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How Much Do I Need for a Smile Makeover?

I am a tad confused about something and hope you can help clear some things up. I want to get porcelain veneers but in order to do that, my dentist is insisting I also get teeth whitening and Invisalign first. I was under the impression that porcelain veneers can make your teeth look white and straight. My teeth aren’t really crooked enough to justify a full orthodontic case. I just have one front tooth that crosses over the adjacent tooth. Have I misunderstood this completely?

Theodora

Hi Theodora,

Porcelain veneer being added to a tooth

Let’s start with the teeth whitening. Whether or not this is useful to you depends on how many veneers you are getting. Very few people can afford to get a porcelain veneer placed on every tooth. That means the other teeth may need some whitening done in order to match your porcelain veneers. Most smiles are 8-10 teeth wide. If you’re only getting four or six veneers, you’ll want to whiten your teeth first to have everything blend naturally. The same goes for your bottom teeth. I doubt you want to spend money to veneer your bottom arch. In most cases, people get enough veneers on their top arch to have a beautiful smile and only whiten the bottom arch.

The Invisalign is a completely different story. Given the scenario you described to me, I don’t think you need orthodontics. Porcelain veneers done well can take care of that issue. The fact that your dentist is suggesting Invisalign tells me that he or she is not comfortable reshaping your teeth for the procedure. Don’t force his hand. Instead, find a cosmetic dentist who has done this lots of times and will be skilled getting it done.

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

Dental Flippers for Toddlers

I would love some advice from you. I have a three-year-old who lost his front teeth due to a nasty fall that caused some nerve damage. I am really worried about his other teeth shifting into the open space. I asked our pediatric dentist for a dental flipper for him and he acted like I was insane. I know we’ll have to cover the cost because he’s on Medicaid and they hardly cover anything and I don’t mind paying. However, the only do-it-yourself ones to purchase online are only for adults. Do you know where I can get one for children?

Beatrice

Dear Beatrice,

Toddler in a dental chair

I am glad that you are trying to be proactive about your child’s teeth. There are situations where teeth are at risk to shift into the empty spaces, but that is with back teeth, especially the molars that need to stay in place until your child is twelve years old. With the front teeth, there really is not the same risk. Let’s say that he did have a back tooth come out. You would not use a dental flipper, however, for a couple of reasons. The first is it is removable. When you are dealing with a toddler, they will have a hard time keeping it in, which means it can’t do its job and they are likely to lose it. It can also be a choking hazard. A second issue will be how much he will be growing, which includes his jaw. You’d have to get a new one way too often. Instead, when a child loses a back tooth, we use a space maintainer. This is not removable by the child and will serve him for many years.

Though your dentist was correct about not getting a dental flipper, I am not convinced that he is serving you well. As a parent, it is your responsibility to look out for the best interest of your child. That includes asking questions about treatments. He should not have made you feel foolish. You may want to consider looking for another dentist. It does not have to be a pediatric dentist. There are family dentists who work very well with children. Then your whole family could attend the same clinic.

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

Can a Dental Flipper Make Teeth Look Straight?

I have crooked teeth but feel I am too old for braces. I’ve heard about a dental flipper that can snap onto your teeth and make them look straight. Will this really work?

Theresa

Dear Theresa,

A dental flipper

A dental flipper

I think whoever told you this had a dental flipper confused with the snap-on smile. A dental flipper is used to replace a missing tooth. It does not fit over a tooth. In case someone reading this is looking into tooth replacement options, a flipper is considered a temporary replacement. It’s inexpensive and people use it to give themselves a “tooth” while they save up for a permanent replacement, such as a dental implant.

Having a Straight Smile Without Braces

Snap-on Smile is something that will snap over your teeth in order to make them look better. They will not look stunning, like they would with porcelain veneers but they will look okay. They are more suitable for something like a photoshoot or one-night class reunion. They are made of acrylic and would need to be replaced every few years.

An image of Invisalign aligners

These days we have better options than ye olde fashioned traditional braces. Now, there is Invisalign. Instead of metal wires and brackets, it uses clear aligners. These are invisible, even at a conversational distance. These are more comfortable than braces and work in significantly less time.

You can go with the snap-on smile and it will give you a decent temporary solution. My suggestion, however, would be to plan long term and get Invisalign. It has an additional hidden benefit of enabling you to whiten your teeth at the same time as you straighten them. The aligners can double as teeth whitening trays. It is like getting a mini smile makeover at a fraction of the cost.

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

Can’t Afford Wisdom Tooth Extraction

I have a back, lower wisdom tooth that cracked some time back. Since then, I’ve been having problems with it falling apart little by little. More and more pieces are falling off. I don’t think there is any more pulp but the tooth is sensitive. I’m wondering if I can just let this slowly fall out by itself or if I have to go to the dentist to have it extracted. I’m dead broke so am hoping I can avoid the dentist. I lost my business during COVID, then got a job with another company and they’ve recently had to shut down as well. What do you think?

