Dental Q & A with Marc Zive, DMD

Mini Dental Implants

Q: How Are Dentures Anchored by Implants?

A: Implant retained denture

Dentures are a low cost, short term solution to extensive tooth and gum disease and tooth loss.  We often find patients who are unable to afford restorative care opting to remove the teeth and get a denture.  Unfortunately, a perfect fit may only occur on the day the impression was taken.  The tissues and bone of the mouth that supports the teeth constantly changes and shrinks one the teeth are gone.  This is why so many dentures do not fit well.

A modern solution to this problem has been the addition of implants placed in the jaw which can attach to the denture.  The implants and denture attachments vary in size, depending on the condition of the jaw in the area of placement, may involve a snap on removable or screwed semi-permanent method of attachment. The implants maintain the denture in a fixed position, eliminating rubbing which cause sore spots and movement due to loss of suction.  Implant retention can make a denture feel like a new set of teeth.

Although dentures are relatively inexpensive, implants are not.  Implants can be as much of an investment to retain a denture as the root canals, crowns and bridges may have been when the patient started down the road to being a denture wearer.

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Cosmetic Dentistry

Q: What Are the Most Common Bridge Complications

Are there any serious complications from bridges? Are bridges safer than dental implants? For those active in contact sports, would it be a concern to have a bridge rather than an implant or vise versa?

A: Bridge vs. Implant

There are no significant complications from getting a bridge over an implant.  Both have risks and benefits.

A bridge requires reduction of the teeth adjacent to the missing tooth area to support and hold the bridge in place.  We recommend this option in our office when the adjacent teeth have already been heavily restored and may require crowns in the not too distant future.  The risks include recurrent decay of the bridge/ tooth margin due to poor hygiene or damage to the porcelain surface.

An implant is used to replace a missing tooth without involving adjacent teeth.  This is a great option when the adjacent teeth have no restorative concerns or potential.  Risks here include failure of the implant to heal into the bone, infection of the implant site and damage to the restoring crown.

Both methods are equally safe and require the same precautions as for natural teeth when you are involved in contact sports.

Q: Can a Broken File from a Root Canal Cause Sinus Problems?

I had a root canal done on tooth #3 about 3 months ago. The tip to the file broke off in the canal after it was all cleaned out. Instead of it breaking off straight in the tooth canal, it is slanted out the side, touching my sinus...at least according to the xray. I have had a sinus headache on that side since this happened and I never had headaches or sinus problems before... is it coincidence or is the file irritating my sinus and should I have it surgically removed? who should pay for it?

A: Sinus Problem and Broken File

We don't like to see it happen, but unfortunately root canal file breakage can occur.  Depending on whether the need for the root canal procedure was to treat infection or structural and at what point in the procedure the file separated is needed to answer the question.

The x-ray you provided is a two dimensional image.  A 3-D Cone Beam Scan would be needed to determine if the file is in the canal or perforating the root tip and into the sinus.  If the file is puncturing the sinus membrane, it needs to be surgically removed.  If the tooth had an abscess on that root tip, an apicoectomy may be needed to clear up any residual infection.  If the file is fully encased in root canal sealing material, it is inert and poses no problem.

I suggest you have an Oral Surgeon or Endodontic Specialist look at the situation and help point you in the right treatment direction.

Q: Lost Four Teeth to an Overbite: Will Teeth Grow Back at 18 Years Old?

Now I am getting treatment for overbite treatment name is bimaxillary protrusion

A: Teeth Removed for Overbite Treatment

Adult Human teeth do not grow back.  In most cases such as yours, tooth removal is a precursor to Orthodontic treatment.  More information about your case would be needed to help point you in the right direction.

Q: What Can Cosmetic Dentistry Do to Help Buck Teeth?

What options offer relatively painless treatments?

A: Correcting Buck Teeth

Buck teeth usually are the result of  misalignment, crowding or jaw size relationship discrepancies.  The most common treatment for this is orthodontics.  Depending on the severity of the condition, traditional braces or an Invisalign type process can be viable options.  Although time consuming and somewhat expensive, the process is relatively painless.

Cases of limited misalignment may be corrected with facial veneers or crowns.  Treatment time is significantly shorter than orthodontics but more invasive on tooth structure.  Local anesthetics can make this another painless option.

When jaw size and position discrepancies are fairly substantial, the only option may be invasive surgery to relocate the position of the jaws.  The surgery and associated healing time can be quite lengthy and uncomfortable but the end result amazing.

Q: What's the Price Range for a CEREC Filling?

A: CEREC Costs

Unlike traditional metal and plastic filling materials, the CEREC restoration is a piece of porcelain which is bonded to the tooth surface.  Metal fillings are press fit to the cavity in a tooth and are subject to decay occurring between the filling and remaining tooth.  Plastic or composite fillings are bonded to the tooth but wear due to abrasive forces faster than surrounding tooth which leads to restoration failure.

Metal and plastic restorations are generally inexpensive.  Cast alloy (gold) and porcelain (lab processed and CEREC) restorations are more costly.  CEREC units which do not involve cusp tips are equivalent to an inlay.  Those involving cusp tips are equivalent to an onlay.  If the CEREC restoration involves more than 60% of the biting surface area, it may be considered equivalent to a crown.

The fee for a CEREC restoration varies with rural fees often lower that those seen in metropolitan areas.  Ask your dental provider for a comparison of fees for the different restorative options available for your case.

Q: Can the Permanent Teeth That Anchor the Bridge Become Loose when a Bridge is Removed?

Does a bridge have an effect on the teeth around it?

A: Bridge removal

Whether the supporting teeth under a bridge become mobile after removal of the bridge depends on the reason for removal.  So long as the teeth and bone supporting them is healthy, I would not expect any problems with  loose teeth.  However, if these teeth have not been cared for properly, decay under the bridge margin has occurred or supporting bone has been lost, mobility may occur.  If it does, eliminating any dental disease and splinting the teeth together with a new bridge should rectify the problem.

Q: Depressed Because of Missing Molars - What Can be Done?

I have first lower molar(LEFT) extracted 6 months ago, and now the first molar right needs to be extracted too. The first upper molar on both side has root canal done. I am 32 years old female and I feel very depressed 'cuse of losing teeth at young age.

I was born in country where people never see dentist until tooth hurts, so i saw one when I was 21 years old and 4 of the molars needed RC. The other teeth are in good shape. But I am a lot concerned about missing more teeth now. Please help.

A: Missing Molars

Regular dental care is very important.  Waiting until a tooth hurts to seek treatment is the quickest way to loose a tooth.  I am glad to see that you have changed your bad habit and now seek to save your teeth.

Once a tooth has become badly infected, a root canal is the only option to save the tooth.  Repairing this tooth is a major investment, both in the tooth and in your overall health.  You can still have a healthy and attractive smile.  You are taking positive steps which can eliminate your depressive feelings.

Your lost first molars can be replaced.  Both permanent bridges and implants are great options.  Talk to your dentist.  Let him/her know what you are feeling about your oral condition.  They will help guide you to repair your teeth and regain confidence.

Q: Can You Use Gum Contouring (With Laser) While on Accutane?

I am a 26 yrs old female on my 4th month of accutane 40mg, I have braces which will come off in 2 months and would like to have laser contouring of gumline for 4 upper teeth and also whitening. I am wondering if this is safe? or is it contraindicated for the oral mucosa as it is for skin.

A: Dental Laser use with Accutane

Accutane is known to increase hypersensitivity to sunlight in some patients.  These patients will get sunburned faster.  There are no known contraindications for the use of a dental laser for gum surgery, such as your gingiva re-contouring question.

The dental surgery laser uses a very confined beam.  Tooth whitening lasers and lights have a much broader exposure.  For this reason I would not advise laser tooth whitening for your case.  There are many great products for teeth whitening used in the dental office that do not use a light or laser.  Discuss the availability of one of these products with your dentist.  Without lights, I have had phenomenal success with my whitening patients.

Q: What Can Fix a One-Tooth Underbite?

I have a major over bite, but my lateral incisor is behind my bottom teeth acting like an under bit, buts its only that one tooth.

A: Single tooth crossbite

There are several orthodontic methods available today to correct your bite.  They include traditional braces, clear aligners and spring loaded appliances.  I would suggest you consult with an Orthodontist to make sure there are no other alignment issues and to develop a treatment plan which suits your needs.

Q: Dental Bridges - Can 4 Abutment Teeth Be Enough for 7 Pontic Teeth?

I would like to have dental bridges for my 7 upper front teeth. Can 4 abutment teeth enough to be able to hold the 7 pontic teeth? How long will it last? Thank u.

A: Anterior bridge

Probably not. The general rule of thumb is that you need to have as much root surface in bone available to support the bridge as there would have been for the teeth being replaced.  Seven teeth, including the canines, is a lot of root surface.  This long a bridge would not be stable with forces on the front area eventually rocking the back teeth right out of the jaw.

A better solution for you would be 3 or four implants to support the seven tooth span.  Your dentist and oral surgeon can help you determine if you are a candidate for implants and what the procedure would entail.  Another option would be a removable partial denture.  Good luck.

Q: Misaligned and Crooked Teeth: What Treatment Would be Best?

I am 20 year old college student and I have am looking to fix my smile. My smile really brings down my confidence and am finally looking to get it fixed. What kind of treatment would be best?

A: Treating misaligned teeth

Your first step should be a comprehensive examination by an orthodontist.  They will evaluate the relationships between tooth and jaw size, tooth position, effects of cross bite and many other considerations.  This will help determine the type of treatment needed, duration of treatment and whether surgical intervention is needed.

Today's orthodontics include traditional wires and brackets, clear brackets, placing fixtures on the tongue side of the teeth instead of the lip side and clear aligners such as Invisalign.  Your orthodontist will discuss one or combination of these methods is appropriate for your condition and aesthetic desires.

Once the teeth have been brought into proper and aesthetic alignment, tooth and gum contours, defects and discolorations can be adjusted or repaired to give you the confident smile you desire.

Q: What Procedure Will Even Out the Size of my Teeth?

I hate that some of my teeth are shorter than others how do I get that fixed?

A: Evening out tooth size

There are many solutions to correcting uneven teeth.  Orthodontics and cosmetic dental procedures are the most common.  First, have a talk with your dentist about your aesthetic concerns and goals.  Your dentist will help you choose the most appropriate options and coordinate any consults with specialists.  Options may include braces, Invisalign, tooth re contouring, bonding, veneers or porcelain crowns.  What choices you make may depend on your budget and time to invest in order to obtain your desired result.

Q: Can I Sell an Old Dental Bridge or Use the Same Material for a New Bridge?

