Click here to read the original post, Are Nesbit Partials Illegal?

Kathy wrote back and confirmed my suspicions. Here is her thank you:

Dr. Hall,
Thank you….for the reply.

I hate my flipper partial. My speech is slurred and my mouth is dry since wearing it. I feel like I have a clump of peanut butter on the roof of my mouth all day long. I am wearing it to keep my teeth supported on either side of the extraction and also because the gap is very apparent when I talk or smile. I do have a consultation from a dentist I found using your site and his front desk did confirm that he did work with nesbit partials. Thank you for being honest which is more than I got from the dentist who took my tooth out.

Thanks….so much, Kathy from Oregon

Everything was great for about two weeks until I would wake up during the night with pressure shocks when biting down but it did subside over time, but then it got worse. I did make an appointment with my dentist and she shaved down some of my white filling.

I went back four days ago. She said to me that she was going to take out my white filling and have a look because what I was describing to her sounded like a crack in the tooth and she would ether put in another composite or a temporary filling. Once she got into my tooth she said my filling was deep after all and it was now even deeper after her taking out the white composite filling, she went on to say there was a small crack in the tooth. She then went on to say that she would just fill it up again with a composite.

Once the procedure was done she told me that she didn’t know what the out come would be and that if it didn’t get any better I would need root canal treatment. This I am really scared of.

Since then it has been giving me shocks when I bite, and sometimes if I just touch it with my tongue. Today it’s not as bad.

What should I do from here? Should I be so scared of getting a root canal? And should I just get my tooth pulled instead? (My wisdom teeth are still coming through)

Thanks in advance
Suzanne, Northern Ireland

Suzanne,
I’m not sure what’s wrong with your tooth. It could be a crack in your tooth. It could be traumatic occlusion, meaning that the adjustment should do. Or it could be that the tooth is infected. The fact that there was no pain until a couple of weeks after the filling was done seems to suggest a cracked tooth or an infected tooth. That would mean that the cavity was deeper than you had been led to believe. But I’d have to see the x-ray and do an examination to know for sure. In the case of a deep filling or a tooth that could potentially crack, you are better off with a white composite filling than with an amalgam filling. Amalgam weakens the tooth and is more irritating to the tooth.

I’m skeptical of the skills of your dentist, so if you do end up needing a root canal treatment, I would recommend seeing a root canal specialist. Do they have those (endodontists) in your health care system? With modern root canal techniques, getting a root canal treatment is usually fairly routine. but it does have to be done carefully or there can be a risk of failure of the treatment and you could lose the tooth anyway.

Do not have the tooth pulled. Without a replacement tooth being placed immediately, at your age with your wisdom teeth still coming through, your second molar will tip forward and throw your bite permanently out of alignment, and you could end up with a lifetime of troubles, especially if you tend to grind your teeth.

But I’m puzzling over what your dentist said, that she saw a crack in your tooth when she went back in. That certainly makes it seem like that’s the cause of your pain. But if your tooth is cracked to the point where that is causing you pain, you should have a crown on the tooth, and not just a filling. It seems like she should have recommended a crown. Without a crown, sooner or later, your tooth will break. And if you don’t need a root canal yet, after it breaks you probably will.

I would ask around for recommendations and find another dentist for a second opinion. If the tooth is cracked but it isn’t yet hurting on its own, doing a crown to cover the tooth could prevent any further problems.

Dr. Hall

I am not happy. I do not want to purchase the permanent fixture that is made of metal. The nesbit makes sense to me and I am prepared to go back to Montana and see my dentist of 20 years. I moved to Oregon 16 years ago. What states “outlaw” the nesbit? Vancouver, Washington is just 10 miles away. I will wear this one while healing and to keep the teeth on either side supported. Two months to heal and then I would like to get a Nesbit. Do you have any suggestions? Wish I had friends to visit in your state.
Kathy from Oregon

Kathy,
I am skeptical about the Nesbit partial being illegal to place in any state. Really? Maybe it is illegal in Oregon, but that would surprise me if it is. I would bet instead that your dentist is probably worried about being sued should you actually swallow or aspirate the appliance. Maybe that’s the equivalent of it being illegal.

