Dental Questions

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This page has been created as a question and answer page for anyone with dental questions. Dagon H.C. Jones, DDS will check this page periodically and answer general questions about dentistry that anyone may have. Other Dentists are encouraged to answer questions as well.

The advice and information given here are strictly for entertainment purposes only. Please understand it is impossible for any health care provider to diagnose or treat any condition via a wiki or any other online source or other media. For the most accurate information please visit your family health care provider whether dental or otherwise. That said, it is an entertaining note that questions are usually answered by dentists within the community. But legally, it's entertainment, got it?

This page is intended for questions about dental procedures, dental science, and dental materials, but not for questions about billing and insurance. Questions about billing and insurance should be addressed to your dentist's office or insurance company.

Questions about fluoride? See Water Fluoridation
Information about Xylitol can be found on the Xylitol page.

Other dentists in the community are welcome to respond to questions as well.

  1. Options for Replacing Missing Teeth
  2. Digital X-Rays and Radiation exposure
  3. Diagnodent and Shallow Decay
  4. Periodontal Disease
  5. Wisdom Teeth or 3rd Molars
  6. Sealants
  7. TMJ/TMD
  8. Root Canals
  9. Dental Emergencies
  10. Dental Filling Materials
  11. Gum Grafts

HIPAARestrictions.png Medical Professionals are limited by [WWW]HIPAA as to what information they can make public about their patients, including who their patients are. As such it is very hard for Doctors, Dentists, and Psychiatrists to respond to negative comments on the wiki. Please keep this in mind while reading any comments.

Please ask away!

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2008-04-18 08:07:17   This page has been here for a while, someone must want to know about dentistry. Am I the only one that thinks this stuff is cool? —DagonJones


2008-04-18 11:06:01   Okay, I will ask something. I need to get a bridge because I am missing tooth #4. What is the procedure like? How long does the bridge last? What can you tell me about cost? —CalamityJanie


Options for Replacing Missing Teeth

bridge.jpg implant2.jpgImplant

2008-04-24 15:25:56   Well first off you have several options for replacing a missing tooth. Usually the best option is a dental implant. After a tooth is extracted the bone in the area will slowly resorb or dissolve away because the bone no longer receives a chewing stimulus from the root of the tooth. This often does not pose a problem for maybe 25-35 years. A dental implant will maintain the density of the bone in this area because it acts like a tooth root. An implant is intended to be permanent, they have only been around for about 25 years but all research suggests that they will last for the life of the patient if properly cared for. Implants have a very high success rate (around 97% in the #4 area). A single implant is often only about 15-20% more expensive than a bridge. A bridge is used to replace a missing tooth by placing a crown on each adjacent tooth with a false tooth (called a pontic) in between the two crowns. I usually only recommend a bridge if the two adjacent teeth would benefit from crowns. It is unfortunate to have to shave down healthy teeth to make a bridge. Having said that a bridge can be an excellent way to restore a missing tooth. They feel natural but because the three teeth are now fused together you will not be able to floss normally between them and you will need to use a special tool called a floss threader to clean under the bridge. Bridges tipically last 15-20 years but can often last much longer if done well and cared for. Eventually the bone around #4 may resorb away enough that the existing bridge does not look very nice anymore and needs to be replaced. Or the bone resoprtion may (this is rare) compromise the adjacent teeth. A bridge is often billed out as the same as 3 crowns, so the price in Davis may be anywhere from $2400-3200 depending on the materials used and the dentist. A bridge takes at least 2 appointments, one to prepare the teeth for a bridge and place a temporary (This appointment can last 1.5-2.5 hrs), then you will have to return in 2-3 weeks to have the custom lab made permanent bridge cemented (0.5-1 hr appointment). An implant will likely cost about $3500-4200, once again depending on the dentist and materials used. An implant is a more involved process than a bridge and often takes 4-7 months before it is completed (this assumes the extraction site of #4 has completely healed). Ussually another doctor, typically an oral surgeon or a periodontist, will place the implant and your general dentist will restore it with a crown. The whole process takes 4-5 apppointments most of which are very short and painless. Hope this helps, I am happy to answer other questions you have. —DagonJones


2008-04-25 10:30:09   Thank you for the detailed explanation Dr. Jones... I have been undecided between an implant and a bridge... I guess I thought a bridge would be much cheaper but it seems to have its downside if it doesn't last as long. And I also agree that it would be a shame to pare down the teeth so drastically on both sides of the missing tooth. When I saw illustrations of that online, it made me kind of sad, I just can't explain it. I had a periodontal procedure about 2 months ago, and Dr. Shirazi presented me with the opportunity to just have the implant done at the same time but I chickened out, and at the time, I still thought a bridge would be better. Well, I guess I can go back. I have braces currently but he said he has barely enough space for the implant to be placed. —CalamityJanie


2008-04-25 10:46:39  You are very welcome. If you are currently wearing braces, you most likely have the opportunity to move the teeth to make more room for an implant, talk to your orthodontist and have your orthodontist and Dr. Shirazi discuss the options. Of course there are other options for the missing #4, including doing nothing (which I dont recommend because the adjacent teeth are likely to shift into the open space). Other options are limited to different types of removable appliances that you would have to take out at night. Most people dont prefer removable appliances but they are more cost effective. —DagonJones


2008-04-29 14:39:37   I've got two main questions. The first is regarding the effectiveness and the relative radiation exposure between conventional film based x-rays vs digital x-rays. The next is regarding "Diagnodent" and similar laser based tools. I just don't know much about what this can be used for, and am wondering if it might be something I'd be interested in.

Thanks for setting this page up, and thanks in advance for any feedback,

Brett


2011-08-23 Dr. Jones. First off, thank you for all of your help yesterday. You have a new patient long-term patient now. I have been reading this page and, since I had my tooth-root extracted on my last visit, was wondering if I should consider saving up for the implant to replace the now missing root/tooth or if it is something I would be functionally fine without. I don't want a bridge in the future but seeing the information here about receding bone structure gives me a bit of pause for thought... Should I, or anyone else, be worried about this? — Wes-P

Digital X-Rays and Radiation exposure

2008-05-01 13:56:57   Great questions because I know there is a lot of “buzz” about digital x-rays (radiographs) and laser caries detection. First off lets discuss x-ray films, dental x-ray films come in 3 speeds, D, E, and F speed. F speed is the most sensitive speed and therefore requires less radiation exposure than the other two films. “Results reported in literature illustrate that switching from D to E speed produced a 30-40% reduction in exposure. Switching from E to F speed produced a 20-25% reduction in exposure, and switching from D to F-speed film produced a 60% reduction in exposure”. The above quote is from an article by the FDA located [WWW]here F speed film is newer and therefore more sensitive, there is little difference in image quality between D, E, and F speed films. Most modern dental offices that do not use digital radiographs use F speed film. I don’t know the exact reduction in radiation exposure by switching from F speed to digital radiographs but I have heard it reported that the difference between D speed and digital is a 90% reduction. So the difference between F speed and digital is probably 20-30% reduction. In my "2008" opinion (which is shared by most dentists I speak to) conventional film produces a clearer image, which makes diagnosing decay easier. However digital films are much quicker, easier to transport, provide the option of digital manipulation, and have slightly less radiation exposure to the patent. Some newer digital sensors have very clear images which are comparable to traditional films. Approximations of the radiation dose received by different medical exams relative to global averages and acute exposures can be found on this [WWW]Wikipedia entry.

Starting in 2012 we introduced digital radiographs into our practice. The clarity of digital radiography is constantly improving. In 2008 (when I first wrote the above) I had not seen a digital image that was as clear as a traditional film, currently our digital x-rays have more clarity than traditional films.

The radiation exposure from a full mouth x-ray series (approximately 18 films) is roughly equivalent to the same exposure the average global citizen receives during two to five days of daily life (background radiation exposure from cosmic radiation, radon gas, etc). I consider the difference in radiation exposure between F speed film and digital radiographs small enough that it is not significant. A full mouth series is only taken about every 5 years, typical dental screening films (bitewing x rays) that are often taken every year have the equivalent of about 1 days exposure of background radiation.

Diagnodent and Shallow Decay

Regarding laser caries detection I will discuss the Diagnodent because it is the only device that I am familiar with and understand the technology. Similar devices exist on the market but I cannot comment on their effectiveness. A diagnodent works by shining a laser into the pits and grooves of a tooth to detects bacteria. Many oral bacteria have molecules in their cell membranes that fluoresce (give off light) when exposed to a particular wavelength of laser light. The Diagnodent measures this fluorescence and gives a number reading and an audible tone. More bacteria produce a higher pitch on the audible tone and a higher number readout. The instrument is sensitive enough to detect small levels of bacteria that do not need a filling so the number readout is important. A number of 30 or above has definitely broken through to the deeper part of the tooth and needs a filling. Numbers from 20-30 are questionable and depend on the visual presentation and the patients decay risk, therefore these are left up to clinical judgment. I have been very surprised by how deep some decay is that otherwise looked and felt normal on the surface. Heavy and dark stains in the grooves of the teeth are an indication of possible decay.

When decay is shallow and in the enamel only it is reversable. Ions from your saliva can absorb into an early lesion and remineralize the affected enamel. Fluoride and other agents can aid this remineralization process. This generally only works on the smooth surfaces of the teeth (like in between the teeth and on the sides). When decay is very shallow on the chewing surfaces of the teeth it often continues to spread despite all best efforts to keep the areas clean. This is because all the pits and grooves of the teeth harbor many bacteria and are difficult if not impossible to clean. Access to decay in the pits and grooves of the teeth is often straight forward; therefore, removal of only the decay with a very small preparation (hole) can be achieved. This is often referred to as "microdentistry". So if your dentist tells you you have cavities ask if any of them are possible to remineralize. Remineralization can be assisted by fluoride mouthrinses and xylitol chewing gum. Xylitol is a natural sweetener that inhibits bacteria from sticking to the teeth. The most important aspect of remineralization is preventing acid attack, so brush and floss daily (flossing is ussually the key) and avoid frequent sugar/charbohydrate snacks. Once decay has grown past the enamel and is into the dentin (the inner part of the tooth) a filling is necessary. If you are attepmting to remineralize some very suspicous areas of decay your dentist may want to take x-rays more frequently to make sure they dont spread too deep.

The Diagnodent is a great tool to help detect decay that is lurking deep in the pits and grooves of the teeth that would otherwise not be detected. However it is just a tool and the dentist has to understand its limitations. A Diagnodent cannot detect decay in-between the teeth and cannot be used next to an existing composite (tooth colored) filling. A Diagnodent will give a false positive if there is heavy plaque or tartar in the grooves so those grooves need to be clean. Also if a Diagnodent is used after a cleaning and the hygienist has used any colored agents (special toothpaste or plaque staining dyes) the Diagnodent may get a reading from the pigments in the dye and give a false positive. Remember that just because the Diagnodent is giving a reading, does not mean that there is decay that needs a filling.
I hope this info was helpful and I am happy to answer other questions. I would not let digital radiographs or use of a Diagnodent be a deciding factor when choosing a dentist. There is a lot of new technology in dentistry but none of it is a replacement for good clinical judgment, skill, and compassion.


2008-11-09 15:40:27   Great page, Dr. Jones. My question isn't about dentistry exactly, but more about low-cost dental services in Davis. Are there low-cost options for dental care in Davis, e.g. for those without coverage needing a filling? —robinlaughlin


2008-11-10 10:08:25   If you are a Yolo county resident and meet certain income requirements you can go to the Davis Community clinic "Communicare Heath centers" which is behind sutter hospital. There are 4 Communicare dental clinics in Yolo county, Davis, Woodland, West Sacramento, and Esparto. The Davis dental clinic is open Tuesday-Friday. 530-757-4667 call for more info. You will need to go into the clinic and fill out an application. They also accept Medi-Cal. If you are having an emergency you can come in at 8am or 1pm (sharp)for an emergency appointment, there is no guarantee you will be seen that day but if there is enough time you will be taken care of. I volunteer there once a month on Thursday nights so you may see me there. Communicare is a good resource but they are underfunded and have such a huge patient base that there is often a very long wait for appointments. Be prepared to provide documents to prove your residence in Yolo county and your income.—DagonJones


2009-05-17 22:20:45   My teeth have severe enamel erosion. The tips of my front teeth seem a bit translucent, and they're very sensitive. I want to find a way to remineralize, however there are two different ways that are confusing me. The first says to use toothpastes like arm and hammer enamel care with ACP. This also contains fluoride, and glycerin. I've heard that glycerin will coat the teeth, and prevent remineralization. The second method is to use all natural, fluoride, and glycerin free toothpastes. Right now I'm trying the Green Beaver brand. This has silica, and sodium bicarbonate, as well as vitamin C, which they claim helps strengthen teeth, and gums. Which of these methods is the correct way to remineralize? Does glycerin containing toothpastes really inhibit remineralization? Which would nullify the benefits of ingredients like liquid calcium, xyitol, and novamin. —bluevelocity


2009-05-18 13:16:45   I do not know if glycerin inhibits remineralization. Logically, I dont see how it could, because if it does leave a film on the teeth, it would be a water soluble permeable layer. The teeth naturally form a permeable protein layer on top of them called the "pellicle", minerals can freely move through this layer to remineralize the tooth surface. To address your question more generally, I dont think remineralization will help your problem. Remineralization refers to restoring minerals to demineralized enamel, this changes the enamel from being weak and soft to hard and durable. However, remineralization can not restore lost tooth structure or rebuild lost enamel (not to a visible extent, only a microscopic one). When acid (either dietary or from bacteria via carbohydrate metabolism) attacks tooth structure it pulls out minerals (demineralizes the tooth). Your own saliva is very good (better than any toothpaste) at providing a super saturated environment of minerals to help remineralize demineralized tooth structure. If demineralized tooth structure suffers a prolonged acid atack it will be destroyed, ussually resulting in a cavity.

You can address the sensativity by using a sensativity protection toothpaste, like sensodyne, but these often do not work all that well. You can use a professional product (only available through a dentist) called MI paste. This is the one product that may be better at remineralization than your own saliva. It prevents sensativity by blocking the microscopic tubules that are in exposed dentin. It can be applied at home and needs to be used for several weeks but generally has very good results.

Regarding the translucent incisal edges, if the enamel is very thin on those teeth you may want to consider having tooth colored composite filling material bonded on to the edges to reinfoce them. Or you can have the thin edges "sanded" off by a dentist. —DagonJones


2009-05-18 15:17:26   Floss first, and then brush; or brush first, and then floss? —TheAmazingLarry


2009-05-21 11:59:47   So, I usually wake up with a thick almost gummy white film on my teeth. Is this plaque or is it this "Permeable protein layer"? —MasonMurray


2009-05-21 19:17:43   The film on your teeth in the morning is definitely plaque, you cannot feel the pellicle, it is only a few microns thick. According to the reseach I have read and how I was taught in dental school, it does not matter what order you brush and floss. But it is VERY important that you do floss daily.


2009-05-21 19:42:25   Plaque is a bacterial biofilm. It's what you gotta take care off every day. If you don't, it'll eventually lead towards cavities and mineralize up to turn into calculus/tartar, which brushing won't remove (but your dentists sharp thingies are meant for). —EdWins


Periodontal Disease

perio1.jpghealth on left, periodontitis on right

recession.jpgRecession on left, normal on right 2009-05-22 23:15:28   The reason flossing is so important is that it removes the plaque between the teeth that brushing alone does not. This plaque can lead to cavities between the teeth or gum disease. The area between the teeth includes the area below the gumline that is between the teeth, also known as the periodontal pocket. This diagram shows a health pocket on the left and a pocket with periodontitis or periodontal disease on the right. Because the pocket area is a low oxygen (anerobic) environment, lots of nasty bacteria can breed there. Over time they produce lots of toxins, your body responds by producing inflamation (redness, swelling, bleeding etc.) Both the bacterial toxins, and your body's own response causes atachment loss, where the gum tissue atachment point migrates downwards, this creates a deeper pocket which is harder and harder to clean and can harbor more bacteria. the presence of atachment loss in the pocket area is ussually the diagnosis of periodontitis. As the gum tissue attachment point migrates downwards, the bone will follow becuase it always wants to maintain a certain distance from the gum attachment point. Periodontitis can result in rececession, which is when the gums visibly move downwards exposing the root surface. There are many other causes of recession, such as vigorous tooth brushing with a hard or medium bristle toothbrush (always use soft or extra soft, they clean just as well) some recession can come with age. Once recession has occured it can only be repaired with a gum graft. The proper treatment for gum disease is scaling and root planing (aka a deep cleaning) this is where tartar and bacteria are removed from below the gumline with specialized instruments (your gums are ussually numbed up for this). Ussually some of the gum tissue will re-attach to the root surface after the scaling and root planing, but because the bacteria can migrate back into these areas, periodontal maintenence cleanings are ussually recommended 3-4 times a year. It takes about 3 months for bacteria to build up the colonies and enviornment required to cause progression of gum disease. Even if there is no re-atachment to the root surface, if there is a reduction in the inflamation, then the severety of the disease has been reduced. —DagonJones

Regarding mouth washes, there are a wide variety of mouthwashes that are designed for different purposes. Some, like Scope, are just to freshen breath. Others, such as ACT or Fluoriguard have fluoride and help prevent cavities. Listerine helps fight gingivitis and gum disease. There is a prescription mouth rinse that kills bacteria responsible for decay and gum disease. I have never heard of mouthwash leading to thrush (or Candidiasis) but I can see the logic behind that because if the micro organism ecosystem in your mouth is disturbed it can allow Candida, a fungus, to proliferate and take over leading to thrush. However, I wouldnt worry about mouthwash causing thrush, I think that is pretty unlikely.

Wow great questions you guys, this is fun!


2009-05-23 10:15:40   Hey, out of curiosity and since you like the questions, here's a family medical oddity. My father's family is prone to never getting some of their adult teeth or getting them very late. My grandfather was x-rayed over and over during WWII by dentists because they were curious about it. I still have some teeth that never changed (premolars, and thankfully they look fine), I didn't get my second molars until I was in my mid 20s, and my wisdom teeth came in (straight and true) five years later. My father and his siblings all have some of their original teeth as well. As a side note, we're all pretty durn cavity free, other than my brother who lost all his baby teeth for adult teeth and had his molars come in at the usual times. I've always wondered how common this is. Have you run across it before or have you ever heard of it? —JabberWokky


2009-05-28 12:48:00   It is very common to have congenitally missing teeth run in families. There does not seem to be any specific pattern, like skipping generations, mother's side of the family, or anything like that. However, it is most commonly bicuspids and lateral incisors that tend to be absent. Ussually people do just fine with the baby teeth but sometimes they will fall out becuse they have shallow root structure or they can also start to resorb (melt away) which may necissitate an extraction. Regarding your second molars (aka 12 yr molars) comming in late, that sometimes happens but to the best of my knowledge it is not related to the congenitally missing teeth. —DagonJones


2009-05-28 18:49:35   Even stranger, I actually had a 3rd set tooth try to come in. I had it surgically removed because it was not properly formed, but my great-grandmother had the same thing.... Odd how it sometimes skips... er... 3 generations? —MasonMurray


2009-05-30 19:17:40   Question: My 6 year old sons "upper right lateral" baby tooth was knocked out @ Kindergarden running around—this was in October. Anyhow, we had it x-rayed and the dentist said we will have to see what happens. The "upper left lateral" tooth fell out and it's just emerging through now. I'm thinking then, his upper r. lateral would also be emerging around this time; but it's not. I felt both sides of his gums and on the right, it feels and also looks like it tooth is kind of stuck up there?? It doesn't feel the same on the left. Is there anything that can be done if the tooth is not coming down? —JRaumer


2009-05-30 22:33:07   I have a temporary crown right now and will get it replaced with a permanent one in a week and I was wondering how durable the permanent crowns are. —hankim


2009-05-31 22:04:46   JRaumer: Your son's tooth is likely to be just fine. the contralateral (other side) teeth rarely come in at exactly the same time, they are often seperated by about 6 months or so, sometimes longer sometimes less. If a primary tooth(aka baby tooth) is knocked out then there is potential for damage to the developing adult tooth, but this is very rare and unlikely. If it looks and feels like there is a tooth under there then he is probably in very good shape, often times there is a very pronounced tooth shaped swelling for several months before the adult tooth finally erupts through the gums.

hankim: A permanent crown is genarally designed to last a lifetime, however, there are many things that can cause a crown to need to be replaced. Decay, excessive wear, tooth fracture, can all necissitate replacement. The average ( and this is a very rough estimate) life of a crown is about 20 years. depending on why the tooth needed a crown in the first place plays a big role in the long term life span of a crown as well. If the tooth had very extensive decay or has a root canal then the life expectancy is less. —DagonJones


2009-06-10 18:01:11   I have a few questions about kids and teething: At what age should youngsters start going to the dentist? And, how do foods affect dental and jaw development throughout the deciduous teeth period? ——related to this last question, I've heard that eating lots of HARD foods (granola, etc) as a kid will result in straighter and stronger permanent teeth later on. Is there any truth to that? —TheAmazingLarry


2009-06-11 13:12:05   Children should see a dentist by age 1. When kids are very young we do a visual exam to check for signs of decay or other oral health problems. We also review proper brushing and flossing techniques for parents, discuss fluoride, diet, etc. from ages 1-5 I ussually recommend an exam once a year, unless the child has a high risk for decay then I recommend every six months. I have never heard of hard foods leading to straighter and stronger teeth, and I cant see how they could. This sounds like an "old wives tale" to me. The position of adult teeth can be influenced by the position of the deciduous (baby) teeth; however, the chewing forces on the baby teeth would have no effect on the development or position of the adult teeth. Tooth development can be effected by systemic factors like a very high fever or certain medications such as tetricycline (which causes gray stains on teeth), but indirect forces would not effect the cells responsible for tooth formation. Heavy chewing forces could lead to more dense bone around the baby teeth because bone is a very dynamic tissue and is responsive to physical forces. Bottom line is hard foods are not needed or recommended for proper tooth development.—DagonJones


2009-07-16 14:01:07   One of my teeth-premolar upper has slight split from one side. Is is straight down split. It doesn't bother me much except I eat too hot or too cold. My dentist was suggesting me to have a drill and fill it. I am very much cautious about my teeth and I am afraid to do the drill thinking that it will make my tooth worse coz my dentist was saying that she will make a horizontal drill and make up the split portion with fill. I am also scared that while making a horizontal drill on my teeth, she may be hurting my next teeth adjacent to it. I would like to get your opinion- Shall I go for Drill and Fill or just let it stay and avoid eating hot and cold stuff.