I have dental bridges for 6 front teeth and 4 abutment teeth. 10 teeth in total. It's expensive. But i want to improve the alignment of the bridge but don't have enough money for a new bridge. Can i sell my old bridge or use the materials for the new bridge? Thank you.

A: Worth of Old Bridge

You are not please with the aesthetics of your present bridge and want to get a new one. Dental Bridges are expensive.  Most of the cost of a bridge is tied up in the labor that the lab technician invests in designing and customizing the bridge for your mouth and aesthetics.  A portion of the cost is associated with the labor and materials used by the dentist to design the bridge, prepare the teeth, adjust the fit and place the bridge on the prepared teeth.  The actual value of the materials that make up the actual dental bridge is relatively small.  Most dental alloys contain a small percentage of gold.  The non-precious metals are added for strength.  The porcelain can not be reused.  The gold alloy can be reclaimed, however the cost to extract the gold from the allow makes the payback minimal.  Several pounds of dental bridges containing gold alloys may yield less that $100 through reclamation.  Reclaiming dental gold alloy is not the same as trading in old gold jewelry.  Personally, a coffee cup full of abandoned dental work collected over 15 years barely covered taking my young family of four out to a local burger joint.  It was a nice treat, but not a source of income by any stretch of the imagination

Q: How Can I Make Sure I Get the Results I Want from a Cosmetic Dental Procedure?

A: Getting what you want from Cosmetic Dentistry

Great Cosmetic Dentistry requires a skilled dentist and a patient who can describe what they want the outcome to look like.  A comprehensive plan is required.  Sometimes, digital imaging and computer graphics can be used to show the patient what is possible in Cosmetic Dentistry.  Sometimes an impression of the teeth can be used to create a model of the teeth.  Tooth shape and position can be altered using wax on the tooth model.  Occasionally, I will apply tooth colored wax or place a tooth colored restorative material on the teeth without bonding adhesives to allow a patient to see a mock up of what can be done.  In many cases the patient can go back to work or home, get feedback from co-workers or family and return for modification.  Once a design is approved, the final restoration using orthodontics, tooth colored composite bonding or porcelain veneers/crowns can be done. Design, material and lab selection are paramount.

Q: Severe Protruded Front Teeth

First thank you for taking the time to view this question. I have severe protruded front teeth and crowdedness. Is it likely that I may need lower jaw surgery?

A: Protruding teeth do not always require jaw surgery

It is difficult to assess the need for jaw surgery from the pictures you posted with your question.  Certainly, you have an issue with crowding.  It also appears that you have an open anterior bite ( the front teeth do not come together.  The pictures were not clear to determine any kind of cross-bite in the back of the jaw.  A detailed orthodontic evaluation  is the only method to truly evaluate the need for jaw surgery.  Severe jaw discrepancies may require jaw surgery.  Less involved case may just involve possible removal of a few teeth to provide enough space to move your front teeth back into a more aesthetic position.  Before rushing to the oral surgeon, get an evaluation from your local orthodontist.

Q: What Are my Options for Having Tooth Gap Fixed or Reduced?

A: Closing the gap

I assume you are concerned about a gap between the front teeth, commonly known as a diastema.  Closure of a diastema can be done through several methods.  Dental bonding with tooth colored composites can close small gaps by widening the teeth on both sides of the gap.  Porcelain veneers can do the same, however I often suggest veneering the front 4-6 teeth to help balance tooth shape along the entire tooth arch and eliminate front teeth that look too squared off.  Another option is moving the teeth together using orthodontics, traditional or clear aligners such as Invisalign.  Bonding is the least expensive method.  I will often test the aesthetics of bonding by applying and carving wax or unbonded composite to the area temporarily and let the patient go home to see how they and their family members like the new smile before making a permanent change to the teeth.

Q: 19 Year Old w/ Overbite. Is There Anyway It Can Be Corrected?

I have had braces before when I was younger, had the herbst appliance and also had headgear. I didn't cooperate very well because I was young and stupid.. Ha, anyways now I'm pushing 20 and regret messing up because I'm stuck with this bite, I am very self conscious about it to the point where it bothers me everyday. Is there anyway this can be corrected without jaw surgery? There is no way I could even afford that with my income.

A: Ortho can fix an overbite

Clint, the pictures you posted with your question do not immediately appear to indicate a need for jaw repositioning surgery.  Unless your previous orthodontist indicated it was necessary during your earlier treatment.  There are many possible treatment methods.  These include traditional brackets and wires, clear aligners such as Invisalign and tooth extraction.  A comprehensive evaluation by an Orthodontist will be needed to design the best treatment course.  So long as you are dedicated to being compliant this time, you will succeed in achieving your aesthetic goals.

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Dental Bonding

Q: Is There Anything I Can Do for This Chipped Tooth?

#25 is chipped from making contact with #8. The thickness was chipped & the front of the tooth bonded. I was told the corner (also thickness chipped) damage couldn't be fixed because it was a small area. Another dentist told me it likely could have been fixed at the time of bonding but for whatever reason the first dentist didn't do it. I know it's not a big chip but it drives me nuts, I drag my lips over the rough edges constantly. Is there anything I can do to fix this or am I out of luck?

A: Fixing Tooth #25

When a tooth is chipped as a result of constantly banging into the opposing tooth, restoration can be a challenge.  Bonding material can be carried up to the esthetic edge, but must be reduced to keep it out of the occlusion.  If the restoration hyperoccludes, it will fracture.

In your case and based on your description, either the bonding can be removed and replaced or the tooth prepared for and a veneer placed.

Q: Can Dental Bonding Fix A Chipped Lower Incisor?

I Chipped the Back Upper Half of my Lower Incisor (#24 or 25, I Think).  Can Bonding Fix This?

A: Bonding a chipped tooth

Dental bonding is a great solution for repairing a chipped tooth.  It usually requires no anesthesia.  The tooth surface is roughened, etched and a tooth colored composite material bonded and shaped to restore the fracture.  So long as the repair is properly shaped to keep it from hitting the other teeth during function and the patient is savvy enough to use the teeth to bite food and not as a tool, the repair can be long lasting.

Q: Which Type of Dental Bridges is Best for 4 Abutment Molars & 6 PONTIC Upper Front Teeth to Make the Abutment Teeth Last Longer?

What kind of dental bridges is best to preserve the health of the abutment teeth?I have 4 molar abutment teeth & 6 continuous PONTIC upper front teeth including canine. It is a long span bridge and I like to know what kind of bridge would you recommend to make my abutment teeth last the longest considering the pressure while eating and the heaviness of the bridge?Would you recommend a heavier or a lighter?Porcelain of fused to metal? I have to preserve my abutment teeth. Please help. Thank you.

A: Ten Unit Bridge

A bridge as long as you described is NEVER A GOOD IDEA.  Having six front teeth supported by only four  in the back is very unstable.  I would rather see you have crowns placed on the back teeth and investigate having two to four implants placed in the anterior to support an implant retained bridge.

Your first step should be a consult with an implant specialist.  In our office we use a 3-D Cone Beam CT scan to determine if there is sufficient quantity and quality of bone to accept implant placement.  We design the bridge using a CAD/CAM system and then virtually place the bridge in the scan so that optimal implant location can be determined.  The scan is also used to define and provide a surgical guide for accurate implant placement so that all implants are placed in the correct location, angle and depth.

The result will be posterior crowns which are not being over stressed by the unstable bridge.  Instead the anterior bridge will be completely supported by a fixed implant base.

Some great descriptions and videos of these procedures and technologies are available on our website.

Q: Which Type of Dental Bridges Would You Recommend to Make the Abutment Teeth Last Longer and Healthier?

I want to take care of my 4 abutment teeth. I would like to know what kind of dental bridges is more recommended so that the abutment teeth will stay healthy considering the pressure of the bite and the heaviness of the bridge. Would you recommend a lighter or a heavier bridge? Would you recommend a pure porcelain or porcelain fused to metal? I have 4 molar abutment teeth and i really want to preserve them because i don't want to wear removable dentures someday. Please help. Thank you

A: Materials and longevity

When looking at different materials for a bridge, be it gold alloy, porcelain fused to metal or all porcelain, the choice is mainly aesthetic with a small consideration to occlusal forces.  The longevity of a dental bridge relies mostly on the fit.  Bridge retainers which are accurately made to fit and seal along the tooth margin will prevent bacteria from leaking under the bridge abutment.  When bacteria builds up along a poorly sealed margin, decay along the margin will ultimately result in failure of the abutment and bridge.

Since a bridge is a single restoration fabricated to look like a series of component teeth, failure of a bridge can be a functional and financial tragedy.  I would recommend you discuss the practicality of  implants for single tooth replacements and/or an implant retained bridge.  Implant/crown margins are not susceptible to decay like their tooth/crown counterparts.

Q: Can I Have Bonding Done on my Teeth Without Grinding Any of Them Down?

My teeth are a little short and a little jagged and overcrowded. Can't I just have bonding done on all of them to make them a little longer and make them appear less jagged? Is it possible that none of the teeth would have to be ground down at all? It just seems like that would be much less invasive and expensive that getting porcelain veneers on all of them. Is it possible it could affect my bite in an unnatural way?

A: No-Prep Bonding is possible

Prep-less bonding can be accomplished, but only in very limited situations.  Teeth are often reduced in thickness when veneered with composite or porcelain.  This is to prevent the teeth from looking or feeling bulky.  Doing this when the edges are angled, chipped or jagged is simple.  Misaligned teeth are a different story.  Depending on the degree of tooth rotation, often a tooth can have material added to one half and require the other half be reduced so as not to make the lip appear or feel bulked out.  Composite veneers are not nearly as costly as porcelain.  Ask your dentist about a "Snap On Smile".  This method will allow you to experiment with what can be done to improve your smile without altering your natural teeth.  Our office tailors the use of prep-less, minimal prep and full prep veneers to fulfill the patient's aesthetic needs.

Q: Old Bonding Has Discolored. Can This Be Retouched Up Without Drilling?

I have anxiety and cannot be numbed up. For the most part my bonding is still very much in tact. I would just like it touched up if possible to whiten my front teeth. Is this possible to do without having to drill out the teeth and start over again? Any opinions on whiteners like Supersmile that are supposed to whiten these dental bonds?

A: Retouching discolored bonding

Older bonding materials were notorious for discoloring over time.  Modern composite bonding materials are far more color stable and resist staining than the older tooth colored materials.  If the material itself has discolored and there is no evidence of recurrent decay then simply abrading and polishing the surface of the filling may return the restoration to it's original appearance.  If an x-ray reveals decay under or around the filling or a dark line or opening is seen along the outer edges of the filling, then replacement is necessary. Toothpastes and whitening products have little to no effect on tooth colored restorations.  Products which are abrasive enough to remove stains from fillings are far more damaging to natural tooth enamel.  I have found that patients hesitant to have the old restoration "drilled out" are usually anxious about having a painful experience.  Ask your dentist which method of anesthesia is best for your level of anxiety, not all methods require a "shot".

