The Cosmetic Dentistry Blog

July 31, 2007

Should I let my dentist replace my fillings?

Filed under: White fillings — iowasmiles @ 6:20 pm

Dr. Hall,
Is it neccesary to remove my silver fillings and replace them? A dentist I recently visited advised doing this at a cost of $3600.
- Tina from Texas

Tina,
Replacing them with new silver fillings? Or with white ones?

Over time, your fillings can become leaky fillings. They deteriorate with age and need to be replaced. Or, especially with amalgam fillings, they can crack or become corroded.

A dentist shouldn’t recommend replacing existing fillings unless there is something wrong with the fillings. If they are leaking, then bacteria will seep into the tooth in the crack between the filling and the tooth and will cause tooth decay to start to form under the filling, which can be serious. So my answer is that it depends. Yes, replace them if there is something definitely wrong with them. Otherwise, don’t.

Another possible situation is that sometimes patients want to have all their old silver amalgam fillings taken out and replaced with white fillings, but that is a personal choice by the patient, and I don’t think a dentist should try to talk you into something like that. It’s a completely optional procedure.
- Dr. Hall

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July 30, 2007

How can I need a root canal when the tooth doesn’t hurt?

Filed under: Pain in teeth — iowasmiles @ 5:56 pm

Hi, my name is Carrie. I am 25 years old. I just went for a dental visit this morning. My dentist told me that I am having a tooth infection in one of my front teeth. It now causing of decoloration to that particular tooth. He recommenced to do a root canal to that tooth and place a porcelain crown over it. However, I do not feel any pain or anything. I am not sure whether to go for it. I would like to have a second opinion.

Do you suggest to go for it?

Beside root canal and crown, is there any other good alternative?

What will happen if i leave that tooth as is?

Thanks a lot!
- Carrie in Brooklyn

Carrie,
In a case like yours where the tooth is turning dark, you generally wouldn’t feel anything–no toothache, tooth pain or anything, even though the tooth is infected. I saw this a number of times when I was in practice. The inside of the tooth is dead–that’s why you can’t feel anything.

If the tooth is discolored, there has to be a reason, and an infection in the tooth is the most probable cause if you have just one discolored tooth.

And you wouldn’t have to do the crown right away, but I’d recommend doing something, if the tooth is discolored. Is the discoloration bad enough that people notice right away? So do the root canal and then do the crown maybe a few months later, to spread out the costs for you.

When the root canal is done, you’ll probably notice that you feel just a little bit better. And, the infection has probably been there for years, which means that you probably won’t feel anything when he does the root canal, because the inside of the tooth is completely dead. If you don’t do this, you just keep going on with this infection in your bone, and it’s not healthy.

To help reassure you, while you’re having the root canal done, ask the dentist to let you smell the instrument he uses inside your tooth, after he first goes inside the tooth. You’ll be disgusted at how it smells, and you’ll understand what has been going on for years in your tooth and you didn’t even feel it. I had many of these cases where the patient had no pain but they had an infected tooth. I’d always ask them to smell that instrument–it was a good education for them. What happened is that you probably had an incident years ago where you bumped the tooth really bad–maybe while you were playing sports or something, and it quietly killed the nerve to the tooth. That’s what usually makes this happen.

Dr. Hall

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July 28, 2007

My all-porcelain crowns look fake

Filed under: Crowns for front teeth — iowasmiles @ 4:47 pm

Dr. Hall,
Recently, I have had 6 front teeth crowned. I asked my dentist after some of my own research, to use only “bonded all porcelain” crowns as I wanted the most natural look possible. It is my understanding that it takes a true cosmetic dentist with extensive training to do this type of crown and so, when the dentist agreed with me, that this was the best thing for front teeth, I went ahead. I do not like the results as they look like false teeth and also do not feel comfortable. Naturally this has been an upsetting experience.

He told me that he would re-do the work. He suggested that I visit the lab person and tell him what I want. I do not have any relationship with this lab person at all but have been going to this dentist for 17 years.

