Two of My Permanent Teeth Never Erupted

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My permanent upper canine and incisor on the right never erupted. I still have small primary teeth that did not fall out. The teeth look weird because they are so small and don’t match the size of the surrounding teeth. I am 27 years old and trying to progress with my career. Can a dentist make the small teeth look larger, or is it best to get them removed and replaced with dental implants? Thank you – Andreas

Andreas,

Thank you for contacting Dr. Brooksher’s office in Baton Rouge regarding your canine and incisor teeth that never erupted. Dr. Brooksher would need to examine and x-ray your teeth before recommending appropriate treatment.

What Happens When Permanent Teeth Do Not Erupt?

When permanent teeth do not erupt, they may be impacted. An x-ray will help a dentist determine whether the permanent teeth have developed. If not, a dentist can create a treatment plan for dental implants.

Treatment options for permanent teeth that do not erupt

Treatment options for permanent teeth that do not erupt may include the following:

  • A dentist may remove the primary teeth and make an opening for permanent teeth to emerge.
  • A dentist may need to remove the primary teeth and replace them with dental implants. If the bone beneath the primary teeth is healthy, a dentist may place implants and temporary crowns on the same day. Otherwise, you may need a bone graft first.
  • A dentist will ensure you have enough space for a dental implant if primary teeth are absent. Sometimes, you may need orthodontics to make room for a dental implant.

We recommend scheduling consultations with two dentists with advanced training in implantology. Look for credentials from one of the following organizations:

  • International Congress of Oral Implantology
  • International Dental Implant Association
  • American Academy of Implant Dentistry
  • American Board of Oral Implantology

Ensure that each dentist has advanced cosmetic dentistry training to provide you with natural-looking implant crowns.

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

 

Dentist Says an Implant Won’t Fit Where Tooth Is Missing

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My dentist says a dental implant won’t fit well in the space left from a missing tooth. When I was 15, I lost a tooth in an accident while horseback riding. Replacing the tooth was not an option for my parents. Now that I can afford it, I have seriously considered dental implants. My dentist shut me down on the idea, though. He says that my other teeth have shifted, and now the space is too small for an implant. So he wants to put a dental bridge in. He explained the process to me, and I really don’t like the idea of bothering my other teeth if I don’t have to. I would like to know if there is a way for me to get an implant. – Abell

Abell –

Thank you for contacting Dr. Brooksher’s office. We understand your concerns about getting a dental bridge instead of an implant.

Can You Get Implants If Your Teeth Shifted?

Model of a dental implant with the crown, abutment, and root form labeled

A dental implant mimics a natural tooth and does not need support from other teeth

If your teeth shifted, you may still be a candidate for dental implants. Your dentist may recommend orthodontics first to move your teeth to the correct position.

Reasons for getting braces may include:

  • Creating space. Proper tooth alignment creates space for a dental implant.
  • Correcting your bite. Well-aligned teeth improve your bite (how your upper and lower teeth meet).
  • Preventing other dental concerns. Depending on the factors that cause your teeth to shift, inserting a dental implant in a space may stress adjacent teeth. Although your teeth may move, the dental implant will not.

What If a Space Is Too Small for an Implant?

Dental implants are available in varying diameters that resemble the size of the missing tooth. Sometimes spaces between lower teeth are too small for a standard dental implant. When that happens, a dentist may choose an implant with a smaller diameter.

Dr. Steven Brooksher, a Baton Rouge fellow of implant dentistry, sponsors this post. Request a consultation with Dr. Brooksher today.

Loose Dental implant – Is a Bridge My Only Option?

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A dental implant I’ve had on my top left incisor for 15 years is beginning to feel loose. My dentist of 8 years says he needs to remove the implant because I have an infection around it. He recommends replacing the implant with a bridge. I don’t understand why I can’t take antibiotics and get another implant instead of a bridge that requires grinding down the teeth next to the incisor. Could the bridge be my only option? Should I see another dentist? – Thank you. Patrick from Oklahoma City

 

Patrick,

Thank you for your question. Dr. Brooksher would need to examine your implant and gums and take a 3-D CT scan of the bone around it to determine why the implant is loose. Afterward, he could explain your treatment options.

Can You Replace a Loose Dental Implant?

