The Cosmetic Dentistry Blog

November 27, 2009

Getting food caught next to my new crowns

Filed under: Dental crowns — Tags: — iowasmiles @ 7:43 pm

Dr. Hall
What recourse do I have if a dentist made my two crowns next to each other too small and now there is a large gap between them which food gets stuck in there? Would he have to replace them? He had me sign something stating that I was happy with the crowns right after he cemented them in. My mouth was numb at the time and I noticed it the next day.
- Annette from California

Annette,
Getting food caught between your teeth is more than an annoyance—it can lead to decay on the adjacent teeth and will also aggravate gum disease. These are serious consequences. You could end up losing these teeth. And I believe the dentist is responsible to make this right. This is assuming that the problem is constant food impaction every time you eat. If the food gets caught only occasionally, that’s not so serious.

Just because you signed something indicating that you liked the crowns doesn’t relieve the dentist of his responsibility to make this right. There was no way for you to tell, while you were in his office, that you would have this problem.

When a dentist seats a new dental crown, he or she checks the contacts with the adjacent teeth. We make sure that there is a solid contact, and this prevents food impaction problems. If the teeth are positioned so that this contact can’t be achieved without abnormal contours of the teeth, sometimes this contact will be opened up wide open and this will also keep food from getting stuck there. If there is doubt about whether the contact is such that food will be kept out of this area, a dentist may temporarily cement a crown in order to test the contact area.

I would start with the assumption that the dentist, once you tell him of this problem, will want to make it right. He’ll have to swallow hard, because this is going to require him to remake at least one of these crowns at his expense. Give him a little time to accept this. But stay with it—insist that it be fixed, because otherwise this will cause you problems that will need to be addressed within a couple of years.

Dr. Hall

Other links:
Read about dental bridges.

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November 23, 2009

My cosmetic dentist wants to use Zirconia crowns

Filed under: Crowns for front teeth, Finding a Cosmetic Dentist — iowasmiles @ 8:14 am

Dear Dr. Hall
To find an accredited cosmetic dentist I used your website. The dentist was not aware of using bonded all porcelain crowns for front teeth, the accredited cosmetic dentist relied on the advice of the lab tech. The lab tech refused to use bonded all porcelain on front crowns (upper)and insisted the dentist use Zirconia. Who is more knowledgeable or experienced in accredited cosmetic dentistry, the lab tech or the dentist? Thanking you in advance for your prompt reply.
Gina from Connecticut

Gina,
I’m not sure I understand what you’re saying.

Are you saying that you went to a dentist that we recommended on mynewsmile.com, and that this dentist had not heard of bonded, all–porcelain crowns for front teeth?

If so, I’d like to know, and I’d like to know which dentist that was.
And how was it that the lab tech was asked?

l want to try to figure out what happened with your case and then see if I can help you.

Thanks,
Dr. Hall

Dr. Hall
When I mentioned to Dr. N. Summer Lerch of New Haven,CT that I was looking for an accredited cosmetic dentist that would be skilled in bonded all– porcelain crowns for front teeth. Dr. Lerch did not confirm or acknowledge your findings that bonded all-porcelain crowns for front teeth would have the strength that Zirconia would have. Dr. Lerch relied on the lab tech’s recommendations for the crowns. Actually the lab tech refused to make the crowns in stackable porcelain. Unable to find another dentist at that time because I was charged in full for payment of my crowns on the day the lab tech refused to use stackable porcelain on front crowns.
If all this is confusing I will include my home phone if you have questions.
Thanks
Gina

Gina,
Zirconia crowns ARE stronger than bonded all porcelain. They have no metal, and while they are not all-porcelain, I would call them all-ceramic, and their appearance is excellent. They can be made beautifully translucent. A conventional porcelain is usually baked over the zirconia framework, and the end result can be made to look so natural that you could not tell them from natural teeth.

I don’t believe that your dentist was unaware of bonded all-porcelain, but rather than for your situation she felt that zirconia would work better. I’m not in a position to second guess that recommendation, not being able to examine you.

