She lets me look in her mouth occasionally. I can see four teeth on the top that have cavities, and two of them look really deep. I don’t see anything really worrisome on the bottom teeth yet, but have not had a really good look at those in a while. The two teeth on top that are really bad have started to chip away, and that brings me to my second question–can anything be done to salvage those teeth? From the reading I have done, I know that if those teeth are pulled, it could mess up the alignment of her teeth permanently, even though they are baby teeth. I’ve been reading about porcelain crowns and white fillings, and both of those sound like good options, if they will work with really damaged teeth. I don’t want her to feel self conscious if we have to do some kind of metal filling or crown.

I know you can’t make a definitive diagnosis just from my descriptions, but any information you can offer would be great.

Thanks,

Doreen in Tallahassee

Dear Doreen,

We recommend locating a pediatric dentist that has experience with sedation dentistry. That way, if your daughter can’t be persuaded to open her mouth, you can have a “Plan B” in place to get her the dental care she needs.

You are absolutely right that the best course of action would be to salvage those decayed teeth. If they cannot be saved, she will need some kind of space maintainers so her permanent molars do not drift forward, which would be expensive to fix down the road. Because these are baby teeth, your dentist will recommend a temporary fix kind of solution, such as a stainless steel crown. This will not look nice, as you point out, but if you are willing to pay for a porcelain crown that will only last a few years, your dentist will certainly place it. If the decay is not too widespread, your dentist might also be able to use white fillings or direct dental bonding to protect the remaining tooth structure. The best advice I can give you in this matter is to listen carefully to what the dentist recommends, and make your decision from the options presented. It is usually a bad idea to push a dentist into doing a treatment that they don’t feel comfortable with.

Another matter that must be addressed is how your daughter’s teeth wound up with this level of decay. The kind of decay you describe has to be fed continuously, all day, every day. Unless you want to face this situation again and again, you’ll need to change the way your daughter eats. She should only eat every three or four hours, and she should be brushing or at least rinsing with water every single time she eats.

Is this standard procedure in cases like this? I’ve never heard of having to wait this long to get a tooth fixed, and want to try and find a different dentist. We were able to save the piece of the tooth that broke off, and it seems to me that we should have that put back in place as soon as possible.  My husband wants to wait like our dentist says, but is open to a second opinion. What should we do?

Shannon in Missouri

Dear Shannon,

There is no medical reason to wait. And yes, you should have that piece of her tooth put back in place as soon as you can. You should seek the services of an expert cosmetic dentist to complete these procedures. This is a challenging situation cosmetically, and you want both teeth to look good and to match each other.

You don’t say how old your daughter is, and that will help determine her treatment. If she is younger, the dentist may use dental bonding until her teeth are fully erupted. If she is older, he may chose to use dental crowns to protect the remaining tooth structure.

She is pretty vocal about being embarassed by her teeth, and we’re trying to do what we can now so this does not have a lasting effect on her self-esteem. She will need braces in another year or two, as soon as her 12 year molars come in, to correct issues from years of sucking on her fingers. I was just hoping there was some kind of teeth whitening treatment that is safe for kids that would at least correct part of the problem now. Our family dentist kind of blew me off when I asked about this, saying that there is not really anything we can or should do until after the braces have been done and are removed. That is years away! Is there anything you can suggest that would help right now?

Thanks for your help,

Theresa

Dear Theresa,

Though your dentist may not have communicated it as tactfully as he should have, in a way he is correct–there are not any teeth whitening products that will correct fluorosis stains. If the yellow staining on her bottom teeth is uniform, you may be looking at a different cause for the discoloration, and that may respond to teeth whitening  procedures. The only way to really deal with severe fluorosis stains is to cover the teeth with porcelain veneers. While there is no minimum age for porcelain veneers (or teeth whitening), make very sure the dentist you choose to do the procedure is knowlegable about working with children, and takes into consideration the degree of present and future tooth eruption.

Fluorosis stains are caused by the consumption of too much fluoride when the teeth are still forming. Sometimes this happens because of too-high levels of fluoride in the drinking water, or by the over-use of unnecessary fluroide supplements. It is also not uncommon to see fluorosis in children who routinely swallow over-large amounts of fluoridated toothpaste. As a reminder, children should only use a pea-sized amount of toothpaste, and should be taught NOT to swallow their toothpaste. If a child is too young to understand that they must spit after brushing, special toothpaste can be purchased that does not contain fluoride.

In the case of your daughter, you should consult with an expert cosmetic dentist who does both porcelain veneers and Invisalign braces. In some cases, porcelain veneers act as “instant orthodontics”, and can be a method of dealing with crooked teeth. It all depends on the extent of the orthodontic work required, and if you consult with a cosmetic dentist that is an expert in both areas, he can offer the best advice on the best course of treatment to give your daughter a beautiful smile.

