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My wisdom teeth need fillings–what kind should I get?

Years ago, I let my former dentist talk me into white fillings, and have had cause to regret it ever since. My teeth became very sensitive, and over time I have had to have all those filling replaced by a different dentist. Two of the teeth my former dentist treated were my wisom teeth, and now the white filling material has completely worn away. The teeth where the fillings used to be look awful. They are yellow and ugly, and it makes me angry all over again that I let that dentist talk me into white fillings. Now my new dentist wants to use the same fillings to fix the problem! She says she does not even place silver fillings anymore.

Do I need to find ANOTHER new dentist? Why in world would she want to use something that clearly doesn’t work for me?

Edith in Tulsa, OK

Dear Edith,

The white fillings are not the problem. The technique your former dentist used to place them was the problem.

Many dentists have gone “mercury free”, meaning they no longer place silver amalgam fillings. Silver amalgam fillings are a source of ongoing controversy in the dental field, and more and more people in the general population are also aware of this controversy. Silver amalgam fillings are more than 50% mercury by weight, a known neuro-toxin. Recent studies are inconclusive about whether or not the small amount of mercury vapor released during chewing is harmful to the body, but many people are opting to err on the side of caution and just avoid them altogether. As an additional factor, properly placed white fillings are without question the better choice from an aesthetic standpoint.

Amalgam fillings require more of the tooth structure to be removed, and the material of the filling actually weakens your teeth. The only real advantage of amalgam fillings is that they are easier to place than white fillings, and the technique to place them is throughly covered in dental schools. Most dental schools do NOT require graduating dentists to know how to properly place a white composite filling.

If your new dentist only places white composite fillings, then chances are good that she is skilled at it. To put your mind at ease, ask her about her training for this kind of procedure. Placing white composite fillings requires strict adherence to the proper protocol. If your former dentist had followed this protocol, your teeth would not have been sensitive.

If you are satisfied that she has the proper training, then I think you can confidently go ahead with the white fillings in your wisdom teeth. The material of the filling bonds with your teeth to actually make the overall structure of your tooth stronger, and will serve to seal the tooth. White composite fillings also do not convey heat and cold the way amalgam fillings do, and so are more comfortable.

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Is Clear Choice a good place to go for dental implants?

I was planning on attending a presentation being held at the local senior center about Clear Choice, but I heard they have had a lot of consumer complaints. I am retired, and on a very tight budget. I do not want to even waste my time going to the presentation if this company is not on the up and up. Can you give me any insight as to whether or not Clear Choice is ethical?

Thanks for your time.

Russel in Cripple Creek

Dear Russel,

We cannot empirically state that all Clear Choice dental implant centers are unethical, though many of what seem to be standard practices for them are highly questionable. Every center is obviously different, with different staff members, and different strengths and weaknesses. The stories that are emerging from people who have had evaluations or attended seminars seem to indicate that salesmanship and marketing are heavily emphasized within the entire Clear Choice organization, and those two priorities make the risk of poor dental health care choices very high. We are especially concerned with the consistent reports of treatment plans that recommend that ALL teeth be removed as part of the treatment. This is almost NEVER a good idea. If you do get a treatment plan from a Clear Choice facility, I would strongly recommend getting a second opinion.

Our best advice to you would be to find a dentist in your area who has experience, training, and credentials in dental implantdentistry. Look for a general dentist or prosthodontist that has several years of experience. A fellowship or membership in the International College of Oral Implantologists or the American Academy of Implant Dentistry is also a good sign. This Detroit cosmetic dentist has impeccable credentials – this will give you some idea of what to look for in a dentist in your area.

 

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Black line with porcelain fused to metal crowns

I have porcelain fused to metal crowns on six of my top front teeth. What can be done to get rid of the the black line where the crowns meet my gums? It was not this bad when they were first placed but over the last two years it has really become noticeable. What are my options, from least expensive to most expensive?

Vienne from New Hampshire

Dear Vienne,

There really is not any inexpensive way to address this issue. The entire structure of your crowns is the problem. A dentist could try to drill away the black line and cover it over, but there is likely a serious color match issue between the roots of your natural teeth and the color of the veneers. Trying to blend those colors together in that tiny space would be incredibly difficult if not impossible, and the results would almost certainly be very unattractive.

Essentially, you have to options: live with the black line, or replace the porcelain-fused-to-metal crowns with all ceramic or all porcelain crowns. Be absolutely certain you chose a skilled, artistic, well-trained cosmetic dentist to do this procedure for you. I would hate to see you spend thousands of dollars to still be unhappy with the results.

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Different types of teeth sensitivity

I went to see my dentist because one of my molars had suddenly become really sensitive to everything, even air. It is winter here, and when the cold wind blew into my mouth it really hurt! Hot food or drinks were bothering it, too.

Anyway, my dentist diagnosed the problem in like two seconds, and I am kind of wondering how accurate that diagnosis can be. He is always in a really big hurry, and this time was no exception. He rushed in, barely listened to what I was telling him, then started squirting my tooth with air while asking impatiently if it hurt. Then he put some “desensitizing bonding agent” on the tooth, and the pain went away, and he said that it should heal on its own, then he was gone. I only know what he put on it because I asked the hygienist.

