Category Archives: Best Dentist

Will This Pulp Cap Work, or Will I Need a Root Canal?

Woman looking unsure of a dental procedure and looking for the best dentist for a resolution

Last month, my dentist filled two cavities. While removing the decay from the third tooth, he mistakenly exposed the pulp. He stopped trying to remove the decay and used a pulp cap to avoid root canal treatment. Before that visit, I had not heard of a pulp cap, but I had to decide rather quickly because the pulp was exposed. My dentist explained the procedure to me and e-mailed some material to me. I want another dentist’s opinion on this, though. How do I know that the pulp cap will work? Are there any symptoms I should watch for that might signal cap failure and that I will need a root canal anyway? Thank you. Lashelle from CT

Lashelle,

Thank you for choosing our office for your question.

We will give you and our readers some background on a pulp cap.

What Is a Direct Pulp Cap?

A direct pulp cap is a procedure to protect entirely or partially exposed tooth pulp. The process allows the dentin (the layer beneath tooth enamel) to grow back and cover the pulp. It can save you time and money and help you avoid root canal treatment.

When Do You Need a Pulp Cap?

You might need a pulp cap if tooth pulp (living tissue and nerves) is exposed during decay removal. If the pulp is not infected, your dentist might be able to prevent damage to it with a pulp cap. Saving tooth pulp can help avoid the need for root canal treatment.

What Is the Pulp Cap Procedure?

During a pulp cap procedure, a dentist will take these steps::

  • Remove tooth decay
  • Apply a cotton pellet to the tooth to stop bleeding
  • Clean and dry the tooth
  • Ensure the pulp is healthy
  • Apply a biocompatible material over the pulp to seal out infection
  • Apply and bond composite filling in the tooth

If a dentist leaves decay in the tooth, it can grow slowly and infect the tooth eventually. If you are not experiencing any symptoms, we recommend not doing anything to the tooth. And if you remain symptom-free, your dentist can x-ray the tooth to see if it is still healthy. A toothache, sensitivity, or swollen gums are symptoms and signs of an infection that will lead to root canal treatment. Otherwise, your tooth should be healthy.

The cosmetic dentists at Burba Dental Partners in Salem, Massachusetts, sponsor this post. Read about their credentials and what they do to provide some of the best dental care in the Boston area.

Why does my root canal tooth still hurt?

My dentist placed three new crowns in August. One crown is on my bottom left, second molar tooth, a second is on my top left, first molar tooth, and the third is on the second molar tooth. The bottom tooth hurt, so my dentist gave it a little time and decided to do a root canal. I got the root canal two weeks ago, but my tooth still hurts. I am almost finished taking the antibiotic. Should I wait until I finish the medication before calling my dentist and scheduling with her? How long should a root canal tooth hurt? – Thanks for your help. Teri from Pittsburgh, PA

Teri,

Thank you for choosing our office for your question.

One of our dentists would need to examine your tooth and x-rays for an accurate diagnosis. And the dentist would ask more questions, including:

  • Has the pain increased or decreased since root canal therapy?
  • What triggers the pain?
  • Is your tooth sensitive?

Causes of Ongoing Pain After Root Canal Therapy

Diagram with five states of root canal treatment
Root canal therapy must clean infection from all canals
  • Untreated root canals – Although most molar teeth have three canals, sometimes a tooth has four or five canals. If your dentist misses them and does not treat the infection, the pain will persist.
  • Problem with another tooth – If another tooth is infected, the pain can refer to other teeth.
  • Inflammation – Sometimes, after root canal treatment, a tooth may be inflamed and sensitive. When you bite or chew on that side, the irritation causes post-operative pain. It can take a while for the tooth to get better. Some dentists make a thin mouth guard for you to wear at night and when you are not eating to relieve the pressure on the affected tooth.
  • Irritation from crown preparation– Sometimes, preparing your tooth for a dental crown and removing some tooth structure irritates it. But it should decrease over time.

Rather than wait until you have taken all the antibiotic medication, call your dentist and ask for an x-ray to ensure she treated all the canals. If necessary, your dentist can refer you to a root canal specialist.

Burba Dental Partners of Salem, Massachusetts, sponsors this post. Our patients say we offer some of the best dental care in the Boston area.

My Perforated Sinus Is Still Infected After Antibiotics

Three days after wisdom teeth extraction, the swelling in my cheek increased. I also had yellow discharge coming from the sockets and my nose. I called the oral surgeon’s office and was prescribed Augmentin for a minor sinus perforation. Although the facial swelling decreased, a CT scan showed that one sinus is still infected.

