Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

May 3, 2018

Whose fault is it that this tooth broke off?

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

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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

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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.

August 1, 2016

Can broken-off teeth be restored?


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Dr. Hall,
My husband has 2 front teeth that are broken off. The roots are intact. Other than a partial plate or a bridge is it possible to have root canals and caps?
– Jen from Ontario

Jen,

Yes, it may be possible to save a front tooth that is broken off, by doing a root canal, putting a post in that root canal, and putting a crown [cap] on the post, if there isn’t too much of the tooth broken off. It depends on the kind of bite your husband has. And it depends on the attitude of the dentist. Many dentists, I can tell you, may not want to attempt that. And recently, as dental implants have become more reliable and more popular, there may be less tendency of dentists to want to try to save teeth like this.

The mechanics of fixing a front tooth like this are tricky. A lot of dentists won’t realize that the main force working against them is a rotational force on the tooth. The front teeth are kind of roundish at the root. Then if the dentist puts a round post into the root, the resultant restoration doesn’t offer much resistance to rotational forces. Over time, then, those rotational forces can work the post loose. A way to brace against those rotational forces is to put two posts into the root.

Another problem that many dentists may not realize about this situation is that the post can end up cracking the root. There is a tendency to think that a rigid post would be stronger, and it may be stronger. But when tipping forces occur against the root, a rigid post will transfer those forces to deep inside the root where the tooth is thinner and they can crack the root. So flexible posts, such as carbon fiber or fiberglass posts should be used on front teeth.

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.

October 26, 2015

The cheapest, easiest, fastest way to fix a front tooth that broke off at the gumline

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Dr. Hall,
I recently broke my front tooth off, right below the gumline. I am looking for the cheapest, easiest, fastest way to fix this. I am 100% against implants.
– Harley from Nebraska

Harley,
Are you really asking me this? I don’t think you really mean the question the way it came out.

For the cheapest, easiest, fastest way to fix your broken front tooth, go to Walmart, buy a tube of Superglue, and glue your tooth back in. Cheap, easy, fast.

Problem is, the repair will only last for a couple of days. But long-lasting wasn’t on your list of requirements.

Another solution, not as cheap but also easy and fast and, as a bonus, long-lasting, would be to have a dentist bond a glob of composite onto the broken part of the tooth, making a little mound. That would last a long time. It wouldn’t look very good, though, but looking good wasn’t on your list.

Let’s re-order your priorities and make it first, something that will look good, and second, something that will hold up long-term. To accomplish that, there are two options. And neither one is cheap, easy, or quick.

It could be possible to repair the tooth by placing a crown on the remaining root. But that would only work if there isn’t a lot of stress on this tooth. If you have a deep overbite or even just a strong bite, it would be hard to get the crown to stay on. But if you have a gentle bite, it could work. You would need to have a root canal treatment on the remnant of your tooth, then have a good, strong post that’s not completely rigid. Either a carbon fiber post or a fiberglass post would work. The stress on a front tooth is mostly lateral. If you have a rigid metal post going down into the root and then put stress on the crown of the tooth, that stress will transfer to the root through the post and tend to cause a root fracture. If the post has a little flexibility to it, however, it will not transfer stress to the root and thus not tend to fracture the root.

And better yet, I would place two posts side by side, to help resist rotational forces that would tend to weaken the bond to the tooth over time. All posts are perfectly round, so any twisting force on them will tend to dislodge them.

However, if there is any significant stress on this tooth, the only solution that will hold up over a long time would be replacing the tooth with a dental implant. This could cost twice as much as a root canal, posts, and crown, and would take substantially longer because of the healing time required. But it would look good and last much longer. Doing the crown first could have you ending up with the dental implant eventually because the crown would fail.

Bottom line—sometimes the cheapest dental solution is the most expensive, the quickest solution takes the longest, and the easiest solution is the most complicated. It’s generally best to just fix it right in the first place and then be done.

– Dr. Hall

Do you have a comment? 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.

October 13, 2015

I have a split tooth – can it be saved?

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Dr. Hall,

I have a split tooth. It’s one of my upper teeth, near the front. A dentist in Ft. Myers, Florida, recommends extracting all of the tooth and then doing a bone graft and then a dental implant to replace it. The tooth is identified as tooth #4 on the dentist’s chart/treatment plan. The dentist stated that there is no possibility to save the tooth.

I want the tooth repaired, if possible. It is a tooth otherwise healthy, however, the tooth is completely split, right down into the root or gum. Causation is unknown to me.

