Dr. Hall,
My last dentist said that I needed a crown on the very back molar on the top left side. A root canal was not done beforehand, however.
Subsequently, about 10 months post-crown, I accidentally was grinding my teeth and broke the porcelain off. First, is it common to crown a live tooth? I had never heard of that before. Secondly, when I look up at the molar now it is pitch black, and when I asked the Doctor, he said not to worry about it, that it was more or less cosmetic but would not pose any sort of health hazard. What do you think? Thank you in advance for your advice!
Sincerely,
-Steve from Minnesota
Steve,
First, yes, it is common practice to crown a tooth that doesn’t have a root canal treatment. Anytime there is a significant risk that a tooth might break, it is prudent to have a crown put on it. The connection with root canal treatment is that when a root canal treatment is done, it makes the tooth much more susceptible to breaking and so, especially with a back tooth, a crown is almost always in order.
Second, about the porcelain chipping off. It’s an indication of problems with the laboratory work, and we don’t like it when that happens. But if there is a metal foundation under the crown it doesn’t require replacement of the crown. The metal will protect the tooth.
- Dr. Hall
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I want to whiten my teeth but I’ve had many composite fillings over the years. Unfortunately, all of my teeth are of a yellowish shade by nature, so if I wanted to whiten them, wouldn’t I have to get the fillings replaced with whiter material and only then do the whitening? And what should I tackle first — should I wait to do whitening until after the canine situation is dealt with?
- Diana in California
Diana,
You definitely want to do the tooth whitening first, and do the fillings later to match the whitened teeth. And you need to wait a couple of weeks after finishing the whitening so that your new whiter color stabilizes. Otherwise your fillings won’t match.
You can’t predict the shade result of bleaching beforehand.
A good cosmetic dentist will know this.
Dr. Hall
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Hi, Dr. Hall.
I’ve read just about everything I can find on your website and I have developed a serious respect for your opinion. You really know your stuff! So I wanted to ask you about my situation to see what you think.
I am 34 years old and have been living with a complicated situation on my upper left for close to 20 years. I have a decaying baby canine which never came out due to the adult canine growing in in the wrong place and never displacing the baby. The adult canine #11 grew in over the top of bicuspids #12 and #13 and, I’m told, is too far away from where it belongs and too complicated in the root structure to be moved with braces. Number 11 is partially obscuring the two bicuspids behind it and creating a triangular inner area which is difficult to keep clean, not to mention embarrassingly unattractive. (My general dentist isn’t even sure what kind of decay might be going on up in there, but so far it doesn’t hurt or have an odor so I’m keeping my fingers crossed.)
That whole area needs some serious work, but I’m not sure what the best option is. Do I extract the canines and get braces to widen the space where the baby was so a full-sized canine implant can be put in? Or do I extract the canines and get a bridge? Or can something else be done with a smaller implant plus veneers or something to create the illusion of normal teeth?
- Diana in Southern California
Diana,
Thank you for your kind comments.
#12 (your first bicuspid) can be made to look like a canine from the front, so if your canine can’t be moved, I’d consider that option, too, after having the permanent and baby canines extracted. Or one dental implant could work – replacing the baby canine with a permanent canine implant. I wouldn’t do the bridge to replace the canine because your bone will shrink in that position over time if you do that and it will be hard to keep it looking natural. But it’s really tough for me to say without seeing you, seeing the x-rays, and doing a clinical examination. You sound like you have a very interesting case–I’d love to have had you come in my door and be given the opportunity to solve it.
My recommendation – just find an excellent cosmetic dentist and trust his or her judgment. You have excellent choices in almost every direction. Just check our Southern California cosmetic dentists page. I am confident, because of the care I exercised in choosing each one, that any one of them could give you a beautiful smile with this situation. I wouldn’t ask your general dentist to do this.
- Dr. Hall
Related links:
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I have finished my Invisalign treatment and am currently receiving retainers every 4 months. However, I am not happy with my dentist and am changing. Will I be able to continue with my retainers? I don’t really want to have to choose a dentist because of an affiliation with Invisalign. By the way, I am extremely happy with my results!
- Linda in Texas
Linda,
Your current dentist, that you are leaving, has an ethical obligation to do everything necessary to facilitate a smooth transition to another dentist. So yes, you should be able to continue with your retainers with another dentist. You could switch even if you were in the middle of treatment.
And even if your dentist doesn’t live up to that ethical code required by the dental association, it isn’t difficult or expensive to have a new retainer made without any of the previous information. The dentist has his or her assistant take a simple impression of your teeth, pour up a model, and send it to almost any dental lab.
And the new dentist does not need to be Invisalign certified. (Though it could be helpful.)
And glad to hear you are so happy with your Invisalign treatment. In surveys of patient satisfaction with cosmetic dental and cosmetic surgery procedures, Invisalign ranks near the top.
Dr. Hall
Related links:
Read about braces in general.
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