A dental implant with the crown, abutment, and root form identified, for information on loose dental implants due to infection

An implant root form needs healthy gums and enough jawbone volume to stay in place

An implant dentist may replace a loose dental implant with or without bone grafting. After a 3-D CT scan, the dentist will explain whether you need a bone graft to support another implant or if you need a dental bridge or an alternative.

What Causes Infection Around a Dental Implant?

A buildup of bacteria around an implant can cause infection in the gums and bone supporting the implant. The infection causes bone deterioration, and the implant will loosen. Practicing diligent oral hygiene, getting regular dental checkups, and not smoking promote healthy gums and jawbone.

Will Antibiotics Get Rid of an Infection Around Dental Implants?

Antibiotics may eliminate the infection around an implant but will not resolve bone loss. The bone will not grow back over time, and only a grafting procedure can rebuild it.

Schedule a Second Opinion

If you lack confidence in your dentist’s recommendation for replacing your dental implant with a bridge, look for an oral surgeon or dentist with advanced training in implants. An accurate diagnosis requires a thorough oral exam and 3-D CT scan, so expect the dentist to recommend those procedures. After the second-opinion implant dentist explains your treatment options, you can decide whether you want a bridge from your current dentist or to switch to a new provider.

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

 

What’s the Cheapest Fix for a Tooth Broken at the Gumline?

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My front left tooth broke below the gumline. I am looking for a cheap, fast way to fix it. I don’t know if there is anything like an affordable implant. Will a mini-implant work? If not, I am interested in something that is not expensive. I suppose there are not many options, but what is the least expensive? Thanks. Bart from WVA

Bart,

Cheap options do not last. You can ask a dentist to bond the tooth back with composite as an inexpensive fix, but it will not look good, nor will it last. Two treatment options can restore your tooth, but neither is cheap or fast.

Restoring a Tooth that Broke at the Gumline

Depending on the severity of the break, a dentist can restore a tooth that breaks at the gumline a dental crown or a dental implant.

Dental crown

If you do not have a strong bite or deep overbite, a dental crown might be able to restore your tooth. Treatment steps include:

  • Root canal treatment
  • Inserting two strong, flexible post in the tooth to absorb stress on the crown and prevent tooth root fracture
  • Building up the tooth and post with composite
  • Bonding the crown to your tooth

Dental implant

Dental implant components, including root form, abutment, and crown

If you need a dental implant, it will mimic a natural tooth.

If your tooth broke at the gumline, weak and you have a strong bite, a dental implant is the only solution. You will need a standard dental implant—not a mini-implant. Although mini-implants are more affordable, they are not durable enough for front teeth, molar teeth, and most teeth. A mini-implant might support a small upper or lower incisor. And some dentists use mini-implants to secure a denture.

An implant and crown cost about twice as much as a root canal, two posts, and a crown, and it takes longer to heal. But a dental implant will last longer because the implant fixture fuses with your jawbone like a natural tooth root.

You can choose to get a dental crown, but understand the risk of failure if you have a strong bite or underbite. It is usually best to get the most effective option and avoid spending more time and money in the long-term.

We recommend scheduling an appointment with a dentist who has advanced cosmetic and implant dentistry training to discuss your options.

Dr. Steven Brooksher, an accredited cosmetic dentist in Baton Rouge, sponsors this post. Dr. Brooksher is a Fellow of the International Congress of Oral Implantologists.

Never Had Issues Like This Until I Got a Dental Implant

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I lost my right second molar at age 17 and never replaced it. As an adult, I decided to do something about it. I wore a partial denture for many years, and now at age 47, I have decided to get an implant.  But I regret it because I never had dental issues like this until I got the implant.

After implant surgery, my dentist told me that he placed the implant, although my bone level was shallow. He said that if it didn’t work out, he could do a bridge instead. I was furious, and after four months, my dentist said the implant was not healing well. I had a lot of anxiety about getting an implant, and it is increasing because someone must remove the implant. But I refuse to get a bridge. I would rather leave the space empty. I’m writing out of frustration but unsure of what question to ask. – Thank you. Marcus from KY

Marcus,

Thank you for contacting our office. We understand that you must be frustrated.

Do You Have Enough Bone Volume for a Dental Implant?