Woman holding her upper nose, perhaps with a perforated sinus and infection - for information from Burba Dental in the Boston, MA area

Then the surgeon prescribed Azithromycin for five days. It’s almost a week since I finished the Azithronycin, but I still have drainage from the sinus hole, although it is a little better. I also feel slight pain and pressure in my sinus. The surgeon asked me to irrigate my gums with a prescription rinse and use Flonase for the sinus. I still feel pressure and some pain in the sinus. Does it sound like the sinus is healing, or do I need to schedule an appointment with an ear, nose, and throat specialist? Thank you. ~ Traci

Traci,

Thank you for your questions.

One of our dentists would need to examine you for an accurate diagnosis, but we will offer some insight based on your description.

Sinus perforation does not usually cause an infection. But an infected tooth can leave bacteria behind after extraction that gets pushed into the sinus. The oral surgeon prescribed Augmentin for the condition that caused facial swelling and Azithromycin for the sinus infection. It seems that your CT scan did not show any fragments in your sinus that are slowing the healing process or require removal.

Lingering Sinus Infection After Finishing Antibiotics

If you finished the Azithromycin yet still feel pain and pressure in your sinus, you probably need a refill. You should continue an antibiotic until the infection is gone to prevent antibiotic resistance.

Flonase is a corticosteroid for reducing inflammation and should decrease pressure in your sinus over time. Although we do not have all the details about your case or your dental records, it seems that your oral surgeon has the issue under control. You do not need to see an ENT, but you should call the oral surgeon to explain that the infection is lingering, and you may need another antibiotic prescription.

Best wishes for a steady recovery.

Burba Dental Partners of Salem, MA, sponsors this post. Please read what our doctors do to provide some of the best dental care in the Boston area.

Botched Tetracycline Case

I’ve had tetracycline stains most of my life. Originally, I had some work done by having dental bonding done over them, but it was time to replace them. I’d since moved to another city and couldn’t see the original dentist. My new dentist suggested we do six dental crowns because it would “hide the stains better.” I did not do adequate research and just trusted what the dentist told me. Now I regret it. The crowns show the stains underneath, especially in fluorescent lighting. Plus, you can tell these are crowns because they look so different from the adjacent teeth.

What do I do here? He’s offered to send them back to the lab, but I’m not sure the results will get any better. Is it okay to ask for a refund?

Lannette

Dear Lannette,

Tetracycline stains are among the most difficlut cosmetic procedures to do. The stains are so dark and so deep, it takes real skill to get the repair opaque enough to cover the stains while still having that natural translucent look. Your dentist likely had good intentions but was in over his head.

Warning Signs He Didn’t Know What He Was Doing

First, he suggested porcelain crowns instead of porcelain veneers. This automatically shows he is not comfortable with cosmetic dentistry. Dental crowns, for this type of procedure, means unnecessarily grinding down healthy tooth structure.

Second, he suggested only six teeth. When we study in dental school we learn about front and back teeth. The first six are considered the front teeth. However, dentists who study cosmetic dentistry, do not divide things into anterior and posterior teeth. Instead, we talk about the aesthetic zone. This is the number of teeth visible when you smile. For most patients, that is eight to ten teeth. Not six.

With those adjacent teeth showing with the dark stains, it makes it obvious your front teeth are crowns.

I agree with you that this dentist is not going to be able to make it any better. I suggest you just ask for a refund. Then go to an experienced cosmetic dentist to do this. The best cosmetic dentists are AACD accredited, so I would look there. Unfortunately, once you have dental crowns placed you are stuck wtih crowns. The good news is an excellent cosmetic dentist can make them look natural and beautiful.

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

Dental Horror Story

I need some help and advice. I had 20-year-old porcelain veneers I wanted to replace. My dentist decided my bite needed to be opened up as well so people could see my teeth so in addition to 8 veneers he added two dental bridges to the mix. The whole time I was in temporaries I was miserable. I would literally call every couple of days to tell them how much pain I was in. I felt like they weren’t taking me seriously. Then the day came for the permanent ones and he placed them in under an hour. They felt as bad as the temporaries. All the dentist will say is all his checkpoints are textbook and it is just a matter of me adjusting to the open bite. Aside from the pain, my mouth is so dry my lips are sticking to my teeth. I’ve been sucking on popsicles and drinking water and soda all day long just to keep my mouth moist. I’m miserable. What do I do?

Lydia

Dear Lydia,

This is an absolute disaster and none of it is your fault. Let’s start with the fact that he wanted to open your bite. The only way to properly do that is to crown at least every tooth on one arch, so he’s already going about it wrong. While he did do temporaries, which is good and necessary, the purpose of them is to make sure the teeth occlude properly and the patient is comfortable, which by definition includes pain-free.

