Tag Archives: dental crowns

Should My Dentist Pay for My Bone Grafting for My Dental Implant?

I lost a tooth almost 12 years ago. I plan on getting a dental implant now that finances are better. However, when I went in for my consultation, my dentist mentioned I’ve lost bone in that area and will need some grafting done. My sister told me that he could have done a socket preservation procedure when he first took out my tooth and I wouldn’t need the grafting now. She recently had a tooth out and her dentist recommended it. Should my dentist pay for my grafting? I’m pretty sure he never offered that option to me when my tooth was removed.

Melanie

Dear Melanie,

illustraition of a dental implant next to natural teeth

The socket preservation procedure your sister referred to was fairly new back when you had your tooth removed. We didn’t have much data at oll on how well the procedure worked. The cost was often prohibitive for patients. Even today, not all dentists offer the treatment option.

The procedure is quite similar to a bone graft and is done by placing bone material in the socket which can fill in the gap over the years. There is still very little data on the longevity of the procedure. Even some successful cases had to have some bone grafting done later anyway, though less than they would have if they hadn’t done it.

Bone Loss after Tooth Extractions

When any teeth are removed, your body recognizes that. In an effort to be as efficient as possible with your body’s resources, it will begin to resorb the minerals in your bone to use elsewhere. 40-60% of your bone is lost within the first three years, though the rate of absorption slows significantly after those first few years.

I don’t think you have a case to get your dentist to pay for your bone grafting. Even if he didn’t offer the procedure to you at the time, which in all honesty there is no way to know, because it was a procedure just getting started he didn’t do anything wrong not suggesting it.

You Don’t Have to Pay for Dental Implants all at Once

You can pay for the bone grafting, then take a break. The implant procedure is paid for in two phases. First, the dental implant itself. Then there is a period of healing while the bone integrates with the implant. This is an imperative step. Without it the implant will fail.

Once that is completed, then the second half of the procedure will commence along with the second payment. That is when the dentist will place the dental crown on top of the implant.

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

Dentist Insisting I Get Invisalign

I feel horrible about my teeth and now my dentist has made me feel even worse about both that and my finances. I have two crowns on my front teeth. They’re 16 years old so they are in definite need of replacing. When I went to see my dentist about that, he insisted I have Invisalign done first before he would replace the crowns. The front teeth do stick out a little, not a ton. I”m ashamed to say I don’t have the money to do both procedures. If I do the Invisalign, I won’t be able to replace the crowns, but my dentist won’t replace them without straightening my teeth first. What do I do?

Miriam

Dear Miriam,

Clear Invisalgin Aligner
Invisalign’s aligners are invisible, even at a conversational distance.

I’m very sorry your dentist has placed you in this position. It is unfair of him to insist on perfect cases or nothing. I am going to tell you now that this isn’t the best dentist for you. I’d like you to look for another one. In your case, I’d like you to look for an expert cosmetic dentist.

Your crowns can be replaced with or without you doing Invisalign. In fact, you can get your crowns replaced and then do Invisalign later if you’d like. It’s completely up to you. It is obvious to anyone with a brain the teeth can have dental crowns, even with their slight overbite, because you already have them.

What Type of Dentist Should you Get

crowned front teeth without all-porcelain crowns and then with

You are replacing your front teeth which is one of the first things people notice about you. You’ll want a dentist who understands both the technical aspects of your procedure but also has an artistic eye. This way you may get a beautiful smile. Plus, you can be assured a dentist with the right skills and training will know to only place all-porcelain crowns on your front teeth.

The image above, on the left side, shows teeth with metal-based crowns on the front teeth. The right side shows that same patient who had their dental crowns replaced with all-porcelain crowns. You can see what a beautiful smile a great cosmetic dentist is able to create.

I’d look for an AACD accredited dentist in your area. If you can’t find one. Try mynewsmile.com. Any dentist they recommend is excellent.

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.

Full Mouth Reconstruction Disaster

I’m having a full mouth reconstruction and things keep seeming to go from bad to worse. When the temporaries were done, everything felt fine. However, once the permanent ones came in nothing is occluding well. Some of the teeth are hitting too soon and some aren’t hitting at all. My mouth feels awful. I can’t even eat. He’s tried to adjust them with grinding them down a bit but everything got progressively worse. I offered to pay lab fees to have these re-done, but he keeps trying to fix it himself. I went to see another dentist, but once he found out who did the work he wouldn’t say anything negative about the work. Before that, he seemed concerned about some things, but now I think he’s just trying to protect his colleague. What do I do?