Sorry for the late reply. I doubt your adjacent teeth will be harmed by the drilling, if it is a vertical crack on the cheek side of the tooth it would be very hard to damage the adjacent teeth. For most fractures I would actually recommend a crown as opposed to just a filling. If the tooth is sensative to cold, and sensative when you bite down then the tooth almost definitely needs a crown. Fractures in teeth can spread pretty easily once established and they can lead to cusp fracture or sometimes root fracture. If there is a fracture in the root, then the tooth will need an extraction. It is very hard to say without actually examining your tooth, but I would not recommend doing nothing. If the tooth is sensative and there is visual signs of a fracture you should definitely have the tooth repaired. —— dagonjones


2009-08-27 19:21:29   My son is 14 years, 11 months. All his teeth have come in and he is currently in braces. His canines came in late (left canine just finished coming down two months ago) and space had to be created with springs to open room for them. Right now, his right maxillary second molar is primarily retained but the oral surgeon said it should have been exposed much sooner and now he should just wait as it probably won't come down after being exposed. There seems to be nothing in its path and the other three second molars came in fine. Could this be related to tooth b being extracted at 10 years old due to a cavity? Is it likely the second molar will come in after being exposed? —Genny

It would be almost impossible for the late/hindered eruption of a second molar to be related to an extraction of tooth B at age 10. The second molars do not replace any primary ("baby") teeth, therefore, it would be very difficult to damage the developing tooth bud of a second molar during an extraction of a primary tooth. By the way primary tooth B is replaced by the upper right first premolar (#5). Delayed or hindered eruption of second molars does happen sometimes, this can happen for a variety of reasons but often it is difficult to know why. Sometimes they can be moved into proper position with braces but that can sometimes be difficult. I would discuss the case with his orthodontist, ask him directly how likely it is this tooth will come into proper position. —- dagonjones


2009-09-09 11:34:57   I have a question. For all of my life, I've had a tiny black dot that appears to be a tiny hole of some sort on the top of one of my molars. It has never bothered me and I've never had a dentist say a word about it. Should I be concerned about it? —ChristyMarsden


2009-09-10 11:33:41   That tiny black dot is probably one of the pits or grooves that are very common in molars. if the pit is deep enough it can pick up quite a bit of stain. Most likely it is only staining and I would not worry about it, especially if you get regular exams. Sometimes those stains can have decay underneath them, a diagnodent (see above) is a good tool to see if there is decay there but ussually it is not necissary becuase the decay can be detected during a standard exam. —DagonJones


2009-09-10 17:57:26   I had a new crown molded a month ago, and the permanent gold one has been in for two weeks now. Would this change be enough to cause me to start biting the inside of my cheek when I eat? I started noticing this once I got the permanent crown put in, and today I started really feeling out the area where this is occurring, noticing that the "real" tooth above the freshly crowned one seems to have some deep gouges on the sides. Now this may have been there from a previous filling-I can't really tell as it may be a tooth colored filling, but it did seem like my dentist drilled on the upper tooth while the lower was being prepped for the crown. Did I imagine that, or would there be a legitimate reason for the dentist to do that, OR is the dentist looking to "guarantee" future revenue down the line when I might need a filling or another crown on my last natural molar? —CFletcher

I am going to give some quick answers and hopefully come back to put in more detail later. It is relatively common to adjust the opossing tooth during a crown preparation, this ussually does not damage the tooth but could make it feel a bit rougher, it can be polished if need be (ask your dentist next time you go in). When two teeth meet togeather there is an ideal amount of overlap that prevents the cheek from getting caught between. that can change a bit when a crown is made, it may not be the dentist or labs fault but rather simply the limitations that are present when making a crown. I have encountered this situation a few times, ussually the body adapts and the person "learns" to stop biting, if it is very serious the crown may need to be replaced. I have met many people who have a cheek biting problem with natural teeth with no crowns or fillings. -dagonjones


2009-09-13 17:40:29   Hi Dr. Jones,

On my last appt, the doctor kept calling out 3's, 4's and a few 5's. He said I had "calculus" and needed a deep cleaning. From what I have had described, the deep cleaning will open up the underside of my teeth to the outside permanently. And, because of this I will be stuck going back 3 to 4 times a year. This frightens me because it 1) opening me up to the outside world sound like it will do more hard than good and 2) since I do not have the ability to go back 3 to 4 times (or ever once a year), if I have this done and can not keep going back over and over and over I will be really, really screwed. Please tell me I am wrong? What do you recommend?
-T —ToddAndMargo
It sounds like you have periodontitis (gum disease) see the above entry :2009-05-22 23:15:28 Peridontal Disease for more info about gum disease and its treatment. Calculs is just another word for tartar, it needs to be removed because it is like a playground for bacteria. The deep cleaning will only remove bacteria and calculus from the tooth root. It will not expose any part of the tooth to the outside that was not already exposed. I think you should really commit to cleanings at least 3 times a year (even if your insurance does not cover all of them), and the deep cleaning (root planing), it can really make a big difference. The long term results of gum disease can be tooth loss, also untreated gum disease can increase your risk of cardiovascular disease, stroke, and type II diabetes. The 3's are not bad and the 4's are marginally bad, the 5's are definitely indicate the presence of gum disease, but it is not just the numbers but the severety of the inflamation present in the gums. Inflamation is indicated by redness, bleeding, and swelling of the gums—dagonjones


2009-09-13 17:56:20   Hi Dr. Jones,

I lost a lower front tooth in a car accident about 40 years ago. I have a lot of bone loss in the empty space. If I can ever afford an implant, I will need bone replacement. Can this be done with ACP (amorphous calcium phosphate) or similar? Or, am I stuck with surgery?

If surgery, where do they get the bone from? And, what effect will stealing the bone have on the site where it was stolen from?
-T —ToddAndMargo

Bone is ussually deminieralized cow bone or human bone from a tissue bank, both of which have NO risk of transmission of disease. If bone is harvested from your own body (which has the best chance of success but also the most uncomfortable) then the donor site will take a while to heal and ussually hurt but it will heal just fine in the end with almost no chance of permanent damage. The bone would ussually come from your leg or your jaw. The bone graft is considered surgery, but you will not likely need surgery to harvest bone becuase most bone grafts today use material from a tissue bank. —dagonjones


2009-12-02 10:12:08   My molar broke last night (on a Tues). A piece of it the broke off and seemed to crumble. I left a message for my dentist, but alas, her office is closed on Wednesdays. I'm flying out of town on Friday. What's a person to do? —NoelBruening

No number given. —Noel

If your dentist does not leave an emergency number just find a dentist who is available that day, Davis is full of great dentists who would be happy to help you out. Most dentists will do a temporary fix for you to last you long enough to get back to see your regular dentist.


2009-12-21 09:10:23   I have a worn out gold crown on a back molar. A couple of local dentists said they would replace it with a $450 stainless steel crown. Other say pretty much over their dead body, but would not give a reason. One says stainless is stronger and last longer, they just look bad. Since it is too far back to see, I do not care. Is there some reason to stay away from stainless and pay the $1100 for a gold crown? —ToddAndMargo


2009-12-22 10:09:24   I would strongly recommend against a stainless steel crown. Stainless steel crowns are pre made and come in a variety of sizes, none of which will provide a precise fit for your tooth. Stainless steel crowns often (almost always even in the hands of great dentists) have very rough margins. These rough margins collect plaque and tartar and often lead to decay in the long run. A custom crown is made in a laboratory and should have a very smooth margins with a precise fit that will not allow bacteria to accumulate. If cost is a big issue just keep the gold crown you have, if there is a hole worn through the top a small filling can be put there. This filling may not even be necissary if there is not decay present. Talk to your dentist and find out if the crown absolutely needs to be replaced, it may be able to be patched. A stainless steel crown will be more expensive in the long run because it will not last as long and is much more likely to lead to decay. Stainless steel is a stronger material than gold but the metal is much thinner on a stainless steel crown than a gold one. —DagonJones


2009-12-22 16:24:58   Hi! Lately I have had a lot more tooth sensitivity (cold and hot) in the back of my mouth, one molar on the right side of my mouth. I have a filling there, not too old...am wondering if this is something I need to be worried about? I brush and floss, no bleeding or pain from that anywhere...Thanks! —jsbmeb


2010-01-05 15:34:18   Your sensativity to cold could be many things, It could be a cracked tooth, infected nerve, decay, or nothing at all. Teeth are often sensative to cold, and this can change with time. Teeth with fillings are more likely to have sensativity but even perfectly healthy teeth can have transient sensativity. I would wait several weeks, your cold sensativity will likely subside with time and it may even come back in the future. If it continues to get worse or if the pain is severe and lingers for more than one minute after the cold is removed you should see a dentist. —DagonJones


Wisdom Teeth or 3rd Molars

Wisdom teeth often need to be extracted because there is simply not enough room for them in the jaw. The definition of impaction is a tooth that cannot erupt fully into the mouth. Sometimes wisdom teeth erupt fully but are in a problematic position and need to be removed. Even if the tooth is not painful or obviously problematic it may require extraction. Impacted wisdom teeth often push against the teeth in front of them and can lead to decay or resorption (biologic destruction). Wisdom teeth extraction can be done under light sedation or general anesthesia (being put to sleep) or no sedation, in all situations the areas are thoroughly numbed so there is little or no pain. Minor swelling is common and often not visibly noticable, very large swelling (like a chipmunk) is infrequent and often the result of an infection but is often easily treated with antibiotics. Pain is usually minor to moderate and often lasts for about 3-5 days and is managed well with prescription pain medication. - Dagon Jones

impaction.gif 2010-01-06 10:15:20   Hi Dr. Jones... This problem has been bothering me for years—I have a impacted wisdom tooth in my lower jaw (mesial impaction? as seen here except it is fully erupted):

I had already spent quite a lot of money a few years ago getting oral surgery to lift and straighten it, but it failed. I've been keeping it clean and so far by flossing and brushing excessively and have not had any cavities in the impacted area yet, but often times I get pain in my jaw and pressure-build up and aches...

I was wondering what my options are? Can it be fixed, or must it be removed? If I get it removed, will I need to remove the corresponding tooth on the jaw above it (I'm reluctant to remove one tooth, yet alone two)? Thanks in advance! —H4rry


2010-01-14 08:55:24   What you are describing is probably "pericoronitis" which simply means inflamation around the crown. It is a common problem with lower wisdom teeth. because the gum tissue sits very high around the tooth plaque, bacteria and food often get caught below the gum and lead to infection, inflamation and pain. The best solution is almost always to remove the tooth. The inflamation can be treated every time by topical antibiotic rinses or debridement (cleaning under local anesthetic) or sometimes recontouring of the gum tissue. I would not recommend these methods because the problem will ussually continue to recur.


2010-01-20 19:43:58   I have two questions. I got braces when I was ten and had them for three years. But once I got them removed I didn't use my retainer because it didn't fit properly, it would pop out. A couple of years later when I went to a different dentist, I was told that because I had braces at a young age the root of my two front teeth are short and weak. My first question is, can getting braces at an early age really do that to the root of the tooth and is the effect reversible? My second question is, because I stopped using my retainer right after the removal of my braces, I have crooked teeth again. I want to get braces again, preferably a removable aligner, but will it further damage the roots of my front teeth? And thanks in advance. —XuJeong


2010-01-25 22:49:09   During orthodontic movement the roots of teeth can become resorbed. It is more likely for this to happen when the teeth are being moved very rapidly (which was not likely the case if you were in braces for three years) , but it can occur during regular orthodontic movement. Unfortunately the effect is not reversable. It is possible to move your teeth again with braces but the chances of further resorption are present and depending on the severety of your resorption it may not be recommended. You would have to check with an orthodontist. The orthodontist would evaluate your x-rays and the severety of crowding and let you know how significant the risks are.

I emailed this question to Dr. Molitor (a local orthodontist and all around nice guy) here is what he had to say:

"These are good questions. There is no evidence that braces at an early age causes increased root resorption. As a matter of fact the opposite seems to be true. That is, orthodontic treatment on the very young rarely produces root resorption. It is true however that orthodontic treatment for younger kids often implies prolonged or multi-phase treatment which can be related to increased risk of root resorption.

For those that have already experienced root resorption, further orthodontic treatment definitely can be risky. The decision to do orthodontic treatment is always a balance of risks and benefits so it would depend on how much the teeth need to move, how much root is left on the affected teeth, and how much the "crooked teeth" bother you. "

Hope that helps.
Matt Molitor


2010-02-03 12:45:23   Any advice for somebody about to see a dentist (for a cleaning) for the first time in over 20 years? I've never had any problems (straight teeth, including wisdom teeth that came in fine and are accessible for cleaning, never had a cavity, etc), but I figure there might be some questions I should ask or something like that. Other than some back of the tooth staining from coffee and tea, I have no issues I can even think of. I should also add that I don't have any fear of dentists at all; I have just been a business owner for many years, and I didn't have dental insurance until I got married, and then didn't think about going until my wife pointed out that with our upcoming move, we'll be changing insurance, so I might as well take advantage of what we've been paying for and go now. —JabberWokky


2010-02-03 20:28:06   Very informative page. I have been considering a dentist but will need time to consider it, however, partly due to personal interactions and partly due to seeing the extremely positive reviews I think I would definitely have visit Dr. Jones. —WesOne


2010-02-03 21:24:40   JabberWokky; when you see a dentist make sure they check your periodontal (gum) health. This step is known as perodontal probing, it involves the dentist or hygienist feeling your gums and counting out a series of numbers. See the entry on this page dated 5-29-2009 for more details. If it has been a long time between cleanings there is likely a good amount of calculus (tartar) buildup on your teeth, which has likely led to inflamation or even gum disease (lets hope not). Dont feel swindled if the dentist wants you to come back for 2 or more cleanings, if there has been tartar on your teeth for more than 20 years it can be very hard to remove and sometimes it takes longer than 1 hour to get it all. If you have other questions after your first visit let me know, you can email me the x-rays and I will be happy to review them and give you my advise. —DagonJones


2010-02-09 10:52:57   What's your general feeling on sealants? I was always a very good brusher and had no cavities until late college. In high school my dentist insisted on sealing my teeth, which my mom (a former hygenist) was not very happy about because she feared they'd eventaully crack and leak, thus trapping things under the sealant. Given a sudden onset of cavities (probably 10 surfaces in 4 years) with no other changes in brushing, flossing, or visiting a dentist, is it possible the sealants were not such a hot idea? Thanks in advance. —AmLin


Sealants

2010-02-09 14:15:13   I recommend sealants based on the risk of decay for the tooth. If a person has a history of decay and the tooth has very deep pits and grooves, then a sealant is a very good idea. For kids under 10 sealants are usually recommended on the adult molars because kids commonly have a higher risk for decay (love of sweets and lack of good brushing). For a good sealant the tooth must be kept very dry during placement, if moisture gets on the tooth during the sealant process the sealant won’t bond well and it could leak. The grooves should also be very clean, it is best to clean out the grooves with a very small drill, a microblaster ( a very small sandblaster), or a spinning brush with pumice. If a sealant is placed well it will last a long time and the risk of getting decay under it is very slight. If a sealant is not bonded well then plaque can get under the seal and lead to decay. If decay is sealed in under a sealant when the sealant is placed, the decay won’t spread (if it is completely sealed) because the bacteria can not get a carbohydrate food source. Overall, sealants are a very good thing; they do much more good than harm. However, they can be a problem if they are not sealed well but this is usually rare.


2010-02-09 15:57:09   I have a cap on one of my upper molars, about two years old. Part of the cap is metal (amalgam, perhaps? not gold). Normally it doesn't bother me, but when I swim in the pool, sometimes I get an uncomfortable "metal" feeling. Any idea what could be causing that? Chlorine? Exercise? I'm clenching my teeth while swimming? Should I be worried about it? —CovertProfessor


2010-02-09 19:47:34   The metal is most likely noble white gold. Similar to the white gold in jewelry. It has a silver appearance in is commonly used in porcelain fused to metal crowns (aka caps). The sensation you are feeling is probably due to clenching your teeth while swimming, I would try to avoid that. Too much force on teeth can cause sensitivity. I would not worry too much about it, it is very common for teeth with dental work to be a little sensitive from time to time (this even happens on teeth with no dental work). I would only worry if it was painful very often (like once or twice a day) or if it started to get increasingly worse. —DagonJones


2010-02-20 15:04:50   Is it possible to induce temporary sensitivity via a ton of sugared candies? —StevenDaubert


2010-02-20 15:44:36   About four years ago I had corrective jaw surgery to fix an open bite. Now my jaw regularly locks and has to "pop" open, which sounds like a loud crack. Is this a normal complication from the surgery, or is it potentially unrelated? —MHaymond

TMJ/TMD

TMJ refers to the TemporoMandibular Joint itself and TMD refers to TemporoMandibular Disorders.

The following is a general list of recommendations for jaw pain (TMJ/TMD):


2010-02-22 11:19:59   So years ago... I got into a pretty bad car accident. Ever since, I've had this jaw popping thing happen whenever I open my mouth big to yawn or the like. It's as if the right side of my jaw unhinges itself and slides to the side ever so slightly. Never caused any pain, but lately I've been waking with an ache on that side. How do I fix that? —Aaron.Curtin

What probably happened to you Aaron is that one of these muscles or ligaments on the right side was torn and did not heal exactly the same as before. So now when you open on the right side the disc slips out of position (resulting in a pop or click). Also your jaw may be translating further on the right side resulting in your jaw moving a bit to the left. The pain you are having on the right side in the mornings is likely due to night time grinding or clenching of your teeth (aka parafunctional habits). These movements can create a lot of stress and strain on the muscles and the joint, resulting in soreness. I would guess that you have had an increase in stress in your life (stress often makes jaw discomfort worse). You could try some of the things listed above (minimize stress, minimize hard/chewy foods, thermal compresses). If your symptoms persist or get worse you should see a dentist, it would probably be best for you to have a custom bite plate made. DagonJones


2010-03-18 14:10:10   During a recent exam I was asked what my daily regimen consisted of: brushing, flossing, etc. One tool that came up that I'd never really thought about was a water pick. I don't use one, and never really thought about using one. I brush and use mouthwash at least twice a day, floss once a day, and have no problems with my gums. Is there any reason to use a water pick as part of a normal daily routine? I've always thought of them as somewhat gimmicky or for people with specific issues. —JabberWokky


2010-03-18 14:23:38   Also during the recent exam, they brought up some non-tooth oriented items. For instance, the fact that my jaw sometimes locks open when I open my mouth really wide (usually in a big yawn), and usually clicks when I open it wide. There's no pain unless it locks, and it happens so seldom that I consider it a non-issue. You've answered the question about the jaw clicking already (although they think mine is because the tendon slides over a bone causing transition). But the question I had after leaving was: how far does the practice of dentistry go beyond teeth? I've always considered it a tooth and gum field. Since they measured my jaw displacement, obviously the jaw hinge is also a common part of the field. Are there any other common non-directly-tooth related problems that one can see a dentist rather than a doctor about (or at least bring up during an exam)? —JabberWokky


2010-03-18 14:26:39   As a third, semi-rhetorical question, is there anything that people commonly do that is worse to the overall health of all parts of your body than using tobacco? —JabberWokky


2010-03-18 16:34:13   If there's only a root, is there another option other than root removal? —BruceHansen

I would have to see the situation; however, there is rarely anything (good) that can be done with just a root. A root canal could be performed on the root then it could be used for retention of a partial denture. —DagonJones


2010-03-22 11:58:29   a week ago i awoke with a sore throat. turns out it was strep and i was put on antibiotics thursday. however, the day prior (wednesday) i noticed some gum tenderness while brushing, which turned into gum bleeding and lots of tenderness/redness of the gums by thursday afternoon & friday, through to today. it would seem to be gingivitis, but i was too ill with the strep to do much about it other than continue to brush and use some listerine. my question basically is: do you think i need to get in to see a dentist asap (i'm out of dental insurance for the year due to a wisdom tooth extraction a few months ago) or, since this was likely triggered by the strep, will continued brushing etc clear it up in time? —RyanJames It is hard to say what is causing the problem, if you don't have a toothache then it is most likely gingivitis. If there is any pus coming from the area see a dentist ASAP (it could be an abscess). If it is gingivitis the best thing to do is brush well (not hard, but thorough), floss, and use listerine. Gingivitis is caused by bacteria and should get better if the area is kept clean. If it does not get better in a week I would go see your dentist. —DagonJones


2010-03-22 16:18:00   With no intent to create a debate, I will ask a very simple question: Is dental coverage included in the new health care bill? —JabberWokky

* I love your debate disclaimer. I don't think it provides for any dental coverage (I have heard of nothing). I have not followed the bill closely, I was going to wait until it was all finished to figure out what it says. My understanding is that even Canada does not have any public dental care despite their renown public health system.