Paul

Dear Paul,

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

I am sorry for all the losses you have sustained during COVID. Losing something you built up yourself is heartbreaking. Compound that with the stress of not feeling like you can afford the care you need and I really feel for your situation. There are a couple of ways this can go. First, it is possible that the tooth will just slowly fall out on its own with no problems for you. However, there is also a possibility that an infection will get into your bone and cause pretty serious problems.

One thing that confuses me about your description is the idea that you don’t think there is any more pulp but the tooth is sensitive. If the infection got into the pulp then the tooth should be dead and it would not be sensitive, unless you are talking about sensitivity to when you are biting down instead of being sensitive to air.

Given your financial situation, here is what I am going to recommend. As long as you don’t have any swelling around your jaw, you are safe to wait this out and hope the tooth dies away on its own. If you start to have swelling, then you have an emergency dental situation and you need to see a dentist as soon as possible.

There are affordable dentists who would be willing to work with you on the payment issue. This would be especially true for someone in your situation who needs real help.

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

In Pain After Dental Work in Mexico

I need some advice and am wondering if I have a dental emergency on my hands. I went to Mexico to save some money on my dental care. They gave the three crowns in all. One of the crowns fell off after a few days, so I made the trip back to have it fixed. Then, they told me it needed a root canal treatment in order to have the crown replaced. When I asked why they didn’t do that to begin with they said root canals only work sometimes so aren’t worth it unless there is a problem. It sounded like they were trying to save me money before so I agreed to the root canal treatment. Now I am in massive pain and the tooth is really sensitive. I called them back and they said I would need to come back in. Now they are saying the tooth is cracked and I will need to extract it and get a dental implant. If it wasn’t cracked before does that mean they cracked it when they did the root canal? Do I go ahead with this extraction and replacement? I’m starting to lose confidence in them.

Bryce

Dear Bryce,

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

STARTING to lose confidence in them? I lost confidence back when the dental crown fell off. Properly bonding on a dental crown is a pretty basic dental procedure. Even the worst crowns should last a minimum of five years. Yours did not even last a few days. As for their root canal treatment, the excuse that they don’t always work does not wash with me. While root canal failure is a thing, if your tooth is infected you need a root canal treatment. Period. However, I don’t think you needed one. You gave no indication to me that you were in pain, which is one of the signs of an infected tooth.

I think you were given an unnecessary root canal. Not only that, they didn’t finish it. If they had, you would not be in pain. You can only have sensitivity in a tooth if there is still some viable tissue. A root canal treatment is supposed to remove all the inside tissue. Obviously, they didn’t. Now they are saying the tooth is cracked and you need to replace it. Even if it is true that the tooth is cracked, that does not make it unsavable.

I would not let these people anywhere near your teeth for even a second. I don’t know what the laws are in Mexico for patient recourse in these situations, but you may end up just having to cut your losses. If you are in pain, and it sounds like you are, I’d like you to schedule an urgent dental appointment with a dentist here in the United States. Get a true evaluation of this tooth and see where you stand. Then we’ll have a better idea of how you can get this healed.

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

Should an Oral Surgeon Do This Extraction?

I had a tooth that I neglected years ago because of a phobia I have with dentists. When the pain became too much to bear I went to see somoene who did a root canal treatment. As expected, the appointment was a nightmare. I did not follow through with the dental crown and neither did the dentist. At the time, I considered that a blessing. Now, the tooth is so far gone that it broke. I went to see a different dentist and he said it is infected and needs to be extracted. He gave me two options because of the state of the tooth. I could do it with him using a local or with an oral surgeon using anesthesia. I was tempted to go with the anesthesia because at least it would be pain free. But, the cost is way more than I can do and the oral surgeon wants payment up front. Here is my question. Am I putting myself at risk by doing this with the dentist? If so, I guess I could try to get a loan to use the oral surgeon.

Dennis

Dear Dennis,

woman asleep in the dental chair from dental sedation

There should not be a reason that a dentist could not do this extraction for you in complete safety. However, that does not mean the dentist you saw is qualified or comfortable doing it. The fact that he suggested an oral surgeon tells me he is not. Plus, given your dental anxiety I do not think a local alone will be enough.

My suggestion is that you see a sedation dentist. They can provide you with oral conscious sedation. This is administered by a pill but strong enough where you can sleep through the entire procedure pain-free. Be aware that you will need someone to drive you to and from your appointment.

The really great news is people in your situation, with anxiety of the dentist, have found that using dental sedation has changed their lives. They’re not only able to get the help they need without fear, but are able to stay on top of their dental care from then forward.

I hope this gives you some confidence.
This blog is brought to you by Gilbert Dentist Dr. Matt Roper.

Dental Sedation with Wisdom Tooth Extraction

My 20 year old has an impacted wisdom tooth. The dentist thinks they will have to remove some of the bone. He wants her to go under general anesthesia for the procedure. Is this necessary because of the bone? I’m uncomfortable with using anesthesia unnecessarily. There are so many risks and we have a relative with serious complications to anesthesia. What would your recommendation be?

Kelly

Dear Kelly,

Someone asleep from dental sedation

Bear in mind I haven’t examined your daughter. However, at her age I would be very surprised if general anesthesia was warranted. With a twenty year old, the bone is still very pliable because there is not really any cementum accumulation at the roots. She is in the ideal age range to have her wisdom teeth extracted. As she ages, that cementum builds up and makes the procedure more difficult with a greater risk of complications.

