General dentistry « The Cosmetic Dentistry Blog

July 3, 2010

Is Supersmile safe for porcelain veneers?

Filed under: Toothpaste — iowasmiles @ 5:27 pm

I read that toothpastes with baking soda are NOT recommended for people with veneers. If that is the case, why does Supersmile contain it and why is it safe for veneers?
Kristina from Texas

Kristina,
I’m not sure where you’re reading that baking soda isn’t good for porcelain veneers or what it is about baking soda that’s not good for veneers. I’d be interested in knowing where you read that. Baking soda has low abrasivity, and it neutralizes plaque acids, and makes a great ingredient in toothpaste.

Supersmile toothpaste is recommended by a number of leading cosmetic dentists for use with porcelain veneers and other cosmetic dental work. In fact, the Supersmile website not only includes my endorsement, but also the endorsements of three past presidents of the American Academy of Cosmetic Dentistry – Dr. George Freedman, Dr. Jeff Morley, and Dr. Jeff Golub-Evans. The reasons we endorse it are because we are familiar with the studies. It is a very effective cleaning agent. There are some stains, such as Peridex stains, where it seems to be the only thing short of a professional cleaning that will remove them. And, it is one of the most gentle toothpastes and will not scratch or harm any cosmetic dental work.

See these testimonials at: http://www.supersmile.com/category/testimonials/dental-professional.
You may also be interested in reading about baking soda as a toothpaste ingredient on the SaveYourSmile consumer information website.

Dr. Hall

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June 19, 2010

Dry sockets and smoking

Filed under: Wisdom teeth — iowasmiles @ 5:52 pm

I know smoking is bad but I had all 4 Wisdom teeth removed 2 days ago and the healing process has been smooth. Very little pain and no bleeding after 5 hours of the teeth being removed. How long should you wait to smoke again to prevent dry sockets because I have had friends who smoke the same day and did not get them and friends who waited 3 days after and got them.
- Jason from Wisconsin

Jason,
Dry socket is an infection of the socket and isn’t related to how soon after surgery you smoke. Smokers tend to get more dry sockets than non-smokers, but it isn’t caused by the physical act of smoking, as many dental assistants, and even some dentists, believe.

Dry socket occurs after about 15% of the extractions of lower wisdom teeth, and it is characterized by a dramatic increase of pain about two or three days after the surgery. When the socket is examined, it doesn’t have a blood clot. Seeing that, dentists many years ago thought that the blood clot must be missing because the patient “sucked it out,” and that this was the cause of the problem. From this erroneous idea come all the instructions to not suck through a straw or smoke, because smoking requires sucking. But scientific studies do not confirm this. The loss of the blood clot is an effect of the infection, not a cause.

The incidence of dry socket increases with increasing trauma to the socket that occurs during the surgery. An oral surgeon, with careful and gentle surgical technique and placing an antibiotic dressing of clindamycin in the socket right after removing the tooth, can nearly completely eliminate dry socket as a surgical complication. I know, because I did that and went for over ten years and hundreds of wisdom teeth extractions without a single incidence of dry socket.

I don’t smoke, and I would love to be able to tell you not to smoke. You’d be much better off to kick that self-destructive habit. But the truth is that you will not cause dry socket by smoking too soon after your surgery.

Dr. Hall

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June 14, 2010

Do I need a root canal?

Filed under: Pain in teeth — iowasmiles @ 10:24 am

Dr. Hall,
okay i dont know if i have root canal yet or having it soon. i had a filling when i was in high school i can see the fillings in my teeth but can not see them very well. my top right and bottom right teethes hurt when i eat or drink something cold. i would sometimes put my head into the sink to put some Heat on it. it works for 5=10 seconds then pain again. i would brush my teeth trying to get the friction from my tooth brush to give it heat. and it does work. but how long is that going to last. first i thought it was cause i was chewing gum while i was smoking if thats the problem ill have to go to the dentists. if you can get back to be asap that would be great.
- Andrew from California

Andrew,
I’m not following all that you’re saying. But persistent pain in a tooth from cold is an indication that the tooth needs a root canal treatment.

