Dr. Hall,
Some months ago I went to my dentist with sensitivity in one of my molars to hot, cold, and pressure. It was agreed that a Cerec crown would be sculpted to replace the offending tooth. An appointment was made for several months later. The appointment was for middle of July. I was very impressed. Several days later I was still experiencing a high degree of discomfort still with hot and cold and pressure. I came in so he could “ease the crown”. It was better but still very sensitive to everything. He assured me that a root canal was not necessary. (This dentist was awarded the young dentist of the year in the UK two years ago.) I was called two weeks later and advised that I should give it another 8 weeks. By now I was going on holidays. During my holiday the pain became excruciating spreading to my entire jaw and creating radiating pain in the adjoining tooth. So much so that I had to buy pain killers. I took these for the duration of the holiday! I am now back 2 weeks, have stopped taking the painkillers and gradually the discomfort has disappeared. Lately, last few days, I can chew hard foods again, toast, nuts etc with the afflicted tooth. Hot and cold is not a problem anymore but I cannot understand it. I have had an ordinary crown applied before with no such problems, it was instant relief. it leads me to suspect that there is something else about “Cerec” crowns that I have not been told. Now it is still slightly sensitive but improving everyday and it would seem that the 8 weeks was an accurate prognosis. Hve you an explanation or clarification. Thank you for taking the time to read nd reply. Yours sincerely,
Erick in Ireland
Erick,
I would have the tooth x-rayed by a different dentist. It’s worth checking to see if the tooth is okay or not.
A Cerec crown is an excellent option. I have one myself. That isn’t the issue here. I’m just not sure why a crown would be prescribed for a tooth that is sensitive to hot and cold. That kind of sensitivity occurs because a tooth is irritated, and a crown preparation is additional irritation. Generally, if I saw a sensitive tooth and it also needed a crown, I would first remove the old filling and any possible decay, and then put some bonded buildup material or glass ionomer and wait to see if the tooth settled down. That buildup would serve as a core for the crown once the tooth settled down. If the pain persisted or got worse, the tooth would need a root canal treatment.
It could be that the pulp tissue in the tooth has died, and this is why it is now feeling better. When a tooth is sensitive to hot and cold, it is irritated. When the tooth starts hurting with intensity all on its own, it’s a reliable indication that it is infected and needs a root canal treatment. It will then get better only when the pulp tissue dies. After that, it may be sensitive off and on to biting, or may not be sensitive at all.
I am not impressed with awards like “dentist of the year” unless I know the integrity of the awarding organization and then maybe the selection process.
Dr. Hall
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I was a thumbsucker up until I was 13. Now my teeth are shaped in a hideous way. I don’t have a typical overbite but my top teeth are shaped in an upward curve. I wish to know which procedure I need to go through to get my teeth fixed to the way they should be.
- Ellie in Trinidad
Ellie,
To correct the mal-alignment of your teeth after thumb sucking, you need to see an orthodontist. There are other possible options to make them look better, but from what you’re describing, the teeth are in the wrong position plus they have an incorrect inclination. Braces could solve both problems.
And, for the benefit of parents who see their children sucking their thumbs. My advice, after working with many parents on this issue during my dental career, and also working with my own children, is to play it cool. If you make too big an issue of it, you will actually reinforce the practice by creating a complex in your child. I would advise doing nothing until the child starts school. Thumb sucking causes no permanent harm when only the baby teeth are in, which is the case up until about age 7. And, if you “play it cool,” usually when the child starts school, peer pressure will help them quit. Notice that Ellie sucked her thumb until age 13. If she had quit when she was 7, she wouldn’t have had this problem.
If their permanent front teeth are coming in and they are still thumb sucking, you may need to intervene. But my warning is to use encouragement, not force, shaming, or other high-powered techniques, to avoid creating an emotionally complex issue for your child that could backfire. If your child finds the habit tough to break, there are aids that can help them break the habit. But they generally only work if the child wants to quit. If that is your child’s situation – they want to quit thumb sucking but find it is an ingrained habit, tell them you can help and buy Thum or another product to help them. Thum is a bitter liquid that you paint on the thumb. It makes thumb sucking unpleasant, and will help, provided you have not made it an adversarial situation with your child.
Dr. Hall
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Today I have been looking at photographs of smile makeover cases done with DURAthin veneers. I must say that I’m impressed.
I’ve been critical on mynewsmile.com and in this blog of Lumineers. They are a brand of ultra-thin porcelain veneers, and I have yet to see a photograph of a Lumineers case that I felt showed beautiful cosmetic dentistry.
But all the photographs of DURAthin veneers that I examined today looked beautiful, and it caused me to wonder about the difference. DURAthin is also an ultra-thin porcelain, and is sometimes used in a no-prep situation.
I think the difference is in the dentists they attract and the way the products are promoted. Lumineers are promoted to general dentists as being very easy to place and very lucrative. Consequently, they attract many dentists who really don’t know what they’re doing when they get into esthetics. Thus, I get many e-mails from their upset clients. DURAthin is taught almost as an elite technique, and the dentists that place them seem to be fairly sophisticated as far as esthetics. For example, Dr. Nils Olson, a mynewsmile.com recommended dentist who has been chosen as the new chairperson of accreditation in the American Academy of Cosmetic Dentistry, and thus could be considered at the pinnacle of excellence (see his Maryland cosmetic dentist website), uses DURAthin in his practice. Dentists like this will use a no-prep technique only when it can produce superior results. Otherwise, they will take advantage of the thinness of DURAthin by doing an ultra-conservative preparation, very possibly in enamel only, which may require no novocain and which could be likened to a mere dusting of the enamel surface.
