Dr. Hall,
I’m 19 years old and am experiencing pain from what I thought were my wisdom teeth. The pain is severe and causes migranes. I went to my dentist and the x-ray showed my bottom wisdom teeth growing in sideways, the lower right one was sitting on a nerve. My dentist said that the pain wasn’t coming from the tooth but from a cavity. He filled it and said the pain should go away, and that I didn’t have to worry about my wisdom teeth at all. I am insecure about it and think, despite what he said, he should have them taken out immediately because of their position. What do you think?
- Lavelle in Kansas
Dear Lavelle,
Many dentists are uncomfortable with taking out wisdom teeth, and their advice is colored by this attitude. I suspect your dentist just doesn’t do wisdom teeth extractions. Most don’t.
I would say absolutely that if you are 19 and your wisdom teeth are sideways, there is no chance of them ever coming in normally, so they will need to come out sooner or later. And it is incredibly simpler to take them out now rather than to wait until they bother you. Any dentist who has taken out a lot of wisdom teeth will tell you that. The risks, complications, and difficulty quickly escalate as you get older. But the timing to take them out would be perfect for you now. They will never be easier to take out.
And I’d say that it’s entirely possible that your pain is coming from your wisdom teeth.
I’d get a recommendation for an oral surgeon and just make an appointment to get your wisdom teeth looked at. And I’d do it soon. It’s possible that you have an infection there.
Dr. Hall
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karejoy89@yahoo.com
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This post was prompted by an e-mail from Dr. Jeffrey Segal, the CEO of Medical Justice Services, not by a visitor question. But the topic is very relevant for many of our visitors, and that is, what is the impact on the dentist of your asking for a refund for dental work when you’ve had a problem? So I wanted to post this.
One of the reasons dentists don’t want to give refunds is that refunds can go on their record at the National Practitioner Data Bank. They want to avoid this. I recommend giving the dentist an easy way to give you a refund.
Oh, and you need to know that most dentists aren’t aware of these rules, so it may help you to educate them as to the latest rules. If you want to go to the original source for this information, see Dr. Segal’s article on refunds to dental patients.
If your demand for a refund is oral and not written, and if the dentist makes the refund himself or herself, rather than going to their insurance company or the corporation the dentist works for, then the refund does not have to be reported. If the demand is written, it needs to be reported. If the corporate entity writes the check, then it also has to be reported.
If I were asking for a refund, and I were getting some resistance from the dentist, I would say something like, “Look, I’m willing to make this easy for you. I’m making this request orally, which means you do not have to report this to the National Practitioner Data Bank. I don’t want to have to go to a formal request or go to a lawyer and make this messy. Let’s just keep it simple.”
- Dr. Hall
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Dr. Hall,
On the subject of teeth whitening, why can’t I just rinse with 3% hydrogen peroxide that I can buy in the drug store to achieve mild whitening?
- Cathy in Louisiana
Cathy,
Rinsing with peroxide might have a mild tooth whitening effect. But it will be very, very mild. The problem is that the whitening agent has to soak into your teeth, and in order to do that, it has to be in contact with your teeth for at least fifteen minutes. When you use the dentist-supervised at-home treatment, you wear the trays sometimes for a couple of hours or even overnight, which allows deep penetration into your teeth.
The discoloration in teeth is usually fairly deep. Your enamel is generally pretty translucent, and most of the color in your teeth comes from the dentin. So the object is to whiten the dentin.
Crest Whitestrips have a peroxide concentration of about 5 or 6%. The instructions are to wear the strip for thirty minutes a day for two weeks, and this produces a very mild whitening. If you rinse with 3% peroxide, your concentration is half that of the whitestrips, and if you rinse for one or two minutes, that will seem like an awfully long time.
I doubt you could go longer than that. So you can do the math and see how weak the effect of this technique will be: about one-fiftieth of the whitening power of Crest Whitestrips.
Dr. Hall.
Related information:
Read about Zoom whitening.
Read about tooth whitening relapse.
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Dr. Hall,
My daughter just got her braces off and there were white spots on her teeth. Our family dentist suggested a Zoom whitening treatment for her, and we did that, but the spots haven’t gone away. Did she do something wrong?
Answer:
This is one of the problems with asking general dentists to do cosmetic dentistry. They just don’t know enough to do this right. Zoom whitening is a very effective treatment, but it isn’t for teeth that are uneven in color. Usually white spots are made worse by bleaching treatments, whether it is Zoom or the take-home tray tooth whitening.
There are several possible treatments available for your daughter’s white spots, depending on what exactly they are like. White spots after braces are usually caused by decalcification around the braces because of some oral hygiene problems the patient had while the braces were on. Tooth Mousse is a product that was developed specifically for this problem and actually helps remineralize these spots. There is another treatment called microabrasion that sometimes works, but it tends to make the teeth slightly creamier in color rather than whiter.
I myself would recommend direct dental bonding over the spots. The softened and decalcified enamel would be removed and replaced with composite. This enamel is actually suffering the early stages of tooth decay, so it has become defective and I feel that a direct repair is the way to go.
- Dr. Hall
Related information:
Alyssa’s white spots from her braces are turning brown and she is freaking out.
