July « 2008 « The Cosmetic Dentistry Blog

July 31, 2008

Pain getting worse after root canal re-treatment

Filed under: Pain in teeth — iowasmiles @ 4:14 pm

Dr. Hall,
I had a root canal done on my lower molar a year ago, since then I’ve had pressure sensitivity and then later sensitivity to heat that would radiate. I went back, and then my dentist decided to retreat the tooth with the thought that there may be another canal. He said there was, he packed it with some medication and a temp. filling and prescribed antibiotics and I am to go back in 3 weeks for the permanent filling. Since he did this I have had pain in the tooth, pressure…nothing to hot/cold, but I can’t chew on that side. My dentist is out of town this week so I have nobody to call. I don’t know if this is “normal” or why I am having this much pain.
- Karen in Missouri

Karen,
Your pain isn’t unusual. Post-operative pain after root canal work is common. I don’t think there’s any cause for alarm, and it sounds like your dentist did everything right, but I’m sure you’d like some relief from the pain.

Pain to pressure that develops long after a root canal treatment was completed could indicate a failed root canal. But pain to cold or heat is a strong indication of another canal being present in the tooth.

There was apparently infection in the tooth. If he cleaned it out some, it’s likely that some of the infected material was pushed out of the end of the root, and this would cause that tissue to be very irritated and would cause pain until your body resolves that. If this is what is happening, the pain could be eased considerably if the tooth were adjusted to where it doesn’t hit when you clench together. Sometimes when the bite is adjusted it provides immediate and complete relief.
- Dr. Hall

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July 26, 2008

Should I have crowns for tetracycline stains?

Filed under: Tooth staining — iowasmiles @ 7:45 pm

Dr. Hall,
I have severe tetracycline stains and have had porcelain veneers for 18 years. They have always been gray, but better than what I had. My teeth are almost black underneath. My dentist brought in the lab specialist that makes the veneers and both have decided to do the crowns. Do you think this is a wise choice?
- Ann from Louisiana

Dear Ann,
Very bad choice, doing the crowns. You don’t need crowns. You need this done by an expert cosmetic dentist. Tetracycline stains are very difficult, and your family dentist simply doesn’t know how to do this. Don’t let them grind your teeth down to stubs.

They recommend crowns because your dentist isn’t a genuine cosmetic dentist, and your laboratory technician isn’t one who specializes in cosmetic dentistry. You don’t need crowns, and even with the crowns, I’m afraid that you will end up ones that look opaque and fake. Only one or percent, maybe two, of dentists can do this beautifully for you.

Your teeth can be beautiful – they can sparkle and be white, natural, and fabulous looking. All it takes is a little effort to find a REAL cosmetic dentist. See the photos of tetracycline-stained teeth on our web site and you will see what the beautiful possibilities are.

And check our list of Louisiana cosmetic dentists. I have carefully screened every dentist listed on that page to make sure they can give you beautiful results. If you aren’t that close to one, believe me when I say it would be worth a drive of several hours, if it needs to be that, to have a beautiful smile instead of one that looks sort of mediocre. Don’t you think so?

Please, for your own sake, do this right. This is way over the head of the vast majority of dentists, which is why you’ve suffered with gray teeth for the past eighteen years.
- Dr. Hall

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July 22, 2008

The oral surgeon wants to take out the wisdom tooth, too.

Filed under: Wisdom teeth — iowasmiles @ 5:35 pm

Dr. Hall,
Thank you for this service. I am a male age 63 male, and need my upper second molar (#15) extracted, which concerns me. I have a 2 1/2 year history of taking Fosamax, though I haven’t taken any the past six months. The oral surgeon insists that he should also remove the neighboring wisdom tooth, because it is a “vertical impaction” that is resting against the side of the #15 tooth and should also be removed to lesson the risk of infection. The wisdom tooth has never caused me problems and more jaw bone work increases my fosamax-related concerns. I’m thinking if a problem develops from there I can later deal with that. Please respond ASAP.

Thanks,
Larry from Missouri

Dear Larry,
I’d have the oral surgeon take out the wisdom tooth also.

If #15 didn’t have to come out, then I’d leave the wisdom tooth alone. But with #15 being extracted, that is going to open up a passageway from your mouth directly to the wisdom tooth, and the chance of getting infection in your wisdom tooth could be pretty high. And waiting until it bothers you would be a bad idea. Once it’s infected, it could be very difficult to get you numb for the extraction, plus extracting an infected wisdom tooth could cause a general septicemia. Plus, with the socket open after the extraction of #15, the wisdom tooth will be much, much easier to take out. Like maybe five times easier.

While you are taking Fosamax, you have increased chances of osteonecrosis after an extraction, or from any tooth infection. This risk, in my opinion, is only an additional reason for getting the wisdom tooth out. In other words, I believe you are at greater risk in taking out just #15 than if you did as your oral surgeon recommends and have both teeth out.

Bottom line – save yourself some misery and just get the wisdom tooth out at the same time. Less chance of infection, less chance of osteonecrosis, less pain, fewer appointments, happier patient. I don’t see any downside.

Dr. Hall

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July 19, 2008

Pain after white fillings

Filed under: White fillings — iowasmiles @ 1:31 pm

Dr. Hall,
I saw another question about pain after having white fillings. My scenario sounds exactly like the one you outlined, where I wanted white fillings (after my wife had several at her dentist that looked great) and my dentist seemed reluctant. I had two done a week ago and have a constant aching on the side of the mouth where they were done. The dentist warned me about the possibility of infection from saliva and seemed very reluctant when I said I wanted white fillings. The procedure was quite painful. Now I have this aching. Is it likely to clear up on it’s own? I am reluctant to call this dentist back. I am using Advil to help with the pain.
- Mark from Washington

Mark,
Thanks for a great illustration of something I try to teach our visitors — don’t try to push your dentist out of his or her comfort zone. When dentists know how to do these white fillings properly, they far prefer them to the old silver/mercury amalgam fillings. And when they are done right, there is no contamination from saliva.