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Dental Crown

Q: Temporary Cement for my Permanent Implant Crown?

My dentist told me that temporary cement rather than permanent cement was used for my permanent implant crown. He said it would be easier to remove if needed. I wonder whether this is a common practice.

A: Implant Crown Cementation

Yes, it is very common to use a "temporary" cement over a "permanent" cement when placing a crown on an implant abutment.  Retrievability is one of the most common reasons.  The abutment is held onto the implant body by a screw.  If the screw breaks, then we would want to have the ability to remove the crown easily so that the screw can be replaced.  Most implant cements are closer in formula and strength to temporary cements just for this reason.

The tolerance or accuracy of fit of the implant crown to the abutment it sits on superior to that of a standard crown cemented to a prepared tooth.  It is this close fit that generally hold the crown, not the cement.  In some cases, I have seen water or saliva bind the crown to the implant abutment.

Q: I Need Crowns on my Molars. Do the Crowns Have an Odor to Them?

Will they cause halitosis? What type of crowns offer the best fit? Thank you.

A: Crowns and Bad Breath

Crowns do not cause bad breath.  Halitosis is the result of plaque and bacteria building up in the mouth.  It may also be caused by untreated oral infections such as gum disease, decay or abscess.  If a crown is not properly fitted to the prepared tooth, leaving an open margin, then buildup of bacterial in this opening can also cause halitosis.

Skill of the dentist in preparing the tooth for a crown, accuracy of the impression and skill of the lab technician making the crown are the factors which effect fit and marginal adaptation.  A poorly designed crown will likely fail.  A properly designed and fit crown will succeed so long as the patient maintains their oral hygiene.

In our office we use the CEREC system to take highly accurate digital impressions.  We examine the digital scan and modify the prepared tooth to optimize crown design.  CAD/CAM or computer assisted technologies are used to mill a porcelain crown that precisely fits the tooth.  The result is a precision fit, aesthetic crown, that can last a lifetime.

Q: How Long is a CEREC Appointment?

A CEREC crown can be fitted in a single appointment, how long is the appointment? Will a CEREC crown last as long as a traditional porcelain crown?

A: Length of a CEREC Appointment

An appointment to prepare and place a CEREC restoration in our office takes less than one hour.  We have become very efficient at doing CEREC, with over 400 units per year in a single doctor office.  Appointment length will vary between doctors, depending on skill and degree of comfort using the technology.  Our office has incorporated the CEREC technology with 3-D X-ray technology and implant design systems, making us the only Computer Assisted Dentistry office in New England.  If the unit needs to be characterized and glazed in a porcelain oven, the procedure takes an additional 30 minutes.

Q: When is a Post Crown Needed over a Traditional Crown?

How often are traditional crowns replaced with a post crown? Are dental implants a recommended alternative at that point?

A: Post Crown vs. Traditional Crown

A traditional crown covers and supports the remaining tooth structure after decay, old filling material and unsupported structure has been removed.

A post/core and crown is used when a tooth has had root canal therapy.  In this instance, the tooth has been hollowed out and the post and core is needed to build up and provide a supportive base for the crown.

Whether a root canal is necessary for a relatively healthy tooth is dependent on how much natural structure of the tooth remains and how close the prepared surface is to the nerve chamber.  The patient's symptoms, if any, and the best judgment of the treating dentist will help guide this determination.

Q: How effective are OTC pain relievers after a dental crown procedure?

What might cause the discomfort or pain? How often do dentists prescribe narcotics to deal with the pain?

A: OTC pain relievers after a dental crown procedure

Most often, pain relievers are not needed after a crown procedure.   Some patients feel some soreness after the procedure, but this is usually the result of having the mouth held open or the cheek and tongue retracted for an extended time.  If desired, an OTC product such as Advil, Tylenol or Aleve can be taken before the anesthetic effect disappears.

Q: How Often Do Cerec Crowns Fail?

Compared to other options for crowns, are Cerec just as reliable? What factors might cause them to fail?

A: CEREC Failures

CEREC crowns do not fail more often than traditional crowns.  Any crown will fail if it is not designed properly.  The crown must fit the bite both when the teeth are closed and in function.  The tooth must be prepared to provide enough thickness for the crown to maintain structural integrity.  The margins of the crown and tooth preparation must be matched so that a proper seal exists, even before cementation.  Home care is also an important factor, since a healthy environment around a crown promotes longevity.

Although the CEREC technology to provide a single visit crown in the dental office is limited in availability, a significant number of professional dental labs are using CEREC technology to fabricate their crowns.

Q: Is Numbing Agent Needed for Cerec Fitting?

What kind of numbing agents are offered when Cerec crowns are fitted? Do patients ever need anything more than tylenol afterwards?

A: Anesthesia for CEREC Restorations

We routinely use anesthesia when performing a CEREC restoration on a patient.  The patient's comfort during the procedure most important.  The only difference between a traditional crown and a CEREC is that the crown can be bonded in place the same day.

This is not to say that anesthesia is required.  We have had many patients undergo a variety of dental procedures without "The Shot", including CEREC procedures.  Frankly, some patients have a greater tolerance than others.

We also recommend the use of analgesics after most procedures to avoid any post operative discomfort as the anesthesia is wares off.

Q: Can a Crown Be Reshaped?

I recently had two new crowns placed on my #10 teeth. I had veneers before &truly loved the look of it, however, my new dentist recommended that I get crowns instead since they both have RCT done on them. My new crowns fit great however, the face of the crowns are so rounded that when I smile in a photo, it looks like my two crowned teeth are barely there. Since they are rounded and not flat like my natural teeth, light does not reflect on them in an appealing way. Can they be reshaped&polish

A: Crown Reshaping

It is far easier to round off a flat or squared area than the reverse.  Said another way, it is easier to remove a little material than put it back.

It is critical that the lab technician consider the contours of the adjacent teeth when designing a veneer or crown so they are mimicked accordingly.  In our office we always try the restorations in and have the patient examine the look in a mirror prior to permanent cementation.  In some aesthetic cases we may place the restorations with a temporary adhesive so the patient can have their spouse or partner get a look before making things permanent.

You probably will need to have the crowns removed and replaced.  If you have a picture of the former veneers or a dental study model that includes the veneers in place, the lab can use them to make a more accurate reproduction.  You can also have the dentist place and modify temporaries until you get the desired aesthetic result, take an impression of the temporaries and have the lab use that information to duplicate the look in the new crowns.

Q: Loose Temporary Crown

My temporary crown is loose. Dentemp from Wallgreens does not help. Composite filling underneath the temporary fell apart - there is not much of a retention now. Will see my dentist only in a month. What can I do to make my life easier?

A: Loose Temporary Crown

You describe situation where I must assume either the tooth preparation is too short or the walls are insufficiently parallel to provide adequate retention.  You may have fractured the buildup material that was copied in the impression sent to the dental lab.

It is important that you see your dentist as soon as possible.  This tooth may need to be rebuilt, re-prepared and a new impression taken.  Otherwise you may face a tooth preparation which continues to degrade and a final crown with no tooth structure to properly retain the crown.

Q: How Quickly Can CEREC Implant Crowns Be Produced?

Is it possible to replace an implant with a CEREC crown in one office visit. What are the steps?

A: CEREC and Implants

CEREC is a computerized crown manufacturing system.  It can be used to make or replace a crown to restore an implant, but it is not capable of replacing the implant post in bone.  Some dentists use the CEREC system to design and manufacture a customized abutment which attaches the crown to the implant body.

Using CEREC to make a crown for an implant is no different than the process to restore a tooth.  Both involve a scan of the supporting structure, in these cases prepared tooth or implant abutment, design of the crown and milling or the porcelain block.  See the CEREC page on our website for more details.

Q: Is There a Such Thing As a Veneered Crown?

My dentist said I am in need of crowns, however, the estimate says 'veneers'. At this prace, they charge more for veneers than they do for crowns. When I asked about this, they said I am getting a "veneered crowns". I'm not sure how I feel about this. Most of the damage to my teeth is in the back from grinding. What is the difference between a crown and a wrap around veneer? I really like my new dentist, but not sure they are being honest with me?

A: Veneer versus crown

GREAT QUESTION.  I will provide some reasonable descriptions of different crown types and terminology.  Ask your dentist to describe the procedure and method of crown fabrication.  Their answers will help you evaluate whether their treatment proposal is right for you.

A veneer commonly refers to a thin shell of porcelain which is bonded to the face of a tooth.  They generally cover the lip side and biting edge, extending about half way through where the adjacent teeth contact each other. These shells are fairly thin and are used mainly to alter tooth size, rotation or color. They rely on the strength of the underling tooth structure rather than material strength.

A crown refers to the placement of dental materials over the entire tooth structure above the gum line.  Crowns require greater reduction of tooth structure, usually 1.5mm from all directions, in order to have sufficient strength.  Crowns may be made of cast metal alloys (gold), all porcelain or porcelain fused to metal.

When a situation lacks the 1.5 mm thickness for porcelain, a cast crown can have to porcelain applied to the cosmetically visible surfaces only and may be referred to as a veneered crown.  Sometimes a porcelain fused to metal crown looses it's porcelain surface to to wear or trauma.  In these cases a veneer of tooth colored composite may be bonded to the crown surface, eliminating the need to remove the crown from the tooth and potential for tooth damage.

Q: What Should I Do if my Temporary Dental Crown Adhesive Fails to Keep my Crown in Place?

If my temporary crown falls out, is it urgent that I get it put back in place that day? What precautions should I take?

A: Temporary Crown Adhesives

Temporary crown adhesives are inherently weak.  This is intentional so that the dentist can easily remove the temporary and clean off the tooth prior to final crown placement.  The fact that temporary crowns are made very quickly and with materials that continue to shrink as they fully cure can result in a temporary crown that does not fit the tooth accurately.

The temporary crown is needed to protect the prepared tooth from fracture and to maintain the spacing of the teeth for easy crown placement.  If the temporary comes off, clean out the crown and push it back into place.  If it stays, get back to the dental office when you have a chance.  If it falls right off, have your dentist re-cement the temporary or get a temporary crown cement kit from the local pharmacy.  Even denture adhesive can be used.

We avoid all of this in our office by using the CEREC CAD/CAM System.  We prepare the tooth, design the crown on a computer and mill an all porcelain crown all in one visit.  This eliminates the need for a temporary crown and provides a more precise fitting restoration than we used to get sending an impression to the dental lab.  Check out our website for more information about this technology.

Q: Cerec and Reliability?