I request any suggestions that you have about repairing the tooth, or about a dentist. l live in the Kissimmee, Florida area. I have the basic Humana dental PPO plan.
Thank you for your attention to this letter.
– James from Florida

 
James,

As you may have seen on the website, I was the one who did the research showing that it is possible to save a tooth with a vertical root fracture. I published that research in the Colorado Dental Journal in 2004, and a Portuguese version of what I wrote was published in Brazil. This is totally contrary to conventional thinking, as almost everywhere else in the dental literature you will read that these teeth are not savable.

One problem with research that goes directly against the grain of the consensus of thought in a profession is that it takes more than one researcher to change that consensus. The feeling is that the research needs to be corroborated by a second, independent party. So you are very unlikely to find another dentist who would try to save a tooth like this. However, just this July, 2015, a research team in India duplicated my research and was able to also save a tooth with a vertical root fracture. So I am hopeful that we’re on the way to getting my research accepted. If these publications will prompt an American researcher to corroborate what we have done, this could begin to become generally accepted.

Having said all of this, one of the things I discovered when I did my research was that in order to save a tooth with a vertical root fracture, it was necessary to get the parts of the tooth back together perfectly and then stabilize the tooth in that condition. If the fracture was several days old, it was impossible to get the two parts of the tooth back together perfectly, so the repair became impossible. I am assuming that with you writing to me and you have already had a dental visit, that this fracture isn’t something that happened today or yesterday. Unfortunately, that does make this tooth unrepairable and extraction would be necessary.

Luckily, dental implants have become a very predictable treatment option, and if that’s what your dentist recommends, that’s what I would do.

Dr. Hall

Do you have a comment? 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.

November 30, 2012

How to treat a cracked tooth

Filed under: Fractured teeth — Tags: , , , , — mesasmiles @ 6:15 pm

I have cracked a tooth. It is on the bottom next to the back. An endodontist looked at it and suggested a crown. but was asked by my regular dentist to take out the filling to see how deep the crack was.This was not done.So my dentist tried to mend the crack.I cannot stand pressure on one side of tooth and it did not work. Since one side of tooth feels strong we are now considering an onlay. Do you feel a cracked tooth can be mended like this? Or should I go with the crown. I hated drilling away so much of my tooth that was not damaged.
– Pamela from Kentucky

Pamela,

I’m not going to be able to give you a certain answer to your particular situation. There are many degrees of cracks in teeth, from a superficial crack that is just in the enamel, to a deep crack that goes all the way into the dentin and could even involve the pulp of the tooth. And there are different places a tooth could be cracked. The crack could be horizontal, involving a cusp or a corner of the tooth, or it could be vertical, down the middle.

And to be clear, here, we’re talking about cracks and not fractures. If the pieces of a tooth move independently, then the tooth is fractured. The idea of treating a cracked tooth is to keep it from fracturing.

And there are different kinds of onlays. Some would work well for any type of crack and some would have restrictions.

An onlay covers all or most of the chewing surface of a tooth. It is a very nice restoration. It is hard to do, so a lot of dentists don’t do them. Since it doesn’t go down below the gumline except between the teeth, it is very gentle to the gums and helps promote good gum health. They can be made out of gold, porcelain, or hardened composite.

A gold onlay covering the entire chewing surface of a tooth would completely protect any type of cracked tooth. I would feel very comfortable with that. If the onlay is made of porcelain, I would only use it to protect the tooth in the case of a minor crack – either a superficial crack or a horizontal crack involving just a cusp or a corner of the tooth. The porcelain is not strong enough to hold a tooth together that has a serious vertical crack. Some supposed experts teach that the bonding strength of porcelain to the tooth is strong enough for this situation, and I believed that at one time, until I used an all-porcelain crown on a tooth that had a serious vertical crack. The porcelain crown and the tooth both ended up cracking all the way through, and I ended up repairing the situation at my own expense.

And hardened composite is considerably weaker than porcelain. I would not recommend that for any type of crack in a tooth.

This idea of repairing the crack with some other technique than a crown – no, that wouldn’t work. It might hold for a short period, but it’s not a long-term solution. Now if you were putting pressure on your dentist to find a more economical solution, then I understand. But if this was the dentist’s first choice of treatment, it makes me a little skeptical. I’m not sure what you’re meaning when you say that this treatment didn’t work, and I’m not following you when you talk about the pressure on one side of the tooth. I can’t visualize what you’re saying. And I don’t understand what that means, that a side of the tooth feels strong. So maybe your dentist is right. But I have this skepticism and would suggest a second opinion.

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.

June 7, 2012

Why do these dentists just want to pull teeth?

