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Decay under a Dental Crown

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I need some advice. I had a dental crown which I’d had for many years. At my last check-up, the dentist said there was decay under the crown and now I need to have a root canal treatment He attempted to do the root canal with the crown still on for close to two hours. He wasn’t able to find the canal and said it had calcified. He suggested I see an endodontist. I did call them, but because I haven’t been experiencing any pain with this decay, they scheduled my appointment out for a couple of weeks. Yesterday, the crown broke off with some of the teeth with it. Now I’m worried there isn’t enough tooth structure left to even replace the crown for. What do I do?

Maisie

Dear Maisie,

Jaw pain can be a sign of TMJ

I’m sorry to hear you’ve been put through this. I hate saying this about a colleague, but it seems you are with a dentist who still needs some training. Or, has a least forgotten some important training. When decay develops under a crown, it is much more efficient to remove the crown, which will need to be replaced anyway. The next step would be to remove the decay, which will enable the canal to be much more visible anyway.

Instead of doing that, he manipulated around the tooth for two hours. That had to be a major contributing factor into how your tooth became weak enough to break. Your dentist should take some responsibility for this in making it right.

If there isn’t enough tooth structure left, which sounds very possible, you will need to have the tooth extracted and then replace it. The ideal replacement would be a dental implant.

What Type of Dentist Should Do Your Dental Implant?

Because your dentist doesn’t understand some pretty basic techniques, I’m going to suggest if you decide to replace your tooth with a dental implant, you have it done by a different dentist.

This is an advanced procedure and needs a significant amount of post-doctoral studies to ensure it is done correctly. For instance, Dr. Hadgis has invested a large amount of time studying about reconstructive dentistry at the Las Vegas Institute for Advanced Dental Studies.

This would be the type of dentist you should look for in your area.

Best of luck to you.
This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

My Tooth Hurts but Dentist Insists it’s Fine

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I had a root canal several weeks ago. The tooth felt a tiny bit better but never normal. The pain has slowly been increasing again and now hurts like mad. My dentist did x-rays and said the tooth is fine and I should see a neurologist. I don’t think I’m imagining this. What can I do?

Asher

Dear Asher,

Man grabbing the side of his jaw in obvious pain and in need of a dentist

Because I haven’t examined your tooth, I can’t give you a definitive answer, but can give you some possibilities that could point you in the right direction.

Toothache from Referred Pain

Sometimes where we feel the pain isn’t where the pain is originating. It can be the tooth on the arch below it or a nearby tooth. If it is your upper arch, you could actually be dealing with a sinus infection. Our sinus cavities are very near the roots of our teeth.

Toothache from Nueralgia

When the dentist suggested you see a neurologist, it doesn’t mean that he thinks the pain is in your head. It is not uncommon for a nerve to cause tooth pain. Seeing a doctor who can properly diagnosis this can be helpful. It wouldn’t be the first place I’d go, but if everything else fails, don’t rule it out.

Toothache from Misdiagnosis

It is also possible that your dentist misread the x-ray or didn’t listen carefully enough to explore other options that could be causing your pain. If this is the case, you’ll need a second opinion.

How to Get a Good Second Opinion from Another Dentist

When you get your second opinion, just tell them when you had your root canal treatment and what your symptoms are now. You can also bring your x-rays, though they may want to take their own as well if they think the problem may actually be in a different area.

What you don’t want to do is tell them who your dentist is and what his opinion of the tooth was. You want their unbiased opinion. One of the reasons for that is you don’t want your dentist’s diagnosis to sway them or, worse, colleagues sometimes don’t want to speak against a colleague they know. If they ask, tell them you just want their thought, nothing else.

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

Dental Implant Fell Out

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I feel like I’m never going to have teeth again. First, my teeth started falling out. I went to a dentist and they said I had advanced gum disease. He started treating it and told me I will want to replace the teeth with dental implants. I did and one of them has already fallen out. I know this is my fault. I should have been going to the dentist all along and not just when they started falling out. Is there anything I can do now or is it too late?

