The Cosmetic Dentistry Blog

June 28, 2007

Pain after a crown

Filed under: Dental crowns, Pain in teeth, Root canals — iowasmiles @ 9:53 pm

Dr. Hall,
I switched to a new dentist and during the required new patient evaluation it was recommended that I have a dental crown placed on my upper next to the last tooth. I had no pain in that tooth, but there had been some discoloration there for several years. The dentist did not perform a root canal. I have had continued pain in the tooth since the procedure. When I went back for the permanent crown after 3 weeks, I told my dentist about the pain. He repeated XRays and said everything looked fine. They only temporarily cemented in the tooth since I was still having pain. He said the tooth would probably get better but might take some time. I was unable to get a time estimate but finally was told maybe months. I said I could live with the pain for months if I knew it would eventually go away and that everything was OK. He said it probably would and if not I would need a root canal. This new crown has never felt right to me and still hurts just as much as it ever has. It has been 3 months now and I have had no improvement. The pain is usually mild as long as I don’t aggravate it. I am unable to eat anything on that side at all. The tooth and gum lines hurts if I touch it with my tongue. Last week the gum became inflamed, red, and extremely painful. The pain radiated to my ear. 24 hours later it was much better. It is still red, but not nearly as much. I am not sure I trust my new dentist. I need another expert opinion. I know that this tooth is only temporarily cemented in and I dread having to reaggravate it when the permanent cement is placed. Thank you in advance for your expert advice!
- Catherine from Texas

Catherine,
You haven’t told me anything that seems out of order, and my guess is that your dentist has done the right thing and you can trust him, at least from what you’ve told me. I myself have had a tooth that has hurt as yours has, and it went on for months while I hoped it wouldn’t need a root canal treatment, but it eventually did.
I would go back to the dentist and relate your experiences, and you will probably end up needing a root canal treatment. If your dentist can’t confirm that and is still puzzled, I would ask him for a referral to a root canal specialist, explaining that you don’t want to deal with the tooth pain. The root canal specialist will be in a better position to give an accurate diagnosis in a situation like this.

I hope this is helpful.
Dr. Hall

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June 25, 2007

A root canal on a porcelain veneer tooth

Filed under: Porcelain veneers, Root canals — iowasmiles @ 1:17 pm

Hello,
If porcelain veneers are put on and then later it is discovered that the person needs a root canal on one of the teeth that is covered by the porcelain, is it very difficult to get to the tooth under the porcelain to do the root canal?
- Kathy in Texas

Kathy,
It’s fairly easy to have a root canal treatment on a tooth that already has a porcelain veneer. For a front tooth, the opening to the canal is made through the back of the tooth and doesn’t affect the veneer at all.

But I want to caution you about this. Teeth with root canal treatments tend to turn dark afterwards, sometimes very dark, and this will show through most porcelain veneers. But there is a way to prevent that from happening, and what you want to do is find out if your dentist knows that technique. Pay attention carefully, and approach this issue exactly the way I explain. Ask your dentist if the tooth turning dark can be prevented and then ask how it is done. You are testing your dentist, so don’t give away the answer. If your dentist responds that he or she will just make sure any gutta percha and other root canal filling materials are cleaned out of the inside of the crown of the tooth, then you can breathe a sigh of relief because he or she understands. If your dentist doesn’t know that, don’t try to teach him or her. I don’t have time in this answer to fully explain why. But it is a very very bad idea to research stuff on the Internet and then try to teach your dentist. If your dentist has not cared enough about this issue to attend enough continuing education to learn it, then there are many other things that he or she doesn’t know that will give you trouble, and there are several other substantial reasons why I have seen so many patients who have tried to teach their dentists and who have met disaster.

Your dentist may insist on doing a dental crown in order to keep it from breaking, but if you don’t have an expert cosmetic dentist, the dentist will have a great deal of difficulty getting the crown to match your existing veneers. And a crown on a front tooth (an incisor or canine) will not help keep the tooth from breaking but will weaken the neck of the tooth. A dental post, on the other hand, will strengthen the tooth, and you may want to check out that link.
- Dr. Hall

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June 18, 2007

How much dental work can I have done in one sitting?

Filed under: General dentistry, Sedation dentistry — iowasmiles @ 8:52 am

Dr. Hall,
I need a lot of work on my teeth. I need over 7 root canals, I have a few cavities, one tooth needs to be shortened and my teeth need to be whitened. I would like to have most of this done at once, how much work can be done in one sitting?
- Lisa in New Jersey

Lisa,
There’s a lot of variation from dentist to dentist as far as how much work they’ll get done in one sitting. You have to ask the individual dentist.

