Hi, Dr. Hall,
I’ve had a bridge on tooth#s 18, 19, 20 for 7 yrs now. I haven’t had any pain with it.
Now, 2 weeks back, I went to the dentist. He told me to replace the bridge. I got the treatment, he removed the old bridge, and put a temporary bridge on. Since then I am having continous pain on that side; I am on motrin every 8hrs, pain is consistent and it is spread to the whole side, even the jaw. Sometimes it feels more when I speak or open my mouth, so he checked and said x-rays are ok. Gums are mildly inflamed, everything looks ok, he doesnot know why pain is so severe and continous.
So he refered for 2nd opinion to an endodontist, whom i have to see yet. Please give your suggestion what it could be?
Thanks a lot.
– Sami from California
We thank our advertisers who help fund this site.
Dear Sami,
It’s not unusual for teeth to be sensitive after they’ve been prepared for crowns or bridgework or while you’re wearing a temporary crown or a temporary bridge, and there are several possible sources of this sensitivity.
The teeth can be sensitive merely from having been worked on. A bridge generally consists of two teeth with crowns on them and one or two false teeth suspended between them. And to place a crown requires shaving those two teeth down one to two millimeters on each side and on the top. It can been fairly traumatic for a tooth, and can cause it to ache or to be quite sensitive to hot and cold foods, air, or other potentially painful stimuli. Now your teeth were initially prepared for bridges seven years ago. Removing the old bridge and preparing for a new bridge would be traumatic to the teeth, but the trauma is much less than what happened seven years ago.
The teeth could be irritated by bacteria. You didn’t tell me the reason for needing the new bridge. If there was decay underneath either or both of the abutment teeth, the bacteria could have been pushed down into the teeth through the porous dentin, and these could be causing irritation.
The temporary bridge could be not covering the prepared teeth completely. If there is an area of dentin exposed and not covered, your saliva, air, or substances in the food you eat could be irritating the teeth.
The temporary bridge could be not fitting into your bite well. If this is the case, you could be hitting extra hard on these teeth when you move your jaw, which will make them ache.
The temporary bridge could be irritating the gums around the prepared teeth.
If the teeth are extremely sensitive to hot and cold stimuli but not too much to biting on them, the cause is likely to be one of the first three I listed. If they are more sensitive to biting, but not so sensitive to hot and cold, it is more likely to be one of the latter two reasons.
None of these sensitivities would likely show up on an x-ray in the early stages. And there could be multiple sources of the sensitivity. all adding up.
If your dentist was unable to figure out the cause, referring you to an endodontist (root canal specialist) is appropriate. The teeth could be examined closely, and possibly tested with hot and cold stimuli and tapping tests to get more information about the cause of the sensitivity and to pin down if it is coming from one particular tooth or both of them.
There might be a temptation to delay making the permanent bridge because of this. I would advise, however, to have the permanent bridge made right away and then having it placed with a temporary cement. This could solve the problem, and there is little chance that this would aggravate the teeth more. And the reason for using temporary cement would be to take time to observe the teeth and see if the sensitivity has died down. When and if it does, a careful x-ray examination should show whether or not the sensitivity was too much for the tooth and the living tissue inside the tooth has died. If that has happened, the affected tooth or teeth would required a root canal treatment, which would be much easier to do with the bridge temporarily removed. But I have seen cases of fairly extreme sensitivity completely go away with no lingering effects once the permanent restoration is placed. I had a case like that in my own mouth. It took the tooth a couple of months to settle down, but now it is fine.
Dr. Hall
Links:
Read more about various types of teeth sensitivity: sensitivity to cold, sensitivity to heat, sensitivity to biting, sensitivity to sweets, sensitivity to air. And read about a toothpaste for sensitive teeth.
What to Do for Acid Reflux
Dear Dr Hall,
I suffer from heartburn and quite often it makes me throw up, and the acid in my vomit makes my fillings in my back teeth very sensitive to the point i cant chew even the softest of food. Could you explain to me why this is?
thank you,
Derek from Nova Scotia
Derek,
This is a serious problem and could ruin your teeth. I hope you can find a way to get your heartburn solved.
