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Replacing a Tooth for a Hockey Player

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I am a hockey player and I have lost two teeth this year. That isn’t normal for me, but it has to be dealt with. What would you say is the best option for me? I’m looking at dental implants but am wondering what would happen if I lost the same tooth again with the implant.

Jack

Dear Jack,

illustration of dental implant next to natural teeth

I am glad you wrote. It certainly has been a tough year for you. Dental implants are the best option in tooth replacements. They are the closest thing to having healthy, natural teeth in your mouth. However, given your current sport and run of “luck” some adjustments will need to be made in order to keep you safe. First, get the implants placed. That is important. You want to protect your jaw from any bone loss. Having those implants in place serve as prosthetic teeth roots so your body preserves the jawbone in that area.

The danger comes if you lose that tooth again, which is a concern you mentioned. The implants are not as flexible as your natural teeth so if that tooth gets hit hard enough then you will end up damaging the bone and jaw, which will be quite serious. Because of that, I don’t want you to place the crowns on the dental implants…yet.

Instead, get a simple, removable tooth replacement like a dental flipper. Then, once you are retired from hockey, that will be the time to place the permanent crowns on your teeth. You’re in a tough sport, but that tells me you’ve got gumption. You’ll make it through this.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

Tricked by “Cosmetic Dentist”

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I went to speak to my dentist about the possibility of braces and then teeth whitening. I have uneven teeth in my front upper arch. My dentist suggested porcelain veneers and said that he could accomplish both of those things at once with porcelain veneers without having to deal with braces for a couple of years. That sounded great to me, so I agreed. He provided 1 tooth bonding and 1 porcelain veneer, plus did some reshaping of my bottom teeth, which we never discussed and I never agreed to. All of this came to a little over $9,000. When he said the job was completed, I was appalled. My smile actually looked worse. The teeth were still misaligned and the porcelain veneer he gave me was too small for the tooth. Plus, my smile was still crooked and yellow. I feel like I’ve paid over 9k to look like I tried to get a smile makeover but it was botched. I asked him how I could get the results he told me we’d get from this treatment. He said only four porcelain crowns on my front teeth, plus a root canal would do it, for an additional $8,000. By then, I’d lost all faith in him and decided to get a second opinion. I’m glad I did. The second dentist thought some teeth whitening and four veneers would solve the problem. No dental crowns. No root canal. I definitely like his plan better. Is there any way for me to get my money back from the first dentist?

Amaya

Dear Amaya,

porcelain veneer being placed on a tooth

What a disaster! I hope you don’t mind if we add this to our pile of cosmetic dentistry horror stories. You should be able to recoup your money. You have two strong things working in your favor. One, he promised results you didn’t receive. Two, he did work on you without your permission or even discussing it. This is a big no-no in the dental world.

Start by simply asking your dentist for a refund. Though, given his actions thus far, I don’t anticipate he’ll just hand your money back to you. I’m going to suggest you get an expert cosmetic dentist on your side to help you request that refund. The dentist you got a second opinion from sounds like he knows what he’s doing. Teeth whitening and porcelain veneers are the right treatment for what you described. However, I want you to make sure. Smile makeovers are not taught in dental school. Instead, a dentist has to invest in post-doctoral training. The best cosmetic dentists are AACD accredited. See what the second dentist’s qualifications are. If they are good, then he or she can help you secure your refund. From there, you can get the smile makeover you were promised originally.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

Pain with a CEREC Crown

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I had an infected tooth. I had a root canal treatment and my dentist suggested a CEREC crown because they are faster. However, ever since I had the crown placed there is pretty serious pain when I bite down on food. I’ve been back twice for him to reduce the crown. It hasn’t helped. Now he’s telling me that it is because of the way I chew that is causing the problem. I am finding that hard to believe. My chewing didn’t hurt before I got this crown. Have you heard of this being a problem with CEREC crowns?

Lindsey

Dear Lindsey,

CEREC crowns block and tooth examples

No, the problem isn’t the way you chew. Like you mentioned, you had never had this problem before. If it was a bite problem, you would have noticed it before this. I don’t think it is the CEREC crown itself either. Generally, because CEREC crowns are milled by a computer they fit better than other crowns.

When a dental crown hurts when you bite down it is almost always from one of two reasons. The first is that the crown is seated too high. When that happens, your crown receives the full force of your bite without other teeth to spread the bite across their surface. The result is painful.

The second possibility is there is still an infection lurking. It is not uncommon for a root canal treatment to fail. An x-ray should be able to clear that up. However, if your dentist doesn’t have good diagnostic skills it can be missed on the x-ray. You may want to see a root canal specialist and have them look at it. It sounds like your dentist is in a bit over his head so he’s trying to throw excuses at you.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

Should She Follow Through with this Full-Mouth Reconstruction?

