Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

March 26, 2011

Is this a case of gorilla bite?

Filed under: Dental crowns,Root canals,TMJ — Tags: , , , — mesasmiles @ 11:17 am

A little over three months ago I had a root canal and crown done. Tonight not only did the crown come out it broke off the post also. What do you reccomend doing to fix this? And since it didn’t even last four months should my dentist be responsible?
– Gerrard from California

Gerrard,
It sounds like a nasty situation, this tooth of yours. I suspect that the crown didn’t just come loose but broke off at the gumline. I’m guessing here somewhat, and answering based on what I’m visualizing of your situation, based on the few details you’ve given me. Not being able to see what has actually happened, I want to try to be helpful based on what is probably going on here. Anyway, if the post broke off, I’m guessing the tooth also broke off. It creates kind of a tough situation because there probably wasn’t a lot left of the tooth to start with. And if the post and crown have failed, it may be that the tooth really can’t be saved.

If not, then maybe the post was just weak and this can be re-done so that it works.

I want to be careful here, because I don’t want to make it sound like your dentist was anything other than well-intentioned and appears to have been trying to save a tooth that is proving pretty tough to save, which to me is admirable. And there could be extenuating circumstances. There are some patients that have what some dentists call a “gorilla bite” that generates a tremendous amount of force, and once they hit a certain age and their teeth start breaking down, they tend to break anything a dentist puts in their mouth. Having said that, if this post and crown only lasted three months, yes, if I were the dentist, I would eat some of the cost. What I would do when I tried what ended up being heroics to try to save a tooth, and I didn’t adequately warn the patient that this treatment might not work, I credited to the patient the cost of what I did do against the more aggressive treatment that I should have done in the first place. You are very likely going to need more aggressive treatment here – possibly a bridge or an implant to replace this tooth. So I think that credit would be fair. But whether the dentist is legally responsible to do that for you would depend on if he or she actually did something wrong, and it’s not clear that this is the case.

If you are one of these people with the “gorilla bite”, then your dentist may have to make you a night guard to help protect you against breaking off more teeth. You can tell the person with the “gorilla bite” by looking at the profile. If the bottom of the lower jaw is parallel to the upper jaw, that’s the “gorilla bite.” If that’s you, get a hard plastic night guard fitten to your upper teeth and wear it faithfully every night. I had three or four patients like that, and that was the only way to keep them from breaking off teeth. If you’re not, then count your blessings and just address this one tooth that may be unrestorable.

Dr. Hall

Links: Read about another patient who kept breaking teeth off, so had his whole mouth rebuilt with 28 crowns and has continued to break off teeth. This is likely a true case of gorilla bite.

 

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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.

January 5, 2011

Persistent pain to biting on a new CEREC crown

Filed under: Dental crowns — Tags: , — mesasmiles @ 8:31 am

Dr. Hall,
I recently received my first cerec dental work done on 3 back teeth. One of the teeth hurts when I chew as if a nerve is exposed. I cringe if I chew something just slightly crunchy e.g. popcorn. I have gone back 2 times had the tooth shaved done. My dentist explained to me that I have a cow chewing effect when I eat and that the pain was more than likely from my chew. I disagree because I have never had this problem. Do you agree with her? Or can you give me a brief explanation without seeing me as to what you think may be happening. I do not enjoy eating for fear I may hit the nerve in the tooth.
– Leigh from Oklahoma

Dear Leigh,
I don’t think your problem of pain when you chew has anything to do with the fact that this is a CEREC crown. Fitting the crown to the bite is usually easier with CEREC, because this work is done by the computer that mills the crown.

There are two likely reasons for a tooth with a new crown to hurt from biting. One is that the bite is high – you hit this tooth harder than the other teeth, which makes it sensitive. The other is that the tooth is infected. The infection can cause an inflammation of the ligament that connects your tooth to the jawbone, which makes the tooth tender when you’re biting on it, or it can even cause a constant toothache.

With two trips back to the dentist to reduce the bite, I would guess that the problem is probably not that this cown is high. So it would be time to investigate if it is infected. An x-ray of the tooth would show whether or not this is the case. However, sometimes the signs of infection are rather subtle on an x-ray, so you may need the opinion of a root canal specialist if your dentist’s diagnostic skills aren’t that sharp. The intensity of your pain as you are describing it along with the amount of time that I’m guessing has passed since this crown was done make me very suspicious that this is the case.
– Dr. Hall

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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 7, 2010

A putrid smell in my mouth, after getting 28 crowns.

