Category Archives: Uncategorized

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Front teeth loose after an assault—will they fall out?

I was recently the victim of an assault, and was punched quite hard right in the mouth. I had to go to the emergency room to get stitches because it tore the corner of my mouth. While I was there they did a CAT scan, and said there are no fractures, but my front teeth are loose. One is more loose than the other.

I don’t have any kind of dental coverage and am worried sick that I might lose my front teeth. From what I have described, does it sound like my dentist will be able to save them? I’ve been online, researching what treatments there are for lost teeth. If they fall out, I don’t think I can afford dental implants or a dental bridge, and it doesn’t seem like a partial denture would look good or be comfortable. I am trying to find out if I can sue the guy that hit me if the cops catch him, but that is kind of a long shot.

Eric in Sault St. Marie

Dear Eric,

We’re sorry that this happened to you. Hopefully the police will find the person who did this, and justice will be served.

In terms of your teeth, if the CAT scan was accurate and there are no fractures in the roots of your teeth, they should be stabilized in the correct position in the day or two following the injury. Your dentist should bond the teeth into place, fixing them in the correct position. The bone will then heal, and your teeth should be fine.

Two or three weeks from now, you should go back to the dentist and have him check for nerve damage on either tooth. If either of the nerves are damaged, you will need root canal treatment. If that is the case, tell your dentist that you do not want a dental crown. Some dentists will place a crown on any tooth that has had a root canal, as a matter of course. In this situation, a crown will actually cause the tooth to be structurally weaker. Also tell them not to leave any root canal cement or adhesive in the crown of the tooth, or the tooth will get quite dark in time.

This blog provided as a courtesy of Dr. Malone, Lafayette Louisiana Cosmetic Dentist.

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My porcelain-fused-to-metal crowns are ugly

For more than twenty years I have had crowns on my two front teeth. They are porcelain-fused-to-metal crowns, as was normally placed back in the day. They have never looked all that great, but in recent years they have really started to look terrible. There is a dark line right where the crowns meet my teeth, and it is really noticeable because  I have a really big smile.

Is there anything that can be done to get rid of that line? If I have to replace the porcelain crowns, do you think Lumineers would work for me?

I appreciate your help with this.

Mallory from New Haven, CT

 Dear Mallory,

There really is not anything that can be done to disguise that black line, which as you have pointed out is one of the major drawbacks of porcelain-fused-to-metal crowns. You also touched a little on the other issue with porcelain-fused-to-metal crowns when used for front teeth — they don’t look very good. Porcelain-fused-to-metal crowns are too opaque to look realistic in the front teeth.

You will need to get them replaced with porcelain crowns, and Lumineers might be an option. But the best advice I can give you is to see an experienced, artistic cosmetic dentist for this procedure. Any dentist can claim to do cosmetic dentistry, but you’ll want one who has training, experience and talent. Smile makeovers require a rare balance of artistry and science, and only a small percentage of dentists have it. Make sure you choose the right professional, and you may have a smile you love for the first time in many years.

This blog brought to you courtesy of Dr. Mike Malone, Lafayette Louisiana cosmetic dentist.

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Are CEREC crowns a good option?

I travel a lot, and time to get any kind of appointment taken care of is in short supply. I recently had an emergency root canal done on an infected tooth (one of my first premolars) while I was on the road, and the dentist said I would probably need a porcelain crown. I am home at most for a day during the business week, and my dentist does not work weekends at all.

I called their office to see what we could work out, and they said that they have new equipment that lets them place crowns in just a single visit, called CEREC crowns. They said this would probably work for me, but they want to examine me before making the appointment to place the crown. That is OK, as I don’t want them to race into anything and try to place something they shouldn’t just to get it done.

My concern is that I have been reading about CEREC crowns on the Internet, and some of the sites are talking about them not looking as realistic as the other kinds of porcelain crowns. I am in sales, and my appearance is critical. I can’t have an obviously sub-standard repair on a tooth making me look cut-rate. My customers are upscale professionals in an appearance oriented industry. All I really want to know is if CEREC crowns can be made to look as realistic as any other kind of porcelain crowns.

William in Charlotte, NC

Dear William,

It is reassuring to hear that your dentist will not race ahead with the crown appointment before taking a good look at your situation. CEREC crown placement does not work for everyone.

The first premolar is visible when you smile, so you are correct in stating that a sub-standard job at matching your other teeth would be noticeable. Your question as to whether or not a CEREC crown could be made to look realistic earns a qualified answer: it depends on the skill level of the dentist using the equipment.

