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Dental Emergency

I Think My Dentist Is Wrong

I see a dentist every three months. Even though it has only been two months, I asked for an extra appointment because I have a tooth that has been hurting for a few days. When I got there he looked at my imaging from my last appointment and said there were no signs of infections. He doesn’t see a crack or erosion in my filling near that tooth either so he thinks it’s probably fine. He gave me a z-pack and said as long as the pain goes away I don’t need to worry about anything. I feel like I’m being blown off. Of course it will feel better with antibiotics, right?

Drew

Dear Drew,

Woman holding her jaw from a toothache

I’m floored. I’ve heard stories about some questionable dental decisions before but this one is straight incompetence. First, let’s start with him looking at the previous x-rays. Of course there would be no signs of infection. Those were your x-rays from before your tooth started hurting. He should have done a new set of x-rays.

Next, let’s talk about him saying that if your antibiotic helps, you don’t need to worry about it or do anything. Your instinct is right. An antibiotic will make it feel better. That’s what it’s supposed to do. The infection will be held at bay until the antibiotics are completed and then the infection will start to flare back up again.

The only way to deal with a tooth infection is for a dentist to get in there and physically remove the infected pulp. Once you are done with this antibiotic, it will return, possibly stronger. At that point I would consider it a dental emergency.

Most people don’t realize that you can die from a tooth infection. In fact between six to ten people in the United States die from them every year. Don’t let this dentist’s incompetence make you one of them.

Find a different dentist and tell them what is going on to get the treatment you need.

This blog is brought to you by a top rated Gilbert Dentist Dr. Matt Roper.
Click here to learn about sleep dentistry.

Invisalign

Can I Get Invisalign After 60?

I just retired and inherited some money. I’ve always been embarrassed by my smile and would like to finally get straight teeth. I know my nephew got Invisalign and he had to tell me he had them. I couldn’t even tell. Am I too old to get that if I’m over 60?

Eleanor

Dear Eleanor,

An image of Invisalign aligners

First, congratulations on the retirement. That is very exciting. It’s even more exciting that you’re getting to live out a dream in improving your smile. The good news is that you are not too old to use Invisalign to straighten your teeth. In fact, you would not even be the oldest.

Dentists have these study clubs where they get together and discuss treatments along with how their patients are responding to them. While they respect their patient’s privacy and do not reveal information like their name or any other personally identifiable information. They only discuss things relevant to the treatment, such as age, etc.

In one of those groups, they were talking about the age ranges of their Invisalign patients. One of them had a 92 year old woman who was getting her teeth straightened and she was doing very well. So you see, compared to that, you are a mere babe.

You are right that no one will even know that you are straightening your teeth, just like your nephew’s treatment. Some people even call them invisible braces. There is another hidden benefit to Invisalign. They can double as teeth whitening trays. You would simply get some professional strength teeth whitening gel from your dentist and wear it in your aligners at a time that is convenient for you.

Doing this will not only straighten your teeth, but whiten them at the same time. Whitening alone can make your smile looks years, sometimes decades, younger, giving you a mini smile makeover. Because you can do them simultaneously, you will also be able to get that makeover at a fraction of the cost it would be if you did them separately.

This blog is brought to you by an affordable dentist in Gilbert Dr. Matt Roper.

Sedation Dentistry

Should I Be Worried About a Rotted Wisdom Tooth?

I am going to be upfront that I don’t like dentists and I rarely go. I had a wisdom tooth that got a cavity. I didn’t see the dentist. Now it’s rotted and has pretty much fallen off. I wondered if I can just be done with the tooth and leave things be. It doesn’t really hurt. But, my sister insists I should have it taken out. She’s a worrier and goes to the dentist all the time. She even gets a physical every year from her doctor.

Henry

Dear Henry,

Man in pain, grabbing his cheek in need of emergency dental care.

Once the dead crown of a tooth is gone, the remainder of the tooth underneath will soon decay and be gone as well. There is little chance that it will get infected at this point, though the risk is never zero.

My concern is more for your future. You lucked out with this tooth. I don’t want you in another situation where you have a dental emergency that goes very wrong. I’m not going to lecture you at all about avoiding the dentist. You were afraid and fear keeps us from a lot of things. What I am going to do is offer you a solution.