What can I do? I truly appreciate your help.
- Leslie in North Carolina

Leslie,
You unknowingly put your dentist in an awkward position. It’s not just that were you asking for a specific type of crown, which generally isn’t a good idea, but you were expecting your dentist to become an artist and do a beautiful smile for you. Yes, it does take specialized extra training to place a bonded all-porcelain crown. But it sounds like the crowns are WORKING ok. It’s just that you don’t like how they look. So it’s the artistry, mostly, that you have a problem with. You want these to look beautiful and natural, and your dentist is not an artist, it seems to me, and doesn’t know how to create that “look.” People who are attracted to the dental profession become dentists, almost always, because they like to fix things, and they have a strong tendency toward a technician mindset and aren’t very artistic at all.

So it looks to me like he doesn’t know what to do. And it sounds like he’s hoping that the laboratory technician will be able to translate your desires into a beautiful smile, but I think that’s just because he’s at a loss as to how to create a beautiful smile. I don’t think it will help for you to go directly to the lab technician.

And your dentist is being really nice to you–to offer to re-do them. He doesn’t have to do that, but he wants you to be happy, so you must have a good relationship. This will be expensive for him.

Here’s what I’d suggest. I’d get some help from a real North Carolina cosmetic dentist by getting a second opinion. I know Dr. Jan Kraska in Greensboro, NC, really well, and besides being a very artistic cosmetic dentist, he is a really nice guy, too. Now that will be a bit of a drive for you, but if you really want a beautiful smile, I think you’re going to have to do this. I’d call and talk to Shelley, his wife, who usually answers the phone, and explain that Dr. Dave Hall suggested this, and that you’d like to get your dentist some help with re-doing these crowns so that you like how they look. And offer to pay for a consultation fee, for whatever time it takes for Dr. Kraska. Then ask Dr. Kraska to help direct the lab to making a beautiful set of crowns for you, or even see if your dentist needs to go to a different lab, or see if he would suggest something else.

I’d let your dentist know that you want to do this. I think if you explain it nicely he will cooperate as much as he can. He sounds like a very honest man who wants what is best for you, so I’d hang on to him for all your long-term care. But I think that he was put in an uncomfortable position since he isn’t an artist, and that’s how you could explain it to him, or however you want to put it.

I hope this is helpful.
- Dr. Hall

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July 23, 2007

Pain after crown preparation

Filed under: Dental crowns — iowasmiles @ 7:26 pm

Dr. Hall,
I had a crown procedure done on a lower molar one week ago. This is the temporary crown. For the first several days, there was some swelling and tenderness of the gum around the tooth (which I expected) and my jaw hurt to open wide. Since those things have healed and I’ve been able to chew, brush, etc. normally around the crown, I’ve been experiencing pain throughout all of my left lower teeth and in my jaw. The pain is not horrible and is relieved by ibuprofen, but it’s pretty uncomfortable. Nothing in particular seems to precipitate the pain (it is there first thing in the morning). Is this just part of the healing process? It seems to hurt more around my other teeth than the tooth that had the procedure.
- Ashley from Florida

Ashley,
The inflammation in your gum is very common. The persistent pain in the jaw to where you have to take ibuprofen to be comfortable–that isn’t that common. While this could be nothing, it is worth checking. The pain is most likely coming from your tooth, even though it feels like it is in the jaw. It is normal for a tooth to feel some trauma after a big procedure like a crown preparation. If I were your dentist, I think I would coat your tooth with some type of desensitizer sealant on the surface of the dentin to try to get the pain to go away.

When a tooth needs a dental crown, it has already been through a lot–decay and large fillings. It’s possible that this tooth has had so much trauma that the inflammation is irreversible and it will end up needing root canal treatment. Your dentist, who knows how deep the old filling was and whether or not there was decay under the filling, will be in the best position to evaluate the cause of this pain.
- Dr. Hall

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July 21, 2007

Dr. Hall–Will veneers make my teeth more sensitive?