2010-03-24 12:56:16   Can eating too much citrus be bad for the teeth? Grapefruit was on sale at Safeway for the past week, and I’ve been eating 1–3 a day… last night while brushing my teeth felt a bit more sensitive than usual. —EBT

Yes, citrus can be damaging to teeth. Citrus fruits are very high in citric acid, that is what gives them the sour or tart flavor. The acid can dissolve the minerals in tooth structure. This can make teeth more sensitive but most often people don't notice any discomfort but the erosion can be seen on the teeth. Lemons are the most acidic and people who suck on lemons often have severe acid erosion on their front teeth. I love oranges and eat a ton of them when they are in season, it is usually not a problem. The best thing to do is avoid keeping the fruit in contact with the teeth for prolonged periods of time, enjoy in moderation. Eating a bunch of grapefruit for a week is not likely to have long term significant consequences, most likely the acid has removed a thin protective layer of calcium that covers any exposed root surfaces. This will often make these rooth surfaces sensitive. Try using a sensitivity protection toothpaste for a few weeks and the sensitivity will likely go away. —DagonJones


2010-04-19 20:19:13   What is the cost to replace a crown on a molar? —shilee91


2010-04-19 21:48:24   A typical crown in Davis costs $800-1000 (regardless of the tooth it is on). If you have insurance, most insurance companies will pay for 50% of the cost. Let me know if you have more specific questions. —DagonJones


2010-04-19 21:56:20   Besides brushing at least twice a day and using flouride and Listerine, what's the best way to get rid of stains around the gum line and between teeth in the time between dentist visits? I read somewhere to brush with baking soda, but then I also read that that's really bad for the tooth enamel. —MonicaWilliams

There are not many home products that remove stains well because it does require a fairly abrasive compound to do so, try using baking soda with dental floss to get the areas between the teeth, use an up and down motion while pressing against each tooth. For areas at the gumline use a brush with baking soda. Baking soda is best used once a week because it is fairly abrasive, I would not consider it bad for enamel but using it daily could cause excessive abrasion. —DagonJones


2010-04-29 01:48:12   I must confess... I'm afraid to go to the dentist. My parents took me up until I moved out, I went once since then, and I have been avoiding dentists altogether for like 3 years now. Bad, I know. I am having tooth pain now so I know I need to make an appointment soon, but I have a question that may or may not help me feel better about going. I am cavity-prone, I get cavities all the time. Why is it that whenever a dentist sees a cavity they have to stab that sharp hook thingy into it and cause me immense pain? If you can see the cavity there already, is it really necessary to jab it? I am cringing just thinking about it now. I know I will have cavities next time I see a dentist so I think this is why I hate it so much. —JenniferCook

This is actually a very good question. Caries (cavities) are diagnosed primarily by feel, not sight. Dark areas in the pits and grooves of the teeth may be heavily stained and not carious. An instrument called and explorer (that little hook thingy) is used to feel these areas to find out if they are soft or hard. If the tooth structure is soft, then it is decayed. This should not hurt but sometimes people have very sensitive teeth or deep areas of decay and it can be painful (I do this daily and only get a painful response about 1-2% of the time). Some areas of decay can be deep within the grooves and below the level of the explorer and wont be detected by feel. To find decay in these areas a [WWW]diagnodent can be used to detect decay. When you see a dentist, ask them to use a diagnodent (call the office to see if they have one) or be gentle and only feel the area if they have to, sometimes the decay is so obvious by sight that feeling it with the explorer is not necessary. No one will be offended and no one will think you are a wimp, we see people every day who are nervous, anxious, and afraid. Don't be hard on yourself about not going to the dentist in the last few years, many other people are in the same situation you are. Your dental team is there to help get you back on track with proper oral care, not scold you for what you did wrong. —DagonJones


2010-06-06 16:30:05   I have several root canal treated teeth, yet everytime my dentist close the canal with the plastic pin. I get a swelling under the tooth. One molar he already extracted because he said it was unsavable. Can a systemic disease be causing the swellings I am experiencing after he close my root canal treated tooth. Thank you

I have never heard of a systemic disease causing recurrent infections in root canal treated teeth, however a compromised immune system can make them more likely to occur. Root canals are not always successful, sometimes they become reinfected and need re treatment or sometimes extraction. I am not sure what you are talking about when you say close the canal with a plastic pin, perhaps you are referring to the "gutta percha" which is a rubber based material used to seal the canals, can you tell me a bit more? —DagonJones

Root Canals

endo1.jpgInfected Pulp

endo2.jpgCleansing and Shaping endo3.jpgSealing with Gutta Percha This is an excellent opportunity to talk about root canals. A root canal (or Endodontic [endo = inside, dontic = tooth] treatment) is performed when the pulp chamber inside a tooth becomes infected. The pulp chamber is the hollow area inside a tooth that houses the nerve and blood vessels. The nerve and blood vessels enter the tooth through a very small hole at the base of the root (see image at the very top of this page). The most common reason for infection of the pulp is bacterial contamination due to decay, a cavity gets deep enough that it penetrates the pulp. Once the pulp is infected, the immune system cannot bring enough blood flow through the small portal at the base of the tooth to supply an adequate immune response to heal the infection. The tooth must either be extracted or the all the nerve and vascular tissue must be removed from the pulp space. Removal of the tissue within the pulp space, sterilization, and subsequent sealing of the canal space is what a root canal consists of.
A root canal begins by removing all decay and providing a clear access hole to the pulp chamber and canals. The canals are then cleaned and shaped using small files. Cleansing refers to removal of all bacteria, nerve and vascular tissue. Shaping refers to widening the canals to remove potentially infected tooth structure and allow adequate room for the filling material. During the cleansing and shaping process the canals are rinsed and sanitized using a diluted bleach solution (all of this is done with a rubber dam to prevent the bleach solution from entering the mouth). Once the cleansing and shaping of the canal is completed the canal is dried and filled with a thermoplastic (softens when heated) material called gutta percha. The material is heated to soften it and it is condensed into the canals so that is fills in all the space, sealing cement is also used to further assure all spaces are filled and sealed. The root canal is now finished and a permanent restoration is needed to fill in the space created by the decay and access cavity. Root canal treated teeth often require a crown to help prevent fracture. Root canal treated teeth have a much higher risk for fracture because they have often lost a considerable amount of tooth structure due to decay and the access cavity.
A root canal can become re-infected for a variety of reasons. If the canal space is not cleaned out thoroughly or if it is not adequately sealed a re-infection is more likely. However re-infections can occur even when the root canal is done ideally. Recurrent decay (a new cavity under the final restoration) can get into the sealed canal space and cause a re-infection.


2010-07-05 19:53:23   Do any dentists in Yolo County or nearby counties use rectangular collimation? The recommendation to use it has been in place since 1989 because it reduces x-ray exposure to 1/4 of what it is with round collimation—and it makes a sharper image by reducing scatter radiation. Do dentists fear the small increase in reshoots more than they fear over-radiating their patients by a factor of four? While it is wonderful that most dentists now use ultra-fast F speed film or digital receptors to help reduce radiation exposure, ADA and others say to use both the fast receptor and the rectangular collimator. Why is this taking so long? Thank you. —BarbaraKing A collimator is the “cone” or cylinder that attaches to an x-ray unit. A collimator directs the x-ray beam. Using a rectangular collimator can reduce the amount of scatter radiation but it also increases the amount of “cone cuts” or operator errors that require retakes. Round collimators are used in most dental offices to reduce the need to retake films. I am not aware of any offices that use rectangular collimation in Davis or Yolo county. I think the reason most offices have not switched is because retakes can be a significant burden, and given the very low radiation exposure of current dental films the need to further reduce exposure is not viewed as a critical issue. —DagonJones


2010-07-12 10:37:43   This is a question I was asked recently and I thought I would post it here. A patient wanted to know if brushing after every meal (about 5 times a day) can cause harm to the enamel of the teeth.

Yes, brushing after every meal can harm your teeth but it is not likely to cause too much damage. When you eat acidic or foods high in carbohydrates an acidic environment is created in your mouth. This acidic environment temporarily softens the enamel of your teeth (the enamel will re absorb minerals and harden in about an hour). If you brush immediately after a meal you can remove some of the softened enamel. I recommend brushing 2-3 times a day and generally before meals or at least 60 minutes after a meal are best. Brushing more than 2-3 times a day does very little to remove additional plaque and does not have much effect on your risk of developing cavities.


2010-07-20 16:43:03   Hi! Thank you for your page. I am an international student at UCDavis and one of the worst things for a foreigner is to learn how to deal with health related issues. Things are done differently in every country, so I guess that helping us to understand dentist procedures could be a nice addition to your page. If interested, I have two questions right away. First, is it common that your main dentist does not pull teeth? In my country that is one of the most basic things but here, I was referred to another dentist who took a whole new set of Xrays and photos and even had his hygienist explain to me how to brush my teeth (which had already been done at my main dentist's office). Of course that was charged and with that visit (plus my main dentist one) I maxed out my insurance. I do not know if that is poor coordination btw the offices or standard practice. Ah, and the second one did not even pull my tooth so I am flying to my country to have the extraction done. Second, if I wanted to change my main dentist, would the new dentist accept the x rays that I already have taken? I don't feel comfortable with Xrays exposition when unnecessary. And how do I know if the new dentist would perform extractions? Thanks! —CarlaGomez

In California it is rather common for general dentists to refer all extractions to an oral surgeon. However, many general dentists (myself included) have a lot of experience with extractions and do perform them in their office. It is just a personal decision by the dentist. You have a legal right to get a copy of your x-rays (your dentist may charge a duplication fee), your new dentist will likely accept the films you bring in as long as the quality is good enough to perform a thorough diagnosis. If you want to know if your new dentist performs extractions just ask the receptionist when you call to schedule an appointment. Good luck! —DagonJones


2010-07-28 11:52:27   When a tooth is extracted, has it become standard practice to pack the empty socket with graft material, whether or not implantology is contemplated?

I ask this because this is what was told me by an oral surgeon. He stated that the bone should be restored for the benefit of those teeth adjacent to the extraction site. My insurance company does not cover this part of the procedure; however, if the application of bone graft material is now considered standard, then I should challenge their denial of coverage.

What is your opinion?

- - Herb

It really depends upon the situation. Placing bone grafting material into a socket (aka socket preservation) is a very good idea if there has been destruction of bone due to gum disease (periodontal defect) or infection from the tooth that was extracted. However, socket preservation is not always needed, there are many situations where bone grafting is not going to do much at all. Socket preservation primarily helps maintain the buccal to lingual width (that is cheak to tongue distance) of the bone ridge. Preserving this width does not do much to help maintain the integrity of the neighboring teeth but it is good to preserve natural looking gum tissue in visible areas of the mouth, especially when a replacement tooth (implant or bridge) is planned in the future. So to answer your question more directly, I do not feel like socket preservation is the standard of care in all situations, but for some situations it is a very good idea. If there is extensive bone loss very close to the adjacent teeth due to periodontal disease or infection, then socket preservation will be a benefit for those teeth. Let me know if you have more questions—DagonJones


2010-08-05 16:14:57   hi dr. jones, my dentist told me (based off of diagnodent) that my wisdom tooth has a cavity on it (a number around 38). she wants to extract it. would it be possible for a regular filling to go on my wisdom tooth instead of an extraction? could that be done? —lifeatapoint


2010-08-05 16:17:45   hi dr jones, another question: is it normal for a white filling right next to a silver filling (on the same tooth) and will that new white filling lead the silver filling in that tooth to expand and/or crack the tooth? —lifeatapoint

Yes, a filling can be done on a wisdom tooth instead of an extraction. You may need to have a silver amalgam filling on that tooth because the tooth must be kept dry in order to use a white filling and that is sometimes very difficult on a wisdom tooth. There may be other reasons your dentist is recommending an extraction (such as risk for gum infections around the tooth) so you should ask her about it. To answer your other question; it is fine to have a composite (white) filling right next to an amalgam (silver filling) on the same tooth. The two fillings right next to each other will not put the tooth at any additional risk for fracture. —DagonJones


2010-09-27 10:37:46   Hello Dr. Jones, What is your procedure for silver filling removal? Do you follow the guidelines listed by the IAOMT for safe removal? —lifeatapoint


2010-11-03 19:00:48   Dr Jones—I'm curious. Having read your Xylitol info, what is your opinion of [WWW]Zellies and its alleged positive effect on dental health? —Users/PeterBoulay

Zellies look like a good product. They are very comparable to Epic mints and gums, they both have the same amount of xylitol per mint and gum. The shape and size of the gum and mints are almost identical they are probably manufactured by the same company and just branded differently. All the claims they make on their website about the dental health benefits of xylitol are accurate and supported by current research articles. —DagonJones


2011-01-24 08:27:29   Nicely done page. On root canals, you might mention that in addition to abscesses, cracked teeth can also require them. Most older folks like myself have had more root canals from cracks than infections.

I'd also appreciate some mention of emergency dental treatment. I assumed that if you were in pain and required treatment, a dentist would find a way to accommodate you. Having been in that situation with one of the most highly regarded dentists in Davis, I've found that it is not necessarily the case. Friends have had the same experience with other highly regarded dentists. Perhaps you could offer guidelines for appropriate dental emergencies and accepted medical ethics that would require that a dentist provide emergency treatment. —JimStewart

You are right Jim, sometimes fractures can go into the nerve and cause the need for a root canal. In my experience I have found that when fractures are that deep, the tooth is often not restorable because the fracture goes too far down the root. So you were lucky to be able to save your tooth with a root canal. Regarding emergencies, I am sorry to hear that you had experiences where you were in pain and your dentist was not available. Most dental emergencies can be managed with pain medication and/or antibiotics for a few days before treatment is needed, so often during a weekend or after hours all that is needed is to phone in a prescription. If there is trauma or other significant issues that require immediate attention Dr. Johnson and I will see patients in the office during off hours. Most dentists I know have an answering service or a cellphone that they use to let patients get in touch with them after hours. If we go out of town for the weekend we make sure that there is another dentist who has agreed to take any emergency calls for us while we are unavailable. The practices I just mentioned are pretty standard for the dental profession. Unfortunately not all dentists are as diligent about keeping their phone with them or being as available as they should, and sometimes patients think they need to be seen immediately when the issue is not necessarily as urgent as they might think. Hope that addresses the issues you were interested in. I can come back later and add some detailed information about what types of emergencies require immediate treatment and which ones can wait a few days. —DagonJones

Dental Emergencies

Fractured tooth: Most fractured teeth are on back teeth that have old amalgam (silver) fillings. Most fractures result in a cusp and/or part of the filling falling out. Sometimes there is sensitivity to cold and heat or no symptoms at all. In these situations it is not necessary to see a dentist immediately. The exposed tooth structure will need a filling or crown but will not be further damaged by being exposed for a few days, after several months the area may start to decay due to plaque accumulation.
Sometimes part of the tooth that broke is still attached to the gum tissue. Part of the tooth wiggles and wobbles (and is often rather painful) but wont come out. These situations often require treatment within 0-48 hours because the fractured portion must be removed under local anesthetic (it is just too painful otherwise).
If there is intense pain that is present all the time on a fracture tooth then urgent attention is required. If there is bleeding from the inside of the tooth that means the nerve is exposed and the tooth will need a root canal or extraction.

Tooth knocked out or loose: in these situations urgent care is needed. If a tooth is visibly loose and there is bleeding from the gums around the tooth the tooth will need to be repositioned and stabilized by a dentist ASAP. If a tooth is knocked out completely, gently rinse off any debris from the tooth in water and take care not to touch the root. Store the tooth in milk or in the mouth of the patient (but try not to swallow it) and contact a dentist ASAP. In some situations the tooth can be re implanted but the success rate is low. If the tooth that was knocked out is a baby tooth then re implantation is not recommended but urgent care is often needed to address other teeth that may be loose or damage to the surrounding soft tissues.

Toothache: Most toothaches do not require urgent care. Most dental pain increases slowly and can be managed with prescription pain medication and/or antibiotics until regular office hours. Antibiotics are only needed if there is swelling (size of a marble or bigger swelling). Sometimes dental pain comes on strong and fast, if the pain is very severe then urgent care may be needed.

Please post on this page if you think of a common dental emergency that is not described above.


2011-01-31 12:26:00   I've had a crown for several years, and in the last few months I get random pain now and then, usually lasting from 10 minutes to an hour or two. Due to general sensitivity (especially to cold) I use Sensodyne toothpaste. Talked with my dentist about it, and she said it looks like I stress-grind, and the grinding pressure on top of the crown is what gives me the pain. She said the fact that I don't feel the pain everyday but rather every few weeks is an indication of that. Anything, other than a mouthguard (or yoga/massages for stress :P), that I can do? —EdWins

There are many things that can cause biting sensitivity, and one of them is frequent clenching or grinding. A membrane of ligaments surrounds the area between the root and the bone. These ligaments can become irritated from too much force and can cause sensitivity in the tooth. Sensodyne is not likely to make a difference for this type of sensitivity, that only really works for sensitivity to cold/heat. A nightguard usually works best, you should also have your dentist check the bite on the crown (she probably did this when you mentioned it), if the bite is a little high an adjustment might reduce the discomfort. What you are describing is very common, even on teeth with no previous dental work. The good news is that the discomfort is often minor and temporary. —DagonJones


2011-02-01 12:45:48   Last year during an overzealous routine clean, about half of one of my top molars broke off horizontally. My dentist reconstructed the tooth, but six months later it broke off again. Now he says I must have a root canal and crown, because he says he has no idea if the root is damaged; there is quite a bit of the tooth left, and it is not discoloured or sensitive. Being terrified of dental work (traumatized as a child), I really don't want to go the root canal way. As this seems to be a purely preventative measure, is there another option apart from extraction. The dentin is exposed, but I'm wondering whether the remaining part of the tooth could be sealed or capped in some way to protect it from decay or infection. I'd appreciate a second opinion. —MaryKeast

post.jpgA root canal is sometimes needed (even when there is no damage to the nerve) in order to place a post and core to support a crown

I won't call what I am telling you a true second opinion because I have no way of knowing the details of the situation without doing an exam. Having said that, sometimes a root canal is needed to place posts into the root so that the posts can help retain a buildup that is needed to help support a crown. However, that does not sound like the situation in your case. You may have the option of doing another filling (which will likely break off again as the first one did), or a crown. It sounds like a crown is going to be WAY better than another filling. You could have a crown without a root canal first. Lets say you get the crown and no root canal, and a few months or years later it becomes apparent the tooth did need a root canal. A root canal can be be performed by drilling a hole through the chewing surface of the crown. As long as the crown is gold or porcelain fused to metal (and not a full porcelain crown) then it is very unlikely the crown will need to be replaced to do the root canal. It is always preferable to do a root canal before a crown because the alternative damages the crown, but it is rarely necessary. —DagonJones


2011-03-07 19:41:04   Hi, I had leukemia treatment 13 years ago which has resulted (amongst other things) in my having a permanent dry mouth condition. I've had a multitude of cavities because of this, and during a recent half year of extreme stress, I developed significant periodontal disease. I had non-surgical treatment for it, and my dentist told me last month that I no longer have any gum pockets and very little plaque(hooray!). Since the three-month long periodontal disease treatment (ouch!), I have been maintaining my teeth with a 35-40 minute session every night, in which I floss, brush with inter-dental brushes, and use a high-quality electric toothbrush for 16-20 minutes. My question is, am I brushing too much? I am under the impression that I do not have any enamel left (is that possible?), but I am very worried about keeping my own teeth (I'm only 33). Is my tooth routine too extreme? —AmberWilkin


2011-04-15 13:35:30   I don't live in Davis so hope it's. OK to post (although moving very there is tempting!) My question is - I had a root canal in 7 from a car accident but for some reason there was an unresolved fracture. Later my tooth broke at fracture and needed a post and crown - another dentist did that work and I left the temp on for quite a while with no problems. Finally got the perm crown and now experiencing excess saliva, which is doubly odd because I had dry mouth before due to medications. It's been about a month. Is this just an adjustment period or should I be concerned? The new crown fits a little differently (better) than the temp but they did make it thicker on the back (I think because my original tooth was thin). Thanks for your mouth. At first I was glad my mouth wasn't dry but it's gone way too extreme. —EmmaInteresting

It is certainly ok to post here if you don't live in Davis (even if you had to live in Davis to post there is no way to confirm that so I don't really care.) I have never heard of a crown causing excess saliva. I don't see how it would be possible unless you were playing with the crown a lot with your tongue. The excess movement might stimulate some more saliva flow but I doubt it would be noticeable. If you stopped using certain medications around the same time, you might be perceiving your now normal saliva flow as excess considering the change. Excess saliva flow will not cause any problems for your teeth or gums, in fact it will help prevent cavities (saliva naturally fights decay). —DagonJones


2011-06-03 13:37:15   Hey Dr. Jones, you are taking my wisdom teeth out in a couple weeks, but I figured I would post my questions here so everybody could benefit from the answers (plus I'll hopefully be too doped up on the day to remember anything, let alone have a coherent conversation).

I've already made a list of soft foods to eat after the surgery (pudding, mashed potatoes, applesauce, plain yogurt, soups, cream of wheat, refried beans, etc. if anybody needs ideas) and I've heard the typical advice about not using a straw, not eating anything hotter than lukewarm, that kind of thing - but I was wondering about some gray areas:

Peanut butter: too sticky?
Pureed Indian food: too spicy? (also, if I get my "supremely spicy" flavor hummus is that bad?)
I also heard that drinking pineapple juice and biting down on black tea bags will speed the healing process. Old wives' tales?

Thanks and see you soon! —MeggoWaffle

Peanut butter is just fine. Indian food might be a bit spicy and therefore irritate the extraction sites but if it does not hurt while you are eating it then you should be fine (just make sure you eat only bland foods if you are still numb). Pretty much any food that is comfortable to eat is ok. Black tea bags contain tannin which constricts the blood vessels and reduces bleeding but will not speed up healing. Pineapple juice does not seem to do anything special, I found several references to it reducing swelling or helping healing on a Google search, but nothing from reputable sources. I searched for research papers on this subject and found nothing so it is most likely an old wives tale. In regards to the anesthesia, you will be rather sleepy and out of it for several hours afterwards so it does help to have a "babysitter". We will not be using general anesthesia or IV sedation so your sedation level will be rather light and easier to come down from. —DagonJones
Update on Pineapple Juice: It has the chemical Bromelain in it, which supposedly reduces swelling. There is a German study from 1989 that found that it reduced swelling a small amount following third molar extraction, but not enough to be statistically significant. So I still don't think it will do any good.
On a side note Grapefruit Juice can increase the effect of many medications because it inhibits an enzyme called Cytochrome P450 (CYP450). This enzyme is responsible for breaking down many medications in the blood stream. So if you have less of the enzyme, the effect of the medication is increased. This is generally undesirable and can cause dangerous difficulties with breathing if taken while using sedatives or anesthesia so it should be avoided when taking any medication.