You state that the dentist’s office “just” got the equipment, which may indicate that your dentist is not yet very experienced with obtaining optimal results. Ask about your dentist’s training and credentials, and pay particular attention to his or her professional affiliations. Membership or better yet accreditation with the American Association of Cosmetic Dentists  (AACD) is a very promising sign that your dentist places a high value on aesthetics. It is also a good idea to ask to see some before and after pictures of actual crowns that your dentist has placed. If he cannot produce any, this could mean that he simply lacks experience with the equipment, and you might be better off with a traditional porcelain crown.

You don’t say that the affected tooth has started to darken, so you have time to make decisions. Best of luck.

This blog post provided as a courtesy of the office of Lafayette Lousiana cosmetic dentist Dr. Mike Malone.

You

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What if Novocain doesn’t work for me?

I have a problem. The numbing medications used by dentists simply do not work on me like they do on other people. Added to that, I have put off some pretty extensive dental work that needs to be done, and now the thought of having to go through that without adequate pain medication is literally keeping me up at night. Between my aching teeth and the idea of what I am going to have to go through to get them fixed, I am missing a lot of sleep.

I really think the only way I am going to be able to get this done is if I am out cold. Are there dentists out there that will knock you out to get extensive treatments done? I know oral surgeons can put you out for wisdom teeth removal and things like that, but I have never looked into what can be done if pain meds simply don’t work.

Lula in San Francisco

Dear Lula,

Yes, there definitely dentists out there that can help you. They are called sedation dentists, although you will sometimes hear them referred to as “sleep dentists” or their practices called “sleep dentistry”. This is not a technically correct term, as their patients are not actually sleeping.

Most of these dentists use what is called “conscious sedation”. This means that you are not fully unconscious for the procedure, though most people don’t remember anything about the treatment. Conscious sedation medication is usually administered through an oral pill, taken before the appointment. For this reason, if you are undergoing a procedure that involved oral sedation, you must have someone available to drive you to and from your appointment, and you probably will not be able to return to work that day.

We should mention, too, that sometimes the Novocain or other numbing medication is not as effective in patients who have a high level of anxiety. Many dentists have great success using nitrous oxide (also called NO or “laughing gas”) to help their patients relax, and then administering the numbing medication. The really great thing about that is that you don’t have to have someone drive you to and from the appointment. The effects of nitrous oxide wear off very quickly, and have no lingering effects that preclude driving or returning to work.

If you and your dentist talk through all the options and you are still not comfortable, then some dentists are trained to administer general anesthetic. Only you and your dentist can decide what level of intervention is necessary for you to get the treatment you need.

Good luck to you.

For information about porcelain veneers or dental implants, see our main website.

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Is there a specific time wisdom teeth should be removed?

Even though I am well into my forties, up until last week I still had all my wisdom teeth. A broken filling in one of the wisdom teeth prompted my dentist to advise me to have both the upper ones out, which I did. She said that replacing a filling in a wisdom tooth would be extremely challenging to do properly, and that a poorly placed filling could lead to an infection, which would likely end with the tooth coming out anyway, so we just cut to the chase.

She is more ambiguous about whether or not I should have the lower wisdom teeth removed. I’ve never had any problems with them, but would it be better to just get it over with if they will cause problems like these down the road. I have good dental coverage right now, and would almost have it all over and done with rather than waiting for a problem to develop.

Thanks,

Paul in Las Vegas

Dear Paul,

There should always be some reason for removing wisdom teeth, beyond them just being wisdom teeth. It sounds as if yours erupted normally, or they would have been causing you problems long before now. I am sure you have heard of wisdom teeth that are impacted. Impacted wisdom teeth can cause a lot of problems with the alignment of your other teeth, and they are best removed as soon as possible, preferably before the age of 25.

However, as you have experienced, even wisdom teeth that have erupted normally can cause problems. Your dentist was wise to recognize the challenge in placing white fillings in wisdom teeth.

In your case, it could happen that the wisdom teeth will super-erupt, which is when missing teeth cause the corresponding teeth in the opposite jaw to grow to try and reach the now absent teeth. This could create alignment problems that could ultimately lead to TMJ issues.

Ultimately, you and your dentist must decide together. In time, it may become obvious that the best course of action is to have them out.

 

For more information about white fillings, dental bridges, dental implants and other restorative services, see our website.

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Porcelain crowns for front teeth?

I have been talking to my dentist about what to do to restore my smile. I have significant wear on my top teeth, and a gap between my two front teeth that has bothered me most of my life. Before I talked to my dentist about this, I did all kinds of research on the different kinds of available treatments, especially looking at different kinds of porcelain crowns. I really think–and my dentist confirmed this–that porcelain crowns will be the best way to fix my teeth.