Which particular crowns should be used in a given situation is a matter that depends on a number of factors. I don’t recommend that patients try to push their dentist into using a particular type of crown, because often part of the decision is based on what works well in the hands of a particular dentist, and this will vary from dentist to dentist. Rather, I recommend that each patient find a dentist whom they trust and has the skills necessary to produce a beautiful result, and then give that dentist free rein to choose the material that works best for them in each particular situation.

Dr. Lerch was carefully considered before I recommended her on this website, and I am absolutely confident that she could produce a beautiful result for you. She has been on the accreditation examining board, which means that her esthetic talent and technical ability are highly regarded among her peers.

As far as relying on information from the lab tech, when a dentist has a trusting relationship with a skilled laboratory technician, yes, we often use them as a source of information on new materials. Zirconia is an up-and-coming material that many top cosmetic dentists are turning to, because it is so strong and can be made highly esthetic. And when it comes to the technical information about the strength of the material and its suitability for various situations, then yes, we will turn to the technician. I have criticized on this blog dentists who use the laboratory technician for a shade-matching appointment, because an excellent cosmetic dentist needs to have a great eye for color and an ability to communicate color. But the dentist and the technician are a team and each brings expertise and talent to every project.

I’m skeptical that the laboratory technician made the final decision in your case. If you were giving me trouble over my choice of material, I might use the lab tech’s opinion to help avoid arguing with you. When we as dentists are faced with a difficult patient who wants to push us into a treatment we know will be sub-standard, it’s easy for us to say things that may seem to that patient to be unreasonable. I’m inclined to believe that Dr. Lerch was showing integrity in your case, but I can see how it wouldn’t appear that way to you.
Dr. Hall

Related information:
Read more about porcelain crowns.
Click here to find an expert cosmetic dentist.

November 21, 2009

Pain after a new filling

Filed under: Pain in teeth, White fillings — iowasmiles @ 8:03 am

Dr. Hall,
I had a composite filling with a ceramic cap done on tooth # 19 two weeks ago. Ever since I have been in severe pain in my jaw and often from the top of my head to the middle of my neck only on the left side. I have been living on Ibuprofen 3-4 times a day. The pain is about an 8 on a scale of 10 being the worst.

The dentist said was because I was grinding my teeth, so I bought a night guard and that was no help. So he proceeded to grind my tooth down to fix my bite, but I am still in a lot of pain! Is this normal? Should I get a second opinion? What specialist should I see? Thank you, Charlotte from Indiana

Charlotte,

I’m not sure what you mean by a composite filling with a ceramic cap. Cap is a lay term for a crown. A filling just replaces decayed or weak tooth structure. A cap or a crown covers the entire tooth.

It certainly doesn’t sound like your pain was from grinding your teeth. If your bite is adjusted properly, grinding your teeth won’t cause pain in a single tooth.

There are lots of kinds of pain that can occur in a tooth, and when we’re examining that, we try to find what provokes the pain or makes it worse. Constant, severe pain usually means that the tooth is infected. If cold brings on pain that goes away once the tooth warms up, the tooth is just irritated. Pain to biting could mean that the bite needs to be adjusted, or it could mean that the tooth is abscessed or that there is some infection in the ligament that holds the tooth in the bone.

Severe pain right after a filling is placed could mean that the tooth had a slight infection before the filling, which was aggravated by doing the filling. Or, if it is a bonded white filling, improper technique could also cause post-operative pain.

In your situation, I would get a second opinion. It doesn’t sound like your dentist is on the right track. I don’t think you need a specialist, just a good, thorough, careful general dentist who understands tooth pain.

Dr. Hall

Related links:
Read about tooth pain after a new filling.
Read more about toothache – the various types of tooth pain and what cause them.