If something cold touches the tooth and it hurts only while the cold is on the tooth, that indicates an irritated tooth that may or may not need treatment. If the pain lingers for more than a few seconds after the cold has been removed, that tooth won’t get better on its own, and it needs a root canal treatment.
Sometimes people are fooled because after a week or several weeks the pain goes away, so they think the tooth is better now. But what happens is that the living tissue inside the tooth dies, and that is usually the reason that the pain goes away.
- Dr. Hall

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June 10, 2010

Risks of wisdom tooth removal

Filed under: Wisdom teeth — iowasmiles @ 6:10 am

I am 35 yrs old and recently started having pain in my lower right wisdom tooth. It is fully impacted. The pain comes and goes within a couple of hours. This has happened 3 times in the last couple of months. My dentist referred me to an oral surgeon who recommends the tooth be extracted. He says the risk of parethesis is about 8-15%. Is that true and should I proceed with the surgery?
- Bridget from Texas

Bridget,

Your oral surgeon is warning you about possible paresthesia, which comes from damage to one of the nerves that go through the wisdom tooth area. There is the lingual nerve that goes to the side of the tongue, and the inferior alveolar nerve that goes to the lip. If this nerve is damaged, you could have anything from a transitory altered sensation in that nerve that lasts a few weeks to a permanent loss of sensation. Temporary damage is far more common. Permanent loss of sensation is a result of severing or totally crushing the nerve, which happens very infrequently.

You need to know that when a dentist gives you warnings about the risks from a procedure, the object they have in mind is to protect themselves against lawsuits. So there is a tendency, especially among specialists such as oral surgeons, to overstate the risks. Without an x-ray of your tooth, I couldn’t tell you if the percentage they gave you is right or wrong. It is high if there are no complicating factors in your surgery.

But you have to have the tooth out. The risk of doing nothing is far greater. The tooth could easily be infected, and a wisdom tooth infection can become life-threatening. And the longer you put this off, the more difficult the surgery will become and the greater the risks of complications.

And I would strongly recommend having ALL of your wisdom teeth out at this time. If you’re having trouble with one wisdom tooth, you will very possibly have trouble with the corresponding one on the other side soon. And the uppers are simpler to remove. The healing time and discomfort are only a little greater in having four wisdom teeth out as opposed to having one. A dentist who really cares about his or her patient will recommend that.

And for others reading this posting, this is an excellent illustration about the wisdom of having your wisdom teeth extracted when you are 25 or younger, if they are impacted. At that age, your bone is quite pliable and the risks of complications are very low. Having wisdom teeth removed at, say, age 20, has about 1/4 the risk of difficulty as having them out when you’re 35. Dentists who would advise otherwise are almost never dentists who have first-hand experience taking out impacted wisdom teeth.

Dr. Hall

May 28, 2010

Do vital pulp caps work?

Filed under: Root canals — iowasmiles @ 1:49 pm

My dentist touched the pulp of tooth # 19 and now the tooth is infected. The tooth is cosmetically perfect and feels as strong and healthy as my other molars. He prescribed a week of amoxicillin and told me my only option is a root canal. What can be done to ensure that the crown does not leak or become infected? Is there a way to tell from an xray if a tooth will need a post? I have done my best to take good care of my teeth, and feel as if the only option the dentists I have seen offer is root canal followed by a crown, but I don’t understand why something less extreme like topical antibiotic and refilling the tooth isn’t possible? This filling last 12 years before this infection, and a crown would last about that long as well? Essentially, what is your opinion of pulp-capping? And is there a point of infection after which root canal is no longer an option?
- Roger from Alabama

Roger,
It used to be thought that anytime there was a pulp exposure on a tooth, the tooth needed a root canal treatment.

However, if there is a “clean” exposure of the pulp, it is very possible to preserve the vitality of the tooth and avoid root canal treatment. I did this vital pulp cap treatment many times, including to a fractured front tooth where the fracture had exposed the pulp.

The important issue is whether or not the pulp is healthy. If the bleeding is minimal and stops within a couple of minutes, that’s a good indication that the pulp is healthy. If the bleeding is hard to control, then the pulp isn’t healthy and the tooth will need a root canal treatment.

