Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

September 10, 2018

Using restraints in treating difficult children


We thank our advertisers who help fund this site.

In my practice, I very much enjoyed seeing children—even children who were difficult to treat. Part of the reason for that was that the pediatric dentist on my side of town was someone I felt was mean and who would put ugly stainless steel crowns on front teeth, so I didn’t want to refer to him. But a big part of it was because I enjoyed the challenge of trying to understand each child and how to get them through the care that they needed.

One issue in providing dental treatment to children is the use of physical restraints. Sometimes it is needed, and I want to address two aspects of that restraint.

The first aspect is the use of a mouth prop to keep their mouth open anytime I was drilling on their teeth. When I was in dental school doing my rotation in the pediatric dentistry clinic, before I took my turn as the operator I did a turn as an assistant. My fellow dental student was doing a small, routine filling on a baby tooth when our patient bit down unexpectedly, poking the drill through to the pulp of his tooth. We had to call the instructor over and upgrade the treatment to a pulpotomy (the baby-tooth equivalent of a root canal treatment) and stainless steel crown. My partner got a lecture about using a mouth prop and I vowed in that moment that this would never happen to one of my patients—I would always use some type of mouth restraint.

I ended up routinely using a Molt mouth gag on all my child patients when I was using a drill on a back tooth. I never, during dental school or my 20+ years of private practice, had an accident like my dental school partner.

a scissors-like device with rubber prongs on one end to hold the mouth open and a ratchet to hold the position

The Molt mouth gag

But there was a very small minority of child patients that we would run into maybe once every couple of years that would need even more restraint to treat them safely. In spite of all the psychology we could use on them, they would thrash around with their arms and legs, making safe treatment impossible. When this would occur, I would excuse myself to the reception room and ask the parent for permission to physically restrain their child. They always gave permission, and we would proceed to wrap them in a papoose and complete the treatment.

a 6-year-old child wrapped tightly in a blanket, restraining his arms and legs

The Papoose Board

This technique has been criticized by some as being mean and traumatic to the child. That isn’t my experience at all. These were strong-willed children who refused to cooperate and were determined to make it impossible to fix their teeth; and without general anesthesia it would have been completely impossible to treat them. Once they fully realized that the treatment was going to go forward whether or not they chose to cooperate, they would completely calm down. I cannot remember an instance when that didn’t happen. Sometimes, having become physically worn out from their earlier resistance, they would actually fall asleep as the treatment proceeded.

Once treatment was done, we would unwrap them, congratulate them on finally settling down, give them their choice of toys from the prize box, and part friends.

– Dr. David Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

August 24, 2018

Steroids for root canal pain – not always the best answer


We thank our advertisers who help fund this site.

Dr. Hall,
I had a root canal and crown done in March 2018, weeks after the procedure I started to have pain. I went back to my dentist who x-rayed the tooth and found no cracks, etc. They referred me to an endodontist in June 2018 and she put me on a course of antibiotics. Two weeks later I saw her again. The pain had for the most part disappeared and she said it would continue to feel better over time. We left for vacation in July and all was well. Then a couple of days ago I woke up with severe toothache. I saw my endodontist the next day she put me on a course of steroids. Iā€™m still in excruciating pain. Throbbing, pulsing pain.
Please help!
Regards Sandra from Ukiah, California

Sandra,
Steroids are becoming popular as a treatment for root canal pain. While they’re effective in some situations, there seems to be a certain amount of misuse because of a lack of understanding of the pharmacology combined with a deficiency in diagnostic skills. In your case, steroids are clearly the wrong treatment.

Plus there are a couple of other things I disagree with about your treatment. But let’s start with the steroids.

A steroid is an anti-inflammatory drug, and a very effective anti-inflammatory. It calms down the body’s response to inflammation. But one thing to understand about the body’s response to inflammation is that there is purpose to it. Part of that response is bringing white blood cells to the area to fight infection. In other words, steroids also act to block the body’s response to infection. This makes it really important for the dentist to know what is going on before prescribing. Is there infection, or just simply irritation?

