Does this crown problem sound like a dental emergency?

I have had porcelain crowns on the teeth that show when I smile for years. They are right up front and I have been quite happy with how they look. But, my tongue cannot seem to leave one of them alone. The best way to describe it is that there has always been a divot and I constantly am messing with it. I don’t think there has ever been anything wrong. Then, the last several weeks, I’ve noticed what looks like a dark section on it and it feels a lot more rough. I have always been one that keeps up with regular cleanings, but I am becoming concerned that this is a more serious problem. Do you think I need to schedule an emergency dentist appointment to get it checked out or re-done?

-Beck in Virginia


Typically, an emergency dentist appointment is warranted if you are in pain or have some sort of urgent dental need. It doesn’t sound like it is causing you discomfort. Yet, it does sound like it is becoming annoying. So, it would be wise to give your dentist a call to explain what is happening with the porcelain crown. It’s not uncommon for a crown to have an imperfection. But what is alarming is the fact that it has changed over time. It is possible the divot is now picking up stains, which is causing the discoloration that you have described. Or it could be that the integrity of the crown is weakening from this flaw.

It may not require immediate replacement, but your dentist may decide to have that one porcelain crown that is bothering you replaced. It all depends on the condition and age of the restoration. Since it is in such a highly visible area, you may want to consider seeing a cosmetic dentist. If the dentist suggests redoing all the crowns so they match, that is a signal that they may not have the necessary cosmetic dentistry experience to make them look beautiful. So, take note of that cue. The only reason the other crowns should be replaced is if they are showing ware.

Thank you for your question.

This post is sponsored by Cleveland dentist Hylan Dental Care.

Will all-on-4 work for me?

I have been trying to figure out what to do because I’m fed up with my dentures. In my research so far, I am intrigued by the all-on-4 dental implants procedure, for many reasons. I understand that it will help stabilize my dentures and it’s a lot more affordable than a mouth full of dental implants. But I have one huge setback. I have a metal allergy. When I mentioned this to the dentist, he didn’t even flinch. He said it was not a big deal. I am still not sure about it. I will suffer greatly if come in contact with metal of any kind. I don’t want to go through the investment and inconvenience of the procedure failing. I typically break out into a terrible rash. How do I know he is right? Do I just take his word for it?

-Dolores in Missouri


Your implant dentist is correct in that the all-on-4 dental implants should be fine. Most “metal allergies” are actually sensitivities. Now, of course, anything is possible, so continue asking questions until you are completely confident in the dentist’s understanding of your individual situation. But most people with sensitivities don’t typically react to all metals. For example, nickel is a big one to steer clear of. Also, any triggers that you may react to must be avoided. So be clear on precisely what metals may set you off.

Titanium or a titanium alloy is what you need to be comfortable with, since it what is most commonly used in dental implants. It is possible that the alloy contains some nickel. Your dentist will be able to give you the complete rundown of the composition of his recommended implants. It will be available through the manufacturer.

If you still are not comfortable that you will not react to titanium, it would be in your best interest to meet with an allergist to get a full diagnosis. You will be able to find out what your triggers are and what to steer clear of, so you can provide that information to your implant dentist. Good luck!

This post is sponsored by Cleveland dentist Hylan Dental Care.

Jaw is killing me after my dentist was not gentle.

I recently had fillings done and the doctor who did it was not a gentle dentist at all. I don’t normally have jaw pain, but today, 24 hours after treatment my whole jaw is in agony. It hurts to even open my mouth to talk. The shot he gave me hurt and I can still feel something like a bruise back there where he did it. I also have pain in my jaw joint. He was pretty rough during the filling. He made me keep my mouth open forever and he kept pressing on my lower jaw throughout. By the end of it, it was hurting, but then he started to “finish” the filling and he literally shook my whole head with the force. He said it was because my cavity was between my teeth, too, and that he had to get in there to smooth it out. He just kept going back in and telling me to hold still, but I couldn’t. He was pulling on me that hard. I’d call them to find out what to do, but I don’t want to get called back in. I don’t want to see him again. How can I treat the pain at home?


Glenn in Nevada

Dear Glenn,

It sounds like he wasn’t a gentle dentist at all. You’re dealing with two different “injury” types. In all fairness, some people have pain from an injection for a couple of days, no matter how careful the doctor is, but there are ways to administer one to minimize it. For instance, entering the tissue slow certainly helps, as does administering the medication very gradually. Afterward, this kind of discomfort is usually quieted by cold. You can drink some cold water with a straw and let it rest in the area or have a Popsicle. Within a day or so, it should feel better.

