Margaret,
This is a situation that underscores the importance of having a trusting relationship with your dentist. There is no way for me to tell if these teeth need crowns or not. Teeth with old fillings can need crowns. It depends on how large the filling is and the kind of stress the tooth is under. And amalgam fillings weaken a tooth much more than composite fillings. But sometimes fillings will do just fine.

As dental students, we are taught guidelines in school. There is a certain width of a filling that weakens the tooth too much and makes it prone to fracture. Beyond this, there are judgment factors. Sometimes teeth with old fillings begin to show fracture lines starting to form, and this is a warning sign that makes placing a crown desirable.

While it’s not always true, dentists are generally honest people. This is fortunate, because your dentist will often tell you things that need to be fixed and there is no way for you to corroborate this, and your teeth feel fine. It is unwise to wait until a tooth hurts to have it fixed, because by then the treatment will always be complicated and expensive. So trust is very important here.

My advice is to look for signals about whether or not you can trust what you are being told. If a dentist seems too eager for you to begin treatment or uses pressure sales tactics, that’s a sign that you may not be getting the true picture of what you need. In your case, saying you need three crowns on three adjacent teeth is a little suspicious, but it may be true. If you have misgivings about what you’re being told, then go somewhere for a second opinion. But if you do that, be very sure you get a BLIND second opinion. It is too tempting for even good dentists to tell you what they think you want to hear so they can land you as a new patient. So give the dentist no clue about what the original dentist said, then compare notes.

Dr. Hall

Read about Los Angeles teeth whitening.

Penny,
If this crown is otherwise doing fine, Id keep it. Gold crowns, if they are done well, can last a long time. You appear to be learning that with this tooth. And it isn’t unusual, after twenty or more years, for parts of the chewing surface to wear through and need repair.

But I would agree with you that I would want the repair with composite filling material  rather than the silver-mercury amalgam. A complication with the amalgam is that you would end up with two dissimilar metals, silver-mercury and gold, touching each other. With the electrolytes in your saliva, this sets itself up like a little battery in your mouth, and the electrical current can accelerate the corrosion of the amalgam and makes it turn black quickly. 

There is a problem, though, in that the use of composite on the back teeth requires special techniques, especially where you are bonding to gold, and it’s unlikely that an amalgam dentist is familiar with these and also unlikely that he would actually admit any weakness in this area. So my recommendation is to either stick with this dentist and let him repair the tooth the way he wants, or find another dentist who does lots of posterior composites and knows metal-bonding techniques,  to do the repair for you.

he complication is that, if your dentist prefers using amalgam here, he is not one I would ask to do the composite repair. Dentists who know how to do the composite repair well almost universally prefer that technique. It is very risky to try to nudge a dentist out of his or her comfort zone. They will not want to reveal their discomfort with a procedure, and it’s a recipe for disaster. These composite fillings are very technique sensitive, and many dentists don’t know how to do them well.

Read about porcelain onlays.
Dr. Thein is a mercury-free dentist.
Dr. Azarbal of Pasadena is also a mercury-free dentist.

My question is, will the gum grow back once the tooth is removed? And once it does is a cosmetic dentist the best type of dentist to see to achieve the best look? Is there a way to place a bridge without destroying the two surrounding teeth?

Thank you so much for your help, this issue has caused me much anxiety.
Ariel from New Jersey

Ariel,
I’m guessing somewhat at what your clinical situation is. Since you don’t know the clinical terminology, it’s probably hard for you to describe what has happened and what you’ve been told. But let me try to be helpful.

Root canal failure happens sometimes, and when it does, sometimes the only option is to take the tooth out. But the gum doesn’t really “grow back” after the tooth extraction, it actually shrinks some because the body senses that the bone that used to support that tooth is no longer needed, and it takes those minerals to use elsewhere in the body, causing a sunken-in look.

You’re talking about tooth #7, which is your upper right lateral incisor, and you say you’re worried about how this will look. That suggests to me that you may have a high lip line where the gum shows when you smile. If that is the case, you need to be aware that if you have a bridge, this tooth #7 will look longer and the gum will look shorter. And yes, if you have a bridge, the adjacent teeth will need to be ground down some and crowns put on them. While this doesn’t destroy those teeth, it does compromise them.

The other option is that you can have a dental implant placed. A dental implant will stimulate the bone in this area and prevent your body from resorbing that bone and will help preserve the natural look of your gums. If your dentist hasn’t suggested this option, it could be that he or she is not comfortable with dental implant work and it may be wise to seek a second opinion.

A further point. If you have the bridge or if you have a dental implant, and the appearance of the gum is a big concern for you, it may be desirable to have some minor gum surgery to “plump up” the gum in this area so that it looks natural.

If you need a second opinion, I would strongly recommend finding an excellent cosmetic dentist. Yes, only a true cosmetic dentist would have the passion to create a beautiful result, and replacing a single front tooth is difficult to get to look natural, especially in a case like yours. The vast majority of dentists would not likely do a good job with this and would not get it to look natural.

Links: Read about how Dr. Thein tries to be the best LA cosmetic dentist.
He also provides sedation dentistry for his patients.

Mary,
I get frustrated with some in the dental profession who perpetuate this idea of “soft teeth” and who can’t seem to explain aggressive decay.

