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When Does a Tooth with a Root Canal Treatment Need a Crown?

I have a root canal treatment that has never been crowned. Recently, I read that is a mistake. Should I get this crowned? I used to have dental insurance, but now I don’t so I don’t want to spend the money if I don’t have to. What are your thoughts on it?

Bruce

Dear Bruce,

I’m very glad this question came up because I have seen some people just crown every tooth that had a root canal. In some cases that can do more harm than good. Much of the answer to this question will depend on which tooth you are talking about. If it is a back tooth, such as a molar, then I would say to crown the tooth. It will protect it from the type of biting forces those teeth face. With other teeth, it gets more complicated.

illustration of a a front tooth

The biting stresses on a front tooth and their adjacent teeth are mostly horizontal because of the tearing stress. This means the neck of the tooth is the most vulnerable. By the time you prepare a tooth for a dental crown, it loses a minimum of 30% of its diameter, putting additional stress at the neck of the tooth. If that tooth also lost a significant amount of structure before the root canal treatment because of decay, there will be even less structure there.

If you place a dental crown on a front tooth that doesn’t have the necessary diameter to support the forces it is subjected to, it could end up breaking at the gumline. Some dentists try to overcome this by placing a post in the tooth, though that can increase the chances of the root fracturing, which will require an expensive repair.

The issue with front teeth after a root canal is that they tend to turn dark, which becomes an appearance issue. Our smiles are one of the first things people notice about us so we want them to look as nice as we can. Here is my advice on how to keep its white color longer and what to do when it does turn dark.

Helping a Tooth with a Root Canal Keep its Color

Your dentist needs to thoroughly clean out any root canal material and cement from the crown of the tooth, these are huge contributors to the dark appearance. Next, he or she should place a white fiberglass post into the tooth. Fiberglass is more flexible and will help with the stress. Finally, fill the remainder of the open area with white composite filling material. Doing this will extend your tooth’s color.

If it does eventually turn dark, instead of crowing it, I would suggest a porcelain veneer placed on that tooth. That removes far less structure, which will be better for the tooth viability in the long run.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.
We treat dental emergencies.

12 Shots of Novocain to Get Me Numb

I recently had a tooth extracted. The whole procedure was a nightmare. It took twelve shots to get me numb. I don’t know how a dentist can miss a spot that many times! Have you heard of this happening before? Is there a way for a dentist to find the right spot the first time so I don’t have to go through that again?

Paula

Dear Paula,

woman wearing nitrous oxide nose piece

While it is possible that your dentist missed the spot to numb your tooth over and over again, it is much more likely that you had some dental anxiety in the beginning which worked against your numbing medication. Then, as you were still in pain, your anxiety went up even more, creating a vicious cycle. There are too many dentists who do not realize the link between anxiety and the inability to get numb in the dental chair.

The simplest solution to this is to find a dentist who offers dental sedation options. It may be all you need is some nitrous oxide, which is administered with a nose piece, as in the image above. This can relax you enough to enable the Novocain to do its job properly. However, if your level of anxiety is super high, you will be better served with oral conscious sedation. This is significantly stronger, in fact, you will likely sleep through the entire appointment. Be aware though, that it is so strong you will need someone to drive you to and from your dental appointment. You will not be able to do this on your own.

Those who have dental anxiety have found that by using the appropriate level of sedation for stressful dental procedures, they are able to have stress-free as well as pain-free dental appointments.

Dealing with a Missing Tooth

You didn’t mention what tooth was extracted. In most cases, it will be very important to replace the tooth. This isn’t just for appearances sake, though that is important. Without that space being filled, the adjacent teeth will start to drift or tip into the empty space. This will throw off your bite, which can lead to painful jaw problems and even daily migraines.

The best option for replacing a single tooth is a dental implant. This is what I would recommend to a patient of mine.

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

CEREC Crowns Doesn’t Fit

I thought CEREC crowns were supposed to be more accurate because they are milled by a computer. I had a four-year-old crown break so I needed to get another one. I was in a hurry and my dentist just got the CEREC machine that is supposed to create your crown in one appointment. When I got the crown it was way too bulky. I came in again and she could see it was too big in spots. While she did grind it down in some of those spots, I am biting my tongue now every time I eat. Is this technology not what she painted it to be or is something else going on?

Mark

Dear Mark,

porcelain block for CEREC crowns

I think the problem here is more your dentist than the CEREC technology. First, she provided you with a dental crown that broke after just four years. They shouldn’t break, especially when they’re that “young”. That by itself tells me she struggles with some basic dental skills.