Filed under: Fractured teeth — Tags: , , , — mesasmiles @ 5:38 pm

Dr. Hall,
I’ve been to two different dentists lately because one of my front teeth, that had previously been bonded, broke almost completely off. Both dentists wanted to pull most of my front teeth and get a PARTIAL! I am a single 35 year old woman and the thought of having removable teeth horrifies me! Please help! Money is not a concern. What can I say to get it through a dentists head that I DO NOT want my teeth pulled?? My teeth do not hurt in anyway, even the one that chipped off doesn’t hurt.
– Donna from Kentucky

Donna,
Don’t try to convince either of these dentists to save your teeth. That would be a mistake, even if you could convince them to try. Dentists vary greatly in their commitment to saving teeth. If a dentist doesn’t believe in saving teeth, there is a reason for it. Often it’s that he or she just doesn’t want to bother. It’s riskier to try to save teeth – you might not be successful. And pulling teeth and replacing them with a partial denture is much easier. Or it could be that the dentist doesn’t have very good skills for saving teeth, so I wouldn’t try to push them at all in this.

I wonder, when I get a question like yours, if the situation isn’t that the teeth are truly hopeless. But I’m inclined to believe, in your case, that is not the case, for two reasons. First, you seem very committed to saving your teeth, so I can’t believe that you’ve been neglectful. And you mention that money is not a concern. And then both dentists are recommending removable partial dentures, which is a really low-class way to fix your mouth, even if the teeth were hopeless. So that suggests to me that these dentists are both looking for easy solutions. Why no mention of dental implants, which is a far superior way to replace missing teeth?

Have you checked with Dr. —? [the mynewsmile.com recommended dentist closest to where Donna lives] That’s where I would recommend going. [He] believes in first class solutions. From what I know of [him], I think that [he] would try to do whatever [he] could to save them. To save yourself some money and some time, I would call the office and be very up front about what you want – you want a dentist who believes in saving teeth. And if they tell you over the phone that [this dentist] is strongly committed to saving teeth, tell them that Dr. David Hall recommended [him] and said he thought [he] would agree to a quick complimentary meeting where you could ask [him] about that, face-to-face. If you like what you hear, you could then schedule the exam.

Your case doesn’t sound simple. This front tooth, if it had been bonded, must have broken before. And now if it has broken almost completely off, that may mean that you have a very strong bite, which would require extra expertise to get your teeth fixed so that they will withstand those biting pressures. You really need to get away from dentists with this small-town-dentistry mentality and into a higher level of care. And by small-town-dentistry mentality, I don’t mean to imply that dentists from small towns aren’t good dentists. I have a great affection for small towns and some small-town dentists are among the best in the country. I refer to a mentality of doing patchwork dentistry, or low-tech dentistry, or avoiding difficult things.

– 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.

October 16, 2010

Can you tell a cracked tooth from an x-ray?

Filed under: Fractured teeth — Tags: , , , — mesasmiles @ 9:58 pm

Is it easy for an x-ray to miss detecting a cracked tooth? I had full mouth x-rays-taken at two different dental offices within a month of each other. Neither set of x-rays detected a cracked tooth. But when I changed to another dental office and that dentist referred me to an Endodontist, from the x-rays the Endo took, he told me I had a cracked tooth that needed a root canal right away. I’m wondering why the other two dental offices missed seeing that cracked tooth in the x-rays, and am wondering if it is common for an x-ray and/or dentist to miss detecting a cracked tooth?
– Grace from California

Grace,
I would put the answer to your question this way – it is very difficult to detect a cracked tooth on an x-ray. Unless the x-ray is taken at the exact angle of the crack, it won’t show up.

I suspect that the endodontist didn’t actually see the crack, but saw some subtle evidence that suggested a crack.

I have four molars of my own that all ended up needing root canal treatments because of cracks developing in them. But none of the cracks have ever shown up on an x-ray.

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.

July 20, 2010

Can a dentist repair my fractured tooth?

Filed under: Fractured teeth — Tags: — mesasmiles @ 1:46 am

Dr. Hall,
Would you know of a dentist that is willing try and repair a split tooth? I would like a dentist to try to save the tooth first before extracting it but I’ve been to 4 dentists and all of them want to extract the tooth. Are you still praticing dentistry? I would fly to another city to get the procedure performed. Your help is greatly appreciated.
Kevin from Texas

Kevin,
You’re referring to my research about saving fractured teeth, where I reported on four cases where I took a tooth with a vertical fracture, got the pieces of the tooth back together, fitting perfectly back together, held the pieces with a crown, and then followed the teeth long term. I actually did this successfully about ten or twelve times during my career, but had four cases documented well enough with photographs and x-rays to be able to include in the article.