What are the disadvantages of having Cerec on the back teeth? Will they be as reliable as other crown options? Is choosing Cerec over other crowns really just a matter of aesthetics and a shorter fitting process?

A: No Disadvantages to CEREC

There really are no disadvantages to a crown produced using CEREC.  The process is more efficient and the precision is at least equal if not better than traditional methods.  Patients respond better to digital impressions than having a mouthful of GOOP.  Having the crown delivered in one visit saves both the dentist chair time and the patient time away from work or family, expense and delays to obtain anesthesia.

There are many modern dental labs which will actually use the CEREC system to make a crown using a stone model made from the dental impression.  Some labs are even able to have the digital impression from the CEREC acquisition unit in the doctor's office transmitted to a fabrication unit at the lab.

The CEREC allows dentists to use modern ceramics, i.e. eMax, which has been shown to be stronger and more durable than traditional porcelain fused to metal crowns.  The CAD/CAM designs produce a far more precise product than the hand crafted crowns made by the lab technician.

I believe that most dental offices will be using a CEREC type system for crowns in the future as this technology becomes a standard of care.

Q: How Involved is a Dental Crown and a Root Canal?

What are the steps involved in getting a root canal and a dental crown, due to an abscessed cavity.

A: Root Canal and Crown Procedures

How complicated a root canal and crown procedure will be is dependent on the severity of the infection, size and location of the pulp canals within the tooth and degree of curvature of the root tips.  If the infection is fairly limited and the canals easily negotiated, the process is quick and easy.  Severe infections can result in an uncomfortable procedure.  Complicated or barely negotiable canals can make it a very difficult procedure for the dentist.

During the procedure, a small opening is placed in the top of the tooth leading to the chamber which contains the nerve, artery and vein (pulp) supplying nourishment tooth.  The pulp is removed and the walls of the canals are cleaned and shaped down to the apex of the root where these vessels enter the tooth.  A rubber based material call Gutta Percha is fitted to the size and shape of the canal to seal off any communication between the oral cavity and jaw through the canal.

When the nerve artery and vein are removed, the tooth remains alive, receiving nourishment through the surface of the root.  This supply is limited and the tooth looses some moisture content making it more brittle.  To preserve the tooth and prevent future fracture, a crown is placed over the remaining tooth.  The crown restores the form of the tooth and brings it back to a functional state.

Q:  Ill Fitting Crown.

My new crown never feels right even after 4 bite adjustments. Dentist says wait 3 days to see if I I can still feel the tooth when I chew. He has ground the tooth to almost nothing and is even now grinding the bottom teeth just trying to get the adjustment right. I am going back again next week. I do not want anymore adjustments, I want the tooth fixed. What else could be wrong. Adjustments are not helping.

A: Well Fit Crowns

Precision is key when making a crown.  The tooth must be prepared to allow sufficient space for the restorative material (gold alloy or porcelain) and anatomical design.  The impression must be highly detailed and accurate to insure a fully deated and sealed crown on the remaining tooth surface.  Lastly, the registration of your bite must be accurate.

When a crown is adjusted to the point of wiping out the occlusal design and/or reducing the opposing tooth, a design problem is probably the cause.  Either the tooth was insufficiently reduced or the bite registration did not record full closure of your teeth.

Replacement of the crown may be needed.  This would allow confirmation or appropriate tooth reduction and recording of a completely closed bite.  A little inconvenience to obtain a comfortable and properly fitting crown.

Q: Do All Porcelain Crowns Stain?

I recently had my front teeth crowned and the dentist had to do some recontouring in order for them to fit properly. Most of this was done on the backs of the crowns, but some on the sides for easier flossing I assume. Are these areas more likely to stain since some of the porcelain surface has been removed?

A: Porcelain crown staining

In general, porcelain does not stain.  Just like grandma's fine china, clean it well and surface discoloration disappears.  Using a toothbrush daily and a periodic polishing by the dental office will maintain the beauty of your porcelain crown.

Porcelain crowns are made with a glazed, smooth surface.  So long as any areas adjusted during placement have been polished smooth,  there should be not scratches for stain to build up on.  If you still find that staining builds up on these adjusted areas, your dentist can repolish them intraorally at your next visit.

Q: Porcelain Crown for Front Tooth

My dentist is placing a porcelain crown on my front tooth. How long on average do you think this crown will last? How many times will I need to replace it if I am only 23? Which type of porcelain crown is the strongest?

A: A lifetime for a front crown

A dental crown has the potential to last a lifetime.  After all, the materials that make up a dental crown do not decay.  The lifetime of a crown is dependent on how it is cared for, professionally maintained and treated over time.  If homecare is not maintained (i.e. brushing and flossing), more than likely the gums and bone surrounding the crown will degrade and decay will set in along the tooth edge which sits against the crown.  Professional maintenance will assist in keeping this area healthy. 

A porcelain crown is not unlike Grandma's fine china.  Just as you would not bang on the china with hard objects, the crown is not a tool for opening bottle caps, holding roofing nails, biting finger nails or banging with oral piercings.

Other factors which effect crown longevity include design of the prepared tooth, having the proper thickness of porcelain to maintain strength, having a well sealed margin between crown and tooth and insuring that the crown is properly adjusted to the bite and chewing forces.

So long as all of the above factors are considered, the type of porcelain is not so important.  There is a vast array of porcelain materials available today.  Some dentists and or lab technicians may have a preference over manufacturer, aesthetics, material strength or material cost.

Even though a crown can last a lifetime, on average a crown might be replaced after 10-25 years due to wear and tear or aesthetic changes to the surrounding teeth.  A friend who installs roof shingles had a crown last only a few days, but now he no longer holds the nails in his lips and teeth.

Q: Will Zoom Whitening Change the Color of Crowns?

All my teeth are capped except 6 front uppers and 6 front lowers. The crowns behind these front teeth are slightly yellow with age. Will this Zoom! process have any effect on the crowns?

A: Tooth whiteners do not alter crown color

Sorry Barbara, but no tooth whitening process will change the color of a tooth colored composite or porcelain tooth restoration, ie. crown.  The tooth whitening materials, such as ZOOM, remove stains which are trapped in the microscopic channels or pores in the enamel.  Artificial tooth materials are non-porous and so do not change as a result to exposure to whitening agents.  Tooth whiteners may remove some surface stains from porcelain crowns, but so will a good scrubbing with a toothbrush or polishing by the dental hygienist.  The crown will only return to the original, unstained, shade it had when it was placed on the tooth.

Q: How Long Do Dental Crowns Last?

I had 4 Dental crowns "installed" on my lower teeth about 2 years ago and already had one of them break. I am VERY careful about the foods I eat (don't eat hard candy, chew ice, etc) and was wondering how long a Dental crown should last under normal usage.

A: Crowns can last a lifetime

It is rare for a crown to fail alone, but not uncommon for the patient to fail their crown.  Crowns, whether gold, porcelain on metal or all porcelain do not decay.  This does not mean that a tooth neglected of good hygiene practice will not decay.  Decay under a poorly maintained crown is the most common cause of crown failure in patients I have seen over years of dental practice.   Poor hygiene is not the only reason.  Although teeth are tools to help us to bite, chew and speak, they are not tools for holding roofing nails, biting finger nails or removing bottle caps.  Using a porcelain crown inappropriately can cause the porcelain to chip or fracture or the porcelain veneered on the metal base to break off.  Common sense is key.  So long as the crown is manufactured to the highest standards, choosing the right material and fitted to your bite properly, it will have the potential to last a lifetime.

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Dental Implants

Q: I Got a Dental Implant 5 Years Ago, and It Broke Off! What is my Recourse?

The implant is upper right, all the way in the back. Will I have to pay to have another one implanted? What is the warranty on these things? I wasn't eating anything out of the ordinary, why did it break?

A: Broken Implant

In general, dental implants do not break.  The actual implant is securely fixed to the bone prior to final restoration.  The abutment, or implant extension, rarely fails.  It is possible for the screw which holds the abutment to the implant to fracture.

Some implant systems were designed to have the retention screws replaced periodically.  If the screw was not tightened properly, it may loosen.  This can result in separation of the abutment from the implant or screw fracture.  If the screw was torqued beyond manufacturer recommendations, a screw fracture can also result.

Implant manufacturers have specialized instruments available to easily remove and replace a fractured screw.  Implant abutments can also be easily replaced.  If the implant has indeed fractured, the manufacturer will usually cover it's replacement.

Q: How Painful is It to Get Dental Implants?

Do most patients use narcotics to manage the pain, or is Advil and Tylenol enough? Do some people get headaches after the procedure? How often?

A: Implant Placement Pain

Implant placement is a relatively painless procedure and is usually done under local anesthesia.  Post-Operative use of narcotic pain medication is rare.  Most patients use an over the counter pain medication such as Tylenol or Motrin.  There are few pain receptors in the bone, most are in the soft tissues (gums).  Since the implant is placed in bone, only the manipulation of the gums during the surgical procedure leads to any source of discomfort.

My implant patients generally report that having a tooth removed is far more uncomfortable than having an implant placed.

Q: Do I Need to Wait to Extract Tooth Before Implant?

I had a crown a root canal and crown placed on #14. I have had complications due to an abscess caused by an unsuccessful root canal. I was told by two dentists that i would need a apexectomy to and a new crown which will cost over 2000. Apparently, there is no guarantee it will work. I'm thinking of getting an implant. Should i extract tooth or wait to see cosmetic doctor?

A: Unsuccessful Root Canal

Unfortunately, you have experienced the fact that not all root canal procedures are successful.  Surgical re-treatment can and often does resolve the problem, but of course there is no guarantee.  Having the tooth removed and an implant placed is a reasonable option.  You would need to see an implant specialist to determine if there will be enough bone to support an implant placed at the time of extraction, if bone grafting or a sinus lift procedure is required or if it would be better to remove the tooth, allow the area to heal and then determine implant placement.

I suggest you discuss your options with both the implant surgeon and restorative dentist before taking any action.  They need to coordinate their efforts and work simultaneously to provide the optimal aesthetic result. Decisions such as these need to be made as a team.

Q: Dental Implants Made in China or Asia?

I learned that a dentist may charge you for a full priced dental implant made at a US lab, and then buys it from a lab in Asia/China at a fraction of the cost. Do you think this is fair or ethical? How can I make sure that I get one made by safe materials and from the US?

A: The Foreign Connection

Unless your dentist charges separate material and labor costs, the question is moot.  Dentist generally charge a reasonable fee to provide a service which includes material, labor, staff, overhead and other associated costs.  Which country the dental products come from should not be of concern.  I would be more concerned with the training, experience and reputation of the dentist.

The fact is that most dental materials are developed abroad.  Many dental companies have offices in the US, but their products are developed, tested and manufactured in Europe and Asia.  Even the "US companies" rely on offshore manufacturing facilities.