He didn’t pay attention to one of your complaints and based on your description, you brought your pain to their attention quite a bit and he plowed right onto the permanent restorations without any regard to what you were experiencing.

It is obvious that he opened your bite too much, which is why you are facing all these issues with dry mouth. All his guff about meeting the checkpoints is nonsense. A key checkpoint is that your mouth closes naturally when at rest. If yours were doing that you wouldn’t be having these dry mouth issues. So he’s not being honest there.

On the note of your dry mouth. Please don’t eat popsicles and drink soda to keep your mouth moist. This is decay waiting to happen. The water is okay.

What to Do Next

He’s caused serious damage to your bite. While bad news, it is also good news. Because your case lacks proper form and function, you are entitled to a refund. However, what I’d like you to do is ask for him to pay for the repairs with a dentist of your choosing.

You need a highly skilled dentist in both occlusion and cosmetics to make this right, especially with the damage he did. The top cosmetic dentists are AACD accredited. For the occlusion of your teeth, I’d look at someone with significant TMJ training.

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

Dentist Destroyed My Smile

I have some abrasion lesions that my dentist decided to help me repair after much begging. Now I think I may have made a mistake. I had a beautiful smile with the exception of the lesions– emphasis on had.

We did dental bonding on the teeth at the gumline and nothing matches. The color my dentist put on there is way too dark and opaque compared to the rest of my teeth. My friends that have seen it have all been quietly polite, but I have noticed the double takes. Is it safe to remove this and have it done by someone else?

Candace

Dear Candace,

I’m sorry you are in this position. This is just one example of why I always tell people who write to not pressure their dentist into a procedure, even a procedure like this one, which should be within their skill set.

Image of a tooth with abrasion lesions

The image directly above is for the benefit of those who may not know what abrasion lesions are. A dentist can simply remove the dental bonding that was done and put new bonding on. I don’t think your dentist is going to be able to do this.

Though technically, with this procedure, any dentist should be able to do it, in most cases of real cosmetic dentistry work, like a smile makeover, you’d need a dentist who has invested in a lot of post-doctral training. As you are going to need another dentist to fix this anyway, I suggest you get the best cosmetic dentist you can. This way you won’t have to worry about another disaster. AACD accredited dentists are in the top 1% of their field. I’d start there.

If you don’t have one in a reasonably close proximity to you, my next stop would be mynewsmile.com. A retired accredited dentist pre-screens every practicioner who wants to be listed. They can’t just pay to get on. Instead, they have to prove their technical knowledge and skill as well as show their artistry. Anyone listed on that site will do a phenomenal job for you.

A Word about Your Dental Bonding

We used to think the reason for abrasion lesions was brushing too aggressively. The latest research, however, seems to indicate it is more the result of someone who clenches their teeth a lot. Clenching makes the teeth flex somewhat at the gumline, this in turn weakens the tooth there and leads to the abrasions.

Because of the flexing, I’m going to recommend you ask your dentist to use a softer, flexible composite bonding material. Otherwise, with a hard material, it could lead to your bonding popping out.

You may also consider having your dentist offer you a custom nightguard. This will help protect your teeth from clenching and grinding, though the night when you are least likely to notice it.

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

Her Dentist is Incompetent or Dishonest

I need some advice. I have horrible dry mouth which is wreaking havoc on my daily life. I’m constantly drinking water, which means I’m also constantly in the bathroom. In addition to that, my teeth are getting super yellow. I have one crown and two porcelain veneers. When I talked to my dentist, he suggested replacing all those teeth, plus the remainder of them with crowns. He said a full-mouth reconstruction will take care of my aging restorations as well as whiten my smile. This seems pretty aggressive and I have no idea if it will also fix my dry mouth. What do you think?

Katherine

Dear Katherine,

image advising she stop with this dentist

I do not want you to see this dentist again. Either he is either incompetent or dishonest. This is a massive overtreatment. A full-mouth reconstruction is for the most severe of cases. This is not the treatment you need. So, why is he recommending it? Let’s start with the whitening of your teeth. This would bring your dentist a few hundred dollars. With a full-mouth reconstruction, he can bring in between 30-60 thousand. Which one do you think is the better moneymaker for him? To me, this speaks to dishonesty.

Now let’s talk about those two porcelain veneers. He wants to replace these with dental crowns? That can only be because he doesn’t know how to do veneers well enough. So, instead of sending you to a dentist who knows what they’re doing, he hides the fact he doesn’t do that particular procedure and suggests something more aggressive. The best dentists try to save as much tooth structure as possible. Your dentist is more interested in his reputation and his bottom line.