Bruce

Dear Bruce,

A man in pain needs to see a Salem Emergency Dentist

There are two things going on here. The first is that your current dentist is in over his head. A full-mouth reconstruction is something that is very advanced. It takes a significant amount of post-doctoral study. For instance, Dr. Burba studied about TMJ Disorder and occlusion at both the Dawson Academy and the Spear Institute. This type of intentional training is necessary to do the type of procedure you are trying to get done.

Occlusion is the study of how your teeth come together properly. You noted that some of your dental crowns were hitting before others. This is why you’re in pain. Normally, your biting force is spread across a group of teeth, but when you have a tooth that is hitting before the group then it is taking all the brunt of your biting force. That is a significant amount of pressure and will lead to pain.

Please bear in mind that I haven’t examined you. However, it also sounds like he’s thrown off your bite as well. This can mess with your jaw joint. That, in turn, will lead to TMJ Disorder, which is a whole other set of pain.

You are probably going to need to have this case re-done. In order to get some of your money back to make it possible for you to get it done right, you’re probably going to need to get a second opinion.

I know you’ve tried this already, but there is a trick to doing it in a way to get an unbiased answer.

Getting an Unbiased Second Opinion

I would look for a dentist who has experience in occlusal studies. In addition to the institutes I mentioned which Dr. Burba attended, you could also look for someone in your area who has attended the Las Vegas Institute of Advanced Dental Studies, often abbreviated LVI.

Once you feel confident that the dentist has the requisite knowledge to know what is going on, tell him (or her) what you’re experiencing. Under NO circumstances should you tell them the name of the dentist who did the original work. That is where you went wrong with your last second opinion.

Dentists know one another. Some are even close friends. They may feel conflicted in criticizing the work of a close colleague. If they ask you who did the work, tell them you just want an unbiased opinion so you won’t be naming the dentist. They shouldn’t have a problem with that.

If the second opinion dentist agrees the work isn’t done properly, you should be able to get at least a partial refund.

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

A Collapse Bite Requires You Choose Your Dentist Carefully

My smile humiliates me. I have to work extraordinarily hard for people to see my teeth. It looks unnatural. Plus, my jaw hurts. My dentist has me wear a night guard for that. It does help and my lips and teeth look more natural when I do. I think it may be that my teeth aren’t big enough. In that case, would porcelain veneers help?

Mary

Dear Mary,

Woman covering her mouth

Based on what you’ve mentioned, it sounds like you have a combination of a collapsed bite along with TMJ issues. If that is the case, porcelain veneers aren’t your solution. However, I do have one for you.

I’m actually relieved you wrote before moving forward. There are too many times we hear from people only after a dentist without the requisite training completely destroyed their bite.

In order to fix what is going on, they will have to open your bite with dental crowns. It will have to be done carefully and methodically with a dentist who knows how to do a full-mouth reconstruction. It will take restoring your bite with provisional restorations first.

This is necessary so that it is reversible until the provisionals are successful. This will mean you are completely out of pain, your upper teeth show normally, you have no speech difficulties, and you are pleased with the appearance of your new smile.

This is a tall order and there are only a small minority of dentists who are able to accomplish this. You’ll want someone who has done extensive post-doctoral work at one of these institutions:

  • L.D. Pankey Institute
  • The Dawson Academy
  • The Las Vegas Institute for Advanced Dental Studies

These are the top schools for this sort of procedural training. Anything less and you’ll end up with an even more serious problem than you are facing now. The good news is, those dentists are out there. You have hope.

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

Affordable full-mouth reconstruction

I never was able to go to the dentist as a child. My parents never had the money. I used to resent them for that. But, I had saved up money to go to the dentist and now I understand. This dentist told me I need a lot of work and suggested what he called a full-mouth reconstruction. This is way beyond anything I can afford. In fact, it costs more than all the cars I’ve owned put together. Is there an affordable way to get this done?

