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Can there be a cavity in a tooth without any outward signs?

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Dr. Hall,
My right lateral incisor (#7) has been diagnosed with a cavity inside it, and dentist claims it needs a root canal. Interestingly, she has referred me to a root canal specialist who has the same very uncommon last name as hers. My previous dentist of last year’s x-rays didn’t indicate any issues with this tooth. And the outside of the tooth has never had work done on it and no surface cavity is showing. This tooth does stick ‘out’ at an angle in the front of my mouth a bit, thus is not receiving pressure from the lower teeth when chewing. I can’t find on the net any answer to is it possible to have a cavity inside of a tooth that has no outward signs of holes or wear?
– Theresa
(See Dr. Hall’s answer below.)


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Theresa,
You don’t have to go to the root canal specialist that your dentist recommends. Given the possible conflict of interest with your dentist and with this diagnosis you are questioning, I’d get another opinion from another specialist or general dentist.

About having a cavity in a tooth without having any external point of entry, no, that can’t happen. Decay has to start on the surface and eat its way into your tooth. When it goes deep enough, the bacteria causing the decay will infect the tooth, which will require a root canal treatment.

an x-ray of two lower premolars and a molar, showing a dark spot in the middle of the first premolar

Internal resorption in a lower premolar. X-ray courtesy of East Hill Endodontics, Kent, WA.

However, it’s possible that your dentist is using different language to describe a problem called internal resorption. Internal resorption is a rare condition where the pulp of the tooth begins to eat away at the tooth from the inside. The cause isn’t known, but this is an inflammatory reaction, so it seems that there needs to be something that begins irritating the pulp. Since there is no history of decay in the tooth, the only way I can imagine this happening is if there was some trauma to the tooth from its sticking out further than your other teeth. But again, this is unlikely, since this is very rare, so my advice would be to find an endodontist for a blind second opinion to confirm the diagnosis. Check my post on how to seek a second opinion:

  • Ask for a copy of the x-ray to take to the other dentist.
  • Don’t let the second dentist know the name of any other dentist involved.
  • Don’t even share the first diagnosis.

You could also send me a copy of the x-ray and I would be happy to render an opinion.

– Dr. David Hall

(There is also a pathology called external root resorption, which happens on the outside of the tooth. This could have the same x-ray appearance as internal resorption. Taking two x-rays at significantly different angles would help pin down whether the resorption is occurring inside the root or outside.)

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

I have throbbing pain in my gum in one spot

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Dear Doctor Hall,

I am intrigued but also worried by a persistent sore point between by last molar top right and the next molar. The gum, not the tooth, is incredibly sensitive and always hurts after eating with a throbbing pain. The pain goes away completely after about 30 minutes-1 hour (better after tooth brushing) after eating and doesn’t return until I eat something again. This has been going on for over a year with a very slight improvement (pain not as bad as 12 months ago) No problem with hot and cold. My dentist has examined it twice and x rayed and can find nothing. There was a root canal treatment on one of the teeth which may well have triggered something but seems to be nothing visibly wrong and the pain is not under or in the tooth but next to it. It is exactly the gum between the teeth which hurts, not the teeth themselves. The dentist advises removing the tooth if the pain doesn’t heal. Seems a pity as I don’t think it is the tooth itself causing the pain, but I might be wrong. Any idea what could be going on? All my other gums are fine. No sign of an abscess no bad breath just very painful on the gum specifically in the space between the two teeth. Comments much appreciated.

Michael W from Germany

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Michael,
You need a second opinion. Is there a periodontist (gum specialist) you can go to?

It really bothers me that your dentist wants to take out the tooth simply because he or she can’t figure out what is wrong. I suspect this wouldn’t be all that complicated for a dentist that knew a little more.

This is a gum problem. I’m pretty confident that the root canal in the one tooth has nothing to do with this. An x-ray of the tooth probably isn’t going to tell you much about the gums. I don’t know much about the status of dental practice in Germany, but even here in the U.S. where we have fairly high educational standards for dentists, some dentists pay very little attention to gum health.