2011-10-02 20:18:04   My 14 y/o daughter has a 12 yr molar that the dentist says x-rays show adult tooth coming in crooked has only eaten away one root. Dentist planned to sedate and remove the tooth which I would have to pay a co-pay for. I told her I'd pay her if she could remove it. She did. I am worried now if she left any root in, have we created a worse problem? Or will her body just reabsorb it as the adult tooth pushes up. Thank you for considering my question. —DebbiJohns

Good question, however, I am a little confused. The 12 year molar (aka 2nd molar) is an adult tooth that erupts into the gums behind the first molar without replacing a baby tooth. I am assuming that she had a baby tooth removed to make way for the adult tooth. It sounds like the adult tooth did not resorb (eat away) all of the roots of the baby tooth, and therefore the baby tooth would not fall out on its own. If the baby tooth was extracted and a portion of root was left behind, most of the time the remaining root will be resorbed or remain in the bone without any problem. In rare situations the root can become infected and require further treatment. Check the area every few days, if the area is very red and swollen and your daughter reports increasing pain, that would be a sign of infection and she needs to go back to the dentist soon. Even without any infection the area should be monitored every 6 months to make sure the adult tooth is erupting normally. Please let me know if you have any other questions (or if I was wrong in my assumption). —DagonJones


2011-12-08 17:54:44   Hi Dagon I was asking a friend of mine a dental question and I was referred here: I had a filling fall out a while back and it is now really starting to hurt me, how much do you think it would cost to get repaired? I didn't realize it had fallen out until now it is located in the top right middle side of my mouth. Thanks —KellenRuel

Tom brings up a good point. Most dentists will replace a filling at no charge if it was done within a year or two, of course this depends on the circumstances of the situation and the individual policy of the dentist. If the filling just needs to be replaced it could cost anywhere from $150-$250 depending on the size of the filling and the type of material used. The fact that you are having pain is a concern because this indicates there is likely decay on the tooth and it may have entered the nerve. If that is the case the tooth will likely need a root canal and a crown (see the above description about root canals "[WWW]here"). If the tooth needs a root canal and crown there is considerable more work involved and the fees could be $1300-$2000 depending on the tooth. If you have dental insurance, your insurance will cover a portion of the fees. If the tooth is hurting all by itself (it throbs or aches when you are not touching it or eating) then that is a sign it will likely need a root canal. If it is just sensitive when you drink cold liquids and the pain goes away immediately after the cold is gone then that is a normal reaction for a tooth that has lost a filling and you most likely don't need a root canal. It sounds like the filling fell out and it felt fine for a while but now it is hurting, this is most likely a situation where decay is present and it has spread to the nerve and you will probably need a root canal or extraction of the tooth. I would advise you to see a dentist soon because you could develop an abscess in this area which is often very painful and a significant infection which will need attention. I hope this helps and I wish you good luck. —DagonJones


2012-01-04 05:42:59   Hi Dr. Jones, I was a regular seeing my dentist twice a year but getting 4 cleanings per year. At my March visit the Hygenist was very aggrssive and scrapped hard and hit my teeth with the polisher and pressed with Her weight against fronts and back of teeth. I was in a state of shock and asked what she did and she said it was just the polish that I was seeing. Lumping as I was rinsing. My tongue on the back of the 4 bottom front teeth felt strange like they were too clean. After that food started sticking too my teeth and food did not taste right. Choking on food as I tried to eat. Now all my teeth are yellowing some translucent, you can see verticle cracks and the sensitivity is constant. I had no sensitivity until this cleaning. I had amalgram fillings from a young teenager and they Are all raised and blackened. Saw dentist in June and begged him to fix 1 molar with a crown as it was raised so high and exposed on the whole tooth. He said he wanted to wait. I went back the following month and he said my teeth are to thin and they all would need to be capped. The 8 bicuspids that never had any fillings are all worn away. I told my spouse about this as I went regular to dentist and to have this happen All at once and not over a period of time seems odd. I note he fired the Hygenist I had for all those years. When we went for the consult he said we will cap them when I deem it necessary. I felt it was necessary then. Nevertheless, he let me suffer and I went to another dentist that said all my fillings were cracked and he worked on upper left and bottom right and now my bite is off having headaches difficulty eating and speaking. My face is distorted, mouth difficult to open, air hurts all the teeth I have hard calculus forming 2 days after a cleaning, gums are receding and I am in agony. Face nose and cheek pain. Lips constantly cracking and mouth ulcers inside on gums. What type of dentist do I need? Who can determine if I have bone loss. Glands under jaw inflamed. Face sinking and redness in nose and cheek and chin area. I stopped using soma care toothbrush for oral b ultra soft. Was always a great flosser but from her scraping the floss gets stuck in every tooth and breaks off. Brushing is painful and food is getting stuck up above my teeth in my cheeks. Using biotine for dry mouth. Lips are enlarged and while all my face is shrinking they are protruding from my teeth shifting forward. Also top molars are shifting out to cheeks and bottom are going inward not the u shape they were. I have vision problems and headaches that I believe Are a result of this. If you need more information please do not hesitate to ask. I tried to have mercury Poisioning test done but not enough lipos in my blood.

I need to start by saying that unfortunately I don’t think I can be much help for you. You describe a lot of symptoms here that I consider to be out of the scope of my practice as a dentist. You list headaches, vision problems, pain in nose and cheeks, and changes to your facial structure. These are all symptoms that I do not feel comfortable diagnosing or treating.
Regarding the sensitivity you are feeling on your teeth, it sounds like you have had a history of periodontal disease as this often requires cleanings 3-4 times a year. Periodontal disease can result in recession that exposes the sensitive roots of the teeth. Sensitivity protection toothpastes (like Sensodyne) can sometimes help or a dentist dispensed product called “MI paste” can be applied to your root surfaces by you at home and that often helps with sensitivity. It is common for sensitivity on root surfaces to increase right after a cleaning because tartar is removed from the surface of the roots. This tartar should be removed because it contains lots of bacteria that can make periodontitis worse, but it also covers the sensitive surfaces of the roots and removing it can increase sensitivity.
Regarding the vertical fracture lines in your teeth; under the right lighting you can often see dozens of small cracks in the enamel of teeth, these are called “craze lines”. They are confined only to the enamel, cause no pain, and are very common. No treatment is recommended for craze lines
You also mentioned your bite is off after some recent dental work. This could be a result of some of the fillings being too high, they may need to be adjusted. I would suggest having the dentist who placed them check for high spots. Often when multiple fillings are done it may be impossible to get the exact same bite as before, this is not always a problem as many people will adjust to a slightly different bite within a few weeks.
Regarding the shredding of floss between your teeth, this is often caused by very tight contacts between teeth or very rough fillings. Aggressive scaling of your teeth by a hygienist would not be able to tighten the contacts, and often would result in smoother surfaces of the fillings unless a filling broke or chipped during the cleaning. I do not think the flossing difficulties are a result of the cleaning you described. I would recommend a high quality floss like Glide. High quality flosses slide easily between tight teeth and tend to shred less.
You also mention food sticking to your teeth, food not tasting right, choking on food while eating. I am sorry to say that I do not know what could be causing these symptoms. I cannot think of any reason why they would be caused by a very aggressive cleaning. I am very sorry to hear you are in so much discomfort and I understand you are very concerned about all the changes you described. I would strongly suggest that you start by seeing your physician to discuss the headaches, facial pain/redness, and vision problems. These could be symptoms related to a systemic heath problem. If you have any other questions please feel free to ask and I will answer to the best of my ability. —DagonJones


2012-01-04 11:30:59 Dr Dagon: Can you please provide your opinion on using amalgam for fillings? What are the alternatives to amalgam and do they last as long?
BrianPaddock

Dental Filling Materials

[WWW]Here is a link to the Dental materials fact sheet that is required to be provided to all patients by the Dental board of CA. This is a very nice pamphlet that details the strengths, weaknesses, and toxicity concerns of available dental materials.
I consider amalgam to be a safe, good restorative material. There are situations when amalgam is the best material. Each material has its own strengths and weaknesses. Amalgam is not a pretty color, but it works well in a moist environment and does not require enamel to bond to the way that composite (white fillings) do so it can be used when composite should not be used. It is less technique sensitive than other materials so it usually lasts longer when used in difficult areas to access (like behind the last molars, or on people with very limited opening). It is very durable to compression forces when it is at least 1.5mm thick, so it is a very good material for medium to large fillings. It typically lasts longer (but not necessarily) than composites because it is less technique sensitive, conditions have to be just right to get a long lasting composite filling. Amalgam is not the best material for very small fillings because it requires a certain thickness to be strong.
The most common alternative to Amalgam is Composite. Composite is a resin (basically a plastic) reinforced with particles of silica. Composite bonds very reliably to Enamel (the hard outer layer of teeth) but less reliably to dentin (the softer inner part of a tooth). For this reason it is not appropriate for cavities that are deep between the teeth because there is often a lack of sufficient enamel on the deepest part of the tooth and moisture control is difficult. Provided moisture can be controlled a composite can be used in a situation like this but it will have a higher chance or recurrent decay than a comparable amalgam filling. Compisite is very strong even when it is very thin, for this reason it is better than amalgam for shallow, conservative fillings.
Another family of tooth colored filling materials are Glass Ionomers and Resin modified Glass ionomers. This family of restorative materials bond to the tooth via a chemical reaction. They absorb and release fluoride over time so they are very good at resisting recurrent decay. They are rather weak to compressive forces and therefore are not appropriate for the chewing surfaces of adult molars. They work well in a moist environment so they a good alternative when moisture control is difficult. Glass ionomers work best for cavities near the gumline. If someone has a deep cavity that involves a chewing surface in a back molar and does not want an amalgam filling, using only a glass ionomer would not be appropriate because it will not withstand the compressive forces over time. So sometimes Glass ionomer and composites can be layered to provide a good long lasting alternative to Amalgams. This technique (sometimes called a “sandwich” technique) contains multiple steps. Due to this fact it is rather technique sensitive and time consuming, so there are more potential for problems like voids between the filling layers.
Other restorative materials include laboratory made gold and porcelain restorations (crowns, inlays and onlays). These restorations have to be made in a lab from an impression of the prepared tooth. Due to this fact they often require 2 visits (but may not if the dentist has an in house computer aided milling machine). Due to the additional expense and time involved these restorations are more expensive than a direct placed filling material. Laboratory made restorations work best when there is extensive destruction to a tooth or fracture of the tooth is a concern. Direct filling materials (amalgam and composites) can leave a tooth susceptible to fracture, especially when the filling is very large. Most gold and porcelain restorations are designed to cover the cusps of the tooth and therefore help prevent future fractures. I was taught and personally think gold is the best restorative material for medium to large restorations. The margins (the area where the restoration meets the tooth) of gold restorations are often smoother than porcelain therefore resulting in less plaque accumulation. There is a lot of information and detail I can go into about each material but this provides a pretty good overview. If anyone has further questions please follow the link to the dental materials fact sheet or feel free to ask. —DagonJones

Gum Grafts

mgj.jpgThe junction between hard gums and thin mucosa

davis wiki gingiva.jpgRecession on two central incisors There are two major reasons a patient is referred to a periodontist for an evaluation for gum grafting. First and most important is to stop recession and bone loss around teeth to prevent the loss of that tooth (or teeth). Second and less frequent is for repair of esthetic defects. Many times, after treating a tooth with a gum graft to restore health and prevent further recession, the tooth also looks better esthetically because the exposed root has at least been partially covered with the gum graft and has less recession.

What happens when a patient is referred for an evaluation of gum recession? I will address that issue and any factors that may contribute to the gum recession including the lack of sufficient hard gum tissue around the tooth. The are two basic types of oral tissues in the mouth: keratinized non-movable hard tissue around the teeth for protection during chewing and mucosa which is more thin and delicate but movable. These tissues have very different functions which is evidenced by their macroscopic and microscopic anatomy. If there is not enough hard keratinized gum tissue around the tooth then there can be progressive loss of gum tissue and bone.   Genetics is probably the biggest factor contributing to recession. People with fair delicate skin generally have fair delicate gum tissue that is more susceptible to gum recession because their gum tissue is traumatized and torn easier during chewing or tooth brushing. Some people also have genetically strong frenums, which is the attachment from the lip. This can predispose them to recession. Another common factor is using or having used in the past a tooth brush with medium or stiff bristles. Years ago dentists used to tell patients to use stiff tooth brushes because they clean better. This is true, but we found that it comes at the cost of causing recession more often. Most dentists now recommend soft or extra-soft tooth brushes. Soft tooth brushes might not clean quite as well, but they are safer for the gums. Likewise, if a patient is using a very abrasive toothpaste (especially ones that advertise their tooth-whitening ability), then beware of their being very abrasive and wearing away the gum tissue. Fortunately the American Dental Association tests toothpastes for effectiveness and safety. If a toothpaste has the ADA Seal of Approval, then it is effective and also safe to use with regard to abrasiveness. A fourth factor contributing to gum recession is the tooth being out of alignment even a slight amount and being traumatized and loosened because of the way the teeth hit.  In that case having their general dentist make the patient a night guard can help significantly. Another factor can be orthodontic movement of teeth. Fortunately, the orthodontists in our area are very proactive in sending patients for an evaluation before or during orthodontic treatment if they suspect a problem. Severe cases of recession usually have more than one of these factors going on simultaneously.

So why should you worry? One reason is that besides loosing gum tissue you are also loosing the bone that supports the teeth. I emphasize bone loss because where you can see the root of a tooth not only gum tissue has been lost, but also the bone that was also covering the root. The tooth is normally embedded in bone and the gum tissue covers the bone. There is an old saying in periodontics that is corny, but summarizes the problem: “The (gum) tissue is the issue, but the bone sets the tone.” Another problem is that roots are very soft, unlike enamel, and are more prone to cavities if exposed to the oral environment. When tooth roots get cavities, the decay can destroy teeth rapidly. If there is bone loss between the teeth (chronic adult periodontitis) in addition to bone loss from recession on the outside surfaces of the teeth, then the situation is more complicated.

What can or should be done? The generally accepted treatment for progressive recession of gum tissue (along with the bone loss that accompanies recession) due to the lack of sufficient hard gum tissue is the addition of hard gum tissue by a gum graft.  I emphasize the word progressive because not all recession needs to be treated with grafting. If someone has been using a stiff tooth brush and has lost some keratinized gum tissue around their teeth but still has enough keratinized tissue remaining to resist further recession, then the treatment of choice may be to simply switch the patient to a softer tooth brush and monitor for further recession. This will  many times prevent further recession and bone loss.  If there is not adequate hard gum tissue to prevent further recession then a gum graft should be considered. The gum graft (a general term which includes “free gingival grafts”, “connective tissue grafts”, and “pedicle grafts”) has more than 50 years of clinical research and there have been many thousands of research publications over the years in refereed scientific journals as to its effectiveness.  The gum tissue that is grafted can come from the roof of the mouth or from a tissue bank. The autogenous tissue (from the roof of your mouth) is firmer and harder than the allogenic tissue (from tissue banks). But using the tissue from tissue banks eliminates a second sore area. The area on the roof of the mouth usually feels like a pizza burn for a week or two, but will totally fill with new tissue in within a few months.

What are the side effects and contraindications? The main side effect is soreness on the roof of the mouth. Patients should kick back for a day or two and sip cold liquids over the surgery areas. I usually give long acting local anesthesia so people can go home and place cold liquids (such as ice water) on the surgery area while still numb. Cooling the surgery area during and after treatment will reduce any bleeding, swelling or post op soreness and help things heal faster. Some people notice a temporary sensitivity to cold that goes away within a few weeks to months. Applying desensitizing agents at post op visits helps greatly. A major contraindication is if patient does not want it.  Uncontrolled high blood pressure or uncontrolled diabetes are also contraindications to gum grafting. Unrealistic expectations is also a contraindication. The larger the amount of recession and the more the bone loss, the less root can be covered for esthetics. Plus, everybody heals differently. I can do the same exact procedure on two different patients and have two different results. One patient may get significant root coverage and the other minimal. Although getting root coverage is not totally predictable, getting adequate hard tissue for health and to prevent further recession is very predictable. Clear communication between the doctor and the patient is very important before starting gum grafting. It is important that the patient understands the risks, benefits and alternatives to various treatments and then makes an informed decision as to their course of treatment and accepts responsibility for their decision. —DavidJolkovsky


leo.jpgDark spot indicating bone loss and infection fistula.jpgA Fistula, an area where pus is draining from an infection 2012-01-09 01:25:05   I am a college student on a very tight budget and have a question. I had a tooth that had decay extra deep and when the dentist drilled it out he said he might have left a microscopic hole in my tooth which would lead the a nerve. He put a special sealent on it to hope and save it. He told me if it was sensitive to hot or cold I would have to get a route canal. The only problem is I can't afford one. It hasn't became sensitive to hot or cold yet but I am wondering if it does, will not getting a route canal cause any other harm to my body besides pain? —kamogurl1213

What you are describing is a rather common situation when decay is very deep. The deepest part of decay can penetrate a very small section of the pulp chamber (nerve canal space), if this happens bacteria can enter the pulp chamber and lead to an infection that requires a [WWW]root canal. This situation can also happen when the decay is very close to the pulp chamber but there is not a visible penetration into the pulp chamber. It is unpredictable to determine whether or not the tooth will need a root canal. In my opinion, your dentist did the right thing by placing a seal over the exposed area and asking you to look out for symptoms. If the tooth needs a root canal it may take months or years before you notice symptoms. You will most likely notice a throbbing pain that occurs for no reason or pain to cold that lingers for several minutes after the cold stimulus is gone. It is possible for an an infection to occur in the root (requiring a root canal) but you will have no symptoms at all. This situation can be detected by taking screening x rays of the root, a dark circle will show up on the x ray around the tip of the root indicating there is an infection present.
To answer your question, if an infection develops and you do not get a root canal the infection can become severe. These infections can be (but are not often) life threatening. Usually the pain is so severe that people have to go to the dentist for either an extraction or a root canal. Pronounced facial swelling can occur due to the infection. Sometimes the infection is not very severe and if the pus can drain (usually through a small hole or "fistula" in your gums that looks like a pimple) then it may not be painful. In any situation it is best to get the root canal or extraction, if an infection is present your body is constantly fighting off the infection and bacterial toxins are created. All of this is not good for your overall health. As the infection continues bone around the tooth will be lost (this can be regenerated later). In your situation I would wait and watch for any symptoms, if the hole to the pulp chamber is small there is a very good chance the tooth will be just fine and you may not need a root canal. —DagonJones


2012-03-10 09:21:47   I am a high blood pressure patient who recently visited a dentist because of toothache. I had thought the enamel on one of my molars was slightly eroded only to find out that I had an infection in my gums. Without any prior antibiotics given, the dentist proceeded to perform a partial teeth cleaning (emphasizing the need for me to come in thereafter several times a year to have my teeth cleaned). This led to further complications as my jaw swelled up with an abcess the size of a nickel. I was in pain for several days thereafter and had to return to demand a prescription for painkillers. Is this proper procedure in cases like these? —TokunbohJiboque

"infection in your gums" most likely refers to periodontal disease. In which case cleanings several times a year are very important as well as Scaling and Root planing (deep cleaning). It is not standard to give antibiotics before a regular cleaning or Scaling and root planing. As a result of a cleaning, sometimes a localized infection and or irritation may occur. This may require antibiotics or pain medication. To answer your question it sounds like pretty standard procedure, however usually a hygienist does the cleaning not the dentist. I would recommend you get a deep cleaning (scaling and root planing) if you were diagnosed with periodontitis. —DagonJones


2012-03-16 23:56:45   I have just had 9 teeth removed and my jaw keeps slipping out of place and I've tried to use a bite guard but its causing more damage to my jaw and when I use the bite guard it hurts my jaw. I just wanted to know if there's anything you'd recommend, because surgery isn't an option, oral surgery has already caused this problem. —RaevynJasmyn Jaw issues can be very frustrating and difficult to diagnose and manage. Unfortunately in order to understand the specific issues that are happening with jaw disorders a physical exam is required so the dentist can feel what is going on with the joint. I would recommend seeing your dentist for a TMJ exam as I am unable to give any sound advice without a physical exam in this situation. —DagonJones


2012-03-31 21:51:11   Dr. Jones, I just had a gold onlay pop off while I was flossing! Of course, this has to happen over a weekend. Is it OK to wait until Monday to see a dentist? Any other activities I should avoid? (other than chewing on that side) —RobertaMIllstein

Inlays do come out from time to time. It is fine to wait a few days to get it re cemented. When an inlay or filling between the teeth is lost food is likely to get caught between the teeth. Be sure to floss or use a toothpick to get this food out after meals. —DagonJones


2012-04-13 12:27:14   What are the best ways to battle bad breath? —JenniferCook


2012-05-08 10:15:13   About 15 years ago, my dentist broke a file in my tooth during a root canal. Today, I went to another dentist b/c I have a pain in my jaw below the tooth where the root canal is. The new dentist said I need to go to an endodontist and have the file extracted. My question is this. Who is responsible for paying for the file extraction? Me or the original dentist? Thanks. —JackieEldridge

I understand that this is a rather frustrating experience for you, however, file separations are a rare but often acceptable outcome. When a file breaks off the accepted method of treatment is to finish the root canal and leave the file in place as part of the filling material then monitor the tooth for symptoms or signs of infection. If 15 years went by without any problems it sounds pretty successful. Even if the file had not broken off and the root canal was done as perfect as possible you might still have a re infection of the root canal system because root canal treatments do not always last forever. It may not be the file that is causing your symptoms. So to answer your question it would be your responsibility to pay for the re treatment. Your question is actually more for a lawyer than a dentist, but if you wanted to file a claim against your previous dentist to try and get him to pay you would not have a very good case. I think you would need to show that the dentist was negligent and file breakage is an unfortunate outcome that can happen even in the hands of the most skilled dentist, but it is often not due to negligence. —DagonJones


2012-05-23 11:54:08   I have a 20 month old son who still uses a pacfier. I have heard differing opinions regarding whether or not a pacifier causes damage to a baby's teeth. What's your opinion? —jsbmeb

Sorry for the delay, I was on vacation for a few days. Pacifiers and thumb sucking can cause orthodontic movement of the anterior teeth, but they will not cause decay or other problems. This is usually not a problem unless the child is using a pacifier or sucking their thumb beyond age 4. The typical result is the front teeth push forward and out so when the child bites down there is a open gap between the upper and lower front teeth. The general recommendation (which may differ depending on who you ask) is to discontinue pacifier use at about age 2, and to discontinue thumb sucking by no later than age 4. —DagonJones


2012-06-14 10:10:12   I went to the dentist yesterday, after having not seen one in awhile. My previous dentist hurt me terribly on my last visit years ago, and it kept me from seeing another one.