The tooth in question has a really large white filling, and when I went in I wondered if that was the problem. Could he really do a thorough diagnosis like I described? I could really use some advice.

Brent in Minneapolis

Dear Brent,

Sometimes it really is quite easy to diagnose pain issues, and from what you’ve written, yours fell into the easy-to-diagnose category. An unprotected, sensitive spot on a tooth will react to blown air with pain, and a desensitizing agent will help with that. If the pain only lasts for a moment and then goes away, that is an indication that the irritated nerve or pulp of your tooth has the chance of healing on its own. If the pain had lingered, your dentist would probably have recommended a root canal procedure, as that would have indicated irreversible damage and a need to remove the nerve.

The real issue here is that you do not trust your dentist. Your letter indicates that you do not appreciate your dentist’s abrupt manner, but more seriously, you do not trust him to provide you with thorough, careful dental care. Good dental care requires trust.

If you want to try and salvage this professional relationship, I would recommend an honest conversation with your dentist. If he responds with impatience or acts annoyed, I think you will have to find a new dentist.

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Question about Snap-On Smile

Is there some kind of temporary dental appliance that gives the illusion of straighter, whiter teeth? It fits over your teeth like a mouth guard would. What is something like that called? Is it expensive? Does it take a long time to be fitted for such a device, and does it hurt?

Alan in Sacramento

Dear Alan,

The dental apparatus you are referring to is called a “Snap-On Smile”, and it fits snuggly over your existing teeth. Such a device is used sometimes for a big event like a wedding, or by actors in the theater. Though it is not durable, it can improve your smile nicely for a short time. A Snap-On Smile is considered a very temporary smile makeover, and should not be confused with porcelain veneers or crowns.

It probably takes at least two weeks, maybe a little more, to complete the entire process to get a Snap-On Smile. A dentist will make a model of your teeth, which is then sent to a dental lab in New York where the appliances are manufactured. Your Snap-On Smile should be shipped to you about two weeks after the lab receives the model from your dentist.

When you receive your Snap-On Smile, no preparation is necessary for your teeth—the appliance just snaps into place. Expect the appliance to make your teeth look bulkier and larger, and remember that it needs to be cleaned after each time you eat.

We strongly recommend that you consult an expert cosmetic dentist to help you acquire such an appliance. He or she will help you get the best results.

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Bad bonding job to close gap – what can be done?

I need to know if dental bonding can be removed without doing any damage to my teeth. I asked my dentist to fix the gap in my front teeth (they were chipped, too, so there was a V-shaped gap). I have not had a lot of experience with this kind of dental repair, but I don’t think he did a good job at all! I’ve seen pictures on the web that look so much better than what my teeth look like right now. There is still a gap, and you can tell where the bonding material begins and my teeth end. In the pictures I’ve seen, the bonded teeth look completely natural. What should I do?

Marcus from San Antonio

Dear Marcus,

I am sorry to hear that you’ve had such a bad experience. You are right in expecting better results. Very few dentists really have the artistic skills to do beautiful bonding work. It is one of the most difficult cosmetic dentistry procedures to master, and requires a high level of training and aesthetic sense.

The good news is that dental bonding is reversible, and can be taken off with a special sandpaper that all dentists have. There should be no damage whatsoever to your teeth.

I hope you won’t let this experience discourage you from seeking a new dentist to complete the procedure to your satisfaction. Look for a cosmetic dentist that is accredited by the American Academy of Cosmetic Dentistry (AACD). ANY dentist can say they do cosmetic dentistry, but it requires many, many hours of specialized training and education to achieve accreditation. I encourage you to seek out someone who can show you pictures of dental bonding work, to reassure you that they have the skill set to do the kind of beautiful work you see in pictures on the web. Good luck!

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How long can I wait to get a dental implant?

One of my molars has decayed below my gumline, and both my regular dentist and a specialist I saw said it has to be removed and replaced with a dental implant. I don’t have insurance and want to spread the cost of the two procedures out as much as I can. How long can I wait to get the dental implant after I have the molar removed?

Theodore in Grand Falls

Dear Theodore –

A few things will affect the timing of your dental implant after your molar is fully extracted. First, you must wait for the infection in the socket to heal. As soon as possible after the infection has cleared, you should have the root form placed. I know you wished to take more time, but I would advise you to keep the delay to a minimum. Here’s why.

After just a few weeks, the teeth surrounding the site of a lost tooth will begin to “tip” into the space, and the corresponding tooth in the opposite jaw (the opposing tooth) will begin trying to grow into the space. All of these are natural movements. Our teeth will naturally shift to touch their neighbors, and meet the teeth in the opposite jaw. If left too long, the shifting of teeth due to the missing tooth can cause headaches and TMJ pain, and can be very costly to repair.

The root form of the implant also needs several weeks to heal and to integrate into the bone of your jaw, so your dentist will need to fit you with a temporary tooth to help hold the space. A dental flipper, which is a simple resin tooth mounted on an acrylic plate, would be effective.