The jaw joint pain is different. This usually comes about when the muscles and tissues are inflamed. The trick is to get the inflammation to go down so it can rest again. Take ibuprofen or another an anti-inflammatory medication and use warm compresses to soothe it. You’ll also want to be very gentle on your jaw until it feels better, so go for soft foods and use a straw to drink. If these remedies don’t settle it down within a week or the pain gets worse, contact another dental office or see your primary care physician. It’s not likely any permanent damage was done, but a prescription medication might be necessary to calm the inflammation. Next time around, you may want to do some research to find a gentle dentist in your area.

This post is sponsored by Cleveland dentist Hylan Dental Care.

Clear Choice is the cheapest estimate. Is this a red flag?

I went into Clear Choice and they dropped their price $30,000 after hearing I was on a fixed income. As amazing as this sounds, I have to wonder if I should beware. This price is literally half price when compared to all the other implant dentists that I have consulted with. I’m only in my sixties and my teeth are deteriorating.

-Phillip in North Carolina


It sounds like you have done a good job of exploring your options and seeking several opinions on your case. The main Clear Choice complaints revolve around the sales tactics used. Generally speaking, the doctors are qualified and will take care of you. So if feel a level of trust and have done your research, that is a huge cost savings.

That said, you need to ensure that all of these implant dentists are pricing the same services. There is such a large variance in treatment plans and philosophies when it comes to replacing teeth. Clear Choice has the reputation of removing all your remaining teeth and placing all-on-4’s. Is that what they are recommending for you? You do have a right to be suspicious with such a drastic drop in fees. Either they were overselling to begin with or they may have changed the treatment plan. If you have any doubt or concern, it’s likely for a reason. So, it can’t hurt to take their estimate and go back to the other implant dentists you’ve seen previously to see if they can compare in fees with this most recent treatment plan.

The big discrepancy here is whether or not, all of these quotes are planning to extract the remaining teeth or not. Have you expressed that you would like all your teeth removed since they are already falling apart? I think you will have a better handle on your options after ensuring that you are indeed comparing apples to apples.

Thank you for your question.

This post is sponsored by Cleveland dentist Hylan Dental Care.

My mom is freaking out because she had another tooth fall out.

I don’t know what to do for my mother. She has always liked the way she looked and as she gets older, things have changed. Now, she’s having issues with her teeth, which is really freaking her out. She has had a partial denture for a couple missing teeth and another one fell out near that location. Then, in a completely different area of her mouth, another one just fell out last night. Obviously her oral health is slipping, so we aren’t sure if a bridge will cut it. Budget is also an issue. Any pointers or advice so I can help calm her down and put her mind at ease?

-Whitney in Indiana


Of course, it is difficult to give specific recommendations without having seen your mother in person. That said, when teeth begin to fall out, it is a symptom of advanced gum disease.

So, if that is indeed what is happening for your mother, a dental bridge will not be the ideal treatment plan because it isn’t likely that she really has any solid teeth left that would be able to support this type of treatment.

If budget weren’t an issue, dental implants would absolutely be the treatment recommendation. Dental implants are the standard of care to replace missing teeth because they function like natural teeth and are lifelike. They prevent bone loss around the implant site and are a permanent solution. But, a full mouth restoration with dental implants would cost tens of thousands of dollars.

At this point, keeping in mind that there are budgetary constraints, your mother may better candidate for complete dentures. This would entail extracting the remaining teeth. The major downside of this plan is that when the teeth are gone, bone loss will occur. If you’ve seen images of elderly with sunken in faces, that is what would end up happening to her as the years go by. The condition is known as facial collapse and if she’s concerned about her appearance, she will not like that. Although, depending on her age, it still may be the best option for her.

If she’s not ready to go to the extreme of having all of the remaining teeth extracted, there is another type of partial denture called a Cu-Sil partial. This type of appliance is similar to a complete denture, but it allows the natural teeth to poke through and they help secure it in place. It will provide more stability than a complete removable denture. But if she truly does have advanced gum disease, it may not be the right fit.  Although, as other teeth fall out, the Cu-Sil partial can accommodate the occurrence with an artificial tooth replacement onto the appliance.

Hopefully this information was helpful. It would be wise to meet with a couple different dentists to obtain multiple treatment plans. Good luck!

This post is sponsored by Cleveland dentist Hylan Dental Care.

