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My daughter’s teeth have severe decay

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I’ve been trying to gather information about dental care for very young children, and your blog seems to be well informed. My daughter is four years old, and to date has not really had a true dental appointment. I’ve taken her to several different dentists, but she refuses to open her mouth for any of them. My first question is whether you think a pediatric dentist would have better luck than a general dentist, or if I will have to think about letting them sedate her, as the last dentist suggested. I hate the idea of sedation, but things are getting critical.

She lets me look in her mouth occasionally. I can see four teeth on the top that have cavities, and two of them look really deep. I don’t see anything really worrisome on the bottom teeth yet, but have not had a really good look at those in a while. The two teeth on top that are really bad have started to chip away, and that brings me to my second question–can anything be done to salvage those teeth? From the reading I have done, I know that if those teeth are pulled, it could mess up the alignment of her teeth permanently, even though they are baby teeth. I’ve been reading about porcelain crowns and white fillings, and both of those sound like good options, if they will work with really damaged teeth. I don’t want her to feel self conscious if we have to do some kind of metal filling or crown.

I know you can’t make a definitive diagnosis just from my descriptions, but any information you can offer would be great.

Thanks,

Doreen in Tallahassee

Dear Doreen,

We recommend locating a pediatric dentist that has experience with sedation dentistry. That way, if your daughter can’t be persuaded to open her mouth, you can have a “Plan B” in place to get her the dental care she needs.

You are absolutely right that the best course of action would be to salvage those decayed teeth. If they cannot be saved, she will need some kind of space maintainers so her permanent molars do not drift forward, which would be expensive to fix down the road. Because these are baby teeth, your dentist will recommend a temporary fix kind of solution, such as a stainless steel crown. This will not look nice, as you point out, but if you are willing to pay for a porcelain crown that will only last a few years, your dentist will certainly place it. If the decay is not too widespread, your dentist might also be able to use white fillings or direct dental bonding to protect the remaining tooth structure. The best advice I can give you in this matter is to listen carefully to what the dentist recommends, and make your decision from the options presented. It is usually a bad idea to push a dentist into doing a treatment that they don’t feel comfortable with.

Another matter that must be addressed is how your daughter’s teeth wound up with this level of decay. The kind of decay you describe has to be fed continuously, all day, every day. Unless you want to face this situation again and again, you’ll need to change the way your daughter eats. She should only eat every three or four hours, and she should be brushing or at least rinsing with water every single time she eats.

Delay fixing my daughter’s broken tooth?

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Yesterday afternoon my daughter fell into the railing of a boat and smashed her mouth. One of her front teeth is broken completely off, and the other has a diagonal crack in it. When I took her into the dentist this morning, he said that he will not have room in his schedule to fix it for at least another three weeks! He says that the root of her tooth needs time to heal and get less sensitive, so we would have to wait anyway.

Is this standard procedure in cases like this? I’ve never heard of having to wait this long to get a tooth fixed, and want to try and find a different dentist. We were able to save the piece of the tooth that broke off, and it seems to me that we should have that put back in place as soon as possible.  My husband wants to wait like our dentist says, but is open to a second opinion. What should we do?

Shannon in Missouri

Dear Shannon,

There is no medical reason to wait. And yes, you should have that piece of her tooth put back in place as soon as you can. You should seek the services of an expert cosmetic dentist to complete these procedures. This is a challenging situation cosmetically, and you want both teeth to look good and to match each other.

You don’t say how old your daughter is, and that will help determine her treatment. If she is younger, the dentist may use dental bonding until her teeth are fully erupted. If she is older, he may chose to use dental crowns to protect the remaining tooth structure.

Dental implants and insurance

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I have been trying to find an answer on this for a while, but maybe I am just not looking in the right places. I am trying to find a dental insurance plan that will help cover the cost of dental implants. I am missing all of my upper teeth. I’ve been wearing a denture for many years, but it is just not working for me anymore. My dentist has suggested dental implants, but the cost is way out of my league. Can you suggest any dental insurance companies that might help me with the costs?

Thanks,

Tim in Greenfield

Dear Tim,

Though I am not intimately familiar with every dental insurance policy out there, I can with some authority say that you are not going to find a company that will pay for implants. If you consider it from a business perspective, it makes sense. They could not sell you a policy and then immediately pay for treatment that far exceeds the cost of the policy, not and hope to stay solvent.

Dental insurance works best when it is sold to an employer, who then provides dental insurance as a benefit of employment, paid with pre-tax dollars. However, even if you had dental insurance through an employer, they would almost certainly not pay for dental implants. Insurance will cover the cost of the cheapest treatment, and dental implants are not cheap. Finally, most policies include a cap of $500 to $1000 per year, which does not make much of a dent in the cost of extensive restorative dentistry.