Dental materials and implants are medical devices.  As such, the FDA must approve them for use in the US.  Dentists in the US are obligated to use only FDA approved products.  Regardless of the manufacturer or their global location, the product is safe.

Q: Can a Bridge Be Made on an Implant and Connect to a Tooth

I have an implant on the upper right first molar. Can a bridge be made by connecting the third molar to the implant because I have just lost the second molar.

A: Implant to Tooth Bridge

The practicality of connecting an implant to a natural tooth using a bridge is the subject of much controversy in dentistry.  There has not been any substantial evidence to support or refute this dental procedure.  The majority of dentists do not suggest connecting an implant to a natural tooth.  In any case, nothing should be attached to an implant that places it under any functional stress until the bone has grown into the implant surface.  Bone attachment stabilizes the implant and takes about three months.

The natural tooth is supported in it's socket by the periodontal ligament.  This ligament acts as a shock absorber for the tooth when it is put under compression during clenching, chewing, etc.  It provides a small degree of tooth mobility so that the tooth does not fracture.

The bone which grows into the implant surface results in a rigid body in the jaw.  There is no give in this system.  Stresses are prevented by carefully adjusting the occlusion so that the implant restoration receives minimal occlusal forces.

When a bridge is used to attach a tooth to an implant, the tooth end of the bridge retains the inherent mobility of the periodontal ligament while the implant side is fixed and rigid.  This difference can result in the bridge retainer attached to the tooth separating, the implant failing due to loss of bone attachment from the motion applied to the bridge or the tooth or implant body being intruded or extruded from the jaw resulting in an unbalanced bridge and potential occlusal interferences.

Personally, I prefer not to risk the longevity of the bridge by using like abutments (tooth/tooth or implant/implant).  You should discuss the long term survivability of a tooth to implant bridge with both your surgeon and restorative dentist.

Q: TADs to Move Jaw Up?

An orthodontist told me that TADs can be used to shift the jaw/teeth up to slightly reduce a gummy smile (my teeth length is fine but my jaw apparently sits too low). Is this possible?? How much can teeth be moved "up" to correct a gummy smile with TADs? When I smile, I currently show an 1/8" to a 1/4" of gums. What can I realistically expect? Are results permanent?

A: Shifting up a gummy smile

TADs to move the teeth upward as a solution to a gummy smile is the wrong approach.  It is not necessarily true that your jaw is too low.  More likely, your lip or smile line is unusually high.  The muscles that surround your mouth in this case draw the upper lip higher than for the average person.

Assuming that your concern is for the aesthetics of a gummy smile, my recommendation would be to have your dentist trim and re-contour the gum-line, a gingivectomy, to reduce the gummy nature of your smile.  This type of crown lengthening should do the trick.  This can be supplemented later with veneers.

Q: How Much Does It Cost for Tooth Replacement

How much does it cost for tooth replacement, After becoming pregnant I had serious gum problems which has made the gum reseed on my bottom 2 teeth. What are the options, I am a singer so obviously my teeth and smile are everything

A: Implant costs

Dental implants involve the placement of the actual implant body in bone, placement of an abutment or extension to accept a dental crown and the crown.  Depending on type or manufacturer of the implant components, area of the country, skill of the dental surgeon and difficulty of the case the implant process is about $4000 per tooth.  Cases that involve multiple implants will usually see a reduced cost for placement of second and subsequent implant bodies.

Other factors that impact on the cost of implants are the need to extract the diseased tooth for implant placement, treatment of any infection present and bone augmentation.  If the healed placement of the implant is not in the optimal position or direction, a customized abutment may be needed and are generally more costly than their readily available stock counterparts.

Treatment options for your case may include a single implant supporting a single crown made to aesthetically appear as two teeth or placement of a four unit dental bridge.  All these ideas are based on your needing to sacrifice these teeth due to severe gum disease.  If the recession is not extreme, a tissue graft could solve your aesthetic concerns.

Q: Can I Have Dental Implants with Two Artificial Knees?

Ive had two knee replacements done. I'm 65. is it possible to have dental implants done after this surgery?

A: Dental Implants after Knee Replacement

YES.  There is no reason why you could not have dental implants placed  after knee replacement surgery.  Just as you did after the knee surgery, you should take antibiotics both before and following the dental surgery.  Your oral surgeon or implant specialist will direct you in the use of antibiotics.

The technology behind the development of joint replacement and tooth replacement implants are nearly identical.  Today, both involve Titanium prostheses placed into healthy bone and the ability of your bone to grow into the surface of the implant.  The result is a stable and strong device that will stand up to physical use (walking or chewing).

Q: How Much Does It Cost to Replace a Tooth

when I was pregnant I had really bad reseeding gums and its messed one of my teeth up. How much would it cost to replace a tooth and how can you treat reseeding gums

A: Tooth Replacement Cost

Receding gums during pregnancy, also known as pregnancy gingivitis is quite common.  Unfortunately, the gums never grow back on their own.  This issue to usually solved by grafting a piece of tissue from another area of the mouth over the receded area.

It is important to save your own teeth if at all possible.  Grafting by a periodontist, gum specialist, is the best first solution.  Sometimes bone supporting the tooth is lost as the gum recedes and can result in loss of the tooth.  Bone is much more difficult to replace.

If your tooth must be removed, a bridge across the gap supported by crowns on both sides or an implant with bone grafting are possible solutions.  Coordination between your general dentist and appropriate specialists is in order.

Q: The Screw Head of the Dental Implant Broke Off. Is This Common? How Difficult to Fix?

My husband is in the process of getting a dental implant. Each step has presented problems. The last part of the procedure that he had done involved implanting the screw. The screw head broke off. The dentist now wants to go in and notch the head with a laser and try to remove it with a screwdriver. My husband is very hesitant to proceed. Is this a common occurrence and what risks are involved with the procedure to remove the screw and replace it with another. What would success rate be?

A: Broken implant screw

Although not common, the occasional implant screw can fracture.  The remaining portion of the screw should be removed by mechanical manipulation.  Notching the screw body with a laser IS NOT THE WAY.  Lasers work by generating heat.  Heating an implant will destroy the bone securing the implant to the jaw at the bone/implant interface.  If the screw body is not too deep in the implant, it may be possible to use ultrasonics to vibrate the screw out of the implant.  The screw might be scored with a cutting instrument and backed out with a screw driver, but care must be taken to not damage the implant or the exposed screw threads on the walls of the implant.  When the screw can not be easily retrieved, removal of the total implant an its replacement is the only choice.

Q: How Much Bone is Needed to Place a Dental Implant?

I have a fixed retainer behind my lower 6 front teeth. Some bone loss has occurred under the retainer. I don't believe that I have had any more infections, but now my teeth have tipped forward. Has this been caused by more bone loss? I'm young and don't want dentures. Could implants be placed if there is at least 50% bone loss? How much bone is needed for an implant? I was told that I don't have any pockets. I can feel pressure on some of my teeth if I push them forward.

A: Implants and Bone Loss

It seems from your description that you are having an issue with bone loss.  This comes from unhealthy gums.  FIRST GET YOUR GUMS HEALTHY.  Implants are not a replacement for teeth lost due to unhealthy gums and supporting bone.  If you can restore your gums to health, you may be able to preserve your natural teeth.  Neglected gum and bone infections result in implant loss as easily as tooth loss.

Q: Braces Before Molar Dental Implant?

Hi, I have two lower first molar taken out, I need to get braces to correct severe overjet/overbite issue. Do I need the braces first or dental implant to replace the molars? How will the braces be placed if the molars are missing?

A: Orthodontics or Implants first

Without hesitation, BRACES FIRST.  Implants are only successful when the jaw and tooth alignment is optimal.  Seek a multidisciplinary approach.  Make sure the general dentist, implant specialist and orthodontist design a coordinated treatment plan.  Orthodontics will correct and stabilize your bite.  It may even close the gap from the missing molars and eliminate the need for implants.  Sometimes braces can correct angling of the teeth adjacent to the space, providing better spacing for a future implant.  A well designed team effort will provide you with an excellent result.

Q: Two Missing Teeth. Space Too Small for Two Implants. Options?

Hi Doctors, my husband has one missing tooth #5 for years, and the space became smaller. However, another one tooth (#4) needs to be extracted. If he has one implant in the place the two missing teeth left, this would leave 3mm empty space. However, the place is not enough for two implants. I would like to know what would be a good option in this case? Thank you for your time.

A: Two teeth replaced with one implant

Great question, Amanda, with many possible answers.  Most importantly, is there sufficient bone in the area to support an implant.  If so, a single implant could be used to support a cantilever bridge (one tooth hanging off the implant supported tooth, a carefully designed single crown that aesthetically appears as if it was two premolars or a single molar sized crown to fill the space.  Which is best will depend on the condition of the surrounding teeth, functional concerns, width of your husband's smile and aesthetics.  Coordinated treatment planing is critical, especially if more than one doctor is working on the case (oral surgeon placing the implant and general dentist restoring the implant).  We use integration of the Galileos Cone Beam CT scan and CEREC crown system to design the case from implant to crown placement.  This system provides us with the ability to design the restoration first, then fabricate a precise surgical guide to place the implant in the optimal position.  Dentists in your area who use this system can often be found through ComputerAssistedDentistry.com.

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Invisalign

Q: Can Bonding Be Removed Without Taking Away Any Tooth Structure? How Should It Be Done?

This question relates to residual Invisalign IPR been bonded by the dentist. I am looking for a second opinion. I want to remove the bonding and close the gaps with traditional braces (if it is possible). I found an orthodontist. Over the phone I was assured that it could be removed without damaging my teeth. But she still needs to see me and take xrays. I am scare of loosing any more enamel. I would like some input from other doctors. please!! I am really nervous about all these.

A: Removing Bonding

Tooth colored composite bonding can be removed from the tooth surface rather easily.  It can be done with minimal removal of underlying enamel provided there is a shade or texture difference between the layers.  If the area were to be re-bonded, the layer of enamel into which the bonding resin penetrated would have to be removed.  In either case, the amount of enamel removed from the surface is inconsequential.  As we live, bite and chew, the enamel layer is slowly thinned through abrasion.

If you are happy with your smile and tooth size, leave it alone.  Do not be concerned with the minimal bonding done to correct spacing left by IPR.  That spacing was probably needed to get proper tooth alignment.  If you follow through with another round of orthodontic treatment, the bonding can be carefully removed with a series of polishing discs which are aggressive on the plastic bonding but have a minimal effect on enamel.

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Porcelain Veneers

Q: Is It Necessary to Level out Chipped Teeth Before a Veneer Can Be Placed?

