The Cosmetic Dentistry Blog

December 29, 2007

Trouble with a root canal

Filed under: Root canals — iowasmiles @ 11:16 am

Hi, I love your blog.
I had the first part of a root canal on molar #30 on October 17th, then the final part at the end of November. It wasn’t as bad as I thought.

The tooth was fine after, but just felt a little funny. Then, recently, it developed sensitivity to cold. Since I should have no pulp or nerve to hurt, or be sensitive, what could possibly cause this? Did my root canal fail?

What do you think?

Thanks so much!
- Jamie in Alabama

Dear Jamie,
If the tooth where you had the root canal treatment is now sensitive to cold, then there is an additional canal that they haven’t found yet. You need to tell your dentist and have it checked out.

It isn’t all that rare to have a hidden canal in a tooth. That happened to me several times to teeth I treated. But the dentist does have to go in and take care of that. Sometimes the dentist will then refer you to a specialist, depending on how hard they think it will be to find that hidden canal. While strictly speaking, this is a failed root canal, it might be more accurate to call it an incomplete root canal.

And usually the fee for a root canal treatment is based on which tooth is treated, so there would be no extra charge because of finding an additional canal. But some dentists charge by the number of canals, which would increase the fee.

- Dr. Hall

Related links:
Read about what is meant by a “dead tooth.”

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December 22, 2007

Dentist says she needs crowns now, not porcelain veneers

Filed under: Finding a cosmetic dentist, Porcelain veneers — iowasmiles @ 3:29 pm

Dr. Hall,
I needed to have 4 crowns on my top teeth replaced because of staining. My dentist recommended replacing them with porcelain crowns and also strongly suggested that I also get 6 veneers, 3 on either side of the 4 crowns to broaden my narrow smile. I was hesitant but he talked to me for a long time and told me how great the new veneers would look and completely change my smile. I agreed to go forward. Well, I had all the work done on Tuesday and started having pain on Thursday. I was going back for a follow-up visit on Friday so I didn’t think much of it. After about an hour of working on my mouth, the dentist told me that the reason for my pain was because a veneer came loose because of my grinding. He made me a bite plate to wear but then he broke the bad news to me. He said that because of my bite, I will probably have to remove the veneers and have all six of those teeth crowned!! I am in shock. I don’t know what to do. Tonight while eating a pizza, one of the veneers fell off. What is happening? Do you think I should see another dentist for a second opinion?
- Geri in Florida

Dear Geri,
It may be good to get a second opinion before you go any further. It’s possible that your dentist is right, but there are so many dentists out there who think they understand cosmetic dentistry and porcelain veneers, and they don’t. And if you are having a porcelain veneer fall off, then I am suspicious that this dentist really isn’t an expert cosmetic dentist. And if he now spots a problem in your bite, but he didn’t see that before he started, then that also makes me suspicious that he is in over his head. Like I said, maybe he’s right. But I’d recommend getting another opinion from someone you know is an expert cosmetic dentist.

My guess is that only 2% of the dentists who claim to be cosmetic dentists are really what I would call expert cosmetic dentists. This is really a very specialized field that requires a lot of post-graduate education, and so many dentists try to get into this because it is a profitable area and kind of fun to do, but they don’t know what they’re doing.

Generally, you can still wear porcelain veneers even if you grind your teeth–but not always. But you would chip and crack the veneers. When one just falls off, that seems to indicate a failure of the bonding technique. I doubt that is from your grinding your teeth.

You have several excellent Florida cosmetic dentists near where you live, that we list on our web site, and they all I’m sure would be able to help you see if you are being taken care of properly.
- Dr. Hall

Related information:
Smile design
Wear a nightguard if you have porcelain veneers and tend to grind your teeth
More information about teeth grinding and other TMJ problems

December 21, 2007

Taking tetracycline and teeth are staining

Filed under: Tooth staining — iowasmiles @ 7:54 am

Dr. Hall,
I’ve been on tetracycline for about 2 years. The dermotologist gave me this for acne. I went to my dentist for a clean recently and they say I have stains on the back sides of my front teeth. They are brown lines. Its from the medicine right? How can I get rid of this problem before it get worse?
- Mindy in Pennsylvania

Dear Mindy,
It’s possible that the staining you’re getting on the backs of your front teeth is from the tetracycline you’re taking, but I doubt it.

Tetracycline stains your teeth by getting absorbed into the enamel and dentin while your teeth are forming, so you need to be under the age of 13 for it really to have an effect. Though there is one study that showed that minocycline, a particular variety of tetracycline, can cause stains in teeth after they’re already formed.

If it’s true tetracycline stain, it’s absorbed into your teeth and needs to be bleached out or covered over with dental bonding or porcelain veneers.

The best at-home stain prevention you can do is to use Supersmile toothpaste. I’d try that and see if it helps keep the stain off.

