Archives for July 2021

My new dental crown keeps coming off

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After my dentist replaced my 15-year-old crown over a root canal tooth, the crown will not stay on. My dentist has reattached the crown four times since March. That’s like once a month. Why did the old crown stay on, but the new one will not stay in place? If this becomes a problem, will my dentist need to extract the tooth and place a dental implant? Thank you. Sienna

Sienna,

Thank you for your question.

A crown can continually detach if it doesn’t have enough tooth structure to help it stay in place. But your dentist—or another dentist—can take steps to keep it in place.

Securing a dental crown that keeps coming off

If your dental crown keeps coming off, it is probably due to stress on the tooth as you bite, tear, chew, or grind—depending on the tooth position. If the problem is due to a lack of tooth structure left, your dentist can take these steps:

  • Remove some of the root canal filler material
  • Cement a flexible fiberglass post about 2/3 deep into the tooth
  • Fill in the tooth with bonding

The process bonds the tooth into the canal and builds up a core material around your tooth. The dentist will shape the bonding to look like a natural tooth after preparing it for root canal treatment.

Afterward, your tooth will hold the crown easily. You can suggest this process to your dentist. If your dentist is hesitant about treating your tooth, we suggest scheduling a consultation with an advanced cosmetic dentist.

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

Saving your tooth is the priority over a dental implant.

Saving your tooth is the priority. Although a dental implant is almost effective as a natural tooth, preserving your natural tooth is the priority.  If any dentist recommends tooth extraction and a dental implant, it should be after an attempt to save your tooth with a post.

 

Steven Brooksher, DDS of Baton Rouge, sponsors this post. Dr. Brooker is a Fellow of the International Congress of Oral Implantologists.

No pain in my canine root canal tooth, but my dentist recommends a crown

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In 2002, I had a root canal on a canine tooth. My dentist of 3 years suggests putting a crown over the tooth to prevent it from breaking. The tooth does not hurt, so I asked my dentist if something is visibly wrong with the tooth. He said no, but the crown is preventive care. Do I need a crown on the tooth? I do not want to refuse treatment and end up with extraction and dental implant. Thank you. Leland from GA

 

Leland,

Thank you for your question.

Root canal weakens a tooth and increases the risk of breaking. But differences between molar teeth and front teeth causes some cosmetic dentists to avoid placing crowns on front root canal teeth.

  • Molar teeth – The stress of biting and chewing pushes the four cusps (the biting points) of molar teeth apart. The teeth are at risk of breaking after root canal treatment.
  • Front teeth – Designed for biting and tearing, front teeth are affected by horizontal shearing stress. Canine teeth absorb horizontal pressure to protect molar teeth. The long roots of canine teeth help them absorb stress.

Does a Canine Root Canal Tooth Need a Crown?

Unless your canine root canal tooth is already missing most of its structure, you do not need a crown. Additionally, a dentist may recommend a crown if the tooth is dark or poorly shaped and detracting from your smile.

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

If your canine root canal tooth is weak, a skilled dentist can reinforce it and hopefully prevent the need for a dental implant

Shaving a canine tooth for a crown requires reducing about one millimeter of tooth structure all around the tooth. The tooth may be left with as little as 50% of its initial fracture resistance.

Many cosmetic dentists strengthen canine teeth by placing a flexible fiberglass post in the tooth and filling in the tooth with composite. This process can protect the tooth from stress and minimize dark discoloration after root canal treatment. The added strength of a fiberglass post helps prevent breakage and the need for tooth replacement options, such as a dental implant.

You can get a second opinion from a cosmetic dentist to see if your tooth is weak and needs a post to support it.

 

Steven Brooksher, DDS of Baton Rouge, sponsors this post.

Is my electric toothbrush damaging my porcelain veneers?

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Two of my porcelain veneers loosed three times within the past five months. My dentist rebounded them. But during my last visit, my dentist asked me what kind of toothbrush I use. I use an ultrasonic toothbrush and Supersmile toothpaste. My dentist blames my toothbrush on the loose veneers, but I know better. And if a toothbrush could cause loose veneers, I asked my dentist why he didn’t tell me that before I got veneers. Please tell me that I am right, and my toothbrush is not causing loose veneers. Thank you. Max from TX

Max,

Although ultrasonic cleaning devices in a dental office can damage dental bonding or veneers, an ultrasonic or sonic toothbrush will not harm them. Let us explain the difference.

Is Your Toothbrush Damaging Your Porcelain Veneers?

Your toothbrush is not damaging your porcelain veneers. And there is a difference between ultrasonic dental tools and your toothbrush.

Ultrasonic dental tools

Ultrasonic dental tools have metal tips that can damage bonding or veneers. The devices can crack the glaze on porcelain veneers. And professional ultrasonic speeds are much higher than your toothbrush.

Ultrasonic toothbrush

An ultrasonic toothbrush has soft bristles that will neither nick bonding or veneers. Instead, they polish your veneers and clean them. And toothbrushes are usually sonic—not ultrasonic—which means their vibration speed is slower and more gentle than dental equipment.

What Is Causing Loose 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 do not loosen if a dentist bonds them properly

Loose porcelain veneers result from failure of your dentist’s bonding technique, aggressive preparation of your natural teeth, or both.

  • Aggressive tooth preparation – Often, a dentist who lacks advanced cosmetic dentistry training removes too much tooth enamel when preparing teeth for porcelain veneers. As a dentist removes more enamel, it becomes difficult for the bonding to adhere to your teeth. And if a dentist grinds your teeth down to the dentin (the layer beneath the enamel), it increases the risk of veneers falling off.
  • Bonding technique – Dentists who take advanced cosmetic dentistry training after dental school learn techniques to bond porcelain veneers securely to your teeth. And they know the importance of removing excess bonding material to avoid irritation and inflammation.

Get a Cosmetic Dentist’s Opinion

Although your dentist is blaming your toothbrush for loose porcelain veneers, that is not the problem. We recommend that you schedule a consultation with a skilled cosmetic dentist to examine your teeth and veneers to identify the issue. A cosmetic dentist will explain the treatment options to keep your veneers intact.

 

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