I don't know dental terminology for tooth id, so please excuse that. But, here's the scenario:

The problems exist on the lower teeth, back right side. On this side, I have a tooth in the far back, then a gap where an abscessed tooth was pulled, then there is the other problem tooth, located right after the gap (tooth, gap, tooth).

Problem 1: Far back tooth on the bottom right has decay that wraps around 3 sides. The dentist said it may be non-restorable, but she would try to fill it, and would probably need a crown. She did x-ray of it, but said she wouldn't know how extensive the problem was until she drilled into it. She wants to attempt to fix it tomorrow.

The tooth is giving me no trouble, and is the only back tooth I have on that side remaining that I am able to chew with. I asked the dentist, since it was a gamble to try and fix it, why didn't I just leave it alone unless/until it gave me trouble. She said that wasn't an option, and then I would be looking at a root canal.

Problem 2: The tooth in front of the gap, the dentist says, is not restorable, as it has a large cavity on the back of it.

I do notice mild sensitivity sometimes with this tooth, but nothing bad. The dentist agreed I should probably leave this one alone until it causes me a problem. When / if I have this one pulled, it will show when I smile.

I do not have the money to go to another dentist right now. I have heard of implants, but know I don't have the finances for them at the moment.

What should I do? I am scared to death I am going to go to the dentist tomorrow, and walk out without a very important tooth, losing my ability to chew on that side.

By the way, I am not referring to a wisdom tooth. All of mine were extracted years ago.

Thank you for your advice. —kbmeador

I would agree with your dentist's advice. If there is a tooth that has very deep decay it is definitely worth trying to save it. If you just leave that tooth alone because it is not bothering you now then you pretty much guarantee that the decay will go into the nerve and will need a root canal or an extraction. If your dentist cleans out the decay and finds that the decay is very close to or a little bit into the nerve then ask her to do a "pulp cap". This is placing a small amount of medication that contains calcium and will help to heal the nerve and hopefully prevent the need for a root canal. This step will improve your chances just a bit. If the tooth needs a crown and you cant afford one you can ask for a bonded amalgam filling. This is a large metallic filling that is bonded to the tooth to help it from falling out and there is some believe this will help prevent the tooth from breaking later. A crown will be much better but a bonded amalgam will be your best bang for your buck. Don't be alarmed if this tooth is very sensitive to cold for several months. If the tooth starts to ache and the pain gets worse then that is a sign the tooth will need a root canal or an extraction.
Regarding the tooth that is not restorable, if your dentist says it is not restorable and it is not bothering you now then it may be best to just watch it for now. However be cautious that sometimes infections can be present and they will not cause any symptoms, so just make sure your dentist is monitoring the area every 6 months to a year. Let me know if you have any other questions —DagonJones


2012-06-22 12:45:36   Hi.. First timer. About 11 years ago, I had 2 root canals done, same time, on my 2 molars bottom right. About 6 months ago, the crown came off the tooth furthest back and I had the remainder of the tooth and roots pulled out. The other day, I went back to the oral surgeon for an implant consult and he told me that the xray (he just took) shows an abscess below the root canal of the 2nd tooth. I am not having any problems with it, but he says he wants to do surgery, or an epicore (sp?) to remove the abscess, while he's doing the implant for the tooth next to it. Does this sound right? Is it possible to have an infection below a root canal? And, why couldn't I get rid of it with some antibiotics? The extra procedure he wants to do is costly, about $800. That's on top of the implant and eventual crown. Just wondering if its necessary, or is he trying to make a few extra bucks? Thanks. —TonyFabrizio

What he is describing is a real thing. Sometimes a root canal can fail or become re infected after many years and need retreatment or an apicoectomy. I generally recommend an endodontist (root canal specialist) evaluate the tooth for retreatment but an oral surgeon can do that too. Antibiotics will not get rid of the infection because there is likely some bacteria or necrotic nerve tissue inside the tooth that will cause reinfection despite antibiotics. DagonJones


2012-06-25 14:54:17   could you please tell me what the pain i might be feeling at the roof of my mouth is i cannot eat any kind of tabasco sauces it causes me real pain. are their open holes? —NancyCollins In your soft palette? Your hard palette? Do you have open cold sores? Do you have cuts that are reacting to the spice? How bad is this pain? Can you describe it? Daubert

If this pain is new and you have not experienced it before it is most likely caused by some type of sore,lesion, or cut on the roof of your mouth. The most likely situation is trauma, either from rough food (tortilla chips) or a burn (usually pizza). If you have ever had cold sores in the corner of your mouth then the virus that causes cold sores (herpes virus) can sit dormant in your body for years and can occasionally cause multiple pimple like sores on the roof of your mouth that can be very sensitive. This type of herpes lesion almost always occurs as 5 or more red dots on one side of the soft pallate only. All of the situations I described (herpes or trauma) are self limiting and should go away within 1-2 weeks. There is also a condition called "burning mouth syndrome" that does not have a known cause. It is characterized by a burning sensation, usually on the tongue, that comes and goes. This condition affects women more frequently than men and is also associated with other neurological pain syndromes. I am not aware of any known treatment for burning mouth syndrome, but it sounds like this is not your situation as it is often characteristically on the tongue.—DagonJones


2012-10-04 20:51:07   Is it common practice for a dentist to put fillings in children without sedating and/or numbing them beforehand? —JenniferCain What you describe is quite common. Because an injection is often very traumatic for kids it is avoided if possible. If the decay is shallow or moderate it often can be removed with no or minimal discomfort, and if the child is moderately cooperative the whole process often goes very smoothly. More extensive work will require anesthetic and possible sedation depending on how cooperative the child is. —DagonJones


2012-10-12 08:01:49   My son is 14 and nearing the end of his years in braces. earlier this year they began to close a 1 to 2 cm gap by his lateral incisors. The left side did fine but the gap on his right — when it closed up his gums got deep pockets around that tooth. So when he flosses it slides pretty far up the tooth. What is the general consensus as to treat this? should people be less aggressive sliding the floss so that ligaments can reattach or should people use a WaterPik type of instrument instead of floss? we are very diligent about cleaning so it doesn't seem to be from lack of proper dental hygiene. there is no swelling or redness or bleeding. He began using Listerine a month ago but we haven't noticed a difference. Thank you so much for your time!! I can't wait to learn why this is happening and the general consensus as to remedy it. —SusanDaniels I cant say what has caused that without taking a look. The fact that there is no swelling or redness is a good sign, he should be able to floss normally, push the floss below the gums with gentle pressure until you feel it stop. It is likely that the gum tissue is just swollen in this area due to inflammation. This is a very common situation with braces and will likely go away a few months after they are removed. He should keep the area clean by flossing and brushing well with a soft bristled toothbrush. Ultimately you should have his orthodontist take a look at the area. —DagonJones


2012-10-16 10:52:00   How strong and functional are porcelain or ceramic crowns? I broke a tooth (front) last weekend and had to get an emergency temporary made immediately. It needs to last me a few months because I need to have a repeat root canal on the tooth first. Now I am worried about the permanent restoration since everything I read states temporaries are NOT strong or durable - are permanent ones much better? Once I have the permanent crown, do you have to be careful about biting things? I don't try to open things with my teeth or bite my nails or anything like that, but I just want to make sure I will be able to eat normally without worrying about it breaking off, as my only option after that is to replace it and I can't believe how expensive it's going to be. I have never had a crowned tooth, although I do have several root canals due to trauma from a car accident about 10 years ago. My other concern besides durability and strength is color match/shape match, as I need it to look natural. My temp looks amazing, I hope the final one can be made exactly the same. —JenF


A permanent porcelain crown should be quite strong, you can eat normally but just avoid using like a tool and you should be fine. The strength of a crown can change depending on the amount of tooth structure you have under the crown, if the accident left you with very little front tooth then the crown will be more prone to breaking off. If your temporary looks great then the permanent restoration is likely to look just as good if not better. Sometimes crowns need to be sent back to the lab one or more times to make subtle changes to the shade or shape to get it just right so be aware of this possibility. —DagonJones


2012-10-26 17:18:09   Hello Dr. Jones

I had a very small filling on tooth number 3 replaced and experienced quite a bit of pain afterwards when chewing. The dentist wanted to wait and see if it the pain subsided on its own so I waited a few weeks but still experienced discomfort so she removed the first filling and did a new one (both were composite). The filling also feels very awkward with sharp edges where food gets caught when I accidentally chew on that side.

She now wants to do a crown and I am concerned since the tooth never bothered me previously.

I requested that both fillings be done without anesthetic and, while they were painful, they were not excruciating.

At present, it hurts when chewing and there is often a dull pain throughout the day.

I appreciate any advice you might have!

Thank you! —tkh777

It is quite possible that the tooth has a fracture somewhere within it and may require a crown, and this might not be apparent until after the filling preparation (at no fault of the dentist). First, I would recommend trying to have the filling replaced with Amalgam one more time before going for a crown. Sometimes changing the filling material helps resolve sensitivity to chewing. chewing sensitivity is more common with composite than with amalgam. Composite is a resin material and therefore has some flexibility, Amalgam is a rigid metal and has virtually no flexibility and is therefore less susceptible to chewing sensitivity. Additionally there is more potential for voids in a composite than an amalgam and internal voids can lead to sensitivity as well. I think you will also have less of an issue with rough edges with an amalgam due to the fact that amalgam cures slowly and therefore less rough edges are created during placement and finishing/polishing. —DagonJones

On a side note recently during an infection control class the instructor informed us that the number one complaint in dental offices is assistants or doctors going into drawers to get clean equipment with gloved hands. I thought about this and realized that often a patient is sitting in the chair and can not see what is going on. We often will retrieve items from drawers without removing gloves, we use a clean pair of tweezers to open the drawer and retrieve the item, that way our gloved hand never touches any items, just the clean pair of tweezers.


2012-10-30 15:59:17 I have a question regarding my mouth.. i had a gum graph done 8 months ago but my problem is dat i have a metal piece hanging from my mouth is dat a good thing —msliline09

I'm not sure what you are talking about here but if there is a metal piece hanging from your mouth dat is probably not a good thing. It might be a suture (stitch) that needs to be removed. Call the doctor who placed the graft and describe the situation. —DagonJones


2012-10-31 17:13:52   Thank you for your quick response in regards to my tooth issue!

I have several more questions. Is there any danger in waiting to do a crown and trying to chew with only the non affected side? Since it hurts so bad, I would imagine that it is not good for the tooth when I accidentally chew on the affected side and that if it is indeed cracked, the crack is widening with chewing.

Also, the filling is towards the front of my mouth. Could I get an amalgram and composite mix for aesthetics?

Lastly, why would it not have hurt prior to the first filling. Is it more likely that the tooth was always cracked or do these things usually happen during drilling to prepare for a filling? I can't understand why it had no problems before and is now painful. How large of a crack will cause sensitivity? And should it feel similar to having a tooth drilled but less severe when biting?

Neat side note about gloves. I had never noticed going into drawers but tweezers certainly make sense.

Thanks in advance and thanks for running this wiki page! —tkh777

If there is a fracture in the tooth it is likely to get worse with time, avoiding chewing on it should help but often the tooth is put under pressure accidentally by food in that area. It may not be a fracture, it could be a void under the filling or a high spot on the filling or sometimes there is sensitivity of an unknown origin. It is possible that it was caused by the drilling of the tooth but there is no way to know for sure, anytime you deal with a biological system there are many factors that come into play and not all of these are well understood. fractures that are sensitive are often very small and not visible to the eye, if there is a fracture it was not likely caused by the drilling but could have been made more apparent by the work on the tooth. Yes it will often feel similar to the tooth being drilled, a sharp quick electrical type of pain. —DagonJones


2012-11-02 16:00:41   My dentist told me that one of the signs of a cracked tooth is that you feel pain not when you bite down, but when you release the pressure. So, for example, if you press your teeth down slowly on a pencil, it won't hurt, but it will hurt after you let go. Is that right? —CovertProfessor


2012-11-07 15:43:29   yes, that is absolutely correct. —DagonJones


cavity.JPGDecay is outlined in yellow, Filling preparations in Red or Blue 2012-11-08 16:45:01   I am 34 with good health, have had history of sealants only, and tonight I just had a dental appointment for a cleaning. My last appointment 6 months ago the only concern brought up was a Diagnodent (sp?) number of 27 on one tooth (#20) which had changed this visit to a 20. The hygienist mentioned no other complications and then the dentist came up to her at the end and just told her to tell me I needed a couple of procedures he jotted down and she could seal my #20 tooth today if I wanted. So she did the seal and as I am paying she tells me "oh yeah you have to come back for a couple of fillings." She then shows me on the xrays that there are two spots with barely visible shadows between two teeth "across from each other" that will need to be drilled. I was floored because I haven't ever needed fillings before and why hadn't the dentist explained this to me as I had to ask her how do you get to those spots between? She said they will have to drill from above then go to the side...I am just wondering if this is truly necessary or if there is another option? I'm afraid they will cause more damage going after a small spot & could my tooth crack from this procedure? Very afraid...I feel like there wasn't enough info given to me and they act like this is no big deal - like everyone should be fine with getting drilled so what's my problem? She even asked me if I would want gas for the procedure...My problem was the lack of explanation, not the pain of a shot. —LaurieBrown

please read the entry about shallow decay [WWW]here. If the decay is in the enamel only then some dentists will watch the decay to see if it spreads, so ask your dentist if it is something that can be monitored. Flossing daily will help to remove plaque that can cause the lesion to grow and therefore prevent it from getting worse. The picture below shows an x-ray, decay between the teeth is outlined in Yellow, Red is the outline of the hole that would have to be drilled to access those cavities. The Blue shows another type of cavity preparation that includes the chewing portion of the tooth, this is sometimes done to increase the retention of the filling and/or remove decay on this surface as well. —DagonJones


2012-11-08 22:22:20   Do you have an opinion on those new water flossers? They spray a stream of water between the gums and are supposed to work like floss. Seems too easy... —EricaMacGregor

To quickly answer, if you are referring to the air/water flossers made by sonicare, I am not sure what the research shows but I DONT think they are as good as floss, in fact the manufacturer recommends the product as an adjunct to flossing, not a replacement. I just cant see an air water blast removing as much plaque as mechanical debridement using floss, the floss will cover more surface area as well. If you ask me it is a good gimick and better than not flossing at all but NOT a replacement for floss. —DagonJones

Water picks seem to be good for removing bacteria that cause gum disease and gingivitis but from what I have heard they do not remove plaque deposits that cause decay, they certainly will remove food deposits that the bacteria use to create cavities. —DagonJones
I use floss / brushing and regular dentist visits for plaque removal, or something Daubert


2012-11-17 17:39:29   Is it possible for the roots of your teeth to grow outside of the gums? —dawnheadley bad1.jpgrecession

To the best of my knowledge this is not possible, it could be Recession, or a fragment of a retained root from a previous extraction or broken baby tooth that is sticking through the gums.


2012-11-27 22:41:14   Nine days ago I had my second lower molar removed due to pain in previously root treated tooth. I have a wisdom tooth on that side which has never erupted. I am 54. The wisdom tooth can be seen quite clearly on x-ray impacted below the bone. I have been experiencing intermittent stabbing pains in this area on day nine of the extraction. The extraction, although difficult looks like it is healing and no sign of infection. Is it possible for a wisdom tooth to start playing up after all this time and also with no other teeth around it. I am very anxious about this as have rather slot of bad luck when it comes to me and my teeth! I am not in agony just a few stounds going on. —Janiceross

You should definitely talk to the dentist/surgeon who removed the tooth. It is most likely a dry socket or discomfort related to the extraction. It is unlikely to be the wisdom tooth but that is a possibility. —DagonJones


2012-12-29 18:22:30   Dr. Jones, I had adult orthodontics. I opted for crowns instead of veneers for insurance/financial reasons on bottom front teeth, they were very worn down. I currently have crowns w/temp cement, making sure I am content with color before they are glued on perm. Previous color was visibly off and crowns had to be broken off. Both crowns do not cover the entire tooth down to gum line (in the front) and the previous ones did, one is more visible than the other. I am concerned about getting cavities in the area that my teeth are exposed or other major problems as I have noticed in the past couple of days that plaque settles there quickly. I have read that composite would only be a temp fix. The assistant mentioned she had noticed the receding gum on one of the teeth previously. That was the first I had heard of that, I go in for regular cleanings and exams and it is the first I have heard of having a receding gum line (just had a cleaning day before crowns were put on w/temp cement.) I am always told my gums look healthy. I will see my regular dentist next week, she was not the one to temp cement my crowns, the dentist who did it would not give me much information, he stated I needed to discuss any issues with my dentist. I'm nervous, since the prep for molding has been painful both times and it was after the 2nd prep that I noticed how much farther down the temp crown went. On the 2nd prep for molding I could feel the string being pushed into my gum, it was a horrible experience. I just thought my gums had been pushed down and it would go back to normal when I got my crowns. The temp crowns are horrid looking, and since they are on the front teeth and I have a big smile, they are very visible. I dread wearing temp's again. This process has been a nightmare and I had always had good experiences with dentists. I am extremely concerned about gap between gum line & crown, please advice. Thank you. —AliciaGarcia

This a really hard question to answer without actually doing an exam. The area where the crown meets the tooth is called the margin, and it is just fine for this area to be above the gumline, however the margin must be smooth to prevent plaque accumulation. recession can occur even if your gums are healthy, so the fact that no one mentioned the recession before does not mean that it was not there, slight recession (1-3mm) is often not a big deal and sometimes is not mentioned. Talk to your dentist about all your concerns, it sounds like you are having a lot of work done and you deserve to have all your concerns addressed. —DagonJones


2013-01-24 21:47:24   Hey Dr. Jones, have you heard of the Soladey-J3X? I am curious to hear your thoughts on it. —LamsonNguyen I have never heard of this before, but a quick google search explained it for me. I honestly can not say if it works or not but it looks kind of gimicky to me. While it is true that electrons can interact w/ acidic protons produced from bacteria I do not see how that would aid in plaque removal. Bacteria use large charbohydrate-protein complexes called proteoglycans to stick to teath, and I don't see how electrons would interfere with this. —DagonJones


2013-02-17 14:42:26   how often root canals recommended to be changed even if the don't bother and done nicely, i have heard every 5 years

A root canal should not be re-done unless there is evidence of re infection (visible on the x ray) or pain. I have never heard of root canals needing to be re done just on a routine basis.—DagonJones


2013-02-26 09:25:39   Hey i am 20 year old college student who has never had a cavity and brushes and flosses everyday. Last week one of my teeth had started to become infected/absess. This infection has now spread to the front of the beginning infected tooth and the rest of my lower front teeth. Along with one of my top front teeth. I have a small sore on my tounge and have a streptococcus infection in my throat now. Please help me my teeth are going down the drain fast. —henryberns

It sounds like a gingival problem based on your description. you should see a dentist soon, if you are an undergraduate at UCD you probably have dental insurance and an office visit will likely be covered at about 80 to 100%. be sure to continue to brush, floss and use a mouthrinse like listerine. Gingival infections often get worse if you do not keep the areas clean, but it is a good idea to be gentle. you could also have [WWW]herpetic gingivostomatitis which I believe is more common in your age group. feel free to call my office 530-756-5300 and ask to speak to me directly if you have specific questions about this. —DagonJones


2013-04-01 12:07:30   Do I really have 4 choices? Consultation revealed 3 options: (1) Nothing, (2) Implant, (3) Post and Crown lengthening. My internet searches unvieled a possible fourth: (4) Forced Eruption. Background: My root-canaled #19 will no longer maintain it's crown. Care to discuss? —StephenASiracusa


I need a little more information here, is the tooth root canal treated? In most of these situations part of the tooth broke off inside the crown and there is not enough tooth structure to maintain the crown. The best and most predictable option in these cases is extraction and an implant. Crown lengthening is a decent option but it involves removal of bone that you might need later if there is a failure with this restoration. forced eruption is difficult on a lower molar (#19) and would not likely get good results due to the large surface area of the roots on this tooth (consult with an orthodontist). I hope that helps.


