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Does this tooth really have to be extracted?

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I had a crown when I was younger that fell off and left half of my tooth there, my dentist tells me I now have a tooth infection under it. There is a little white bubble under my tooth – he didn’t say what the name of the infection is but I’m kinda worried about it. My dentist says he just has to take out my tooth but from what it says on your website he’d have to do a root canal right?
– Maggie from Rhode Island

Maggy,
I think it would be worth it to seek a second opinion about this extraction and see if the tooth can’t be saved. Some dentists, unfortunately, are all too eager to extract teeth when it isn’t necessary.

It could be that your dentist is right, that the tooth has to be extracted. But your dentist should have explained why the tooth can’t be saved and why a root canal treatment and a crown wouldn’t work. If he didn’t, ask another dentist.

It could be that the tooth has decayed so much and there is so little left that there is no way to restore it. It could also be that with the crown of the tooth being missing for so long, the teeth on either side have drifted together so that there isn’t space enough to restore the tooth. But if your dentist didn’t explain this to you, I would get a second opinion to ask another dentist if he or she thinks the tooth can be restored.

Your question reminds me of a man who was president of the American Dental Association in the 1980s who was kind of a crusader for saving teeth, Dr. Burt Press. He often said that too many dentists are too eager to take teeth out. He had a funny way of putting it. When we were in dental school, we were given statistics about how many teeth are lost because of gum disease versus how many are lost because of tooth decay. He said he questioned those numbers. “You know why so many teeth are lost?” he asked. “Because dentists take them out.” But rescuing teeth is hard work, and sometimes you fail. Some dentists like to try to save them, because it’s a noble feeling to save a tooth. But some dentists don’t have that attitude and just take them out.

So my advice is to get a second opinion.

Dr. Hall

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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.

My temporary crowns hurt

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Hi Dr Hall,
I recently had two crowns replaced on the upper right side. The gap between the old crowns was too big and too much food getting trapped there. I had temp crowns for a total of three weeks, while I waited for my permanent ones to be ready. Unfortunately, the last week the temp crowns smelled, tasted horrible and I started to feel some pain. My dentist assured me that the pain would disappear once the new crowns where cemented in. The pain did not disappear and it only increased in the days after the permanent crowns where put in. I went back to the dentist and he explained the maybe the bite was off. He did a little drilling to fix the bite and now it hurts only in that one area but pain is still there. The pain comes and goes but it hurst to chew on that side or bite down on that side. Is this common? He assured me that I did not need a root canal. Thanks
– Larissa from New York

Larissa,
There are various types of pain that you can have when you are wearing temporary crowns, or when you have a new crown. Some are serious, and others aren’t.

Three weeks is a little long to be wearing temporary crowns. The last week you were wearing them and they smelled and then started to hurt, what was happening there is that they were beginning to leak, and microscopic particles were getting in between the temporary crowns and the teeth. Those trapped particles started to smell, and since they were in direct contact with the porous dentin of your teeth, they would also irritate the teeth.

I have had that kind of pain while wearing a temporary crown, and it was very uncomfortable. I do think your dentist should have explained better what would happen once the crowns were cemented. The cement is an additional irritant of the tooth, and the sensitivity could increase right after they are cemented, but then it would gradually subside and disappear. If it didn’t subside and go away, it would mean that the irritation was too much for the tooth, and it may end up needing root canal treatment.

The pain to biting is probably a separate issue. I would assume that the bite just needs to be adjusted until it is comfortable. There is a chance, however, that everything – all the irritation from being worked on, etc., has caused the pulp in one or both of the teeth to die, which would then begin to irritate the ligament that holds the tooth in. It would be prudent, at your next checkup, to ask that the roots of these teeth be x-rayed, just to make sure everything is okay. Especially if the sensitivity to biting or chewing never really completely goes away.

Dr. Hall

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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 get a refund from the dentist who screwed up.

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Dr. Hall,
In November 2009 I had a crown put on my number 8 front tooth. My tooth was slanted from sucking my thumb when I was little, and this was to fix that.

About 3 weeks after my crown was put on my tooth was really sensitive to hot and cold. I was told that was normal for the first few weeks. About 4 months later my tooth was hurting so bad that I had to go to the ER! The next day my face swelled up and I was out of work for 5 days. When I went to another dentist, they told me that my tooth was infected and that I would need a root canal and a new crown. I was like WHAT??? how could this happen? She told me that I had an open margin and it was from the crown not being placed properly.

I called the first dentist, who did the crown, and I told the secretary the situation. I told her that i deserved my money back because for his mistake i have to pay for another crown and a root canal!! she said that once the crown was in my mouth it was my responsibility!! I said even if it was a failed job???

Is he liable for this? Shouldnt he pay?? I have seen the xray and the open margin is huge! ! If he we re to have taken xrays at the end of the job he would have seen the open margin and knew it had to be redone.

At the time I was making payments on the crown and paid a little more than half. After I found out about his mistake i told the office i was not paying the balance . About three months later I got a notice saying he was suing me for the balance! I couldnt believe it ! I of course filled a countersuit and when I went to the small claims court his lawyer told me if i drop the counter claim then the dentist would “forgive my debit”. I said NO I want the money that I paid him and his lawyer said “Well he is not willing to do that.” The case now has to be handled by the superior court because civil court can’t deal with things like this.

My question is should this guy have fixed his mistake? Because of him I was in the most extreme pain I was ever in, I had to miss days of work, I had almost a dozen appointments ( emergency room, doctors and dentist visits), my face swelled up so bad that I could barely see and I had to get a new crown and a root canal . Please let me know what you think!