Immediately after a root canal treatment there is ordinarily some irritation of the tissue around the end of the root caused by pushing some of the infected material inside the tooth through the end of the tooth, maybe pushing some of the disinfecting solution and filling materials through the end of the tooth, and possibly from the root canal files actually poking through the end of the tooth during the instrumentation of the tooth. This irritation can cause a vicious cycle of post-operative pain because the inflammation causes swelling of the tissues around the end of the tooth, pushing the tooth up, causing traumatic occlusion, which exacerbates the inflammation, pushing the tooth further up and increasing the pain. Steroids can be an excellent therapy for this situation, though there is some risk because some of the problem is the infected material pushed out of the end of the tooth. For this reason, steroids given to patients post-operatively are often combined with a short course of antibiotics.

But when a tooth flares up weeks after, as happened in your case, that is probably going to be solely because of infection. It is much too delayed to be connected in any way to irritation from the actual treatment. That’s why the endodontist prescribed antibiotics in June, which worked. The success of the antibiotic therapy confirms that the problem was infection.

But it’s at this point where I begin to disagree with your endodontist. The fact that you had an infection flaring up in the tooth weeks after the completion of the root canal treatment indicates that there was some problem with the root canal treatment. The root canal systems inside some teeth can be complex and it can be easy to miss parts of the system that don’t get fully cleaned out and sealed. So I have a hard time figuring out why your endodontist, who has to know this, would tell you after a delayed post-operative infection in a root canal tooth, that everything is going to be fine now. In most cases, that tooth is going to flare up again with another infection—it’s just a matter of time.

And sure enough, several weeks after that, your tooth did flare up. And here is another part of what she did that is puzzling to me. How can it be not clear that this is an infection and not simple inflammation? In my opinion, steroids are absolutely the wrong treatment here. You need another course of antibiotics and, at a minimum, the root canal treatment needs to be re-done because it has clearly failed.

This brings me to another part of your treatment that I disagree with, and that is placing a crown on this tooth before being sure that the root canal treatment was successful. The crown makes re-treatment more difficult, since now a hole needs to be drilled in the crown to get access to the roots and visibility is impaired.

My recommendation? Find another endodontist who is willing to tell you the full story of what is happening to your tooth and address a real solution. The first dentist missed part of the root canal system (or some similar mishap in the procedure) and the treatment has failed. This isn’t to condemn your dentist—as I said, some of these teeth have complex canal systems and in some cases it can be nearly impossible to clean them out and seal them completely. Anyway, your options now are:
1. Root canal re-treatment,
2. Root canal surgery, or
3. Extraction of the tooth.

Good luck,
Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

August 3, 2018

Update on Clear Choice Dental Implants Centers


We thank our advertisers who help fund this site.

Dr. Hall, I have been reading your posts about Clear Choice and reading the comments but notice that most of them are from a number of years back. I am doing my due diligence before i say yes to Clear Choice and would like to ask if your thoughts and information about Clear Choice have evolved or changed in 2018?
Thank you
David from Rhode Island

David,
Thanks for your question. I haven’t posted some of the recent comments I’ve received from Clear Choice patients, and I need to bring this subject up to date.

I don’t believe the business philosophy of Clear Choice has changed any. Of course, different locations are going to be different, but I have seen no indication of any change in their guiding philosophy, which includes the following elements: They generally employ very qualified surgeons and prosthodontists, they charge high prices, and they put a strong emphasis on sales with a tendency to use high-pressure sales tactics. Clinically, they have a strong preference for extracting all the teeth, often teeth that other dentists would consider savable. And then for a full mouth restoration, they will use the all-on-4 dental implants technique for pretty much everyone.

So my advice would be the same as it has been in the past: Get a second opinion. Don’t rely on what they tell you. In getting your second opinion, look for dentists who have credentials with the International Congress of Oral Implantologists and/or the American Board of Oral Implantology, which is associated with the American Academy of Implant Dentistry. After getting the second opinion, if you feel that Clear Choice is going to give you the best care, then go with them. But my guess would be that in most areas you would be able to find excellent care from highly qualified surgeons and prosthodontists for more down-to-earth fees. There are many more surgeons now doing all-on-4 dental implants and having excellent success with them. Plus their may be options for your case that Clear Choice didn’t share with you.