Now she has this great new technology. Normally, when you are preparing a crown with the CEREC machine, it is basing it off of a tooth that is already there and has been scanned into the program. Because your tooth already had a dental crown and now that was broken and gone, there wasn’t a previous tooth for her to base the crown on.

That being said, the software has the ability for the dentist to design a crown for a tooth that is no longer there. It’s fairly easy to shape the tooth using the software. The problem is she doesn’t know how to do that yet.

You have a couple of options here. The crown needs to be replaced. It also needs to fit so perfectly you don’t even know it is there. Nor, should you bite your tongue because of its fit. You can either have her provide you a traditional crown that is made in a laboratory, but again, I’m concerned that the last one only lasted four years.

Alternatively, you could just ask for a refund and go somewhere else to get your crown done. You may want to do this to make sure you get the right crown.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper. We’re open Saturdays.

Must I Go to an Oral Surgeon to Get Dental Work Done?

My dentist tried to numb me for two different procedures. Neither time worked. I’ve always ended up having to go to an oral surgeon and have my work done with an I.V. that knocks me out. That makes getting any dental care quite expensive. Am I condemned to spending a fortune and still not having healthy teeth? Have you heard of someone in my situation before? Is there a different solution?

Matt

Hi Matt,

Someone asleep from dental sedation

Yes, I think I know exactly what is going on here. The great news for you is there is a solution. One thing I’ve found is that patients with dental anxiety have trouble getting numb. Sometimes it will seem like the numbing medication is working but once the work starts, they can feel pain. However, if they can be relaxed with something like nitrous oxide before the Novocain is administered, then when they are relaxed give them the numbing medicine, it works almost every time.

Some patients have such a high level of anxiety that they need a stronger level of sedation. For those patients, I recommend oral conscious sedation.

For either of these, you will not have to see an oral surgeon. Just do an internet search for a “Sedation Dentist”. They are able to help you in the office, saving you a good amount of money. You will also find that if you use oral conscious sedation, your dentist will be able to do a lot more work in each sitting. This will allow you to catch up on your work more efficiently. In fact, you’ll probably sleep through all the work.

One thing to be aware of, however, is oral conscious sedation, though administered with a simple pill, is so strong you will need someone to drive you to and from your appointment.

Once you’ve caught up with your work, if you’re looking for a quick, inexpensive way to improve the appearance of your smile quickly, I’d consider teeth whitening. That one procedure takes years off the appearance of your smile.

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

How Much Dental Work Can be Done at Once?

I will be honest and admit that I have neglected going to the dentist for many years now. However, it has gotten to the point that I need to do something. I can see decay and a couple of broken teeth. I’m sure I need even more work than I think I do. In order to get this over with fairly quickly (you can probably tell dentists aren’t my favorite thing), how much work can be done in one sitting, so I can minimize the appointments?

Kirk

Dear Kirk,

Someone asleep from dental sedation

While each dentist varies from office to office in how much they’ll do at each appointment, you will find the dentists who are willing to do the most in one sitting are sedation dentists. There is a procedure, oral conscious sedation (OCS), that enables both the patient and the dentist to get through more work at a time. Some people have dubbed it sleep dentistry because they are so relaxed they end up sleeping through the entire procedure.

There are many reasons patients avoid the dentist. One of the leading causes is dental anxiety, which can usually be traced back to a traumatic dental appointment. Having a means to experience stress-free and pain-free appointments with OCS has changed many lives.

Avoiding a Dental Emergency

Hopefully, you’ll find a sedation dentist fairly soon. I am especially concerned about the broken and decayed teeth. These can quickly turn into a dental emergency if the pulp of the tooth becomes infected. When you think about how close your jaw is to your heart, lungs, and brain, you can see how a simple tooth infection can turn life-threatening.

People tend to underestimate the seriousness of toothaches, which is why even in the twenty-first century we still have people who die from a tooth infection.

I’m not saying this to frighten you. I just want you to recognize, if the tooth starts to feel pain or if a pimple develops on your gums, both are signs of an infected tooth and you will need to be seen as soon as possible.

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

This Dentist Doesn’t Understand Tooth Infections

I had a tooth infection and went to see a dentist. It’s my first time with this dentist. To be honest, I usually avoid dentists but this one couldn’t be helped I was in so much pain. He gave me and antibiotic and I started to get better, but now I’m worse again. Do I need a second round or did I have the wrong antibiotic?

