Cure for Fluorosis

I used to catch my daughter in the bathroom sucking down whole tubes of toothpaste. We eventually had to lock them up and then supervise her while brushing. Now she has white spots on her teeth and they look a bit splotchy. I did some reading and I bet it is something called fluorosis. Is there anything I can do to help with this? I’m sure as she gets older it will bother her. I was thinking of teeth whitening. What are your thoughts?

Dennie

Dear Dennie,

white spots on teeth

It looks like you are trying hard to stay on top of your daughter’s oral health as well as her cosmetic appearance. You are right that it could be fluorosis. Teeth whitening, while it sounds like a good idea, will actually not help. It will whiten the surface of the teeth evenly. This means the uneven color will still be there only more evident.

You have a couple of options in the treatment of white spots. In some cases, using a treatment called Icon can work. That would be my first try because it doesn’t require any detailed cosmetic work.

If that doesn’t remove the spots, your other options are cosmetic. She’s too young for porcelain veneers. That will be an option after her teeth are fully developed. I would go with dental bonding. This uses a composite resin the dentist will hand sculpt onto her teeth and cover the white spots. However, this isn’t the type of procedure your average dentist can do. You will need an expert cosmetic dentist.

Finding a Great Cosmetic Dentist

Many people do not realize that cosmetic dentistry isn’t a recognized specialty. Any general dentist can call themselves a cosmetic dentist regardless of the amount of training they have put into developing their cosmetic skills. This is not something dentists learn in dental school. They have to invest time and training post-doctorally.

The best cosmetic dentists have reached accreditation with the American Academy of Cosmetic Dentistry. They are among the top 1% of cosmetic dentists in the country. However, it is not always easy to find one near you. If you run into that problem, an equally good option is to go to mynewsmile.com. They pre-screen cosmetic dentists for their training and artistic ability. They can also do a fine job for your daughter. Most of them are accredited or almost accredited (a process that takes years).

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

Problem Speaking After Porcelain Veneers

I had ten porcelain veneers put on ten teeth. Ever since then, I have had trouble speaking. I’m not sure what to do. It feels like the backs of my teeth are too thick and my tongue is pushed. It’s making me talk weird. My dentist has no idea what is wrong. Have you heard of this?

Brooke

Dear Brooke,

A single porcelain veneer being held up by a dental instrument

Looking at the image of porcelain veneers above, you can see that it doesn’t have any part of it that goes on the back of your teeth. It won’t affect your speech there. However, there are some dentists who place porcelain crowns and tell their patients it is porcelain veneers. If they surround your teeth, they’re crowns. If they just go on the front of your teeth, they’re porcelain veneers. Sometimes the length of porcelain veneers can affect your speech, but you said it was bothering you from the back. That’s not the same.

If it turns out he place crowns, then he’s not only been dishonest, he’s also thrown off your bite. If that’s what happened, you can get him to pay for these to be re-done by a dentist who has both cosmetic dentistry training (preferably someone who is an AACD accredited dentist) as well has having done post-doctoral TMJ training. That’s the kind of dentist who will know how to repair the bite’s position as well as give you a beautiful smile.

Another possibility is your dentist did place porcelain veneers and the thick feeling in your tongue is completely unrelated. You could have had an allergic reaction to something and that is why you’re having trouble speaking.

How Can You Get Help

The first thing I would do is get a second opinion. I again suggest going to a skilled cosmetic dentist. There is a trick to this, though. Dentists know each other. They are one another’s peer group. So one dentist might hesitate to say something unkind about work their friend did.

This is why you won’t tell them who did the work. First, ask him if you received porcelain veneers or dental crowns. Then, ask him if he knows why you’re having trouble speaking. If he asks for the name of the dentist tell him, you want a blind, unbiased second opinion so you won’t be sharing any names.

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

Root Canal with Porcelain Veneers

I have eight porcelain veneers on my upper teeth. Recently I learned I had a periapical abscess and my dentist says I need a root canal treatment. First, how did I end up needing a root canal to begin with? Second, how do I keep this from ruining the look of my porcelain veneers?

Kaleigh

Dear Kaleigh,

I’m sorry this happened. I can understand your concern about needing a root canal treatment. Most expert cosmetic dentists go their entire careers without a porcelain veneer they’ve placed needing a root canal treatment.

teeth being prepared for porcelain veneers

The picture above is the right way to prepare a tooth for porcelain veneers. Using a depth limiting diamond bur, your dentist should place grooves in the teeth only 1/2 millimeter in depth. Then, they’ll go back and prepare the remainder of the surface to even out with the grooves with a traditional diamond bur. When done this way, there is little stress to the tooth causing the need for additional treatment.

Unfortunately, not all dentists understand that.

illustration of a tooth prepared for a dental crown

Some dentists will be too aggressive in their preparation of the teeth and get all the way down to the dentin. Others do a crown preparation, as seen above. They are actually placing porcelain crowns and just call them porcelain veneers.

This type of aggressive preparation is much more likely to stress the tooth and cause problems. This is likely what happened to you.

Protecting a Porcelain Veneers During a Root Canal

There is no way around getting the root canal. If you leave the periapical abscess there, the infection will cause serious problems and could even put your life at risk. Dental infections still lead to death when untreated.

The good news is, there are steps your dentist can take to preserve the color integrity of your veneer. The majority of darkening which takes place after root canals is because of left behind dentin and root canal filling material. Your dentist needs to thoroughly clean out the crown of your tooth.

From there, he’ll need to place a fiberglass post down into the root. The remainder should be filled with a light colored composite resin.

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

Does a Tooth Infection Cause a Fever?

My child’s dentist told me that a dental infection will not cause a fever. I’m a little confused by this because I was previously under the impression it could. They didn’t seem to want to explain anything. I came across your blog and thought I’d ask you. Can a dental infection cause a fever? Why or Why not?

Camille

Dear Camille,

Woman holding her jaw in pain from TMJ

I think there was likely a communication error here. What they likely meant to say is that a dental infection doesn’t always come with a fever. Often, a dental infection is contained within the tooth and a fever won’t be a symptom. Sometimes, however, it will create a fever. It is an infection. Another symptom some patients have is a feeling of being run down. In fact, I’ve known doctors who when they can’t figure out why a patient feels so poorly will send them to the dentist. If it turns out they have a dental infection, having it removed makes them feel better.

If you and your child are getting regular dental care, it is unusual for a tooth to suddenly blow up. Most of the time cavities can be caught early and you can get a small composite filling. However, if you delay going in or don’t see the dentist regularly, it can grow without you realizing it.

If they decay get’s too large, you will go from needing a small filling to needing a dental crown. If it grows even further, then you’re talking about it reaching the pulp and a root canal treatment will become necessary in addition to the crown. Preventative care is the least expensive dental work you can have.

When Patients Avoid the Dentist

It doesn’t sound like you are someone who avoids dental care. However, I’m saying this for the benefit of others who might be reading this who do struggle. In general, people avoid the dentist for two reasons. The first is financial. The second is fear of the dentist.

If finances keep you from the dentist there are a few options. Some dental plans are inexpensive. They’ll cover your cleanings and check-ups and give mild discounts on the larger ticket items. However, getting those check-ups usually prevents you from needing any of the bigger treatments.

Additionally, most dentists are compassionate and went into the field because they want to help people. If you explain financial issues, they may be willing to allow you to pay out your treatments.

If fear keeps you from the dentist, there are dentists who are great at working with patients who suffer from anxiety. You can do an internet search for them and it may give you the positive experience you’ve been needing to get back to the dentist regularly.

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