Mindy

Dear Mindy,

woman smiling with a dentist behind her

I’d love for you to write me back again and tell me what dentist gave you dental implants while you were diagnosed with advanced gum disease. With any sense of logic, they should have realized if your gums are unable to retain your teeth, there is no way they will be able to retain your dental implants. You were not a candidate for this procedure and should ask for your money back immediately. If your dentist gives you any trouble with this, let him know you’ll be speaking to the dental board. That should change his mind.

A dentist is responsible to let a patient know when a procedure won’t work for them. It does your oral health no good to have work done which is bound to fail. I’m sorry your time and money were wasted by this dentist.

What a Dentist Should Do From Here

You’ll probably guess that I think you’d be better served with a different dentist. But, there is hope and you can have teeth again. The first thing you’ll need to do is continue with your gum disease treatments. This can be made well with diligence. I realize you haven’t been to the dentist much. I’ve often found that when patients avoid seeing the dentist, it is because of anxiety.

Sitting in the dental chair isn’t always the most fun. Fortunately, I’ve found a great solution for patients who struggle with severe anxiety. In your place, I’d look for a sedation dentist. Especially in cases such as yours, where there is likely a lot of work which needs to be done, it can make everything much easier to handle for you. First, you’ll have a completely stress-free and pain-free appointment. Second, you’ll be able to get a lot more done at each appointment getting you caught up more quickly.

Once your gums are healthy, that is when dental implants become a good option for you. Because you’ve lost bone structure you may need to have a bone grafting procedure done first, but that is a fairly standard outpatient procedure. From there, you can move forward with your plan. Dental implants are a great replacement. It can be like having healthy, natural teeth again. Just make sure you get a different dentist first. Preferably, one with considerable implant training.

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

Why Won’t a Dental Implant Fit?

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I lost a tooth several years ago. It wasn’t in an obvious place so I didn’t worry about it too much. I recently got into an accident and lost the tooth next to it. This one is visible. I decided it was a good idea to fix both of them.

My dentist said I can’t because there’s not enough room for two dental implants. He wants me to do a dental bridge instead. I don’t understand why if there were two teeth there, it is not possible to do two implants?

Jay

Dear Jay,

diagram of a dental implant

As you can see from the diagram above a dental implant is like having a natural tooth again. Like your teeth, dental implants have both a root and a crown.

The reason there likely isn’t room for two dental implants is shifting. When you lost the first tooth, but didn’t put anything in the space where the tooth was, the adjacent teeth slowly started drifting into the empty area. Now there’s likely room for one implant, but not two.

That being said, a good dentist looks for creative ways to give their patients the best treatment possible. Okay, you can’t get two implants in there. What if we put two crowns onto a single implant? That could work. Full-sized dental implants are strong enough to handle two crowns.

Dental Bridge Versus Dental Implant

The thing which concerns me about doing a bridge, especially in your case, is it removes healthy tooth structure unnecessarily. If you had a tooth missing and wanted a dental bridge, either to save money or because you don’t like the idea of implant surgery, than fine.

However, you are a patient who clearly wants the best option. Unless the adjacent teeth were unhealthy and needed crowns anyway, it’s a waste of great tooth structure to do a bridge. There is a time when it makes more sense to do a dental bridge instead of an implant. You’re not in that situation.

Never Force a Dentist’s Hand

My suspicion is your dentist isn’t comfortable with the dental implant procedure as a whole. So, rather than say he doesn’t do dental implants he is suggesting a procedure he is comfortable with.

While a little pressure from you may get him to agree to your procedure, that would be a bad idea. Pushing a dentist out of their skill set to get the treatment you want, usually doesn’t end with the actual results you want.

Instead, you would want to go to an experienced implant dentist. Then you’ll be able to get both teeth at once.

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

Is Surgery Necessary to Fix My Gums?

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I’ve had receding gums because of a variety of reasons, including gum disease. I asked my dentist if there was a way to fix it. He said yes, but when he described the procedure I kind of got the heebie-jeebies. Is there a way to repair my gums without surgery?

Mandy

Dear Mandy,

While most dentists can repair gums, most of them are still doing it using the grafting method your dentist likely described to you, which includes surgically removing tissue from the roof of your mouth. I don’t blame you getting the heebie-jeebies thinking about that.