Of course I can’t tell you for sure what is wrong without a personal examination. But the first thing I would check would be for pockets between these two teeth. This could be a periodontal abscess which would mean that there is a particularly deep pocket between these teeth. Food particles could end up here after you eat and when they disintegrate the pain goes away. It’s possible that a quality deep cleaning could solve your problem.

Do you floss? If you don’t, that could be a contributing factor here, because you would be much more likely to develop gum disease if you don’t floss. If you do floss, I’d be curious to know if flossing between these teeth, with a technique that gets the floss down into this pocket, has any effect on the pain.

Anyway, please don’t let this dentist take out your tooth, and see if you can find a dentist who knows what is wrong.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

Can teething cause a fever?

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Dr. Hall,
Our 8-month old keeps having fevers, and we’re wondering if that could be from his being on the verge of cutting new teeth. His gums are swollen on his lower front. A friend told us that we need to make an incision in his gums to fix this, but I’m skeptical of that. Can you help?
Michelle from Colorado

(See Dr. Hall’s answer below.)


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Michelle,
Let me say right off that I don’t recommend cutting your baby’s gums. I paid close attention in my pediatric dentistry courses in dental school and I have never heard of that before. Mother nature has a way to make sure those teeth come in normally, and you don’t need to help her any. The pressure causing eruption of the teeth comes from the growth of the root—as it gets longer, the tooth is pushed up and out through the gum. I would worry, if you try to accelerate that process, that the root may not be formed enough to fully support the tooth.

Photo of the face of a crying baby, showing two new teeth in the front of the lower jaw.

(Photo courtesy of St. John’s Pediatric Dentistry, St. John’s, FL)

About fevers and cutting teeth. Yes, children can get a mild fever from erupting baby teeth. Other symptoms associated with teething are fussiness, drooling, restless sleep, and lack of appetite. I would give them a little Tylenol for this—no surgery.

And while we’re on the subject of tooth eruption, let me say one thing about the eruption of permanent teeth, because in some circumstances, those teeth may need some help. If the permanent tooth has appeared in your child’s mouth but the baby tooth is still there, you probably want to have the baby tooth extracted. Otherwise, it could cause deflection of that permanent tooth. This can occur most often for the erupting premolars that are replacing the baby molars. Erupting permanent teeth will dissolve away the roots of baby teeth as they come to the surface. The baby molars have multiple roots, and if only some of those roots have dissolved away, the baby tooth will hang on by maybe a couple of the undissolved roots. That can cause the permanent premolar to be deflected to the side instead of its normal position.

Or, in the front, when the baby teeth have no spaces between them, the larger permanent incisors may come in deflected from their normal path without dissolving the entire root of the baby teeth. With consultation from an orthodontist, I would extract enough baby teeth to get those front teeth to come in their normal position. True, that will make it so there isn’t enough space for back teeth, but in my view it is better to deal with the crowding back there and help your child at least have straight front teeth until they get their braces.

So get a little help for these situations.

Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

The dentist keeps adjusting, but his bite is still off

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Hello Doctor Hall:

I have ten zirconia crowns and they have all been burred down trying to fix my occlusion – after the first adjustments I developed hives on the inside of my lips and gums, and no dentist seems to be able to figure out where these hives came from or how to deal with them. Is it possible that shaving the crowns may have released something that now is irritating my mouth? This has been going on for eight months, the entire case has been a mess, my bite is off, etc. But the thing that no one can tackle is why I have hives now? Is it possible that burring through the finished surface of the zirconia has made my mouth react like this? – Richard

(See Dr. Hall’s answer below.)


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Richard,
Zirconia is a very tough material, and this would be a difficult appointment, having them ground down to fix your occlusion.

Let me deal with your question directly, first, and then offer some other comments about your case.

Yes, theoretically you could have had an allergic reaction to all the zirconia dust, but that would go away once the dust had cleared out of your system. I wrote in an earlier post that we have no confirmed cases of zirconia allergy reported. If you were truly allergic to zirconia, you would have had a reaction before any of the grinding. Yours seems to be another case of burning mouth syndrome, which appears to be triggered by stressful dental experiences.

About your ten crowns that have apparently disrupted your bite. And you say that your bite is still off. It’s a nice feeling when your teeth all mesh together harmoniously and you can chew normally. When your bite is off, that can throw your jaw muscles into spasm and can lead to headaches and various other problems, associated with TMJ disorder. I would recommend that you get a second opinion, because I’m worried that your dentist is in over his or her head.