Keith

Dear Keith,

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

Dear Keith,

Our parent’s actions often seem more understandable as we age, however, avoiding the dentist altogether is never recommended. It will actually end up costing you more money in the long run, something your parents just may not have understood.

That being said, I don’t think this is the best dentist for you to be seeing. He’s jumping a lot of guns. I don’t know if he’s doing that because he’s lazy or because he is trying to milk you for as much as he can. Either way, you want a different dentist.

A full-mouth reconstruction means grinding down all of your teeth and placing dental crowns on all of them. This can only be done by the top 1-2% of dentists in the country.

It takes advanced training in both restorative dentistry and aesthetics. Not many dentists have this. If it’s done incorrectly, it can completely destroy your bite, leading to severe TMJ problems.

Find a Dentist Willing to Work Hard

What you need instead is a dentist willing to work hard to preserve as much of your healthy teeth as he can while taking care of the issues that have further and need treatment.

Affording this is easier too. You simply have the dentist list out everything that needs to be done to your teeth without wasting unnecessary structure.

Ask him to list it out from most urgent to least. This way you can do what’s known as phased treatment. You work on the urgent things so you don’t end up with a dental emergency, then slowly (as you are able) get the next thing done.

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

Dentist Blamed my Bite for Broken Teeth

I kept breaking teeth when I ate. My dentist said it was because of my bite and suggested I crown every tooth so he could fix it. That was 50K+ so I expected decent results. Instead, I have several broken crowns. Now, my dentist is blaming my habits for breaking my teeth. He said I’m grinding my teeth at night and need to wear a night guard and something else during the day. I’m having trouble buying this for two reasons. First, because he originally said the cause was something else but when his repair didn’t work he’s now suddenly coming up with a bad habit that’s my fault. And this is the first time I’ve heard of this so-called habit. Second, because I break my teeth when I eat and not when I sleep. Do you have a recommendation?

Kyle

Dear Kyle,

Chart of TMJ and Neuromuscular Dentistry

I understand why you’re concerned. It doesn’t sound like your dentist really knows what he’s doing with this. After spending over $50,000 dollars, you have a right to be frustrated. I have two suggestions for you. First, I want you to get a second opinion. However, I don’t want you to get it from any dentist. Instead, I want you to find a TMJ Dentist.

While there isn’t a TMJ Specialty, there are dentists who’ve invested more time in studying the causes and treatments. You want a dentist who’s invested the time doing that post-doctoral. For instance, Dr. Burba studied at both the Dawson Academy and Spear Institute. Both are well known for their TMJ and neuromuscular training. Another great school for that is the Las Vegas Institute (LVI).

The reason I want you to see a TMJ dentist is due to the crowns you’ve had placed. What your dentist did is known as a full-mouth reconstruction. It takes expert level knowledge in occlusion to do this correctly or you could end up with serious problems with your bite. I don’t have the confidence your dentist has done this training.

TMJ and Night Guards

The second thing I’m going to recommend is you follow through with his suggestion of a mouth guard. While he didn’t run any tests or talk about evidence of teeth grinding before this problem, a night guard is not a bad idea. Though, I doubt you’ll need one during the day. The reason I say that is because people who grind their teeth at night don’t realize they’re doing it.

Teeth grinding causes a bunch of problems. Not only can it lead to TMJ Disorder, but it can also cause you to crack or break your teeth. I realize when your teeth break is during meals, however, that doesn’t mean they’re not being weakened by the habit.

One other thing. If you do grind your teeth and there was evidence of that, but your dentist didn’t mention it until now, that is severe negligence on his part. If that’s the case, I think you need a new dentist.

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

Store Bought TMJ Treatment

I’m drowning in medical bills right now and don’t think I can afford a dentist. But, my jaw has locked up. My sister says TMJ does that and that I need an oral device to help. All I know is I can’t even eat. I’ve heard you can use an oral mouthguard to treat TMJ. I saw one at the pharmacy the other day and it was only about $20. I can afford that much. Is there anything I need to know about using it?

Drew A.

Dear Drew,

TMJ Treatment Dentist

Your sister is right on both points. Lock-jaw is often caused by TMJ Disorder. While, the orthotic anterior repositioning splint can be used to treat TMJ, that’s not what you saw at the store. A mouthguard is completely different. They’re used to protect people’s teeth from habitual tooth grinding. If that’s an issue you struggle with, you’ll want a mouthguard after you finish your TMJ treatment. However, the store bought ones aren’t custom fit. They just come in small, medium, or large. You can also find a one size fits all. They’re okay on a temporary basis, but you’ll grind through them rather quickly.

