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Dental Emergency

What I Do? The Emergency Dentist Perforated My Sinus

I’m in massive pain and I no longer trust the dentist I went to see. I had a molar that was killing me. I went to see an emergency dentist. He said my mouth was in pretty bad shape and he couldn’t tell which molar was the problem. He suggested I have both extracted. I was in so much pain I would have agreed to have my jaw removed at that point. There didn’t seem to be any problem taking out the molars and I went home feeling a smidge better, but still in pain. I thought it was just healing from the procedure. A few days later, I started feeling weird pops and growing achy. I called their office. Not only did they not tell me that anything went wrong during the procedure, but they just suggested I take a decongestant. Not much longer I developed a fever. They called in an antibiotic for me, but I insisted on coming in for them to look. They complied. It wasn’t until I go there that they mentioned my sinus was perforated during the extraction. I was really upset I wasn’t given that information. It seems kind of important to know I now have a hole where I shouldn’t have one. They even pulled some bone fragments out of the area. The problem I’ve got is I’ve finished the antibiotics and I still feel horrible and still have a fever. As I said at the beginning, I don’t trust this dentist anymore. What do you recommend?

Peggy A.

Dear Peggy,

Gilbert Emergency Dentist

There were some serious mistakes made here, so I don’t blame you for not trusting this practice any more. In the first place, while perforations do happen, there are very specific and important protocols which should have been taken. At the very least, he should have told you in order to warn you not to do things like blow your nose, which could derail any healing process.

Then, the incompetence of not clueing into the possibility that you had an infection when you called the first time is beyond me. Plus, it sounds like he placed you on the wrong antibiotics. You should have been significantly better within two days.

This needs to be addressed. First, talk to your doctor about what’s going on. He can get you on the correct antibiotic and arrange for you to have an emergency ENT (Ear, nose, and throat) appointment. They should get you on the road to recovery soon.

I’m guessing the reason you went to an emergency dentist to begin with is because you don’t have a regular dentist whom you see. Generally, that happens when a patient has dental anxiety. If that’s you, I wanted to give you some hope. When you start looking for another dentist, I’d like to suggest you try someone who uses dental sedation. This can give you a pain-free, stress-free appointment. I think it will help you feel comfortable going more regularly.

One of the best thing about most sedation dentists is they don’t judge or lecture. They’re used to working with fearful patients and are very compassionate.

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

CEREC crowns

Will CEREC Crowns Hold Up as Well as Regular Crowns If I Grind?

My dentist just got a CEREC machine and wants me to get one for my new cavity. I’m a little concerned it won’t hold up as well as regular crowns. I tend to grind my teeth at night. Is he wanting me to get these just to try out his machine or are they legitimately strong? I don’t want to waste money.

Greg L.

Dear Greg,

Gilbert CEREC Crown

Both CEREC crowns and traditional crowns are equally strong. The biggest difference is one is milled by computer and can be completed during your appointment instead of having to be sent out to a lab to be completed. This eliminates the need for a second appointment or a temporary crown.

However, if you are a teeth grinder that needs to be addressed right away. Your crowns, whether traditional or CEREC, will not hold up to the stress the grinding places on them. Truthfully, neither will your natural teeth. It’s likely the reason you’ve had to have so many dental crowns to begin with.

Not only does teeth grinding wear down your enamel which leaves your teeth vulnerable to both decay and cracking, it also will cause jaw pain, headaches, and eventually TMJ. That can become serious.

I’m very surprised your dentist hasn’t recommended a night guard to protect your teeth. As soon as your crown is completed, you need to be fit for a custom nightguard. You won’t be able to stop grinding your teeth, especially if you do it mostly in your sleep. However, the nightguard protects them from the stress of the grinding.

After that, a well made dental crown can last upwards of 15 years.

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

Sedation Dentistry

Can I Still Get Dental Sedation If I Take Anxiety Meds?

I’m on two medications. One for depression and one for anxiety. I want to get sedation when I have my dental procedure done but I’m worried they won’t let me. Can you tell me what sedation medications they use so I can make sure it’s fine with my medication? I’m afraid if I tell them about the meds they’ll send me away.