There are two problems with your finding a dentist who will repair this for you. The first is a matter of timing. If you read the article carefully, you’ll notice that one factor I discovered that was critical in saving the tooth was that the fracture had to be addressed immediately, within a day or two.

I’m just guessing that if you’ve been to four dentists already that more than a day has passed since the tooth fractured.

The second problem is that my research hasn’t been accepted yet. In order for my research to be accepted, someone else is going to have to replicate it. That’s how these new ideas get established. Rarely will one researcher be able to establish that.

But any of your work in spreading the word about this research may touch some other dentist with a thirst for research to try to duplicate what I did. That will be too late to help you, but someone else may be helped.
Dr. Hall

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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 16, 2007

Filed under: Fractured teeth — mesasmiles @ 5:44 pm

Dear Dr. Hall,
My wife has a tooth that has been sensitive for quite a while, and nothing the dentist did helped. It’s a lower molar, and has a large amalgam filling in it. Well, they just told us it is cracked, between the roots, and said that it has to be extracted.

Do you think there is a possibility of healing the crack? Or does the tooth have to be extracted?
– Loren in Iowa

Dear Loren,
I’d have to see the crack to tell you for sure, but from what you told me it sounds like the tooth could be saved. If the crack is in what we call the furcation–between the roots–and if the tooth hasn’t yet separated into two pieces. The problem would be getting a dentist who would be willing to try that. It would need a crown, and either a gold dental crown or a porcelain fused to metal crown. If the pieces haven’t separated yet, that would be all you would need to do. When they do separate, it becomes more complicated, but if you catch it within the first couple of days, I outline a procedure in my article, “Saving Fractured Teeth,” for getting them to knit back together.

Dentists are a very cautious bunch who rely a lot on the opinion of other dentists. I’m still waiting for another American dentist to take up my research and try to duplicate it. It usually takes several independent studies for a blockbuster idea like “you can actually save teeth with vertical cracks” to become accepted. It would take a dentist who is the pioneering sort and who would be willing to stick his or her neck out in the pursuit of truth. There aren’t many like that, unfortunately.
– 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.

October 25, 2007

Saving a cracked tooth

Filed under: Fractured teeth — mesasmiles @ 8:04 am

Dr. Hall,
I have been reading your article on Restoration of fractured teeth.

In Sept 2007 I had a filling in #14 which caused a lot of pain. On Oct 1, 2007, an endodontist started a root canal, but quit after removing the pulp because she detected a vertical mesial to distal fracture. My dentist doesn’t believe her, wants a second opinion including its depth, position, and whether she can “describe” the tooth.

I need an endodontist who understands your article, but your categories do not cover this problem. I have called the endodontist and requested that she remove the temporary filling and collect the data my dentist requested, but she has refused to work on it any further. She feels that “no cracked tooth is worth saving.”
– Sharon in Illinois

Sharon,
I don’t know any endodontist to send you to.

As far as my research on saving fractured teeth, this is kind of a blockbuster, revolutionary idea, and it usually takes ideas like that some time to get credibility in the dental community. I think someone’s going to need to get inspired to duplicate my research, and maybe a couple of people to do this, before the idea takes hold. When you’ve got an idea like that, people who just read the study tend not to believe that you saw what you say you saw.

And then remember, there is a stringent set of requirements for actually saving the tooth, as far as the nature of the fracture, the timing in catching it, and the methods for treating it. The article makes all of that clear. It’s a minority of fractured teeth that can be saved.

And then the other obstacle is that there is a strong sentiment among dentists to take the safe course. It’s a much safer feeling for a dentist to just extract a fractured tooth. No one would ever give the dentist trouble over that. But you start saving teeth that might not make it and if it doesn’t make it, that’s when the dentist could have trouble. That’s one of the unintended consequences of the great compassion that trial lawyers have engendered for patients who have suffered from treatments–dentists have learned that it’s smart to play it safe.

A dentist has to have enough passion for saving teeth to be willing to risk that the treatment might go bad in order to pursue this kind of treatment or research. And I haven’t found many endodontists, curiously, with a passion for saving teeth. They tend to be perfectionists and conventional thinkers. Their dental school professors told them cracked teeth can’t be saved, so they’re not going to go out on a limb. I even had one tell me a tooth was cracked and couldn’t be saved when it wasn’t cracked at all.

I’d print out the article and share it with your general dentist and see what he or she can do. It sounds like your dentist is dedicated to saving teeth, because he or she isn’t giving up easily on this. – Dr. Hall

Related information from the www.mynewsmile.com web site:
Root canal treatment
Failed root canal treatment

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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.

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