Fortunately, there’s now a newer method which allows you to have surgery-free, suture-free repairs done to your gums, called the Pinhole Surgical Technique. The procedure has only been around for about a decade, so there aren’t any long-term studies on them. However, the short-term studies have been fantastic and patients love the convenience.

Because it hasn’t been around for long, not many dentists are certified in the procedure. It requires additional training on how to do the new method. It also requires specific specialized tools as well. It’s a big investment for dentists. You may have to do an internet search to find a qualified dentist near you who can perform it well.

Just make sure you have your gum disease completely under control before moving forward though. Healing your gums is priority one.

Surgery-Free Gum Repair with the Pinhole Technique

Before and after photos of pinhole surgical technique

Your dentist will make a tiny entry point about the size of a pinhole (hence the name) in your gums. Then, using tools designed specifically for this, he will loosen and shift the gum tissue into place and add some collagen strips both to aid in retention of the placement as well as encourage your body to produce more.

It’s an outpatient procedure usually completed between one and two hours. The healing time is simple. There is very little swelling and the entry point is healed within 24 hours. Just be sure you find a certified provider.

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

Dentist is Insisting on Dental Implants

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I’ve been in a pretty bad car accident which has caused me to lose most of my bottom teeth and three on top. I went to see a dentist about getting dentures for the missing bottom teeth and a bridge for the missing top teeth. He said because I’m 29 I need to get dental implants. The difference in price between those two procedures is astounding. Is it truly necessary or is he just trying to bully me into the more expensive procedure?

Katherine Y.

Dear Katherine,

An illustration of what facial collapse does to a jaw. Two pictures of the same woman. One with and one without facial collapse.

The results of facial collapse can be devastating.

You are in quite a pickle. At 29 you likely don’t have a lot of money. But there are serious consequences for getting dentures at your age. When your teeth were knocked out (and I’m so sorry you had to go through that) your body recognized there were no longer teeth there. Because our bodies are so efficient, it starts taking the minerals used in our jawbones and spreads them to other places in the body that will need them. This has the unfortunate result of shrinking your jawbone. In dental circles, it’s known as facial collapse. You can see a visual representation of it in the image above.

It’s your young age which makes this so dangerous to you. While facial collapse normally takes a decade or so, that would only put you at 39 years old or possibly in your early 40s. You would look 80. But, worse than that, you’d be a denture cripple. You see there would no longer be enough jawbone left to hold in your dentures. You’d have no way to eat.

Dental Solutions to Facial Collapse

Once that happened, you could have bone grafting done to rebuild what was lost, then have new dentures made, but the process would just start over and you’d suffer from facial collapse again.

What your dentist is wanting you to do is prevent it from the beginning. Dental Implants signal to your body there are still roots there needing to support your teeth. Therefore, your body doesn’t remove any of the minerals and your jawbone stays intact.

While your dentist is advising you properly, it is your body and he shouldn’t insist on the ideal treatment. Instead, he should give you all your options and let you decide.

There are some “in-between” treatment options which could help. The least expensive of those is snap on dentures. This is done with as few as two dental implants and helps keep your denture in place. It will preserve the bone where the two implants are and give you time to save up for more.

Discuss this option with your dentist. If he still insists and you just can’t do the ideal treatment, simply go to another dentist who is more understanding to patient’s financial restrictions.

I hope this helps.
This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

Dental Options for a Tooth Gap

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I’ve got an obvious gap between my two front teeth. It bothered me all the way through high school and college. Now that I’ve got a decent job, what are my options for fixing this?

Brenda L.

Dear Brenda,

A woman with a tooth gap

Solutions for a Tooth Gap

Just so you know, you’re not alone in being uncomfortable with some aspect of your teeth. Most Americans have something about their smile they’d like to change. Fortunately for you, your issue is one of the easy ones.

Dental Options for Fixing a Tooth Gap

  • Invisalign

If you’d like to actually close the gap between your front teeth, Invisalign is a great way to do that. No longer do adults have to wear unsightly and uncomfortable metal braces. Now you can wear invisible aligners which straighten your teeth comfortably without anyone knowing. Even at a conversational distance, people can’t tell you’re wearing them.

