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Dentist injured her tooth removing the retainer

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Dr. Hall,
My 18-year-old daughter had her lower permanent retainer taken off 3 weeks ago. She had been wearing it for almost 3 years after having braces for 18 months. During the removal, tooth #25 was injured and it is now receded and slightly grey. It is painful for her to bite anything with it and hurts when she wears her removable retainer when water gets under the retainer. Her dentist took an x-ray—which looks fine to me, but based on doing a cold test he thinks her tooth is dead or dying and recommends a root canal. The endodontist he recommended does not use the GentleWave technology. She is leaving for college in 2 weeks and wants to follow the dentist’s recommendation but I am hoping the tooth is just bruised and inflammed and can recover. Would you wait on doing a root canal or is there an alternative to heal the tooth?
Thank you!
Caprice from South Carolina

I found your website searching for tooth root x-ray.

(See Dr. Hall’s answer below.)


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Caprice,
I have a direct answer to your question first, but then I have a couple other concerns that I’ll get to.

First, for the direct answer: no, if a tooth is dying or dead there is no other way to heal it other than a root canal. The problem is that since the inside of the tooth is a very confined area with no space for the living tissue to swell or to bring in antibodies to fight an infection, once it becomes diseased the only solution is to remove that tissue, which is what a root canal treatment is.

But I have a couple of other concerns about your daughter’s case, and an additional point.

My first other concern: I’m really curious about how this tooth was injured in the process of removing the retainer. I’m guessing that this must have been a fixed retainer that was bonded to the teeth but still, removing it should be a fairly routine procedure. Your dentist, of course, would be liable for the damage to the tooth and should be paying for the root canal treatment.

Next, I’m concerned about the diagnostic skills displayed here. You are saying the dentist thinks the tooth needs a root canal. If you’re meaning that the dentist is unsure of the diagnosis, that leaves me wondering. The tooth suffered some trauma after which it has begun right away to turn gray and is sensitive to biting and sensitive to cold. That’s enough right there for a definitive diagnosis of a dying tooth. And then the x-ray will show definite signs of a diseased pulp, if the dentist has sufficient diagnostic skills to properly read the x-ray. So I’m hoping you’re just using soft language and not telling me that the dentist is hedging on this diagnosis. If your dentist is unsure, I’d get a second opinion, maybe from an endodontist.

I’m not getting strong feelings of competence about this dentist of your daughter’s. I’m hoping there is more to the story here to explain these possible lapses.

Finally, you have no requirement to go to the endodontist your dentist recommends. Even if he is paying for it, you can find an endodontist on your own. This new GentleWave technology is attractive and is getting good reviews in the dental literature. If you want to find an endodontist who uses this technology, you’re within your rights to go looking.

I’m sorry for what happened to your daughter’s tooth, and wish her well.

– 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.

A retainer after Invisalign treatment

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Dr. Hall,
I’m just finishing my Invisalign treatment and then I moved away. Do I need to find a new Invisalign dentist, or can I just finish with my aligners and let it be at that?
– Supreet from Ontario


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Supreet,
The need for supervision by a dentist during Invisalign treatment can vary. Sometimes the sides of the teeth need to be sanded down a little bit to make room. Sometimes there are little “buttons” that need to be bonded to the teeth to help the aligners grip them and rotate them, and then these “buttons” need to be removed at a later point. Sometimes little things can go wrong and they need to be corrected. But sometimes the dentist just needs to watch.

Especially if you are at the end of your treatment, there is probably no supervision needed at all. Still, there should be a minimal fee for a dentist in your new city to take over and finish your case. You can try calling around and asking what the fee would be for that. Your records would be transferred to the new dentist and your previous dentist could communicate if there is anything special that needs to be done to finish you.

Having said that, could you get by without having another dentist involved? Quite honestly, there’s a good chance you could. I would remember, however, that after completing any orthodontic treatment, a retainer may be needed to help stabilize the teeth and prevent relapse. A convenient thing with Invisalign is that you can just use your last set of aligners as retainers. Here’s a guide on how long to wear those aligners:

I would wear them all the time for a month, then start backing off. Wear them at night only for a month or two. Then try every other night and see if that works. Here’s how you tell if that will work. If your teeth move during the two days you have left your retainer out, you’ll be able to tell, because it will be a little harder to put the retainers (aligners) back in. If that happens, go back to wearing the retainers every night. But if your teeth haven’t moved, continue with the every other night for a couple of months longer and try backing off some more. If your teeth are stable, you can back off to wearing the retainers once a week or not wearing them altogether. But keep them around so you can check on whether or not your teeth have moved.

There are some sad stories of orthodontic patients who didn’t wear their retainers and relapsed, spoiling their lovely smile. Don’t let that happen to you.

– 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.

Should I continue to wear my retainer?

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I had braces in my teens. I was told to wear a retainer for a month fulltime then only at night. I had a slight relapse in my upper front teeth. I talked with a new orthodontist who said new braces could fix the problem, or I could use my old retainer to move them as close to aligned as I could and a new retainer made to hold them in place. He said 6 months of fulltime wear and then night time wear should keep my teeth aligned. I’ve since worn my newly made retainer fulltime for almost three years. I notice after a few hours whenever I remove the retainer that the one tooth in particular seems to have shifted some, therefore I’ve not yet been brave enough to not go more than a few hours without it. Am I being paranoid about the movement of my teeth? If not, then will the movement stop or become less noticeable once I get the courage to wear it only at night? I mean if my teeth move slightly throughout the day and I have to force them back every night…is that normal? That can’t be good over time right?
– Ty in Indiana

Ty,
I don’t think you’re being paranoid about your tooth movement. If your teeth are starting to move within a few hours after you take your retainer out, then you need to continue to wear the retainer all the time.

If you don’t like the idea of wearing the retainer during the day, there are a couple of other options.

One is that you can get a teeth bleaching splint made. The clear bleaching trays help hold your teeth in position and aren’t as noticeable to others as a normal orthodontic retainer.
Another option is to have a permanent retainer bonded to the insides of your teeth, either upper or lower. This, however, does complicate cleaning your teeth – you have to use a floss threader to clean between them.

I don’t know why your teeth aren’t stable yet, but they aren’t. So get used to the retainer. It isn’t good for your teeth to be moved back and forth, so use the retainer to keep that from happening.
– Dr. Hall

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See our page on How long should I wear my retainer?

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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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