My front two teeth chipped when I fell down the stairs. My dentist has given me a choice of getting either veneers or crowns. But he is edging towards Zirconium crowns over Empress Veneers. I wanted to go for Veneers due to minimal tooth reduction but he says that quite some tooth will be lost anyway for veneers since he'll be leveling it.  Will leveling really be necessary for veneers apart from the obvious front shaving

A: Level out Chipped Teeth Before a Veneer

In general, I do not believe that chipped teeth need to be leveled prior to veneer placement.  Sometimes the biting edge of the tooth may be reduced in order to have the veneer wrap over and replace the incisal edge.  Minimal surface reduction needs to be balanced with veneer thickness so that enough surface area is preserved to maximize bonding and material strength.

Q: Is Replacing Dental Veneers Expensive?

I'm considering dental veneers for my four or six front upper teeth. They are small, narrow, and have gaps between them. It's like I'm not even smiling when I smile. I want a wider smile. However I heard that when veneers need to be replaced, you have to get the whole thing done over again, and that's expensive! What if, 20 years later, I don't have the money to replace the veneers? What would happen? That's scary, but every doctor is dead-set against bonding (sigh), so what can I expect?

A: Replacing Veneers

Nothing in life lasts forever!  Not even dental veneers.  Potential replacement after 20 years, as you suggest, is not a reason to avoid having them done now.  You may invest in a car, drive it for 20 years and then decide it is time to replace it.  Your new car will be another investment, but not necessarily a reason to forego a car today.

High quality veneers prepared and placed by a skilled dental professional will last a long time.  The aesthetic results and positive effects on self confidence are well worth the investment for most patients.

Q: Gum Discomfort/burning Sensation Just Above the Veneer, Is This Normal?

For the past few days I have been having upper gum discomfort in the area just above the veneer. Veneers (upper front 4) were placed a month ago by a very competent dentist). The other three teeth do not have any gum sensitivity around them. The tissue does not seem inflamed, just has this burning sensation that is constantly present. I am aware that sensitivity is normal within few weeks after but not sure why only one tooth is affected. I take very good care of my teeth and gums

A: Burning gum above a veneer

Most patients do not have adverse reactions to restoration such as porcelain veneers.  In rare cases, a patient may have an allergic reaction to the restorative or bonding materials, but these usually manifest themselves shortly after placement.

In your case the sensation involves one of four teeth, suggesting a localized problem.  Issues may include the veneer being placed too close to the bone supporting the tooth (violating the biologic width), excess bonding material trapped under the gumline and causing a local irritation or my favorite, PCKS.

PCKS stands for Pop Corn Kernel Syndrome.  When corn is popped, it's thin outer shell fractures and can be easily caught under the gums.  Like a suction cup, this shard can adhere to the tooth and be difficult to remove.  Dental floss can generally catch the edge and remove the shard.  Similar irritation can result from other food debris getting caught under the gums.

Arrange to see your dentist.  Simple removal of the cement or food debris stuck in this area may quickly alleviate your symptoms.

Q: What Is The Best Option For A Dead Front Tooth?

My dentist sent me to a specialist who performs root canals. This dentist told me that my tooth has calcified and he cannot perform a root canal. All of my other teeth are healthy and straight. Should I consider a veneer or crown for this front, top tooth? Will it be possible to match it to my other teeth?

A: Treating the Calcified Tooth

If you saw a specialist, then we must assume the tooth is in need of endodontic therapy.  Sometimes a damaged tooth root will calcify.  This means that the canal has been blocked by calcium deposits.  In many cases, a special chemical can be used to break up these deposits so that the canal can be instrumented.  When this is not possible, the tooth needs to be treated from the root tip end in a surgical procedure.

You should have the infection involving this tooth treated prior to considering it's restoration.  Placing a veneer or crown is appropriate after endodontic therapy and can be accomplished so that the restoration matches the adjacent teeth.  Restoring the tooth and ignoring the need for root canal therapy can complicate future endodontic treatment and/or result in future loss of the restoration or the tooth itself.

Q: Can Insurance Cover Any of the Costs of Porcelain Veneers?

I have severe tetracycline staining and in need of about ten to twelve porcelain veneers. Will insurance cover any of this?

A: Insurance coverage for porcelain veneers

Dental benefit plans, unlike medical insurance, are designed to help defray some of the cost of your dental care.  Dental plan providers place limits and restrictions on how the benefits can be used.

Dental plans do not usually cover cosmetic procedures.  Tetracycline staining is a side effect, not a disease.  Veneers in this case, as in most instances, would be considered cosmetic and not a covered benefit.  To be sure, have your dental office submit a pre-determination of benefits to verify benefit eligibility.

Q: What Brands of Hygiene Products That Work Best on Veneers?

What kind of maintenance is required to keep veneers clean and looking great? Does this include more frequent cleanings at the dentist's office?

A: Cleaning Veneers

When you ask about cleaning veneers, I assume you are referring to Porcelain Veneers.  Most commercially available dental hygiene products are safe for use on porcelain veneers.  These products are also generally safe for use on Composite or Plastic Veneers, but I would suggest a product which is low in abrasive.  Unlike porcelain veneers, the plastic veneers will tend to absorb more stain and loose their shine over time.  This is especially so when the surface is repeatedly scratched by abrasive dental cleansers.

If your home care is up to par, then seeing your hygienist every six months should be adequate.  The only reason for more frequent visits is when a problem of gum disease requires the hygienist's attention more often.

Q: Is There Any Connection Between Porcelain Veneers and Bad Breath?

If so, what regimen is useful for porcelain veneer hygiene?

A: No bad breath from veneers

Veneers are generally not responsible for bad breath.  Mouth odor comes from the presence of gum disease, poor oral hygiene, digestive system issues and tooth decay.  Only when veneers are designed or placed poorly, having open margins where food and bacteria can collect does mouth odor emanate from the veneers.

It is important to practice good oral hygiene habits at home daily as well as periodic examinations and maintenance with the dental staff as indicated by the dentist and hygienist.  When mouth odor persists, a dental visit is a must.  These odors can also be indicators of serious medical problems like Diabetes and other systemic diseases.

 

Q: What Are Two Main Differences Between Crowns and Porcelain Veneers?

What a couple of reasons one should opt for a crown over veneers?

A: Crown vs. Veneer

A crown fully encases the tooth and requires removal of 1.5 mm of the tooth surface.  A veneer is a thin shell bonded on the front surface of a tooth.  Unlike the crown preparation, veneers require little tooth reduction and in some cases none at all.  Veneers used to reshape teeth can be ultra-thin.  Veneers used to hide discolorations of natural teeth need only be thick enough to mask out the area.

Both methods have gone through dramatic technical advancement to the point where personal preference is often the deciding factor.

Q: Porcelain Crown Vs Porcelain Veneers for Peg Laterals After Braces

I am getting my braces removed in 1 month. I have went to three cosmetic dentists for consults for treatment of my peg laterals. I received three different treatment plans. 1st - 2 veneers on teeth 7 and 10 2nd- Bonding on teeth 6, 7, 8, 9, 10 and 11 3rd- 2 three quarter porcelain crowns on teeth 7 and 10. The all sound OK to me however I can not determine which treatment would be better. I am also getting my teeth whitening before any treatment. THANK for any help

A: Treatment of Peg Laterals

The 3/4 crown and the veneer are two names for the same procedure.  Both involve minimal reduction of the tooth and placement of a porcelain shell over the tooth to change appearance.  I prefer this option over the bonding of a plastic composite over the face of the tooth.  Over time, the plastic materials loose their luster and anatomy due to wear and often discolor.  This does not occur with porcelain.

Q: Is Bleaching of Teeth Possible if Having Porcelain Veneers?

If I have only a few of my teeth covered up with porcelain veneers, can I bleach the teeth without veneers then? Or does the bleaching harm the porcelain veneers?

A: Bleaching Veneers

Veneers are not harmed by dental whitening.  In fact, whitening products do not affect them in any way.

I would strongly suggest you consider whitening prior to having the veneers placed.  Once you have whitened your natural teeth to an acceptable shade, the veneers can be fabricated to match your natural teeth.  It will also give you a reference point should you decide to repeat whitening in the future.  It is not easy to control the whitening process or extent, so trying to whiten teeth to match veneers is not always perfect.

Q: How Long Should a Dentist Be Liable for Replacing Any Defective Porcelain Veneers?

I had full mouth Porcelain Veneers at 51 yrs old, (I'm 58) and my Dentist knew I have health issues, but recommended them. The cost took my savings. I'm "NOW" finding out what it costs to address other problems. I recently was told I need 2 root canals costing $2,500.00. I'm concerned that I have no alternatives as I age and my health worsens. No way will I be able to sustain the length of time laying in a chair,financial strain, or discomfort I'll need for replacement. What Choices Do I Have?

A: Veneer Replacement Liability

Although we would like our dental work to last forever, nothing does.  Just as a car shows signs of age after use for seven years, so will your veneers.  Depending on many factors, such as how well the veneers and underlying teeth were cared for and maintained, diet, and changes to your overall health over time, most dental work including veneers may need replacement.   It is unlikely that any action by the dentist placing veneers many years ago would result in a need for root canal therapy today.

Q: Non Preparation Porcelain Veneers

I'm thinking of getting non preparation porcelain veneers. But talking about non preparation veneers, what about the area between veneer and gingiva? Isn't there a little area, which isn't covered by the non prep veneer?

A: No Prep Veneers

All veneers, including the no preparation variety should cover the entire face of the tooth.  The edge should extend down to and perhaps slightly below the edge of the gums.  A skilled dentist placing the no prep veneer at the gum line will use a diamond tip to gently blend the edge of the veneer into a seamless transition to the tooth surface under the gums.  So long as you maintain healthy gums, you can avoid any recession that might make the transition visible.

Q: How Do Dental Veneers Get Replaced?

I'm assuming dental veneers have a certain "shelf life". What does it take to get replacements? Is the procedure lengthy, require specialists in revision, more expensive? The more detail the better! Thank You.

A: Veneer Shelf Life

Unlike composite or plastic veneers which tend to loose their sheen, change color or end up with defective margins after several years, porcelain veneers can last a lifetime.  As with any dental restoration, periodic maintenance is required.  Since the porcelain itself will not change color, a good professional polishing can remove stains and restore luster.  Periodic visits to your hygienist to remove plaque and bacterial buildup and maintain the health of the gums and teeth abutting the porcelain will prevent decay from occurring at the margins.

Veneers are replaced when decay occurs around them, they fracture or if the patient wants a change of tooth shade.  In each case the veneer must be ground off the surface of the tooth, a layer of tooth removed to eliminate the tooth surface embedded with adhesive and new veneers fabricated.  The process of removing the old veneer is similar to the original procedure to prepare the tooth but may be more time consuming because of the care needed to carefully remove the veneer while minimizing collateral damage to the remaining tooth.  Depending on how long ago the original veneers were placed, you may see increased expense since all costs go up over time.