Leslie

Dear Leslie,

A woman grabbing her jaw in need of an emergency dentist

Either there is some miscommunication between you and your dentist or he has a profound lack of understanding of how dental infections work. An antibiotic is only useful to hold off a dental infection. It won’t cure it. In order for a tooth infection to be completely treated, a dentist has to get in there and physically remove the infected pulp. This can be done by a root canal treatment or by extracting the tooth completely.

It is always better to try and save a tooth, so a root canal would be my first recommendation. If your dentist didn’t tell you this would be necessary and just prescribed you antibiotics and sent you on your way, I would consider this gross negligence on his part.

Yes, you would start to feel better after taking the antibiotics, because they were doing their job. Once they ran out, however, because the infected pulp is still there, it rears its ugly head again. This will continue to spread and what was a dental emergency can turn into a life-threatening emergency rather quickly. This is because your heart, lungs, and brain are all close to your jaw. This needs to be treated.

Dealing with Dental Anxiety

I noticed you said you usually avoid dentists. That is a common issue, especially with patients who suffer from some dental anxiety. If that is you., one step you can take that will help is to see a sedation dentist when you go in for your treatment. They can provide you with a pill that will completely relax you, allowing you to get the dental care you need in an anxiety-free and pain-free way.

Please don’t put this treatment off. It’s important. Sadly, people still die from tooth infections.

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

Dentist or Oral Surgeon?

I’m going to honest and just admit I avoid the dentist. I had a filling fall out. I avoided the dentist. Then I needed a root canal treatment. I did get that, but it was rather traumatic. So, I didn’t go back for the crown. Now my tooth was hurting so badly that I had to go to a dentist again. Though I did go to a different dentist. He told me the tooth is too far gone and needs to be removed. However, he said it’s extensive enough that I may consider an oral surgeon because he’d have to cut through both gum and bone. I like the idea of it not costing as much going to the local dentist, but wonder if it’s not safe and that’s why he mentioned an oral surgeon.

Patty

Dear Patty,

Someone asleep from dental sedation

I hate it when dentists say stuff like this. It makes patients uneasy. They wonder if they’re being unsafe choosing the more financially feasible option for them. I don’t know if your dentist phrased it that way because he’s uncomfortable with the procedure and he was trying to steer you another direction or if he’s perfectly comfortable doing it and just giving you non-opinioned options.

I’d ask your dentist a few questions before making a decision:

  • How comfortable does he feel with the procedure?
  • Has he done this type of extraction before?
  • What type of sedation does he offer?
  • What are the roots like? Straight and tapered or twisted with knobs?

The Importance of a Sedation Dentist for You

Based on what you’ve described of your oral hygiene habits, you have dental anxiety. It’s not uncommon. However, it wreaks havoc on your oral health, as you’ve discovered. If you were comfortable going to the dentist when your filling first came out, you wouldn’t be facing this difficult extraction and then facing pricey tooth replacement options.

Dental Sedation will change your life. However, at your level of anxiety (and especially for your extraction procedure), you will need something stronger than just nitrous oxide. You will need oral conscious sedation. This is strong enough to allow you to sleep through the procedure.

You will be able to have stress-free dental appointments from now on and even get all your teeth back in shape.

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

Can’t Afford Pediatric Dentist; Are General Dentists Cheaper?

There are two pediatric clinics in our area. One has a great reputation but is expensive. The other is cheaper and where all the low-income families go (we’re low-income ourselves), but has a horrible reputation and I don’t know a child who likes it. I don’t want to send my son there. Would a general dentist be less expensive? Do they take children?

Bea C.

Dear Bea,

Four Smiling Children
Finding Affordable Pediatric Dental Care

We want the absolute best for our children. Few things are more discouraging than when we can’t afford it. However, being low-income doesn’t mean you can’t find affordable dental care, even pediatric care. Let me answer your two questions separately.

Are General Dentists More Affordable than Pediatric Dentists?

It depends. Each dentist determines his or her price independently. You may have some specialists which are significantly more expensive than your average general dentist. At the same time, you could have some who want to keep their prices down so affordable specialty care is available.

As you don’t have many options when it comes to pediatric care in your area, you have a couple of options. You may want to talk to the good pediatric clinic to see if they have affordable payment plans. Even if they don’t have in-office plans (like Dr. Roper does), many are willing to work with Care Credit, which is a medical card that offers low and even no-interest payment plans.

Do General Dentists See Children?