Sir i got all my 28 teeth replaced with crowns for the purpose of teeth lengthening. Upper & lower molars(8) of Porcelain fused to Metal. Premolars of Zirconia(8). Incisors & canine (12)of Empress. And now after 2 months from the procedure done am having very much bad breath that its very much difficult to live with and even to breathe, and it tastes like vomit. Still after using mouthwash and brushing twice a day its not helpful and the smell is as it is. even i got done scaling but still the smell and taste of the teeth remains. Please tell me some solution that can be done now to get rid of this as its too much difficult to live like this. i am really helpless. And also tell me is it was right for the teeth lengthening??
– Ogas in India

Dear Ogas,
There is something very wrong with your dental work. It my days of practice, I had several occasions to replace dental work done in other countries, and I frequently found poor dentistry with overhangs that would catch food or other basic defects.

The materials your dentist used sound first class. But if there are overhangs on all the crowns, that could produce the putrid smell that you’re experiencing. I can’t tell if that’s the case. There are other possibilities.

If this problem is allowed to remain, it will likely lead to gum disease and early loss of your teeth.

There are excellent dentists throughout the world. But I believe the consensus among the world’s dentists is that there is no place that has as high standards for dental care as the United States. So what I would look for would be a dentist in India with some credentials from an international organization based in the United States. A couple examples of that would be accreditation or some other credential from the American Academy of Cosmetic Dentistry (There are two accredited members of the AACD in Mumbai, India, and several accreditation candidates in the country), or fellowship or diplomate status with the International Congress of Oral Implantologists. There may be other credentials. I would track down a dentist with a credential like that and go there for an opinion on your case. Go to the website of the specific organization and they usually have a search tool for finding a credentialed member.
– Dr. Hall

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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.

November 27, 2009

Getting food caught next to my new crowns

Filed under: Dental crowns — Tags: — mesasmiles @ 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.

We thank our advertisers who help fund this site.

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.

November 10, 2009

Did my dentist miss his margins on my CEREC crown?

Filed under: Dental crowns — mesasmiles @ 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

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.

October 31, 2009

Sensitivity to Cerec Crown

Filed under: Dental crowns,Teeth sensitivity — Tags: , — mesasmiles @ 9:24 am

Dr. Hall,
Some months ago I went to my dentist with sensitivity in one of my molars to hot, cold, and pressure. It was agreed that a Cerec crown would be sculpted to replace the offending tooth. An appointment was made for several months later. The appointment was for middle of July. I was very impressed. Several days later I was still experiencing a high degree of discomfort still with hot and cold and pressure. I came in so he could “ease the crown”. It was better but still very sensitive to everything. He assured me that a root canal was not necessary. (This dentist was awarded the young dentist of the year in the UK two years ago.) I was called two weeks later and advised that I should give it another 8 weeks. By now I was going on holidays. During my holiday the pain became excruciating spreading to my entire jaw and creating radiating pain in the adjoining tooth. So much so that I had to buy pain killers. I took these for the duration of the holiday! I am now back 2 weeks, have stopped taking the painkillers and gradually the discomfort has disappeared. Lately, last few days, I can chew hard foods again, toast, nuts etc with the afflicted tooth. Hot and cold is not a problem anymore but I cannot understand it. I have had an ordinary crown applied before with no such problems, it was instant relief. it leads me to suspect that there is something else about “Cerec” crowns that I have not been told. Now it is still slightly sensitive but improving everyday and it would seem that the 8 weeks was an accurate prognosis. Hve you an explanation or clarification. Thank you for taking the time to read nd reply. Yours sincerely,
Erick in Ireland

Erick,

I would have the tooth x-rayed by a different dentist. It’s worth checking to see if the tooth is okay or not.

A Cerec crown is an excellent option. I have one myself. That isn’t the issue here. I’m just not sure why a crown would be prescribed for a tooth that is sensitive to hot and cold. That kind of sensitivity occurs because a tooth is irritated, and a crown preparation is additional irritation. Generally, if I saw a sensitive tooth and it also needed a crown, I would first remove the old filling and any possible decay, and then put some bonded buildup material or glass ionomer and wait to see if the tooth settled down. That buildup would serve as a core for the crown once the tooth settled down. If the pain persisted or got worse, the tooth would need a root canal treatment.

It could be that the pulp tissue in the tooth has died, and this is why it is now feeling better. When a tooth is sensitive to hot and cold, it is irritated. When the tooth starts hurting with intensity all on its own, it’s a reliable indication that it is infected and needs a root canal treatment. It will then get better only when the pulp tissue dies. After that, it may be sensitive off and on to biting, or may not be sensitive at all.

I am not impressed with awards like “dentist of the year” unless I know the integrity of the awarding organization and then maybe the selection process.

Dr. Hall

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.

September 29, 2009

My dentist wants to do a metal crown.

Filed under: Dental crowns — mesasmiles @ 1:13 am

Hello Dr. Hall
I’m having a crown put on one of my rear molars. The dentist says it’s not possible to use porcelain due to the size. Something about how there is not enough space. So they’ve given me the option of metal or gold. Is this possible? I read that metal takes more space than porcelain. I don’t want metal, if at all possible.