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I used to grind my teeth but didn’t know that until I went to see a new dentist for jaw pain after moving to a new city. He said it has been going on for years and now I need a full-mouth reconstruction. Here’s my problem. He did the lower arch first. I hurt for quite a few days after. Plus, the dental crowns look so dull and lifeless compared to how my natural teeth did. I miss my sparkly smile. I’m no longer having the jaw pain I was having. Is it completely necessary to do the upper half? I don’t want to have a dull smile. I’d rather just get some Zoom Whitening done so the upper teeth aren’t darker than the lowers and be done with it.

Olivia

Dear Olivia,

An image of a crown being placed

I am sorry you are going through this, especially when it was so preventable. If your previous dentist would have brought it to your attention and provided you with a nightguard, your teeth would not be worn down and you wouldn’t be spending a fortune repairing the problem. However, that is water under the bridge and you have to move forward from here.

Bear in mind everything I am telling you is based on general principles. I haven’t examined you so won’t be able to address your case specifically. Let’s start with what is bothering you about the first half. When you say you hurt for days afterward, there should be some soreness for a short period of time, but not a lot of pain. If you are sensitive, here are a couple of options that could eliminate that problem with the upper arch.

One option is your dentist could do porcelain onlays, which stop short of the gumline, instead of full crowns. This will prevent any sensitivity at the gumline. Another option would be to do porcelain crowns that stop at the margin instead of going into the sulcus.

The other issue you mentioned was the appearance of your porcelain crowns. This is completely down to the skill of the dentist. If they do not look natural, then it is a reflection of his skill as a cosmetic dentist. This is easily solvable by having a dentist with more cosmetic expertise and artistry take over.

If you decide to go that route, your dentist is ethically obligated to provide all the diagnostics and notes on your case so you won’t have to start over.

Finding an Expert Cosmetic Dentist

Because there isn’t a recognized specialty in cosmetic dentistry, it makes it a bit of a challenge for patients to know who has invested in the post-doctoral training and who hasn’t. The American Academy of Cosmetic Dentistry realized the quandary that puts patients in and started an accreditation program. This gives patients confidence in knowing the dentist they chose has the technical skills along with the artistry to create a beautiful smile for them.

In order to get AACD accredited, a dentist has to pass stringent exams and then present visual evidence on a large number of specific cases they’ve done to an examination board, who will judge the health and artistry of their work. AACD accredited dentists are considered the best cosmetic dentists in the country.

Should You Finish This Reconstruction

One of the things I worry about with you not finishing off the case is your other teeth getting worn down by the dental ceramics on your bottom arch. Some modern ceramics are easier on natural tooth structure, so you may want to talk to your dentist about what he used and how hard it is on teeth.

However, if you are out of pain, which is why you went there in the first place, maybe the bottom arch will be sufficient. If that is the case, then get your Zoom Whitening and be done with it. If, later, you determine you’d like to finish the procedure up you can. Just make sure your dentist is qualified to give you a beautiful smile with correct occlusion.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

CEREC Smile Makeover?

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I need a crown on one of my lateral incisors. My dentist has a CEREC machine and plans on using that. He knew I’d mentioned before that I wanted to improve my smile so thought we could do that at the same time using the CEREC machine to do some veneers as well. I’d heard of CEREC crowns, but not CEREC veneers. Is that a possibility?

Carson

Dear Carson,

Block of porcelain for a CEREC crown

While possible, it isn’t easy. CEREC crowns and veneers are milled from a single block of porcelain. On back teeth this is easy. On your very front teeth, it will take some expertise is color theory to know which stains to add where to make them look natural. The key to whether or not they will look natural is the dentist you use. I wouldn’t let anyone other than a dentist who is AACD accredited attempt this.

Your dentist shouldn’t mind you asking. If he says he isn’t but that he is qualified none the less, that is possible. There are some highly skilled cosmetic dentists who are on their way to accreditation. It takes quite a few years to obtain. However, I’d still want to know they have the requisite training.

Cosmetic dentistry isn’t a recognized specialty and smile makeovers aren’t taught in dental school. It’s totally up to the dentist how much, if any, post-doctoral training they receive. If your dentist isn’t accredited, you can ask him where he received his cosmetic training.

No matter what dentist you go with, make sure they do a temporary try-in of your porcelain veneers and dental crown before they permanently bond them on. That way if you are not thrilled with the results, then it can go back to the lab until they are made to give you the gorgeous smile you deserve.