Anyway, I’m soliciting more DURAthin photographs from our expert cosmetic dentists, and keeping an eye out, and will keep visitors to this blog and website posted.
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I had braces in my teens. I was told to wear a retainer for a month fulltime then only at night. I had a slight relapse in my upper front teeth. I talked with a new orthodontist who said new braces could fix the problem, or I could use my old retainer to move them as close to aligned as I could and a new retainer made to hold them in place. He said 6 months of fulltime wear and then night time wear should keep my teeth aligned. I’ve since worn my newly made retainer fulltime for almost three years. I notice after a few hours whenever I remove the retainer that the one tooth in particular seems to have shifted some, therefore I’ve not yet been brave enough to not go more than a few hours without it. Am I being paranoid about the movement of my teeth? If not, then will the movement stop or become less noticeable once I get the courage to wear it only at night? I mean if my teeth move slightly throughout the day and I have to force them back every night…is that normal? That can’t be good over time right?
- Ty in Indiana
Ty,
I don’t think you’re being paranoid about your tooth movement. If your teeth are starting to move within a few hours after you take your retainer out, then you need to continue to wear the retainer all the time.
If you don’t like the idea of wearing the retainer during the day, there are a couple of other options.
One is that you can get a teeth bleaching splint made. The clear bleaching trays help hold your teeth in position and aren’t as noticeable to others as a normal orthodontic retainer.
Another option is to have a permanent retainer bonded to the insides of your teeth, either upper or lower. This, however, does complicate cleaning your teeth – you have to use a floss threader to clean between them.
I don’t know why your teeth aren’t stable yet, but they aren’t. So get used to the retainer. It isn’t good for your teeth to be moved back and forth, so use the retainer to keep that from happening.
- Dr. Hall
Other links:
See our page on How long should I wear my retainer?
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Why didn’t my dentist mention the option of a Maryland Bridge? I only found it by an internet search.
- Deborah in Kansas
Deborah,
A Maryland Bridge doesn’t work for most cases where you have a missing tooth. Plus, some dentists don’t know how to do them, and there are technical problems with their use in that they aren’t as strong or reliable as a conventional bridge.
If you have a missing tooth, in my opinion the dentist should give you the option of either replacing it with a conventional dental bridge or with a dental implant. In some cases, a removable partial denture may be an appropriate option. Only in special circumstances would a Maryland Bridge or an Encore Bridge be an appropriate option.
- Dr. Hall
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My 6 year old daughter has two broken baby teeth that are molars. The teeth have broken because of cavities/decay. The dentist we took her to is recommending that we extract the teeth immediately. Is this the right thing to do?
- Kristina from Wisconsin
Kristina,
When an adult tooth is infected, we do a root canal treatment. However, when a baby tooth is infected, root canal treatments rarely work, and never for baby molars, so the tooth has to be extracted. So your dentist is right to recommend they be taken out. The infection can spread in the bone and affect her developing permanent teeth.
You didn’t mention space maintainers. But I assume that your dentist is also recommending putting in one or two space maintainers, depending on which baby molars are involved. That is critical to prevent serious problems with her permanent teeth. At age six, her permanent first molars are either just about to erupt or have just erupted. They will drift forward and block out her permanent premolars, which could then erupt sideways or not at all. When baby canines and incisors are extracted, they don’t need space maintainers. But for baby molars, unless the patient is around ten to twelve years old (when the permanent premolars are erupting), they do. If your dentist hasn’t recommended that, you should find another dentist for your daughter.
- Dr. Hall
Related links:
Click here for basic information about pediatric dentistry.
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Dr. Hall
It appears my wife needs completely new upper and lower arches. Assuming that’s true, how can I determine the best implant provider in the Chicago area? We have been to Clear Choice and Your Implant Solutions. They seem more interested in getting a commitment. Have you heard anything about A Center for Dental Implants (ACDI) and their affiliation with Resource 1?
- Jim in Chicago
Jim,
I have heard some patient experiences with Clear Choice Dental Implant Centers that make me very wary of them. I don’t know anything about Your Implant Solutions. But I do know this. When dentists try to push people into treatment, offer specials if you start right away, or use any kind of salesmanship tactics, it is very low class. I would not trust any dentist affiliated with an organization that uses any kind of pressure sales technique. I have heard of several such experiences patients have had with Clear Choice. So I would trust your instincts in not wanting to go to either of those places.
I don’t know anything about A Center for Dental Implants, either. I don’t trust large, impersonal dental clinics in general. I don’t know if that’s what they are. Pick the dentist, is my advice.
As far as dental implant providers in the Chicago area, I know an excellent one, and that is Dr. William Cohen of Glenview. He is highly ethical and will present all your options without any pressure of any kind. When I lived in Iowa, I drove to Chicago for my dental care and he was the one who did my dentistry. He has a website, so you can Google him. He has a surgeon in the office who does the implant surgery, and he does the restorative part.
Dr. Hall
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