This is called acid reflux. The problem is that when you throw up, that is very acidic, and it dissolves away the enamel on your teeth. So I don’t think it’s your fillings that are sensitive – it’s your teeth. It’s similar to the damage we see from bulimia.
The best treatment is prevention. If you can get the acid reflux solved, then, possibly some fluoride treatments will strengthen your teeth to not be so sensitive and maybe so that they don’t decay.
Otherwise, you may need to have all your back teeth crowned. That will cover them to protect them from the acid. But that’s not a long-term solution, because there’s always a thin strip of the tooth that isn’t covered, and the acid can attack that and undermine the crowns.
Meanwhile, be SURE that everytime you throw up you IMMEDIATELY rinse out your mouth thoroughly with water. If you can catch this in the first few seconds, you can limit the damage from the acid.
Dr. Hall
We thank our advertisers who help fund this site. |
A note about Lava Crowns
Dr. Hall
I have to replace my 3 crowns b/c they are very old (possibly 20 yrs). Two of them are the molars on either side next to the end one. I am trying to decide if PFM crown is good enough or if I need to spend the extra money on lava crowns. The dentist is recommending that I go with the the lava b/c there seems to be some gum receding where the crowns are. I can’t tell if there is or not but the lava crowns are $200 more expensive for each. Is there that much of an advantage to go with the Lava vs. PFM if they are not one of the front teeth and more in the back? thank you very much I appreciate any advice.
– Helen from California
Helen,
Maybe I’m missing something. I can’t understand, from what you’ve told me, why your dentist thinks Lava crowns are better on first molars. I don’t know what it has to do with gum recession because no one will see that tooth very well.
A Lava crown is all ceramic. As such it is more esthetic than a porcelain fused to metal crown. But it isn’t quite as strong. And besides being stronger, a porcelain fused to metal crown will generally fit more precisely, especially if the metal is a high noble metal. Esthetics in a crown are more important the closer the crown is to the front of your mouth. But strength is more important the further back you go, because the chewing forces are much more powerful in the back of your mouth.
I recently got crowns on my upper left first and second molars. I wanted the very best, and I got a porcelain fused to gold crown on my first molar, and a full gold crown on my second molar.
If these first molars are upper first molars and you have an exceptionally wide smile, it is possible that the esthetics of the Lava crown could matter. But for over 95% of patients, there will be no noticeable difference in the esthetics, because these teeth, while they may show a little bit, are in the shadows.
And just because a crown is old is not a reason to replace it. I’ve seen crowns 20 and 30 years old that are functioning just fine. If there is decay leaking in, then yes, it needs to be replaced.
I’d suggest a second opinion. What you’re telling me about your dental needs isn’t adding up.
Dr. Hall
The teeth of my five-year-old are rotting.
Dr. Hall, I had a question for you. I was doing research for my 5 year old daughter and her dental needs. She has 4 upper molars that need work done. Her two first molars have small cavities, but they are pretty deep. The two se! cond molars have both lost some tooth structure due to decay – I believe about 30% of the tooth is lost. My first question is: What is your take on this? I wanted to know what what I can do for this. I don’t want her two second molars pulled unless that is my only choice. She has stated that the 2nd molar on the right side hurts when she chews down on it. I want to thoroughly do my research before I send her to a pediatric dentist. Every single dentist she has had, she has not let them do any work on her mouth, which is why its escalated to this point. She will most likely have to be put under sedation to get this done. I am not sure if she needs white fillings, bonding, or onlays. How should I proceed? Thank you and have a great day.
Colleen from Brooklyn
Colleen,
At the age of 5, she has only baby teeth in her mouth, but those teeth are needed to help her eat now, and also to hold the spaces for the permanent teeth. If those teeth are lost, she will need space maintainers or her permanent molars will drift forward and crowd out her permanent teeth, and her mouth will end up being a huge mess.