But I, too, am leery of the Nesbit partial, for that very reason.

How do you like the temporary fixture that you are now wearing as a tooth replacement? The way you are describing it, it sounds like a flipper partial – a small plate of plastic held in by tiny wire clips. Why don’t you just keep wearing that? There’s no law that says you have to throw that away after two months. I’ve seen those flipper partials last for years and years. They’re not ideal, but they work.

If you really want a Nesbit, I would start by asking other dentists in your town. I’d be surprised if you have to go into a neighboring state.

Dr. Hall

Links: read more about removable partial dentures
Click here to ask the dentist a question.

Follow-up: Kathy wrote back and confirmed that I was right – Nesbits are not illegal in Oregon, and she found a dentist who will do one.

Joe,
I’m at a disadvantage in not being able to see this stain you’re talking about, so I’m going to take a guess at what it looks like. And I don’t know how old they are.

Porcelain veneers have the characteristic of being very stain resistant – even more stain-resistant than natural teeth. And, as you said, they are also very color stable. When they do stain, it is usually from one of two causes. Either the surface of the porcelain veneer has been damaged – the glaze has been broken possibly due to the use of power polishing equipment or acid fluorides. Or, there is something getting under the veneers.

For the sake of being able to say something, let’s assume that these are older veneers that have been on maybe ten or twenty years, and that the stain starts right at the edge of the porcelain veneer and involves the first millimeter or two of the veneer. This is the type of stain that would be the most likely to confine itself to the edge of the veneer.

If these assumptions are correct, then the stain probably comes from leakage – the margin of the porcelain veneer has broken down and microscopic particles are getting between the veneer and the tooth. It is called microleakage, and it starts being just a stain, but if not addressed and repaired, it can grow into decay.

If this is the case, you would not be able to have this stain polished out. The veneer would have to be removed and replaced. And it wouldn’t be related to any damage that could have been done during your cleaning.

Dr. Hall

Links: read more about stained teeth.

Thank you
Rose from Michigan

Rose,
I don’t know that I can explain what is wrong with your teeth. I’m not following the explanation of what you are saying your dentist told you. He apparently is trying to translate a clinical diagnosis into something you would understand, but as you relay to me that “translation”, I am not able to get anything better than a vague understanding of what is going on with your mouth.

But I can tell you this much. It does sound to me like your dentist knows what he is talking about. There are nerve disorders that can mimic toothaches. And if prednisone and Tylenol was able to get your pain to go away, it sounds like he is on the right track. And if your dentist were trying to take advantage of you or cover up for his own ignorance, he has a ready excuse for any number of treatments in an attempt to solve your pain. So I respect that he has advised against any further treatment of these teeth.

My advice would be to go to the neurologist.
Dr. Hall

I also have a mild phobia of dentists and don’t go as often as I should.

The older I get, the more I realize that my smile is affecting my self confidence and I really want to do something about it. I wouldn’t trust the guy I’m going to now for any cosmetic work, since reading your blog and looking at dozens of before and after shots from other dentist, I’m beginning to understand that you really need a professional who has a passion to get good quality work. A family member of mine has recommended me to his dentist, who did a lot of cosmetic work and gave him a beautiful smile makeover, but cost him upwards of $30,000+. I don’t have this kind of money to spend, and I personally think my family member was overcharged.

My question to you is can you recommend someone in my area that I can trust? I see a lot of advertisements in my area (I live close to NYC) for these “top rated” cosmetic dentists, but it seems like they all overcharge you so they can put another fountain in their office. I appreciate any feedback you can provide and I found your blog very knowledgeable!

Thanks,
Randy from New Jersey

Randy,
We have a variety of dentists that I recommend on mynewsmile.com as far as the fees that they charge. I don’t know the relative fees of most of the dentists we list – I do know some.

The ones we recommend in Manhattan are all expensive. And any dentist who markets heavily is likely to be expensive.