Whether you have enough bone level for a dental implant is something that any responsible implant dentist determines before surgery. Implant dentists take a 3-D digital CT scan before recommending implants. The scan helps your dentist identify:

  • Bone level
  • Oral anatomy
  • Best implant location

We are also concerned because if you have had a missing tooth for 30 years, your dentist knows that you have experienced significant bone shrinkage.

How Much Does Bone Shrink When a Tooth Is Missing?

When a tooth is missing, bone shrinkage progresses rapidly. If your dentist takes a 3-D CT scan before placing an implant, they will notice the shrinkage and determine if you need bone grafting. An article published by the American Academy of Implant Dentistry on how missing teeth affect your bone notes that when you have a missing tooth, bone shrinkage occurs at these rates:

  • 25 percent in three months
  • Up to 50 percent in six months

How to Deal with Poor Implant Dentistry

When you are a victim of poor implant dentistry, your dentist owes you a refund. You paid your dentist for a service you did not receive—a healthy, functioning dental implant. Also, our dentist failed to meet the standard of care by not taking adequate x-rays to measure your bone volume. So, your dentist owes you for the implant process and negligence.

What Are Your Options After Dental Implant Failure?

If you have experienced dental implant failure, get a second opinion from a skilled implant dentist. Look for credentials from one of these organizations:

  • International Congress of Oral Implantologists
  • International Dental Implant Association
  • American Academy of Implant Dentistry
Dental implant components, including root form, abutment, and crown

Discuss your sedation options with an accredited implant dentist

Schedule an appointment for an examination. The dentist will explain your options for sedation and a comfortable procedure and recovery. And expect a skilled implant dentist to take a 3-D CT scan before recommending treatment options. Also, talk to your new dentist about your anxiety and what triggers it.

 

Dr. Steven Brooker, a Baton Rouge Fellow of implant dentistry, sponsors this post. Dr. Brooksher is accredited by 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.

Can a dark tooth be saved?

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Last year I fell during my morning run and fractured my right front tooth, and now the tooth is dark. My dentist did a root canal on the tooth, so I wasn’t expecting it to turn dark. My dentist didn’t mention that I should expect it either. I had an exam two weeks ago, and my dentist explained that sometimes root canal teeth turn dark. How do I know that the tooth is not decaying and that I will eventually need a dental implant? My dentist says she can put a veneer over the tooth. I don’t want to say that I do not trust my dentist, but I am skeptical because she didn’t warn me that it might turn dark. Although my smile is not perfect, I like it. And people compliment my smile. Should I be concerned about my dark tooth, or is it okay to proceed with a porcelain veneer? And what if the veneer doesn’t match my other teeth? Thank you – Emery, from Jackson, MS

 

Emery,

Although Dr. Brooksher would need to examine your tooth for an accurate diagnosis, a porcelain veneer can conceal a dark tooth.

Why Does a Tooth Turn Dark After Root Canal Treatment?

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

An extraction and dental implant are not necessary for a dark tooth

A tooth turns dark after root canal treatment due to dentin (the layer beneath the enamel) staining or leftover root canal filler material.

  • Dentin stain – When the pulp—living tissue, nerves, and blood vessels—inside your tooth dies, it can stain the dentin. And dentin is the layer beneath your tooth enamel. If a dentist does not thoroughly clean out the infected tooth pulp during root canal treatment, it will stain the dentin and how through your tooth.
  • Leftover root canal filler material – Some root canal filler materials accelerate tooth darkness if a dentist leaves the material in the tooth crown. But a skilled cosmetic dentist knows to clean filler material to slow the darkening process.

Treatment for a Dark Root Canal Tooth

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

A single porcelain veneer can conceal a dark tooth

Internal bleaching will lighten a dark root canal tooth. After bleaching, a cosmetic dentist will work with a skilled ceramist to craft a porcelain veneer that perfectly matches the characteristics and color of your natural teeth.

Unless you have an advanced tooth infection or new trauma to the tooth, your dentist should not suggest aggressive treatment. Instead, a dentist will recommend a dental implant if they or an endodontist (root canal specialist) cannot save your tooth.

Get a Second Opinion for Your Dark Tooth

If your dentist does not have advanced cosmetic dentistry training, you can check the credentials of a few cosmetic dentists in your area. Schedule a consultation with one or two cosmetics to discuss your options for whitening your dark tooth.

