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,
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.
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,
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.
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,
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.
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,
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.
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,
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.
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,
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.
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,
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.
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,
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.
My dentist said that I needed porcelain veneers because my teeth were discolored, one was a bit crooked, and I would sometimes grind my teeth. The whole process has been a nightmare. They keep popping off, even if I’m eating something as simple as a banana. I would say not a week goes by when one of them doesn’t come off. It’s crazy embarrassing, especially because the only thing left is a small nub of a tooth under the veneer. He does glue them back on, but I usually have to wait a day or two to get in. I think he should consider it an emergency and glue it back in that day. Is this normal?
Penny
Dear Penny,
No, this is not normal. It also sounds to me like your dentist provided you with dental crowns instead of porcelain veneers. Your teeth only have a minimum amount of surface of the front of the tooth removed for porcelain veneers. When you start talking about nubs, that sounds like dental crowns. You can see in the picture above the comparison of the two preparations.
Porcelain veneers are an advanced cosmetic procedure which requires significant post doctoral training to know how to do. Dental crowns, on the other hand, are taught to every dentist in dental school. Unfortunately, your dentist doesn’t even seem to know how to pull that off. My guess is (and please bear in mind that I haven’t examined you) that your dentist has over contoured these dental crowns and that is why they keep popping off.
If you’re grinding your teeth, you will need to wear a nightguard while you sleep to protect them, but that isn’t the problem with your crowns. When they are properly formed and bonded on they are secure. They certainly wouldn’t fall out from eating a banana. Yes, I agree with you that your dentist should fit you in the same day to bond that back on. Most dentists leave some room in their schedule for dental emergencies.
However, I think you need to have these crowns looked at by an expert cosmetic dentist. I’m concerned about the amount of crowns popping off. It may be you need these completely redone. If that is the case, don’t just ask for a refund. Ask for the dentist to pay to have this repaired by the dentist of your choice.
This blog is brought to you by Gilbert Dentist Dr. Matt Roper.
I had porcelain veneers put on my teeth to cover my tetracycline stains. I’d actually gone to another dentist to have it done quite a few years ago. One of them has recently broken horizontally. I went to see my dentist and he fixed it with some glue, but it looks like an obvious fix and feels uncomfortable on my upper lip. He’s said it will be a couple of weeks before we he can get to my temporary crown. I was hoping to get this fixed faster, but he said it isn’t a dental emergency. Do you recommend I try to get in to see someone sooner or will everyone make me wait?
Stephanie
Dear Stephanie,
There are a couple of issues here. While this situation isn’t your typical dental emergency, like an infected tooth, most cosmetic dentists would understand the importance of an aesthetic emergency. A second issue is his idea of giving you a dental crown. Why? Is something wrong with the tooth where it needs a crown? If not, then that would be a major overtreatment and completely unnecessary.
This can be repaired with another porcelain veneer. My guess is that your dentist does not have the training or skill to do porcelain veneers. They are an advanced cosmetic procedure. Instead of telling you that he is out of his depth and recommending a skilled cosmetic dentist, he is steering your toward a procedure that he is comfortable with. Every dentist knows how to do porcelain crowns.
My suggestion is that you go back to the original dentist who did your veneers and have him make you another one. If he is retired, then I would look for another cosmetic dentist in town who has training in porcelain veneers. Just make sure that they show you some examples of their work. They should have a smile gallery of cases they have done. If the results aren’t beautiful, then look for a different dentist.
This blog is brought to you by Gilbert Dentist Dr. Matt Roper.
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