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November 16, 2009

Another Clear Choice complaint

Filed under: Clear Choice Dental Implants Centers — iowasmiles @ 10:00 am

Clear Choice spent a fortune on huge newspaper ads touting their 1 day service which was not true as I thought. They also spent a fortune on a posh Marriott Hotel banquet room giving hundreds of people a very expensive cocktail party including beer, wine, other mixed drinks, plus a huge array of food. Next they gave an hour speech about how all kinds of people had their teeth done in a day. They would not quote prices or costs, though. I went to the offices (in St. Louis)  for an interview with a very inept Marketing Business major who could not get the xray machine to work. She came back after a visit with a dentist we never even got to meet and said I needed all my teeth pulled and it would take much longer than 1 day, plus the cost would be close to $60,000 and that was the minimum he would do for me. What a big, hideous joke.
- Carol from Missouri

Carol,
Thanks for the information. I have heard from several sources of this type of treatment plan being given out at Clear Choice, and it’s beginning to look like this is typical for them. I am highly suspicious. I would not believe that all your teeth need to be pulled just because they said so.

I think you’re smart to get a second opinion.
- Dr. Hall

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November 13, 2009

Composite and Alcohol

Filed under: Tooth bonding — iowasmiles @ 9:34 am

Where do you get your information that alcohol can dissolve resin veneer cement? A patient told me about this article on your website.
- Dr. Young

(see Care of Cosmetic Dental Work)

Dr. Young,
It’s not that the alcohol dissolves it—it softens the resin. I don’t remember where I first heard it, but I’ve known it almost since I started doing any bonding. It was a frequent source of discussion in American Academy of Cosmetic Dentistry circles, and we advised patients with extensive direct dental bonding to even avoid alcohol-containing mouthwashes.

I also saw the effects in my patients. If they used excessive amounts of alcohol frequently, the composite work would come back looking seriously pitted and worn after only a year or two. It’s not so noticeable if it’s smaller bonding work, but they can ruin a complete composite veneer, for example.

Dr. Hall

Other links:
Read about DURAthin porcelain veneers.
Dr. Abraham Abaie is a Scottsdale dentist.

November 10, 2009

Did my dentist miss his margins on my CEREC crown?

Filed under: Dental crowns — iowasmiles @ 5:52 pm

Dr. Hall,
My employer assures me the radiolucent images of his Cerec crown margins are just radiographic burn-out and not poor margins. Can you support this?
- a dental hygienist

Dear Hygienist,
It’s possible that a radiolucency at the margins of your CEREC crown are from radiographic burn-out. A better x-ray may help tell for sure.

If it is a gap at the margin, it should be clearly defined – you should be able to tell distinctly and precisely where the radiolucency begins and where it ends. If it is fuzzy – it just gradually fades into the tooth – then it’s probably radiographic burn-out. You may want to ask another dentist to look at it for you, if you have doubts.
- Dr. Hall

Related links:
Read about the new DURAthin veneers

November 6, 2009

A broken piece of tooth left in my jaw

Filed under: Wisdom teeth — iowasmiles @ 5:34 pm

Dr. Hall, I was searching online with the statement “wisdom teeth piece left in gumline” and I found a post of yours. You stated that the dentist makes a choice of whether or not he should leave the piece left in the gum. What are the actions that can occur if something does go wrong later on. I am asking because I had this happen to me and I am trying to figure out what I should do. I have seen two other dentists and they said they will not do the surgery to go in and remove the piece because they are scared of nerve damage in my face. Is there any legal responsibilites by my old dentist? I appreciate you time and any information you can give me.
- Chris from Virginia

Chris,
You didn’t say whether or not you are having trouble with this piece of tooth left in your jaw. If you aren’t having any trouble, then that is the end of the issue.

Even if you are, though, I don’t think the dentist is responsible for anything. And here is the reason: It seems to me that if you have two other dentists who are afraid to go after this piece for fear they will damage your nerve, then the dentist was reasonable to leave it in. If the piece is bothering you a great deal, then you can make a decision that you will take the risk of damage to your nerve, absolve the dentist or oral surgeon of any responsibility, and have it taken care of. But you will need to sign away your rights to complain later.

