Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

May 10, 2016

Is this a salivary gland stone or a toothache?


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Dr. Hall,
I had a mercury filling replaced in my bottom back tooth closest to the ear. Now pain develops and radiates into my ear. Before the filling I was experiencing the same discomfort with some earache. My ear is good. The doctor suggested I have a salivary gland stone. I tend to believe it’s a dental problem.
– Bruce from Nova Scotia

Bruce,
A salivary gland stone? That seems like a stretch for your situation.
You can get calicifications in your salivary gland ducts, but the pain would not radiate to your ear. It would be in the soft tissue, in one of your salivary gland ducts, if you had pain. A couple of those ducts are under the tongue, and one is in the middle of each cheek. A salivary gland stone will cause swelling in that duct when you eat and maybe pain, and it would show up on an x-ray.
No, pain radiating to your ear sounds very much like a toothache. And if you have had a recent filling in a lower molar on that side, that would be the first tooth to check.
I would get a second opinion.
– 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 29, 2013

There are a lot of things that can look like decay on the x-ray under a filling. Be careful here.

I have had a filling in the back of my lateral incisor (#7) since childhood that has been replaced several times over the past 10 years due to leaky margins, etc. The last time it was filled was in January of this year when my then dentist placed a pulp cap to avoid a root canal. There was minimal bleeding and he used a caries detector with dye to remove any caries by hand to avoid drilling too close to the pulp and then filled it.

I did not have any discomfort to hot or cold or any pain afterward. I still do not have any pain in this tooth on tapping or when eating and it feels fine but it was discovered at my new dentist that there is what looks like some decay under the filling on x-rays during my last exam in June with my current dentist and she says I have to have a root canal and a crown placed.

My question would be; if there is no sensitivity/discomfort in this tooth, would it be possible to remove the filling, clean out the decay and then place another filling or do I have to accept the root canal/crown diagnosis? I have already researched and contacted Dr. Hurley in Bedminster for the crown after finding her on your provider list for New Jersey, but would of course like to postpone the “bigger” treatment if possible. Thank you so much in advance for your attention and advice and I love your very informative website.
– Kathryn from New Jersey

Kathryn,
I’ll go a step further even beyond your suggestion of waiting to have this root canal done. And I’ll be direct. No, I would not have this new dentist do a root canal and crown on this tooth. It sounds to me like they are a little too eager to do something quite aggressive here. Have another dentist look at this.

It’s interesting how you put the diagnosis – “It was discovered that there is what looks like some decay under the filling on x-rays during my last exam.” There are a lot of things that can “look like decay” on an x-ray. An empty space, a radiolucent glass ionomer base, or any of a number of radiolucent filling materials can “look like decay.” If the filling looks intact and isn’t leaking, after a close visual exam, I would leave it alone. If the tooth is infected, it would show up on an x-ray of the ROOT of the tooth.

A tooth that becomes infected will almost always hurt at some point, though there are exceptions. It will start by being sensitive to cold and ordinarily that will blossom into a full-fledged spontaneous toothache. The toothache, if untreated, will go away, and the tooth will die, after which it will usually become sensitive to biting on it. But that may not happen. It is uncommon for a tooth to die quietly, with no symptoms, but it does happen. The way to diagnose that is not by seeing something that “looks like decay under the filling,” but by seeing signs of infection around the end of the root of the tooth on the x-ray.

Finally, this idea of doing a crown on a lateral incisor after a root canal – I would not let them do that, even if it DOES need a root canal. A lateral incisor is a very thin and delicate tooth. To prepare a lateral incisor for a crown, most of the tooth structure has to be removed, leaving it very weak and vulnerable to breaking off. The average lateral incisor is going to have a diameter at the neck of the tooth of about 5 millimeters. To do a crown, at least a millimeter has to be ground off all the way around, leaving it with a diameter now of about 3 millimeters – which represents a decrease in resistance to lateral fracture of more than 60%. So, even though a back tooth with a root canal treatment needs a crown to keep it from fracturing, a front tooth is a completely different situation.

