Donna,
Don’t, please don’t look for the cheapest cosmetic dentistry available. You don’t want that. I can just see you getting this work done and then e-mailing me back in tears wondering how you can undo this work because it looks ugly.

You’d be a great candidate for a Snap-On Smile. This is the very least expensive way to get a new smile. It only lasts about four years, but you could get it to last longer if you only used it when you were out in public.

It’s a simple procedure. The cosmetic dentist takes an impression of your teeth, and then the laboratory makes you a new smile out of a hardened acetyl resin. When you get it back from the lab, you literally snap it into place over your existing teeth. It gives you a beautiful, white smile.

The cost is going to be about $1000 for a full arch of teeth, which is about one-tenth of what porcelain veneers or Lumineers would cost. It would be about half that for just the six front teeth.

Paul,
If a tooth is infected and then it is extracted, your body almost always heals the infection by itself within a few days. The reason is that the source of the infection is gone, and your functioning antibodies and white blood cells can ordinarily take care of the infection. Because you have an open socket, the infection that before was trapped and festering now has easy drainage. An exception would be when a tooth is impacted and the gum has to be incised and maybe some bone removed to take it out.

So to answer your question, the gum may well be infected after an extraction, but it may not matter. Warning signs of trouble of an infection that isn’t healing would be post-operative pain that increases from one day to the next, swelling that keeps increasing after the second day, or pus draining from the area of the extraction. If you have any of these symptoms, you should call your dentist.

Links: read more about tooth extractions.

Thank you in advance.
- Russell from Texas

Dear Russell,
There should be a reason for removing wisdom teeth, besides just that they’re wisdom teeth.

It sounds like your wisdom teeth were all normally erupted, and not impacted. Impacted wisdom teeth should be removed as early as possible – like by age 25 is best, because the potential for later complications with them is a significant risk.

There can, however, be problems with wisdom teeth that have erupted normally. They can be difficult to restore, so if they need extensive work, it may be advisable to have them out. They can complicate your home care by making your second molars more difficult to keep clean. In your case, if the upper wisdom teeth have been removed, the lower wisdom teeth could tend to super-erupt and end up hitting the gums of your upper jaw. If any of these are problems in your mouth, then it may be justified to have them extracted now.

All of these issues are matters that have to be sorted out by looking at your mouth. Its a judgement call, and I would just refer you to the opinion of your own dentist on that.

Please, let me know if you can help me or know of someone who might. I will be forever grateful. 

Thank you,
Katie from Michigan

Katie,
I don’t have any special resources or a dentist near you that I could refer you to, but I may have some suggestions.

I don’t know exactly what you need, but judging from what you seem to be telling me, it seems to me that you should be able to phase your treatment somehow in such a way as to make your dentistry affordable.

When you have a lot of decay, broken-down teeth, and teeth that need to be extracted, here is a way that can sometimes be done to try to fit this into a do-able budget.

First, the dentist can go in and remove all the decay, just filling the decay as economically as possible. If the tooth needs a crown, the crown can wait, and the dentist can just do the buildup. If necessary, temporary fillings can be placed, just to eliminate the decay. Glass ionomer filling material is fairly easy to place, it has a moderate bond with the tooth, and it releases fluoride. It isn’t a long-lasting filling material, but it’s a great base or a buildup for a crown, it’s relatively inexpensive to place, and it releases small amounts of fluoride to help guard against further decay.

The second step would be to take out any hopeless teeth. For teeth replacements, if you can’t afford implants or bridges, there is a less expensive option. A removable partial will save quite a bit of money.

If your dentist is unwilling to discuss these options with you, I would call around and find a dentist who will work with you. Just explain when you call that you need a lot of work and want to phase your treatment so you can afford it, and ask if the dentist is willing to do that. Some dentists will let you come in and ask questions without charging a consultation fee.
I hope this is helpful.

Thank you.
Orbatos from Japan

Orbatos,
There are two reasons that dentists don’t generally do root canal treatments on wisdom teeth. The first is that these teeth aren’t really very useful.

