All posts by goodtooth

goodtooth writes blog posts on behalf of Dr. Brad Hylan

Will a Maryland bridge work for two teeth?

I have two teeth that will need to be treated. They are next to each outhr. I’ve been researching and have seen that a Maryland bridge is an option for a missing tooth. Will it work for two teeth, instead of just one?

-Jeff in Indiana

In some instances, a Maryland bridge will work for two teeth. But it will not work for more than that. That said, you still need to be careful in this case because of the extra stressed placed on the bridge. It would be most appropriate for two teeth on the bottom that are small in size.

When considering a dental bridge, the force and stress exerted to it is important to factor in. The vertical force doubles when there is more than one tooth on a bridge.

Additionally, there is another factor that should be taken into account, as well. The bridge will flex more when there is an additional false tooth it is supporting. The longer the span of the restoration, the more it will flex, which in turn stresses the abutments.

Typically, a Maryland bridge is bonded to the inside of a tooth. And even with only one tooth, some dentists feel that you’d be taking a chance with the Maryland bridge.

So, use this information when you consult with your dentist. Try not to feel pressured and be sure to explore all the acceptable options that may work for your specific situation and budgetary constraints. You may also be interested in evaluating the pros and cons of a dental implant vs a dental bridge. It may be in your best interest to meet with multiple dentists to best compare your options. Thank you for your question.

This post is sponsored by Cleveland dentist Hylan Dental Care.

My tooth is loose from an accident. Will an emergency dentist know what to do?

I had a silly accident where  I pulled something on top of me in the garage and it cracked into my face. I iced and took ibuprofen but now it feels like it’s loose. Should I schedule an emergency dentist appointment? Will they know what to do? The tooth feels wiggly now. It’s the weekend (of course) and I don’t know if I should tough it out and wait for my regular dentist or not? If I’m going to lose it anyway, should I just wait?

– Sherry in Nevada


Try not to chew on it and not to mess around wiggling it. The sooner you are into a dentist the better. So, it would be best to try and schedule an emergency dentist appointment, as soon as possible. It is possible that you have injured the ligaments that hold the tooth in place. Think of it like a rubber band being stretched out. If it is stretched or strained too much, it will break.

Try to avoid any unnecessary movements because you run the risk of the tooth eventually falling out if it becomes too lose. The emergency dentist can evaluate the severity of the traumatized tooth and take action right away. He or she will make an effort to stabilize the tooth to stop any movement. It will protect the tooth and the best case scenario is for the tooth to heal without any intervention.

If there is damage to the inside of the tooth where the pulp is located, there is a chance that it may require a root canal treatment to save the tooth and a dental crown.

Until you can get in for your appointment, you should avoid chewing on it and stick to very soft foods so you aren’t tempted to chew with it. Also, feel free to keep up with the ibuprofen to help with any inflammation.

It is hard to give you any further specifics without seeing your case in person. Have you tried contacting your regular dentist? Many times they will have an after-hours or dental emergency system in place for patients of record. So, start there and if you that isn’t an option, try searching for an “emergency dentist” in your town.

Good luck! Hopefully this post encourages you to take action right away.

This post is sponsored by Cleveland dentist Hylan Dental Care.

Is it possible for a cavity to heal or go away?

It’s been months now that I have had a cavity. I think it is pretty deep in the tooth and the tooth is partially chipped. I don’t have dental insurance, so I have been putting it off for far too long. It used to ache and hurt when I first noticed it. But now it doesn’t hurt anymore. Did it go away? I do everything I can to keep it as clean as possible. I’ve even been rinsing with mouthwash daily. Did this heal it? If not, in my research, I saw that the the tooth will fall out eventually. Do you know how long that will take to happen? It’s one on my back molar teeth. Is there anything I need to do in the meantime, until it falls out?

-Jake in Ohio


Thank you for your question. Unfortunately, a cavity does not heal on its own. You mentioned that you didn’t have dental insurance, which has kept you away from the dentist. This is also unfortunate, because this could have been taken care of quite easily and economically early on.

It would still be in your best interest to see a dentist to see if the tooth is salvageable. Since you no longer have any discomfort, the cavity may have reached the inside pulp of the tooth. If that is the case, you may be dealing with a possible tooth infection. This can be quite serious if it is just left alone. The infection can spread to other parts of your body and cause serious complications. But the good news is, the root canal treatment may be able to save the tooth.

Waiting for it to fall out really isn’t the best plan. If you are young, you may be dealing with some painful, annoying consequences for letting it go down the road. Your teeth may shift around and your chewing efficiency may be compromised. You may also have bone loss to deal with. There are many affordable dentists around that will work with you on payments or make a plan to phase out treatment over time, so it fits in your budget.

In the future, keeping up with regular checkups and exams is far more economical and better for your overall oral health, than never going in.

This post is sponsored by Cleveland dentist Hylan Dental Care.

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.