Now, if you don’t do a crown on a front tooth after a root canal, it will be susceptible to discoloration. But that susceptibility can be decreased and postponed by several years by careful handling of the tooth after the root canal. If all the root canal filling material is cleaned out of the part of the tooth that shows – carefully cleaned out inside down to the root of the tooth. Then, a translucent post can be placed in the root canal space to reinforce the strength of the tooth. If that is done, it could be five or ten years before the tooth shows any signs of discoloration, and you could do a crown then.

And furthermore, if you are going to have a single porcelain crown done on a front tooth, you definitely want a dentist with good artistic ability, such as Dr. Hurley, to do it.

– Dr. Hall
follow up: The next day, Kathryn sends an x-ray of the tooth, and I offer my opinion. It appears that this tooth does not need a root canal treatment. There is a dark area next to the tooth, but it doesn’t extend near the pulp, and there are definite signs that the root is healthy.

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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.

December 6, 2012

Dentist said everything was fine – but she grinds her teeth, so it’s not fine

Filed under: TMJ — Tags: , , , , , — mesasmiles @ 8:39 am

Hello Dr. Hall, I was hoping you could help and provide a little insight. I have been grinding my teeth for some time now while I sleep. My last dental cleaning and checkup was 8 months ago and everything was fine. I have recently been feeling pain from my lower back teeth. The dull pain lasts for 2 secs and then stops. It feels like someone is pulling at my back tooth and letting go. I feel this pain on both sides of the mouth (all back lower teeth). I have never had a cavity before so I don’t know what to expect. Does this seem like cavities? Or could it be something else? could it be from clenching teeth while asleep? What should I do to help my situation, I feel this pulling sensation and it’s very hard to describe. Hope you can help.
– Mona from New York

Mona,

Your two statements seem to contradict each other. You said that in your checkup everything was fine, but then you said you’ve been grinding your teeth in your sleep for some time now. If you have a grinding problem, then everything is not fine.

I’m not sure what is wrong with your teeth because I don’t have all the details – like what brings this pain on. And it would be helpful to see the x-rays and actually see your mouth and check things like tooth mobility. But I’m worried that your dental examination may not have been as thorough as it should have been, just from your comment that everything was fine in your checkup. Now I don’t know this for sure, not having been there, but I know this is a common problem in much dental care – a focus on cavities and fillings, and not paying much attention to other important dental problems like TMJ, gum disease, or occlusion. You get this in budget dental clinics and chain practices. I think you should get another opinion from a dentist who is possibly more thorough.

Having said that, your pain doesn’t sound like it comes from tooth decay. It sounds like the pain some people get when they have gum disease. Or it could be from the trauma of your grinding. I would find out, because either of these problems could be serious. If it’s gum disease, by the time you start having pain you could have significant bone loss. If it’s the grinding, you can literally grind your teeth away, and the solution could be as simple as wearing a nightguard.

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 2, 2012

Strange toothaches – what’s the answer?

Filed under: Pain in teeth — Tags: , , — mesasmiles @ 5:40 pm

I have several tooth aches that have already had root canals. My Dentist put me on prednisone and tylenol 3 for 6 days and the pain went away. Now that the medicine is all gone, the pain is back. He says I should see a neurologist because there is a nerve that goes to the side of my head that is telling the tooth that it is not dead. The neurologist is supposed to give me medicine which may help. Can you explain it to me a little bit better. I have good days and bad days with several teeth hurting on one side of my face. I have 4 teeth in question and they all have good root canal done. My dentist says they are all in very good condition and he doesn’t want to bother the root canals. Any advice sure would help me.

Thank you
Rose from Michigan

Rose,
I don’t know that I can explain what is wrong with your teeth. I’m not following the explanation of what you are saying your dentist told you. He apparently is trying to translate a clinical diagnosis into something you would understand, but as you relay to me that “translation”, I am not able to get anything better than a vague understanding of what is going on with your mouth.