2013-04-09 12:18:36   Thank you for the reply, and yes, #19 was indeed root-canaled. Also thank you for the insight, re; future options. I didn't consider the negative result of bone loss and how it may impact future implant success (or failure) if I eventually need an implant. But at least I now know that forced eruption is not an option. —StephenASiracusa


2013-04-23 05:04:49   Alright - I have been thinking about making my own toothpaste. Some things I've read say that baking soda will hurt the enamel of the tooth, while others don't mention it (and of course, no one cites any science on the internets, it seems). What do you think? —ChristyMarsden

I think you should just buy toothpaste, there are so many options to choose from. Store formulated toothpastes have all the good stuff in them, fluoride to protect from cavities, detergents to help clean off plaque, and abrasive particles to remove stains. Baking soda is a very good cleansing agent but it is a bit too abrasive for every day use, if you use it every day it can wear down the enamel a little too quickly. Many toothpastes have varying degrees of abrasiveness, it all has to do with the particle size of the abrasive agents. Most toothpastes that claim to be "whitening" do so by having more abrasive particles to remove stains better so they are often not indicated for daily use. If you want fluoride free toothpaste (which I personally don't recommend) or all natural toothpaste then use Tom's brand, it is pretty good. —DagonJones

Thank you so much, DagonJones! I miss having you as my dentist ... I'm ashamed to say that I haven't been to one since I left Davis because I'm not sure any will be as good. But I'll get the normal toothpaste (whitening makes my teeth too sensitive) and keep flossing away. I very much appreciate your knowledge! —ChristyMarsden


2013-05-22 16:05:21   Dr. Jones, thank you for your help! I've had tooth pain around #2 for months. It was on-off, sharp pain w/ sensitivity to cold and hard food. Relieved with NSAIDs. I went to a new dental practice in Jan (4 months ago) for a focused exam with the chief complaint of "cavity." At the exam, no films were taken and the dentist found nothing unusual on exam except for minimal recession that he said was likely not contributing. In fact, he explicitly said I do not have a cavity. A few days later, I went for a new patient comprehensive exam & cleaning. Again the complaint was brought up, a different dentist at the same practice took a look, and also blamed the slight recession for the pain. A full, routine x-ray panel was taken that was unremarkable.

Two weeks ago, the pain became more severe such that sucking & smiling widely hurts and the tooth is more sensitive. Two days ago, I noticed foul odor from #2. I went to the same dentist this AM and he took an xray of #2 that revealed significant decay of the distal surface confirmed on exam. The dentist (mid-30s) said he had never seen decay in that spot before (on any patient). The excuse was the decay was partially hidden by gum and not captured on the comp exam x-ray. The root cause was theorized to be due to maxillary bone loss s/p wisdom tooth extraction that left #2 vulnerable to decay. The dentist charged me for the encounter (insurance had paid for the prior two not helpful exams) and referred me for root canal.

Will dentists typically charge for an missed diagnosis leading to an additional non-insured visit? And is this type of missed diagnosis routine or should the dentist have taken more responsibility? Is the insurance company the party I should complain to in hopes of getting reimbursed? —EricKing

The type of decay that you are describing is notoriously difficult to diagnose, there is a natural concavity on the back of most 2nd maxillary molars and decay can get rather deep in this area and look within normal limits on an x ray (there is naturally a dark spot on the x ray here), and due to how the gum tissue often sits the decay can be under the gumline and not visible on routine visual inspection. So I don't think it is due to any lack of skill by the dentist, regarding the difficulty in discovering this decay.

I recommend you call the dental office and talk to them first about your concerns. —DagonJones



2013-06-13 02:35:20   Hi, i am 43 years old, recently i contacted dentist as i dont hav wishdom tooth and other one tooth. i need to put new teeth agaist this. i have also gaps between three gaps (in downline) as it is not much but i dont like. she suggested bridge/crown treatment. she called me and as i dont know the procedure, she started reducing my teeth, after one tooth i realized that my natural tooth are reducing for this treatment, she had done this with my all front teeth. now she called me after one week for trail of cap / crown. if i dont want what can i do as she already reduced my teeth..what will be the procedure for crown treatment, is it good or not as i dint have any pain nothing. is there any problem after crown treatment in eating or anything...pl reply me —anju

you are committed to some type of crowns now that your teeth are reduced, however if you are not happy with the appearance of the crowns before they are cemented just let your dentist know and she will be able to change the shape and color with the lab. There should not be any problem after crown treatment, if you are not having any sensitivity now you are not likely to experience sensitivity. Crowns cover the reduced teeth and replace the removed tooth structure, they can break or get decay under them but if they are well cared for they should last decades. —DagonJones


2013-06-14 08:00:09   I had my wisdom teeth extracted about 6 years ago. The oral surgeon punctured my gums and caused a severe infection which almost killed me. It included the infection bursting in my mouth, lockjaw, not being able to eat or drink. I went to him several times and he told me it was tonsilitis as he's prying my mouth open. Anyway, I had to see a ear, nose, throat doctor and as soon as he looked in my mouth rushed me in to do emergency surgery. I had an infection in my whole mouth which was beginning to spread down my throat and headed to my brain. Ever since this time, whenever I get any type of toothache or abscess it feels like my whole jaw hurts. It also affects me physically. I am physically fatigued and just feel sick all over. I normally have to get stronger antibiotics than just penicillin. When I have had other teeth extracted in the past, it takes me a longer period of time to get over the extraction and usually have to have another round of antibiotics. What is wrong with me? Am I just crazy? My dentist doesn't seem to understand when I try to explain this to him. —RaneyMiller I cant say but you may have some latent infection in your jaw, this is a difficult thing to evaluate and I would recommend seeing an oral surgeon and getting a 3D icat scan (a 3D x ray). The fact that you feel fatigued would suggest a latent infection, the pain in your jaw from toothaches could be residual nerve damage. I am not sure, your whole situation is not something I am familiar with. I would consult with an oral surgeon or a TMJ specialist. —DagonJones


2013-06-19 03:22:27   I have a 14 years (running) old son and 7 years old daughter. i thought my son has teeth little bit outside, i consulted dentist but they advised me that you wait for 2-3 years as he is small, he will be ok as he time goes, pl tell me if i want to put him braces when should i do..... for my daughter she has her two last teeth downline totally damaged ( i dont know exact word, as she eats more chocolates and all, both last downline teeth are black and i think it shd be removed. pl advise me what is the treatment they require... —anju


2013-06-22 00:11:37   this is further to my question on 13 june. my doctor placed temporary crown and also both side missing tooth with bridges. first of all all teeths are thick, i dont feel comfortable, i cant chew food. it dont match with my upper jaw... i fear now how can i eat as i dont have any natural teeth in downline as remaining teeth were reduced for crown and bridges...also temporary crown come out after 3 hours. pl i need yr advise, and tell me after crown, bridge treatment i cant eat as earlier...i am scared i feel very depressed.. —anju

I am very sorry but I cant answer your questions over a format like this, I would need to do an evaluation on you and your children to understand what the specific issues are. I can say that bridges often take some time to get used to, they feel very different at first but after a few weeks you should adjust to them. It is also possible they do not fit well and need some adjustment. Call your dentist for a consultation they will often not charge for an appointment like this. you have many questions and you should take the time to discuss your concerns with your dentist. —DagonJones


2013-06-29 02:49:45   I just had fillings done on 3 of my teeth on my right top side. I was not having any pain when i went to have this done. It has now been 3days,and one of the thooth i had worked on is hurting me real bad. It is waking me from my sleep. I am taking tynol for pain. I was wandering if this is possably normal, or do i need to conntact my dentist? My teeth are also now very sensitive. Hot or cold never bothered before, but now i am having problems chewing my meals that are hot, and things that are crunchy. I have had fillings in the past. I did not have any of these problems. Thank you for any advise! —RebeccaHardin

Sorry everyone, I was on vacation last two weeks. Pain after fillings is unfortunately rather common and considered normal. sensitivity to hot and cold is especially common. However if the pain is waking you up at night it is possible that the decay was very close to the nerve in the tooth and it is possible the tooth needs a root canal. If the decay was very close to the nerve then the nerve can be irritated by cleaning out the decay, of course if you did nothing the decay would eventually reach the nerve and you would develop an infection. My advice is to wait 2-3 weeks, the pain should start to diminish if it does not, call your dentist for an evaluation for a root canal. —DagonJones


2013-07-01 16:06:02   Dr. Jones - On Feb 9, 2012 I had both upper wisdom teeth and the molar in front of the upper right wisdom tooth extracted by an oral surgeon. My dentist had determined that the three teeth had to go because of decay below the gum line. Within a few weeks of this procedure I began experiencing dry mouth and to a lesser extent burning mouth with no interruption or improvement in the symptoms to date. I have been seen by my family doctor, two ENT's, a different oral surgeon, and my regular dentist with really nothing to show for these visits and no improvement. I have been tested for Sjogren's, thyroid function, kidney function, and whatever else blood can be tested for. I do not take any Rx medicine. I guess my main question is what exactly might be causing my symptoms and do the symptoms probably relate to the tooth extractions. I recently became aware of a condition called Occlusal and/or Oral Dysesthesia which seems like a possible cause. I also haven't been checked for a possible neurological cause. I'd like to know what you think might be the cause and also what your advice might be re what treatment to pursue at this point. Thanks —TomKoester

I wish I had an answer for you, however I do not know what is causing your symptoms. I would assume it is something that is not clearly understood. Human biology is incredibly complicated especially when it comes to sensory issues. It sounds like your health care providers have done very good due diligence when it comes to checking for all the known issues that could be causing your symptoms, the fact that nothing was discovered is frustrating. It is possible that it is related to the extractions but I could not say for sure. Regarding oral Dysesthesia this seems to be a catch all term for idiopathic (from an unknown sorce) oral discomfort, there is also "burning mouth syndrome" which may be an adequate way to describe your condition. The best you can probably do is use different products to alleviate the discomfort, there are a variety of dry mouth rinses/ sprays that you might try. The burning sensation could be secondary to dryness —DagonJones

Dr. Jones - Thanks for your prompt response. "Idiopathic" does indeed seem to be the key word to describe this stubborn problem I have. I am thinking of trying to get in to see an oral pain specialist at a state university dental school a few hours from where I live. Do you see this as a logical and worthwhile course of action? Again, thanks for your prompt and thoughtful response.


2013-07-02 09:39:05   I'm 72 years old and have all my teeth, with exception of four molars extracted when in my early teens...either side, top and bottom. My last filling was some eleven years ago. I always clean my teeth morning and night. I do not suffer any regular or periodic toothache. However, since moving to Spain seven years ago my regular diet is to eat a mix of fresh fruit each evening....banana, orange and apple mix. I now notice that my gums are receding and one back tooth is quite loose. Should I adopt a different late night supper mix???? —BarryWootton

It is incredibly unlikely that the fruit is causing recession and loose teeth. most likely this is due to periodontal disease, which often gets worse as time goes by. Genetic predispositions for periodontal disease are much more active in the later half of life. I would highly recommend you see a dentist for an evaluation and commit to periodontal treatment and very regular periodontal maintenance (cleanings). Even if you care for your teeth very well at home a professional cleaning is essential to maintaining health because the hygienist uses instruments to remove deposits that cannot be removed at home. You may not have periodontal disease, some recession comes from a variety of other causes ( age, vigorous tooth brushing, heavy clenching, naturally inadequate thickness of gum tissue ) but the loose tooth is often an indicator of periodontal disease. —DagonJones


2013-07-12 04:03:02   Dr. Jones, I recently received a gold implant to replace a fractured back lower molar. It's a snug fit and I'm very happy with it. However, the gold has a small sharpish point that sticks out laterally into my tongue a little, which the dentist left on purpose - he said my tongue would get used to it. Indeed it's starting to annoy me, but it's only been a day. Can you explain what the purpose of leaving this little point might be? —BobEggerton

I dont know for sure, it is probably due to the contour that is necessary to meet with the opposing tooth. An implant has a smaller base than a natural tooth, therefore the shape of the tooth has to have a more pronounced taper and this shape change is probably what you are noticing. It might be possible to smooth it off if it continues to bother you but wait at least 1 week to allow you time to adapt. —DagonJones


2013-07-15 17:39:09   Hello Dr, I noticed a light tan/brown round spot on one of my big front teeth, very oval shaped and nearer to the top portion of the tooth. It somewhat came on quickly.. maybe over the course of 2 or so weeks. I know I should not have but I scraped it a bit because I thought it was a stain. The coloring is gone, but there is an indentation of where the stain was, also (which i expected) my tooth feels sensitive now. Is this really really bad? I haven't been to the dentist in a long time. I have tried to google what this might be but haven't found any answers yet. I don't know if the enamel is completely gone in this area to what but you can tell it is a different type of texture then the rest of my tooth. I am kinda freaking out that I ruined my tooth. Any help would be great. —sarahstewart

If you can post a picture or email it to dagonjones at gmail that would be helpful. there are a couple of situations this could be, either it is calculus (tarter ) that formed there and you scraped it off, or there is some decay on this tooth, or you have some recession that exposed some of the root surface of the tooth. The root surface is naturally darker and more prone to staining, and it is often very sensitive to touch so this is probably what is going on. if you scrape the root surface hard enough you will remove some of it and increase sensitivity but this is not the end of the world. Try using some sensitivity protection toothpaste for a few weeks and that might help. It is probably best if you see a dentist because you might have a cavity here that needs a filling. Don't worry too much you probably did not cause any irreversible damage. —DagonJones


2013-08-13 12:10:40   I am currently part way through a course of dental work including five implants and replacing a number of crowns. A number of these crowned teeth are already root filled and though my dentist says this root filling work has been of good quality he wants to re-do the root fillings before he replaces the crowns. He says he can't guarantee the new crowns unless he does this. Could you give me your view on the advisibility of disturbing root fillings that have remained in place successfully for a number of years? Would it be better to leave them alone? I would value your opinion. A. D. —AmandaDavidson

2013-08-18 18:14:40   I personally would not plan on re doing the root canals unless there was evidence they were failing. It is unlikely to cause any problems by re doing the root canal. It sounds like your dentist is advising a "better safe than sorry" plan for these teeth and if you are going through a very detailed and comprehensive treatment plan this may be a good idea. However re treating a root canal before a crown is not normally necessary. If the root canal fails after the new crown is placed then a hole can be drilled through the crown to do the root canal, this hole does not often significantly weaken the crown unless it is an all porcelain crown. —DagonJones


2013-08-18 09:57:35   i have a crown on my lower incisor with another crown second molar back and a bridge between. About three weeks ago I started having tooth pain in that area, that continued to worsen to the point of going to the ER. Was prescribed something for the pain and amoxicillan 875 bid. Three days ago while eating pound cake of all things, my crowns/bridge fell out. I no longer have dental insurance, live in a different state than before, am in severe pain and my jaw is swelling. Dont know what to do. feels like a nerve is exposed. The ground down teeth are both black in color. Is that the way they were prepared before crowning? HELP —tammyginn

The black color is likely due to decay (but can also be just non problematic staining), the swelling is likely due to infection. You probably need to have one or more teeth extracted. I would recommend you see a dentist as soon as possible, if infection is involved then this situation can be very serious. Do a google search for local community dental clinics or dental schools if your finances are very tight, you might be able to save some money this way but it will likely take more time. If you can't get to a dentist soon then you should go on another round of antibiotics ( go to urgent care) but keep in mind that antibiotics will only keep the infection down for about 3 weeks. —DagonJonesDagonJones


2013-08-18 22:26:10   I recently had my 6 mo. checkup. When completed my dentist said that he could do a little bonding to three teeth if I wanted him to do so. The procedure was very minimal and was totally (all three teeth) completed in 10 -15 min. The bill came in the amount of $435.00. Can this be right??? —JanisWingate


2013-08-26 05:55:16   This tooth is a molar and was root canal treated . It was not effective and eventually the crown broke and i had to extract the tooth . Now after 2.5 years there is a small hole in my gums in the place of the extracted tooth and is sensitive . What could this be ? will it close on its owm. Pls help —deborahpeerez I am not sure what this hole is, it is possible a fragment of infected tooth was left behind and the hole is a latent infection. I think you should see a dentist and get an x ray of this area for evaluation. —DagonJones


2013-08-26 23:16:19   Hi, I have been to several dentists and Orthodontic Specialists about a problem with my wisdom teeth. I would appreciate any input you may have. I have a lot of problems with my wisdom teeth, particularly on the bottom. They have been coming in since I was about 15 and my mouth on both sides will swell up off and on, but they have never fully come in. I am now 31. I have gotten Xrays and CT scans of my mouth and all dentists told me I cannot have them removed as they are too close to my nerves and that my jawbone is thin and my mouth is too small so they won't come in fully. They admitted that the solution is to have them removed, but all of them told me that there was a very high possibility that I will lose feeling and have numbness in my mouth and possibly face due to it being so close to my nerves. I, naturally, opted out for this and continue to suffer from the regular swelling and pain. —RosaGitana the best option for you is probably a coronectomy. This is a procedure where the crown is removed from the tooth but the roots are left in place and bone will heal over them. This is generally the best option for people in your position. You should see an oral surgeon about this such as Dr. Tomaich. I have reviewed sevaral cases with Dr. Tomaich where he has performed coronectomies with good success. —DagonJones


2013-09-07 05:57:07   I am interested in getting implants, over dentures, and I asked for a written diagnosis and plan with costs. My dentist ignored my request. I can get this done by my car mechanic but dentists don't think they need to do the same? —JeanMcloryd The communication in your dentists office probably broke down. It is standard procedure for a dentist to give an itemized financial estimate for any treatment. I would just call and request again. You may need to come in for another evaluation to get an exact estimate so your dentist can make a detailed plan.


2013-09-10 21:11:47   I broke a tooth towards the front of the left side and had to get a bridge. however, since the bridge my mouth seems always dry and I notice scratches on my tongue with an uneplainable taste in my mouth any ideas what it may be? I reached out to the dentist and he is saying that I mouth may need time to adjust. however, is been a little over 6 months and there has been no change. please provide your thoughts? —joanjenkins


2013-09-13 23:18:17   I am sorry to say that I do not know why you would have dry mouth or any of your other symptoms after a bridge. —DagonJones


2013-09-16 14:56:12   I had a 4 unit bridge put in to replace teeth 23 24 25 & 26 bottom front. They look funny like match sticks and skinny and crowded. Just not shaped right. My dentist said we could replace them with 3 teeth instead of the 4. Said there was not enough room and that's why they look like that. That doesn't make since to me because I had 4 teeth there before they pulled them. My question is can that be done and will they look normal.
Leslieesprzaa —Leslieesparza
after the teeth are extracted there is often some bone loss and the new artificial teeth on the bridge will need to be longer (making them appear thinner), also your previous lower anterior teeth probably had some crowding. when the teeth are made for the bridge they are made straight and might have to be more narrow. If you have 3 teeth instead of 4 it will look normal many people only have 3 lower incisors and it is very hard to tell. —DagonJones


2013-09-19 17:46:50   I am a little confused about my situation and will very appreciate if I could get some advice. I am in mid 20s and recently found out that I have been brushing and flossing in wrong way. Since I haven't had cleaning in 3 years and my gum was bleeding, I went for a check-up. Then I had to change the dentist and got another check-up (long story) So, the second dentist recommended me to have a deep cleaning. I heard deep cleaning usually takes about 3 hours and the gum is sore for a few days from scraping. But mine took only about 45 mins for all quadrants and it did not feel any different from regular cleaning (but it was 3 years ago that I got my last cleaning). So, it has been 2 days since the cleaning and my gum is not bleeding anymore. In fact, I don't even feel any soreness or pain except from anesthesia injection. I'm worried the cleaning might not be thorough. Should I be worried or is the procedure just different for everyone? Also, the first dentist said she saw some bone loss from gum disease in my X-ray while the second one said it is only gingivitis and I do not have any sign of bone loss.I am confused and don't really know what to do. Should I seek a third opinion? Thank you. —emmarald

A deep cleaning often feels just like a regular cleaning to the patient. But it would be impossible to do a good job in all 4 quadrants in 45 minutes unless your tartar was very light, in which case you probably don't need a deep cleaning. It is possible that the diagnosis was only for localized deep cleaning in one or two quadrants. The gums are not always sore after a deep cleaning, it really can vary from person to person. The diagnosis of bone loss via the x rays can vary by dentists. some dentists may see it and not mention it because it is so minor, some normal bone contours can look like bone loss. I would not worry about getting a third opinion but I would talk to your dentist or hygeinist about what exactly was diagnosed regarding your cleaning and what has been performed so far, it sounds like there is some confusion. Just be frank and ask the question just like you asked me. —DagonJones


2013-09-24 05:26:21   First off, I am amazed at the amount of time you have spent giving free answers and sharing your knowledge with all of us! Thank you! I have a few semi-related questions for you. I have been taking Phentermine for quite awhile. I know it dries out my mouth and have heard it may be a contributing factor to cavities. I went from having one cavity two years ago to. ... SEVEN this check up. I am religious about brushing and flossing and was shocked to hear this. The office gals said it may also be related to having a baby at 36. Can you say if either is possible? My next issue is with the one cavity I had filled two years ago. At the time the dentist drilled for what seemed like forever. He apologized and said it was pretty deep. Afterward he said he maybe should have done a root canal. I have to admit I didn't know the difference at the time. I had only ever had cleanings and sealants ever done. I requested the composite and he told me that was a good choice but that it may be a tad more sensitive. Six months later I went back for a cleaning and told the dentist on rounds about my sensitivity and he said just use a sensitive toothpaste and that it looked fine. It had always been sensitive but continuously grew worse. This year the dentist said I had a cavity at the root of this tooth and I would need an extraction! I was horrified. I asked for another dentist and got her opinion and she said there would be no other alternative it was too late. I made an appt with an oral surgeon for two months later. I could not make it that long. My tooth became infected and I am lucky enough a dentist took pity on me and came in on a Sunday to pull it and relieve me of some of the worst pain I have ever endured. Seriously. I've had the children, a dislocated shoulder, ruptured ear drum, this was still worse! Could this have been avoided and could I still have my tooth (that I am literally in mourning over) had the first dentist done it correctly?
Sorry for writing a novel. And thank you in advance!