So go with the sedation, if that’s what it takes to get this done.
Your care and concern for your daughter shows in your questions. Your daughter now has gotten to a point where she needs some tough love, maybe tougher than you’re used to. The reason children at this age get so many cavities is because of their frequency of eating. Decay of the type you are describing, at her age, requires constant feeding all day long. If you give in to every request for food or treats, this is the result. But if you let your daughter go hungry for three or four hours so she can build up enough appetite for a regular meal, and do that consistently, you will guide her into a more healthy eating pattern, and you won’t have to deal with recurring dental disasters like this. Otherwise, plan on going through this ordeal on a regular basis.
Dental work on baby teeth is usually geared toward short-term maintenance of those teeth, because the teeth will fall out around age ten to twelve. So when a large portion of a baby molar is missing, a dentist will usually place a stainless steel crown or some other type of prefabricated crown, which will cost considerably less and take much less time than the precision crowns that are made for adult teeth.
Dr. Hall
Related links:
Preparing your child for a dental appointment
We thank our advertisers who help fund this site. |
Crown is turning dark. Should I have a Lava crown?
Dr. Hall,
In 2005 I chipped my front tooth (#9) and had to have a root canal done with a tooth-colored post. I then had an all-porcelain crown placed on the tooth and it looked perfect. Over the past 3 years, my tooth has slowly turned gray. I’ve been told it is the original, underlying tooth that is slowly decaying and shining through the all-porcelain crown. I wanted to have the root canal redone to completely eliminate the gray, but my dentist said that it’s not a good idea since I have a post in that tooth. She said the only alternative is to go with a Lava crown, which would mask the gray somewhat but not perfectly. I desperately want the gray completely gone – is there any alternative besides a dental implant?
– Danielle in Florida
We thank our advertisers who help fund this site.
Danielle,
This is kind of a tough question, but there is an answer.
First, I want to comment on the tooth turning gray underneath your crown. A lot of dentists don’t realize that root canal filling materials, when left in the visible part of the tooth, are strong contributors to this graying of your tooth. I’m not absolutely sure of this, but my guess would be that your tooth wasn’t cleaned out thoroughly when the tooth-colored post was placed.
Yes, one solution could be to mask the darkening color. But it doesn’t need to be a Lava crown. Even regular feldspathic porcelain can be made opaque. But it is a less-than-ideal result.
My response to a problem like yours would be to take a little extra time and care and get this done right. Yes, a post is difficult to remove. But if it is tooth-colored, it is probably fiberglass or some similar material and they can be removed safely. Get it out, clean out the tooth thoroughly, bleach it if necessary, and put on a new crown that is naturally translucent, giving you your beautiful smile back.
If this dentist is the same one that first put the post in, then as I see it, she gets a grade of about “C” for her cosmetic dentistry skills. Yes, she did a lovely crown, but she missed cleaning out the tooth and her understanding of esthetic dental materials and opacity is a little lacking. You need an excellent cosmetic dentist with “A” skills for this job. Check our list for someone in your part of the country. Then go back to your regular dentist for the rest of your care, because it does sound like she has some good skills. Not great on the cosmetic dentistry, but very few dentists excel at that.
– Dr. Hall
Links:
See our page on all-porcelain crowns for some comments about Lava crowns.
Daughter’s teeth are stained with fluorosis.
Dr. Hall, I’m writing about my 9 year old daughter. She has severe fluorosis stains on her teeth. Her bottom central and lateral incisors are extremely yellow (those are the only permanent bottom teeth she has so far). Her top central and lateral incisors are very blotchy, and one of them is jagged on the side. She currently has braces correcting the problems resulting from years of sucking her fingers. Her teeth have bothered her for some time. The only reason we put braces on now, instead of waiting for the 12 yr molars, is to give her more self-confidence with her smile. It also gives us a little more time to figure out how to correct the fluorosis.
Thanks, Carly from Arizona
Carly,
You say your daughter has severe fluorosis. When fluorosis is severe, you need to cover the stained teeth with porcelain veneers – cover all of the teeth that are part of her smile.