Tooth whitening.
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My husband’s dental crowns keep coming off usually within a week or two of getting them recemented. His dentist is saying there is nothing more they can do. We are thinking about implants but it doesn’t look like they stick up much…will he have the same problem with the implant crown coming off? Are there different types of glues for crowns that could be causing this problem?
- Pat in Arizona
Dear Pat,
It isn’t that hard to get crowns to stay on. I’d get a second opinion. In twenty-some years of practice, I never had a crown that I put on come uncemented and have to be recemented, once I permanently cemented them. If they are done right, they stay on.
How well crowns stay on depends on the shape of the tooth preparation. When the preparation is too tapered, it’s hard to keep the crown on. So that’s probably the problem. You may need new crowns, or a knowledgeable cosmetic dentist may be able to bond these crowns on. There are bonding agents now that bond metal, porcelain, teeth, and everything imaginable. Expert cosmetic dentists are trained in all these high-tech bonding techniques. I can’t tell you without seeing them, but this is ridiculous to put up with crowns that won’t stay on.
- Dr. Hall
Click here for referral to an expert cosmetic dentist.
Click here for information about temporary crowns, all-porcelain crowns, or Cerec crowns.
Click here to ask Dr. Hall a question.
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Dr. Hall,
I just had a chipped tooth repaired and the color doesn’t quite match and you can tell it’s a repair. Should I go back to the same dentist to have him fix it or do I try to find another dentist? Also, should I be charged for the redo from the same Dr?
- Jeanie from New York
Jeanie,
I’d give this dentist another chance to match the color and see how it goes. If he has trouble getting it right the second time, then I’d look around for an expert cosmetic dentist. I wouldn’t bail out too quickly, but be ready in case you do.
And there shouldn’t be any extra charge for getting the color right. That’s part of what he should be expected to deliver.
Direct tooth bonding is difficult for general dentists–they generally aren’t really good at color manipulation with these materials. And sometimes they don’t have enough of a selection of shades and textures of material in stock to do the job right.
- Dr. Hall
Additional information:
Click here to find an expert cosmetic dentist.
Click here to ask Dr. Hall a question.
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I have a bad smell in my my mouth. I brush daily but it still smells. Any suggestions?
- Garth in Indiana
Dear Garth,
There are several possible causes for having bad breath or a bad smell in your mouth, even though you brush.
The cause of bad breath is usually bacteria that are in your mouth. So brushing is a good first step. But I would also consider flossing daily, and if that still doesn’t do enough, then get a tongue cleaner.
There are also products you can buy that are very powerful in fighting bad breath. Check out BreathRx, which is available in many stores and from many dentists. They sell special rinses that are very effective, and they also make a bad breath toothpaste that you could use.
Some dentists take a special interest in treating mouth odor problems, and you can find them on the Internet.
- Dr. Hall
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Dr. Hall,
I am 13 and had braces on for two years. After they were removed, my top front eight teeth have enamel erosion and destruction of the tooth surface. My dentist wants to do porcelain veneers. I am a grinder also. Is this a good plan for me?
PS – The orthodontist didn’t mention this tooth destruction, and I had my teeth cleaned four times a year.
- Amber in Florida
Amber,
If you’re 13, I wouldn’t recommend the porcelain veneers for your 8 front teeth. I think that’s too aggressive a treatment for the problem you have and for your age. The enamel erosion is probably just spots around where the brackets were. I think you’d be best off getting direct dental bonding, but you’d need to go to an expert cosmetic dentist for that. Check out our Florida cosmetic dentists.
You should go to an expert cosmetic dentist anyway, if you were to get porcelain veneers, so you don’t end up being one of our cosmetic dentistry horror stories.
As far as getting your teeth cleaned four times a year, that is good that you did that, but you can see that it didn’t stop the decalcification. When you have braces, you need to brush your teeth around the braces after every time you eat. If you don’t, you risk having these spots when they’re removed, because the food just sits there and the acid-forming bacteria multiply in the decaying food and cause these spots.
- Dr. Hall
Read more about white spots around braces.
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Hi!
Hopefully you can answer this question. I’m supposed to be getting my braces off in 6 days and I’m really excited. Then today I noticed that my adult back teeth are coming in. Will they still take my braces off or are they going to wait? Thanks!
- Amber in New York
Dear Amber,
Whether or not you can get your braces off when your new adult back teeth are coming in depends on several things, and I couldn’t really say. But I’m guessing that your dentist or orthodontist took x-rays when your treatment started and is aware that those teeth would be coming in right about now and therefore, you’ll be fine.
Before you can get your braces off, your teeth need to be straight and stable. If all your other adult teeth are fully erupted, and they are straight, and your bite is right, and the new molars are coming in straight, then that shouldn’t be a problem. But your orthodontist or dentist will probably have you wear a retainer, which is a wire that is either cemented to your teeth or attached to a plastic base that you snap in and out. The retainer will keep your teeth from being moved by the new teeth coming in.
- Dr. Hall
Related information:
adult braces
Read about various options for treating crooked teeth
Straightening teeth with Invisalign invisible braces
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