But I can tell you this much. It does sound to me like your dentist knows what he is talking about. There are nerve disorders that can mimic toothaches. And if prednisone and Tylenol was able to get your pain to go away, it sounds like he is on the right track. And if your dentist were trying to take advantage of you or cover up for his own ignorance, he has a ready excuse for any number of treatments in an attempt to solve your pain. So I respect that he has advised against any further treatment of these teeth.

My advice would be to go to the neurologist.
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.

September 12, 2011

Dr. Hall advises patient who is worried Army will pull his tooth. Can this toothache wait?

Filed under: Pain in teeth — Tags: , , , — mesasmiles @ 6:35 pm

Hello Dr. Hall,
I am in the Army National Guard and about 15 months ago during an exam, they decided I needed to have two fillings done in order to be deployable. This exam was done in the back of a tractor trailer by the way. I have received many fillings in my life, but the two I got that day have been horrible. The EXTREME sensitivity to hot and cold started that day. As well as not being able to chew on that side of my mouth.

At every opportunity I have expressed to the Army how much pain I am in because of these two fillings, each time I was basically told if they had to do anything about it, I wouldn’t be deployable. I sucked it up, and here I am in Afghanistan. The Forward Operating Base I am on doesn’t have any doctors or dentists, and recently the molar has started hurting 24/7. What is the reason for the discomfort? I am leary of them sending me to another FOB for treatment, because I don’t just want them to pull it (The Army’s favorite fix).

Is there another way to fix it? A root canal maybe? I am almost at my wit’s end with this and ready to knock it out myself. Oh and by the way, the dentist who did this to me, in the same day he extracted 4 wisdom teeth from another soldier, and stitched his gums to the inside of his cheek. I feel I was subject to the same skill.
– Ryan, in Afghanistan

Ryan,
I feel for you. I have had a toothache like you are experiencing, and they can be miserable.

It does sound almost for certain that you need a root canal treatment on this tooth.

Let’s give the army dentist the benefit of the doubt and say that these teeth already had cavities in them that were so deep that some bacteria had already entered the pulp. And let’s say that the teeth were filled with silver amalgam. I don’t know for sure what the Army uses for filling material, but I guess that it’s silver amalgam, since that is the cheapest filling material and the easiest to place. Amalgam conducts heat and cold readily. So that means that the tooth is going to get highly irritated right after the filling is placed, and if there are some bacteria in the pulp, that aggravates the infection and the tissue inside the tooth will then flare up into a dandy of a toothache.

The good news is that this process is self-limiting. Since a tooth is unable to recover from an infection inside the tooth, the tissue inside the tooth will end up dying, and the pain will go away. The time it takes for that to occur can vary a lot from one case to another, but usually it will be a matter of a few days. Then the infection spreads into the bone from the little opening at the apex of the tooth. While this can create a rapidly swelling abscess and a toothache also, it usually doesn’t, and your body ordinarily can wall off the infection and keep it from spreading.

Now keep in mind that I haven’t examined you or seen any x-rays, so my knowledge of your situation is limited and I don’t want you to take this advice without any question. But, based on what you have told me, here is what I would do, because, like you, I wouldn’t want them to pull this tooth, so I would take the risk of this really flaring up and try to avoid that. I would wait out this toothache. It will subside. Then I would cross my fingers and hope that it becomes a mild, well-controlled abscess and not a nasty one, and when I got to a place where I could have a private dentist look at this, I would get the root canal treatment done, and a crown put on the tooth.

It could be that your army dentist drilled too far and wasn’t careful in placing these fillings. It could be that an insulating base should have been put into the tooth under the amalgam filling material. Or, if this had been filled in a private dentist’s office, it could have been filled with a composite material that doesn’t conduct heat or cold. Or it could be that the decay was already so deep that there was nothing the dentist could do to avoid what happened.

I wish you well.

And I thank you, as a fellow American, for your service to our country.
– 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 11, 2011

I brush and floss every day but still need root canals. What can I do?