If your inferior alveolar nerve is severed in the process of getting this piece out, then your lower lip on that side will be permanently numb. While it feels weird for several months, eventually people get used to this and forget that it’s numb. You do have to be forever careful, though, because you can’t feel it if you bite your lip or burn it. I think you need to decide whether or not you want to take that risk.

Dr. Hall

Related links:
Read about the post-operative complications possible with wisdom tooth removal.

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November 4, 2009

A mysterious case of tooth pain

Filed under: Pain in teeth — iowasmiles @ 5:27 pm

Hi Dr. Hall,
I am writing because I could use some expert advice and I am impressed with your posts. 

I just finished a two month course of treatment where #14 was a retreated root canal and #15 was first time root canal. Anyway – there had been a sizeable black area in the bone above 14 before the RC but 14 had been asymptomatic for years. It was only when 15 needed a root canal due to a large filling that 14 “woke up”. 14 had no pain until 15 had the RC. After the two root canals, 15 resolved pain but #14 didn’t. Both teeth were re-medicated 4 times over a two month period before root canals were finally completed today. #14 is still tender and painful just to rub my tongue on it. Endodontist is highly skilled with excellent reputation and says the #15 looks great and #14 has no signs of fracture visible using microscope from inside and no sign of fracture on xray. The gutta percha did not ‘ooze’ out of filling on xray so Dr. says this bolsters evidence of no fracture. He did say the ho! les at bottom of root were larger than normal but he said that was from original root canal 20 years ago. He said that he ostensibly ‘corked’ the holes by pushing the filling material through the root openings past the tooth (which I can see on post treatment xrays). He said any excess will be reabsorbed over time. The dark shaded area above #14 appears a slight bit reduced as compared to xrays one month ago but the Dr. says that may just be angle of xray. The black area is like an 8mm pocket in the jaw (it is not surrounding the tooth’s root as would be the case with an abscessed tooth root.)

Question: My endodontist can not offer any explanation for pain in #14 other than effects of bone loss over the years due to that slow growing pocket of infection. Should I request an antibiotic to try to see if this pain is possibly from infected ligaments around the tooth now that the inside of tooth has been treated and retreated and remedicated for two months? Will the dark area on the x-ray – if it is bone loss – eventually regenerate into bone? If the black area is infection, will it reinfect the teeth? What to do? The endodontist said if it really bothers me then extract the tooth but if it were his mouth – he’d said he’d try to save the tooth. My problem is the pain is wearing me down and I have lost almost 20 lbs in 2 months from not being able to properly eat. I fear that unless we know the problem – extraction might not even be the solution. What do to? At! my wit’s end. Should I get antibiotics? Dr said to delay seeking restorative crowns till pain is resolved but not sure how long to wait. Any thoughts would be greatly appreciated.
Thank you
Nan from New Jersey

Dear Nan,
I’m not going to be able to tell what’s wrong with your tooth from here, but from what you’ve told me it sounds like your endodontist is careful and caring. Too many of them give up on a tooth too early as a way to protect themselves, and it impresses me that he’s willing to stick this through and try to save your tooth. Everything you’re saying he is telling you makes sense to me.

The black area on the x-ray, once everything is healed, will fill in with bone over a period of months. And it appears that the infection isn’t spreading. Even if it does spread, it is highly unlikely that it would infect other teeth.

If an antibiotic makes the pain go away, then, yes, that’s a great indication that the pain is from an infection and not, say, from a nerve that is acting strange, or from stress on the tooth, so that could be worth trying.

If there is pain when you chew, you can have your dentist reduce the tooth so you don’t hit it at all and this should help.

And I would agree with your dentist. While he is in favor of trying to save this tooth, if you get to a point where you just don’t want to monkey with it any more, then you can have it extracted. But you would definitely want to know that it is this particular tooth that is causing your problem. Sometimes pain can feel like it is from one tooth but it is really referred pain and the source is somewhere else. I have had patients swear that a lower tooth, for example, was the source of their toothache, when it was actually an upper tooth.

Dr. Hall

related links:
Read more about root canal treatment and failed root canals.
Read more about pain after root canal treatment.

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