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How long do I wait after an extraction to get an implant?

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Hi. I had a tooth extraction after about a year of problems with a root canal. That is a long time for an infection, so I’m wondering how long I need to wait to get my implants placed? Also should i take antibiotics?

Beth Q.- Santa Clarita, CA

Beth,

When your tooth becomes infected, the tissue inside the tooth dies. There is a spot at the apex of the root where the infection can creep into the surrounding bone. Fortunately, your body fights that off very well. Once your tooth is extracted, the source of the infection is removed and your body goes to work quickly eliminating the remaining infection in your bone. An additional benefit of the extracted tooth is there is now a wide drainage hole into the bone that is now the heart of the infection. These factors mean there are rarely problems of residual infection after a basic extraction.

Impacted/infected wisdom teeth are separate cases.  Instead of the infection being inside the tooth, it is actually in the space between the tooth and the gum. On top of that, the removal of a wisdom tooth requires cutting into the surrounding bone and tissue, which gives an additional opportunity for the infection to spread. In these cases it is not uncommon to have complications with infection, and dentists generally prescribe antibiotics during the healing time to prevent problems with infection.

So, the answer to your question depends on which type of extraction you had.

I will offer one other piece of advice, though you didn’t ask. Be careful who you have do your dental implants. There are many horror stories from people who didn’t realize the dental implants are an unregulated part of dentistry. Any dentist can place them, whether they are qualified or not. You want to get someone who has a lot of dental implant qualifications, such as taking courses from LVI. If it is a very visible tooth, you’ll also want to make sure your dentist also is an artistic cosmetic dentist, so you won’t be disappointed with the way your new prosthetic tooth looks.

This blog is brought to Grosse Pointe Woods dentist Dr. Theodore Hadgis.

Dental Bonding vs. Crown to fix a broken tooth

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I have a front tooth that is broken off about halfway. I’ve been to two dentists asking how best to fix it. I got two completely different answers, so I’m hoping you’ll be the tie-breaker, without me having to pay a THIRD dentist for an opinion. The first dentist said to use dental bonding to fix the front tooth, the second said bonding isn’t a good idea and I should get a crown placed.

Frank L.- Tennessee

Frank,

Truthfully, you can do either one, though with that much of your tooth missing, I would personally lean toward the crown. Why don’t I just give you the pros and cons of each and you can decide which best fits your desires and situation.

Dental Bonding Verses Dental Crowns:

  • Bonding can be done in one appointment, a crown usually takes two appointments.
  • While both procedures require a high amount of artistic talent, bonding is one of the most demanding of a dentist’s skills set. Many dentists shy away from bonding because they are not skilled enough in this procedure. You will want to ask to see before and after photographs of previous cases to make sure their work is of the caliber you would want for a front tooth. If they don’t have photos, that may be an indication they are not serious cosmetic dentists and you need to find someone else.
  • The porcelain on crowns is more durable and stain resistant than the composite material used for bonding.
  • If the bonding is extensive, covering a large area of the tooth, there is a risk of it breaking, because it isn’t as strong as a porcelain crown.
  • Bonding is slightly safer than crowns. There is a risk with crowns that the pulp of the tooth will be irritated and you will end up needing a root canal.
  • Bonding requires very little removal of tooth structure, whereas your tooth will have to be shaved down considerably for a crown.
  • It is fairly easy to have dental bonding upgraded to porcelain veneers or a crown if you’re not happy with it, but once you get a crown, you are pretty much forever committed to having a crown on that tooth.

Whichever procedure you choose, be careful about the qualifications of your cosmetic dentist. Because there is no recognized specialty in cosmetic dentistry, any dentist can call themselves a cosmetic dentist. This is your front tooth and will be a very visible and important part of your smile, so be careful who you choose.

This blog is brought to you by Grosse Pointe Woods cosmetic dentist Dr. Theodore Hadgis.

Lumineers disaster- How do I get a refund?