Filed under: Root canals — Tags: , , , , , , — mesasmiles @ 7:40 pm

Dear Dr. Hall,
I am 27 years old in the middle of two root canals. The first one was a tooth whose white filling had begun to fail. The second was a crown placed a year and half ago that started to become sensitive to temperature and could not be used to chew with. I have become very worried about the health of my teeth. I have quite a few old (ten years or more) silver filings in the back of my mouth. These two root canals had fillings that were very close to the root of the tooth. I am also a stress grinder which has led to the cracking of at least two teeth. It seems like all my teeth hurt at this moment. Especially the canine on the side of my first root canal treatment. What can I do about the future of my teeth? I don’t want a bridge or implant so young. I brush and floss everyday, sometimes three times a day.
– Janie from New Hampshire

Janie,
I can relate to your experiences. In my late forties, I got my first toothache. It surprised me, because as a dentist, I have taken very good care of my teeth and have sought out the best care I could get from the best dentists. While I had a fair amount of decay in my young adult years, I hadn’t had dental problems for quite some time. The toothache came because I got little cracks in my teeth from the old fillings. Over the next ten years I ended up needing root canal treatments in most of my molars, and all of my molars now have crowns on them.

Still, I don’t have any serious worries about losing my teeth or needing bridgework or implants. Root canal treatments, once they are successful, last for a lifetime. And if crowns are done well and are well cared for, they will last 20, 30, maybe 40 years.

Your problems are not the usual but are not uncommon either. After a tooth has been worked on several times, it is easy for it to develop sensitivity. And grinding your teeth puts a lot of stress on them.

My advice is to be sure you get good dental care. Don’t look for cheap care. Cheap care ends up being very expensive in the long run. Look for a quality dentist who is trustworthy and stays abreast of the latest techniques. Then, if you trust this dentist, stay regular with your checkups and do what the dentist recommends. Follow through with your home care. And to keep tooth decay down, avoid frequent snacking. Most people, and even some dentists, don’t realize how much damage frequent snacking during the day does to your teeth.

For your grinding (dentists call it bruxism), a nightguard can do wonders to provide considerable protection to your teeth.

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.

September 23, 2010

So many things wrong – where do I start? Find another dentist!

Filed under: Pain in teeth — Tags: , , , , , , — mesasmiles @ 5:11 pm

Dr. Hall,
I had a toothache.. Went to the dentist… He said that my filling in my 2nd to last molar is cracked… he also said the last molar needed to be fixed. So they did a deep cleaning… Drilled out the old fillings and capped both teeth with a single temporary cap… The next night I was in sooo much pain and my face swelled up… My throat and under my tongue was swollen… They put me on pain killers and antibiotics… After a week the told me that the tooth 2nd to last tooth died and it needed to be pulled… So they pulled it… this was all done on 9/18/10… But some friends told me that the dentist should have lanced my gums to let the infection drain… I’m still on pain killers and antibiotics.. There are still some swelling under and on my jaw on my throat and under my tongue… So what should I do???? I don’t want to be hospitalized for this or die after everything I have been reading… Can you please inform me of what to to????
– Joyce from California

Joyce,
Either I’m not getting the full story or there is something wrong with your dental care. I’ve got a lot of questions about what was done for you.

But first, pulling the infected tooth without lancing the gums is usually okay. The idea is to get the infection to drain, and with the tooth removed, the infection will usually drain just fine through the empty socket. But since you have swelling in your throat, hopefully you are still taking the antibiotics. If you’re not on antibiotics, I would find an excellent dentist and get another prescription.

But the way you’re telling about what happened in your dental care makes it sound like other parts of your treatment weren’t done right.

First, if you had a toothache and then putting the temporary cap or crown on made the tooth start to hurt as much as you’re saying, that means that this tooth was already infected before anything was done. I’m not sure why your dentist couldn’t tell that. It appears that the tooth was already abscessed, and that should have been visible on the x-ray that they hopefully took.

Second, I question doing the deep cleaning and fixing the teeth at the same time, as a treatment for your toothache. What was going on here? Couldn’t the dentist figure out what was the cause of the pain – is that why you got this scatter-gun-style treatment of trying everything? Was he or she hoping that one of the treatments would work? Usually when there is a toothache, you do a careful diagnosis and figure out the cause of the pain, and then get you out of pain. Deep cleaning is a great treatment for gum disease, but it carries a risk of causing an infection to flare up temporarily.