I have been contacted by a couple of patients who have had problems with their care. Not many, because I think they try to get very qualified dentists, but I have seen an uptick in clinical complaints from some locations in the last couple of years. But when there are problems, the patients seem fearful about saying anything. So I wonder if they have you sign papers which enable them to threaten you if you publicly voice any complaints. I had one individual who sent me his complaint, but before I could publish it he contacted me again, very fearful that he would experience retribution from Clear Choice, and he asked me to promise not to say anything about it. I had one recently who was emphatic about not using his name or location, lest he experience retribution. Maybe I’ll go ahead and publish that with those details removed to help bring this subject up to date.

Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. If you have your own Clear Choice complaint, click the link for the form for that.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

July 26, 2018

Sinus perforation from a dental implant – did the surgeon do it right?


We thank our advertisers who help fund this site.

Hi Dr. Hall,

First, thank you for taking the time to answer questions. šŸ™‚

My question is about the impact of a sinus perforation, removal of an implant, and antibiotics. I just had a dental implant (tooth #2) removed last Wednesday, six months after it was placed, he suspected bone loss and the gum was not filling in correctly. Also, when he placed the implant it punctured the sinus by a few mm.

After the removal, the OS said there was no infection and it was very easy to remove because it did not integrate at all, and there was no need to give me intravenous antibiotics during the process (I was sedated). He put me on sinus precaution of Flonase, no blowing nose, and no sneezing with mouth closed. He said he did not repair the perforation in my sinus, he just cleaned the area and stitched the gums. He said it would heal on its own and we should wait a year to see if the hole fills up with sinus tissue or bone and start again from there.

The following week I had continual congestion, especially at night, even though I was using the Flonase. I also had odd crackling in my ear when I moved my jaw (not jaw popping and no pain- just crackling like a blown speaker) I went back to him five days later and he said everything looked great. I did not agree and I requested antibiotics because I felt like it was getting infected. He reluctantly complied and since then my congestion has cleared significantly and air no longer escapes through the site. My question is, was it detrimental to not have been given antibiotics from the beginning and how do you know the sinus has healed correctly and the bone is not compromised with a lingering infection and congestion in the first week?

Thank you so much for sharing your knowledge!
– Kelly M.

Kelly,
First, answering your question directly, there is no harm in not starting the antibiotics right away. The indiscriminate prescribing of antibiotics, “just in case you have an infection,” is leading to a serious public health problem by helping cultivate antibiotic-resistant bacteria. Then, when you really need the antibiotic, it doesn’t work. So I like the idea that your surgeon waited to see signs of infection before prescribing the antibiotic. And Flonase seems a good choice also.

But there is another, more significant issue that you bring up that I want to address, and that is the failure of this dental implant. The implant perforated the sinus by a few millimeters??? That’s kind of a biggie. A few millimeters in dentistry is a lot. And the implant didn’t integrate with the bone at all. That’s another biggie. I hope your dentist has a good explanation for these two kind of serious errors.

To be clear here, the idea of the implant perforating the sinus is an issue with oral surgeons, with many maintaining that it isn’t a big deal. Others say that it is an indication of sloppy surgery that just increases the risk of implant failure. Many surgeons will say that they have perforated the sinus many times with implant placement and the site heals and everything is fine. But others will point to cases where this has allowed infection to get in around the implant from the sinus cavity. And then they also point to the issue of how much bone support the implant has. For however much the implant pokes into the sinus, that is that much less bone that is supporting the implant. I believe almost all surgeons will agree that while they may be able to get away with an implant sticking into the sinus one or two millimeters, “a few millimeters” is too far.

I don’t know what prompted the removal of the implant, but you’re lucky that this happened just six months from its placement, hopefully before anything was attached to the implant. Others who have had a sinus perforation from a dental implant haven’t been so fortunate. They have had persistent nasal problems for years after the implant restoration, only resolved by removal of the dental appliance that was attached to the implant and then possible bone grafting to repair the defect created followed by re-doing the implant surgery,

The standard of care for implant surgery requires the dentist to take whatever x-rays are necessary—preferably three-dimensional ones—to insure that there is enough bone present to stabilize the implant. So my question is, what is your surgeon going to do to insure that this doesn’t happen again? In other words, if your implant ended up so far into your sinus, there’s not enough bone there to support the implant. That would call for some bone grafting. In the area of the sinus, this is usually done in what is called a sinus lift procedure. Has your dentist suggested that?