When I did these vital pulp caps, I would put a cavity cleanser containing chlorhexidine gluconate on the exposure, then some type of base such as calcium hydroxide, and a resin ionomer over that. Then you wait a few weeks to see if it heals. If the tooth becomes very sensitive, or if their is tooth pain, then the pulp cap didn’t work. But my experience was that usually the tooth would heal without incident.

You said your tooth #19 is infected. Just because the tooth has a pulp exposure doesn’t mean that it’s infected. If it doesn’t hurt, then it very well could be not infected. And the antibiotics won’t help. Penicillin won’t help an infection that is inside a tooth. I’ve never known penicillin to be any help in a situation like this.

I hope this is helpful. I don’t understand the other things you’re saying and asking about the filling and a post and everything else, but hopefully this information will be useful for you.
Dr. Hall

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May 13, 2010

Root canal tooth is infected, and I’m pregnant.

Filed under: Root canals — iowasmiles @ 10:27 pm

Hello Dr. Hall,
I am 26 weeks pregnant, and I recently had a digital xray, as tooth nr 15, up, was getting sensitive. This is a tooth that had a rootcanal treatment before, and it also has a pile in it. The dentist said that there was an infection under the roots, and he gave me 3 options: 1. retreat the root canal 2. apicoectomy 3. extract the tooth and do an implant I am still hesitating between 1 or 1-2 together, just to be on the safe side . He said that usually 60-70 % of the redone root canal treatments are successful, but in my case as I am pregnant what if not. As I will be soon getting in my third trimester it will be more difficult to operate. I am also worried because of the lidocaine injection, and what it might do to the baby. I know it is usually safe, category B drug, but still. My question is: 1. Does apicoectomy need more lidocain than retreating the root canal? Is the dosage bigger? 2. How fast would my dentist know if the just rootcanal would be succeesful? Would I feel pain in week or two if it was not successful, or not because there are no nerves in the tooth. He said he won’t know it in a year. That seems long to me, I am just talking to the redoing of the rootcanal treatment and not the apico. 3. Can apico be redone on the same tooth if it is needed? Basically if root canal would have solved the problem, having a done apico can shorten the life of a tooth if just simply cleaning up the canal would have done the trick? 4. I am also worried something may go wrong during the procedure and then I’d be in pain after and need to take drugs. Right now I am not in pain, although sometimes my tooth is sensitive. It hasn’t been lately, but I know there is no guarantee to when the infection advances and then I feel it. Thanks for your answer. Both my dentist and endodentist are basically new for me, and I wanted to have another professional opinion. I know it is not easy to answer not having the Xray there. I appreciate it.

Best regards,
Anna from British Columbia

Anna,
I would have the root canal treatment re-done and nothing more at this time. But I would have it done by a root canal specialist. Specialists would be likely to have the special tools that will make this treatment more predictable.

As far as the local anesthetic is concerned, I wouldn’t worry about it. To re-treat the root canal would require very little anesthetic, because the tissue inside the tooth is dead. Root canal surgery would require considerably more anesthetic. Ask the dentist to use only the minimum anesthetic required. Yes, Lidocaine is one of the few drugs that has been proven safe during pregnancy, but still, there is no need to overdo it. And another point about your pregnancy, I imagine that the infection is a minor one, but it would still be better to be rid of it.

The dentist should be able to tell right away if the treatment went well. While it is true that re-treatment is unsuccessful somewhere between 25% and 50% of the time, when it isn’t successful, it is usually because there was a difficult problem during the treatment – such as a blocked canal, a ledged canal, curves that were difficult to negotiate, or some other cause. And the dentist will know if there were any of these difficulties. If no problems like this arose, and the dentist feels that he or she was able to instrument the root to the very tip and got a good apical seal, the results should be fairly predictable. On the other hand, if the treatment didn’t go well, you could then make the decision to go ahead with the apical surgery (apicoectomy).

