Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

August 11, 2016

This dentist does a really fast crown preparation


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Hi Dr. Hall,
Should I consider leaving my current dentist? When I first met my dentist, I was amazed a how incredibly fast he could trim down a tooth for a crown. It seemed like less than ten seconds. However it now seems as though he shaved some teeth down too far. Two of his crowns have fallen out twice, and there does not seem to be much tooth left to hold them. Could it be that he was working too fast and took too much off of the existing teeth?
I am not planning on suing but I cannot afford to lose any more teeth to his crown work, and cannot afford implants at the moment. Should I seek out a different dentist? Is there any guarantee with a crown?
– Marcos from New Jersey

Marcos,
While there is not really a guarantee with a crown, there is a concept in dental care called the standard of care–a minimum standard that an average dentist should provide his or her patients. There may be situations where there simply isn’t much tooth left to hold the crown on, so even a dentist who is doing everything right could have problems with an occasional crown staying on. But if there are recurring problems with crowns from a particular dentist with crowns falling off, that could indicate a breach of the standard of care and the dentist could be liable.

I realize that you don’t want to sue, and I’m not suggesting that. But knowing the dentist’s liability can be used to give you a bargaining position to get things fixed correctly without having to pay another dentist to do this over.

You say that two crowns have fallen off twice, and that you could see there wasn’t much tooth left on these teeth. While I don’t know the history of these teeth, that, together with your description of how little time this dentist spent on the crown preparations, suggests to me that the teeth were prepared with too much taper. I refer you to my earlier post on this subject, The Main Reason Your Crown Probably Fell Off, where I explain the role of taper.

In over 20 years of dental practice and placing many hundreds of crowns, I never had a crown that I placed fall off. I say that not to brag but to make the point that if a tooth is properly prepared and a crown properly cemented, it will stay on. Yes, it takes more time and trouble to prepare a tooth precisely so the crown stays on, and it is also more time and trouble to seat and cement a crown with an ideal preparation, which is why most dentists compromise on the ideal preparation a little bit. It sounds like your dentist compromises a lot in the interests of speed.

So to get to the point. Yes, if I were you, I’d find a dentist who does crowns that stay on. And then I would get these two teeth fixed with crowns that stay on. It may be necessary to have new crowns made. Even if a tooth is over-prepared, there are ways to modify the preparation, either with retentive grooves, or with a buildup and possibly the use of pins, so that a crown will stay on better. Or, depending on the material in the crown, it may be possible with bonding technology to get a poorly prepared crown to stay on. I would find a dentist who can take care of this for you, and ask that dentist to help you get some type of refund, even if it’s a partial refund, from your current dentist.

– 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 21, 2015

What is this amalgam glass ionomer filling I got?

Dr. Hall,

A substantial amount of tooth structure was removed during the procedure of 3 fillings in my molars. Those teeth were not painful, so I do not understand why it was necessary. The edge of one tooth was removed with the filling overflowing on that part to replace it. A little bit disintegrated, thus a bit of gum is exposed. Food gets stuck there fairly easily.
I am curious as to what type of filling material was used. I think it might be amalgam glass ionomer. It is a lighter colour than traditional amalgam fillings, and different in texture.
Also, how long should those fillings approximately last before they need to be replaced? I am only 20 years old, so I don’t know how what options I have to make those teeth more functional and aesthetically pleasing. I am distraught.

– anonrocker in the U.K.

Dear anonrocker,

I can only guess at the type of fillings you got. It would help to know on what basis you are saying these were amalgam glass ionomers. Kind of sounds like they told you something about it for you to use this term “glass ionomer.” And you don’t say what was different about the texture.
I’ll take your word that it was indeed a glass ionomer restorative and guess from there. There is a product called Miracle Mix that is a glass ionomer mixed with a silver alloy, so it has a grayish color to it. It is used usually as a buildup material for a large cavity when the tooth needs a crown, and the crown is then done over this restorative. I also used it as temporary fillings when a person had a lot of decay that needed to be arrested quickly and economically. Then we would either go back and drill off the surface of the Miracle Mix and do a composite filling on top of it, or we would do a crown over it.
Miracle Mix comes packaged in little capsules similar to the way amalgam is packaged, and it mixes in an amalgamator, also the same as amalgam. It is very quick and easy to use (i.e. cheap). There is no mercury in it
A nice feature of this restorative is that it has a high fluoride release, so it resists any recurrent decay on the tooth. Another nice feature is that it has a moderate chemical bond to tooth structure, so the tooth is unlikely to break around it. A not-so-nice feature is that it isn’t very wear resistant. It has kind of a gritty texture to the surface, and it will both wear off and dissolve over time, so that it will likely last only 2-3 years.
The good news is that your teeth are probably just fine for right now, except for the place where the food gets stuck. That should really be fixed because it will promote decay and gum disease in that spot. The bad news is that you’re going to have to have all these fillings fixed later. You shouldn’t need to have the fillings replaced–just re-surfaced with something more wear resistant. Go back to the dentist and ask if this was indeed Miracle Mix or some other similar glass ionomer restorative, and then go from there.
About the amount of drilling. While it could be that the dentist drilled away too much, a tooth with a large cavity can easily be asymptomatic. In fact they usually don’t hurt. So it’s also entirely possible that the dentist didn’t drill away too much.
If you want quality dental care in the UK, my advice would be to get away from the government program. It’s nice that so many people are getting dental care. But there is little incentive in your government-covered dental care for excellence in treatment–all the incentive is to run the patients through and take care of what they need in the easiest, quickest way possible.

– 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.

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