Lisa W.

Dear Lisa,

Dental Sedation

The problem with your request is two-fold. One, every dentist uses different sedation medication so there would be no way to know whether or you’d be checking the right medication. Second, your dosages make a difference as to how much the dentist can give you. I know you’re worried about being sent packing, but that won’t happen.

Dentists who deal with anxious patients are used to patients on multiple medications. The only thing you’ll need to do is schedule a consultation with your dentist so he or she can make sure whatever they use will work well with what you’re taking.

If what they use would interfere they will either change what they use or make arrangements with another dentist who prefers the other medicine to work with you.

Dental anxiety is common and you shouldn’t feel embarrassed by it, but what you’re doing is brave. You’re facing your fears to get the treatment you need. That puts you ahead of many patients who can’t do that and then end up with a dental emergency.

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

Affordable Dentistry

Do Affordable Dentists Always Price Gouge?

I haven’t been to the dentist for about three years because of unemployment. I’m still unemployed, but just felt like it’d been too much time and I needed to at least get a cleaning. I specifically looked for an affordable dentist. Yet, when I went there I felt like they nickled and dimed me for everything. Not only did they do the more expensive “deep cleaning” but they charged me for a fluoride treatment, and dental sealants. They’ve also asked me to come back in two weeks. How can I possibly do that after being out so much money today? Is this what I can expect from “affordable” dentists?

Luisa M.

Dear Luisa,

First, it’s impressive that you’re making such an effort to get dental care when you’ve been struggling with unemployment for so long. It shows you care about your oral hygiene. The deep cleaning can be typical, especially if you haven’t been to the dentist in a while. The fluoride treatment is useful, but optional. It helps kill bacteria. However, they should have asked.

One thing that puzzles me is the dental sealants. Those are usually placed on children. And, it is something they should definitely have asked about before placing them. In fact, generally an office goes through any procedure to make sure you understand the charges and agree to them before you start. I’d contest the sealants and fluoride because they didn’t ask.

In future, I’d suggest you still look for affordable dentists, but ahead of time discuss what their payment policy is. Also, be clear with them that you want to approve any extras along with their costs before hand. Be aware that many dentists will let you pay out any necessary expenses to get the treatment you deserve.

The upside to getting the dental sealants is you won’t have to worry about cavities getting into the grooves of your molars.

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

Dental Emergency

I Think My Tooth is Crumbling

I had a root canal done. My dentist put in a temporary filling until I could do the dental crown appointment. I’m still a few days away from that. When I went out for a meal today I felt something grainy in my food. I think my tooth is crumbling. What do I do? I don’t want to lose the whole thing and not be able to get the crown.

Emily S.

Dear Emily,

My suspicion is it’s not your tooth crumbling, but instead the temporary filling dislodged. Take a peek at the tooth. If there’s a hole in the center of the tooth, that means you’ve lost the filling. If the shape of the tooth is changing, then the tooth is crumbling.

If it’s just the filling, don’t worry. They’re designed to come out easily so the dentist can do the needed work in time. As your appointment is only a few days away, you can just get some temporary filling material to hold you over until your appointment. It’s designed for people in just your situation. It wouldn’t last for more than a few days, but as you’re going in for your dental crown at that point, no problem. You can find them at most drug stores.

If it’s the tooth, that’s an entirely different situation. You’ll need to be seen right away. Like you said, you don’t want to lose so much tooth structure that you’ll have to get an extraction and replacement tooth. Your dentist should have an after hours protocol. Give them a buzz and there should be instructions on their voicemail.

If they don’t have an after-hours call number, then just see an emergency dentist. They’ll make sure your tooth is protected so you can still get your crown.

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

CEREC crowns

Why Does My CEREC Crown Look Like a Piece of Chicklet Gum?

My dentist got in this new CEREC machine. He was so excited. In fact, I remember him talking about how he couldn’t wait to get it at my last appointment. So, when I needed a crown, he was almost giddy. He’d get to use his new toy. I was happy for him and happy about only needing one appointment. But, when I got the crown, it’s way whiter than the rest of my teeth and looks like a rectangular piece of Chicklet gum. I can’t believe my dentist was so excited about this. Is that was CEREC crowns always look like? I wouldn’t mind if it were a back tooth, but it’s a front tooth and very distracting.