Training in the complexities of how the teeth meet together and mesh to provide a harmonious bite—this isn’t part of the regular dental curriculum. To study this in depth, dentists attend one of several post-graduate institutes. Four of those are:

  • The L.D. Pankey Institute in Florida
  • The Dawson Academy in Florida
  • Spear Education in Arizona
  • The Las Vegas Institute for Advanced Dental Studies in Nevada

I would find a dentist who has graduated from one of these institutes and get a second opinion on your case. I’m just guessing that the lack of harmony in your bite is an ongoing source of stress, and I wouldn’t be surprised to learn that is the cause of your hives.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

My crown has fallen off three times!

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Dr. Hall,
My crown has fallen off 3 times. I have returned to him again and he says I need a gingivectomy to keep the crown secure by giving the crown more tooth area to bond the crown. This sounds extreme to me. Also the base of my tooth is blackened where I recall it was not when he placed the crown the last round. I’m holding the loose crown now and need to decide soon!

Please advise!

– Nancy from San Francisco

(See Dr. Hall’s answer below.)


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Dear Nancy,

The procedure is called crown lengthening—trimming the gum and maybe some of the bone to expose more of the tooth so that it can retain a crown. Sometimes that is necessary, and I had occasion to do that in my practice.

My problem with your situation is that your dentist should have known up front that crown lengthening would have been required to retain the crown. Coming to you after the crown has fallen off three times makes me not trust him. Did he not realize when he first prepared your tooth that crown lengthening would be required? Or is it that crown lengthening isn’t actually required in your situation and this is just an excuse he is giving you?

It is possible to do a crown on a short tooth and have it stay on without doing crown lengthening and without having any problem. But the tooth has to be carefully prepared with only a very slight taper and possibly cutting some grooves into the sides of the tooth. I have a blog post about crown retention form that you can read here. It cuts into the excuses that many dentists use to explain why their crown fell off. In over twenty years of practice, I never had one of my crowns fall off, because I always prepared them with a tight draw. Many dentists don’t like to prepare a crown with a tight draw because it is more demanding and even a slight error can mean that the crown won’t fit at all.

It is when a tooth is “bombed out” with most of the crown either broken off or eaten away by decay that crown lengthening is required.

Bottom line—I wouldn’t trust this dentist to try again and would get a second opinion. He’s clearly planning to do a new crown for you, so I’d have another more expert dentist do it. I don’t know what the blackening of your tooth is, but something doesn’t sound right about that either.

Oh, and I think your dentist should refund you AND the insurance company, if insurance was involved. If he doesn’t, I’d complain to the dental board and to the insurance company. A crown isn’t serviceable if it won’t stay on, so there should be no fee for it.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

How far back should my denture go?

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Dr. Hall, should the lower dentures cover the area where my wisdom teeth were? I am chewing on my wisdom teeth gums and can’t seem to get the dentist to understand. There are no parts of my new dentures covering this area.
– Carroll from Louisiana

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Carroll,
Removable dentures are never completely comfortable, but this bit of discomfort is within the ability of your dentist to correct.

The short answer is yes, your denture should cover the area where your wisdom teeth were and maybe go even further back—as far back as possible. There is a pad of tissue just past where your wisdom teeth were that is called the retromolar pad, and we like the denture to cover that, if possible. Covering too much of the retromolar pad can cause the lower denture to interfere with the upper, and that is the limitation of how far back we want to go.

The problem in your case is that your dentist, in order to fix this, would have to start with new impressions, so it would be quite a bit of work and some extra laboratory work. I’m wondering if it isn’t so much that your dentist doesn’t understand what you are asking, but actually does understand and just doesn’t want to do it.

A photo of a lower impression tray, showing it extending only far enough in the back to register the teeth.