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Please help me. I just spent a lot of money having 6 Lumineers put on my daughters front six top teeth. They are horribly done, too bulky, squared instead of tapered (as we requested), and the color doesn’t match her other teeth. Here is what happened: We had a consultation for Lumineers and showed the dentist a picture of the kind of Lumineers smile we wanted. He said he was Lumineers certified and could do that. He also said we’d get to try them in and see them in different lights, and if we weren’t happy he could make some changes. Unfortunately that didn’t happen. When we came in to have them put on, he put them on with some kind of temporary paste. Her mouth was pulled back quite a bit, so it was hard to tell how they really looked. He kept telling my daughter how beautiful they looked, but I thought they looked too bulky and square. I couldn’t tell the color issues until we got home. He actually only let us look at them in one lighting, saying it was the most natural lighting.  I mentioned my feelings, and he said that was because it was a temporary paste and they’ll look even better when they are on permanently. They didn’t, and when my daughter went to school she was teased mercilessly, being called horse teeth. So, I took her in to fix all the gaps in her teeth so she’d feel less self-conscience and instead the situation is worse. I spoke to the dentist about it and he said he’d taper them some, but I think I just want to have them removed and get a refund. Is that possible? I’d like to find a different dentist to do these for her.

Laurie, A frustrated mom- Kansas

Laurie,

I’m sorry for your experience. Unfortunately this type of situation is not uncommon. There is a difference between a dentist who does cosmetic work and a cosmetic dentist. There is no recognized specialty in cosmetic dentistry, so anyone can learn the procedures and call themselves a cosmetic dentist. Being Lumineers certified doesn’t guarantee quality veneer work either. To get certified to place Lumineers you just attend their class. There is no test to make sure the dentists know what they’re doing. There is no examination of the quality of their work. If you sit through the class, you’re certified.  What you want to find more than a Lumineers certified dentist, is a truly excellent cosmetic dentist, who can do beautiful porcelain veneers whether he uses the Lumineers brand or not. An excellent cosmetic dentist cares about the artistic quality of his work and will not be satisfied until you are.  One way to find that is to look on the mynewsmile.com website. On that site, a cosmetic dentist recommends quality cosmetic dentists in each state. It isn’t easy to get recommended by him. Dr. Hadgis  is and had to demonstrate is qualifications both in his training, and in submitting samples of his work.

I also think you have a decent chance of getting a refund if you go about it carefully. First, make sure you don’t have them do any more work on this case. This just increases their chair time and costs them more money, as well as you.

Second, let him know how dissatisfied you are. Your best points are: 1. He didn’t follow through with his word of letting you look at it in different lights and making sure you were completely satisfied before permanently bonding them. 2. Your daughter has suffered emotional hardship.

Third, I would enlist the help of a dentist from either out of state or another city. Go and see a qualified cosmetic dentist elsewhere, letting them see the poor craftsmanship of your current dentist’s work, and ask if he’d be willing to help you get a refund. Dentists care about their reputation with their peers, so he’ll be in a better position to criticize the work than you will.

Finally, if you’ve put the charges on your credit card and haven’t paid them yet, let the dentist know you plan on filing a complaint with the credit card company and will be refusing the charges unless you get a refund.

If you follow these steps, you have a decent chance of getting a refund and having quality cosmetic work done on your daughters smile.

Good luck.

This blog is brought to you by Grosse Pointe Woods cosmetic dentist Dr. Hadgis.

Bleaching bonding

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I wonder if you can help me. Two of my front teeth have dental bonding on them that are about 15 years old. I know it is time to get them replaced, but my finances aren’t that great right now. I know that you cannot make dental bonding any whiter by bleaching them, but can you whiten them back to their original color?

Daniel M.- New Jersey

Daniel,

No teeth whitening method will make your dental bonding any whiter. In fact, it will only make them look worse because  your natural teeth will get whitened from the bleaching. If your discoloration is from external stains instead of inside the bonding material, it is possible the discoloration could be polished away. Be sure you get an expert cosmetic dentist to do this, otherwise you could end up with a disaster.

If, however, the stains are internal, polishing won’t help. They will have to be replaced. With your finances currently not where you want them for replacement, my recommendation will be to leave it as is and wait until you can afford to get them replaced. Don’t look for a bargain by finding an “affordable” cosmetic dentist. As with the polishing, be sure you get them done by a highly qualified cosmetic dentist. If you want it done right, and with it being your front teeth that is even more important, you need someone with an artistic touch. To find a great cosmetic dentist in your area, you can check on mynewsmile.com. They screen cosmetic dentists from each state checking both their educational qualifications as well as their artistic expertise with their cosmetic work.

This blog is brought to you by Grosse Pointe Woods cosmetic dentist Dr. Ted Hadgis.