Any skilled, experienced and well trained dentist can redo veneers.  Look for someone who is up to date with recent materials and methods.  Technology in dentistry is constantly changing  quickly and dramatically.

Q: Unhappy with Color of Veneers

I Had 16 Veneers Seeded Yesterday.  I Am NOT Happy with the Color.  What Should I Do? Although they supposedly look "natural" I clearly stated repeatedly that I wanted them WHITE and that was my only reason for getting veneers in the first place. I would estimate them to be between a bl3 and bl4 and I wanted bl1. What can I do now....$17,000 later?

A: Unhappy with Veneers

When getting dental veneers, communication between the patient and dentist is critical.  Size, shape, texture and color or the veneers must be considered closely.  Depending on veneer thickness, the base color of the underlying tooth becomes a major factor in final appearance.  The veneers should be tried in using a non-adhesive paste the same color as the intended adhesive so that the color can be better controlled and the patient given an opportunity to view their new look before it is permanent.  I will often have the patient step outside into the daylight with a mirror to approve the case prior to cementation.  This way we retain the ability to adjust or remake the veneers if necessary.

Shade should be selected by using dental shade tabs placed between tooth and lip using office and natural light, not by looking a shade guide directly.  Natural teeth are not stark white, they contain some red, orange, yellow, brown and blue.  We have the patients select the shade without seeing the code on the tab.  Only the doctor and lab are aware of the shade code to be used.  This way numbers and letters do not influence the patient's selection.

You can always request that the doctor remove and replace the veneers with a brighter product, however this would further alter the remaining tooth to remove the layer of tooth embedded with adhesives.  If you have not told family, friends or coworkers about having this procedure done, see how they react at first glance to your new look.  You may be pleasantly surprised.

Q: One Dark Front Tooth - Options?

My front central incisor is dark due to dental trauma 3 years ago. I am going for a root canal since I am also having pain. Can I place one veneer or crown on this tooth? Will it block the dark color and match my other teeth?

A: Esthetics is prime when considering crowns or veneers on front teeth

When a tooth is traumatized and the nerve damaged, the tooth may darken due to death of the nerve.  A root canal therapy is your only option.  Sometimes, an internal bleaching procedure can be done after root canal therapy to lighten the tooth.  When internal bleaching is not enough, a crown or porcelain veneer is indicated to mask the discoloration.  You indicated this was an upper central incisor, the focal point of the smile.  Under these circumstances, I would recommend doing the same procedure, crown or veneer, on both upper central incisors to provide an aesthetic match.

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Smile Makover

Q: Smile Makeover - Cost of Crowns + Implants

How much do dental implants and crowns cost?

A: Implant and Crown Fees

Fees for dental implants and crowns vary widely.  Factors such as urban vs. rural office location, proximity to major cities, East/West coast vs. mid US, materials choice, lab expense and skill/experience/demand of the practitioner can have a major impact on treatment fees.  Crowns can vary in type of porcelain, gold or precious metal content of the underlying alloy, oversees vs. domestic dental lab and artistic skill of the lab technician.  Implant case fees are effected by implant manufacturer, material type, degree of surgical placement difficulty and whether customized or off-the-shelf components must be used to restore the case.

Get a consultation and estimate from a dentist you trust to conduct the procedure.  Compare the quote to what your budget allows.  Then only you can determine what areas you may be willing to compromise to meet your budget requirements.  Remember, do the job right the first time and complications will be avoided.

Q: Why Do Dentists Always Recommend the Most Conservative Option when It Comes to Crowns Vs. Veneers?

I've genetic enamel hypoplasia and most of my teeth have been filled/patched up to some degree. I wanted to get crowns for my entire smile line but my prosthodontist insists that it's better to be conservative and do veneers for some that don't require crowns. However, with my hypoplasia and the rate my teeth deteriorate, it's only a matter of time before the back of the tooth may start to erode if I only protect the front with a veneer. Why not crown it and avoid future problems altogether?

A: Best to be conservative, sometimes

Modern dentistry has evolved to the technical level where the most conservative form of treatment is usually best.  We always want to preserve as much of the natural tooth structure as possible.   Aesthetic dentistry uses the porcelain veneer to alter tooth color, shape or appearance over the more aggressive full crown.  After all, no one sees the back side of the tooth.

Your case is the exception.  Enamel hypoplasia involves a defect in the structure of tooth enamel, making much more susceptible to damage and decay.  In this case, conservative is not best.  A full crown is indicated to protect the entire tooth surface.  Otherwise, you will be looking at removing the veneer and replacing it with a crown at some future date.

Q: Why Are Smile Makeovers So Expensive?

I was thinking about a smile makeover, full mouth, and saw that it can cost over $30,000. Is this because dentist fees are really high, the time to do the procedures is extensive, or the materials are costly? What justifies the high prices?

A: Smile Makeover is an Investment

A smile makeover can be a major investment.  Depending on the condition of the teeth and gums, patient desires, skill of the dentist and cost of materials, the cost of a makeover can be substantial.  Most people looking for a makeover are concerned with aesthetics.  A smile makeover is a lifetime investment in your appearance to others and yourself.  You need to have an idea of what the value of a smile makeover is to you.

We all select things based on how attractive it makes us feel and look to others.  It effects our selection in the car we drive, clothes we wear, hairstyle and where we live.  Whether consciously or sub-consciously, we all set values.  Choosing a smile is no different.

Be sure to get your smile makeover from someone who is skilled, has advanced training in aesthetics and not just the training from dental school, you are comfortable with and that you are familiar with their work.  Shopping for a cheaper price often leads to a poorer long term result.

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Teeth Whitening

Q: What's Best to Whiten Very Brown Stains in Between Teeth Due to Smoking?

A: Brown stains from smoking

Without a doubt, the best way to eliminate brown stains in between teeth from smoking is TO STOP SMOKING.  When smoking is not an issue, there are many ways to remove these stains.  Thorough brushing with a high quality toothpaste can remove most stains.  A professional cleaning will remove what you miss.

Whitening is not the best solution.  It will have an effect, but these whitening products are best suited to lighten overall tooth color.  They do in part remove stains, but that is not die true function.  Best to quit the habit, you may find the brown in between the teeth disappears

Q: Coffee After Professional Whitening?

Is it a myth that after your teeth are professionally whitened, you have to drink coffee through a straw, otherwise your teeth become permanently stained?

A: Coffee After Professional Whitening

The tooth staining which occurs from drinking coffee is not permanent.  Whitening does alter the surface of the teeth.  The saliva will rehydrate and remineralize the surface of the teeth in a relatively short time.

I do not recommend consuming any foods or drinks that can stain the teeth for at least 12 hours after whitening.  It is during this period that the teeth will be most susceptible to absorbing stains.

Q: What Are Good Whitening/bleaching Products To Use With Invisalign?

I've read around that nite white is the best. Is there a product that is equally as good, and cheaper, possibly? I also tried looking for the 10% but only found the 22%. I read online that I shouldn't try to bleach too much or too often so I was trying to look for a lower percentage. Thank you!

A: Whitening during Invisalign

NOT A GOOD IDEA!  Invisalign is a great orthodontic process that uses thin, clear, retainers to move the teeth.  It is a 24/7 procedure for many months.  Whitening is a short term procedure.  Overuse of these gels can potentially cause damage to the tooth and will probably cause a substantial sensitivity problem.  Although most dentist supplied whitening gels are safe to use in the aligners, the temptation to overuse them is great.

When our patients come to the end of their Invisalign treatment, we will often provide a complimentary  whitening gel supply to use during the last two weeks of treatment with their final aligner.  The patient gets a great looking and bright smile and the office prevents overuse of the whitening product.

Q: What is my Best Bet to Treat my Tetracycline Stained Teeth?

I have heard so many mixed reviews about veneers and lumineers that I'm not just confused. Could bonding even work? I'm afraid of lasting pain or sensitivity after a procedure and would just like a natural, lasting, painless smile. What would be the best option for me?

A: Hiding Tetracycline Stains

Unlike foods and smoking which stain the surface of the teeth, tetracycline is absorbed into the tooth structure as it is forming and growing.  It is an internal discoloration.  Tooth whitening will not succeed in masking this type of discoloration.  Plastic composite bonding can be used to hide the stains, but over time the composites will stain, margins break down and the restoration loose it's aesthetics.

I feel that a veneer is the least invasive procedure.  By reducing the surface of the tooth appropriately, the porcelain can be made thick enough to mask the discoloration and retain the natural shape and appearance of the tooth.  I do not think Lumineers are a good choice, they are an inexpensive knock off of the traditional veneer and do not work well in your situation.

Another alternative would be a crown.  Choosing between and veneer and crown would be dependent on whether there are significant dental restorations existing in these teeth already.

Q: I Am Trying for a Baby, the First Day of my Last Period Was Ten Days Ago

I would like to have my teeth whitened by laser in 4 days time. It's highly unlikely that I'm pregnant yet but need to know if it would be safe to do so.

A: Laser Whitening during Pregnancy

We tend to be overly conservative when it comes to considering medical and dental procedures during pregnancy.  Tooth whitening, whether in the office or a take home product is fairly benign.  Although we are very cautious to not let any patient injest the whitening product, it is doubtful it will in any way harm the fetus, but it may upset your stomach.

I personally feel it is better to err on the side of caution.  If you can delay whitening until after delivery of the baby, think of it as a post partum gift to yourself.

Q: Teeth Whitening Before Dental Crowns and Veneers?

I'm planning to get 4 crowns and 4 veneers on my top front teeth. I was told that I should whiten my teeth first before the procedure. Is that true? I figure since the teeth would be covered, I don't need to whiten them.

A: Whitening before veneers

The suggestion to whiten your teeth before placing crowns and veneers is related more to your other teeth than to the teeth being treated.  Over the counter and professional whitening products only work on natural tooth enamel.  They will not alter the color of tooth colored composite or porcelain restorations.

Especially if you are having this dental work done for cosmetic reasons, you will want to have the crowns and veneers designed to match your remaining teeth.  Whitening in advance allows you to obtain the tooth shade you want and match the dental work to that shade.  If the natural teeth darken sometime later, you will be able to whiten the natural teeth to match the unalterable dental work.

If the teeth to receive the dental work are heavily discolored, whitening before design and placement can provide a better cosmetic result.

Q: Has Anyone Tried "Go Smile"?

I am trying to find a good home whitening product. Any suggestions?

A: Home whitening

There is a vast array of tooth whitening products available today.  Professional whitening, whether in the office or take home trays, is the most reliable and safe method.  These products have been tested and approved as a medical product by the FDA and are closely monitored by your dentist.  Additionally, their effects are the most long lasting.

