Dental Double Cross

I’ve kind of had it. I had a dental crown placed on a back tooth. It didn’t feel right from the beginning. The dentist adjusted it, then it fell out. He put it back. It felt worse. He adjusted it again, but nothing got better. He told me I’m just not used to crowns and I’d become accustomed to it. I was frustrated, but what could I do? Now, a piece of it broke off at dinner. I’d had it with the dentist that placed it. Instead, I went to see an emergency dentist. All I needed him to do is reattach the broken piece, but he’s insisting the entire crown needs to be re-done. Now, I have to pay for an entirely new crown. Can’t he just fix it? I’m willing to live with the pain at this point. I just need a dentist who’s not going to do a double cross.

Karen

Dear Karen,

A Dental Crown being Placed

I don’t blame you for your frustration. It doesn’t sound like your dentist has done his job. Nor does it sound like he’s shown any interest in the fact you’re in pain. I have to say, in most cases the “You’ll get used to it line…” is code for I don’t know what I’m doing or how to make it right.

As for the emergency dentist, I don’t think he was trying to cheat you. It’s very likely that the crown broke in a way where a true repair is impossible.

What Caused Your Emergency Dental Visit

There are a couple of things which can cause pain on biting with a crown. The first is a lingering infection. I don’t know if your crown was due to large decay or a root canal treatment. If it was a root canal for an infection, it’s possible there is still an infection there causing pain. There are canals in the tooth which can be quite adept at hiding. It’s possible your dentist missed one.

The second thing which can cause pain is when a crown is seated too high. I tend to lean toward this because of the fact that it broke when you bit down. Generally, our biting force, which is quite substantial, is spread out as our teeth meet together. However, if a crown is seated too high it absorbs all the force. This could lead to it breaking.

Crowns on molars are a little trickier because you have to factor in the occlusion with the other teeth. It’s very likely your dentist could do a fine crown on other teeth, but a molar is a bit beyond his skill set. The fact that his bonding didn’t hold makes me question his skill set already. But, occlusion requires the kind of extra training you would see with dentists who take an interest in treating TMJ Disorder.

Your Options

Option One: You could ask your original dentist to make you a new crown (free of charge). His didn’t meet even the minimum standard of longevity. I don’t know that you’ll get any better results the second time with him, but you’re certainly able to try.

Option Two: You could ask for a refund and allow the emergency dentist to make a new crown for you. The refund would keep you from having to pay for two crowns and you may have better luck with this dentist.

Option Three: As it didn’t sound like you were thrilled with either dentist, you could take the refund and find a completely different dentist altogether.

I hate that you’re having to go through all of this trouble for a crown.

This blog is brought to you by Salem, MA Cosmetic Dentist Dr. Randall Burba.

My Mouth Is Sinking In

I need some advice. You can barely see my front teeth when I smile. It makes it look like I don’t have any and is embarrassing. I do have jaw pain which I wear a night guard for. My face feels more comfortable and natural when I wear it. But, most of the time, my jaw tightens and I have trouble forming certain letter sounds. My dentist suggested porcelain veneers but I wanted to get a second opinion. What do you think?

Pamela

Dear Pamela,

A Chart showing how joints muscles and teeth all work together in TMJ

I’m concerned by some things I’m hearing. I think you need a different dentist. While it is true that getting porcelain veneers can give you a gorgeous smile, it will not help the root of your problem. In fact, it’s likely to make it worse, specifically your jaw pain and issues with pronunciation. You may actually end up with a locked jaw.

Go see a dentist with a lot of training and experience in TMJ Disorder. You’re probably thinking, “Great, that’s not a specialty. How do I find one of those?” Well, I’m glad you asked. You can look on their website or ask their staff where they received their TMJ training. If they only mention their dental school, that’s insufficient. Here are some great institutions. I’d want them to list at least one of them:

  • The Pankey Institute
  • Dawson Academy
  • Spear Education
  • The Las Vegas Institute for Advanced Dental Studies

It sounds like this has happened over time, which may mean you’ve worn your teeth down causing them to overclose. If that’s the case, then it’s very likely you’ll need a full mouth reconstruction. Picking the right dentist for that is just as important as finding an expert in TMJ Treatment.

You want to have a functional smile, but one you’ll also be proud to show everyone. In your place, I’d start by finding an expert TMJ Dentist, but then also see if they’re an expert cosmetic dentist. It is possible to get both. For cosmetic dentistry, the ideal is to get a dentist who has attained accreditation with the American Academy of Cosmetic Dentistry.

This blog is brought to you by Salem. MA Cosmetic Dentist Dr. Randall Burba.