Does this sounds like the correct diagnosis?

I’m really disappointed after seeing the emergency dentist yesterday. I knew I was neglecting a filling. It was diagnosed about a year ago. I mentioned it to them when I called, but I also told them that I thought it was the tooth next to it that was bothering me. I assumed they were going to do the fillings and that the emergency dentist allowed enough time for them, because I told them at least part of what was wrong on the phone. I went in for the visit and he ran a couple of “tests,” which basically amounted to him hitting the teeth with his mirror a few times. News flash. It hurt. My teeth hurt before I went in. Duh. Anyway, he then tells me that I need a filling, but not on the tooth that I already knew needed a filling, so I asked about the one with a cavity and he looked again and said I was right. He then says that I need to come back and have the fillings done. Well, I’m still in pain and the emergency dentist did nothing. I can’t help but wonder if he was in a hurry since it was the end of the day and, if he was in a hurry, could he have missed an infection?

-Jeff in Texas

Dear Jeff,

Infections are usually obvious. If you had x-rays and an exam, it would be very difficult to miss. Cavities can cause some pretty strong tooth pain, especially if they are deep. It doesn’t necesarily mean that there is an infection or that the teeth need root canals.

As far as the tests go, the emergency dentist was probably trying to ascertain which teeth were bothering you the most, so that he could give you a treatment plan and tell you how to move forward. Sometimes teeth refer pain to their neighbors or teeth can be cracked and cause pain. That isn’t always obvious, even with a visual exam and x-rays.  The tests are an unfortunate, yet important, part of being diligent.

It’s concerning that the second cavity was missed until you said something, though. This does suggest that he was hurried and certainly makes it understandable that you’d question the diagnosis. The best way to go forward is to have those fillings done as soon as possible, perhaps by a different dentist. Bear in mind, doctors don’t always allow time for the work to be done when they haven’t done an exam, simply because they don’t know how much time to set aside or whether you’ll go through with having your teeth fixed. If you schedule with someone else, try to take an appointment earlier in the day and let them know that you just had the teeth diagnosed and what the recommended treatment is. Then, ask if they will consider setting aside time for the repairs. Best of luck to you.

This post is sponsored by Cleveland dentist Hylan Dental Care.

What is the best way to fix teeth that have broken off?

I am wondering what the options are for my mother. Her two front teeth are broken. The roots are still in her gums. Are a dental bridge or partial denture her only choices? Or would it be a possibility to get root canals topped with crowns?

– Sherri in California


It is difficult to make specific recommendations for your mother, without having seen her case in person. Generally speaking, root canals are possible. It all depends on exactly how much of her natural tooth structure is remaining. A post may be required with the root canal to support the porcelain crown that goes on top.

Many dentists will recommend dental implants to replace missing teeth, because they are a permanent solution. So, you may have to look around for a dentist that is interested in trying to save what’s left of those teeth. It would be wise to find an implant dentist in your area that is experienced in dealing with traumatized teeth. Discuss your interest in saving the roots and be prepared to talk through the possible treatment plans. Dental implants are now considered the standard of care in similar situations. Sometimes, a post may end up fracturing the root. Then, there will be additional issues. So, it may be in your best interest to see a couple different dentists and listen to their treatment plans.

A dental bridge or partial denture may also be options worth exploring. It all depends on your budget, the philosophy of the dentist, and your mother’s desired results. Sorry that the answer isn’t completely straightforward. With broken teeth, there are many factors to be considered.

Thank you for your question.

This post is sponsored by Cleveland dentist Hylan Dental Care.

Affordable Dental Implants Doctor Ruined My Smile

I saw an ad for affordable dental implants and the doctor seemed to check out with my online searches. My lower two front teeth were loose and had been for some time. It seemed to me they weren’t going to get better and implants were my only viable option, if I wanted something to function like my real teeth. I went in and got an estimate from the affordable dental implants doctor and he priced out the surgery and placement of the posts/implants, the abutments, and the crowns for two teeth. He also suggested that I get extractions done right then and there, as well as something called “bone beads” to help me heal, which insurance did not cover. After six months of healing and no teeth, I went back for the surgery and he said he couldn’t do it without more procedures. He says I still don’t have enough bone and that I need gum treatments. I’m not sure what to do at this point, but I’m starting to wonder if I should have had those teeth removed at all and the cost seems to keep rising. I still have no teeth. My smile is ruined! How should I proceed?