Photo courtesy of Midway Dental Supply

The first step in making a lower denture is the preliminary impression. This preliminary impression is made with a stock tray, and should register this retromolar area. In order to do this, dentists will use a stock tray specifically made for denture impressions. On the right, on the top, is a regular impression tray for the lower teeth.

a photo of a lower denture impression tray, showing flanges in the back designed to register the retromolar area

Photo courtesy of SurgicalExcel

Below that is an impression tray specifically made for taking an impression for a lower denture. You’ll see that at the back end of that tray are flanges that extend back further. Those are designed to help register this retromolar area, as well as wider parts of the mandible. The idea is for the impression to register as much of the mandible as possible. The further the denture extends into these areas, the more stable it will be. When taking this impression, the dentist should tug on your cheek some, as well as ask you to move your tongue a little, so that the impression also registers the limits of how far the denture will be able to go without interfering with movements of your tongue or cheeks. You can reference my page on the steps of creating a quality denture for further information on impression techniques.Was your dentist a little lazy or sloppy in getting this preliminary impression? While it looks like this is what happened, I don’t know all the details of your case, or if there were extenuating circumstances in your case that made your dentist want to keep your denture shorter.

You’ve probably already paid for the denture, so you don’t have a lot of leverage to get your dentist to re-do the denture. This doesn’t seem to me to be so bad as to be called malpractice, so I don’t think you have any legal recourse. You could try sharing this blog post. If that doesn’t work, you could threaten to post a negative online review and see how far that gets you.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

Are the same-day crowns as good as the old-fashioned ones?

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Dr. Hall
I was reading on your site about removing a metal post in a tooth, which made me think of my experience. In May of this year I saw my dentist in The Netherlands for a checkup. I had a crown that was made by computer in 2017 and she said that this crown wasn’t fitting well and needed to be re-done. Also, the previous dentist had removed metal posts from my tooth before placing the crown. The new dentist said that the posts should have been vibrated out with ultrasonics and not by drilling.

My questions are:
1) Is the computerized-3D crown process as good as a ceramic old-fashioned crown?
2) Did drilling the posts out of the tooth damage my bone?

Thank you very much
Tessa from the Netherlands

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Tessa,
Yes, it’s nice if you can vibrate out the post with an ultrasonic device. Most dental offices have ultrasonic scalers. But I can tell you from experience that this may not work. So, if you want the metal posts out, there may be no option but to drill them out. No, this won’t damage the bone. How can drilling on a tooth damage the bone? Dentists are always drilling on teeth. The risk in drilling out the post is that the drill could slip and perforate the side of the root, which would damage the tooth to the point where it would have to be extracted. For any people who have experience drilling into metal, you know that it is very easy for the drill to skate along the surface of the metal, so this is a real risk. But it sounds like your dentist got through that without any unfortunate accidents.

And then telling you that this crown “isn’t fitting well” makes me wonder. I’m not sure what that means. Are there gaps at the margins of the crown? If so, why doesn’t she say that clearly? That’s what we look for when we’re checking a crown—we use an explorer and run it around the margin to see if there are gaps. If there aren’t any, then the crown is fine. Also, her statement that drilling out the posts would damage the bone, that makes me suspicious. Some dentists try to accuse a previous dentist of doing something wrong as a way to get you to believe that they are better and to justify their plans to re-do the dental work of the previous dentist. I don’t know if that is happening in your case, but I have enough suspicion to make it prudent, in my opinion, to seek a second opinion about this crown that supposedly “isn’t fitting well.”

About crowns made with a computer. This process was developed about 35 years ago by Dentsply Sirona, which is when CEREC crowns were introduced. In the early days there were issues with the accuracy of fit, but that is no longer an issue. When I needed a crown 15 years ago, I decided I wanted to experience this technology and so went to a colleague who had a CEREC machine. I have had no trouble with that crown. It fits just fine. The whole process, which includes optically scanned impressions of your teeth instead of impression paste is a highly precise process that creates a high quality crown.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

I have to have all my teeth extracted. How can I keep my face from collapsing?

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Dr. Hall,
I just turned 40 & have to have the rest of my teeth (16) pulled. I am a crying mess. I recently found I have a severe calcium deficiency which I am slowly but steadily turning around, but I need dentures & can’t afford a full set of implants. I have 1 implant already.
Would you say all-on-4 would keep my face from collapsing? Or do you have other ideas for me? I am a single mom of a 1- & 3-year-old and don’t want to look like their grandma. Please help.
– Stephanie from Minnesota

(See Dr. Hall’s answer below.)