It is important to know that if they are permanently bonded on and you don’t like them, there is no recourse. The only standard is that they are functional. Beautiful isn’t a requirement. That is why you have to be careful who does your smile makeover.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

From Dental Crown to Extraction

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I’m a little frustrated. I had a dental crown and root canal treatment. I was horseback riding and had an accident which broke the dental crown. I had an emergency dental appointment and they fitted me for a new crown. It kept feeling really weird. I let it go for a while, but then the crown fell off after a second accident. When I went in to see the dentist again he said the tooth was eaten up by decay and needed to be extracted and replaced. How can that happen? Did the dentist do something wrong when he replaced it the first time? How would I not feel pain with that much decay? What kind of tooth replacement are best in these circumstances?

Katy

Dear Katy,

image of dental implant in three stages

I don’t think your dentist would have done anything to cause decay. A lot has gone on with that poor tooth, especially given you’ve had two riding accidents that have knocked off your crowns. Teeth that have had a root canal treatment become very brittle and vulnerable. That is why we almost always place a crown on the tooth.

There are many ways bacteria could have gotten in there. There is a very sound reason why you didn’t feel any pain. The root canal treatment cleared out all the pulp in your tooth. There wouldn’t have been anything really to feel. That tooth is dead.

So where do you go from here?

Tooth Replacement Options

After you have your teeth extracted, it will be important to replace it. Without that, the adjacent teeth will shift and tip into the open space. The best replacement option is a dental implant. These mimic your natural teeth by placing a prosthetic root inside the jawbone, then places a dental crown on the implant to serve as the visible part of your tooth.

Another good option, when it comes to replacing a single tooth, is a dental bridge. This suspends a false tooth between two dental crowns. Getting a bridge makes more sense if one or both of the adjacent teeth already need a crown. Without that, you have to grind down healthy tooth structure, which isn’t a great option if it is avoidable.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

Dentist or Oral Surgeon for a Tooth Extraction

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I had a dental filling which fell out. I was foolish and didn’t go back to the dentist because my last appointment was a bad experience. I know I should have because eventually the tooth developed an infection and I was in tremendous pain. In fact, it was so unbearable I went to see another dentist. This dentist did a root canal treatment, but we never scheduled a follow-up appointment. Because of that it eventually developed more decay. Now, I’ve got a dentist telling me it needs to be extracted. He suggested the extraction would be complicated enough that I might consider an oral surgeon. I did some number crunching and the oral surgeon would be a lot more expensive. Am I putting myself in danger by going with the less expensive option?

Amanda

Dear Amanda,

Woman asleep in the dental chair from detntal sedation

I feel it was unfair of your dentist to phrase it this way. It makes you feel like going the affordable route is dangerous. It’s possible he feels this procedure is above his current skill level and that is why he’s recommending an oral surgeon. If that is the case, I definitely wouldn’t have your dentist do it. He could get into a situation during the procedure where he doesn’t know what to do.

Before making a decision, I’d ask some more questions. Has he done this type of extraction before? What is his comfort level in performing the procedure himself? Does he offer dental sedation?

If it turns out he’s experienced and comfortable with the extraction and he offers sedation options, you’re fine to go ahead having the extraction done at his office. Based on how he framed it, however, I don’t think that is going to end up being the case. You will either need to see an oral surgeon or use a different dentist who had more experience in this particular procedure.

How Using Dental Sedation Can Change Your Life

When you have dental anxiety, it often has a negative impact on your oral health. You’ve already experienced this so you understand, I’m just saying it for the benefit of others. However, knowing that doesn’t take away your anxiety. I do have something that actually could help, though.

Going to a dentist who offers sedation doesn’t have to be reserved for the most difficult of cases. It can be done for any procedure you’d like. Though, if you’re just getting a cleaning, I wouldn’t go for the “big guns”, like oral conscious sedation or I.V. Sedation. You’ll be fine with just nitrous for that.

If you’re having specific work done, such as dental fillings or a dental crown, you could then upgrade to something like oral conscious sedation. You’ll also find you can get more work done during each appointment, allowing you to catch up much more quickly on the work you’ve been needing. Before you know it, you’re all caught up and no longer even need sedation.

This blog is brought to you by Hilton Head Dentist Dr. Bonnie Rothwell.

Can I Fix the Color of My CEREC Crown?

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I had a CEREC crown done on one of my canine teeth about three weeks ago. We never really discussed the shade while I was in the office, but as soon as I got home, I realized that it was a bit lighter than the rest of my teeth. Well, once I saw it, I couldn’t un-see it, and now every time I look at myself, all I see is that darn tooth. It looks fake.

I didn’t want to bother my dentist with this at first, so I started playing around with at-home whitening products to try to get the rest of my teeth to match, but I’m just not getting them as bright as that CEREC crown. This probably sounds crazy, but I’m starting to wonder if the dentist can darken it just a bit, so it’s a better match. Is that even possible?

Thanks,

Stan

Dear Stan,

image of porcelain block for CEREC Crown restoration

Your question isn’t crazy and, particularly with a tooth near the front, your dentist should have shown you the work before you left to ensure you were happy with it.

