Root Canal or Dental Bonding

I went to an endodontist for what I thought was a dental emergency. My tooth is darker. He said the tooth is still viable and likely doesn’t have to a root canal treatment. In that case, I think I could just get dental bonding done to make it look better. My endodontist said I’d have to get several teeth bonded for it to match. I’m not sure I want to do that if I will need a root canal in the near future. What do you think?

Trisha

Dear Trisha,

Illustration of an abscessed tooth

If he’s telling you the tooth is viable and saying you don’t “have to” have a root canal treatment, then you don’t have a tooth infection and don’t require a root canal. You either need one or you don’t. Saying you don’t have to have one is misleading. My guess is you have a cracked tooth. Doing a root canal treatment won’t help that.

If you want to treat the color, dental bonding or a porcelain veneer can do that. As to your dentist’s suggestion that you’d have to have several teeth done in order for them to match, that is only true if you go to an inexperienced cosmetic dentist. An expert cosmetic dentist can match a single tooth.

Finding that Expert Cosmetic Dentist

Very few dentists are skilled in cosmetic dentistry. The best have reached accreditation with the American Academy of Cosmetic Dentistry. To reach that level, they have to pass stringent exams as well provide visual evidence of their artistry in a large number of cases they’ve completed.

If I needed cosmetic work done on a visible tooth, I would go to an AACD accredited dentist. You are assured a beautiful result.

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

Should Dental Crowns Touch

I got a dental crown on a left rear molar. I’m a little concerned that it isn’t touching the opposing tooth. Does that matter or am I making a mountain out of a molehill?

Mike

Dear Mike,

Chart of TMJ and Neuromuscular Dentistry

I’m glad you are checking on this. It matters very much that your dental crowns touch. In fact, it even matters how they touch, this is called occlusion and it is important for proper function of your bite and jaw. If your jaw is properly aligned all your teeth touch when you clench them together.

One way to test this is to place a thin strip of plastic, 0.05 mm thick and the width of a tooth, on your back teeth. You should be able to clench your teeth together and prevent the strip from being withdrawn.

When you have back teeth which don’t touch, they will eventually drift toward each other, but that doesn’t mean they will meet in the right place. A misaligned bite is one of the causes of TMJ Disorder. That is a lifetime of pain which can be avoided by your dentist properly placing your dental crown.

Have your dentist re-do this. If you have trouble getting him to agree, show him this post.

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

Insurance Problems with Dental Implants

I need some help. I want to get dental implants, but can’t seem to get my medical insurance to cover it. Why wouldn’t they? It’s not like being unable to eat is good for my health? Will dental insurance cover them? If not, what do I do? I’ve heard dentures are bad for someone my age (I’m 52) but that may be all I can afford.

Grannie G.

Dear Grannie G.,

before and after side images of a woman suffering from facial collapse
Gentting dentures at the wrong age can lead to facial collapse

We sometimes forget that insurance companies are a business. As such, they want to make money. They’re not really there to think of the best option for the patient. Because dental insurance is available, medical insurance companies won’t cover anything which has to do with your teeth.

Dental insurance plans tend to cover the least expensive option available. For tooth replacement options, that would be dentures. So, you’re more likely to get most or full coverage of dentures, but only partial coverage of dental implants. That leaves you covering most of the bill.

Whoever advised you about the dangers of getting dentures at your age was correct. When your teeth are removed, your body begins resorbing the minerals in your jawbone to use elsewhere in an effort to be efficient with its resources. This has the unfortunate effect of shrinking your jawbone. Depending on how quickly the resorption takes place, in ten or so years you’ll no longer have enough jawbone left to retain your dentures. This is known in dental circles as facial collapse.

I don’t want you to despair, though, there are ways to afford dental implants.

Affording Dental Implants

Staged Payments

The first thing you should know is payment for the dental implant procedure is usually done in two stages. First, is the surgical stage when the implants are placed. Then, after a period of time designed for both healing and osseointegration to take place.

Once that is done, the second payment is usually made when the implant crowns are designed. This allows you to break up the cost.