The second is that the roots are generally very difficult to treat with root canal treatments. They tend to be very curved, and access is very difficult.

With any root canal treatment, there is a chance of root canal failure. On a wisdom tooth, those chances for failure will be the highest of any tooth, and the cost of the treatment will be the highest of any tooth.

Generally, most dentists wouldn’t recommend going though any extraordinary means to save a wisdom tooth unless you are missing the adjacent tooth and this tooth is needed as an anchor for a replacement tooth.

I have had consults with 2 dentists and they were quite different. Dentist #1 insists that I need crown build ups for #9 & #10 because of the root canals and that possibly some of the other 4 may need build ups as well. Dentist #2 does not think build ups will be needed. They also differ in price, while I am not trying to be cheap I do not want to be taken either. I saw dentist #1 twice and he had to revise my ‘treatment plan’ cost because he left out a fee the first time. It was an $1800 fee for ‘customization’ — dentist #2 does not charge this fee. It that a common fee to have, I am suspicious of it because on the first visit he did not mention it, it was not until visit #2 when he realized I wanted to maybe round out the edges of my teeth that there was suddenly a fee. Dentist #2 suggested the rounding of the edges. Dentist #1 uses empress c! rowns, dentist #2 lets the lab pick the material based on my molds. De ntist #1 is much more expensive than #2 mainly because of the customization fee. So, I guess my questions are as follows: 1. what fees are standard for crowns (crown, crown build up, diagnostic cast) 2. should the dentist decide the material (empress, procera, etc) or the lab 3. does it matter what lab is used? #1 uses Williams Dental Lab in CA, while #2 uses Georgia Dental Labs) 4. On teeth that are already crowned is it typical to need to do a crown build up on them? 5. Is a customization fee normal? Thank you.
- Mitch from Georgia

Mitch,
There isn’t enough information for me to tell you if either of these dentists will do good work for you, but I’m getting negative vibes about both of them. The “customization” fee of dentist #1 really bothers me, because to me, every case where there are six crowns on the six front teeth should be customized. This after all is your smile and your personality. Was dentist #1 really thinking of just giving you a “one-size-fits-all” smile until you wanted to bring some personality into it?

A question you didn’t address is whether or not the appearance of this work matters to you. If you just want the teeth protected and it doesn’t matter if your smile looks real or fake, then I think you’re on the right track. But if you want this to look lifelike, then I think you need to seek out an expert cosmetic dentist. And I suspect that neither one of these dentists is an artist. Only about one out of every fifty dentists is. And once you’re in the hands of a dentist who is passionate about creating a beautiful smile for you,  he or she will start by asking questions about the kind of personality you want to project with your smile and exactly what customizations you will want – before they even start.

A real cosmetic dentist will insist on doing all-porcelain crowns on these teeth. Empress is one brand of all-porcelain. I’m not impressed with dentist #2 letting the lab choose the material for these six crowns. The choice of material can make a big difference in how the result looks, and there are different preparation requirements for different materials. The material needs to be chosen before you start. A good cosmetic dentist will have a definite opinion about what material works best in their hands and gives the most beautiful result for a particular case.

About the buildups – if they are needed, then you should go with the dentist who recommends them. If they aren’t then that isn’t necessary. I don’t know what to tell you on that one. For natural-looking all-porcelain crowns on these front teeth, it would be common to have a translucent or white fiberglass post and buildup in each of these teeth, if one hasn’t been done. And I can’t tell the quality of the dentist from the laboratory. Different dentists can use the same lab and get very different results. The lab will try to meet the dentist’s standards. An excellent cosmetic dentist does need an excellent cosmetic dental laboratory technician to produce beautiful results.

I hope this is helpful.

Barbara,
Do you think you could buy fire insurance for your home AFTER your home has burned down? No company is going to sell you a dental insurance plan when they can predict ahead of time that they will pay out more than you pay in. Would you do that if you owned the insurance company?

