Archives for September 2020

A well-known dentist messed up her smile

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In 2014, I received a crown for my right center front tooth. My dentist got the color and the size of the crown wrong. A friend told me about a well-known dentist who replaced my crown in June 2019, but the crown looked gray. He did a second crown, and the color was better, but the tooth was noticeably too long. The second dentist told me that I needed Invisalign, which he provided. My treatment is complete. Now I have a gap between my front teeth. But I also have anxiety now, which has never been an issue. In August, I scheduled an appointment for a third opinion and planned to get an exam, but I was so anxious that the dentist told me to reschedule the appointment when I have time for sedation.

Last month I had two consultations with two more dentists. When I mentioned the second dentist’s name, who left the gap between my teeth, they were skeptical about my report of what happened. I am beginning to think that I need to leave town to find another dentist to correct my smile. Am I too picky? Thanks. Daina from MS

Daina,

We’re sorry that you’ve had two negative experiences and that they led to dental anxiety. Although your second dentist is well-known, it doesn’t mean that he’s a talented, artistic cosmetic dentist who produces beautiful results.

Although most dental schools, the American Dental Association, and many reputable dentists have a negative view of cosmetic dentists, there is an art to producing beautiful smiles. Read the Wikipedia article about cosmetic dentistry. It’s written by someone with an academic mindset who has a condescending attitude about cosmetic dentistry.

We’ve seen many stories like yours. A patient doesn’t like the dentist’s work because their teeth are too white and look fake, but the dentist insists everything is fine. The dentist devalues the patient’s opinion of their smile.

But great cosmetic dentists are sensitive to the patient’s smile and self-perception. If a patient has reservations about their smile, the cosmetic dentist considers the case a failure. And the dentist will redo it.

Photo of woman sitting back in a dental chair with her eyes closed; for information on Baton Rouge sedation dentistry during tooth extraction.

Sedation dentists are empathetic toward patients with dental anxiety

A well-known dentist with an excellent reputation might have great mechanical techniques but be unfit for appearance-related dentistry. Real cosmetic dentists often aren’t the most valued and prominent dentists in the community.

You’re not too picky. Your smile affects your confidence. So, find a cosmetic dentist who respects that. Look for a dentist who is a member of and has credentials from the American Academy of Cosmetic Dentistry. You’ll find a dentist who is an artist, who will accommodate your dental anxiety with sedation options, and who will regain your trust. And a true cosmetic dentist will give you your ideal smile.

Steven Brooksher, DDS, an accredited cosmetic dentist in Baton Rouge, LA, sponsors this post.

Shouldn’t a sinus perforation have healed by now?

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In June, my dentist extracted two teeth, and I’m waiting to get dental implants. For one upper right tooth, my dentist said he could see into my sinuses. He prescribed antibiotics for me to take for a week. I didn’t have any special instructions other than taking antibiotics. My other tooth healed fine, but the sinus perforations still isn’t closed. My primary care doctor prescribed more antibiotics. I have a continual headache and a low-grade fever. How long does it take for a sinus perforation to heal? It’s going to be months before I can get dental implants. I think I need a second opinion. Am I going to need an oral surgeon or an ENT doctor to close the perforation? Thanks. Clay

Clay,

It seems that your dentist doesn’t know how to handle a perforation that doesn’t heal. It’s wise to get a second opinion.

How Long Will Does It Take for a Sinus Perforation to Heal?

If your sinus is perforated from tooth extraction, the tissue normally heals within four to six weeks. Bone grafting is often needed, though, and it will heal in about six months. If a perforation from an extraction doesn’t heal, there are several possible causes. Two possibilities include:

  • A root tip from the tooth is pushed into the sinus
  • A bone fragment remains

Has your dentist or primary doctor sent you or an x-ray of your sinus? It’s best to visit an otolaryngologist (ear, nose, throat (ENT) specialist) who will request an x-ray, see I something if blocking the sinus, remove it, and ensure the infection goes way by prescribing more antibiotics.

If there is a bone fragment in your sinus, it’s good that your dentist didn’t close the perforation. The irritation from the fragment would cause ongoing infection and fluid drainage into your mouth and nose.

Closing a Sinus Perforation

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

After sinus perforation and bone grafting heal, you can receive dental implants

How is a sinus perforation closed? Although your doctor might have a specific technique, the procedure includes steps like these.