One made by your dentist will be more effective. I know your TMJ is the focus right now, but if you don’t protect your teeth from the grinding there are serious consequences. Not only does the grinding aggravate your TMJ, but it can lead to cracked teeth or even teeth coming loose and needing to be replaced. Best case scenario, they end up ground down to nubs and all need to be crowned. Talk about expensive!

But, back to your current issue. Here’s what I’d like you to do in the immediate so we can try to get the swelling down and get you eating again. I’d like you to take 800 mg. of ibuprofen about three times a day. In addition, you need to alternate heat and ice packs. Wear them for about ten minutes at a time, a few times a day as you’re able.

You will need to see a dentist to get the appropriate treatment. I know you’re buried in medical bills right now. Many dentists are compassionate and would be willing to work with you on payments so you can get the treatment you need right away and pay it out later.

Even if you can’t find one willing to work you, Care Credit is a fantastic option. It’s a medical “credit card”, but they let you choose your terms.

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

Diet or Dentist For TMJ?

I feel a little foolish asking this question but I’m wondering if TMJ can be a diet related problem? I have horrible jaw and head pain, especially in the mornings. My closest friend truly believes that if I switch to a whole foods diet it will be taken care of. Even as I type it, it seems like a stupid idea. However, I’ll have to admit my friend is a lot healthier than I am. So maybe there is something to what she has to say.  Do I need a dentist or a diet change?

Lucia M.

Dear Lucia,

There is one aspect of TMJ which can be diet related, but one only. Chewing. TMJ is a disorder of the temporomandibular joint.  Changing your diet won’t repair the joint. However, if you’re eating things such as raw carrots and apples it could be adding stress to the joint. It might be a good idea to lay off the hard and chewy foods while your dentist gets to the cause of your problem.

Your symptoms sort of sound like the cause could be teeth grinding. You wouldn’t necessarily even know you’re doing it if it’s happening while you’re asleep.

If that’s the cause, a simple mouthguard could be just the solution for you. Your dentist can custom design one to fit comfortably in your mouth while you sleep. If you start to grind your teeth, the mouthguard will absorb the pressure, protecting your teeth and your joint.

This will also protect your teeth from damage. The grinding can cause your teeth to become loose or cracked, causing you to need a dental crown.

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

Is a Defective Crown a Dental Emergency?

Several years ago, I had porcelain crowns done across all my front teeth. They look great overall, and I’m actually still very happy with the aesthetics. One of them has always had a rough spot or a divot, though. I can feel it with my tongue, but I have never been able to see anything wrong with it. I did mention it to the dentist who did the crowns and she smoothed it out some, but I’ve still noticed it over the years. It was close, but not quite perfect. Lately, it has been feeling different- much more rough,  and I can actually see a dark mark. I don’t know if it’s just attracting stains or what, but I don’t think I’ve changed my habits and I get regular cleanings. I’m a little concerned that it is failing and that I’m going to be out on a business trip and the whole thing will crumble. Is this urgent enough to warrant a trip to the emergency dentist? Should I have the crown redone now or am I worrying about nothing?

Hank B. – Kansas

Dear Hank,

This may not necessitate a trip to the emergency dentist,  but it is something you should get checked out in the near future. It’s common for crowns (and natural teeth) to have some defects, but it sounds like yours has changed. It’s possible it has cracked.

If that’s the case, you would notice that it’s picking up stains as well. If it’s cracked, it will eventually break. There’s no way to predict exactly when that will happen.

Rather than letting it turn into a trip to the emergency dentist, especially if you’re an avid traveler, you should find a dentist who is skilled at cosmetic work in the very near future and have him examine it.

Depending on the age of the crown, it might be time to start thinking about replacing them all. Don’t be surprised if the dentist mentions this. However, the only reason to update the others is age or wear and tear. If the dentist suggests switching them all out so he can make them all match, that’s a sign that you’re not working with a skilled cosmetic dentist. You should be able to have just that one replaced and have it blend naturally, without having the others redone, too. Best of luck to you.

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