- Dr. Hall

Related information:
Tooth whitening

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December 17, 2007

Excessive tartar buildup

Filed under: Gum disease — iowasmiles @ 7:27 pm

Dr. Hall,
My problem is excessive tartar build-up. My hygienist has asked me to come in every four months instead of the usual six months in an effort to clean them before the plaque hardens further. My teeth cleaning regime includes flossing once a day, using a Sonacare toothbrush for 10 minutes twice a day, brushing with a regular soft bristled toothbrush and toothpaste, and brushing with baking soda (I added this step when I found that plaque is acidic in nature and thought perhaps the baking soda, as an alkali, might neutralize the plaque). All this, and with my four month checkup approaching, my teeth feel scuzzy and I dread the visit to the hygienist, who, I believe, hates to see me coming!

Any advice on fighting this plaque/tartar problem?
- Judith in Arizona

Judith,
You’re doing all the right things as far as combating this tooth tartar problem.
When you have a lot of tartar or calculus, here’s your checklist:
1. Get your teeth cleaned more frequently.
2. Don’t miss a day flossing or brushing. When you give the plaque more than 24 hours undisturbed, you’re letting it harden into tartar or calculus.
3. The one thing you didn’t mention is a tartar-control toothpaste. Most major brands have a tartar-control formula that will help keep the accumulation of tartar down.

Baking soda is good for your teeth and gums, but it won’t fight tartar.

And then, to help you understand this issue, I should point out the difference between supra-gingival calculus, which is also called tartar, and sub-gingival calculus.

Supra-gingival calculus forms above the gum line, and is visible in the mouth. It contributes to gum disease. But it is relatively soft and easy to remove. When you use the word “tartar,” this is what you’re talking about.

Sub-gingival calculus forms on the root surfaces below the gum line and is not visible in the mouth. It is much harder and more difficult to remove, and is not affected by tartar-control toothpastes. It is also much more serious and if left on the teeth will contribute to serious gum disease which will involve the gradual loosening and loss of your teeth. If you have a lot of it, it can take multiple appointments for a hygienist or a dentist to remove it all.
- Dr. Hall

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December 12, 2007

A broken file in a root canal tooth

Filed under: Root canals — iowasmiles @ 3:17 pm

Dr. Hall,
My dentist performed a root canal today and informed me that a tip of one of the metal instruments broke off in the canal. (I actually heard it and thought my tooth had broke!) He informed me that he was not going to try to fish it out. Since it was ’sterile’ he was just going to leave it in the canal and put the post and cap on.

Is this what he should be doing? Or will it hurt me in the long run? This doctor has become notorious for not taking a lot of time with patients and overcharging, so I am nervous.

Thanks in advance for your help.
- Connie in New Jersey

Connie,
These metal files can break off easily, and that happens to a lot of dentists.

The tooth may or may not have problems later. It could end up needing re-treatment for the root canal treatment. You didn’t say which tooth this is, so I can’t tell you exactly what to do–I’ll have to just give you some guidelines. If the dental post is to be in the same canal as the broken instrument, I’d advise you not to let him put the post in the tooth. Putting the post in could make it impossible to get back into that canal in case the tooth needs to be re-treated later.

But then the post may be needed to help hold the crown on. If that’s the case, you may ask him to refer you to an endodontist (root canal specialist), who will have special equipment to be able to retrieve the broken instrument and fill the root canal. Meanwhile you could wear a temporary crown on this tooth or a temporary filling.
- Dr. Hall

Related information:
Failed root canal treatment
Root canal surgery
Dead tooth

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December 6, 2007

Take out wisdom teeth in pairs.

Filed under: Wisdom teeth — iowasmiles @ 4:27 pm

Dr. Hall,
I am 61 and my dentist feels I should have my #1 upper wisdom tooth removed. He says it is dropping down into space created by an earlier lower wisdom tooth removal. It could be a problem later if interferes with other teeth. What should I do?
- Mark in Florida

Mark,
You need to have that wisdom tooth taken out. Your dentist is right. It’s useless, and it could disrupt your bite and contribute to tooth decay or gum disease in other teeth.

It’s a good idea to take out wisdom teeth in pairs, at least, so I would have taken it out when the lower was removed. What good is the upper wisdom tooth with no lower to chew against? And usually, if the wisdom teeth on one side are trouble, the same is true of the other side of your mouth, so I generally removed them all at the same time, unless one pair was not going to cause any trouble.
- Dr. Hall

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December 4, 2007

Bonding is yellow

Filed under: Finding a cosmetic dentist, Tooth bonding — iowasmiles @ 7:52 pm

Dr. Hall,
I took my 12-year-old daughter to the dentist, and wanted to fix the slight discoloration in her two front teeth. The dentist put composite on the teeth and they were yellow. Yes, she has two yellow front teeth. I went back and told her I couldn’t accept this and she needed to fix it, she shaved off some of the bonding and composite and applied more and again, it’s yellow. It’s peeling off to a certain degree. What can I do, I am scared that this dentist isn’t qualified to correct this problem and now, I’m scared that they won’t be able to fix them. She told me that she may have to do a veener, isn’t she to young for this? What options do I have? Can you simply remove what was put on there? And will the dentist have to pay to correct this problem?
Thanks,
Carol in North Carolina

Carol,
I think you’re on the right track–you need to get another dentist to do this for you, and I would try to get the dentist to pay to correct this problem. But legally you may not be able to force the dentist to do that–you’ll likely have to use whatever persuasion will work for her–sweet talk, a threat of going to a lawyer, whatever you think she’ll respond to.