The thing is, we don’t agree on what kind of porcelain crowns would be best. Both my dentist and his partner say they will only do porcelain fused to metal crowns. Everything I have read makes me believe that porcelain fused to metal crowns will not look as nice as I want them to look when we are done. Their reasoning for this is that I sometimes grind my teeth, and can’t stand wearing a night guard. They both say that the all ceramic Zirconia crowns like I want are not strong enough to last if I continue to grind my teeth. Both my dentist and his partner have impressive credentials, which is the main reason I chose them.

In your experience, do all ceramic crowns like Zirconia tend to sustain damage if used on an occasional grinder? It is not all the time, just intermittent.

I have waited a really long time to get this done, but I just can’t get excited about the porcelain fused to metal crowns. My dentist is all ready to get it done, but I think they will look fake, and I don’t want to spend that amount of money on something that is not exactly what I want.

I could really use your help on this.

Thanks,

Jerry in Indianapolis

Dear Jerry,

I think you’re going to need a second opinion. The Zirconia porcelain crowns that you mention are indeed very strong, certainly strong enough to withstand great stress. If your teeth grinding is not constant or severe, they might well work as a great option for you. An added bonus is that the all-ceramic or all-porcelain veneers can be made thinner than porcelain fused to metal crowns, and so less of your natural tooth structure has to be removed to place the crowns.

It is possible that despite the impression credentials your dentist and his partner take more of an engineering approach to restoration rather than an artistic one. It is also possible that your grinding problem is worse that you think it is. I strongly encourage you try again with the mouth guard. Teeth grinding can cause very serious, life-long issues.

In either case, if you are determined to go with the Zirconia crowns, then you would be best served to seek another dentist. It is always a bad idea to push a dentist to do something he does not want to do. For whatever reason, your dentist and his partner are not comfortable with the Zirconia crowns, and you are fortunate that they have the professional integrity to be completely honest with you about this. Insisting on a treatment plan your dentist is not comfortable with often ends badly, so if you are certain the Zirconia crowns are what you want, you’ll need to find a dentist who is comfortable placing them in your situation.

 

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My six year old son’s teeth are in bad shape

My son is six years old. I’ve just started to research dental information to address some serious problems with his teeth.

He has at least four cavities that I can see. Two of them are small in diameter, but seem to be quite deep, and two other teeth have actually started to chip away from the decay. I’m afraid there may be more, but he won’t let me get a really good look in his mouth to tell.

What are my options with these kinds of problems? I really don’t want to have any teeth pulled if we can possibly avoid it. They are all molars, and from what I have read so far that could really screw up the alignment of his teeth later on. Can they do some kind of porcelain crowns or white fillings? I don’t want them to look bad and make him embarrassed, either. I’ve read that with kids they often do some kind of metal crown, but those are so ugly!

I also wanted to ask about sleep dentistry (also called sedation dentistry). I think I am going to have to locate someone who does this kind of dentistry, because my son just will not open his mouth for the dentist or the hygienist. We’ve tried three different dentists with no luck. I was hoping he would mature enough to cooperate, but we just can’t wait any longer.

I appreciate your help,

Maranda in New Brunswick

Dear Maranda,

You’ll want to find a pediatric dentist who also performs sedation dentistry. I think you are correct in saying that you simply cannot put of your son’s dental care any longer.

You are also correct that removing the molars without also putting in some kind of space holder will cause a lot of problems down the road. Those molars are also important in helping him eat, so ideally your dentist will try to salvage the teeth rather than extracting them. In pediatric dentistry, much of the work is often geared toward short term maintenance and temporary fixes, because those teeth will not remain in place forever. Usually they will place a stainless steal crown, but if you are adamantly opposed to the steel, your dentist can work with you to find a suitable material.

Another issue that must be addressed is the eating pattern that probably produced this kind of severe decay in such a young child. The kind of decay you’ve described is caused by constant eating. If you want to put a stop to these kinds of serious dental problems, you’ll have to put a stop to the eating habits that produce them.

 

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Will bleaching harm my porcelain veneers?

Will Crest Whitestrips (or any other over-the-counter whitening product) damage my porcelain veneers? I had porcelain veneers placed on my teeth a couple of years ago, and while the veneers still look fantastic my other teeth have yellowed quite a bit. It is pretty noticeable, since I got the veneers to match my then freshly-whitened teeth.