Filed under: Lumineers, Pain in teeth, Porcelain veneers — iowasmiles @ 8:56 pm

Dr. Hall, my question is will Lumineers help with sensitivity to things. I am a person that has been struggling with health issues because my teeth will not allow me to eat or drink many things that my body needs because of this problem. This is the LAST resort in helping my body get back to “normal”. I have tried everything to get what my body needs and my teeth will not allow it because of the high Ph levels in my mouth plus the sensitivity that my teeth obtain. So that is my question, could this procedure help with tooth sensitivity? Thank you for your time. – Dustin in Missouri

Dustin -
All of these sentivities can be treated, often with Lumineers or another brand of porcelain veneers. But first you need an expert cosmetic dentist with experience who has seen all of the various types of sensitivity. Younger cosmetic dentists tend to jump to conclusions too quickly, and your problem needs a thorough diagnosis to find the source of the sensitivities.

On rare occasions, an individual needs to get root canal treatment in order to have a beautiful, pain-free smile using porcelain veneers. Root Canals on front teeth are simple and quick to do. Modern advances have made them even easier on the patient, and a good cosmetic dentist will know how to keep this root canal tooth from fracturing later. The treatment, when properly done, can give you the beautiful smile of your dreams and end your tooth sensitivity.

Here is a list of possible causes of sensitivity:

  • You have leaky, poorly sealed fillings that need to be removed and filled again and sealed properly.
  • You have a sensitive spot on the root of your tooth, next to the gum, that reacts to gusts of air or touching .
  • Your bite is off and your teeth therefore don’t come together normally, which puts them all under stress when you try to use them.
  • You have tooth decay.
  • You unknowingly grind your teeth at night while you’re sleeping and your teeth are very tender to biting on when you get up.
  • Other possible causes.

You need to have a thorough examination to determine the nature and cause of the sensitivity. I wouldn’t do a smile makeover until you have the specific answer to your sensitivity.

I hope this is helpful.

Dr. Hall

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July 17, 2007

This dentist claims any dentist can do cosmetic dentistry

Filed under: Hate mail — iowasmiles @ 1:26 pm

You are illusionists if your feel that only the “real cosmetic dentist” can achieve wonderful results. It would seem that you all are trying to promote the idea that only you all are “masters” of the art. As I see all the promotional articles it would appear that you all are masters of “hard sell.” I feel sad for the mentality that now pervades our once great profession. You may reply.
- Dr. Bob in California

Dr. Bob,
On the contrary, a good cosmetic dentist is very much a soft-sell person who tries hard to please the patient and who knows that any cosmetic dental treatment must be driven by the patient. If the patient is unhappy with his or her smile, then the case needs to be done. If the patient is happy with how they look, then no treatment is indicated. That’s what I was taught in my cosmetic dentistry courses. And a good cosmetic dentist knows that the case is a success only when the patient is happy with the results.

There is a distinct mental attitude difference between a technician-oriented dentist who is very good at what he or she does, and an artistically-oriented dentist who loves creating beautiful smiles and is very good at it.

Imagine yourself trying to convince Julia Roberts, for example, if she wants a new smile, that the dentist on the corner can do that just as well as say Dr. Debra Gray King in Atlanta, or Dr. Jerry Bellen in San Francisco. You’ll never convince her that there aren’t certain dentists that are excellent artists and many that aren’t. You and I know that she’s going to be very fussy about who she lets do that for her.

But I understand the sensitivity that many dentists feel when we discuss the differences in abilities between dentists. Every dentist wants to be an expert, and it takes a big person to admit that others, who have the same advanced degree that they do, are better at certain things. And the general public who visit this web site are very appreciative for our pointing out who are the great artists in this profession.

There is a philosophy of professionalism that wants to uphold the “status” of the professional and is hyper-sensitive to criticism. But I adhere to the philosophy that the greatest professionalism is to be of service to the public.