Again, it depends on the dentist. There are general dentists who enjoy working with children. They’re qualified to treat them and even had to do a pediatric rotation during their training. If ever something came up that required more of a specialist, they could give you a referral.

I’d start by talking to your dentist. It’s always convenient for the whole family to attend the same clinic together. There’s a medical advantage as well. The dentist will have a fuller picture of what your child’s genetic leanings will be when it comes to oral health.

If mom and dad are prone to decay even with good oral care, the dentist will know to keep a closer eye on the children’s teeth, which tend change quickly so they don’t end up with sudden large decay which could have been dealt with sooner.

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

Will an Emergency Dentist Bill a Venue for Me?

I’m in a bind. I’m a college student who grew up in a group home. Once I turned 18 I’ve been pretty much on my own. I went on a date where we went dancing. They had a platform which we were dancing on along with a bunch of other people. Apparently too many people because it collapsed. Outside of a few bruises and realizing my date cared more about his well-being than mine, I thought I was okay. But, this morning my front teeth feel loose. I don’t have a ton of money but I don’t want to lose my teeth. Would an emergency dentist charge the venue? I don’t know if I have enough to cover this. I don’t even know what “this” is.

Corra L.

Dear Corra,

A woman grabbing her jaw in need of an emergency dentist

First, I want to express that I’m sorry you’ve had to grow up in a group home. Hopefully, you have a good group of friends that help you feel you have some back up in this world. It is important that you see an emergency dentist. In the meantime, be sure not to wiggle them. I know it’s tempting, but you risk snapping your ligaments, which will derail your efforts to save the teeth.

I’m going to start by telling what to expect when you see an emergency dentist. They’ll check the tooth along with x-raying it to make sure no damage is done to the pulp. IF the pulp is damaged, you’ll need a root canal treatment and dental crown. Because you’re talking about your front teeth, be sure they only give you all-porcelain crowns (as opposed to the metal-based crowns). They look more natural and you won’t have to worry about a gray line developing at the top of your gumline.

If the pulp is fine, they’ll just need to splint your loose teeth to some stable teeth. It may just be a matter of giving the ligaments time to heal.

Affording an Emergency Dentist

Unfortunately, the dentists will not be able to bill the venue. Dentists can only bill those receiving the service or their guardians. However, save every receipt for every scrap of money this costs you. I’m sure they’ll be a lawsuit of some kind given that people were hurt and you’ll probably get the money back.

Even though the dentist can’t bill someone else, it doesn’t mean you’re trapped and can’t get the help you need. Most dentists went into the field because they wanted to help people. In fact, there are affordable dentists who will be willing to work with you. I believe, you especially, given your unique circumstances, will find dentists compassionate.

Some have in-house payment plans. Others use Care Credit. Either way, you should be able to get the care you need and then pay it out.

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

Do I Need a Special Dentist for Invisalign?

I want to get my teeth straightened with Invisalign. Do I go to a special dentist like an orthodontist or cosmetic dentist or will my regular dentist do?

Charles I.

Dear Charles,

A woman placing her Invisalign aligners

There are certain things which require a specialist, but Invisalign isn’t one of them. In fact, not even cosmetic dentistry is a recognized specialty. Any general dentist is technically allowed to call themselves a cosmetic dentist. Obviously, a patient needs to be cautious about getting an advanced smile makeover done by just any dentist because skills vary from dentist to dentist, so you’ll want to check out why type of results they get before committing.

Even though orthodontist is a recognized specialty, a general dentist can do braces and other orthodontics if they’ve invested the time in training. Many have, and many patients find they save money by going to their family dentist for their braces.

Invisalign is different from all of those procedures. The treatment plan and design of aligners is done by computer with a special software program designed to make your treatment plan as efficient as possible. Results are likely to be the same across the board no matter which dentist you go to for treatment. If your dentist offers Invisalign, you’ll be safe to get it done from him (or her).

Bear in mind, not everyone is a candidate for every procedure. If you’re not, you have options.

Options to Invisalign

  • Traditional Braces: Most people are a candidate for Invisalign. Every so often, though, we run up against a case that has much more severe issues than normal with their bite. In that case, traditional braces may be the better route for you.
  • Porcelain Veneers: If there are more things you’re interested in changing about your smile than just some orthodontics, a smile makeover may be just the thing. While these won’t actually straighten your teeth, they can be designed to make your smile look straight. Additionally, they can change the shape, size, and color of your teeth at the same time.

I hope this helps. Talk to your dentist about your goals. Together you can come up with all your best options.

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