The dentists who will do the most work in one sitting will be those who do sedation dentistry. You can find listings of sedation dentists if you do a Google search on sedation dentist.

If you want a New Jersey cosmetic dentist who can also do sedation dentistry, I’d recommend Dr. Joel Singer. He is up just outside Manhattan, which is at the other end of the state, but if the appearance is important to you, you’re going to have to go that far. If your tooth whitening is not complicated, and there isn’t other work on front teeth, you could have a general dentist do that.

If you don’t want to go with sedation dentistry, then it partly depends on your endurance ability. If dentistry doesn’t make you uncomfortable at all, then you could probably do a four-hour appointment in one sitting, and if your dentist can work fast, then you can get a lot done.

If your seven root canal treatments are on front teeth, then a general dentist or a cosmetic dentist who does root canals could get them done in one appointment. If they are on molars, and it’s important to you to get them done in as few appointments as possible, I’d go to an endodontist (a root canal specialist), as they work much more quickly than non-specialists. It can take a general dentist one and a half to two hours to do a molar root canal, where a specialist will get the whole thing done in an hour, easily.
- Dr. Hall

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June 15, 2007

Teeth discolored and not straight

Filed under: Invisalign, Porcelain veneers — iowasmiles @ 7:35 pm

Hi,I have bad discolored teeth, and they are not straight either. What’s the best solution for me?
Thank you,
Jamal in Mississippi

Dear Jamal,
There are two good possible solutions for discolored teeth–either porcelain veneers or teeth whitening.
There are two good possible solutions for teeth that aren’t straight–braces (either Invisalign invisible braces or conventional wire-and-bracket braces) or porcelain veneers.

If your teeth are both discolored and not straight, it generally makes the most sense to get porcelain veneers and take care of both problems with one treatment. However, cosmetic dentists who do Invisalign can use the Invisalign aligner trays to double as a home tooth whitening appliance and do both treatments simultaneously.

And as far as getting this done, I would recommend you see Dr. Denis Freiden, a Memphis cosmetic dentist, even though it means a drive to another state. Mississippi is a very unfavorable state for cosmetic dentists, so they go elsewhere. We do have a Mississippi cosmetic dentist in Laurel, Mississippi, but that is at the other end of the state for you and a longer drive than to Memphis. Creating a beautiful smile takes artistic passion and artistic ability, so good cosmetic dentists are fairly uncommon.

- Dr. Hall

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June 8, 2007

Too Young for Porcelain Veneers?

Filed under: Finding a cosmetic dentist, Porcelain veneers — iowasmiles @ 9:18 pm

Hi,
I have a chipped front tooth, and some slight spaces in my smile seven years after braces. I am twenty-four and am looking into porcelain veneers from an LVI preferred expert cosmetic dentist. I am wondering how young is too young to get veneers? Am I too young? Should I maybe consider bonding or a combo of Invisalign and bonding?

I just want to make sure I am making the right decision before anyone grinds down my tooth enamel and there is no turning back. Which would look better? Also, is it better/healthier to bond than to veneer? And once you veneer can you ever go back to your natural teeth or will they look weird or not be strong enough on their own?
Thanks,
- Brittany from Colorado

Brittany,
You aren’t too young for porcelain veneers. It’s good to have your teeth fully erupted before you get porcelain veneers, which is at about age 18 or older.

And I hope you’re in the hands of an artistic cosmetic dentist. Being LVI preferred isn’t any kind of a guarantee. It just means that they’ve attended the LVI course and have paid the fee to be on the “preferred” list. Some of the LVI preferred cosmetic dentists are excellent, and some aren’t very good. It’s a mixed bag.

Direct tooth bonding isn’t a good choice for a complete smile makeover. It’s very difficult to do bonding and have it look beautiful, and then it can scratch and get dull and stained too easily. Porcelain veneers don’t stain and they last a long time. But if it is for slight gaps between the teeth, direct bonding could work well.

Orthodontics, including Invisalign, doesn’t work well for spaces between the front teeth because the teeth tend to want to move back to their original position.

I wouldn’t make a decision based on whether or not you could go back to your natural teeth. Why would you want to do that anyway? No one ever goes back to their original teeth once they get a beautiful new smile. Just be sure you have a good cosmetic dentist who does beautiful work.
- Dr. Hall

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