Direct tooth bonding is an art, and you really need an artist/dentist, as you’ve been learning the hard way. I’d recommend, with the age of your daughter, that you stick with direct bonding. Another dentist should be able to take off the bonding that’s there and fix this right. But, you need an artist.

Don’t let this dentist do porcelain veneers on your daughter. It wouldn’t be unreasonable to have porcelain veneers. If they are done ultra-thin, that could work. But I’m confident this dentist doesn’t know how to do beautiful porcelain veneers either.

You see, dentists take up the profession because they like to fix things. 95% of them aren’t artistic. And on top of that, the training we get in these artistic areas, particularly with color, just isn’t very good. And, to make it worse, even of the maybe 5% who are artistic, most of them don’t bother to get the advanced training they need to be really good at cosmetic dentistry. To protect the public, cosmetic dentistry should be a specialty. But, in order for that to happen it would have to be voted on by the profession. And since the vast majority of dentists think that cosmetic dentistry is no big deal (because they have NO artistic sensitivity), that will never happen. So you have a situation where maybe 1-2% of the dentists can do this work and have it look beautiful.

Check our list of North Carolina cosmetic dentists. They should all know how to take care of this. And don’t rely on advertising to pick a cosmetic dentist. A lot of dentists will advertise that they do cosmetic dentistry, because it’s a very lucrative portion of the business. But they aren’t artists. True cosmetic dentists are rare, and that’s what you need.

Good luck,
Dr. Hall

Click here for referral to an expert cosmetic dentist.
Click here to ask Dr. Hall a question.

December 3, 2007

Worried about coming root canal treatment

Filed under: Root canals — iowasmiles @ 1:06 pm

Dr. Hall,
My dentist told me I need a root canal treatment. The tooth has been aching now for a month. I am taking amoxicillin 500mg 3 times a day but the pain is still there. Could you tell me why the tooth still hurts? I am having a root canal next week and wondering if there is alot of pain involved in this. I have heard horror stories about root canals.
- Carol in Michigan

Carol,
The pain is probably coming from inside the tooth, and the antibiotics really won’t heal the inside of your tooth, so that’s why it continues to ache. I’m skeptical that you even need the antibiotics.
Yes, sometimes root canal treatments can really be nasty, but that’s the exception–usually they’re fine. I’ve been blessed to need four molar root canals because of cracked teeth. For one the dentist had trouble getting the tooth numb, and it was honestly pretty rough until my tooth finally got numb. For the other three, they were painless.

I think you’ll be fine.
Dr. Hall

Related topics:
The cause and treatment of toothache
What to expect when you need a root canal procedure
Three types of tooth infection, and how they’re different

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December 1, 2007

Getting a second opinion

Filed under: Finding a cosmetic dentist — iowasmiles @ 1:06 pm

Dr. Hall
First of all, I would like to thank you for providing this site. I don’t know what I would have done without it.

My Cosmetic Dentist is very prominent and I believe he is very competent and is truly an artist. I have never suffered from any tooth pain or discomfort, so I initially thought that my smile could be fixed with 2 dental implants, 2 crowns, and whitening. However, his quote was for $78,000 (2 implants and 24 crowns for smile reconstruction). I asked if there was a way of phasing in the work over time or doing a portion of the work. The answer was a flat “no.” It was all or nothing. They would not give me a pricing breakdown either. Does this seem like a normal case? I must get a second opinion because I do not have the funds to go with the first quote. Can you recommend a Dental Artist in the Toronto area?
- Chad in Ontario

Dear Chad,
I definitely wouldn’t accept that treatment plan without a second opinion or two. Especially if you’re not experiencing any discomfort. I don’t like it when dentists do the “all or nothing” thing. I think it shows a lack of sensitivity to the patient. Now maybe this dentist is right and that’s what you really need. But check with another excellent cosmetic dentist or two to see what they say.

Just go to our list of Ontario cosmetic dentists. I screen them carefully for artistry and training, so you can be confident they know what they’re doing.

And, just trust me on this recommendation because I’ve been in a lot of these situations. Don’t give ANY CLUE to the second opinion dentist about what the first dentist said, and don’t identify the first dentist or they may call each other. If they ask you to reveal the first treatment plan or the dentist, tell them you’ll tell them after they commit themselves to a recommended treatment plan. And don’t say why you want a second opinion. For example, don’t say you thought it was too expensive for your budget. You want a BLIND second opinion, uninfluenced by what the first dentist said. Get a copy or two of the x-rays of the first dentist–pay for them if you have to and cut out any information that identifies the office–and then go to your second opinion.

Dr. Hall

Other related information:
Porcelain crowns
TMJ disorder

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