My recommendation would be oral conscious sedation. This is sometimes called sleep dentistry. However, don’t push your dentist into that. His suggestion signals to me he is not completely comfortable with the procedure. Your daughter would be much better served finding a dentist who is experienced and confident. To find that dentist, simply do an internet search for “Sedation Dentist”, find out if they do wisdom tooth extractions, then schedule a consult with them.

If they recommend general anesthesia as well, there may be some complicating issues the first dentist did not explain to you. My guess is your second dentist will think oral conscious sedation will be perfectly sufficient.

There are always additional risks with general anesthesia. With your family history, it seems like that risk is higher. I’m with you on this one and would not want to jump into that unless it were absolutely necessary.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.
Click here to learn about our emergency dental services.

Is a Cracked Crown a Dental Emergency?

I have five porcelain crowns. They have served me well for just over 15 years. With one, there has been a slight defect in it from the beginning. It was never before visible, but could only be felt by my tongue. Lately, it has changed. I can now see it and it feels more like a crack. I am assuming I have to replace the crown, which I am fine with. I am just wondering if it requires an emergency appointment. I don’t want it to break in public.

Allie

Dear Allie,

Gilbert CEREC Crown

While I would not consider this a dental emergency, I would not put it off either. Based on the changes you described, I would expect it to go sometime soon. It has had a good life. Given the amount of time you’ve had all of these crowns, I would expect that others will start to show their age soon too. You have a couple of choices here. You could replace the dental crowns all at once, or you can just replace them one at a time. There are benefits to both.

If you get them done all at once, you will be done with it. Though, of course that is a bigger chunk of money at once. If you do them one at a time, you can pay a little at a time, but you will be making trips to the dentist more often, possibly at unexpected and inconvenient times. It really is six of one; half a dozen of the other. It’s just which inconvenience is the least problematic for you.

One thing to be aware of is that you don’t want a dentist saying you have to replace them all at the same time in order for them to match. That tells me the dentist does not have adequate cosmetic skill. Speaking of aesthetics. If you want to whiten your teeth, the time to do it is now before you have the new crown made. This way, the crown can be made to match the new whiter color. It is certainly not required. I just wanted you to be aware that teeth whitening only works on natural tooth structure so the crowns themselves will not whiten.

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

Traumatic Tooth Injury and Dental Anxiety

I took a pretty bad fall and now two of my teeth are starting to turn black. Is there something that can be done to help this? I have to tell you I haven’t been to the dentist in two years because I have horrible dental anxiety. The last time I went the teeth were healthy.

Brooke

Dear Brooke,

woman asleep in the dental chair from dental sedation

When a tooth turns black after an injury, it means the nerve inside the tissue of your teeth has died. The treatment for this will be a root canal treatment. Then a dental crown can be placed over the tooth to both protect the tooth and to improve its appearance.

I do understand that you are not comfortable at the dentist and have some dental anxiety you are dealing with. I want to make sure you know there are dentists who work with anxious patients. By seeing a sedation dentist, you can have a completely anxiety-free and pain-free dental experience.

Most dentists offer two levels of dental sedation: nitrous oxide and oral conscious sedation. Nitrous is sometimes called laughing gas. It doesn’t actually make you silly as it does give you a relaxed, floaty feeling. This is often enough for some patients to have an easier dental experience. It has the additional benefit of allowing you to get on with your day immediately following your appointment.

If your anxiety is stronger, and for some it is debilitating, then I would suggest oral conscious sedation. This is so strong that some call it sleep dentistry because you are so relaxed you can sleep through your appointment. The only real downside is that, because of its strength, you will need someone to drive you to and from your appointment as well as stay with you for a few hours after your appointment until you are lucid and steady on your feet.

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

Options for a Tooth Gap

I have an 8mm gap in my front teeth. My dentist is suggesting I get Lumineers to fix that but I’m a bit nervous about that. I see the Lumineers have mixed reviews. Are there other options for me that do not include 3 years in metal braces?

Cameron

Dear Cameron,

An image of Invisalign aligners

Whatever you do, please do not allow your dentist to do Lumineers on your teeth. For one, 8mm is enough space for a whole other tooth. This is a very complicated case for any brand of porcelain veneers and you are correct that Lumineers is touch and go at best. This is due to two factors.

1. They are highly advertised to inexperienced cosmetic dentists. You would need one of the top 1% of cosmetic dentists for your particular case.
2. The company that owns Lumineers insists dentists use their lab, which is not known for having excellent results.

My suggestion would be for you to get Invisalign. This can straighten your teeth and close that gap in half the time of traditional braces. Not only that, they can do it invisibly. There are no metal wires and brackets. Instead, Invisalign uses clear aligners. These are much more comfortable and, because they are removable, it is simple for you to brush and floss your teeth.

They have an additional hidden benefit of allowing you to whiten your teeth at the same time. This is because the aligners can double as teeth whitening trays. It is like getting a mini smile makeover at a fraction of the cost.

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