To get a handsome smile, it sounds like you will need a smile makeover with either porcelain veneers or porcelain crowns. Probably porcelain crowns – since you say you have worn your teeth down from grinding your teeth.

Here’s what I would do. You’re in New Jersey. Call the dentists on our New Jersey page and ask what their fee is for a porcelain crown. Some won’t give you a fee over the phone, but some will. And use that to find a dentist who fits your budget.

All the dentists I recommend have passed my careful screening, so I have confidence in all of their work. But not all of them are expensive. So give that technique a try.

If a dentist is really expensive, it’s not an indication that they do great work. Some mediocre dentists charge high fees. However, if a dentist is really cheap, it is generally a good indication that the work is poor. Some excellent dentists have moderate fees, and some have high fees. But that is the extent that the old maxim “you get what you pay for” works. What you want to find is that excellent dentist in your area whose fees are moderate.

Dr. Hall

Tiffany,
The best solution for making small teeth larger would be porcelain veneers. While dental bonding could be used, that’s not the best solution, and I’ll explain why.

The dental bonding material is relatively soft, compared to, say, tooth enamel, which is very hard. It will feel hard to the touch, but it is susceptible to scratching, and it can also absorb stains. So it won’t look that good for very long. Porcelain, however, is even harder than tooth enamel and less susceptible to staining. So what you would have with dental bonding would be a smile that would look really great for a year or two and then it would start to look dull and stained. But with porcelain veneers, with proper care they will stay shiny and bright for 10, 15, 20 years or more. Dental bonding can be less expensive – done well it may cost maybe 2/3 of what porcelain veneers would cost. But by the time you replace it or resurface it 4 or 5 times it ends up being considerably more expensive.

For a beautiful job, expect to pay $1000 to $2000 per tooth, maybe a little more on the higher end where you are in southern California.

And be very careful where you go for your porcelain veneers and absolutely do not try to look for bargains here. While many dentists claim to be able to place porcelain veneers, only about one in fifty is artistic enough to do a good job with them. If the procedure is too expensive for you, the best choice would be to do nothing. Your own natural, small teeth will look better than a poorly done set of porcelain veneers. But if you go ahead and get veneers and then don’t like how the final result looks, you will have no legal recourse. Look for our cosmetic dentistry horror stories section to read more, if you’re not convinced.

Dr. Hall

Links: Look for more blog posts about cosmetic dentistry horror stories.

Ann,
I looked at their website, and I have a couple of comments.

First, their teeth whitening agent is 35% carbamide peroxide. This is a valid whitening agent – it will whiten your teeth. And, with the exception of the “cold blue light” that they add to the process, which I don’t believe will accelerate anything, I don’t see any hocus-pocus in the technique or the products they offer. However, I can’t endorse what they are doing for a couple of reasons.

First, their price is kind of high. They are charging $158.00 for the whitening kit. While some dentists charge more than this (some charge a lot more), some charge less. If your dentist charges more than this and you just don’t want to pay that fee, I’d just shop around for another dentist. Sometime, just after you’ve had your teeth cleaned and checked, just call around. Tell the new office you’ve just had a cleaning and an exam and just need the whitening. How much would it be? Go to that dentist for your whitening, and back to your regular dentist for your other care. Or, another approach would be to level with your dentist. If it were me, I would just say, ‘Hey, I found this offer for a kit I can buy for $158, and I read comments by a dentist online who said this would really whiten my teeth. If you can come down on your fee to something close to that, I’ll get it from you.”

You see, there are two problems with buying this kit over-the-counter. The first is the tray that they make is not going to fit nearly as closely as the one a dentist will make for you. So you are going to have a lot of leakage, which causes three problems. First, there is a reduction in effectiveness when the tray leaks. Second, you waste a lot of gel, which drives up the cost even more. Third, there is a greater chance of irritating the gums.

And then there is the safety issue. I published a report a couple of years ago of a woman who needed a root canal on her front tooth because of the side effects of an over-the-counter whitening system. It’s always best to use this kind of thing under professional supervision. There are issues about existing dental work, exposed root surfaces, open margins on fillings, etc., that should be checked before starting whitening.