Cyrill K.

Dear Cyrill,

I’m sure you’ve heard the phrase, “The only difference between men and boys is the size of their toys.” It sounds like your dentist was as joyful as a boy at Christmas with his new CEREC machine. While it is the CEREC which mills the crowns, it’s the dentist who designs the crown.

If your crown looks like unnatural, it’s not because it’s a CEREC crown. It’s because your dentist isn’t a skilled cosmetic dentist. Have you tried telling him how unhappy you are with the crown? He might be willing to re-do it, especially if it means he gets to use his new machine again. Or, he may give you a refund.

If the color difference is the only issue, you may want to consider whitening the surrounding teeth to match the crown. Any teeth whitening you do will not affect the crown. It only changes the color of natural tooth structures. However, you mentioned the shape being different from the other teeth too, so re-doing it is the only thing which will fix that.

If for some reason he refuses, you may want to get a second opinion on the crown. If it’s obviously mismatched to the surrounding teeth, that dentist could put pressure on him to refund your money. Dentists care about what their peers think of their work.

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

Sedation Dentistry

Can I Have Dental Sedation If I’m on Medication for PTSD?

I’ve served in the military for 12 years. I loved my service and the military dentists did the best job they could, but they’re designed to do patch jobs and get us back into service as quickly as possible. A lot needs to be fixed with my mouth, functionally and cosmetically. Unfortunately, I’m being treated for PTSD. If there are people over me, I lash out. I’m going to need sedation dentistry, but don’t know if I can with the PTSD meds I’m on. Any advice?

Allen H.

Allen,

Up front, I want to thank you for your service. You’re keeping our family’s safe. I am beyond grateful. Our country owes you a debt. Don’t think for one second you’re not appreciated. Secondly, the fact that you’re getting treatment for PTSD shows you’re not just brave, but intelligent and wise.

Sedation dentistry will be a great option for you in this situation and can be used with many medications. I recommend getting with the dentist ahead of time and discussing your medications. That way he or she can plan to use medications which have no contraindications with the medications you’re on.

Make sure you tell the dentist that you’re interested in cosmetic work, too. This will enable them to make the best decisions and give you all the options. There are some treatments which if you plan on doing teeth whitening at any point, you’ll want to have it done first. Things like porcelain crowns and fillings cannot be whitened after they’re bonded.

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

Affordable Dentistry

Cheap Versus Affordable Dentists

I’m worried this “affordable dentist” is going to kill my sister. My sister needed to replace a tooth. She’s a single mom and barely gets by financially. I wanted to help her, but she’s determined to do things on her own. I was relieved she decided on a dental implant instead of a removable partial denture. I knew enough to know she needed to preserve her bone structure, especially as young as she is. But, it turns out she just went to the dentist who charged the least. Since then, she’s had nothing but trouble. It’s been infected…twice. Now the post has broken, taking a chunk of bone with it. In order to get this repaired, she’s going to need expensive grafting. How could this happen?

Cassie H.

Cassie,

There’s a difference between cheap and affordable. Obviously, your sister got cheap. While a dentist can do everything right and a dental implant still fail, this sounds like the dentist cut some corners with the materials he used in order to keep his profits up while having lower prices to draw patients in. There’s nothing that can be done now to help your sister’s situation. She will need that bone grafting, but the infection will need to be dealt with first. In fact, if it’s affecting her bone and spreads it could be life threatening. Make sure she takes this seriously.

If she’s determined to see this through without help there’s not much you can do, but there are some helpful things you can suggest. The first would be another dentist. There are affordable dentists who don’t cut corners. Often they’ll offer some type of in-house dental plan, or they take payments for treatments through a service like Care Credit. This will get your sister the care she needs while allowing her to pay it out without accruing a ton of interest costs.