I want to be careful here, because I have an incomplete picture of what is going on with you. But just from what you have told me, if I were getting an implant and my surgeon, in placing the implant, punctured my sinus and there was no osseointegration of the implant with the bone, I wouldn’t want this surgeon doing any more work on me. For you, as a minimum, I would get some answers about this, and maybe a second opinion.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

May 29, 2018

I went directly to the dental lab to make my partial


We thank our advertisers who help fund this site.

Dr. Hall,
I had an upper partial made by a dental lab. I did not go through a dentist.

The last partial I got, nine years ago, my dentist used this lab. They did such a good job that I decided to go directly to them this time. But this time it’s not working out so well. I have a front tooth missing that was supposed to be replaced using this partial, however, the tooth won’t stay fastened to the metal. There was so much plastic backing that all the pressure was on my one bottom front tooth. He ground down a lot to make my bite touch but now there is not way of holding this tooth in place. Also the plate is too short and is sitting in the cavity where my old tooth was and it creates a rocking motion when I chew.

I have been back at least nine times and the last time he told me to go away and stop bothering him. I asked for my money back but he refused. What can I do to get my money back?
– Bill

Bill,
A very interesting question, and there are some interesting points to make in answering you.

I must say that I’m not following you as far as understanding the problems you are having with the bite and the one tooth in this removable partial denture. The rocking I understand, and that is a fundamental problem that in most cases is due to a distorted framework—a problem that could have originated with a distorted impression. Fixing this would require starting over again. The impression is supposed to be taken by the dentist, who is trained and experienced in creating an accurate model of your teeth that will enable the technician to fabricate an accurate metal framework. Technicians aren’t trained to do this step, which is one of the reasons it is illegal for them to do that.

So the answer to how to get your money back is fairly simple—just threaten to report the technician to the authorities. This seems mean because, while it was illegal for him to make this removable partial without involving a dentist, you were the one who asked him to do it, so you should share in that responsibility. But he is the one who knows the law better and so bears the bulk of the responsibility. So just go to him and tell him that if he doesn’t refund your money you’ll tattle to the state dental board and agree to be a witness in his prosecution. My guess is that this will work magic. And hopefully that may save some other patient from making the same mistake you did.
– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

May 3, 2018

Whose fault is it that this tooth broke off?

Filed under: Fractured teeth — Tags: , , , , — mesasmiles @ 9:41 am

We thank our advertisers who help fund this site.

Dr. Hall,
I had a crown put on tooth #7 (right lateral incisor) about 40 years ago but no root canal. My dentist said I now need a root canal on that tooth due to decay under the crown. I’ve had no pain, abscess or any indication of infection. The dentist attempted a root canal through the back of the crown and after 2 hours he gave up and said the canal is calcified and he is unable to locate it. He put a temporary filling in the crown and said I will need an endodontic specialist to perform the root canal. Because I am not in pain, the endodontist booked me an appointment 4 weeks out. Well it’s been 2 weeks and now my crown (with some tooth inside) has broken off and I don’t know what to do. I’m elderly and can’t spend a fortune on this tooth issue when it probably should have been left alone in the first place. Should I just get an implant? Attempt a root canal? I doubt there is enough tooth left to put a new crown on even if the root canal is successful. I bought some DenTek at the drug store today and can reattach the crown myself. I would greatly appreciate your perspective on this.
Ruth

Ruth,
I’m going to start by trying to answer a question that you were too polite to ask: Whose fault is it that this tooth broke off?

Your dentist was drilling inside this tooth for two hours looking for the root canal and not finding it. It’s hard not to believe that doing so seriously weakened the tooth and is the reason it broke off. And having done that, he didn’t pass that information on to the endodontist or do anything in the meantime to strengthen the tooth. Hopefully he has learned a lesson from this, but meanwhile you are victimized here. It seems reasonable to me that he should accept some of the responsibility for the fix you are in.

With there being decay under the crown, the logical way to proceed here would seem to me to be to take the old crown off (it will have to be replaced anyway), get rid of the decay, and then finding the canal would be much easier. If the tooth really got infected, then the decay penetrated into the canal. But even if it didn’t, having the crown off greatly increases visibility and access.