Thanks in advance for your help,

Antonio in Chicago

Dear Antonio,

The only kind of over-the-counter whitening products I would recommend in your case would be Crest Whitestrips, or some other version of that product produced by another manufacturer. The whitening agent, peroxide gel, is held to the teeth by the strips so the can penetrate the tooth structure and whiten the teeth. Be extremely cautious about the product you select–some products have acid that etches the enamel of the teeth, after which you apply a white pigment. These products do give the appearance of a temporary whitening, but will ultimately allow more stains to adhere to the teeth via the damage to the enamel of the teeth.

There is a problem with Whitestrips in your case as well. The strips are designed to cover only the front six teeth, so to use them, you will have to trim the strips themselves. That is quite a lot of messing around, especially when you consider that it may take several applications to get the degree of whiteness you want. By the time you purchase all the kits, you may very well wind up spending as much as you would just getting the professional teeth whitening done at your dentist’s office.

In your shoes, I would likely go to an office to get the the whitening done. In the end, you’ll probably spend about the same amount of money, and you will save quite a lot of time.

I hope this was helpful.

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Brown spots won’t respond to whitening products

I am in my early 20’s and just recently graduated from college. For almost as long as I can remember, my front teeth have been discolored. I have ALWAYS taken really good care of my teeth (no cavities!), but my mother told me the discoloration was caused by an illness I had as a small child. Now I am trying to get my professional career off the ground, and I feel like my teeth are making an awful first impression.

With the support of my dentist, I have tried almost every over-the-counter teeth whitening product available. If anything, my teeth look WORSE now. The spots did not change in color one bit, but the contrast with the surrounding tooth material (which whitened considerably) is even more noticeable and ugly. Now my dentist is suggesting a “trial” treatment, where he will grind away at the spots until they are gone. The problem is he doesn’t know how much he will have to grind, and I just cannot imagine how this will ever look good!

What about professional whitening? I just really need to get this issue addressed. My teeth are holding me back, and my self-confidence is really taking a beating. I don’t want potential employers to think that I am the type of person who doesn’t even properly care for their teeth!

Thanks so much for your help,

Leta in Albany

Dear Leta,

First and foremost, find a different dentist. Your current dentist obviously does not understand the principles of teeth whitening or he would not have had you wasting your time and money on repeated attempts of the same treatment. Professionally whitening is unlikely to yield the results you want, either. And the idea of grinding away the spots could go horribly wrong.

You need to seek the services of a talented, experienced, educated cosmetic dentist. Make sure you thoroughly check their credentials, and ask to see pictures of their work.

Depending on the severity of the spots, there is a very small chance that a technique called microabrasion might work. This is often used with white spots, but is only effective with brown spots when they are very superficial.

If the spots are small, dental bonding may work to cover them. This is one of the most difficult and artistically demanding skill sets in cosmetic dentistry, so make very sure the dentist you chose is not just competent, but exceptional. If bonding will not work, porcelain veneers may be a solution. Both of these treatments require a high degree of artistry and skill.

I hope you can find the right dentist to help you.

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Should I wait to fix my child’s broken tooth?

Last evening at t-ball practice my youngest daughter was hit in the mouth with a bat. One of her front teeth on the top broke right off, and the other one has a crack all the way across it. We took her to our family dentist first thing this morning, and he said he won’t have time to fix it for three weeks. Three weeks! That just seems crazy to me. Everything I’ve ever heard or read about damage to teeth says that you should “get to a dentist right away”. Well, what is the point of that if they aren’t going to fix it?

One of the reasons our dentist gave for the delay is that the root of the broken tooth needs time to “desensitize”. Is that customary? If it is, then I guess we will wait, but my instinct is to take her to a different dentist, one who will treat this with some urgency.

I hope you can answer this quickly. I don’t want to wait, but I’d like some expert advice about what to do.

Nora in Bar Harbor, Maine

Dear Nora,

Your instincts are correct – there is no reason to wait to address this.

If you have the piece of the tooth that broke off (and see this response promptly!), an expert cosmetic dentist might be able to reattach that portion of the tooth. If you don’t have the piece or it is too badly damaged, a likely procedure to repair both teeth is direct dental bonding.

For this reason, I strongly suggest you chose an expert cosmetic dentist for this procedure. Direct dental bonding requires more than excellent technical skills and training. It requires artistry. The bonding material must be color matched and placed with an eye to the gradients of color that comprise her natural teeth. Only truly gifted cosmetic dentists can do really beautiful direct bonding work.

You don’t say how old your daughter is, but because of your reference to t-ball I am guessing that she is under 10. Direct bonding is a great solution for younger patients. When she is older, she will probably need a single dental crown for the tooth that was broken, but your dentist will have to make that decision when the time comes. If the other tooth is severely damaged, both front teeth may need crowns.