Ideally, a Good Color Match is Selected from the Start

Your dentist had color options. Really, the materials come in every shade imaginable. He could have had an exact match. He chose not to. That’s a shame, but it’s also very telling. It means he’s not an “artist.” He’s more into the mechanics of dentistry, which is ok for everyday needs, but not great when you want your smile to look natural and aesthetically pleasing.

Varnishes and Stains Exist

There are varnishes and stains that can be used on dental restorations, though they’re typically used before the crown is cemented in your mouth. He may be able to darken it a bit and there’s no harm in letting him try.

You May Have to Have Your CEREC Crown Replaced

You deserve to be happy with your smile and he biffed the color. You may have to have the whole thing replaced. However, this time, make sure you get to look at it BEFORE they cement it. He should use a temporary try-in paste and allow you to look at your CEREC crown under various lighting conditions. Look at it in the chair. Get up and go into the bathroom and check it there. Venture outside and view it in natural sunlight. If it isn’t right, don’t let them cement it. You can also get involved during the shade selection process, either by examining the shade guide or physical material before they put it in the milling machine.

Request a Lab-Made Restoration if All Else Fails

Assuming you trust your dentist and have a great relationship with him other than this blip, one last line of defense is to revert back to a lab-made crown. Although you’ll have to wait two weeks for the lab to make it, the lab technician will hopefully have a better eye for detail than your dentist. For the best results, you’d really want to switch to someone with real expertise in cosmetic dentistry for these sorts of things, but you’ve already started with him, so as long as you’re keen to continue, give him the chance to fix his work too.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

Dentist Wants to Crown Healthy Teeth

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I need some advice. I’ve had horrible tetracycline stains most of my life. I’ve gone to three dentists to try to get this fixed and all of them want to put crowns on my teeth. I don’t want to do that because the teeth are perfectly healthy. Do I have an alternative?

Brenda

Dear Brenda,

HIlton Head Porcelain Veneers

First, I will say so you’re aware, tetracycline stains are among the most difficult cases for a cosmetic dentist to deal with. Truthfully, I’d say only about 2% of dentists can do this well.

For the benefit of those reading who are unfamiliar with what tetracycline stains are, I’ll explain. When children are given the antibiotic tetracycline before the age of 12 it causes severe staining on the developing teeth.

The stains are so dark that most dentists have trouble finding the balance between getting the porcelain veneers translucent enough to look natural but still not show the staining through.

Finding a Cosmetic Dentist To Fix This

There is definitely an alternative to getting dental crowns. Seeing as your teeth are healthy, you don’t want to remove any structure unnecessarily. I mentioned porcelain veneers above. That’s what I’d recommend. But, again, not every dentist can do this.

I’d ask any dentist to show you examples of the work they’ve done with tetracycline stains. Make sure they show you before and after so you can see if the staining is as dark as yours.

Another option is to go to aacd.com and look for an accredited dentist with the American Academy of Cosmetic Dentistry. These are the top cosmetic dentists in the country and will have the color knowledge and skill to give you a beautiful smile.

If there’s not one within a reasonable travel distance to you, mynewsmile.com also recommends excellent cosmetic dentists. Not all of them are accredited, but they’re all screened for both skill and artistry. You can feel confident they can perform this as well.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

Bone Grafting for Dental Implants?

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I want to get dental implants. My dentist said he does them all the time and offered to do them for me. He even does the surgery, or so he said. But, once he got in there, he told me I wouldn’t be a good candidate without having some bone grafting done first. Is this legitimate or is he just trying to squeeze another surgery out of me?

Ben B.

Dear Ben,

An illustration of a dental implant

I’m curious as to whether or not your dentist has given you a reason to mistrust him in the past. If you’re worried your dentist is dishonest, you’d be better served with a dentist you feel has integrity.

In regard to your question about bone grafting, it is a legitimate procedure. As you can see from the dental illustration above the titanium implant gets placed directly into your jawbone. The right amount of bone is needed to keep the dental implant secure and in place.

Your dentist was actually trying to protect you from as wasted procedure. Without the right amount of bone, you’d end up with dental implant failure.

Things to consider with Dental Implants

Your dentist already hit on an important one—the density of your bone. While some people just have bone that is less dense, you might want to look into why you needed bone grafting. Are you a smoker? Is it possible you have gum disease? Both of those things will affect your bones. Those underlying issues will need to be addressed in order for you to move forward.

Another thing to consider is cosmetic. Once you are able to finally get your dental implant, the crown’s color is permanent. If you want to whiten your teeth at any point in the future, you may want to do it before you get the implant crown done. Then the crown can be made a beautiful white color to match your teeth.

This blog is brought to you by Dr. Bonnie Rothwell.

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