Thanks,

Tim in Greenfield

Dear Tim,

Though I am not intimately familiar with every dental insurance policy out there, I can with some authority say that you are not going to find a company that will pay for implants. If you consider it from a business perspective, it makes sense. They could not sell you a policy and then immediately pay for treatment that far exceeds the cost of the policy, not and hope to stay solvent.

Dental insurance works best when it is sold to an employer, who then provides dental insurance as a benefit of employment, paid with pre-tax dollars. However, even if you had dental insurance through an employer, they would almost certainly not pay for dental implants. Insurance will cover the cost of the cheapest treatment, and dental implants are not cheap. Finally, most policies include a cap of $500 to $1000 per year, which does not make much of a dent in the cost of extensive restorative dentistry.

The sad thing is, most people do not realize that dentures may not be a permanent solution. The bone at the site of a lost tooth begins to be reabsorbed into the body almost immediately. If ALL of your teeth are missing, you can suffer from a condition called facial collapse. The bone of your jaw deteriorates so badly that your face seems to “fold in” on itself, and wearing dentures can become incredibly uncomfortable or even impossible. In some cases, even dental implants aren’t the immediate solution – the patient must have bone grafts before any implant root forms can be placed. As you might imagine, surgery of this type can be intensely demanding, both physically and financially.

Dental implants stop the reabsorption of the bone, and help you maintain good oral health. If you are simply unable to finance the full set of implants, your dentist may suggest mini-implants, which are small implant root forms used to “anchor” a full denture in place. Not all implant dentists will do this procedure, so you would need to locate a skilled, educated dentist who provides the full range of dental implant services.

Good luck to you.

I recently graduated from college, and am starting to interview for my first professional position. I feel like my teeth are really holding me back. They create an impression that I am careless, and I am any but that!

Under the care of my dentist, I have tried every kind of over-the-counter whitening product there is. This just seems to be making the situation worse. The teeth around the spots get whiter, but that makes the spots themselves look even darker. At my last visit, I told my dentist that I am really frustrated with our lack of progress, and he suggested what he called “an experiment”, where he would grind away the front of my tooth to remove the discoloration. The only thing is, he doesn’t know how much he might have to grind off! I have an appointment, but the more I think about this plan the worse it sounds.

Does this sound like a normal course of treatment? We’ve never tried professional whitening with the laser–would that be better?

I could really use some advice. Thanks in advance.

Vanessa in Shreveport

Dear Vanessa,

Do not keep that appointment to let your dentist conduct his “experiment”. He does not seem to understand whitening, and his attempts to manually remove the stains could do a great deal of damage to your teeth. It is also very unlikely that professional whitening will produce any better results than the over-the-counter products.

I strongly recommend that you find a skilled, trained cosmetic dentist to help you determine the best course of treatment. Depending on the type and severity of the stains on your teeth, there is a small chance that a procedure called microabrasion could work to remove the stains. Generally, only the most superficial brown stains can be removed with microabrasion, but it is a possibility worth discussing with a qualified, experienced cosmetic dentist.

You are likely looking at porcelain veneers or direct dental bonding to address the issue. Both of these procedures are beyond the skill sets of most dentists, so it is very important for you to chose the right dentist to help you.

Best of luck to you in your new profession.

What kind of filling should I get to replace the white ones. The white fillings just don’t seem to work for me, but my current dentist doesn’t even do the old-fashioned silver ones anymore. Should I find a different dentist?

Julia in Chappell, Nebraska

Dear Julia,

The white fillings are not the problem – the issue is the faulty technique that was used to place them.

White composite fillings are more challenging to place than silver amalgam fillings (also called mercury fillings), it is true. Very strict protocols must be adhered to, and the area where the filling is being placed must be kept absolutely isolated from saliva. If this had all been done properly when your original fillings were placed, you would not have had any problems.

Silver amalgam fillings are easier to place, but there is a reason many dentists no longer place them. The material used in the amalgam material is more than 50% mercury by weight. A great deal of controversy currently surrounds the use of amalgam fillings, as the current research is inconclusive as to whether or not the mercury in them is potentially harmful to the body. Many dentists have decided to err on the side of caution and simply place white filling instead.

Health and safety issues aside, white fillings quite simply look a great deal more attractive than dark, ugly amalgam. Less of the tooth needs to be removed for white fillings than with amalgams, and the material itself bonds with your tooth, making the entire structure stronger and more stable over time.

The key to success with white fillings is to make absolutely sure that the doctor placing them knows what he or she is doing. Placing white fillings is an exacting procedure, and requires specific training. Ask your dentist about this, and make sure you are comfortable with the answer. If your dentist ONLY does white fillings, then very likely they are both well trained and skilled in their placement. But do check, just the same.

If you do feel uncomfortable with your dentist’s skill set for this procedure, I would suggest finding a new dentist, since your current one does not do amalgam fillings, which leaves you no options.

Good luck.

I don’t have dental insurance, and it is really expensive! Do I really have to replace that tooth? How long do I have to decide? I am only 45, and all my other teeth are in pretty good shape.

