this mistake.

Patient Floundering

Here lies one of the big problems with services such as Smile Direct Club. Patients are left to flounder. If it weren’t for the fact that she’d been documenting her treatment on YouTube and it caught the attention of Smile Direct Club, she likely would have been left trying to shove these on every day, causing serious ireparable damage.

Many people are attracted to these mail order services because of their discounted prices. What makes their prices so low is you do not have a dentist you see regularly that check on your treatment. Bodies are unique. Because of that, even when someone is given the correct aligners, the treatment may not respond as it was supposed to. That is one of the important ways being under the care of a dentist is important. Early intervention in these cases can save the treatment and the patient’s teeth.

Affording Invisalign

If you want to safely straighten your teeth, I recommend Invisalign. It has one of the highest patient satisfaction rates of any treatment. If the cost makes you feel you could more quickly get your teeth straightened with a mail order service, consider talking to your dentist.

Most dentists are willing to work with patients under financial strain. Some have in-house payment plans that will allow you to pay things out as you go. Almost all dentists work through Care Credit. This is a medical payment service that pays for your procedure, and allows you to pay them back with extraordinarily reasonable interest rates.

A Hidden Benefit with Invisalign

There is a way to “double-up” your treatment in a way that saves you a lot of money while giving you a mini smile makeover. Because your aligners are custom fit and you are under the care of a dentist, your dentist is able to provide you with the professional teeth whitening gel that you can wear in your aligners as you straighten your teeth. This enables you to whiten while you straighten.

This blog is brought to you by Lafayette Dentist Dr. Emily Foreman.

Teeth Whitening

Her AT-Home Bleaching is Causing Pain

I’ve been doing at home bleaching of my teeth with a kit I purchased over the counter. Everything was fine until today. While wearing the gel strip, I had a zing of pain that lasted for about 40 seconds. I noticed the area getting the zing is a tooth where I had a chip repaired. The dentist used dental bonding to repair it. Does this mean the whitening gel is weakening the bonding?

Karen

Dear Karen,

Teeth Whitening Trays

Dental bonding is a great solution for a chipped tooth. Fortunately, the teeth whitening gel will have no effect on the bonding. The problem, based on the type of pain you are describing, likely has to do with there being a sensitive spot on your tooth. Hopefully, you are doing this bleaching under the supervision of a dentist. This way he can treat the sensitive spot.

If you’re just doing this on your own, you’re going to need to see a dentist. Don’t whiten until that spot is treated.  Be careful about DIY kits. While many times they turn out just fine, there have been occasions where it led to a person needing a root canal treatment. Until your dentist treats the area, pause your bleaching.

One thing to be aware of is that teeth whitening gel only works on natural tooth structure. That means everywhere, except where the dental bonding is will whiten. The composite material that repaired your chipped tooth will stay the same color.  This means you will have to redo the bonding to get the tooth uniform. Wait until you reach the level of whitening you want though. Then, wait a week to give the color time to stabilize.

If you ever decide you want to whiten your teeth in just one appointment, ask your dentist about Zoom Whitening.

This blog is brought to you by Lafayette, LA Dentist Dr. Emily Foreman.