Which metal for a crown?

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I need a crown put on a rear molar. My dentist said due to space issues it will need to be a metal crown. I wasn’t too excited about that at first, but realize there isn’t much option. Now that I’ve come to terms with having a metal crown I was wondering which metal. I can have the regular metal or gold. Are there advantages to one?

Jay- Cape Cod

Jay,

The space issue your dentist referred to is probably because it takes more space to use porcelain. They have to be made thicker than metal. If there isn’t much space there already, then metal is the better choice. Seeing as it is on a rear tooth, it won’t detract from your appearance.  If you’re going with metal, I highly recommend a gold crown. They are corrosion resistant, are more malleable (which makes them easier to fit), and will not crack.

This blog is brought to you by Grosse Pointe Woods Cosmetic Dentist Dr. Theodore Hadgis.

Lumineer keeps falling off

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I had two Lumineers placed on my front teeth a couple of years ago. One of them is fine, but the other one has already fallen off three different times. Each time it causes my gums to bleed. Do you know why this one lumineer just won’t stay on?

Sincerely,

Janet S.- Arkansas

Janet,

Lumineers are a particular brand of porcelain veneers.  All brands of porcelain veneers are placed with special bonding techniques that aren’t always taught in dental schools.  However, if a dentist has adequate training they are not that hard to place. I would guess that your dentist does not have that training. The Lumineers brand does not require much for a dentist to get certified to place their brand. You are very fortunate that your veneer hasn’t broken any of the times it has fallen. It is also possible for a patient to swallow their veneer.

My recommendation to you would be to have a different dentist place your Lumineer on the next time you  have a problem. Though there will be a charge for the new dentist to bond it, it will be a lot cheaper than having to replace a shattered Lumineer. The mynewsmile.com website can recommend a dentist in your area that is qualified to place your veneer for you. They screen cosmetic dentists carefully for both their education and the quality of their work. Whomever you find on that site, will be safe for you.

Good Luck!

This blog is brought to you by Grosse Pointe Woods Cosmetic dentist Dr. Hadgis.

Can tooth infections actually be dangerous?

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I heard something today that really freaked me out, so I am asking an expert if it is true. I am pretty sure I have an infection in one of my teeth, and one of my friends told me today that it could actually be dangerous. Is that true?

I broke one of the teeth in my upper jaw last week. I don’t have the money to visit a dentist right now, but I think I’m going to have to do something. The pain is getting steadily worse. The swelling is now noticeable, and the pain is radiating all over my face, and down my neck. I was going to take some antibiotics that I had left over from a strep infection, but they have expired. What should I do? Do I have to visit a dentist, or can I just go down to the clinic and get an antibiotic?

Marley in Chica

Dear Marley,

Your friend is right. This situation is dangerous. An untreated infection in your tooth can spread to your brain. You must get this addressed as soon as possible.

You must either have the tooth repaired (with a root canal treatment and porcelain crown), or have it extracted. If you do not treat the tooth with a root canal treatment (or removal), you will not remove the source of the infection, and taking oral antibiotics will only make the bacteria that remains resistant to treatment. For this reason, you really should see a dentist to have this looked at. An emergency room doctor could remove the tooth, but it would be best to try and salvage the tooth.

Post courtesy of Dr. Hadgis, Grosse Pointe Woods cosmetic dentist.

Is my son too young to have all his teeth pulled?

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What are the consequences of having all your teeth pulled in your late teens? My youngest son is not yet 20, but he has been a drug addict for years. He is currently clean, and working hard to stay that way, but all the years of abuse have taken a heavy toll and his health in almost every regard. One of my main concerns right now is his teeth.

They are simply ruined. He is only able to chew with the teeth at the front of his mouth, and even that causes him a lot of pain. Many of the teeth are half rotted out, and several are missing. Almost none of them look healthy enough to save.

I took him to see a dentist as part of a free health care promo at the clinic where he gets treatment for the drugs, and he said that we should just pull all his teeth and fit him for dentures. They set up an appointment in 3 months for him to go in and get the whole thing done in one afternoon. My son seems resigned to this, but I don’t think it sounds totally right.

Isn’t that a lot to have done in one afternoon? And won’t he be too sore for them to fit dentures? I took my Grandpa in once, years ago, for a fitting, and they put all this goop on his gums. Won’t that get in the open sockets and cause him pain, and risk infection? This all seems really like he is being shuffled through as quickly as possible.