We have a page on our web site devoted to the reasons for having pain after new white fillings.

If your dentist is reluctant to do a procedure that you want, in most cases it’s wise to back off.

I would recommend getting these fillings replaced by a dentist who knows how to do them right. If they were indeed contaminated during the bonding process, not only have you allowed bacteria to get in the little tubules of the dentin of your teeth, but the filling is not sealed against continual contamination. You may be able to get insurance coverage for this, but even if you can’t, I wouldn’t risk further harm to your teeth.
- Dr. Hall

Related links:
Tooth pain after filling
Silver fillings – many dentists call them silver fillings, but they have more mercury in them than silver. I like to call them amalgam fillings, which is the more correct term for a mixture of silver and mercury.
Find a cosmetic dentist.

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July 14, 2008

Front teeth too big. What can I do?

Filed under: Braces, Invisalign — iowasmiles @ 1:05 am

Dr. Hall,
I have a problem with my two front teeth. They are big. They are long. And they are set a bit more forward than the rest of my front teeth.

But, I don’t know what to do with them! I’ve done a bit of researching about different cosmetic dentistry options but nothing seems right. I don’t need anything added to them to make them bigger than they already are.

So, what is it that I need to do? Have them taken out and get dental implants? Is there a procedure for this? And do you have a referral for a dentist in NYC?

Thanks so much. I’ve been cringing at pictures for too long now.
- Claire in Brooklyn

Claire,
Don’t have your front teeth taken out! You don’t need to be that drastic.

I would recommend going to a really good cosmetic dentist and then trusting them to find the solution. I have looked for good cosmetic dentists in Brooklyn and can’t find one, but Dr. Robert Schwartz in Manhattan is excellent and he could fix this for you. You don’t have to figure it out for yourself.

I will tell you my impressions, from how you’re describing your problem. But my disclaimer is that I haven’t seen your teeth, so don’t take this as gospel. Depending on the results of your examination, an entirely different course could be advisable.

It is possible to make teeth smaller by carefully trimming them down with diamond burs and diamond strips. From the way you’re describing your teeth, I’m guessing they could be filed down on the sides, making them narrower, and then trimmed on the biting edges to make them shorter. Then a simple spring retainer could be used to push them back in alignment with your other upper front teeth.

Or, after they are trimmed, Invisalign invisible braces could be used to position them.

If they are really huge and require a lot of trimming, porcelain veneers could be needed to cover over the exposed dentin.

Anyway, several options. But all of these would be beyond the ability and training of the family dentist on the corner. You need an expert cosmetic dentist, or you could get yourself into a big mess that becomes very expensive to fix later.

Good luck,
Dr. Hall

July 10, 2008

Porcelain crowns are now rough/dentist on our insurance list

Filed under: Crowns for front teeth, Dental insurance, Finding a cosmetic dentist — iowasmiles @ 12:02 am

Dr. Hall,
My wife recently had porcelain crowns on front upper teeth. At a follow-up appointment, the dentist attempted to “buff” the crowns to make the color match color of surrounding teeth. Now her color is still off and the crowns have no shiny appearance. The dental assistant who says she was present during buffing says the color is as close a match as possible with what was available and that porcelain won’t be shiny like natural teeth. Unfortunately, the dentist is not a cosmetic dentist. We are seeing him because he’s on our insurance approved list.

Any advice will be greatly appreciated-
- Charlie from Indiana

Charlie,
A couple of points.

First, yes, you are right, the porcelain should be shiny. But it’s worse than you think. Besides looking dull, when the dentist buffed off the glaze on the porcelain, he or she made them so that now they will stain, so they will look even worse as time goes on. But a cosmetic dentist can bring the shine back with a diamond polish.

Second, you have to decide if you just want your teeth “fixed” so they are functional, or if you want them to look nice, because if you want them to look nice, you will have to pay for it. You will not get a beautiful result from a dentist that is on any insurance company approved list. Dental insurance companies make these approved lists by finding dentists who are willing to cut corners and thus cut costs. That approach is simply incompatible with good cosmetic dentistry.

My advice would be to find a cosmetic dentist near you from our list of Indiana cosmetic dentists, and have that dentist bring back the shine and make these look as good as possible. The dentist you are going to may be a good “fixer,” but does not appear to even understand the esthetic problem he or she has created.
- Dr. Hall

July 2, 2008

My new composite filling is a little sensitive

Filed under: Fillings — iowasmiles @ 7:22 am

Dr. Hall,
I have recently had tooth whitening and front composite fillings replaced. I am experiencing no pain or sensitivity to hot and cold. However one of my front composite fillings when pressed in the corner gives a slight sensitive pain. The filling was removed and replaced and problem still exists. Do I need to see a dentist again?
- Jeremy from Los Angeles

Dear Jeremy,
I don’t think I could tell you why your tooth is sensitive without seeing it, but I’m reasonably confident it’s nothing you need to worry about.
Sometimes with the white fillings a patient will experience strange slight sensitivities. There could have been some irritation with some of the bonding process. It’s also possible that in polishing the filling the enamel of the tooth was irritated. A sensitivity to just touch, especially if it’s slight, sounds pretty benign.
- Dr. Hall

Related links:
Pain or hurt after new fillings
Why is a tooth sensitive to sweets?
Dental bonding

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