The sad thing is, most people do not realize that dentures may not be a permanent solution. The bone at the site of a lost tooth begins to be reabsorbed into the body almost immediately. If ALL of your teeth are missing, you can suffer from a condition called facial collapse. The bone of your jaw deteriorates so badly that your face seems to “fold in” on itself, and wearing dentures can become incredibly uncomfortable or even impossible. In some cases, even dental implants aren’t the immediate solution – the patient must have bone grafts before any implant root forms can be placed. As you might imagine, surgery of this type can be intensely demanding, both physically and financially.

Dental implants stop the reabsorption of the bone, and help you maintain good oral health. If you are simply unable to finance the full set of implants, your dentist may suggest mini-implants, which are small implant root forms used to “anchor” a full denture in place. Not all implant dentists will do this procedure, so you would need to locate a skilled, educated dentist who provides the full range of dental implant services.

Good luck to you.

Can I get white fillings in my wisdom teeth?

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About 15 years ago, I allowed a dentist to place white fillings in my teeth, which turned out to be a big mistake. My teeth became very sensitive, and I had to have all of them redone by a different dentist. At that same time, the original dentist also put “preventative” fillings in two of my wisdom teeth. This was supposed to protect those teeth from ever getting cavities, but now the filling material has completely worn away and my wisdom teeth look awful underneath the places where the fillings used to be. The teeth are really ugly and stained.

What kind of filling should I get to replace the white ones. The white fillings just don’t seem to work for me, but my current dentist doesn’t even do the old-fashioned silver ones anymore. Should I find a different dentist?

Julia in Chappell, Nebraska

Dear Julia,

The white fillings are not the problem – the issue is the faulty technique that was used to place them.

White composite fillings are more challenging to place than silver amalgam fillings (also called mercury fillings), it is true. Very strict protocols must be adhered to, and the area where the filling is being placed must be kept absolutely isolated from saliva. If this had all been done properly when your original fillings were placed, you would not have had any problems.

Silver amalgam fillings are easier to place, but there is a reason many dentists no longer place them. The material used in the amalgam material is more than 50% mercury by weight. A great deal of controversy currently surrounds the use of amalgam fillings, as the current research is inconclusive as to whether or not the mercury in them is potentially harmful to the body. Many dentists have decided to err on the side of caution and simply place white filling instead.

Health and safety issues aside, white fillings quite simply look a great deal more attractive than dark, ugly amalgam. Less of the tooth needs to be removed for white fillings than with amalgams, and the material itself bonds with your tooth, making the entire structure stronger and more stable over time.

The key to success with white fillings is to make absolutely sure that the doctor placing them knows what he or she is doing. Placing white fillings is an exacting procedure, and requires specific training. Ask your dentist about this, and make sure you are comfortable with the answer. If your dentist ONLY does white fillings, then very likely they are both well trained and skilled in their placement. But do check, just the same.

If you do feel uncomfortable with your dentist’s skill set for this procedure, I would suggest finding a new dentist, since your current one does not do amalgam fillings, which leaves you no options.

Good luck.

Can I wait to get a dental implant?

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The molar second from the back on my right hand side has decayed underneath the gumline and my dentist says it has to come out. It is in my upper jaw. My dentist and the specialist I went to for a second opinion both say that I need to get a dental implant to replace the molar.

I don’t have dental insurance, and it is really expensive! Do I really have to replace that tooth? How long do I have to decide? I am only 45, and all my other teeth are in pretty good shape.

Brad in Mesa, AZ

Dear Brad,

Unfortunately, even if you had dental insurance, you would likely have to pay for the cost of the dental implant out of pocket. Most dental insurance plans do not cover the cost of dental implants, even when they are the recommended course of treatment.

You definitely should get the tooth replaced, and the sooner the better. When a tooth is removed, it takes just a few weeks for the surrounding teeth to begin to shift towards the resulting gap. The tooth in the opposite jaw that used to line up with the now-missing tooth (the “opposing” tooth) will “super-erupt”, or grow to try and meet with the other tooth that is now absent. All of this shifting around is the body’s natural response to the missing tooth. Your teeth will shift to meet when you bite, and touch their neighbors. When there is a missing tooth, these movements will create problems with your bite alignment, which may lead to TMJ problems, including headaches.

The longer you let this situation continue, the more damage will be done, and the more costly it will be to correct.

A dental implant is the best choice to replace a missing tooth. You are too young to contemplate living with a missing tooth and the resulting problems with your remaining teeth.

If the socket is infected, you will have to wait for that to clear up to proceed with the implant procedure, but your dentist will be your guide in this. The root form will need several weeks to integrate with the bone before the replacement tooth can be placed, so in the meantime you should wear some kind of temporary “placeholder” such as a dental flipper.

Best of luck to you.

Are porcelain fused to metal crowns the best choice for my front teeth?