-Joshua in North Carolina

Dear Joshua,

There are a couple of warning bells that go off when reading your message about affordable dental implants. First off, it sounds like the reason your teeth were loose was never addressed. This is a huge concern. If it was due to periodontal disease, you wouldn’t have been a candidate for implants. That would have needed to have been brought under control first and would explain the need for additional “gum treatments” now. The doctor should have discussed this with you from the start. There’s no telling if the teeth that were extracted could have been saved now that they’re gone, though the lack of information given to you is a huge concern.

Going forward, you probably do need other treatments before you can undergo the surgery and have your dental implants last. It’s a good idea to consult with another dentist before you do anything else, just to make sure you’re getting the right treatments. There’s also no reason why you shouldn’t have been offered some form of temporary replacement teeth. It’s typical for an office to offer to create a flipper or partial denture, to prevent the other teeth from drifting, help maintain adequate space, for aesthetics, and so you can eat easier. This is still an option now. Book a consultation with another dentist or perhaps even two, to see where you stand.

This post is sponsored Cleveland dentist Hylan Dental Care

Can I Take Sleeping Pills Instead of Seeing Sedation Dentist?

I like the idea of seeing a sedation dentist. I have dental anxiety and I don’t want to really be aware of what’s happening. I just want to go in and have it done. The problem is, my regular doctor isn’t a sedation dentist. He won’t do it at all. Is it safe for me to just take my regular prescribed sleeping pills before I go in and let those work their magic?


Kelly in South Dakota

Dear Kelly,

A sedation dentist does more than just administer medication. Doctors that specialize in this kind of treatment have extra training. They’re well-versed in potential interactions and know what to do in the event of a dental emergency. They also have a keen understanding of how the medications they prescribe work, so they know what normal behavior on the medications is. On top of this, you are monitored the entire time you’re in the office of a sedation dentist. They’ll check your vitals and have someone with you the whole time, to make sure that you stay safe.

It is possible that your regular office will be ok with you taking some type of medication during your treatment, but you should have a discussion with your doctor about it well in advance. He’s going to need to make sure that you won’t have any interactions with other medications he gives you. The other concern is that the medicines you’ll normally receive in a dental office aren’t intended to put you to sleep. They make people so comfortable that they do sometimes doze off, but that’s not what they’re intended for. So, if you take a medication that totally puts you out and you can’t follow instructions or corporate with your treatment, there could be issues. On top of this, your doctor and his staff may not be getting regular emergency training because this is not part of their normal services.

The bottom line is that you may be allowed to take something prior to your visit, but a sleeping pill will probably get nixed. You need to ask this question of your dentist. Only he knows what he and his staff are capable of handling. However, your best bet is to seek out a sedation dentist to do the work, to ensure that you are as relaxed as possible during treatment and that your safety is looked out for properly.

This post is sponsored by Cleveland dentist Hylan Dental Care.

Feeling guilty about seeing a different dentist for affordable dental implants.

I have been very interested in getting dental implants to replace my missing teeth. But I keep putting them off because I cannot afford them. So, I have been looking all over trying to find more affordable dental implants than what my current dentist offers. I recently came across an implant dentist in a surrounding suburb that works with people that have budget issues and offers relatively affordable dental implants. Am I cheating on my regular dentist? I feel so bad about it. I don’t want him to refuse to treat me when he finds out I had the implants done elsewhere.

-Gene in Ohio


You are in no way solely obligated to receive every dental treatment from your current dentist, just because you have been seeing him for routine care. That said, just be sure the dentist across town that is offering affordable dental implants isn’t cutting corners and offering a substandard product.

Dental implant fees vary from one practice to another. But theoretically, most implant dentists rates will be fairly comparable. So if there is a huge difference in fees, you need to dig a little deeper and find out more about it. Affordable dental implants mean different things to different dentists, as well as different things to different patients. For example, you may not be comparing apples to apples. Your dentist may be pricing traditional dental implants and the new dentist may be quoting mini implants. Or the dental implant brand and products may be a factor in the discretion. Be sure that the affordable implant dentist isn’t getting parts from overseas or choosing less quality materials. Parts can vary by hundreds of dollars.

Ultimately, dental implants need to be done by a dentist that you trust. That is hands down the most important factor. If you get a good deal and then the dental implants fall out, become loose or get infected, it will end up costing you much more in the long run.

So, don’t feel bad. Just proceed with extreme caution.

This post is sponsored by Cleveland dentist Hylan Dental Care.