For some, even that is too much. Because of that many dentists will work through Care Credit, which allows you to take out a low-interest payment plan in order to get the treatment you need. If you qualify, this company allows you to choose how long you’ll take to repay it, thereby essentially choosing the cost of your payments.

Dental Implant Options

You don’t have to get a one-to-one tooth/implant replacement ratio. It is much more affordable to get implant overdentures which will use four to six implants per arch and then anchor your dentures to them.

If this is still too much money, snap-on dentures are a great option. It will allow you to use as few as two dental implants. It will anchor the denture in that spot and protect the bone where the implants are. This will get you started while allowing you to save up for more implants if you so desire.

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

Do You Really Need an Expert Cosmetic Dentist?

I keep hearing how important it is to see an expert cosmetic dentist if you want a smile makeover. What I don’t understand is why. Don’t they just send out the work to be done at a lab? If so, wouldn’t the lab be the most important part of your smile makeover?

Landon

Dear Landon,

Photo of a single porcelain veneer held by dental forceps.
Porcelain veneer

You’ve asked an important question. A lot of people think of it with the analogy of it doesn’t really matter which gallery you purchase the art if the artist who does great work. That works for art. But, a dentist isn’t a gallery. Think of it more like it’s the doctor who determines your illness and what medicine will cure it, not the pharmacy where he sends the order.

The lab needs the right prescription to do that work. The truth is no matter how good the lab and ceramist are, they cannot work around a bad dentist. The foundation for the beauty of a smile makeover is in the hands of the dentist, not the ceramist. It’s the dentist who has to give the shade map of the final result, the surface texture, the degree of translucency, as well as a mock-up of the final result. The dentist has to approve what the ceramist does to ensure they followed his directions.

Even if a bad dentist uses a good lab, the results won’t be what you were hoping for. Always choose the dentist. Let the dentist choose the lab. The best dentists usually have an almost symbiotic relationship with their ceramist anyway.

Finding the Best Cosmetic Dentist

Because there isn’t a recognized specialty in cosmetic dentistry, it is hard for patients to recognize who has the skills to give them a beautiful smile. The American Academy of Cosmetic Dentistry recognized that problem. As a result, they started an accreditation program with a two-fold purpose. One is to help train dentists in the art of cosmetic work. The other is to have a recognition system to help patients know who has what it takes.

The best dentists have reached accreditation. These are the top 1% of dentists in the country. Any one of them can give you a stunning smile. Most smile makeovers are done using porcelain veneers. You’ll find these dentists will often have a beautiful smile guarantee.

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

Best Brand of Porcelain Veneers

I just had my teeth whitened and then got in an accident which has caused me to need repairs on several teeth. I’m considering getting porcelain veneers but want to know which brand is the best before I invest. What is the best at this point and time?

Larry

Dear Larry,

A single porcelain veneer being placed

It is great that you want to do research before investing in your smile makeover. You never want to go into any dental procedure without understanding what you’re getting into and whether or not your dentist is qualified.

However, I want to change your tactic. There really isn’t a best brand of porcelain veneers. They each have unique properties with different strengths and weaknesses. However, it is the dentist which makes the difference.

Think of it as an art form. If you commissioned an oil painting, you’d research the artist, not the paint. This is the same thing with smile makeovers. Two different dentists can do the same smile makeover with the same materials and come up with totally different results.

Finding the Best Cosmetic Dentist

Cosmetic dentistry isn’t a recognized specialty. That means any general dentist can call themselves a cosmetic dentist regardless of their skill level. This makes it hard for patients to know whether or not they’re getting an artistic dentist or a dabbler.

Because of that, the American Academy of Cosmetic Dentistry began an accreditation program. This process tests dentists for both their technical knowledge as well as their artistic ability. They have to pass exams as well as demonstrate their artistry by providing visual evidence on a large number of cases they’ve done.

Becoming accredited takes years of training. Those who attain accreditation are among the top 1% of dentists in the country. They can give you a stunning smile makeover. In fact, most of them have a beautiful smile guarantee.

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