Your leading source for cosmetic dentistry
information and referrals.

Do I need fluoride treatment as an adult?

Posted on by .


We thank our advertisers who help fund this site.

Hi Dr. Hall,
I am wondering if you can help me with a few dental exam questions? When I go to the dentist it seems they insist that I receive x-rays every six months. Is this necessary—what is the recommendation? Also, as an adult, do I need fluoride and if it is not needed will it have a negative effect if I get it?
– Kay from Arizona

Kay,
The general guidelines for routine checkups are to have bitewing x-rays (two or four x-rays taken while you bite on a tab that holds the film) once a year and a panographic x-ray or full series of x-rays (showing the roots of the teeth) once every five years or more.

There are variations from this that can depend on the individual. Some people with aggressive decay problems may need x-rays very 6 months, but that would be rare. In my practice of over a thousand patients, I maybe had a handful of patients for whom I would want x-rays that frequently. I did have some for whom I recommended x-rays less frequently.

As far as fluoride treatment, that is generally given to children and youths up to age 14—in some cases up to age 18. Once the permanent teeth are fully formed and the enamel has matured, the benefits of fluoride treatment are less. Adult fluoride treatment would similarly be justified in the case of some patients with aggressive decay problems.

There are no deleterious effects of fluoride treatment on natural teeth. But if you have any porcelain work, the most common type of fluoride can etch the porcelain, destroying the glaze and possibly removing some of the color. Most fluoride administered in dental offices is acidulated fluoride. The acid in the fluoride assists in its absorption by the teeth, but that same acid will etch porcelain, making the surface more rough which makes it attract stain. Also, the dental laboratory technician who fabricates the porcelain restoration will sometimes place tints in the surface in order to match the coloration of adjacent teeth, and those tints could be dissolved away by acidulated fluoride.

– Dr. Hall

Do you have a comment or a question or anything else to add? 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 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 to tell from the x-ray if a tooth needs a root canal treatment

Posted on by .

Kathryn from New Jersey asked me if she could wait to have a root canal treatment. She had a tooth that was recently filled, then went to a new dentist who said that there was something on the x-ray that looked like decay under the filling, therefore she needed a root canal treatment. See the earlier post: “There are a lot of things that can look like decay on an x-ray.”

Here is the x-ray she sent, with the tooth in question marked:

does this tooth need a root canal treatment?
And here are my comments:

Kathryn,
Maybe there needs to be more training in dental school on radiographic diagnosis. This is by no means a case calling for plunging in and doing a root canal treatment.

Yes, I see the dark area under the filling, but I see three characteristics of this dark area that they are not telling you about:
1) While tooth decay will show up as a dark area, not all dark areas are decay. This could be a radiolucent base material under the filling, a gap in the filling, or decay – three different possibilities.
2) The dark area is on the surface of the tooth. If it is decay, the dentist should be able to poke that area with an explorer and it will be soft. You gave me no indication that they did this because you said, “There is what looks like some decay under the filling on x-rays.”
3) The dark area does not go anywhere near the pulp. Now there is an optical illusion that creates the impression that the dark area is directly under the filling and between the filling and the pulp. The way to deal with that is to cover up the filling, which is white, with your finger. Now look at the remaining tooth structure. When you do that, you can see the clearly defined margins of the dark area (decay would have fuzzy edges) and that they stop well short of the pulp. There are a good 2 to 3 millimeters of solid tooth structure between the filling and the pulp, with no radiolucent area except that which is on the surface of the tooth, which is also a good distance from the pulp.

Now I can’t give a definitive diagnosis here without actually seeing your tooth and finding out more about what went on, but I can tell you that if they are just relying on the x-ray, there is no justification for doing a root canal treatment. There is no indication of inflammation near the root tip, which is the first indication of an infected tooth that can be seen on an x-ray. And you are saying that the tooth feels fine.

Finally, there is some clear evidence on the x-ray that the root of the tooth is healthy.