Thank you,
– Rose from California

Rose,
When porcelain is used in a crown, it does have to be thicker than metal. And in some situations, on second molars, there is very little space to work with. I can understand why your dentist would want to use a metal crown if space is limited in your mouth.

There are various options for a metal crown. Gold is the most common metal because it is corrosion-resistant, and can be cast to a fine finish line so that it fits better than any other type of crown. If you have to have a metal crown, I would highly recommend gold. It might cost more, but you will get many more years of service out of your typical gold crown than any other metal.
– Dr. Hall

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 12, 2009

Temporary crown fell off

Filed under: Dental crowns — mesasmiles @ 4:29 pm

Dr. Hall,
If a temporary crown falls off will a little toothpaste or vaseline re-activate it?
– Marlene from California

Marlene,
I’m assuming you’re asking how to fasten the temporary crown back on  your teeth. You’re smart to know that you need to have this temporary crown back on. It is possible for your tooth to get damaged if it is exposed for several days without the temporary crown on. Also, your teeth will drift together and make it so your permanent crown won’t fit, meaning that you will have to go back through the entire crown preparation process again and get another crown made, and your dentist may charge extra for that.

Toothpaste or vaseline won’t hold the temporary crown. Actually, my opinion is that your dentist should assume the responsibility for re-cementing your temporary crown for no charge. I think most dentists do that. That’s the best option.

Three other options if you can’t get in to see your dentist:
Superglue. It will hold things on your teeth quite well. But beware – you could complicate the final treatment because of problems in cleaning off the superglue later. So only do this if you call your dentist and she or he says it’s okay.

Denture adhesive. This will hold fairly decently.

Drug stores often have temporary dental cement to help hold on temporary crowns.

I hope this is helpful,
Dr. Hall

Related links:
Read about dental crowns in general and porcelain crowns in particular.
Cerec crowns don’t require a second appointment, so no temporary crown is necessary.

We thank our advertisers who help fund this site.

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 29, 2008

Is it common to crown a live tooth?

Filed under: Dental crowns — mesasmiles @ 9:25 am

Dr. Hall,
My last dentist said that I needed a crown on the very back molar on the top left side. A root canal was not done beforehand, however.

Subsequently, about 10 months post-crown, I accidentally was grinding my teeth and broke the porcelain off. First, is it common to crown a live tooth? I had never heard of that before. Secondly, when I look up at the molar now it is pitch black, and when I asked the Doctor, he said not to worry about it, that it was more or less cosmetic but would not pose any sort of health hazard. What do you think? Thank you in advance for your advice!
Sincerely,
-Steve from Minnesota

Steve,
First, yes, it is common practice to crown a tooth that doesn’t have a root canal treatment. Anytime there is a significant risk that a tooth might break, it is prudent to have a crown put on it. The connection with root canal treatment is that when a root canal treatment is done, it makes the tooth much more susceptible to breaking and so, especially with a back tooth, a crown is almost always in order.

Second, about the porcelain chipping off. It’s an indication of problems with the laboratory work, and we don’t like it when that happens. But if there is a metal foundation under the crown it doesn’t require replacement of the crown. The metal will protect the tooth.
– Dr. Hall

Related links:
Dental crown

We thank our advertisers who help fund this site.

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.

January 18, 2008

Crowns won’t stay on.

Filed under: Dental crowns,Second Opinions — mesasmiles @ 10:20 am

My husband’s dental crowns keep coming off usually within a week or two of getting them recemented. His dentist is saying there is nothing more they can do. We are thinking about implants but it doesn’t look like they stick up much…will he have the same problem with the implant crown coming off? Are there different types of glues for crowns that could be causing this problem?
– Pat in Arizona

Dear Pat,
It isn’t that hard to get crowns to stay on. I’d get a second opinion. In twenty-some years of practice, I never had a crown that I put on come uncemented and have to be recemented, once I permanently cemented them. If they are done right, they stay on.

How well crowns stay on depends on the shape of the tooth preparation. When the preparation is too tapered, it’s hard to keep the crown on. So that’s probably the problem. You may need new crowns, or a knowledgeable cosmetic dentist may be able to bond these crowns on. There are bonding agents now that bond metal, porcelain, teeth, and everything imaginable. Expert cosmetic dentists are trained in all these high-tech bonding techniques. I can’t tell you without seeing them, but this is ridiculous to put up with crowns that won’t stay on.
– Dr. Hall

Click here for referral to an expert cosmetic dentist.
Click here for information about temporary crowns, all-porcelain crowns, or Cerec crowns.
Click here to ask Dr. Hall a question.

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.

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