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Stephanie,
My first question for you is, Why do you have to have all your teeth extracted? You’re not giving me any details about this treatment plan, so my first response is to question it. Dentists vary in their desires to save existing teeth. Some view it as much simpler to extract teeth and do a denture. Saving teeth can be much more complicated. I would suggest getting a second opinion. Find a dentist who has strong views about trying to save teeth and see what he or she recommends for you.

Second, I’m not sure I understand this severe calcium deficiency you say you have. Is this something your dentist told you? A calcium deficiency doesn’t have anything to do with the health of your teeth, not at this point in your life. It can lead to cramps, nerve problems, or osteoporosis. But the teeth are all fully formed and will not be affected in adults by any calcium deficiency. I have heard this used as an excuse to explain problems with tooth decay, but there is no connection. The greatest contribution to decay problems is frequent snacking. There are other contributing factors, but that is the one that most often leads to rampant decay.

If you indeed do have to have all your teeth extracted, and you have no teeth or dental implants left in your jaw, you will, over a period of ten or twenty years, end up with facial collapse as your body gradually resorbs your jawbone, which it perceives you no longer need. You’re correct that this will leave your face looking sunken-in and old. But worse, it will leave you a dental cripple, unable to adequately retain any kind of removable lower denture and also impairing your having a satisfactory upper denture. The presence of any dental implants will prevent any bone resorption around those implants. Even two implants will be a great help, and a snap-on denture would be a tremendous improvement over a removable denture. Better would be four implants.

With freshly extracted teeth, you probably wouldn’t need the all-on-4 denture. What the all-on-4 denture does is eliminate the need for bone grafting when you have had a lot of bone resorption already. But if the teeth have just been extracted, there isn’t time for bone resorption. Though it would be best if the surgeon would place some bone graft material in the extraction socket—a relatively simple procedure.

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

This missed diagnosis caused him a lot of pain

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Hello Dr. Hall,

I have recently gone though what felt to me like a dental nightmare! I would appreciate any advice that can be given.

Situation: My #19 tooth (lower left 1st molar) started to feel pain to cold foods and beverages and the tooth was sensitive to the touch. I went to an “advertising” dentist and he did an exam and took x-rays. His diagnosis was that I have all my wisdom teeth and 3 are impacted but one is showing and should be pulled (could be pushing on a nerve). He also said that fillings should fix the issue.

I had the fillings done and two days later my mouth started really hurting. Went back to the dentist and he corrected my bite by adjusting the filling. He gave antibiotics and suggested over-the-counter pain meds. That didn’t help so he then again suggested getting the wisdom tooth pulled. I told him the source of the pain felt deeper and not close to that wisdom tooth.

I got the wisdom tooth pulled and continued on the antibiotics. It felt like things were getting better but I guess once I stopped taking pain meds and the antibiotics ran their course the pain was back with a vengeance. My mouth started swelling and the pain was unbearable. I went to the dentist again. He gave me antibiotics again.

Early the next morning I went to the ER and they could see that I had an abscess. I went back to the dentist again and he referred me out to an endodontist. They couldn’t see me for several weeks so I went back to the oral surgeon who did the wisdom tooth. He agreed that there was an abscess infection and recommended that we pull that tooth. My anger comes from me specifying that the #19 tooth was the source of the original pain and I had to pay for several visits to the dentist, ER, and oral surgeon before the correct procedure was done and the pain eliminated. Is there any legal recourse for a situation like this?

– Jason from Texas

(See Dr. Hall’s answer below.)


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Jason,
You’re telling me a story of gross incompetence, a true dental horror story. And yes, I would call what was done to you to be dental malpractice. Based on what you are telling me, your dentist made serious diagnostic and treatment mistakes at every step of the way. If I were you, I would demand that this “advertising” dentist pay you not only for the extra visits to the oral surgeon and ER, but also for the cost of an implant and a crown to replace your missing first molar, or you will see a lawyer who will add pain and suffering damages to your claim.

Here’s a list of the mistakes he made.