Now, let’s talk about that full-mouth reconstruction. This is one of the most advanced procedures a dentist can do. My gut tells me your dentist doesn’t have the training or skills to pull this off. Not only can it give you permanent dry mouth, but he could also throw off your bite so significantly you are in constant pain with TMJ disorder.

My very strong recommendation is you find a different dentist. In your case, one with great skills and cosmetic dentistry. Look for an AACD accredited dentist. They will whiten your teeth and replace your porcelain veneers and dental crown in a way that is beautiful and blends seamlessly.

About the dry mouth. This will be detrimental to your oral health, which you already know. I’d like you to talk to your medical doctor. It’s possible he has you on some medication which is causing this. If that’s not it, he or she can do some investigating to figure out what is the true cause and hopefully get you some relief.

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

A Dentist Who Disagrees with Me

I’m a little tired of you saying that a patient has to see an accredited cosmetic dentist if they want a beautiful smile. First of all, cosmetic dentistry isn’t a recognized specialty. It’s an area of interest. Being AACD accredited doesn’t make you better than a dentist who isn’t. You also act like anyone who uses Lumineers doesn’t know what they’re doing. Why does using a specific brand make you less of an expert? All you are doing are scaring patients. You’re probably just doing it to drive them to you. There are other good dentists.

Dr. H.

Dear H.,

Pretty brunette with a beautiful smile
Can a beautiful smile be guaranteed?

You are right that there isn’t a recognized specialty. That’s part of the problem. Any dentist no matter how much or little training they have in cosmetic dentistry can call themselves a cosmetic dentist and do a smile makeover. When they don’t have the artistry necessary, it is the patient who suffers.

What I did NOT say is that only an AACD accredited cosmetic dentist can do a beautiful smile. I’m sure there are dentists on their way to accreditation who create beautiful smiles. However, my blog is here to help patients, not dentists. It is too hard for a patient to investigate each dentist to know which ones will give them a stunning smile and which ones will make them into the next cosmetic dentistry horror story.

How are they to know which post-doctoral schools to look for in their training? Or how to tell from the smile gallery photos whether the gums are healthy?

Accredited dentists have already proven their technical knowledge and artistry. It is an easy way for the patients to know they are getting the best dentist to do their smile makeover.

I’m not saying you have to get accredited to be good. I’m saying being accredited shows you are and gives the patient some measure of security.

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

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.

Blacklisted by Best Dentist

I’m afraid I’ve been blacklisted by the best dentist in the area. He came highly recommended by several of my friends. They’ve all been to him for various cosmetic procedures, from whitening through veneers, and everyone says such wonderful things about him. Maybe I built him up too much in my mind, but I recently went in for a consultation about having my teeth fixed up a bit. I have some awkward spacing and one tooth is a little twisted. I wanted to have them straightened out and whitened. Everything seemed fine. I met him and thought he was fantastic. He talked up veneers and I felt great. But, then his assistant came in after and gave me the estimate—it was thousands more than I could afford. I asked if there were alternative solutions and the girl huffed at me a bit and then went and got the dentist. He came back and basically told me that if I didn’t want to do it his way, I shouldn’t be in his office.

I was devastated. I really thought this guy would be great, but I can’t afford to go through with the treatment and my friends keep asking me when I’m going in to see him. I have absolute faith in his capabilities, I just wish he’d work with me on treatment. Is there any way to salvage this?

Thanks,

Anonymous In MA

Dear Anonymous,

Woman giving thumbs up in a dental chair
How do you know if you have the best dentist for your needs?

Let’s be realistic for a moment here. If he was the best dentist, would he be treating you this way? The answer is no.

He’s Not Taking Good Care of You

Perhaps he has amazing artistic skill and can craft beautiful smiles, but that’s only half the battle. Being able to make patients feel comfortable and helping them get around their barriers is equally important. In your case, cost is a barrier.

A good dentist would understand this and pitch solutions that work within your limitations. Perhaps you might be better getting six porcelain veneers instead of two or four. Maybe that is the best way to improve your smile. At the same time, maybe two will provide you with adequate results and be a bit more affordable. Or, perhaps Invisalign combined with teeth whitening is a better option for your budget. There are always multiple approaches. If he isn’t willing to explore them with you, he’s not doing you justice.

You Can Find a Better Dentist

Go have a consultation with another dentist and be upfront about your budget from the onset. A great dentist will go over your options with you. For what it’s worth, you don’t have to explain to your friends why you’re seeing someone else. The prior office has an obligation to keep your information confidential, so unless you tell your friends why you left, they never need to know.

This blog is sponsored by Salem Dentist Dr. Burba.