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My front teeth are worn, and they have a good-sized gap. The dentist I’ve been seeing recommended porcelain fused to metal crowns, which sounded good to me until I started reading about other kinds of crowns that are available. It seems like all ceramic crowns like Zirconia might look better on my front teeth. I’ve been waiting a long time to get this done, and I want it to look really good.

When I asked my dentist about the Zirconia crowns, he said that his practice will only do porcelain fused to metal crowns. I am not sure if this is just for me, or if he just won’t do them at all. When I chose this practice, I checked out all the dentists’ credentials, and it sure seems like at least one of them would have the training to do the all ceramic crowns. My dentist says that the Zirconia won’t last, because I sometimes grind my teeth and just can’t wear one of those night guard things.

And one more thing—is it normal to charge more for an anterior crown than a posterior crown? That seems odd to me. I could use some advice!

Thanks,

Elizabeth in Indianapolis, IN

Dear Elizabeth,

It sounds like you should get a second opinion.

You’ve done your homework well; Zirconia crowns are extremely strong would work very well for front teeth. They can also be made thinner than porcelain fused to metal crowns, which means that more of your natural teeth can be left intact when the crowns are placed, which in turn leaves your teeth stronger and more stable.

I suspect, just based on what you have told me, that your dentist may have impressive credentials, but may not have a true feeling for appearance related dentistry. Few cosmetic dentists would elect to place porcelain fused to metal crowns on the front teeth, if there were any other viable options. This is a very important point: If you do want all porcelain crowns, then you will need to find a different dentist. Most dentists will resist doing procedures they are not comfortable with, and the end result can be disastrous for the patient.

Another concern is your grinding, and resistance to the night guard. As you age, unchecked grinding can ultimately lead to your teeth snapping off at the gumline. I urge you to try again, possibly with a different appliance. And finally yes, it is fairly common for dentists to charge more for anterior crowns than posterior crowns.

Best of luck solving your dilemma.

Will any dental insurance companies pay for dental implants?

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I am currently wearing dentures, but they just aren’t going to work for me anymore. My dentist says I need to get an entire set of dental implants in my upper jaw, but there is no way I can afford the cost. Are any of the dental insurance plans you know of good about paying for dental implants? Even if they will only pay for part of the cost, that would help.

Thanks for your help.

Theo in Indianapolis

Dear Theo,

 It sounds like you are in a bit of a tough spot. Many people do not know that when they get all their teeth extracted, the bone of their jaw is reabsorbed gradually by the body, causing the jawbone to shrink over time. Over 20 years, the jawbone may deteriorate so much that wearing conventional dentures is impossible. It sounds like you have reached this point, which may also mean that in addition to dental implants, you may need bone grafting to provide a stable base for the dental implant root forms, which will add to the expense of the procedure.

The bad news is that you are not going to find a dental insurance plan that will cover the cost of your dental implants. If you think about it logically, it would not make any sense for a dental insurance company to sell you a policy, then agree to pay out for a procedure worth many, many times the cost of the policy. They would not stay in business long that way!

The best dental insurance plans are almost always available through an employer, and even those do not like to pay out for dental implants. As a general rule, most dental insurance plans will pay for the least expensive treatment, which in your case is dentures. Sadly, the insurance company does not really care if the treatment will work well for you or not.

Talk to your dentist about less expensive alternatives, or ask what kinds of financing he has available. Best of luck to you.

Can dental bonding be removed or reversed?

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I need to find out if my teeth will be damaged if I have some bonding work removed. I asked my regular dentist to fix the gap in my front teeth a couple of weeks ago, and I am so not happy with the results! My dentist did not seem very happy when I asked him to use bonding to fix the gap in my teeth, but I did a lot of research and it seemed like the best solution to my problem. In addition to the gap, my front teeth are also chipped in the the shape of a “v”.

After the procedure, there is still a gap in my teeth, and I can actually see places where the bonding material is easily distinguishable from the natural structure of my teeth. This is not at all what the examples I saw on the web looked like! I need to find a new dentist, but first I need to know if they can take off what was done or not.

Thanks for your help,

Kyra in East Lansing

Dear Kyra,

Good news – tooth bonding is reversible. A special sandpaper can be used to remove the bonding material and restore your teeth to their previous state. Any dentist would have this sandpaper available, and the procedure is not difficult or painful.

I would strongly recommend going to an expert cosmetic dentist when you are ready to have this procedure re-done. It is likely that dental bonding will work very well for you to fix the gap and chip, but freehand dental bonding is an extremely challenging dental procedure.

If dental bonding is done by an artistic, skilled individual, the results can be really beautiful, and completely undetectable. You are absolutely right that you should not in any way be able to see where your natural teeth end and the bonding material begins.

We’re here to help.

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If you have questions about dental care, we are here to help. Dr. Hadgis specializes in cosmetic dentistry, dental implants and neuromuscular dentistry techniques that can help eliminate your TMJ pain.

Email our office with questions, and we’ll do our best to post your answers promptly.