Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

May 16, 2018

Will my electric toothbrush loosen the post in my tooth or the crown?

Filed under: Uncategorized — Tags: , , , , — mesasmiles @ 11:06 am

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Hi Dr. Hall
On your page about how to remove a post in a tooth you mention that an ultrasonic tip can be used to help remove a post. I have a crown on a post and want to use an electric toothbrush. Is there any chance that an electric toothbrush can cause the crown falling off or post loosen up due to the vibrations?
– Anna

Anna,
Many of today’s electric toothbrushes use sonic vibrations through the bristles to help loosen plaque. I don’t believe these are strong enough to loosen anything that is cemented in your mouth.

The ultrasonic tip that a dentist would use to help remove a dental post cemented in a tooth would be the tip of an ultrasonic scaler—a powerful tool used by dental hygienists to help clean teeth. The tip is rigid and imparts the full strength of the ultrasonic vibrations to whatever it touches. When used to remove a post, it has to be pressed firmly on the post for an extended period of time.

By contrast, the vibrations of a sonic or ultrasonic toothbrush are transmitted through the soft bristles and thus are very gentle.

– 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.

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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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.

January 24, 2018

The filling in my root canal tooth came out

Filed under: Root canals — Tags: , , , , — mesasmiles @ 6:10 pm

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Dr. Hall,
So it might sound a little crazy, but I had a root canal done a few years ago. Since then I haven’t been to the dentist, and can’t currently go due to financial problems and no health insurance. Since it’s been so long the cap or synthetic tooth, has fallen out and is now revealing a metal rod. The rod seems to be moving back and forth. What would be my best option? Can I remove the metal rod myself? Should I just leave it till it falls off or till I can get to a dentist?
Heather from Pennsylvania

Heather,
You really need to go to a dentist for a simple replacement of the temporary filling material. And knowing that your finances are strained, you may be able to talk some compassionate dentist into doing this very cheaply or even for nothing at all. Hopefully this tooth hasn’t been exposed too long, which would require a re-doing of the root canal treatment. Goodness, a dental assistant could do this for you—just get some Cavit and plug it into the hole. Otherwise, you’re going to lose this tooth. Cavit is a simple temporary filling material that comes out of the tube as a paste but when placed in a moist environment like your mouth it hardens. Since it requires no mixing or tray of tools, it can be placed in a few seconds.

When a tooth has a root canal treatment, the root canal filling material then needs to be protected against the oral fluids. Otherwise, saliva will seep down and loosen that root canal filling, which allows the tooth to become re-infected. This causes failure of the root canal treatment. The tooth would then need a new root canal filling in order to save it. So the dentist will put in a temporary filling and then plan when to finish the treatment of the tooth, probably protecting it with a crown.

When I was in practice, knowing that some patients could get into your situation and not come back for the crown, I would fill the tooth with a bonded core material, often using a metal post. If they didn’t get back right away, this would hold up for several years. Maybe something like that has been done in your situation. If the metal post is still present, hopefully there is still time to save the root canal treatment, but the hole needs to be sealed.
– 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 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.

September 16, 2017

I have a titanium allergy and think I have a titanium post in my tooth


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Dr. Hall,
I have recently been diagnosed with a titanium allergy. I have two crowns on my left side, upper and lower. I have various odd symptoms that have been addressed with my dentist. They have been checked out and I’ve been told everything “looks” fine. The dull ache surrounding my upper remains. I’m wondering if I have a titanium post and if this is possibly contributing to this dull ache and possibly other unexplained ailments throughout my body. Where do I go from here?
– Jennifer from Kentucky

Jennifer,
Titanium allergy used to be considered very rare, but with the increasing use of dental and orthopedic implants, which almost always use titanium, there are increasing reports of titanium allergy. The MELISA Medica Foundation, which conducts the MELISA test for metal sensitivities, estimates that as many as 4% of the population could be allergic to titanium. However, this test has been criticized as generating false positives, and my guess would be that titanium allergy is less prevalent than that.

Titanium is a very biocompatible metal, apparently due to its high corrosion resistance. Given this corrosion resistance, I would not think that the presence of titanium in a post inside of a tooth would affect tissues outside of the tooth, but I guess that would be possible. If you want to investigate that, I would just go to the dentist that put the post in your tooth and ask if it is titanium. Your dentist should have a record of the type of post that was inserted. I will add that there should only be a post in your tooth if the tooth has had a root canal treatment.

Metal posts are often used in root canal teeth to help retain the buildup that is placed in the tooth and the buildup in turn helps retain the crown on the tooth. For many years, stainless steel posts were the standard. Stainless steel contains nickel, and it is estimated that 10 to 20% of people are allergic to nickel. It was assumed that this wasn’t an issue, because the post was sealed inside the tooth and not in contact with living tissue. Then, about 30 years ago, it was discovered that corrosion products from the stainless steel could leach through the teeth and many dentists, including me, switched to using titanium posts.

Could your dull ache be from a metal sensitivity? I would say that it could. I would wonder if there is any metal in the crowns you have—that is something worth checking also. There could also be a problem with the occlusion of the crowns. In any of these scenarios, everything would “look fine,” but that doesn’t mean that everything actually is fine.
– 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 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

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 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.

February 2, 2016

Do I really need this crown on a root canal tooth?

Filed under: Dental crowns — Tags: , , — mesasmiles @ 7:38 am

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Hi, Dr. Hall,

I had a root canal done on a molar almost 5 years ago. After the dentist did the canal he put in a filling which has recently come out. I went back and he has told me I need a crown put in with posts, I was wondering if this is necessary rather than just getting another filling? What are the pros and cons of crowns? and is it strange that he didn’t originally put in a crown as there’s not much of the tooth left and I think he probably would’ve known the filling wouldn’t last. Any help would be great as I really don’t know what to do.
Thanks,
Melissa from Ireland

Melissa,
The only puzzling part of your situation is why the dentist didn’t recommend a crown when the root canal was first done. Now you’re in Ireland where much of the dental care is publicly funded. I’m wondering if that has something to do with this.

Not every tooth that has a root canal treatment needs a crown. I’ve written before on this blog about the need to be careful in doing crowns on front teeth that have root canal treatments, as a crown will weaken a tooth against lateral stresses. But practically every molar with a root canal treatment does need a crown. The reason is that once a tooth has a root canal treatment it tends to become more brittle over time and more susceptible to breaking. Molar teeth in particular are the most susceptible of breaking in this circumstance for two reasons. They are the teeth furthest back in the mouth, so they receive the greatest chewing pressure. Furthermore, because of their cusps, the stresses on them tend to separate the cusps, which subjects them to a high risk of cracking in two. A crown will protect the tooth against cracking in two.

So yes, I would do the crown.

And a post or posts would be needed if there isn’t much of the tooth left to hold the crown on—if the tooth is mostly filling. Otherwise you wouldn’t need a post.

– 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.

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