If you look at a clearly healthy tooth – for example, the canine tooth next to this one. There is a thin white line that goes all the way around the root of the tooth. This is called the lamina dura. When a tooth gets infected, one of two things happens to this white line. It either becomes broken in the area around the root tip, or it pulls away from the tooth. When I look at the lamina dura of your lateral incisor, I can follow it all the way around the root tip. Because of the angle, the lamina dura appears more fuzzy than it does on the canine, but it is nonetheless there and intact. THAT is the key to the diagnosis of this tooth. The root is healthy.

Dr. Hall

We thank our advertisers who help fund this site.

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.

A tricky diagnostic problem? Not really.

Posted on by .

Good day Dr. Hall,
I am 24 years old and broke off at least 1/3 of my left front tooth when I was 21 or 22. I was in France at the time and had to have an emergency root canal as the nerve had been exposed. When I got back to England (where I lived then), I went straight to my dentist who drilled out the filling to check the work. He concluded it was good, refilled it and later put a crown on it. This was fine for a long time, with no pain.

In November 2010, after I moved to Georgia, the crowned tooth became excrutiatingly sensitive to hot and cold, and occasionally ached when not eating or drinking at all. So after a couple of months, the pain had become far less intense and only now sensitive to very cold. I decided I would still go and have it checked, after an x-ray and some wiggling of the tooth my dentist could not tell what was wrong, so referred me to an endodontic specialist. The specialist said he thought the symptoms were coming from the tooth next to it as I have been putting pressure on that tooth in my sleep.

So nothing has been done to the crowned tooth and the wiggling of the tooth which they both did actually made the pain come back again. It is still bothersome and I am very worried. The pain is starting to get a little worse again, now. With both dentist and specialist saying they can’t see anything wrong on x-rays, and I have no pain when they tap the tooth, I am at a loss. I fear that I will eventually lose the tooth if nothing is done to solve whatever is wrong. What do you think this could be? I find it strange that the tooth gave me no trouble for over a year and then all of a sudden became unbearably sensitive. I very much look forward to your reply, and thank you in advance for your advice.

Kindest regards,
Danielle from Georgia

Danielle,
I’m not sure why there is so much puzzling about this tooth. This isn’t that difficult a diagnostic situation.

Let me clarify a couple of points to bring some sense to what has happened to you..

First, I’m understanding you had a root canal treatment on your left front tooth 2 or 3 years ago. That removed the nerve from the tooth, so there is no way it could have any sensation to hot or cold, unless the root canal treatment wasn’t really done. It is very rare for this upper front tooth to have any extra canals or other strange anatomical features that a dentist might miss in doing a root canal treatment.

Second, not seeing anything on the x-ray is no great mystery. When the pulp of a tooth is inflamed, it doesn’t show up on the x-ray until the inflammation progresses to infection and the infection begins to leak out the end of the tooth into the bone. It also isn’t sensitive to tapping until that happens.

Going back to the original accident that caused your left front tooth to fracture. As large as the fracture was, there had to be some trauma to the teeth next to it. So for one of these teeth to be acting up at this point is not the least unexpected. I have seen that before where a tooth has been traumatized and it is fine for several years and then begins to act up.

If the pain is pretty much gone now, it could mean one of two things. Either the tooth has recovered, or the tissue inside the tooth is dying. If it is dying, that will show up on the x-ray in time, plus the tooth will turn darker. So as long as it is not hurting, there is no great urgency and I would leave it alone and get an x-ray at your next regular check-up and see what it shows. If it shows nothing, count your blessings, but have the tooth x-rayed again every few years, just to be sure. If the tissue does die, which is what will probably end up happening, it means that you’ll need another root canal treatment and a crown – it’s not that difficult to fix.

Dr. Hall

Links to related pages:
Why is a tooth sensitive to biting?
Why is a tooth sensitive to heat?
Sensodyne is a toothpaste for sensitive teeth.

We thank our advertisers who help fund this site.

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.

Categories

Follow this blog

Get every new post delivered right to your inbox.