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

Pain after root canal treatment got better then worse

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After getting a second root canal on my tooth, the pain came back a few days later. I called my dentist, and she said my tooth should be fine. I read online that after root canal treatment, peak inflammation and pain can occur for 48 to 72 hours but should improve. The hygienist at my dentist’s office is a good friend of mine, so I called her yesterday, and she said that the pain returning can mean that the second root canal failed. I hate to take a hygienist’s word over my dentists, so I decided to write for a tiebreaker. I know that I will need to see my dentist again, but which prognosis seems correct? I am concerned about losing the tooth and needing a dental implant – Sareda from Knoxville, TN

Sareda,

Peak inflammation after root canal treatment occurs in the following 48-72 hours if a dentist does not treat the pain by reducing the occlusion (the way your upper and lower teeth fit together). Inflammation can cause post-operative pain that hurts right away, peaks, then improves. When the local anesthetic wears off, an untreated tooth feels worse the second and perhaps third day before improving.

When root canal post-operative pain improves, then returns

If you experience peak pain on day two or three, but it improves and begins to hurt again, it can be a sign of post-operative infection. But not every case of post-operative pain is a sign of root canal failure.

  • The risk of root canal failure increases in a tooth with two or more root canal treatments.
  • If a tooth had a repeat root canal treatment and you have passed the peak pain period (48-72 hours), but the pain returns, it is often a sign of root canal failure.
  • The American Association of Endodontics advises that if severe pain or pressure lasts for more than a few days, you should contact your endodontist.
Diagram of the phases of a dental implant for a comparison to a partial denture.

A dental implant can replace a tooth after root canal failure and extraction

Please schedule a follow-up appointment with your dentist. If your dentist’s response is unsatisfactory, we recommend that you get an exam from an endodontist (root canal specialist). When root canal treatment fails, an endodontist might recommend root canal surgery by making an incision in the root tip to treat the tooth. If you want to avoid tooth extraction and a dental implant and your dentist cannot resolve the issue, an endodontist or a dentist with advanced implantology training will give you the best chance at saving a problem tooth.

For information about how to avoid implant failure, read our post: My painful dental implant and bone graft failed

Steven Brooksher, DDS, of Baton Rouge, 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.

Three Reasons Your Dentist Recommends a Post and Core Even If Insurance Doesn’t Cover It

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I have a left incisor that is severely decayed. My dentist recommends a crown instead of a filling, but he wants to add a post and core. The dentist’s office submitted it to my insurance in early March. My insurance will give some benefits for the crown but not the post and core, which costs $420. So now, I’ll be paying for the remaining cost of the crown and the post and core. I’ll have to charge the balance on my credit card, which I am not fond of doing. Are the post and core necessary? Thanks – Russell

Russel –

Although your dentist is interested in your long-term oral health, your dental insurance company’s goal is to economize and save money. Your dentist might have explained the purpose of a post and core, but we’ll review it to help you understand your dentist’s perspective.

Why Are a Post and Core Needed?

Post and crown (top photo) and dental bonding built up around the post (lower photo)

A post and core give a strengthen your tooth and help anchor a dental crown

A dentist might place a post and core after root canal treatment. If there isn’t a lot of healthy tooth structure left, your dentist can’t properly prepare the tooth, and the crown can come off easily. The following steps are involved:

  1. Perform root canal treatment and remove decay and tooth pulp
  2. Insert a post into the canal of the tooth
  3. Bond the post in place
  4. Use dental bonding and shape it around the post to mimic the shape of a natural tooth prepared for a crown
  5. Bond the crown to the built-up post

The post and core are essential for reinforcing the tooth and creating a firm bond for a dental crown that lasts.

What Might Happen without the Post and Core?

  1. If a dentist bonds a crown to your severely decayed tooth, the tooth can further weaken and break. If the break is severe—or if the tooth gets infected—you might lose the tooth.
  2. And your dentist will need to replace it with a dental implant and crown—which is more costly than a post and core. A single implant costs over $1500. And there are additional fees associated with implant placement, including surgery, sedation, the implant crown, and more.
  3. Your dentist is protecting your oral health and limiting your long-term out-of-pocket expenses by recommending the post and core. Listen to your dentist—not the dental insurance company.

This post is sponsored by Steven Brooksher, DDS, a Baton Rouge dentist and a fellow of the International Congress of Oral Implantologists.