Congratulations, by the way, on your pregnancy, and good luck with your tooth.
- Dr. Hall

May 12, 2010

What to do about too many cavities

Filed under: Tooth decay — iowasmiles @ 6:37 am

I have what I thought was soft teeth, however i guess not. I brush my teeth 1-2 times a day and no matter what I constantly have to have alot of work done on my teeth. My teeth are sensitive, I brush with Sensodyne. I am wondering wh! at to do. I constantly have a large balance due to the amount of work and when I get it paid down I go back and am back to where I started. More work and more bills. Is there anything you can suggest? I am a single mom with no real money to keep paying high bills but my teeth and smile mean the world to me. Too bad the smiles don’t happen often.

Gina from Michigan

Gina,
I guess you read our page about soft teeth. There are some extremely rare genetic conditions where people have teeth with no enamel or little enamel, but in all my years of practice I never saw anyone like this and never saw a patient with “soft teeth.” Though I had many who claimed to have soft teeth or who told me their earlier dentist told them they had soft teeth. But their teeth were always just as hard as anyone else’s.
They were looking for a cause as to why they had so much decay. In every case but one I found that they had a serious snacking habit. Now I don’t know if this is the case with you, but I will mention it.
Here is my list of misconceptions about tooth decay:
1. A high rate of tooth decay is caused by “soft teeth.” In all but rare cases, this is totally false. It is usually caused by too frequent snacking.
2. Toothbrushing totally prevents tooth decay. So many people believe this, but toothbrushing prevents only one type of tooth decay, and that is smooth surface decay. And even then, it can’t overcome the effects of too frequent snacking. Most tooth decay occurs either between the teeth or in the pits and fissures of the teeth where the toothbrush can’t reach. And why is that? It’s because most people brush their teeth.
3. ONLY toothbrushing prevents decay. Actually, the strongest decay prevention comes from your own body defenses. Your saliva has minerals that will actually re-mineralize early decay lesions and repair them. This remineralization process takes several hours, though. So if you are constantly snacking, like say every hour (some people snack every few minutes!), you will overwhelm your body’s defenses and the decay will grow rapidly.
4. Only sweets cause decay. While sweets cause decay, anything that has carbohydrate in it will promote decay just as readily. Bread, crackers, fruit, (especially dried fruit, because it sticks to your teeth)–all of these things can cause serious decay. Potato chips and pretzels are bad because they also stick to your teeth.
5. It’s okay to snack in bed. This is actually the worst time for you to eat anything. When you fall asleep, your body shuts down saliva production. It’s your saliva that has the reparative substances that battle decay. Babies that are given bottles of formula when they go to sleep can see their teeth completely rot down to the root in a matter of weeks.

My advice to you: Eat only at mealtimes and then maybe have one or two snacks during the day. And soda with sugar in it counts as a snack. Brush right before going to bed, and floss then, too, so you also clean between your teeth. Brush again after breakfast. I believe that 99% of the people that follow a prevention routine like that will have very minimal tooth decay.

I hope you find this helpful and that you will implement what I’ve told you here. It will make a total difference in your dental health.
Dr. Hall

A related link: read about whitening toothpastes, and one that we recommend.

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May 7, 2010

Roots of wisdom teeth were left in the jaw.

Filed under: Wisdom teeth — iowasmiles @ 3:20 pm

Dr. Hall,
Hello. I had a wisdom tooth partially removed with the roots still intact. The dentist could not pull out my tooth. It was pretty excruciating. I sat for four and a half hours before he called it quits. He partially removed some bone to try to extract it the tooth but it didn’t work. He broke the tooth and took out what he could and cleaned up the bone as much as possible before sewing me up. He stated that he cut down the tooth enough for the bone to grow back over the roots that was left and that tissue will heal and start to grow back over the wound. My question to you sir is it ok for the roots to still be there. Am I still prone to serious infection if the bone grows over the roots, and will tissue grow back over some of my exposed jaw bone? I appreciate the help.

Thank you
- Darian from Belgium

Darian,
I was surprised to read what had happened to you. I have heard of general dentists attempting wisdom teeth extractions and other difficult extractions, and finally giving up because they became too difficult. But in the situations I have heard of, the dentist then referred the patient to an oral surgeon to complete the work.