Fluorosis is caused by consuming too much fluoride while the teeth are forming. Much natural drinking water has some fluoride in it. There is some natural water that doesn’t have enough fluoride, which makes teeth more susceptible to decay. Communities where this occurs generally add fluoride to the drinking water to bring it to the optimal level of about one part per million. But some communities naturally have water that has too much fluoride, and then some of it needs to be removed. If it isn’t, drinking that water for extended periods while the teeth are forming can cause fluorosis. Or, where people are drinking their own untreated well water, this can occur. Fluorosis can also be caused by mistakenly consuming fluoride supplements when it isn’t needed or by swallowing too much fluoridated toothpaste.
Mild fluorosis causes spotting of the teeth, and the spots can be white or brown, depending on the severity. Often direct bonding can be used in these cases, which just covers the affected spots.
If the fluorosis spotting is extensive, then the teeth need to be covered more extensively, and porcelain veneers would be the treatment of choice.
If there is just a general yellowish color, but that color is even – not mottled – then I would try teeth bleaching first. If that is the case, you’re probably not dealing with fluorosis but some other cause of the staining.
Just be sure you go to a highly experienced and capable cosmetic dentist. This is beyond the ability of your family dentist. Beyond the technical ability and beyond his or her artistic understanding.
You’ll want to wait until the braces come off. And the dentist will need to know how to time the work. I don’t know how long the braces will be on, but when they come off it may be possible that her very front teeth still haven’t fully erupted. In that case, it may be best to do some direct bonding temporarily, or something else. There will be a lot of different ways to tackle the problem, and a lot will depend on her attitude toward the problem. Dentists who aren’t artistically sensitive just aren’t equipped to handle these self-image issues very well, but experienced cosmetic dentists are quite used to them.
There is no minimum age for porcelain veneers, as long as the dentist knows what he or she is doing, and properly factors in the degree of present and future tooth eruption and other factors. Children can also have teeth bleaching.
– Dr. Hall
Click here to find a cosmetic dentist, screened for training and artistic ability.
How long before I should get my dental implant?
Dr. Hall
I found out today that I have a dead first molar underneath a crown that just broke. My dentist felt that he could not get all of the decay out if he did a root canal, therefore, he recommended having an oral surgeon pull the tooth and then come back in 3 months for a bridge. I am waiting back to hear from an endodontist to see if she can do the root canal to save the tooth. I am learning that an implant is the better route if the tooth can’t be saved. I just took out dental insurance today and I know that crowns are not covered for one year. I do not know yet if the insurance gives any coverage for implants yet as I haven’t asked. Do I have to have the tooth pulled right away? If I do have to have it pulled, how long can I go before I start having problems in my jaw due to a missing tooth? If I have to wait one year to do something which I hope I don’t have to, will this cause any problem or does it need to be taken care of sooner than one year? I am 52 yrs old and have fairly healthy teeth. This particular tooth should have had a root canal when the crown was put on 9 years ago and the dentist opted not to do it because he put the crown on too fast and didn’t want to do the root canal through the crown. The pain that I was having at the time stopped when the crown was put on and it seemed to be okay. But there were no tests done to determine if the tooth needed a root canal after the crown was put on.
Thank you,
Rosemary from Oklahoma
Dear Rosemary,
There are some dentists that seem to me to be too eager to pull teeth. It’s better to save the tooth. I’m not sure I understand why the dentist would feel that he can’t get all the decay out. I’d be inclined to get a second opinion on that one. See what the endodontist (root canal specialist) says.
And yes, for replacing a single missing tooth, I think a dental implant is nicer. But I wouldn’t go more than a couple of weeks with the tooth gone before getting something in the space. Even at age 50, the teeth can start to tip into that space rather quickly. You haven’t told me anything that makes it seem like there should be a rush to take this tooth out. Is it not hurting? You didn’t mention any pain. Now a dental implant needs time to heal before actually placing the tooth on it, but they should make something temporary to fill the space while you are waiting for the implant to heal.