Aggressive tooth decay is almost always caused by too frequent eating. There are some disorders that aggravate decay, such as enamel hypoplasia, or cancer treatments that destroy the salivary glands, but those disorders are rare. To understand this better, there is an excellent page on tooth decay on the mynewsmile.com website that you can read.

So you have several things you can do to protect your teeth and keep you from losing them:
1. Minimize continual decay by limiting between-meal snacks to one or two a day.
2. Protect existing teeth with large fillings by doing crowns. Some dentists are reluctant to suggest crowns and subject patients to patchwork dentistry. But this is false economy and subjects your teeth to risk.
3. Have frequent checkups – certainly every six months. And if you have a tendency to be surprised by large cavities that only show up on the x-rays, then I would advise having more frequent x-rays. Don’t limit yourself to what your dental insurance covers – get the care you need.

I hope this is helpful.

Link: See our Los Angeles emergency dentist page.

Thanks
- Pam from Missouri

Pam,
If you have porcelain veneers and anything is moving, it is your teeth. If the porcelain veneers are bonded to your teeth, they will be tight and there can be no movement. If they are not bonded, they will fall off. There really can’t be any in-between for porcelain veneers.

Other links:
York, PA Invisalign by Dr. Currie

Serena
I would strongly recommend against getting bonding as a less expensive alternative to porcelain veneers. Do the teeth bleaching, and leave it at that. Bonding, if done right, will be almost as expensive as porcelain veneers, and it will last only about one-tenth as long. This makes it a very short-sighted alternative. Bleaching will get rid of the yellow color. They won’t return to their original yellow color, but your bleached teeth will tend to pick up more stains as time goes on. In that case, you just keep your bleaching trays and do a touch-up treatment every couple of years, and you will keep that nice white color for the rest of your life.

Other links:
Oklahoma City tooth whitening from Dr. Kari Bender

Mark,
It’s hard for me to tell, from a distance, what the problem is with your porcelain veneers, but I can help by giving some insights.
First, patients are not always aware of whether or not they grind their teeth at night. It may not necessarily be grinding, but could be nighttime clenching. Having said that, you can still have porcelain veneers with nighttime grinding, and the dentist can work around that, if they know what they are doing. Worst case scenario would be that you would need to wear a nightguard.

If that isn’t what is causing the problem, yes, it could be that your porcelain veneers simply aren’t bonded on properly. You say four teeth have broken. I don’t know if that means that the porcelain veneer has fallen off, or if the porcelain veneer has chipped or cracked, or if the actual tooth has broken. Usually, if it isn’t properly bonded, the entire porcelain veneer will fall off. Or it will crack and maybe half will come off. If the veneer has chipped and more than, say, 80% of it is still attached to the tooth, then it isn’t likely to be a bonding failure.

I hope this is helpful.

Recently, I have noticed my teeth are pretty yellow, and so I have been making changes. I floss my teeth, I brush my teeth, and I use mouth wash, I have also given up pop except on ocassions and I have tried to change my eating habits.

I have noticed though that between my teeth, and mostly between specific teeth, it is brown down along the sides, not all the way down, but it starts from the top of the tooth toward the gumline down to about a 3rd of the tooth, and so far it is just along the sides where my toothbrush cant get to. So, what does it all mean? Is it something really bad? Can I do anything about it on my own (not going to dentist cause I cant afford it!!!) If you can give me any information it would be greatly appreciated, and, tips on how to whiten my teeth, anything that you can tell me will be grateful but I have been really worried about these browning areas.
- Brandon from Washington

Brandon,

If money is a problem for you, I need to tell you something. Dental neglect is very expensive. If you haven’t been to the dentist for ten years and now you’re starting to see funny colors on your teeth, I would scrape together a couple of hundred dollars and get your teeth at least checked, small cavities filled, and getting them cleaned could also be helpful. I’m not sure what is wrong, without seeing it, but the brown areas could be decay, and that worries me.

Almost all dental problems start as simple, small cavities. When they are allowed to grow they become root canals, crowns, bridges, implants, and other very expensive things that cost thousands of dollars. You need to know what is happening to your teeth, before they start speaking to you.

Watching the pop drinking is good. Adding flossing to your routine is good. Mouthwash really won’t help any of your dental problems – it provides cosmetic help and may help your breath smell better. Limiting the frequency of eating is the best single preventive practice you can undertake to keep from getting cavities. Added to your brushing and flossing, that should keep you in good shape, and if you need to save money on dental care, you could maybe go every couple of years until you get into your thirties when gum disease starts to become a real threat.

Just a word to the hopefully wise.

Read about Los Angeles affordable dentistry.

Carlton,
Who told you that you can’t get porcelain veneers? I suspect it may have been a dentist who doesn’t really know much about veneers. I am skeptical of that advice. There are situations where porcelain veneers are contraindicated, but simple tooth sensitivity isn’t one of them.

Veneers can actually reduce sensitivity if they’re done right. If you can have dental bonding, you can have veneers. The difference is that bonding is made out of composite and veneers are made out of porcelain. The porcelain is much stronger, shinier, and it lasts many times longer than the composite. Especially if you are a heavy iced tea drinker. Bonding will absorb the stain from iced tea, but porcelain veneers are even more stain resistant than your natural teeth, IF they’re done right.