  • Dental Bonding

A good cosmetic dentist could close the gap between your teeth with bonding. It uses a composite resin which can be done in one appointment. The dentist will hand shape the resin to close the gap between your teeth. It will blend in perfectly with your natural tooth structure.

  • Porcelain Veneers

The first two procedures listed would be my actual recommendation for what you’ve mentioned. To do porcelain veneers for a simple tooth gap would be a massive overtreatment. So why do I mention them? Veneers are useful when you want to fix several things about your smile. They’re mostly used for a complete smile makeover, changing the shape, size, and color of your teeth.

If your dentist is a skilled cosmetic dentist, he’ll be able to do any of the above-listed procedures. Otherwise, I’d only recommend the first (Invisalign) procedure, which can be done by any dentist without much problem.

This blog is brought to you by Dr. Theodore Hadgis.

What Are Mercury Fillings?

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I have a cavity and have to get a filling. My sister-in-law keeps saying I have to get only get the mercury-free fillings, but how do I know it’s that? Are the other ones called mercury-free?

Amelia L.

Dear Amelia,

The old type of traditional fillings were, and still are, loaded with mercury. Their clinical name is amalgam fillings, but they’re more commonly called silver fillings. The reason your sister-in-law told you to stay away from them is mercury is known to be a toxin, with deleterious effects on both your health and cognitive function. In other words, mercury is bad for both your body and brain. That being said, the American Dental Association has declared these fillings are perfectly safe with testing data to back up their claims. Those who disagree also have tests to back up their claims, which leaves patients in a quandary. Which is correct?

Most have decided not to risk it and because we have other options in fillings, they’ve decided to go to dentists who offer mercury-free fillings. These are called composite fillings or, sometimes, white fillings. They have no mercury content and are just as useful as fillings as their older counterparts.

Talk to your dentist about your concerns. It sounds like this may be your first cavity. That’s pretty impressive. If the cavity is in a visible spot when you smile, your dentist can match it to the color of your natural teeth. No one will even be able to tell there is a filling there.

Something to consider is whether you’re planning on doing any type of cosmetic work in the near future. If you plan on doing something, like teeth whitening, you’ll want to do it before the filling so that your dentist can match the filling to the new brighter, white coloring. Once it’s bonded in place, the color can’t be changed. What’s bonded there is what you’ll get. However, that only matters if it’s on a front, visible surface of your tooth. If it’s in the grooves of a molar or some other less visible area, the matching doesn’t have to be as precise.

This blog is brought to you by Dr. Theodore Hadgis.

Is 75% off dental implants too good to be true?

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I just received an advertisement in the mail that said I could get dental implants for 75% off. Is that a legitimate offer? I know how much my dentist charges for dental implants. 75% off would be extremely helpful. Is it OK to go to this dentist with the sale just for this one procedure and then go back to my dentist for everything else?

Bethany – Minnesotta

Bethany,

There is an old adage/proverb that says, “If something seems too good to be true, it probably is.”

Let’s do a little math. In general, a single implant costs around $2000. At 75% off it would be $500. If they’re using high quality fixtures that have been approved by the FDA and ADA, the fixtures alone will cost from between $300 to $500. That doesn’t leave the dentist much profit, if any.  If the dentist used a service to market his special they’ll take about half of his fee, which could leave the dentist in the red.

Now a dentist may have gone into the field because they like helping people, but they won’t stay in business long if they don’t make money. So, how do you think the dentist will handle the implant situation?

Many dentists are honest and will honor their special even if it means losing profit. However, there are dentists who will do whatever it takes to stay in the black, even if it is dishonest. Maybe he’ll use cheap dental implant fixtures. If so, that not only puts you at risk for dental implant failure, but can put your health at risk too.  Maybe they’ll save money by placing mini implants instead of traditional implants. Or maybe they’ll  raise their rates right before the 75% off, so as not to lose so much per procedure.

Whatever you decide, talk it over with your dentist. He will find  out about you going somewhere else the next time you came in for an exam anyway, so you might as well get his input.   Your dentist may even know the ohter dentist and can give you his opinion of hin or her.

The trust between a dentist and patient is irreplaceable.

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