I generally recommend people going to dentists who try hard to save teeth. I associate that attitude with a higher level of integrity and greater skill and knowledge. I hope that’s not too blunt. Sometimes teeth really can’t be saved, but then some dentists are just too eager to pull them. A second opinion should help clarify whether it is really hopeless or not.
And I don’t know if I understand what you’re telling me about this tooth needing a root canal treatment years ago. If you are giving me a correct sense of what happened, then I think the dentist who put the crown on didn’t do the right thing. It’s a basic rule – when you have infection or decay, there is no benefit to watching it grow. Just because the dentist would have to drill through the crown is not a good reason for not doing the treatment – that is done all the time. Getting it taken care of promptly saves trouble down the road. I guess you’re a walking illustration of that principle.
Dr. Hall
Pain after a new filling
Dr. Hall,
I had a composite filling with a ceramic cap done on tooth # 19 two weeks ago. Ever since I have been in severe pain in my jaw and often from the top of my head to the middle of my neck only on the left side. I have been living on Ibuprofen 3-4 times a day. The pain is about an 8 on a scale of 10 being the worst.
The dentist said was because I was grinding my teeth, so I bought a night guard and that was no help. So he proceeded to grind my tooth down to fix my bite, but I am still in a lot of pain! Is this normal? Should I get a second opinion? What specialist should I see? Thank you, Charlotte from Indiana
Charlotte,
I’m not sure what you mean by a composite filling with a ceramic cap. Cap is a lay term for a crown. A filling just replaces decayed or weak tooth structure. A cap or a crown covers the entire tooth.
It certainly doesn’t sound like your pain was from grinding your teeth. If your bite is adjusted properly, grinding your teeth won’t cause pain in a single tooth.
There are lots of kinds of pain that can occur in a tooth, and when we’re examining that, we try to find what provokes the pain or makes it worse. Constant, severe pain usually means that the tooth is infected. If cold brings on pain that goes away once the tooth warms up, the tooth is just irritated. Pain to biting could mean that the bite needs to be adjusted, or it could mean that the tooth is abscessed or that there is some infection in the ligament that holds the tooth in the bone.
Severe pain right after a filling is placed could mean that the tooth had a slight infection before the filling, which was aggravated by doing the filling. Or, if it is a bonded white filling, improper technique could also cause post-operative pain.
In your situation, I would get a second opinion. It doesn’t sound like your dentist is on the right track. I don’t think you need a specialist, just a good, thorough, careful general dentist who understands tooth pain.
Dr. Hall
Related links:
Read about tooth pain after a new filling.
Read more about toothache – the various types of tooth pain and what cause them.
We thank our advertisers who help fund this site. |
|
Sensitivity to Cerec Crown
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
Space Maintainer needed
My 6 year old daughter has two broken baby teeth that are molars. The teeth have broken because of cavities/decay. The dentist we took her to is recommending that we extract the teeth immediately. Is this the right thing to do?
– Kristina from Wisconsin
Kristina,
When an adult tooth is infected, we do a root canal treatment. However, when a baby tooth is infected, root canal treatments rarely work, and never for baby molars, so the tooth has to be extracted. So your dentist is right to recommend they be taken out. The infection can spread in the bone and affect her developing permanent teeth.
You didn’t mention space maintainers. But I assume that your dentist is also recommending putting in one or two space maintainers, depending on which baby molars are involved. That is critical to prevent serious problems with her permanent teeth. At age six, her permanent first molars are either just about to erupt or have just erupted. They will drift forward and block out her permanent premolars, which could then erupt sideways or not at all. When baby canines and incisors are extracted, they don’t need space maintainers. But for baby molars, unless the patient is around ten to twelve years old (when the permanent premolars are erupting), they do. If your dentist hasn’t recommended that, you should find another dentist for your daughter.
– Dr. Hall
Related links:
Click here for basic information about pediatric dentistry.
We thank our advertisers who help fund this site. |