  • Place collagen plugs or another resorbable membrane in the tooth socket
  • Gently place bone graft around the sides
  • Secure the bone graft and protect the site with another collagen plug or resorbable membrane
  • Stitch the membrane over the graft to keep it in place

After closing the perforation, a specialist will prescribe antibiotics, and based on the severity of your infection, tell you how long to take them. You’ll have follow-up appointments to ensure the area heals well.

Tell your ENT doctor about your plans for dental implants to replace your two missing teeth. The doctor and your implant dentist can discuss the optimal time for implant placement. Both the perforation and bone graft must heal before you receive dental implants. Otherwise, the implant and your jawbone won’t fuse, and the implants will fail. Be patient.

 

Steven Brooksher, DDS, a Baton Rouge dentist and Fellow of the International Congress of Oral Implantologists, sponsors this post.

When steroids after root canal treatment don’t work

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In April, my dentist did a root canal on a molar tooth and put a crown on it. About two weeks after the procedure, the tooth started to hurt. My dentist did x-rays and said there are no cracks in the tooth, and it appears to be stable. My dentist referred me to an endodontist two months letter because the pain persisted. The endodontist prescribed antibiotics for two weeks. When I returned to the office, the endodontist examined my tooth and said it would continue to improve. I traveled to late July for an extended stay with my elderly parents, who needed my help with a personal issue, and my tooth was fine. After returning home last Tuesday, a severe toothache woke me up from sleep. The endodontist prescribed more steroids, but my tooth is still throbbing. Help! What is wrong with my tooth? Am I going to need an extraction? Jennifer from Laurel, MS

Jennifer,

Although steroids are a popular treatment for root canal pain, sometimes they don’t work. And in your case, it’s clear that your endodontist’s treatment isn’t working. A combination of poor diagnostic skills and a lack of understanding of pharmacology for your case—is prolonging your recovery.

Root Canal Treatment Pain and Steroids

We disagree prescribing steroids for your root canal treatment pain several reasons:

A steroid is an effective anti-inflammatory drug that calms the body’s response to inflammation. But inflammation has a purpose. The body’s response is to send white blood cells to fight infection. So steroids not only block inflammation, they block the body’s response to infection. A dentist must understand what’s happening inside a tooth—irritation vs. infection—before prescribing medication.

After root canal treatment – Immediately after treatment, tissue around the root end gets irritated for a variety of reasons:

  • Pushing infected pulp through the end of the tooth
  • Pushing disinfectant and filling materials through the tooth
  • Root canal files poking the end of the tooth

Irritation and inflammation – The irritation causes the tissues to swell, push the tooth up, create traumatic occlusion, and results in a cycle of post-operative inflammation and pain. Although steroids can treat the inflammation, some of the infected material was pushed through the tooth’s end. Both antibiotics and steroids may be required.

Ongoing inflammation – When a tooth is inflamed for weeks, as in your case, infection is usually the sole cause. That’s why the antibiotics that your endodontist prescribed in April/May worked.

But at this point, we disagree with your dentist. Weeks after the root canal treatment was completed, your tooth became infected. That means there was a problem with the root canal treatment. Sometimes root canal systems in teeth are complex. It can be easy for a dentist to miss some of the canals and thoroughly clean and seal them. We’re unsure of why your endodontist, a specialist, would tell you that it will take time, but your pain will improve. In most cases, as you experienced, another infection occurs.

And unfortunately, the endodontist placed a crown on the tooth before knowing if the root canal treatment was successful. Now root canal treatment is more complicated because an endodontist will drill a hole in the crown to access roots. And visibility is impaired.

What’s the Solution?

How can your endodontist not understand that your tooth is infected, not just inflamed? In your case, steroids are not the answer. You need antibiotics, and an endodontist needs to repeat the failed root canal treatment.

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

If you can get root canal treatment instead of a dental implant during pregnancy, choose a root canal

And unfortunately, the endodontist placed a crown on the tooth before knowing if the root canal treatment was successful. Now root canal treatment is more complicated because an endodontist will drill a hole in the crown to access roots. And visibility is impaired.

We recommend that you find another endodontist who is willing to tell you why you’re in so much pain and how to treat your tooth. Your options will include:

  1. Root canal re-treatment,
  2. Root canal surgery, or
  3. Extraction of the tooth and tooth replacement with a dental implant

Steven Brooksher, DDS, a Baton Rouge dentist and founding member, L.D. Pankey Alumni Dental Study Club, sponsors this post.