I don’t know how much of the tooth was left in your jaw, but the larger the piece, the greater the risk of subsequent infection, or cyst formation, or other complication. In some cases, it is wise to leave a root tip in the jaw when it is in a risky position such as near a nerve or near the sinus. But that doesn’t seem to be the case here – it just seems like it is a matter of the tooth being beyond the difficulty of your dentist. Yes, bone will probably grow over the roots, and it is possible that you will have no further trouble with this. But it is also possible that you will.

I would suggest going to an oral surgeon in the next couple of days and having him or her x-ray this tooth and examine you, and see what they think should be done.

Dr. Hall

PS – The following was not part of my e-mail to Darian:

I get frustrated when I hear Americans complain about health care in the United States. There are a number of stories I have heard from people in Europe and Asia that are like this and reveal a much lower standard of dental care than would be considered acceptable in the United States. This corroborates what I saw in my practice when I had to re-do foreign dental work. I guess it is just a human tendency to not fully appreciate the good things we have.

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Link: Check Naperville emergency dentist Dr. David Newkirk

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May 3, 2010

Pain from teeth bleaching

Filed under: Teeth sensitivity, Tooth whitening — iowasmiles @ 2:07 pm

Hello, I have been using an at-home whitening system for about 2 weeks with no problems. Then yesterday, I used them and I felt a sharp pain that lasted for about 30 seconds The source of the pain was my front tooth which has a dental bond. It was chipped and repaired about 10 years ago. My question is – is my bond nearing the end of its life cycle, or is the whitening weakening the bond? I suspect it is both. Thank You, Kim from Texas

Kim,
I doubt that the tooth bleaching system would weaken the bond on this tooth. Bleaching gel hasn’t been known to weaken bonds like this. Plus, if the bond were weakened, the repair to the chip would probably fall off – it wouldn’t just be this pain.

The kind of pain you experienced can be caused by the bleaching gel on a sensitive part of the tooth. That’s what I would suspect. If this tooth was otherwise injured and repaired, there could be a sensitive place that used to be covered by some bonding agent and that has come off.

Your case is a good illustration of why, when you’re doing teeth bleaching, you need to be under a dentist’s supervision. I assume that you are. You should let the dentist know about this, and hopefully they can find the exact cause of your problem. If it is indeed a sensitive spot, it could be coated with something to take care of the sensitivity, and you can go on with your bleaching. But get this solved before you bleach any more.

- Dr. Hall

Read more about sensitive teeth.
Other links: Chicago porcelain veneers.

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April 27, 2010

Surprised at the amount of swelling after wisdom teeth removal

Filed under: Wisdom teeth — iowasmiles @ 8:50 am

My son had 4 wisdom teeth removed two days ago, and from the removal his face is severely swollen on the left including his eye. I am seriously concerned could he possibly have nerve damage that is affecting his eye and! jaw which would require additional surgery? Or will anti-inflammatory medication, time, washing with warm salt water and penicillin help decrease the swelling? Thank you From Mother with frustrated son
Angela in Maryland

Angela,
You’re e-mailing me two days after this surgery, which is typically the worst day for the swelling, and then it tends to go down after that. I’m not hearing anything from you suggesting any nerve damage. The swelling comes from the surgery and always happens when you have impacted wisdom teeth removed. If the upper left wisdom tooth was a little difficult and required removing bone to get it out, as they often do, that tooth is very near the eye and the swelling will be up in the eye area. Now I can’t examine him, so I’m just going by what you are telling me. But you’re not telling me anything unexpected, really.

I would just follow the instructions of the dentist who took them out, and I would expect steady improvement. If at any time his situation gets worse – the swelling increases instead of decreasing, or there is an increase of pain from one day to another, then you should tell your dentist, and your son may need additional help.

You may give some feedback to the dentist that took them out. We always tried to brace our patients for the worst, and we described a worst-case scenario of what they would experience afterwards, so they didn’t worry if that happened. It’s not smart to paint too rosy a scenario for the patient – I would put my optimistic outlook aside and describe the worst I thought could reasonably be expected. If you weren’t expecting this, maybe your dentist could use a little lesson in post-operative instructions.

Related link: read about tooth infection.

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