Thank you for your appreciation of all my time and advice, it is really nice to hear. Any medication that causes dry mouth will often have a profound increase on your risk for decay. Saliva is the main protective factor against decay. Saliva rinses away acid, remineralizes tooth structure, and buffers acids. John Featherstone (current Dean of UCSF school of Dentistry) worked for several years trying to create an anticavity/ remineralization rinse and could not make anything as good as your own saliva. So the Phentermine is likely causing the increase in decay risk. I am not aware of any connection between decay and pregnancy, there can be a connection between pregnancy and gingivitis. However I have heard people speculate that immune system changes and pregnancy can be a factor for decay but I have not read any evidence that shows a conclusion.
Regarding the deep decay: It is very common for deep decay to later lead to a root canal. Most of the time the need for a root canal becomes obvious because the discomfort slowly gets worse. Very rarely the infection can spread so rapidly or severe that the tooth needs an extraction and that sounds like what happened here. I think your dentist did the right thing by cleaning out all the decay and watching the tooth (instead of moving right into a root canal), I would have done the same thing. But it is unfortunate that you ultimately lost the tooth. Sometimes being more conservative with dental work can have negative results, but most of the time being conservative saves the patient from possibly unnecessary procedures.


2013-09-27 17:19:33   Hey. First of all, I'd like to thank you for all your support offering free advice and help for those who are anxious about their dental health.

I've had a problem with my molars for a few years now, where they have developed black stains in the pits of my first molars, which is also starting to develop in my secondary molars. It's never hurt, nor does it look like that it's actually burrowing into the enamel of them. My dentist took an x-ray and didn't have any immediate concerns, but i've read that the initial stages of decay doesn't particularly show on x-rays.

I was wondering that, because my diet is entirely based on fizzy drinks (I am not a water drinker), and my drinking method is that I don't gulp (but I hold the liquid in the back of my mouth before sucking the liquid down), that these dark stains are nothing more than stains, rather than suggesting the initial stages of decay. Also my teeth look extremely healthy apart from these pit stains.

Also my wisdom teeth have started to form, and i've noticed there's a black dot on one of them. Is that normal? Is there any cause for concern?

Thanks a lot for the help. —JackGoss
prr.jpg1. heavy stains 2. opening of grooves, removal of stains/ decay 3. sealant/ filling placed Black stains on the chewing surfaces of teeth are often stains in the pits and grooves. It is correct that it is often difficult to see decay in these areas on the x rays until the decay is rather deep. If you have a low risk for decay then I would recommend just watching these areas. The best way to be sure is to do a preventive resin restoration. This is something between a sealant and a filling (closer to a filling really). A small bur is used to open the grooves of the teeth to remove stains and look for decay, if decay is found it is removed. Then a flowable filling material is used to fill in the voids and seal off the areas where there was no decay. This procedure can often be done without anesthetic (no shots). I am often surprised by the extent of decay that I find when doing these types of restorations, however, sometimes I find no decay at all, only stains. Most of the time there is decay present. —DagonJones


2013-09-30 13:30:50   This is my first 'wiki' and am hoping it is correct. I am starting to question some of the interventions of my dentist. After our long time excellent dentist had to retire, my family went to a new family practice. I have begun to feel like he is adding possible unnecessary procedures to our care plans. Too many red flags are going off. I am a retired critical care RN, so I have some knowledge about medicine and research what I don't, but I am completely stumped here....am I being paranoid or is something wrong. Here are the events: Recommendations to my 15 year old son for teeth whitening. I had a top back molar removed due to 3+pockets. He never mentioned about removing the bottom. All other were fine and I increased my cleaning schedule, started water picking around gum line twice daily, increased flossing, and started xylitol and other rinses. I really got scared when I lost that tooth so I wanted to do all I could to prevent further loss. Six months later he was impressed and pockets stayed the same. Six months later, pockets the same, but then he says that now he has to remove the opposing bottom back molar. Nothing is wrong with it but his rationale is that because there is no tooth opposing it, food can get trapped in crevices and decay can start. This tooth did not wiggle at all and pocket was 1. I refused that and still have no problem 18 month later. He also said I had a cavity to fill, but it was actually a small chip from a fork bite-down accident in which I chipped the front tooth and two other teeth. My prior dentist bonding the large front chip and said the others were too small to bond, they would probably fall off too quickly, and it didn't affect looks hardly....so I left it go. I told this new dentist that story and he said, but it will eventually go into the dentine. I then said, "But it's been ten years since I had that chip, and no problems yet, so I'll let it go." Then he told my son last visit that he would have to remove all his fillings and redo them....that is normal practice. Last week my daughter saw him. She has 5 sealants from about five years ago. She is 19. He told her and I he needed to remove all them with a drill and replace them with normal adult fillings. He would use composite, since he doesn't use any mercury. There wasn't anything wrong on the X-rays. This is just normal practice he said because the adult teeth now bite down too hard on the childhood sealants. I told him I didn't like the fact that he would drill in teeth that have no decay, and then fill....that they can become a place for further leakage and now enamel is gone. When I questioned him this time and the other times, it seemed like the office girls were nervous, and also him. Please tell me if this is normal practice. Thank you so much. A good dentist a treasure.....and I lost mine, but when I find another, I will cherish him/her. I can tell you are a good person to take your time our of busy life to do this. —ColettePizzarella

contact.JPG Regarding removing old sealants: removing sealants and replacing them with conservative fillings (like the one I describe in the previous question) is often a good idea. I would only do this procedure if I saw evidence of stains or decay around the old sealants, this is often seen as dark stains along the edge of the sealant or a gray shadow under the sealant. I would not recommend removing sealants "just because".
Regarding replacing old fillings: If there is no sign of decay, fractures, voids, or defects in the filling I see no reason to replace it.
Chips in teeth: small enamel fractures rarely need a restoration (the usually don't get worse if left alone), however fixing these small chips is often quick and painless and removes the rough spot and reduces plaque accumulation. Many dentists have different opinions about when to fix these chips, if they are very small then there is a greater chance that the repair will fall out. I suggest that if it does not bother you, leave it alone
Removing teeth: If a molar does not have an opposing tooth it can hyper erupt which will create a space between the teeth that collect food. Removing these teeth is done to protect the tooth next to it. These teeth do not always need to be removed, it is ok to watch and wait. You can ask your dentist or hygienist to evaluate the area during every exam. It is much more common for an upper molar to hyper erupt after a lower molar is removed. After an upper molar is removed the lower molar is often slightly in contact with the remaining upper molar in front of it and this prevents it from hyper erupting (see photo at right)

I would recommend you get a second opinion. Your current dentist may not be trying to swindle you, he may just be the type of dentist who believes everything should be a perfect as possible, and you may be the type of person who is comfortable with "good enough". So it may just not be a good fit between you and your current dentist. —DagonJones


2013-10-03 08:08:59   Hello. I hope you can help me out. I had a filling fall out of tooth # 2 , went and saw my dentist who said it needed to be removed because most of the tooth was gone and something about the pulp. He took X-ray and said tooth #15 was doing the same thing ( #15 had no filling but again something about the pulp ) He said it was cracked but to me it looked like the tooth pictured in the post dated 2013-9-27. I've been going to this small practice consisting of two dentist and two hygienist since I had baby teeth and I am now 39 yrs old. My last cleaning I had I asked him about tooth #2 and he kept telling me it was fine & that he had fixed it. I have/had no reason to not trust him and I have fillings so I just said okay. Well fast forward to now.. He has retired and when I went in to see the other dentist I told him about all that, well, he looked at X-rays and it sure was there. He apologized over and over. He said they made a mistake. I get it. I'm not mad or anything like that. I am worried about my dental care there now because I believe I have receding gums and when I tell them they say no, but I can see it and I say yes. I don't know what to do about that. There stuff is severely outdated too. What do you think I should do about the gums receding and they are not listening. What do I do? My second question is this - I went and had tooth 2&15 extracted and it was awful. When the oral surgeon finally got tooth 15 out, one root was still in there. He said he got it. It was very rough! Now on that side my jaw is popping and clicking which I did not have that ever in my life before. When I open my mouth it does slight curve movement to that side and I'm noticing my jaw is not closing where it once did. It has only been a week though but I'm scared that he hurt my jaw. I don't have numbness or anything but do have sharp pains shooting to what feels like the front of my teeth and this only last seconds before its gone again. He also said during the extraction he was going to use this tool to " loosen it up" and I'm wondering what he was using that on? My jaw ? This was on tooth 15. I'm not sure that even needed out, but I am no dentist. What should I do about jaw cracking and popping and the movement of it? Should I be worried? Third question —is —- my son had braces which are now off ( finally) but he had stinky breath I chalked up to braces, but now they have been off for nine months and still stinky breath, right after he brushes even. He gets teeth cleaned twice a year at dentist (same office) and they don't say anything. His gums look red to me and I know they do bleed at times...all of which I related to the braces coming off and all that. What could that stinky breath be about? Should I take him to a gum guy ? ONE more question... Since my extraction I've been reading a lot and I read about how a lot of wisdom teeth are taken out when they don't need to be. Well, that is the next thing for my son because the dentist said so but I'm wondering if he really needs them out. Is this true about wisdom teeth? Is there a way for just a regular non dentist mom to know or anything I should ask the oral surgeon ( not the same guy i went to ) when we go to the consult? Oh.. I did forget I wanted to ask you about oil pulling. What is your take on that? I want to start doing that in hopes it will help my gums. Is it safe ? Thank you so much! I am obviously feeling not so good about things right now and our dental care & health which I believe is SO VERY important. Sorry for all the questions. —HeatherA


2013-10-03 08:28:20   I forgot to ask if my teeth are going to move or shift. It may sound crazy but it already looks as they have. Is this temporary? I want to thank you so much for all the help, comfort and knowledge that you are giving people. It's so very nice of you to take the time to do this and answer questions. Thank you!! —HeatherA


2013-10-03 15:51:55   Mr. Jones, Hello! Have a new problem that came to pass today in the saga otherwise known as my mouth :) well, I took me a light and looked in the mirror and surprise - the roof of my mouth is a yellowish color. The back of my throat is bright red with possibly tiny bumbs but the blood vessels are weird looking. The bumps on the back of the tounge that are supposed to be there ( I think ) they are red and inflamed. Are those my taste buds? I do have a funny taste in my mouth too. The roof of my mouth looks yellowish, whiteish with a red spot that's been there since day one of this ordeal...it is going on day 7 tomorrow. Took my antibiotics like a good girl. Did what I was told. I even took some pictures for you if you would like to see but I wouldn't be offended if you didn't . I took them to send to my mom because in reality I'm very afraid. I'm so scared. I just have this feeling and not a good one. I did call and I do have appointment tomorrow with the guy that took them out but I can't say I'm comforted with that aspect. Symptoms are... Teeth have a weird sensation when I am walking, ear pain on one side, hard to swallow although throat doesn't seem to be hurting, headache, jaw doing popping cracking, bruising on cheeks inside of mouth, yellowish, whitefish blueish color on roof of mouth but in sections, swollen bulbs on tounge, red tounge, red gums, funny taste in mouth, UMMMM.... I THINK that's all. Had the two upper molars extracted last Friday morning (tooth 2 and 15) they did bleed for 2 days, not gushing but did continue to bleed beyond what I thought was normal. I also had bloody snot which is unusual for me. I have always taken care of my teeth. I had my wisdom teeth out when I was 18 and I recall that was a walk in the park compared to this...granted I was younger. I am otherwise a healthy 38 year old female, except for right now I'm feeling pretty bad and worried thank you again & sorry I am burning up your board! I really am, I feel so bad I keep writing. Sorry :o( —HeatherA

First off Heather, take a deep breath, you are most likely going to be fine. Jaw pain after extractions is very normal, there is a lot of stretching of the jaw that has to take place to get out molars and you have to hold your mouth open for a long time. This can result in some popping/ clicking. See the above section about TMJ/TMD for some more info about this. Your current situations sounds like an infection of some sort, you may have a virus (a cold or flu) this would explain the redness and irritation in your throat and tongue. The big red bumps at the back of your tongue are probably your circumvallate papillae, which are normal circular bumps that contain taste buds (taste buds are microscopic). Regarding receding gums: recession can be caused by a number of things but I would not worry about it too much, as long as the recession is 3mm or less I would recommend just monitoring your condition to make sure the recession does not get worse (see above section about gum grafts). Your teeth can and do shift over time, this is normal and it typically does not reverse itself, once again it is not a bid deal unless it creates esthetic problems or the crowding is so severe you cant clean your teeth well. The best way to prevent further shifting is with a retainer you would wear at night. If you want to reverse the shifting you would need some sort of braces or invisalign orthodontics. There is limited literature on oil pulling but from what I have read it is safe and somewhat effective, but (to the best of my knowledge) it does not appear to be more effective than antibacterial mouthrinses (like peridex a prescription mouthrinse).


2013-10-07 20:49:21   I had a tooth pulled at 10am the hole is not bleeding but im coughing up blood with clots —.sherriplemmons I would guess that when you cough you are getting some blood from the extraction site mixed in, it is very normal for the extraction site to slowly ooze blood for the first 24 hours. If you are sure you are coughing up the blood then I recommend you see your physician.—DagonJones


——sequestrum.jpgBone sequestrum
2013-10-08 15:59:15   Hello, I had extensive work on my teeth; several implants and one bridge. I've had no trouble whatsoever until now. It's been over 10 month since the work was done, however the 2nd molar lower left was extracted. It was a difficult extraction, and the dr. thought he was going to need to wait until the next day to continue, however I told him to go ahead and pull it so I wouldn't have to deal with it the next day. Suddenly I felt some soreness, and just happened to run my tongue in that area. I could feel what could be bone exposure through the gum, or a tooth chip, however from looking at it, it appears to be a very small area of exposed bone. There was no implant placed here. What is the procedure for correcting this, given both possibilities? Thanks!!!! —CrownVic47

If the area is on the lingual (tongue side) of the jaw then this is most likely a bone sequestrum. A sequestrum is a dead piece of bone that is working its way out due to a normal process of necrosis. These are pretty common (especially after extraction of lower molars), they are often painful for a week or two then go away. Sometimes they require a very small surgery to remove the piece of bone. If the piece is on the top of the jaw (chewing surface) then it could be a root fragment or an exposed piece of bone. You should call your dentist to have him/her take a look at the area and see what the best course of action is, but there is no cause for alarm as all these situations are relatively common. —DagonJones


2013-11-04 21:06:43   I had some pain above my # 13 tooth about 3 years ago and it lasted for about 3 years then it went away. I visited the dentist and had them look at it. They found nothing wrong with it and was told it was my sinuses causing the pain. So then today I was at the dentist and they told me that I needed to see a specialist cause I was probably going to lose that same tooth that I had previously complained about. I was floored. they said it was because I had tooth resorption. It cannot be saved. So my question is, why was this not looked into when I complained of this pain? why was I brushed off. I knew something was wrong and was told everything looked fine, when today they took more extensive x-rays and found the problem. I am currently breast feeding and will not be able to take any pain medication for an extraction and am nervous about having an implant due to my history with my body rejecting foreign objects. Why is a root canal not an option? If the tooth is so bad that the only option is to remove it why wasn't it noticed sooner? —Amberskelnik

Root resorption can be difficult to discover. Once it is discovered there is often not much that can be done to save the tooth. Resorption is a process where the body starts to "eat away" the tooth root, the causes and process are not fully understood. Sometimes a root canal will stop internal resorption but this rarely works, if it is external resorption (this sounds like your situation) then a root canal will do nothing. People often can have pain or discomfort on a tooth that has no known origin and is transient, additionally resorption can only be seen on the x ray once it is rather well established. Resorption rarely causes any discomfort. I cant say exactly why it was not discovered sooner but it was likely not able to be diagnosed at the first time you came in, even if it was discovered then there is virtually nothing that can be done. You should have very little discomfort after the extraction so tylenol might be good enough for the discomfort. The other alternative is to pump and store breast milk for a few days so you have an additional supply if you need the prescription pain medication, be sure to talk to your dentist or doctor about your breastfeeding/ medication concerns. —DagonJones


2013-11-09 01:37:45   I just got a tooth pulled two weeks ago. But they didnt take out the whole tooth. Are they able to charge me again to get the rest out? Have another appointment coming up and I had let them know that I still have half my tooth still in. Not to mention when I first went in that I had a tooth that was hurting bad and they were suppose to take care of it. They told me the work I needed to get done and as I walked out my tooth wasn't fixed and I had asked about what I should do. They prescribed me antibiotics and pain meds. Went in and that's where they pulled two of my teeth and still didnt fix the bad one that was hurting. I do like them they are nice but not sure if they are going towards my needs and if they continue to do work that I don't need right away, I kinda don't feel like they are there for my best interest. How can I help solve the situation and also not get charged a ton and know what my dental covers? —Annamaec22

I think you should directly express your concerns to your dental provider. It is pretty common to plan to do all extractions first simply to remove the source of any potential infections. However if you are having pain in another tooth you should let your dentist know and ask to have that taken care of. —DagonJones


2013-11-09 20:59:21   First, thank you for your previous response. I saw a specialist and he told me they would do an implant at the same time as the extraction, and because my # 13's root goes into the sinus cavity I'm gonna need to have a bone graft using bovine to do a sinus lift. Is this a good product? I am nervous that my body will reject this and I will be at square one. Also could I have long term sinus. Problems if the position and shape of that cavity is being altered? How painful is this extra procedure? Is there a better product and is this the normal material used? Also should I worry about tooth resorption on my other teeth? Is it related to a immune response similar to an auto immune disorder? Should I ask who manufactures the implant? I was quoted 2975 with the bone graft is this reasonable? This price does not include the crown. —Amberskelnik


2013-11-10 18:04:26   Amber, using bovine graft in the sinus is predictable. There are a lot of clinical documentation noting its success if used during sinus lift. Grafts typically undergo processing so they lack clinically significant antigenicity. I am guessing the bovine graft the periodontist/oral surgeon uses is probably Bio-oss. You can go onto the manufacture's website to see how it is processed if you are still concerned. Tooth resorption shouldn't be an issue, as resorption typically occurs when the periodontal ligament is damaged and bone gets in direct contact in the tooth (which does not happen during sinus lift).

Henry —HenryTHsu

Risk of sinus problems after a sinus lift are almost unheard of. The membrane of the sinus is left intact and only a small portion of the sinus shape is changed, the shape of the sinus cavity varies greatly between individuals and the specific shape is not critical. The procedure has very little pain associated with it, often only Ibuprofen is needed for discomfort but if pain is more significant prescription pain medication will work very well. As the above person mentioned (thank you so much for your input), risk of rejection of Bio-oss is very, very low. Additionally the risk of rejection of a titanium implant is very low (less than 5 %). The price you were quoted seems about right for the procedure described. Resorption is not linked with any autoimmune disorders (to the best of my knowledge) —DagonJones


2013-11-20 06:26:40   Can healthy Cementum be used in implant surgery after a bridge falls out? —BeverlyGiterman

I am not sure what you are asking here. Cementum refers to a very thin layer of tooth structure on the surface of the roots. If implants were coated with a layer of cementum then they would integrate very well because they would mimic the natural root surface. Some implant manufacturers coat the implants with minerals that are similar in structure to cementum to achieve this effect. To the best of my knowledge cementum is not used in any bone grafting or implant surgery because it is very impractical to harvest human cementum because it is such a microscopically thin layer. —DagonJones


2013-11-24 11:36:45   Hi. I live in the UK, and have just commenced some dental bleaching treatment, through my dentist, which is to be done at home over a period of weeks. I have had little sensitivity, and my smile is certainly slowly but surely getting brighter. However, prior to this I had noticed some transparency on the lower half of my two front teeth. As the whitening is doing its work I have now got a small white line across these teeth, and the transparency underneath. I have ordered calcium, Vitamin D and Magnesium supplements and K2 to try to restore this problem, as I have heard many success stories from people who have had the same problem using these methods. However, should I need to resort to something more invasive, what would be my best treatment option. Can my dentist apply a composite filling at the back of these two front teeth to take away the problem. These are healthy teeth, no sensitivity, and I am reluctant to have too much done to them if possible. Im just so upset that I have this line of transparency to deal with now. Please help. Yasmin —YasminDavidson

I had a simlilar experiance like yours when I bleached my teeth. Bleaching will increase transulcency of the teeth and may reveal enamel fluorosis or other white spots that are deeper within the tooth. These white spots might have not been visible before the tooth became more translucent. Taking supplements will not make any difference because the teeth are already formed and additional minerals will not be incorporated into the tooth. Composite fillings on the back or the front of the teeth are the best option for eliminating this issue, however it can sometimes be difficult to get a good shade match with these materials, talk to your dentist, they should be able to go over the options with you. —DagonJones


2013-11-28 01:21:02   I'm having sharp stabbing like pain feel like its my top back tooth sometimes but also my bottom back at times.the pain last seconds...it comes only when trying to eat or if something is hot or cold ..the pain sometimes when active feel like the left side in p pain I went to dentist they did fillings even then I was still in pain even after pain meds was giving to numb me during the procedure I don't think she knew what to do she had me make another appointment I need help I been reading post and im thinking it mite be a infection of some kind but I don't know?? ehen im not eating or causing any straine its find but when I eat,yawn,eat or drink anything hot or cold or chew omg that pain —jamila3wld

You might have a cracked tooth, a small fracture within the tooth that is sensitive to biting and to cold. Your dentist can check for this by isolating biting pressure on different cusps if one is significantly more sensitive then the tooth will likely need a crown. However it may not be a crack but just normal tooth sensitivity, I have several patients who have these type of symptoms that you describe without any obvious pathology. It is a little frustrating, but may be nothing to worry about. —DagonJones


2013-12-17 15:00:44   I lost a filling on the side of one of my teeth and had it replaced with a new dentist here in Oregon. The numbing agent is finally worn out I think (6-7 hours later) but I'm getting twinges of pain in teeth on that side of my mouth. Do I need to do anything or is it the sort of thing that will go away on its own? —Angel.York

The symptoms you are describing are very common for 2-3 weeks following a new filling. I suggest you give it some time and it will likely go away, if not, contact your dentist. —DagonJones


2013-12-25 13:55:21   I have a 12 year old son who has very bad teeth, as well as mine. But I am more concerned about my son. My son has had a very hard life. He was put on anxiety medicine when he was in kindergarten and continues taking the medication. On Feb 5, 2013 my oldest son passed away. His birthday is Dec 24, 1998. He was 15yrs old when he passed away. My 12yr old son cries everyday about his teeth. His last dentist appointment did not go well. His dentist would not even clean his teeth, he said it wouldnt help and he needs to have them all pulled and get false teeth. The same dentist told me the same about my teeth but I got a second opinion and they helpd me keep as many teeth as they could, however, after my son passed away I stopped going to the dentist and gave up on everything. My 12yr old has a hole in his back tooth, and alot of stains and alot of cavities. He brushes 3 times a day. Where we live we dont have many options to choose from, dentist around here dont care, but at the same time my son is getting into a deeper depression. He is afraid to go to a dentist because of what his last dentist said. I already lost one son and I feel like im loosing my other son just because of his teeth. I dont know what to do or who can help him. What type of dentist does he need, how to find one who cares and tries to help. I live in Madison, North Carolina. I am a single mother without a job. My whole life is going downhill. Please give me any information that you can yo help my son, he is all I have left in my life and I cant stand to see him feel this way and scared and he is so ashamed of his teeth. Please help. —Amandavernon

I am sorry for loss. It is common for grief to be so overwhelming that it is hard to move on. It may be helpful for you to focus on how your son would like to see you and your younger son move on. You may find one of the best ways to honor his memory is to take care of yourself and your family as best as you can. Your loss is great and devastating but it does not have to destroy you, you can heal from this.