Meanwhile, to answer the question you actually asked, if the tooth is down to a stump then yes, it may be difficult to put a crown on it and you could lose the tooth and need an implant. However, if your bite isn’t particularly stressful, the right kind of dental post in the tooth could enable it to hold a crown, even if there isn’t much of the tooth left. But after the fiasco you’ve been through, I’m doubtful that your current family dentist has enough expertise to pull that off. The placement of the post or posts would need to be done in such a way as to brace the restoration against rotational forces, and that can be tricky. Posts are round and lateral incisors are kind of round in cross section, and it doesn’t take much twisting force to loosen a crown and post in this situation.
– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

April 21, 2018

Water relieves the pain in my tooth


We thank our advertisers who help fund this site.

Dr. Hall,
It’s been ten years since I got my two fillings. One fell out but doesn’t hurt. The other one is still in but is causing severe pain. It doesn’t bother any to bite on it, but it hurts most of the time. The only thing that relieves the pain is water and only for a few seconds. Any advice?
– Brandon from Oregon

Brandon,
I wish I had better news for you, Brandon, but your tooth, the one with the filling, is showing classic signs of a dying pulp and you’re going to need a root canal treatment on it. I’d get the other filling replaced before it’s too late.

Here’s what’s going on. There has been some decay get into the tooth, probably getting under the filling. That decay has grown until it has infected the pulp. As the infected pulp tissue dies, it can go into a state where it is called a gangrenous pulp. In that state, it gives off gasses that increase the pressure inside the tooth and cause a toothache. When you cool the tooth with water, it causes the gas to shrink somewhat and eases the pain.

This is a classic situation. When a patient reports that cold water or ice water is the only thing that relieves their toothache, you can be 100% guaranteed that they’re suffering from a gangrenous pulp in a tooth that has almost died. Relief can be obtained by simply creating an opening into the tooth to relieve the pressure, but then it needs to be followed up with a root canal treatment to fully remove all of the infected tissue inside the tooth and seal it against further problems.

It’s a similar situation when a tooth is sensitive to heat—it’s a nearly dead tooth.

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

April 13, 2018

My wisdom tooth is touching the nerve. Will it cause nerve damage to take it out?


We thank our advertisers who help fund this site.

Hi Dr. Hall,

I am most grateful I came across this website. I have read the posts and I can’t say how much appreciation I have to see your honest and direct feedback and opinions.
I would be very very grateful if you could shed some light with your experience in my situation:
1. I have an impacted lower left wisdom tooth, I did an x-ray and the doctor (surgeon specialist) said it is close to the nerve and he recommended me to take a CT scan, which I did.
2. CT scan came back and he told me the tooth is touching the nerve (how much I don’t know), but I asked him what is the probability of damaging the nerve? He said 10% chance to damage the nerve, but after reading your blog about the risk of nerve damage, it seems like with a tooth touching the nerve – chances of damaging the nerve should me much higher? please would very very much appreciate your thoughts on this.
I am turning 30 years old this year.
One more piece of information – the impacted wisdom tooth is lying horizontal and food gets stuck there most of the time when I eat.
– Dennis

Dennis,
You referenced my earlier blog post on what are the real chances of nerve damage from wisdom tooth removal. The main point there is that the surgeon is more likely to exaggerate the chances of nerve damage rather than minimize it. I would take the 10% chance of nerve damage that he has quoted you as a fair estimate. And I would add to that that the damage would most likely be temporary. The most likely type of damage would be compression or bruising of the nerve, and not severing the nerve. I’m not saying that permanent damage isn’t possible but that it isn’t likely.

The use of CT scans is decreasing the chances of damage to the nerve because the surgeon can now tell, in advance, exactly where the nerve is in three dimensions. When I was doing this, if the nerve appeared superimposed over the tooth, I didn’t know whether it was in front, behind, touching, 1 millimeter away, or anything like that. So I had to be very cautious and allow for multiple possibilities.

Your surgeon just has to avoid any pressure in the direction of the nerve and, in sectioning your tooth prior to removal, has to stay away from the nerve. Then, post-operatively, you need to be aware that there will be swelling that could press against the nerve. If you notice any prolonged tingling or numbness after the novocain has worn off, advise the surgeon, and he will likely prescribe a steroid to hold down the swelling and minimize that pressure against the nerve.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

April 4, 2018

A botched sinus perforation


We thank our advertisers who help fund this site.