Dr. Dave Hall

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July 16, 2007

Big hole where wisdom tooth used to be

Filed under: Wisdom teeth — iowasmiles @ 11:41 am

Dr. Hall,
 I had all four wisdom teeth removed a little over a week ago. Overall it is fine, except for that I have a huge, gaping hole on the lower right. It’s not painful, but it seems to be too large to be healthy. It is very easy to get food stuck in and it seems like it’s just waiting to be infected. Is this normal? If not, what do you advise I do?
- Will in Maryland

Will,
It’s normal to have a hole like that for weeks after wisdom tooth removal where you catch food. Your body has to build new bone there, and it takes a while.

It’s going to catch food in the meantime, but it won’t cause an infection. Try to rinse it out well a couple of times per day, and that will help keep it from smelling.
Dr. Hall

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July 12, 2007

Tooth knocked backward

Filed under: Braces, Root canals — iowasmiles @ 5:06 pm

Dr. Hall,
One of my front teeth was knocked backwards 7 days ago and the root of the tooth went forward protruding into my upper lip and I can feel it almost in my right nostril. I went to the dentist and he was able to match up the bottom of my right front tooth with my left front tooth, but the injured right front tooth root protrudes way out and hurts my gums above the tooth. I can feel it when I put a finger in my right nose, it is very uncomfortable and it is poking into my upper lip. Is there any way an oral surgeon or anyone can reposition the tooth root back to where it was before the tooth was knocked out of place? My dentist says nothing can be done, but I honestly don’t see how I can continue going through this pain and discomfort with the tooth root being in the place it is in right now. Any help would be greatly appreciated.
- Dale in Maine

Dale,
I wish I would have caught you within the first day or two of the accident. Once it’s been a week or more, I think you have to wait until this is fully healed and then have the tooth moved orthodontically. When the injury is fresh you can just crunch things back into place. But even so, I’d get it moved. It can be done with placing braces on the front teeth for a relatively short period of time.

And you’re probably going to need a root canal treatmenton this tooth. When that is done, be sure the dentist or root canal specialist doesn’t leave any gutta percha or root canal cement inside the crown of the tooth, because that will lead to eventual discoloration of the tooth. In time, the tooth will probably get a little darker anyway. But darkening will take a number of years if they can keep that gutta percha and cement cleaned out from the inside of the tooth.

Dr. Hall

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July 10, 2007

Didn’t get braces taken off

Filed under: Braces — iowasmiles @ 4:59 pm

Dr. Hall,
When I was in my teens, I had braces put on my teeth. Being young, I stopped going to my regular appointments and never got them taken off. Now I am 35 years old and needless to say over the years, not having the braces taken off has caused numerous problems and deterioration on my teeth. In a nutshell, my mouth includes some teeth with part of the brace remaining, others where the brace has fallen off but left a mark and gaps where teeth use to be. I don’t know where to start but am desperate to start corrective action. What procedures would I need done?
- Angela in Mississippi

Angela,
You would need, of course, to get the remaining braces off. Then, depending on how much of the tooth is damaged, you would need to get either porcelain veneers or porcelain crowns.

We all did stupid things when we were young and know better now. All you can do is fix what needs to be fixed and move on. But you should be able to get everything put back together and have a beautiful smile. I’m sure what you have now makes you feel self-conscious. It will be nice to get it taken care of.
- Dr. Hall

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Replacing old porcelain veneers

Filed under: Porcelain veneers, Toothpaste — iowasmiles @ 3:24 pm

Dr. Hall,
I have 6 porcelain veneers placed on 15 yrs ago. If I want them whiter, what is the procedure for updating these older veneers, when will they come up with a procedure to whiten porcelain crowns, etc.? Thank you so for any info you can give. I purchased the Supersmile toothpaste from your site and it appears to have whitened my old veneers a little.
- Sondra from New York

Dear Sondra,
The way to update old porcelain veneers is to replace them, and I see no prospects for any technology being developed to whiten old porcelain veneers or crowns.
I always wanted my porcelain veneer patients to use Supersmile toothpaste. It does help. It keeps the stains off, or, if you have stains, it removes them.
Dr. Hall

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