Archives for June 2020

When a Dentist Recommends Extraction But You Want to Save Your Tooth

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I’ve had a crown on a left incisor since I was 15 years old. At my last exam, my dentist told me that the tooth looked like it might be infected. He removed the crown and said there is a white bible under the tooth, and it’s infected. He recommended extraction and said that a root canal wouldn’t work. I haven’t scheduled the appointment yet. Why can’t he try a root canal? Thanks. Josiah

Josiah,

We recommend that you seek a second opinion because some dentists readily extract teeth that can be saved. Burt Press, a 1980s president of the American Dental Association, once said, “You know why so many teeth are lost? Because dentist take them out.”

It takes effort to save a failing tooth, but some dentists think it’s worth it to save them and avoid tooth replacement options, including dental implants. You have the right to know why your dentist recommends extracting your teeth, and he should have explained why root canal treatment won’t work.

Sometimes a Tooth Cannot Be Saved

Diagram of the phases of a dental implant for a comparison to a partial denture.

Although dental implants mimic natural teeth, keep your natural teeth whenever possible

Severe decay and little healthy tooth left – Severe decay and limited healthy tooth structure prevent a tooth from being restored with a crown.

  • Not enough space to restore it – When a tooth is worn or broken and doesn’t have a crown on it, the teeth on either side can drift and narrow the area around the damaged tooth. There isn’t enough room for a crown.
  • Extensive damage below the gumline – If there is a severe split or crack below the gumline, it might be possible to save part of the tooth. Often, an endodontist or dentist will extract the tooth.
  • Severe trauma – At times, when trauma fractures the tooth roots—particularly closer to the gumline—it’s challenging to save a tooth.

If you can’t get a satisfactory answer from a second-opinion dentist, you can ask for a referral to an endodontist, a specialist in root canal treatment and root canal surgery.

Steven Brooksher, DDS sponsors this post. He practices in Baton Rouge, LA. Dr. Brooksher is a founding member of the L.D. Pankey Alumni Study Club for continuing dental education.

Are Crowns on All Teeth Needed As I Recover from Bulimia?

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I’m recovering from bulimia, and I have had three consultations with cosmetic dentists who have good reputations. One of them suggests a complete smile makeover with porcelain crowns. He said the crowns would restore my decayed teeth, correct my bite, and make my smile beautiful. 10 of my teeth are severely decayed, 2 have some decay, and the others are healthy enough not to require major work. I’m concerned about the dentist grinding down all my teeth when only 10 are severely decayed. Unfortunately, my consultation with the dentist who wants to do all crowns was the last of the three. I was surprised by his recommendation, and I couldn’t ask the other two dentists about it because I had already seen them. Each dentist agrees to give me sedation for anxiety and do wax-ups of my new smile. But now I’m concerned and getting more anxious. Did the first two dentists miss something about the condition of my teeth and which treatment is best? Or is the third dentist too aggressive? Thanks. Micah from TX

Micah,

Congratulations on your recovery from bulimia. Although Dr. Brooksher would need to examine your teeth, dental history, and x-rays to evaluate your case accurately, your explanation of the third dentist’s recommendation raises concern.

Advanced, ethical cosmetic dentists treat teeth conservatively, preserving as much healthy tooth structure as possible. And they don’t try to convince patients to receive treatment that makes them uncomfortable or recommend an aggressive treatment plan without the patient’s request.

Does It Take All Crowns to Get a Smile Makeover?

If you get the sense that a dentist is a salesperson, opt for a conservative cosmetic dentist who will transform your smile in a way that preserves your healthy tooth structure whenever possible. As you recover from bulimia, a conservative approach will increase your confidence in your smile. A full-mouth reconstruction that grinds down all your teeth for crowns is required in these instances:

  • Severe issues with your bite that cause pain
  • Facial collapse
  • Many decayed or broken teeth
Before-and-after photos of dark, uneven, and broken teeth transformed by a smile makeover from Baton Rouge cosmetic dentist Dr. Steven Brooksher.

Dr. Brooksher gives his patients healthy, natural-looking smile makeovers

It’s wise to return to either of the first two cosmetic dentists you saw and discuss your concerns about porcelain crowns for all your teeth vs. the dentist’s recommendation. The cosmetic dentist will further explain why he or she recommended specific treatment and not all crowns for your teeth. Often, a smile makeover includes a combination of treatments, such as cosmetic bonding, porcelain veneers, dental implants, and sometimes crowns.

If it increases your comfort to return to both cosmetic dentists, don’t hesitate to do so. Best wishes on your journey and your new smile as you recover from bulimia.

This post is sponsored by Steven Brooksher, DDS, a Baton Rouge dentist and accredited member of the American Academy of Cosmetic Dentistry.

Will Porcelain Veneers Affect the Backsides of Her Teeth?

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My teeth look terrible, and I am considering getting porcelain veneers. I had braces in fifth grade, but I didn’t wear a retainer. I was not responsible, and my mom was to busy to make sure I wore a retainer. Now my teeth look worse than they did before braces.

My concern about porcelain veneers is how they will affect the outside and insides of my teeth. My teeth are quite uncomfortable on the inside against my tongue. I want that feeling to go away—not just to have veneers make my teeth look good on the outside. What can be done about that feeling that I hate? Thanks. Ashleigh from San Antonio, TX

Ashleigh,

Thanks for submitting your question to us. Observing how your teeth look and feel, and how they affect your confidence will help you choose an option that matches all improvements you want for your smile.

People who prefer porcelain veneers over orthodontic treatment want fast results without waiting months, or more than a year, to align their teeth.

Orthodontics or Porcelain Veneers?

Photo of the tip of dental forceps holding a single porcelain veneer; from the Baton Rouge office of accredited cosmetic dentist Dr. Steven Brooksher.

Porcelain veneers cover the fronts of teeth

But if your teeth are severely misaligned, braces or Invisalign are best. Severely misaligned teeth are hard to clean and avoid decay. A cosmetic dentist might recommend clear braces, like Clear Correct, instead of porcelain veneers. Porcelain veneers are bonded to the fronts of your teeth and may not improve the feeling on the backside of your teeth.

Orthodontic treatment will align the front and back of your teeth—where your tongue and teeth touch. If both aesthetics and the way your teeth feel against your tongue are important to you, choose orthodontic treatment over porcelain veneers.

Schedule an appointment with a cosmetic dentist who offers orthodontic treatment. He or she will explain your options and what to expect on the tongue side of your teeth.

Accredited cosmetic dentist, Steven Brooksher, DDS of Baton Rouge sponsors this post.