Are they any other options?

Thanks.

Lucy in Flagstaff

Dear Lucy,

This is not a good treatment plan. If your son has all his teeth removed before he is even 20, he will be a dental cripple by the time he turns 4o. The jaw bone deteriorates at the site of a lost tooth, so imagine what happens when ALL the teeth are gone. In time, the bones of the jaws become so thin and fragile that dentures are not an option.

Get a second opinion. If even some of your son’s teeth can be saved, they can be used to anchor dentures, and will slow the bone loss in his jaw. Search the internet for “affordable dental implants” or “mini dental implants”. If none of the teeth can truly be saved, he better start saving for dental implants. Even a few will dramatically slow the bone deterioration that is so necessary to avoid.

Grosse Pointe Woods cosmetic dentist Dr. Hadgis’ office sponsored this blog post.

Can I consider getting bone grafting?

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I have some questions about bone grafting. I’ve been missing the six center teeth on my lower jaw for many years, and have worn both a dental bridge and a partial denture. The bone of my lower jaw has really gotten thin, though, and my dentist says we need to consider dental implants. To do the dental implants, though, he also says that he thinks I will need bone grafting.

He will be referring me to a specialist for all of this, as he says that he himself does not have the proper training or facilities. Is that normal? And he didn’t tell me much about bone grafting – is it safe? My overall health is excellent, but when I started looking for information on the Internet, I kept finding a lot of horror stories.

Any information you can give me would be greatly appreciated. Thanks for your help.

Henry in Bangor, MA

Dear Henry,

If your general health is excellent, that is a good indicator that you are a good candidate for bone grafting. Of course, the specialist your dentist refers you to will take a close look at the specifics of your case before recommending treatment of any kind. He or she will look at your x-rays, CT scans and will certainly perform a thorough examination.

You should be reassured that your dentist is referring you to a specialist, if your case is complex. Similar to cosmetic dentistry, the American Dental Association does not recognize a separate specialist designation, but extensive training beyond dental school is required to perform this kind of treatment. Even after your dentist makes a recommendation, make sure you do your own homework. Check the specialist’s website, and ask about training. Look for evidence that he or she has taken coursework at a facility like the American Academy of Implant Dentistry, or the Academy of Osseointegration, or the International Congress of Oral Implantology.

The office of Grosse Pointe Woods cosmetic dentist Dr. Hadgis has posted this information as a courtesy.

What would happen if I switched dentists in the middle of treatment?

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I am having a real problem, and don’t know what to do. I am in the middle of treatment with a prosthodontist that came highly recommended, but things are not going well. I am getting porcelain crowns on almost all my teeth. We had the first fitting of the top six center teeth. The tops of the teeth were really rounded, and I could feel where the crown and the natural tooth met. They did not look natural at all! My dentist assured me before we started all this that it would look beautiful and natural, and they really didn’t! I asked him to redo the teeth. He seemed annoyed, but did it. Now the fronts look OK, but the crowns do not cover all of my teeth in the back anymore. Part of the reason we are doing this is that my teeth are really sensitive. I can’t stand anything hot or cold near the roof of my mouth. So now the second round of fittings for the first six teeth are not right either, and all of my other teeth are still in temporaries!

I have lost all confidence in this dentist. Is it too late to change? Can I ask to have my case transferred? I kind of don’t care if I make him angry. I just want this over with, and for the amount of money I am spending I want it to look perfect.

Any advice you can give would be great.

Lola in Spokane

Dear Lola,

It sounds as if the dentist you are working with does not have an artistic mindset, but rather a mechanical one. If he is not overly concerned with the appearance of your teeth, then you’re fighting against the tide trying to get him to spend time on cosmetic concerns. Though one might expect a prosthodontist to be an expert on crowns, they rarely have the cosmetic sense to do really beautiful work. The function of your teeth will be fine, but you’ll cringe every time you look in a mirror or see a picture.

It is not too late to change. You need to have an honest conversation with your current dentist, and ask him how to work out the details on the finances, assuming you have already paid some money for this work.

Best of luck to you.

This blog and post sponsored by Grosse Pointe Woods cosmetic dentist Dr. Hadgis.

For more information about smile makeovers, including porcelain veneers, see our website.