What you need is to see a dentist who offers dental sedation options. There are several levels of sedation. The one I’d recommend for you is oral conscious sedation. This is sometimes called sleep dentistry because, if you wanted to, you could sleep through the entire procedure.

This has changed the lives of countless people who were just as afraid as you were. Now they are able to see the dentist regularly without anxiety. You will even be able to get all of your oral health care caught up.

This blog is brought to you by Friendly Dentist in Gilbert Dr. Matt Roper.

Porcelain Veneers

Will Peroxide Help My Porcelain Veneers

I had a set of porcelain veneers done overseas. They look okay, but my gums have been red and swollen from the beginning. The dentist told me that was normal and would go down in a few days. It hasn’t. In fact, it’s been well over a month and my gums are miserable. Do you know if I did a peroxide rinse if it would help with the swelling and tenderness? If so, will it damage the veneers?

Greg

Dear Greg,

An image of a porcelain veneer being held up to a tooth.

While peroxide will not damage your porcelain veneers, it will not solve your problem. In this case, the problem is the veneers themselves. I know you likely went out of the country in order to save money on your smile makeover. This is often called dental tourism. It works sometimes, but not as often as is safe for people to risk.

Your dentist lied to you. The redness and swelling is not normal. Because your underlying problem is the veneers, the first order of business is to find the underlying cause of the problem. If you don’t fix that, not only will you have the irritation, but it will lead to gum disease. Here are a few possibilities:

  • The margin between your porcelain veneers and your teeth are supposed to be completely seamless as well as smooth. Without that, there will be an overhang. It will catch food debris. This will become a breeding ground for bacteria and infection.
  • The veneer can be overcontoured at the gumline. That means there is an extra bulge in the veneers at the gumline, that also traps food debris and bacteria.
  • Your dentist could have left hardened cement that hasn’t been cleaned off the tooth. This will leave a very rough surface there, which will cause irritation. This one would be the easiest to solve.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.
Click here to learn about sleep dentistry.

CEREC crowns

Should I Change Away from CEREC?

I needed a dental crown on a front tooth that I broke, but needed to leave town in two days. My dentist suggested a CEREC crown. I agreed. The crown was done and I left town. The very next day, my crown fell off. I was in another state and had to see an emergency dentist. He looked at it and told me that whoever did my crown did not bond it on properly. He fixed it and I was able to finish my trip. I did notice the color was off, but this was true from the beginning of the crown, not because it fell off. I talked to my dentist about this situation and he agreed to do the whole thing over. After some research, I am thinking that this dentist may be in over his head. Should I go to a traditional crown instead of CEREC?

Lindsey

Dear Lindsey,

block of porcelain for a cerec crown.

CEREC crowns are wonderful and convenient, but they’re not the best on front teeth. This is because they are milled from a single block of porcelain. That means they will not have those subtle variations in opacity and color that your natural teeth will. On teeth that are not directly exposed to light, such as our front teeth, that’s not a problem. They will still look natural and blend in. But, with front teeth, they will look flat. So, yes, I would go with the traditional dental crowns.

That being said, crowns on front teeth are difficult to match exactly even with traditional crowns, and your dentist does not inspire confidence in me. If he could not properly bond on a dental crown, which is one of the first things we learn in dental school, then I have my doubts that he has the skills to do this well.

However, if you want to give him a chance, I would tell him that you want him to try it on with a temporary try-in paste so that you can get a good look at it in a variety of lights and feel confident that it is what you want. Only then should he bond it on permanently. If you don’t like it, then he should go back and make the needed changes. He should be okay with this. Even skilled cosmetic dentists usually need two or three try-ins.

This blog is brought to you by Gilbert Family Dentist Dr. Matt Roper.
Click here to learn how he keeps dentistry affordable.

Emergency Dentist

Death from Tooth Infection

I have a toothache and went to see the dentist. He told me I had a tooth infection and needed a root canal treatment. I’m quite busy at the moment. I’ve had other infections, such as a sinus infection that I just sort of put up with and it eventually healed itself. I suggested this to my dentist and he said, and I quote, “That’s a good way to die.” Seriously?! Is he serious or just trying to scare me into getting the treatment?