2014-01-08 22:54:30   Hi Dr Jones.long history with tooth 15. Good place to start..2 years ago I had to have root canal done on it.still been in pain since then. They said probably cracked.so because of it being part of a bridge..I would lose bridge and show missing teeth. So I just dealt with the pain.it wasn't real bad mist the time. About December 13 the wwhole kept side of face got a burning rash feeling and same time terrible headache usually just on left side but eventually became whole head most the time and the tooth or that jaw aara started to hurt whole lot. So I got it pulled about Dec 17.it was cracked in center of roots. Anyway she had to cut all the way up to where cheek meets gums to get out and the stitched it all up.Took pain meds seemed not to bad headache felt some better and the face burning was slowly diminishing. About the 4th day the area seemed to be hurting more and headache back full force. Did a nasal rinse and it felt like about 4 drops of the solution came out the hole. I could be crazy, I am not sure. Went to see a different dentist cause the one who pulled it was out. He said it was possible could be small hole. Gave me climatic in 300 my 4 a day and per pain med.so by couple days before end of antibiotics I was getting better seemed headache was diminished and tooth area bone was better..oh when I went back and got antibiotics I was having what felt like lot of pain in bone.so a day or so after then the headache was slowly coming back so went and saw the original dentist she said it looked ok but seemed a bit concerned there was still some swelling going on.gave me a lighter pain med and off I went.saw her 3 days ago for some other work and she looked at it and said nothing..but I told her I was getting better I guess just cause if I said that I would be..haha. today the bone just started hurting pretty bad and I felt where the pain was which I hadn't before and there was and big bump wear she had made the incision up to the cheek area. It's hard.and the headache has come back full force.i always have some crazy problem whenever I have dental work done and the dentist thinks I am crazy but they always find out there was a problem. Like root canals one time I went through 5 months of terrible pain finally went and seen a 3rd endo with this special camera and he saw the problem there was an extra tiny root or something that most people don't have but I seem to have them on all text I have had root canals on and my old dentist should have known I was with him like 15 years. Amyway. I just don't want to be a problem to my new dentist. But the headaches are so bad. Any suggestions of why this could be happening. I also have bad to on that side just sayin.please help.thanks and sorry for the long explanation but I wanted you to know all the details. Thanks again. —VondaHack

It is possible that there is a sinus communication, which means that either due to the extraction or the infection that was there, a hole is now present between your sinus and your mouth through the tooth socket. If these are small they often heal on their own but may require surgery. Ask your dentist about this. The bump near the incision is probably scar tissue. —DagonJones


depending upon how far you can open your mouth, and how the access is to the area, it may not be possible to put in a filling, the decay will eventually spread to the nerve and cause an infection so extraction would be the only option. —DagonJones


2014-02-05 08:31:58   I need a root canal and I'll be paying cash from my Health Savings Account. Is there any way to find out if the dentist will be charging me the same amount as an insurance company would pay him? —JimStewart


2014-02-10 08:18:12   Call the dental office and ask directly, they should be able to tell you. —DagonJones


Transferring question from Who, What, When, Where, Why, HowJT:

2014-02-10 06:41:50   We noticed at the fluoride varnish toddler program my 2 yr old has a small cavity between his two upper front teeth. The dental assistant there suggested I see a pediatric dentist and have two fillings done. So I went and it took a month to complete there process of apts to lead up to having something actually done. The pediatric dentist suggested crowns. Now my son is only 2 and the rest of his teeth are very well kept and felt that was too excessive. Had a second opinion and she thought the same, to just have fillings. So I went back and told him I felt uncomfortable that I'd prefer the fillings for now. He agreed to do it. But instead of doing that he went against my wishes and simply shaved each tooth from the gumline straight down to the biting surface on each tooth. Now the dentin is exposed. He hadn't filled it. My heart is broke. I feel he did this to simply be spiteful to get my money for the crowns. Which is probably what is needed now since what had happend. I don't know what to do, I've been crying all weekend I feel I am to blame since I was there while it happend. —Katelynn113


2014-02-25 14:40:14   sorry for not writing sooner, have not been to check this page in a while. It sounds like a pretty frustrating situation. I would take your child to the other pediatric office (the one that recommended only fillings) and have the teeth evaluated and get their advice on what to do next. Don't worry too much, those primary front teeth are very common to get decay or trauma. Even if they have to be extracted early it does not cause any long term problems other than being toothless until about age 7. —DagonJones


2014-03-12 07:31:20   I am allergic to glycerin and need to find dental floss and toothpaste that doesn't contain glycerin. please help me!!! —maryleclair


2014-03-12 11:53:28   I am sorry I don't know of any toothpastes that are glycerin free. If you do a detailed internet search you will probably find some. —DagonJones


2014-03-12 15:18:08   Recently, while on vacation, I had a crown placed over the last bottom right molar, (#31 I believe); my regular dentist has told me that it is ill-fitting in that it does not contact the adjacent tooth. My original tooth had good contact. I have noticed that food gets packed in between the two teeth. My dentist advises a re-do on the crown and tells me the food packing between the teeth can/will cause decay and subsequent bone loss. My regular dentist would do the re-work, which would probably require a root canal, or he could (on my behalf) send a letter to the other dentist that created the poor fit. The crown work was done out of state and I will not be in that area again for several months. How bad an issue is the gap? What action would you advise?

an open contact between the adjacent tooth is a significant problem. food will constantly get pushed in there and can create very significant bone loss and/ or decay. This does not always happen but given the location I would recommend having the crown redone. You could probably wait a few months if you need to just be sure to floss regularly after meals. I think you should probably just have your regular dentist do it, going back to the other dentist is often a big hassle and it may not save you money when you factor in travel expenses etc. —DagonJones


Hello Dental Questions page, I have a query for you: Recently my #8 which is a full ceramic replacement set into the bone (that I got when I was 10, thanks Public skate park!) chipped on the bottom right exterior... It's not that massive of a chip, & it isn't deep. How do I proceed? Will I have to get the whole shebang redone, can the tooth be touched up? Can it be capped? Daubert

Yes it can be touched up, it can either be polished or a small ammount of composite bonded to it. The bond between composite (resin filling material) and porcelain is not very strong so these repairs have a tendency to chip off every year or two. It is probably possible to replace the whole crown as well. I am not sure by what you mean "set into the bone" that seems to imply an implant but an implant would not be possible on a 10 year old so it is probably a porcelain crown that is deep below gum line, maybe with a root canal. Either way there are plenty of options to address your issue. —DagonJones

This question is about dental enamel that seems to be growing faster on one tooth in particular, while no other teeth are showing such activity.
The tooth I'm asking about is the second one from the back of my mouth, on my right, on the tongue-side of the tooth (wisdom teeth all removed at age 23 or so; I'm now 61), and this weird activity is actually annoying, in that it is coming in contact with my tongue (as well as my tongue seeking it on its own, as happens).

I noticed this a couple of years ago, where I realized there was almost a needle-sharp point on one "corner" of that tooth, and it seemed sharper every time I touched it with my tongue. I felt it with my fingertip, and realized it was not how that tooth had been previously. In an emergency measure (admittedly probably not wise) I took a "diamond" metal nail file and smoothed out the tip of the point with a couple of soft strokes, which seemed to take care of the immediate problem. I was surprised several weeks later, that the sharp point had returned! I put up with it until I couldn't stand it any more, and GENTLY filed it a bit more.

Flash forward to recent dental work on that tooth (I deny that there was any breakage on the tooth; nothing changed except for that one strange "stalagmite" seemingly growing faster than surrounding enamel on it). The dentist thought it was due to a broken area she noticed when replacing the filling, but it is worth noting, when I first encountered the situation, it was shortly after she'd worked on it a couple years prior. Here's the interesting part: after she replaced the filling recently, no more than a month ago, I now am encountering that same rapid growth of the same "corner" of that tooth, again into a rather sharp point! I'm tempted to make a mold of the area, every few weeks to prove my point (no pun intended!), because while I love my Dentist, she doesn't seem to have an answer as to WHY this would happen, and frankly, the possibilities rather concern me.

Your thoughts?

I have never heard of such a thing before, it is really hard to say without taking a look at the area. It is most likely not growth of enamel because enamel does not grow on a tooth once the tooth is fully formed. It might be growth of calculus (tartar) or possibly the cusp tip is getting sharper from grinding on the tooth, which can create a sharper point. —DagonJones


2014-03-26 14:36:12   What rights does a patient have wrt excessive dental appts for one procedure. I have been trying to get my bridge replaced (now has been almost two years for the process). This upcoming bridge will be the fifth bridge my dentist will be inserting. This all started because my dentist's assistant temporary cement she mixed with my original temp bridge would not come off to put in my permanent bridge. I have had at least four appts with him hammering my temp bridge top try and break the seal. I think I have had 15 appts in total. The last appt I had to replace the third bridge, the lab didn't put enough material on my bridge so when he was grinding it down to check my bite level, he hit the metal screws or nails they put in to make the bridge. So...he was checking the height and I was grinding on my metal filling and the nail from my bridge...ughh. Today he called he called me and said the lab screwed up yet again, and now the bridge he got made again isn't going to work. The fourth bridge I will have put in. You must know he has already written off $1200 of my $4300 cost of the bridge, and the bridge is paid in full. The last appt I went to last week was four and half hours long, he didn't offer me a break or a bathroom break. I have severe arthritis in my back, three herniated disks, and severe pain. I was processing the freezing every 45 mins so had four needles up the front of my nose area...my jaw was so sore I had a headache for a week after and can not chew on that side as a shooting pain goes up my front top tooth. All in all, when he called today to say I have to get another new bridge made, I almost went into a panic attack. I have a severe fear of dentists as it is, so I would rather deliver a baby then go back. Should I demand all my money back I have paid out of my pocket for this minus what my dental plan has covered of course. I realize the lab screwups aren't not directly his fault, but it is his practice, and he is ultimately accountable. Please Please someone who has some idea of my rights please give me some advice. I am beyond upset at this. —PennyEffler

I am sorry Penny but I want to keep the forum about specific dental issues and not legal/ billing questions, so I cant really help you because I am not a lawyer. Your dentist may be an excellent practitioner with a streak of bad luck, your teeth may be a very difficult case, or it is possible that your dentist has made some oversights. There is just no way for me to know so I don't want to speculate. My advice first would be to call the office, voice your concern, and try to come to a resolution you are happy with. —DagonJones


2014-03-27 11:24:47   My 6 year old son has an infection (abcess?) on the upper front gum. It is just smaller than a pencil eraser and it does not hurt. It is directly above a baby tooth that has a filling. It appears to be draining. He was taken to the dentist and the dentist said that it would go away on its own? My question is is that true? I thought abscesses for more serious than that, He said to bring him back if it starts to hurt or doesn't go away. But I'm still concerned, Could an infection like that even if it's smaller than a pencil eraser but like a big pimple affect the adult tooth in the gum? —jessicalyon

It is unlikely to effect the adult tooth, however generally in these situations an extraction of the baby tooth is the best solution. I would recommend getting a second opinion, if the abcess is coming from an infected baby tooth it should be extracted. However sometimes minor irritations in the gums can present like what you are describing so it is possible no treatment is needed. I would have to see an xray to be sure. —DagonJones


2014-03-27 17:37:21   Do misaligned teeth have anything to do with TMJ? In high school, I had braces to correct my malocclusion. My teeth were straightened for a while, but then one day, two years after I got my braces taken off, I lost my retainers and never got them replaced. Now most of my teeth have shifted back to their original position before I got braces. My jaw first started to "lock" 4-5 years ago when I was eating bread. At first I thought it was caused by my wisdom teeth growing in, but even after I got them removed, I would still experience clicking and locking jaws. Because of that, I am no longer able to open my mouth as wide anymore like I used to —MichelleNguyen

Occlusion refers to how the teeth meet together, this can have an effect on TMJ symptoms. However, your TMJ symptoms may not be related to the history of your braces at all (Many TMJ disorders manifest in late adolescence ). Unfortunately TMJ disorders are a complicated issue with many factors, even with some very advanced examinations there are a lot of unknown factors. The clicking noises by themselves are not a significant problem (these sounds are quite common and do not always represent significant pathology). As long as you are not experiencing any chronic pain I would not be too concerned. Even a normal functioning Jaw can lock open at times, given all your symptoms I would say that you likely do not have any significant jaw disorder now but you are at a higher risk for developing chronic pain symptoms. My recommendation would be to get a dentist to make you a hard night guard or "bite plate". This is a device that will help stabilize your jaw at night while you are sleeping, it is likely to help prevent any possible further exacerbation of your jaw symptoms. —DagonJones


2014-03-30 13:11:59   Hello. 4 days ago I went in to get my teeth prepared for a temporary bridge. The dentist decided that my front left tooth, which was to be one of the anchors for the bridge, was not suitable due to decay. He showed me the x-ray and there was some, not a lot, but he said, ultimately, it could become worse, so better to just take it out (it had had a 30 yr old crown on it, still strong) and then shave down the other front tooth to use as anchor. I was mortified to be losing my two front teeth (I am 51 and work with public). This means a 5 tooth bridge at the cost of $4000 (I am also a single parent with a disabled 22 year old)

By the time he got to this point, he had already prepped the other teeth, so it seemed there was no choice but to agree to it. So he shaved my right front tooth down to a stub then he yanked, tugged, pulled and finally got my left front tooth out. I heard his assistant ask "Suture?" and he said "No, No". I had been in the chair for almost 3 hours, I was the last patient and it was closing time. One of the other assistants was coming in and grabbing tools to sanitize off the tray and cleaning office already. He made the temporary and cemented it in. I was still bleeding from the pulled tooth and there was a gap above the temp. bridge and the area of the pulled tooth, so they gave me gauze and told me to hold it there. Gave me a whole bag of gauze and the receptionsist told me if it was still bleeding after all the gauze was used up, to switch to tea bags. For the next 6 hours later...I could stop it for a few minutes, then it was like a dam would bust and bright red blood would gush fill my mouth. I couldn't talk, I had to keep a towel to my mouth and let the blood pour out and blood tinged saliva in between.

After 6 hours of this, my other son came home from work and immediately took me to ER where they had to stitch thru my gums (since the temp bridge was in the way) 3 stitches to compress the area and it finally stopped bleeding. I called the dentist a couple days later (was too angry to speak to him) and left voicemail to let him know I had to go to ER to stop the bleeding. He called back and unfortunately I missed his call but in his voicemail, he apologized and minimized (called it a "little trip to the ER") and then said he had put "a compression splint against the socket". THIS I do not recall. He had been very good about explaining everything else, I was awake the entire time, I don't recall any action inside the socket besides blotting and air blowing and more blotting with gauze as temporary bridge was being shaped. I did question about the bleeding and why wasn't a clot forming while still in his chair and he said, well, it's normal and he is still kinda disturbing the area, but it should be ok.

Sorry to go so long...MY MAIN QUESTIONS ARE:

1) WHAT IS A Compression Splint and is it normal practice to put one in a freshly extracted tooth before a temporary bridge is cemented on over it (all within an hour time frame).

2) Is a Compression Splint something you can see on an X-ray?

3) Was this negligence to not ensure the bleeding was stopped? The assistant herself obviously felt a suture was needed. Also, the temp bridge is a little sloppy, there is cement around the outside of it as if he didn't take the time to clean it up. I saw him leave the office before I had finished paying up front. Normal closing time is 5 and it was 5:30 by the time I left...so I feel like this "unexpected" extra procedure came up (tooth extraction and one extra tooth to shave down, additional paperwork to charge the additional $800 and sign new consent) doubled the time frame they had set aside for me and in the end, everyone was just wanting to get out of there (me included) so the quality of work went down and became rushed and sloppy. AT MY EXPENSE.

My son was horrified when he came home and saw all the blood. I do not know if I can trust him to finish the job he started. —JoanneStreeter

1) I am not certain, but I think what he means by a compression splint is a part of the temporary bridge that puts pressure on the extraction socket. So a compression splint is part of the temporary bridge, it is a false tooth that extends very slightly into the socket area to put pressure there and help hold a blood clot in place.
2) It does not involve any treatment to the extraction socket itself, so it will not show up on the xray other than being part of the temporary bridge, and you would not notice any different activity in your mouth other than the dentist making the temporary bridge.
3) Regarding possible negligence, I won't comment because that is a legal question. However, it is common for an extraction site to bleed for about 24 hours after, this bleeding can sometimes increase after the patient leaves the office. Sutures can sometimes help retain a blood clot but don't always make a difference, the main purpose of a suture is to hold tissue in place where it should be for proper healing. If the tissue is sitting in a good position for healing then a suture is not needed. I do a lot of surgical extractions in my office and my assistant often will ask about a suture when one is not needed, this may have been just a routine question the assistant asked. Your description of the extraction (yanking, tugging, whole bag of gauze, mention of teabags) all sounds very routine.
I or my assistant always check and make sure bleeding has stopped before the patient leaves. Many times I call the patient that night and they say that it is bleeding a lot and I am certain they left with very minimal bleeding, sometimes it is patient perception and sometimes the bleeding increases after the patient leaves. Regarding excess cement: It is often hard to get all of the cement off of a temporary, ideally all the cement should be removed but sometimes some gets left behind (we are all only human) and this excess cement is rarely a problem, (it may cause a slight increase in temporary irritation on the adjacent gum tissue).
I hope this information is helpful to you and I am sorry to hear you had such a negative experience, I understand your frustration. —DagonJones


2014-03-31 11:15:42   I recently went for a check up, and the dentist said I had an impacted wisdom tooth that grew in sideways. I've had it like this for almost 15 years. He wants to have it extracted, but he also wants to extract the perfectly straight upper wisdom tooth on the same side as well. Why? Should I allow them to extract both or tell them to just extract the impacted one? —TonyRomano

yes get both of those teeth out. Even though the impacted tooth has not caused any problems for the last 12 years, it will most likely cause an issue as some point in your life. Extraction of a wisdom tooth when you are young is routine and heals much quicker than when you are older (the bone becomes more dense). Also if the impacted tooth causes a problem you may have to have the tooth in front of it extracted as well. I recommend removing the straight tooth above it for many of the same reasons, if that upper tooth does not chew against a tooth on the bottom it is only going to cause problems for the tooth in front of it by trapping plaque and bacteria. Wisdom teeth are notoriously hard to keep clean and often suffer from much worse gum disease than any other teeth in the mouth. —DagonJones


2014-04-15 06:38:05   Hello there, I had a root canal performed due to infection last year with no problems. Recently a 1/4 of that tooth cracked off as I ate a boiled sweet. I went to the dentist 2 weeks ago who said it looked clean and fine with the option of having a filling, crown or leaving it for now. So I decided to leave it for now being a student and saving. However over the past week whilst brushing my teeth I have noticed grey/black on my toothbrush and saliva. It's not blood. I wonder if I am disrupting the material used for the root canal whilst brushing against it? Is this harmful or not? I have made another dentist appointment for 2 weeks time. Any advice for the meantime? Kind Regards. —Jadewootton

I would guess that that black stuff is just food that got caught in the area, it is probably not root canal material, that is often pink or white. Black could be debri or stained tooth structure. You probably will be fine to wait another 2 weeks but I recommend you definitely get a crown on the tooth if it has had a root canal and a fracture. A crown will protect the tooth from further fracture, a filling will not. —DagonJones


2014-04-19 09:12:49   Hello,

My dentist said that I need my upper incisor tooth extracted because my body is rejecting the tooth. I want to do an implant. Would it be better to have the implant done at the same time the tooth is extracted, assuming no bone grafting is required? Also, if bone grafting is require would be better to add the graft at the time of extraction?

Thanks!


2014-04-19 09:18:43   Hello,

My dentist said that I need my upper incisor tooth extracted because my body is rejecting the tooth. I want to do an implant. Would it be better to have the implant done at the same time the tooth is extracted, assuming no bone grafting is required? Also, if bone grafting is require would be better to add the graft at the time of extraction?

Thanks!

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