Your dentist may be able to work out financial arrangements with you to make your very necessary dental care more affordable. Good luck!

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Will dental insurance cover dental implants?

I am currently wearing full upper dentures, and I hate them. Nothing my dentist tries with them seems to work, and he has now suggested that I go to dental implants. I can not afford to do that on my own. Is there any kind of dental insurance plan out there that would help me cover some of the cost of dental implants? Thanks for your help with this.

Eliana from Miami

Dear Eliana,

You’re in a difficult position, and you’ve highlighted a little known issue that occurs when people have all their teeth removed. What many people don’t know is that when you lose a tooth, your body reabsorbs the bone at the site of the missing tooth. If you’ve lost ALL your teeth—whether through extraction or decay—your entire jawbone begins to shrink. After 20 years or so, you will be unable to wear any kind of denture at all. Restoring your oral health at that point becomes a lot more complicated, and will probably require bone grafts in addition to dental implants. Dental implants help halt the bone loss that makes your jaw bone shrink, and can serve as anchors for your dentures if you have no alternative but to have them extracted.

Sadly, no private dental insurance plan I am aware of will pay for dental implants.

To understand this, you have to think about it from the perspective of the dental insurance company. They wouldn’t stay in business long if they sold you a plan and then immediately paid out for coverage that dramatically exceeds the cost of that plan. They are a business, and businesses need to make money.

Dental insurance through an employer makes more sense to most people. Essentially, your employer is using pre-tax dollars to pay for the cost of employees’ dental care (along with a small profit for the insurance company) as a benefit of employment. Dental implants are almost never covered through an employer’s dental plan, either. They pay for the least expensive treatment, which is a denture rather than implants. If you require any kind of extensive dental work, the typical annual maximum of $500-$1,000 doesn’t usually go very far.

Talk to your dentist about financing your care. He may be willing to help you figure out a financial plan that will suit both of you to see you get the care you need. Good luck!

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Which is best, Zoom whitening or at-home teeth whitening?

In your professional opinion, which is better, Zoom whitening, or one of those at-home whitening systems? I know your office does the Zoom whitening, but I trust you to give me an honest opinion.

Heather in St. Joseph

Dear Heather –

The short answer to your question is “It depends.” Used according to the instructions, both at-home and Zoom whitening systems yield similar results. Deciding which system is best for you depends a lot on your personality, time constraints, budget, and the nature of the stains on your teeth.

At-home whitening systems need to be applied every day, according to a specific set of instructions. It can take weeks or even months to see results. If your personality lends itself to this kind of patient, consistent approach, then an at-home whitening system would be great for you. They are less expensive than Zoom whitening, so if you have more time than money, an at-home system might be the right choice for you.

Zoom whitening is accomplished in one or two visits to your dentist’s office. If you have a tight schedule, or tend to have trouble sticking to a strict routine, Zoom whitening is a great choice for you. It is more expensive than an at-home system, but many people consider the savings in time to be more than worth the difference in price.

I do recommend checking with your dentist before you go with an at-home system, as some stains will not respond to teeth whitening procedures. If your teeth are stained by tobacco, coffee, tea or some foods (such as berries), an at-home or Zoom whitening procedure will be effective. If your teeth have tetracycline stains, then you will have to make different choices to get whiter teeth. Zoom whitening (or at-home systems) are not very effective in treating tetracycline stains. In fact, sometimes the tetracycline staining is MORE noticeable after a whitening procedure is done.

Also, if you have a tooth or teeth that have become discolored after root canal treatment, that tooth will have to be taken into consideration during the whitening process. If that is your situation, you really should consider having your whitening done under the watchful eye of your dentist.

I hope this information helps.

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Porcelain crowns for “peg laterals”.

My new dentist says I have “peg laterals” and suggests that I have porcelain crowns placed to correct them. My old dentist always said I would need braces to close those gaps in my teeth. I am confused about what to believe! My old dentist retired, and I don’t really know this new one very well yet. What are “peg laterals”, and what is usually done to correct them?

–Anthony in Topeka

Dear Anthony –

It is hard to develop trust with a new dentist. I would suggest you talk honesty with your dentist about your concerns regarding these apparent differences in opinion about how to address your dental issue.

Simply put, “peg laterals” are when your lateral incisors (the teeth on either side of your front teeth, or central incisors) are too small. This discrepancy in size makes them resemble small “pegs”, hence the term “peg laterals”. Without an examination, I could not presume to tell you how your particular case should be addressed, but I can tell you that you should really trust the dentist you choose to help you.

In some cases, a porcelain crown can be used, if there is adequate space surrounding the peg lateral. If there is not, some orthodontic work might be necessary to create a space for a natural looking crown or veneer. In your case, it could simply be that your teeth have shifted, and therefore the professional advice you have received has changed.

Whatever the case, it is very, very important that you trust your dentist. If you are unable to have an honest conversation with him about the best way to fix your peg laterals, then it is definitely time to seek a different dentist. We strongly recommend you find the services of an expert cosmetic dentist to help you with this – make sure they are accredited through the American Academy of Cosmetic Dentistry, and that they have pursued specialized training above and beyond that required by general dentistry schools.