Andrew

Dear Andrew,

Woman holding her jaw from a toothache

I am glad you wrote. I know it would be easy to feel like your dentist is using scare tactics to get your business. In this case, however, he is right. A tooth infection is different from other types of infections. With a tooth infection, the pulp inside the tooth dies. When that happens, even antibiotics won’t help because there is no longer any blood flow to get the medicine there.

In the meantime, the infection continues to spread. Your jaw is quite close to your heart, lungs, throat, and even brain. You do not want the infection reaching there. Each year, there are between six to ten deaths from untreated tooth infections.

The only way to get rid of an infected tooth is for a dentist to physically remove the infected pulp. That can be done with either a root canal treatment or tooth extraction. A root canal treatment will save the tooth. If you end up having to extract the tooth, then you’ll need to replace it. This is just for the sake of your appearance. It’s because the adjacent teeth will shift or tip into the empty space.

If you do end up needing a tooth replacement, I recommend a dental implant. It is the closest thing to a healthy natural tooth. However, if you get treatment soon enough, you should be able to just get a root canal treatment and not have to worry about that.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.

Porcelain Veneers

Did Getting Porcelain Veneers Harm My Baby?

Can you help me? I’m in a bit of a panic. I just found out I’m pregnant, but just a few weeks ago I had porcelain veneers placed. Someone told me that the dentist would not have done the porcelain veneers if he knew I was pregnant. Does this mean that by getting them placed I harmed my baby? Is there any way to reverse any damage I’ve done?

Catherine

Dear Catherine,

An image of a porcelain veneer being held up to a tooth.

The first thing that I want you to do is take a deep breath. In the case of porcelain veneers, your baby is completely safe. Dentists are taught to avoid dental work in the first trimester of a woman’s pregnancy because the baby is more susceptible to substances at that point. Most women don’t know they’re pregnant for quite some time through the first trimester, so you’re not the first mom to have work done without knowing they were expecting.

The only medication used during the porcelain veneers procedure is a local anesthetic. These are the safest medications around. In fact, one of the most common of the local anesthetics is Lidocaine. This has been used countless times not only during pregnancies, but even during the deliveries. You don’t have anything to worry about.

Looking ahead, it is important that you keep up with your dental care, especially during pregnancy. You don’t want to develop a tooth infection. Not only will that lead to the need for emergency dental care, but any infection you have your baby will deal with as well. I would schedule your cleaning and check up for the time period during your second trimester. Once you hit the third trimester, you are not only a bit larger, but you have a whole other human pressing down on you. Because of that, you will not be as comfortable in the dental chair as you would like. The second trimester tends to be the most comfortable for expectant moms.

Congrats on the new blessing!

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.

Sedation Dentistry

Is Dental Sedation Safe?

I keep reading about how dental sedation can help someone with like me with severe dental anxiety. I was about to schedule an appointment, but then I read about a case where someone died because of sedation and the dentist was blamed. Is dental sedation really safe?

Emma

Dear Emma,

woman asleep in the dental chair from dental sedation

I think I know of the case you are talking about. In fact, if it is the case I’m thinking about (and it’s the only one I’ve heard of in years) a colleague of mine was actually called as an expert witness in this case. Before I go over the case for those who are unaware of what happened, I want to assure you that dental sedation is completely safe.

The Wrongful Death Case

The patient was a 270-pound female with extreme dental anxiety. I do not mention her weight as a means of being cruel. It is actually quite relevant to the case. She was given 1.0 mg of Triazolam. This medication is commonly used for dental oral conscious sedation. This is a pill, which the patient is instructed to take at a certain time before their appointment and will be taking affect by the time the patient arrives. When this patient arrived, she showed no signs of there being any issue. She entered without needing assistance and was able to communicate well.

However, once she was given the local anesthetic, something every dental patient is given during a procedure even if they don’t use sedation, things changed. She quickly became unresponsive. She was taken to a hospital where she later died.

The Iowa dental board asserted that the dentist gave the patient double the recommended dose of the sedation medication. The typical recommendation is 0.5 mg and she was given 1.0 mg. They accused the dentist of overdosing the patient. Here is why that is absolutely ridiculous and I’m dumbfounded as to why the board would even suggest it.