For those reasons, you are much better off getting this service from a dentist. You do not need an expert cosmetic dentist for most routine whitening cases – this is one area of cosmetic dentistry where almost any dentist will do.

- Dr. Hall

Links: Can I whiten my teeth while nursing or pregnant?
Three types of teeth stains.

Sylvia,
I’m at a little bit of a disadvantage not being able to see this myself, but at least from what you’re telling me it seems pretty clear that your tooth needs a root canal treatment. And I will tell you why I think that.

I am interpreting the “inflammation on a nerve” that you are telling me about as signs on the x-ray of pulpal inflammation. When the pulp of a tooth is inflamed, often the first sign is either a widening of the periodontal ligament space around the end of the root, or a breakdown in the bony lining of the socket of the tooth, also occurring at the end of the root. When anything shows up on the x-ray like this that indicates inflammation of the pulp of the tooth, it is pretty certain that you are going to sooner or later need to have that root canal treatment.

Taking some amoxicillin you had at home for a tooth infection isn’t a good idea. But the response of your tooth – the pain went away and then came back two weeks later – is another pretty certain indication that the tooth is infected, which means you need a root canal treatment. The problem with having taken the amoxicillin is that now you are that much more likely to have an amoxicillin-resistant infection in your tooth. You can never wipe out a tooth infection with antibiotics alone because the antibiotics have no way to get inside the tooth. So the infection will always come back, and the next time it’s always more likely to be an antibiotic-resistant infection.

Your porcelain veneer won’t fall off this tooth if you get a root canal treatment. But let me give you some helpful advice on how to have this done so that you preserve the esthetics of your smile. And this is something that many dentists don’t know, unless they are really expert in appearance-related dentistry. There is a strong potential for a tooth with a root canal treatment to turn dark. That dark color will show through the porcelain veneer and will require it to be done over again unless the dentist takes this simple precaution. After the root canal treatment, the dentist needs to clean out all root canal filling materials and cement from the insides of the visible part of the tooth – the part that shows above the gumline. Then she should cement a translucent fiberglass post inside the tooth to reinforce it and fill up the rest of the inside of the tooth with a light-colored composite material that will preserve the original color of the tooth. It is the root canal filling material and cement inside that cause most of the discoloration of the tooth. But by cleaning all that out and filling it as I have described, it won’t permanently prevent any discoloration of the tooth, but it may put it off for a good five to ten years. At that point you can get new porcelain veneers or go to a crown on the tooth.

Show this e-mail to your dentist, and she can contact me if she has any further questions.

Having this delayed response to the traumatic injury and decay you experienced 9 years ago isn’t unusual at all. Most dentists have seen this sort of thing before.

Dr. Hall

Julie,
This doesn’t sound good.

The dentist told you to take ibuprofen for a FEW WEEKS??? Are you serious? So much ibuprofen over that long a period of time can damage your liver or your kidneys. You are taking 3200 to 4000 milligrams a day. I think the maximum recommended dose is about 2400 mg per day over short periods.

No, this kind of pain after getting crowns or porcelain veneers is not normal. Something is wrong. Some tenderness or soreness for a couple of days maybe could be expected. And your teeth should all be touching evenly.

You need a second opinion from a reputable American dentist. You have two excellent cosmetic dentists near you. [Names not included in this post]. Have one of them look you over and see what is wrong before this gets out of control and so you can get off this ibuprofen immediately. It does sound like you may need a root canal treatment. Don’t have that done in Mexico, please.

Only about one out of every fifty dentists in the United States is capable of doing a beautiful smile makeover. However, most of our dentists are fairly competent in general dentistry. If you go to Mexico, your chances of getting in trouble with even basic general dentistry are high, and there are probably only a handful of good cosmetic dentists in the entire country. One for sure—there may be more.

Dr. Hall

Links: Read more about cosmetic dentistry costs.
Read more about the quality of dental care outside the US.