Other whitening products include those available to the public on store shelves or commercial sources.  Some of these are safe, work well and have reasonable lasting results.  Some do not work well except in printed advertisements.  Still others can be quite caustic and damaging to the teeth.

It is easy to get drawn in by all the marketing out there.  My suggestion is to talk with friends or co workers who have had success or other patients in the dental practice who have given their permission to act as referral sources.

Q: How Long Will the Pain Last from Tooth Whitening?

I had the procedure done this morning at 11am and I am in the worst pain I have ever been in. I read one comment from a patient who experienced pain for a year...is that possible? Thanks

A: Pain or sensitivity after whitening

Some patients note an increase in sensitivity during and/or after teeth whitening.  This condition is usually of short duration, lasting a day or two before returning to normal.  Using a tooth whitening product which contains fluoride can help reduce the risk of post whitening sensitivity.  Patients in our office who have a history of sensitivity prior to whitening are often instructed to use a high strength topical fluoride  for several days prior to and after the procedure to reduce or avoid sensitivity.

Overuse of whitening products can also cause sensitivity.  It is very important to follow the instructions of your dentist when using a take-home product or the manufacturers instructions on the over the counter products.  When used properly, tooth whitening products do a great job.  When used to excess, they have the potential to damage your teeth or make them very sensitive.

Q: What to Do when Gums Peel and Blister After Teeth Whiting

I used the teeth whiting for 3 days. i stopped Tuesday and today is Friday, because it was painful to my gums. Now my gums are peeling and white. I don't know what I can do to not continue to lose the damage gum area. Can I prevent the lost or do I just have to deal with the facts. Which I don't even know what they are either. So horrified, I really like my mouth and teeth. so extremely up set right now....

A: Gum Blisters after Whitening

When teeth whitening products get on your gums, they turn white and the surface sloughs off.  Although not pleasant to look at, it is a minor form of damage that often heals in less than a day.  Most teeth whiteners are a form of peroxide.  When you place peroxide on your skin to clean a cut, the surface turns white.  The speed and severity of this white effect is dependent on the strength of the peroxide. 

When having professional whitening in the dental office, customized trays and special materials are used to protect the gums from this effect.  The control the application of the peroxide to tooth surface only.  Over the counter whitening products use a one-size-fits-all approach and so the peroxide product more frequently reach the gum surface.

When using whitening strips, be sure to apply them only to the tooth surface leaving a little space above the gums.  When using trays, place only enough whitening gel to coat the surfaces of the teeth without squeezing out onto the gums.  These tricks will help avoid this kind of minor damage.

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Tooth Repair

Q: Tooth Broken to the Gum Line

I had a tooth that cracked and I ended up having a root canal and a crown. About a year ago the tooth cracked off at the gum line. I'm scared to death of the dentist and haven't gone to have anything done with it. However, it now has what feels like a wire coming out of the socket. Can anyone explain how they'll get the rest of the tooth out? Maybe if I know what's going to happen I'll finally go and get it taken care of

A: Broken root canaled tooth

The "wire" you feel coming out of the top of the root may be the post that was placed into the root canal space to hold the core.  If that is the case, then the core material failed and is still inside the crown.

Provided the fracture of the core was not due to recurrent decay, there probably should be enough tooth structure remaining to replace the core and crown.  If decay was involved, the ability to restore the tooth will depend on there being sufficient tooth structure above the supporting bone level and an adequate ratio of bone supported root to crown.

The worst case scenario would be that the tooth can not be restored and the remaining root needs to be removed.  Solutions to replace the tooth would include a dental bridge across the gap or placement of a dental implant.

You should discuss all of this with your dentist in a consultation.  Commitment to a treatment plan should only be done after considering all options.

Q: In Dental Bridges, Can 4 Abutment Teeth Be Enough for 6 Pontic Teeth?

I have continuous 6 front pontic teeth including the canines. I still have 6 molars left. I had dental bridges and only have 4 abutment teeth for that 6 pontic teeth. Would that be enough? Will my 4 abutment teeth remain healthy? Also what should be done to keep the abutment teeth in good condition? How can i be sure there would be no leaks for food or water inside? Thank you very much.

A: Long Span Bridge

Although it is common to replace the four upper central and lateral incisors with a bridge from canine to canine, bridges beyond that length are not advisable.  This anterior bridge usually works because the canines have the longest roots and thus ample support in replacing the front teeth.  Bridges to replace all six anterior teeth do not last and when they fail, it is catastrophic.

A better solution would be to look at implants.  My preference would be four implants placed in the canine and central incisor positions.  This would allow either a six unit bridge, or even better, two 3-unit bridges.  The three unit bridges would be more durable and if something did happen to require repair or replacement, a small section would be involved rather than the entire span of a 6-unit bridge.  Placing six implants with individual crowns is another option.

A last alternative would be a removable partial denture.  They are functional and inexpensive compared to implants or bridges, but relay on healthy, stable teeth to support them.  They are often not as comfortable as the fixed dental prosthesis.

Q: Root Canal for Broken Tooth?

I chipped my front central tooth in half. My dentist is going to put on a veneer, but she tested the tooth for root canal and said it is fine. Even though there is no need for a root canal now, should I have one done anyway? Other than the cost, what would the negative be of having a root canal on the damaged tooth?

A: Endo for half tooth

I will assume you fractured the tooth horizontally, you have had no pain, no bleeding from the tooth center when it broke and the nerve was still live when tested by your dentist.  A veneer to restore the broken edge is a great choice.  Even though a problem was not apparent during pulp testing, the more important question is what is the proximity of the fracture to the pulp chamber.  If there is considerable distance, then a root canal may not be necessary.  If the fracture is close to the pulp, the nerve may have been damaged or traumatized beyond recovery and a root canal is probably a good choice to avoid future problems.

Since root canals on front teeth are done from the back side of the tooth, if a future root canal is needed, it probably will not effect the veneer.  Your dentist can brief you on the situation.  She can explain the pros and cons of doing a prophylactic root canal and guide you in the decision making process.

Q: Broken File in Root Canal

I just had a root canal done today due to a deep filling I've had for a while. During the procedure, the general dentist broke the file inside the root. According to him, it should not be a problem but I am extremely concerned and don't feel comfortable having something there that shouldn't be. He said the tip broke off pretty deep. I am in a lot of pain. Could it be from the file or just the rct itself? Should I be concerned that the file broke and remains in my root canal?

A: Broken Root Canal File

A broken file being left in the root canal space, especially when it is lodged deep in the canal is not a common occurrence but does occasionally happen.  It is not a cause for grave concern.  As long as the canal was cleaned and sterilized properly and the canal fully sealed to the tip of the root, a broken instrument can be incorporated into the canal filling without fear of complication.  A separated or broken root canal file usually occurs when the file binds in a narrow or severely curved canal.  It is not a reflection of the dentist's skill or ability to perform the dental procedure.  The tooth was stronger than the dental file.  Pain after a root canal procedure is fairly common, especially if the tooth was abscessed or an instrument or irrigating solution went beyond the tip of the root and into the surrounding bone.  The discomfort should subside quickly as your body heals from any residual infection.  A very small percentage of root canal procedures fail without having any apparent cause.  If the discomfort lingers, check with your general dentist as to whether a consult with a root canal specialist is needed.  Unless the broken file extends beyond the tip of the root, it should cause no discomfort and is most likely encased in the root canal filling material.

Q: How Can I Keep my Gums Healthy?

I'd like my gums to remain in good health...tips for doing so?

A: Maintaining Healthy Gums

If your gums and bone supporting your teeth are already healthy, keeping them that way is simple.  GREAT HOME CARE.  Daily brushing and flossing to remove bacteria and plaque can easily maintain oral health.  If your gums appear swollen, puffy, red or bleed easily when you brush and floss, then they are not healthy.  Gum therapy by your Dentist or Dental Hygienist is necessary to return your gums to a healthy condition followed my meticulous home care.  Regardless, regular visits for dental hygiene is also required to maintain healthy gums.  Dental hygiene programs are tailored to fit the needs of each patient and may include visits with the dental hygienist at three, four or six month intervals.  Adhere to the frequency recommendations of your dentist or hygienist for a lifetime of healthy gums.

Q: Will Medicaid Cover a 5 Year Old Chipped Tooth?

My Front Tooth Was Chipped About 4-5 Years Ago Will Medicaid Cover It still? Did I Wait too Long?

A: Repair of a chipped tooth by Medicaid

Rules for coverage under Medicaid dental vary between states.  If the tooth was previously repaired under the Medicaid program, there may be a waiting period before the program will pay to repair it again.  Most programs will provide an initial repair of the tooth regardless of when the damage originated.  It is best to check with your Medicaid dental provider for details on what services are covered and how frequently.

Q: What type of dental work will medicaid cover?

A: Medicaid Dental Plan Coverage

Dental work provided by Medicaid varies from state to state.  Some states provide comprehensive care for all patients while other states may only cover basic preventive services.  Most states also require Medicaid recipients to obtain their dental care from a closed panel of dental providers.  Check with your local Medicaid office for details on what your specific state plan provides for dental care.  Also check the list of providers in your area.  It is best to verify with the dental office that they are still providing care and accepting Medicaid patients before obtaining dental treatment.  Most importantly, these programs are generally free for the patient but are costly for the dental provider.  Most office receive minimal reimbursement for their services.  If you make an appointment, keep it or call well in advance to change or cancel.  When a patient is a No-Show, it adversely effects the dental office, the Medicaid system and prevents another patient who wanted treatment from having the opportunity.

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Zoom Whitening

Q: If I Zoom Whiten my Teeth Before Getting a Crown Will I Have to Always Zoom to Maintain?

Everything I have read says to get Zoom done before my permanent restoration. However, If I do that doesn't that mean I am signing up to do Zoom (or some other strong whitening) for life? Otherwise wouldn't I eventually end up with the super white crown but the rest of my teeth not matching due to naturally occurring stains?

A: Zoom Before Getting a Crown

When my patients have an interest in tooth whitening, I always direct them to consider having the whitening treatment before I prepare the crown.  This is especially important if the crown is to be placed in the aesthetic zone.

Teeth will whiten but dental restorative materials do not.  Whether porcelain or plastic, the dental materials have a specific color based on their manufacturer.  They are non-porous.  Whitening products work by removing stains from the microscopic pores in the tooth enamel.  You can remove surface stains from dental restorative materials with a good professional polishing, but the base color will never change.

Whitening before having aesthetic dental work done is the preferred course of action.  The color choice for the dental work can be controlled to match the lightened enamel of the natural teeth.  If the enamel discolors over time, a simple touch-up whitening kit can be used to return to an aesthetic match.