Thanks!
– Sarah from Massachusetts


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Sarah,
You have quite the story!

I have to qualify this because I can’t judge this without seeing. But just going from what you’re telling me, yes, your former dentist is liable for violating the standard of care. The most important thing to check when a new crown is being seated on a tooth is to run the explorer around the margins and make sure there is a good fit to the crown. Usually a dentist won’t take an x-ray before seating a crown, but they always need to run that explorer completely around the margins of the crown and check for any open margins. But having the x-ray you have is good documentation showing his negligence.

The problem, though, in many cases like this is that the dollar amounts involved make it impractical to involve lawyers and to go to trial. But here are a couple of things you can do to increase the pressure on this dentist to refund your money:

1. Threaten to complain to the dental board. Not as serious as a malpractice suit, this is still something that the dentist is strongly motivated to avoid.
2. Have the new dentist help you. A call from one dentist to another, verifying that there was indeed a problem with the work, can be very persuasive. In a trial, you HAVE to have an expert opinion of a dentist to back up any claim of negligence. Your word isn’t good enough.
3. Have a lawyer write a threatening letter. Rather than pay for an entire malpractice case, just having a letter from an attorney can get the dentist to take your complaint more seriously.

Dr. Hall

Click here to read more about porcelain crowns on front teeth.
Click here to ask the dentist a question.

 

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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.

Bleach Your Teeth with Clorox?

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I was checking out the dental questions on the Yahoo! Answers websites this morning, and found this interesting one from a guy. Here’s the question:

“Can I bleach my teeth with regular bleach?

“I want to bleach my teeth, and I have a whole like jug of bleach (like what you use on white clothes), how should I use it just gurgle it around in my mouth or what?”

He had thirteen answers from sensible people who responded with varying levels of horror.

I have a rather different take on this question, colored by my experience as a cosmetic dentist. It was maybe about 25 years ago, before teeth bleaching was widely practiced, that I had a patient who told me that she gargled with Clorox to help keep her teeth white. She was a young woman, and I have to admit that she had nice, white teeth. And her oral tissues were all intact and healthy, in spite of the warnings of all those sensible people. But I told her that I didn’t think that was smart.

Clorox isn’t an acid, it’s a base, kind of like lye. And it’s corrosive and, given enough contact time, can burn living tissue. Plus, contact with certain other chemicals can cause it to release chlorine, which is a toxic gas that will kill you. Though, clearly my patient was alive, quite healthy, and had nice, white teeth.

Interestingly, it’s probably a majority of dentists who use Clorox or another brand of household bleach in doing root canal treatments. The active ingredient is sodium hypochlorite, which is an excellent cleanser to use inside a tooth root for dissolving away all the dead organic debris inside a cleaned-out root, and for disinfecting the tooth. They taught us this technique in dental school.

But don’t gargle with it.

There’s actually a question posted on the Clorox website in their FAQ section: Can I use Clorox® Regular-Bleach to gargle, brush my teeth or clean cuts and scrapes? Their answer: “No. Clorox® Regular-Bleach is not for personal usage.” Of course, they have to do that to protect themselves. My young pretty patient would disagree. And definitely the fears published by many dentists are overblown.

Actually, according to PubMed, it is also safe to do periodically as an oral rinse, but only diluted. They recommend a 1:20 dilution. But, of course, if you splatter any of the rinse on your clothes that would not be good.

So there you go. That’s the official word. There is also a notice on the Clorox label: “It is a violation of federal law to use this product in a manner inconsistent with its labeling.” So beware—someone may sic the bleaching police on you.

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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.

My tooth has a really sensitive spot at the gumline

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Dr. Hall,
Very recently for the past few weeks one of my teeth has grown rather sensitive. Not to cold or hot, but if I scrape it with my fingernail near the gum line it almost feels like touching a nerve. The funny thing is, eating, drinking, brushing and flossing are all painless; its only sensitive to pressure with something hard, like a toothpick or fingernail. I was wondering what this might be.

I see the dentist about 2-3 times a year, and they always tell me my teeth are extraordinarily clean. I’m just very paranoid about my teeth. I hate getting dental work, and I don’t want to find out it requires a painful procedure to get it fixed. Help!
– Brandon from Ontario

Brandon,
It’s important to pay attention whenever a tooth is sensitive for an extended period of time. Even if the cause isn’t serious, the constant irritation of your tooth isn’t good and can lead to nerve damage inside the tooth, requiring root canal treatment. Since your sensitivity is intermittent, it’s not likely to damage the tooth. But still, it’s uncomfortable and I would try to address it.

I’m encouraged to know that your tooth isn’t sensitive to heat or cold or anything other than touching it in this one spot. Teeth can have sensitive spots like this, and usually those spots can be sealed over with something to alleviate the sensitivity. It’s kind of like a tiny filling.

Teeth tend to flex a little bit right where the crown meets the root. A lot of dentists aren’t familiar with this phenomenon, and it was only recently that it was discovered. But the tooth flexes at this spot, and causes tiny particles of tooth structure to break off, sometimes causing a sensitive spot, and sometimes continuing to progress until a significant groove develops. The trouble with treating them is that dentists have a hard time getting fillings to stick in this location – they tend to pop out. The way to get fillings to stick in this position is to use a flexible filling material, like a microfill composite.

So ask your dentist to seal over this sensitive spot, and if there is enough room for a filling, to place a small amount of microfill over the spot, and I believe the sensitivity will go away.
– Dr. Hall

Related links:
Read more about teeth that are sensitive to touch.
Read about a toothpaste for sensitive teeth.

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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.

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