Hello Dr. Hall-
I had my right rear molar extracted because it felt sore when chewing and didn’t hit much on teeth below. The molar, I found out later, was in the sinus. Anyways, after the extraction, the dentist put a plasma plug into the socket and sewed that and something neon yellow into the tooth socket.

While recovering, about an hour after the extraction, I was feeling a lot of sensitivity in the right canine tooth. After carefully drinking a green smoothie, I noticed some of that liquid was in my nose with some blood. I went home to take it easy and did almost nothing and didn’t talk because certain words made me feel like air was going into the socket.

I called the dentist and went back. They did the exam and then they cut some of the tissue, scraped some bone and filled the area with collagen and sewed it in, this time with non dissolvable stitches and said come back in three weeks. I have been only drinking fluids, not bending, not looking down, just on bed rest eating healthy meals. Today is six days after surgery, and the packing has dissolved and most of my symptoms are back and my sinuses or ears are both aching. Yesterday the ear pain came and went. I am not talking because it feels sensitive speaking certain letters.

Do you think I should give this dull throb time to heal itself and keep taking it easy? Is this sounding like dry socket and a perforation? If I found food I drink in my nose – does this define a perforation? The dentist didn’t speak clear English so I am not sure what I have. I have been in so much pain from swelling and bruising. I took all 5 days of antibiotics and the sinus pills but the pressure and pain in my ears makes me think this is all causing a sinus infection? I also noted oral thrush as I have been taking antibiotics for a month. What should I do? I have no insurance. Is it definitely a sinus perforation if I saw my smoothy in my nose? Is it dry socket? Shall I give it a few more days? Yesterday I placed a small sterile gauze ball over the area. It was too uncomfortable and when I removed it, it had a bad odor. Thank you for this blog and for your help! What shall I do?
– Vanessa from California

Vanessa,
It certainly doesn’t sound to me like you are in good hands. I would find someplace to go for a second opinion.

With the pain and delayed healing, and you mention swelling, it sounds to me like, on top of the sinus perforation, you have an uncontrolled infection. If that is the case, you need a dentist who understands infection and knows how to pick the right antibiotic. I would tend to check with an oral surgeon, with that being the case. It also could be that you have a root tip or a bone fragment that went up into the sinus and that is what is causing the infection and complicating the healing.

And these sinus perforation repairs should not be falling out after a couple of days. I don’t understand that—if they sewed it closed, why is it coming out? Yes, when you have fluids or air passing between your mouth and your nose, that is a sinus perforation. Again, hopefully a dentist with a better command of the situation can get this fixed properly for you.
– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

March 16, 2018

Ordering Implant Parts Online


We thank our advertisers who help fund this site.

Dear Dr. Hall
I have full upper dental implants, the kind that are removable, the kind that snap in with four posts. I need the locator male retention caps, but my dentist charges me $25 for one! Not one set—one single little piece of silicone or nylon (I’m not actually sure what they are made of). I can’t afford to pay that much anymore. I have seen them online for $20 for a set of four, but I cannot order them because I’m not a dentist. Is there anywhere I can buy them without being a licensed professional?
– Sue from Las Vegas

Sue,
While I understand why your dentist may feel that he or she needs this markup because of high office overhead, this is such a small item in the dental office operation scheme of things, you would think they could make some allowances. Anyway, I have a couple of ideas for you.

The first is to call around, explain your situation to various dental offices, and I’ll bet you could find someone who would order them for you at cost. Dental offices tend to be populated by friendly, kind people, and I would think you could find a sympathetic dental assistant who would order these for you. The dentist doesn’t actually have to be personally involved at all. The staff usually does all the ordering.

But I actually believe you can order these without being a dentist. If you go to ebay rather than an established dental supply house, I am finding dental implant locator caps available there from overseas sellers and they are not requiring any documentation of your being a dentist or dental professional. The caveat here is that you need to know exactly what you want and how to pop them into your denture. There are various strengths of these caps—soft ones and firm ones that give different amounts of resistance. And they’re about $20 a set or more, depending on whether or not you get some other things with the caps.

Good luck.

Dr. Hall

Do you have a comment or a question or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

Older Posts »

Powered by WordPress

Follow this blog

Get every new post delivered right to your inbox.


Categories