Does Cosmetic Dentistry have to be a Fortune or a Failure?

Several years ago, I had four dental crowns placed on my front teeth. I decided it was time to upgrade my smile and had a consult with my dentist. I told him I wanted something which would improve my smile but not cost a fortune. He suggested teeth whitening. I went ahead with that. The rest of my teeth look great, but the crowns now look dingy compared to the rest of them. I don’t know what went wrong, but my dentist said it was probably time to replace them anyway. When he did the temporaries, I realized that the crowns would be ugly. I didn’t want that either, it’d be no better than leaving them as is, but without the extra cost. I decided just to get a consult from one of those touted cosmetic dentists. He agreed the crowns needed to be redone, but insists I need work on eight teeth because of the width of my smile. That will be quite a pretty penny. Do I have to spend a fortune or be left with an ugly smile?

Andrea

Dear Andrea,

Woman giving thumbs up in a dental chair
If you want to have a smile in the dental chair you need to choose the best dentist

You’re in a bit of a tough spot and it’s all because your family dentist didn’t know (and apparently still doesn’t) know a thing about cosmetic dentistry. He should have told you that the teeth whitening procedure you had done would bleach your teeth but have zero effect on your crowns.

However, you were smart to not go through with his re-do of your crowns. His cosmetic skills are non-existent and you’re talking about your front teeth. You want the best cosmetic dentist you can find. The dentist who’s telling you that eight crowns are necessary is likely trying to give you a perfect smile. If you have a wide smile, eight porcelain veneers are common. Sometimes, even ten are necessary.

However, you don’t have to have all eight done. If you’re happy with the color and shape of the two teeth adjacent to either side of your four front teeth, then you can just get four all-porcelain crowns to go with them. A great cosmetic dentist can make your smile look stunning even with those limitations.

Finding the Best Cosmetic Dentist

You may have to find a different cosmetic dentist than the one insisting on eight teeth. Some will only do the ideal. However, you can find incredible cosmetic dentists who will work within your desired smile.

My recommendation is for you to look at two different online resources. The first is the American Academy of Cosmetic Dentistry’s website (aacd.com). The second is mynewsmile.com. Both of these will recommend the best of the best cosmetic dentists in your area. If you use the AACD site, make certain you check that you want an accredited dentist or an accredited fellow. Those are the best.

This blog is brought to you by Salem, MA Cosmetic Dentist Dr. Randall Burba.

Is There a Dentures Support Group?

Please help me. I feel so foolish. It’s bad enough losing your teeth. But, being poor and losing your teeth is the absolute worst. I couldn’t afford to get dental implants, and yes, I know they’re better. I’m just stuck with dentures. I absolutely hate them. I don’t know if there’s a group or something which talks about how they deal with dentures, but I really need one.

Carolyn

Dear Carolyn,

An image of a snap-on denture
Snap-on Dentures will keep them secure

I’m not aware of a denture support group, but it sounds like a good idea. You might even be able to start one at your local dentist’s practice. I say that with confidence because you’re not alone in your feelings. Many people struggle with dentures.

Common Struggles with Dentures

One of the biggest complaints is it’s much more difficult to eat food. Many times that can be improved with a better fit of your dentures. However, there are limitations. Even the best fitting dentures still reduce your chewing capacity by 50%. Cutting your chewing capacity in half is a huge drop in quality of life.

Another problem is they slip and slide. Removable dentures are, by their very title, removable. Because there’s nothing anchoring them there, they will move. This will happen more and more as your jawbone shrinks, which is a devastating side effect of dentures known as facial collapse. Eventually, you won’t be able to keep them in at all.

I realize I’m not telling you anything you didn’t already know and you want solutions, so let’s move on.

A Snap-on Dentures Solution

Without having the money for dental implants, most patients feel hopeless, like they’re trapped. However, there is a sort of “part way” procedure that will help a little.

Generally, when you’re talking about implant supported dentures, you’ll need about six for each arch. However, with snap-on dentures, you can get as few as two. This can make a world of difference.

Benefits of Snap-on Dentures

The most obvious benefit is they cannot fall out. The implants anchor the dentures to your mouth securing them so you’ll never have to worry about embarrassing public slips.

They’ll help you retain your jawbone where the implants were placed.

They give you a stop gap while you work toward more implants. Obviously, the more implants you have the better, but starting with two gives you hope, a bit of relief, and a place to start.

Our life circumstances change all the time, and there may come a time you can afford to get more implants. This also allows you to save up a bit at a time and you can add two implants in stages as you’re able, until you have the security and chewing capacity you want.

This blog is brought to you by Salem Dentist Dr. Randall Burba.