In order to establish the safety of a medication, the recommended does isn’t the standard for evaluation. This is because some drugs have a very narrow safety margin and even giving a tiny amount over the recommendation is dangerous, but for other drugs (like
triazolam) there is a HUGE safety margin.

I won’t get too technical, but if you want all the technical details please write again and I will give you all the data. The maximum safe dose of a drug is the LD-50, which is when 50% of the animals in the clinical trial died. Tested on mice, which are extremely small compared to even a normal sized human, the recommended does is no greater than 1,000 mg/kg. When you are talking about a woman who is 270 pounds, which is a little over 120 kg. That would mean she was safe to have up to 120,000 mg of the medication.

Obviously, the dentist didn’t give her anywhere near that. There was no overdose from the dentist. The coroner didn’t give an official cause of death, which is odd. The patient did have a history of drug use, so (and please understand I’m just wondering about this next statement, I have no documentation) I wonder if she’d taken something else along with the medicine her dentist gave her or if given her physical condition combined with the stress it was just too much for her.

Bottom line, dental sedation is very safe. In fact, patients with dental anxiety find that it completely changes their life for the better and they are finally able to get the dental care they need.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.
Click here to learn how he tries to keep dental care affordable.

Dental Emergency

Why Aren’t My Antibiotics Working?

I had what I thought was a sinus infection. My doctor just called me in an antibiotic because I get them all the time. However, I realized the next day that a tooth was seriously hurting. I figured the antibiotics would work either way, but they are not. The tooth felt better for a short period of time and then started hurting again. It hasn’t improved since. Are you supposed to take a different antibiotic for tooth infections than you would for a sinus infection?

Brandon

Dear Brandon,

Woman holding her jaw from a toothache

While I don’t know what type of antibiotic you used, that is not the main problem for why you are not healing. Antibiotics are used for tooth infections, but only to help get the infection under control. Antibiotics cannot cure an infected tooth. The only way to do that is for a dentist to remove the damaged pulp. Yours will begin to spread, which is why toothaches are considered dental emergencies.

There are two ways to do that. First, with a root canal treatment. This is the ideal option because it can save most of your tooth. The other way to deal with an infected tooth is to extract it. Once a tooth is extracted, it will need to be replaced.

If it is left as an open area, the other teeth will drift or tip into that spot, which will throw off your bite and lead to painful TMJ Disorder. Replacing the tooth, with a dental implant will protect your bite. It is also a very nice tooth replacement that will look, feel, and function just like your natural tooth structure.

Don’t put off getting this looked at by a dentist to get the right treatment. Tooth infections spread outside of the jaw. When lift untreated, they can become life threatening. People still die from tooth infections every year. Plus, the sooner you get in with your dentist, the better chance you have to save your tooth.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.
Click here to learn about sedation dentistry.

Emergency Dentist

Does a Tooth Infection HAVE to be Treated?

I have a tooth infection and my jaw is a bit swollen. Everyone is saying that I need to go to the dentist, but even though it hurts, I feel confident it will go away. I get sinus infections all the time and they go away with antibiotics. I have some left over that I’m taking, but my sister is driving me crazy about this and keeps telling me what I’m doing is dangerous. Can you tell her that it will be fine and will work itself out?

Murray

Dear Murray,

Man in pain, grabbing his cheek in need of emergency dental care.

Tooth infections are a bit different because at some point the pulp inside the tooth dies and then the antibiotics can not get to the infected part of the tooth. That infection spills out to other parts of the body. A dentist has to physically remove the infected pulp. There are only two ways to fully treat a tooth infection. The first is with a root canal treatment, which is ideal because it saves your tooth. The second is to extract the tooth.

While the antibiotics may help you feel better for a bit and hold the infection at bay, once they run out the infection will flair back up. People die every year from untreated tooth infections because they mistakenly believe it is no big deal.

If your jaw is swollen then yours is already spreading and you have a dental emergency. I do think that you need to see a dentist. Hopefully, a root canal treatment will be sufficient. If not, then you’ll need to extract the tooth. It will also be important that you replace the tooth as well. Otherwise the adjacent teeth will shift or tip into the empty space, which will end up causing your bite to be thrown off. If you do need to replace the tooth, I recommend a dental implant. It is the closest thing to having a healthy natural tooth.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.