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Bonding Looks Awful

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My daughter (11 years old) fell and took out a chuck of her two front teeth. The edges or outline were okay, but the middle was pretty much knocked out. Her pediatric dentist suggested dental crowns on those two teeth. I wasn’t crazy about that idea so I took her to my general dentist. He suggested dental bonding. I liked that idea better, but it looks absolutely awful. It’s uneven (like bumpy) and the color doesn’t even match the rest of the tooth, let alone the teeth next to them. She’s humiliated and dreads going to school every day. Did we do the wrong procedure? Should we have gotten crowns?

Emily

Dear Emily,

Before and after dental bonding

Dental bonding was the correct procedure for this. The problem lies in the skill of your dentist. This is not a procedure that your average family dentist could do well. Dental bonding is an advanced cosmetic procedure, made even tougher by the fact that it has to be done freehand. I think she needs an expert cosmetic dentist to redo her dental bonding.

If it is as bad as it sounds, your dentist should have the integrity to recognize that and offer a refund. When you replace it, have it done by an AACD accredited dentist. These are the top cosmetic dentists in the country. They can give her a beautiful, natural looking result that blends in seamlessly with the rest of her teeth, similar to the picture above.

Do not do dental crowns. I’m concerned that her pediatric dentist suggested that. First, the pulp of the tooth in an 11-year-old is large and close to the surface. Doing a crown on it can damage the tooth pulp, which will markedly complicate the procedure and lead to the need for a root canal treatment. Additionally, her teeth, bite, and jaw are still developing. She’ll quickly outgrow that dental crown leaving gaps and exposing her to serious decay risk, not to mention looking weird, unless you replace it every couple of years. A good pediatric dentist should understand this.

I’d focus on getting her bonding replaced. Then, you can decide if it’s also beneficial to look for a better pediatric dentist for her.

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

Antibiotics for a Tooth Infection

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I had a tooth infection a couple of weeks ago. I went to see my dentist who prescribed me antibiotics. I’ve taken them. Things were fine at first, but now I think the infection is back and it seems to be getting worse. The point from my tooth is swollen to halfway up my cheek toward my eye. Do I need a refill on the antibiotics or a different antibiotic? I’m not sure what to ask for when I call them.

Liz

Dear Liz,

Woman grabbing her cheek in pain, in need of an emergency Dentist

I am hoping there was some type of miscommunication here between you and your dentist. He should have scheduled a follow-up appointment with you to deal with the infected tooth. Unlike with other infections in the body, antibiotics alone are not enough. Your dentist has to go in there and physically remove the infected pulp. That can be done one of two ways.

Ideally, the tooth is saveable and all your dentist will have to do is a root canal treatment. Sometimes, however, the infection goes too far and the tooth has to be extracted. You may be wondering what the point of the antibiotics were if they would not solve the problem. They are used to help hold the infection at bay until your dentist can do the physical work necessary to obviate the infected pulp. This is why you started to feel better, but then once the antibiotics ran out, your infection returned full force.

I would consider this a dental emergency and call your dentist. If for some crazy reason he thought antibiotics were all he needed to do than you need a different dentist. My guess is he mentioned scheduling a follow up but you were in so much pain you missed it. It’s time to get the work done and get rid of this infection once and for all.

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.

Nightmare wtih Two Front Crowns

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I am at a loss at how to proceed with my daughter’s teeth. We were trying to straighten this all out before my daughter left for college. It has been a nightmare. Her school ended up going virtual because of COVID-19 which, in a crazy way, was a blessing because we’re still dealing with these two teeth. One tooth had a root canal treatment and crown. This tooth started turning dark. Our dentist suggested doing porcelain veneers on both front teeth so they could match. We agreed. When they first came in, they didn’t match at all and he agreed to re-do them. He put back on her temporaries and we waited again. The second go-round wasn’t much better but he has already bonded them on. One tooth is much grayer than the other and the one that isn’t gray sticks out more than the other. He thinks he can move that back some but says there is nothing that can be done about the gray tooth because of the dark tooth underneath, but that is why we came in the first place. Am I being unreasonable? [photos enclosed]

Maggie

Dear Maggie,

porcelain veneer being placed on a toothNo, you are not being unreasonable. In addition, your dentist has been less than honest. Are you sure he said porcelain veneers? What he provided your daughter isn’t veneers, but porcelain crowns.

As you can see from the picture on the left, porcelain veneers are thin wafers of porcelain. They do not require your teeth to be ground down the way your daughter’s teeth were. Plus, that one tooth already had a crown. He would replace a crown with a crown. The nub that is left of the original tooth would be too small for a veneer.

I think the biggest problem here is your dentist is in over his head. Matching a single porcelain crown to a front tooth is quite difficult. Because of that, many inexperienced cosmetic dentists will tell their patients they need to do two in order to get them to match. That is what your dentist attempted to do, but because of the root canal, he wasn’t even able to do that. Additionally, the difference in depth of the two crowns is also unacceptable.

Under normal circumstances, I’d tell you to insist your dentist re-do this and get it right. However, I don’t think your dentist will be able to. I want you to just ask for a refund. It shouldn’t be too hard to get because he lied about the procedure.

Once you’ve secured your refund, I want you to look for an AACD accredited dentist. These are the best cosmetic dentists and have proven artistry and skill. They’ll be able to give her two porcelain crowns that match. They will even know the techniques to get the grayer tooth to look white as well.

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.

Porcelain Veneer Instead of Crown After Root Canal Treatment?

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I recently had some trauma to a front tooth which required a root canal treatment. My new dentist is well-known for his cosmetic skills. I haven’t utilized that yet. However, he is suggesting a porcelain veneer on the tooth. Everyone I know who’s had a root canal treatment received a crown over the tooth. I would think that would be more secure. Is he suggesting a veneer because he’s a cosmetic dentist? Which is the better restoration after a root canal?

Amelia

Dear Amelia,

Difference between tooth prep fro a crown and a veneer

In dental school, if a student is asked the question, “What restoration do you use with a root canal treatment?” The expected answer is a dental crown. Most of the time, that’s the right answer. Often a crown is needed because there is too much decay and the tooth has to be ground down and protected. When there isn’t decay, you have more of an option.

On back teeth, a dental crown still makes sense because of the way we chew and how that affects our biting force. However, on front teeth, it’s a completely different story. Our biting force with front teeth is lateral, meaning the lower front teeth push forward on the uppers, and the upper front teeth push backward on the lowers.

Look at the two images above. The tooth prepped for the dental crown is ground down. That particular prep is very conservative, so that tooth will be stronger than most crowned teeth. Think about if that front tooth was hit with something. There is not enough of a base to keep the tooth secure. It will break.

Now look at the tooth prepped for a porcelain veneer. It removes much less tooth structure giving it a much stronger base.

This means on a front tooth, a dental crown would weaken the tooth. A porcelain veneer actually makes more sense.

That long answer to your question means, your dentist was right. A porcelain veneer is a great restoration in your case.

Who Should Place Your Porcelain Veneer?

When you’re talking about a porcelain veneer on a single front tooth, you need an expert cosmetic dentist. You seem to have one. You mentioned your dentist was known for his cosmetic dentistry. However, for the benefit of those who are reading this and don’t already have a well-known cosmetic dentist let me tell them what to look for.

When you need an expert cosmetic dentist, I would suggest you go to the aacd.com website. The American Academy of Cosmetic Dentistry has an accreditation program. Those who reach accreditation are the best of the best of cosmetic dentists. They will give you a gorgeous porcelain veneer. If you’re after a total smile makeover, you will get a stunning smile.

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

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