First, at your initial appointment, with pain in the tooth to cold, you clearly have an inflamed pulp and he should have told you that a root canal treatment could be needed. Add to that pain to touch, and you have a high likelihood of needing a root canal. Bacteria had gotten into the pulp of the tooth, causing inflammation, and probably had begun to spread to the area around the root tip of the tooth, which would make the tooth sensitive to touch. It is puzzling to me why, with these symptoms, he would begin talking to you about your wisdom teeth.

At your second appointment, he continued with gross misdiagnosis. You have a new filling repairing what was undoubtedly deep decay, and he is adjusting the bite? The prescription for antibiotics seems to suggest that he suspected an infection in the tooth, but I’m wondering why again there appears to be a complete lack of knowing what to do. If he had missed this at the first appointment, surely he should be able to see it now. If he doesn’t like doing root canal treatments he should have referred you to an endodontist (root canal specialist) at that point. And antibiotics for a tooth infection? Since they can’t get inside the tooth, antibiotics will never completely cure a tooth infection. They only keep it at bay while waiting for treatment to be completed.

At the third appointment when you now have swelling, this should have been crystal clear to the dentist. But you just got antibiotics again. How did your dentist pass these courses in dental school about tooth infections?

It took the ER to tell you that you had a tooth infection, and when you told that to your dentist he referred you to an endodontist. Okay, your dentist doesn’t want to do root canal treatments. But he should at least know how to relieve your pain. With swelling in the jaw, the pulp of your tooth is dead, and if he had simply drilled an opening into your tooth, that would most likely have immediately relieved your pain.

And finally, with a raging infection and toothache, referring you to an endodontist who couldn’t see you for two weeks—that is the last straw. So now we have a combination of gross misdiagnosis with indifference to human pain. Based on what you are telling me, you have a great malpractice case here. I’d be tempted to go directly to a lawyer, but I think the nice thing to do would be to first give your dentist a chance to simply pay for all the extra treatment required. That would include everything you have spent so far plus the cost of replacing this missing first molar. When that tooth is missing, the tooth behind it will tend to tip into the space, and the tooth above will drift down, really messing up your bite and possibly leading to later TMJ disorder.

Sorry for all your pain and hoping you get this resolved,
Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

This dental “insurance” is actually just a marketing scheme

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Dr. Hall,
I hope to get veneers and a crown from an excellent cosmetic dentist while avoiding paying too much. The Colonial Dental Plan has around 15 providers in its network, and I am considering buying in. It would cost me $1100 (around 20% off of $1400) per veneer for just $300 to join the plan. I am from Portsmouth, RI, and I was wondering if you knew the best cosmetic dentist to do this procedure within the Colonial network. Thank you for your time.
– Andrew from Rhode Island

(See Dr. Hall’s answer below.)


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Andrew,
This doesn’t sound to me like a plan that will work. I have an inbox full of stories from people who were looking for bargain cosmetic dentistry, who are wishing they had never done it, and who are now needing someone to re-do the work. You can see some of their horror stories posted on this blog under “cosmetic dentistry mistakes.” A good portion of the practices of excellent cosmetic dentists is devoted to re-doing existing dental work.

You will most likely be happier with how you look, if you are looking for a bargain, by just doing the crown. If it’s on a front tooth I would go to an (expensive) excellent cosmetic dentist and have just that crown done to match your existing teeth. That will be better and much cheaper than what you are contemplating.

But you are thinking about making your situation even worse by trying to go through this Colonial Dental Plan network. Let me tell you how these “insurance” networks work. They aren’t actually insurance at all but marketing schemes. Colonial sells you this plan, and they pocket the entire fee you pay. Then they refer you to a dentist that Colonial was able to talk into giving free exams to patients and other work for a discount. Why did these dentists agree to give patients a discount? Because Colonial told them they would bring them patients to fill their empty chairs. I know this because this sales pitch was made to me several times when I was practicing. No excellent cosmetic dentist I know would be willing to make that arrangement with Colonial. These dentists are using the best materials and the best dental laboratories and they have taken extra training and are willing to take extra pains to make sure their work looks beautiful. In dentistry, as in many other businesses, “beautiful” costs more than “ugly.” No, the dentists in this Colonial plan are dentists who are having trouble making it on the strength of their reputation.

Use good common sense and stay away from this apparent “bargain” that, over the long haul, is actually rather expensive.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

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