The way dental insurance works is that your employer pays the insurance company. They pay enough to compensate the insurance company for all the benefits they pay out, plus a little profit margin. The employer then works that into a budget, and they base that budget on the average cost for each employee. What causes it to make sense is that when the employer pays for it, it’s paid with before-tax dollars. If they didn’t pay the insurance company, they would pay that to you, but you would get taxed on that amount. That’s where the money savings is for you. And for every one of these dental insurance plans, they place strict limits on the dollar amount of benefits that they will pay in any one year. $50,000 is way more than any dental insurance I have heard of. Annual benefits range from $500 to $2000 per year.

Related links:
Read about how we provide affordable dentistry in Cleveland.

Carrie,
You can have an infected tooth and it doesn’t hurt. If the pulp of the tooth is dead, it can be infected, but since the nerve is dead, you won’t feel it. And you will have infection spilling out into the bone (which is probably what your dentist saw on the x-ray), but your body walls it off, and it really doesn’t hurt. But then when the dentist goes in to clean that out and seal the tooth, that can upset the equilibrium and cause a temporary flare-up like you are experiencing. Usually the flare-up heals within a few days. Reducing the occlusion so you don’t hit the tooth when you bite together is a helpful move. So the fact that this tooth hurt so badly after your root canal treatment doesn’t mean the dentist did something wrong. I’m guessing it will probably settle down in a few days. Then, when you go back in 6 months for a regular checkup, you should have this tooth x-rayed. If the bone has healed in that time, that indicates that the root canal treatment was a success.

As far as whether or not it needs a crown afterwards, your tooth #7 is your upper right lateral incisor, which is one of your four front teeth. For a front tooth it isn’t always that necessary to get a crown, unless there was a large cavity in the tooth. There is an interesting blog post about front teeth, root canals, and crowns. On that post, it says that if you don’t get a crown, you want to be sure that the dentist cleans out all the root canal filling materials from the crown of the tooth, which is the part that shows that isn’t the root. Old gutta percha and sealer cement will cause the tooth to quickly darken and be ugly, so that needs to be cleaned out. A lot of dentists don’t realize that. And then a flexible fiber post placed inside the tooth could be helpful to strengthen the tooth against breaking off.

Dr. Hall

Colette,
If you see 1/3 of a tooth gone, the decay is usually considerably more extensive than that.

When children that young have that many large cavities, it can be because of their eating patterns. Does she have frequent snacks all day long? Extensive tooth decay requires frequent feeding. Food passes through the mouth, and a meal will cause the activity of tooth decay bacteria for about twenty minutes. For that much decay, it requires feeding all day long.

For right now, you need to get her the dental care she needs. Your daughter may end up requiring sedation to get this work done. But get it done. If she loses these baby molars and nothing is done, her permanent molars will drift forward and block out her other permanent teeth, and her mouth will end up being a mess with teeth pointed in all directions because of the crowding that will happen.

Then, for the long term, I would try to encourage better eating patterns. These can be tough habits to break, but I would encourage you to tackle this. You may have to let her go hungry for two or three hours in order for her to build up enough appetite for a meal. Somehow you have to get her out of this pattern of constant snacking. It’s not only bad for her teeth, but snack foods are also not very nutritious, so this will help her in several ways.

Links:
Cleveland pediatric dentist.

Mike,
There is nothing wrong if there is bone poking through your gum after your tooth extraction, unless it’s causing some pain.

What happens after a tooth is extracted is that the bone that is left may have sharp edges because of the hole in the bone that is created. As your gum shrinks around that bone, the sharp edges can be left exposed. In time, your body remodels this bone and smooths everything over.

If it is too irritating to you, you can have your dentist smooth out the bone. That’s an easy procedure that doesn’t require novocain because there are no nerve endings in that bone. If it’s accessible to you, you could smooth it off yourself with a nail file.

Other links:
Read about Dr. Hylan’s Cleveland emergency dentist policy.