Brad in Mesa, AZ

Dear Brad,

Unfortunately, even if you had dental insurance, you would likely have to pay for the cost of the dental implant out of pocket. Most dental insurance plans do not cover the cost of dental implants, even when they are the recommended course of treatment.

You definitely should get the tooth replaced, and the sooner the better. When a tooth is removed, it takes just a few weeks for the surrounding teeth to begin to shift towards the resulting gap. The tooth in the opposite jaw that used to line up with the now-missing tooth (the “opposing” tooth) will “super-erupt”, or grow to try and meet with the other tooth that is now absent. All of this shifting around is the body’s natural response to the missing tooth. Your teeth will shift to meet when you bite, and touch their neighbors. When there is a missing tooth, these movements will create problems with your bite alignment, which may lead to TMJ problems, including headaches.

The longer you let this situation continue, the more damage will be done, and the more costly it will be to correct.

A dental implant is the best choice to replace a missing tooth. You are too young to contemplate living with a missing tooth and the resulting problems with your remaining teeth.

If the socket is infected, you will have to wait for that to clear up to proceed with the implant procedure, but your dentist will be your guide in this. The root form will need several weeks to integrate with the bone before the replacement tooth can be placed, so in the meantime you should wear some kind of temporary “placeholder” such as a dental flipper.

Best of luck to you.

When I asked my dentist about the Zirconia crowns, he said that his practice will only do porcelain fused to metal crowns. I am not sure if this is just for me, or if he just won’t do them at all. When I chose this practice, I checked out all the dentists’ credentials, and it sure seems like at least one of them would have the training to do the all ceramic crowns. My dentist says that the Zirconia won’t last, because I sometimes grind my teeth and just can’t wear one of those night guard things.

And one more thing—is it normal to charge more for an anterior crown than a posterior crown? That seems odd to me. I could use some advice!

Thanks,

Elizabeth in Indianapolis, IN

Dear Elizabeth,

It sounds like you should get a second opinion.

You’ve done your homework well; Zirconia crowns are extremely strong would work very well for front teeth. They can also be made thinner than porcelain fused to metal crowns, which means that more of your natural teeth can be left intact when the crowns are placed, which in turn leaves your teeth stronger and more stable.

I suspect, just based on what you have told me, that your dentist may have impressive credentials, but may not have a true feeling for appearance related dentistry. Few cosmetic dentists would elect to place porcelain fused to metal crowns on the front teeth, if there were any other viable options. This is a very important point: If you do want all porcelain crowns, then you will need to find a different dentist. Most dentists will resist doing procedures they are not comfortable with, and the end result can be disastrous for the patient.

Another concern is your grinding, and resistance to the night guard. As you age, unchecked grinding can ultimately lead to your teeth snapping off at the gumline. I urge you to try again, possibly with a different appliance. And finally yes, it is fairly common for dentists to charge more for anterior crowns than posterior crowns.

Best of luck solving your dilemma.

Thanks for your help.

Theo in Indianapolis

Dear Theo,

 It sounds like you are in a bit of a tough spot. Many people do not know that when they get all their teeth extracted, the bone of their jaw is reabsorbed gradually by the body, causing the jawbone to shrink over time. Over 20 years, the jawbone may deteriorate so much that wearing conventional dentures is impossible. It sounds like you have reached this point, which may also mean that in addition to dental implants, you may need bone grafting to provide a stable base for the dental implant root forms, which will add to the expense of the procedure.

The bad news is that you are not going to find a dental insurance plan that will cover the cost of your dental implants. If you think about it logically, it would not make any sense for a dental insurance company to sell you a policy, then agree to pay out for a procedure worth many, many times the cost of the policy. They would not stay in business long that way!

The best dental insurance plans are almost always available through an employer, and even those do not like to pay out for dental implants. As a general rule, most dental insurance plans will pay for the least expensive treatment, which in your case is dentures. Sadly, the insurance company does not really care if the treatment will work well for you or not.

Talk to your dentist about less expensive alternatives, or ask what kinds of financing he has available. Best of luck to you.

After the procedure, there is still a gap in my teeth, and I can actually see places where the bonding material is easily distinguishable from the natural structure of my teeth. This is not at all what the examples I saw on the web looked like! I need to find a new dentist, but first I need to know if they can take off what was done or not.

Thanks for your help,

Kyra in East Lansing

Dear Kyra,

Good news – tooth bonding is reversible. A special sandpaper can be used to remove the bonding material and restore your teeth to their previous state. Any dentist would have this sandpaper available, and the procedure is not difficult or painful.

I would strongly recommend going to an expert cosmetic dentist when you are ready to have this procedure re-done. It is likely that dental bonding will work very well for you to fix the gap and chip, but freehand dental bonding is an extremely challenging dental procedure.

If dental bonding is done by an artistic, skilled individual, the results can be really beautiful, and completely undetectable. You are absolutely right that you should not in any way be able to see where your natural teeth end and the bonding material begins.