And I don’t understand why you were on antibiotics for a week before the dentist could tell that the tooth had died. That doesn’t make sense to me.

And you didn’t say anything about any suggestion the dentist made about saving this tooth. The tooth is dead so you have to extract it? Am I just being given a shortened version of this story? There are options that should have been mentioned to you.

If all of this was done and I’m just missing those parts of the story, then I would go back to this dentist and make sure that you are being given an antibiotic that is actually effective against this particular infection. If I am hearing this story right, then I wouldn’t have confidence that this dentist would give you the right prescription. I would recommend you find another dentist to get you the right prescription for the right antibiotic and get you healed.

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 12, 2010

Sinus infections, heart attacks, and toothaches.

Filed under: Pain in teeth — Tags: , , — mesasmiles @ 6:22 am

Dr. Hall,
I have pressure pain on the back bottom teeth, that started after my sinus infection started. Is it common for the bottom teeth to hurt also? There is no sensitivity to hot or cold and only really hurts from the top, the sides of the teeth do not hurt. My jaw and upper teeth hurt too.

– Ken from Arkansas

Ken,
It’s not common, but it’s not rare, either, to have a condition called “referred pain” in your teeth. You can have a problem in your upper teeth and it feels like the lower teeth hurt, too, or sometimes even just the lower teeth hurt when the problem is an upper one. Or to feel pain in your upper teeth from a sinus infection, or to have that pain referred to lower teeth.

One of your sinuses is very close to the roots of the upper back teeth, so it is fairly common for a sinus infection to cause a toothache. This pain might be aggravated by pressure, and wouldn’t usually involve sensitivity to cold.

One quirk of pain in the teeth is that one possible symptom of a heart attack can be pain in the lower jaw or pain in the left arm. So it’s a good idea, whenever you have pain that you don’t understand, to see a doctor.

I hope this is helpful,
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.

July 28, 2010

A Case of Root Canal Failure

Filed under: Root canals — Tags: , — mesasmiles @ 10:23 am

Dr. Hall,
I had a root canal on the last upper right molar approximately 1 year ago. I have had no problems since then until last week. The previous week I had a cold & took a z-pac antibotic. No sinus infection that I know of. Then my tooth gradually began to hurt with pressure (no problem with hot or cold) and got progressively worse over a weekend. The dentist thought I had an irritated socket and removed some of tooth surface to correct the bite. 3 days later I am still in pain & taking large doses of ibuprofen and acetaminophen. Today he checked my gums and found a pocket on one side of this tooth of 5mm. My checkup of 6 months ago was recorded at 3mm. He treated me today for periodontal diease thinking this could be the source of my pain and he eliminated the bite altogether on this tooth. The tooth is not loose and shows no problem on the xrays. I was hoping to save this tooth, but I having serious doubts now after the periodontal procedure. I have been in a lot of pain now for a whole week and more today after the procedure. At this point I just want this tooth out of my mouth. How common is it to have periodontal issues on a crowned tooth with root canal? The readings on my other teeth are 1mm & 2mm. I feel like this is most likely not the problem and I most likely have a cracked root. Thank you for any comments.
– Sharon from Texas

Dear Sharon,
I’m not sure why your dentist is puzzling over this and trying all these theories. From the very first symptoms, when the tooth started to hurt to pressure one year after having a root canal treatment, it seems to me like a straightforward case of root canal failure. Everything else you’re saying only reinforces this. I can’t confirm that, of course, without an exam, but the history of this tooth fits that, and that would be the first thing to check. I’d ask your dentist to refer you to a root canal specialist, because they specialize in dealing with root canal failure.

And, while a 5 mm pocket isn’t perfect health, that shouldn’t be causing any pain. That sounds strange to me that your dentist would treat you for gum disease thinking that this was related to your pain. Maybe there’s something I don’t know about your case that makes him think that.

I see on the map that you aren’t that far from Dallas. You should be able to find a good root canal specialist (endodontist) there to help fix this tooth.

Links: Click here to ask Dr. Hall a question.

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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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