Another thing is preventative care. I don’t know why she lost a tooth so young. It could have been an accident, which isn’t necessarily preventable or it could have been because she avoided treatment because of costs. If it’s the latter, there are dentists who will work with patients in difficult financial situations, like your sister. Also, some cities have dental or hygiene schools in the area that give discount services. The care is good because they’re examined by a student and the teacher. They’ll do her x-rays, exam, and cleaning at a hygiene school. If there’s anything more serious they’ll send her to a clinic.

If she goes regularly, there’s much less of a chance of her needing such a serious procedure. When things are caught early they can be treated without invasive care.

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

Dental Emergency

Worried a Dentist Killed My Tooth

I had a toothache. I went to see an emergency dentist because I don’t have a dentist of my own and this seemed urgent.  I described what was going on. He told me he can’t see anything wrong but my description means I’ve cracked my tooth. He suggested a crown. I decided to get right on it to be done with the whole disaster. Unfortunately, not only am I still hurting, but the tooth next to it has started turning gray. I’ve read that means it’s either dead or dying. Did my emergency dentist cause a new emergency?

Bebe M. – Virginia

Bebe,

I feel it’s unlikely the dentist injured or killed the tooth.  There are three possibilities that come to mind right away. I’ll start with the least likely one. Let’s say you injured the cracked tooth and then a few days later, without realizing it, you injured the tooth right next to it.  Yeah, like I said, not likely. But, it’s possible so I mention it.

Another more likely scenario is that both teeth were injured at the same time but the uncrowned tooth took a little longer than the other to show symptoms. This does happen.

As this tooth is dead or dying it will need a root canal treatment. You’ll want to deal with this quickly, though I know you’re tired of the situation. If you don’t it’s going to harbor bacteria and then you’ll have a serious dental emergency on your hands.

I am going to suggest that you go to a different dentist to have this treatment done because of the third possibility—misdiagnosis. It could have been the graying tooth that was the problem all along. Maybe it was referring pain and that’s why the dentist thought the crowned tooth is the problem or maybe he just messed up. Either way get the x-rays the first dentist did and bring them to the dentist you hire to do the root canal treatment. He or she can look at them and let you know if something was missed. If it turns out it was, you can get a refund on your first treatment.

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

 

CEREC crowns

Are CEREC Crowns Reliable?

I need to get my first crown. I’ve been doing some research and think I want to go the CEREC route. However, I need to be sure they’re reliable. I work in a field where my smile is important. I have a few friends that have crowns and they all have had problems with them falling out at one time or another. Most of them said it was the temps that fall, which is why I’m thinking a CEREC. However, one of my friends even has his regular crowns fall out. Plus, they don’t look that great. I do wonder if this has more to do with his dentist. He doesn’t have much money, so I’m not sure he’s going to the best dentist.

Ben H. – Ft. Worth, TX

Ben,

You’ve brought up a few important concepts. First, is bonding. The biggest factor in a crowns ability to say is it being designed to fit properly.  A well-designed dental crown will stay in without any bonding agent.  Of course, that wouldn’t hold if you were eating something sticky which could pull down from an unbonded tooth. However, once it’s bonded you should be able to eat what you want.

Yes, temporary crowns do have a tendency to fall out. That’s because they’re designed to be removed easily to make way for the permanent crown.

CEREC crowns are bonded in immediately, so you’ll not have to deal with a temporary crown. They’re also milled by a computer, which does sometimes increase the accuracy. Though, a traditional crown can be equally well made.

Your comment about your friend’s experience and a less expensive dentist is interesting. People sometimes mistake cheap dentistry for affordable dentistry. You can have an affordable dentist who still uses quality materials, but works to keep his prices lower in other ways. Or, maybe he or she has interest free payment plans. A cheap dentist, on the other hand, will advertise their low prices to draw people in, but uses cheaper materials to keep his profit margin up. Or, it could just be a matter of him not being a very skilled dentist.

As to the appearance of the crown, that also depends on the skill of the dentist. Some dentists are more artistic than others. I’d recommend asking to see before and after pictures of their work to get an idea what type of results they can deliver.

Also, because you mentioned appearance being important to your job, if you’re going to get your teeth whitened, do it before getting the crown made. You won’t be able to change the color of the crown once it’s done. So make sure your teeth are the color you want.

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