So, Exactly Why Do I Need that Crown? Thursday, Jun 16 2011 

What a common question in the dentist office. Whether it is for a single crown or twenty to restore an entire mouth, patients like to know the specific reason they are being asked to spend that much money. The reason for the diagnosis for a crown has many answers, but in most situations they focus on supporting the tooth and making it stronger.

From previous post, I pointed out that teeth that have had a root canal are prime candidates for a crown. The tooth has been weakened and needs some additional support to function properly in your mouth. If we continue along that path of making a tooth stronger, it is easy to see why a tooth that has a large cavity or filling which is begining to break down or has decay needs a crown. Enamel is very hard, but the dentine under the enamel is not. Once decay starts to eat away at the dentine, the enamel becomes undermined and is weakened. It will begin to crack and break away from the tooth. A tooth has five parts or surfaces–top, or chewing part, cheek side and tongue side and a front and back. If three or more of those parts are broken down or missing the tooth is in bad shape.  A crown can replace those parts and with a core build up the dentine part of the tooth which has been eaten by decay or removed in the process of placing a filling is also replaced making the tooth strong once again.

Fillings do not last forever. They are good replacements for missing or damaged parts of a tooth, but with time they fail. Now it is true that with proper brushing and flossisng, you  can make a filling last years, if not decades. But when they begin to fail, decay can start around the edges where the tooth and filling meet. With time, the decay will penetrate into the tooth itself and create more problems–more tooth parts destroyed and possible damage to the nerve of the tooth, which might lead to needing a root canal. When a tooth with a large filling reaches that point, it is time to consider a crown. 

Sometimes, crowns are used to change the color or shape of a tooth. The tooth might be in decent condition, but the patient wants things  changed. A better color, a more natural shape or a new smile would require crowns to accomplish those goals.  A crown is versatile, it can be made to do many things in the mouth. Teeth that are worn from chewing or grinding would benefit from crowns.  Crowns can make teeth look longer and more youthful; they can make a mouth which has broken down and worn teeth, look better and more healthly as well as function properly. Crowns are placed on teeth which will support  a fixed bridge which allows the dentist to replace missing teeth like they were still part of the mouth.

Crowns can be made any color, or shape and from a variety of metals. Diamonds, rubbies and other precious stones can be placed in the crown.  Intials, and designs or other shapes can be incorporated into the crown. So, when a tooth is damaged or needs serious help, the crown is the best bet.

So, You Want White teeth? Monday, Jun 13 2011 

Theoretically, one in a hundred people have white teeth. By this I mean that their teeth are noticeably lighter than most people. However, by todays standards, their teeth are not white enough. Today white means the color of a piece of copy paper or a bleached white shirt.

Well, you can get your teeth that white, but it will involve some effort, money and possibly pain. The cheapest method would be Crest White strips. A good method but you must follow the directions perfectly and be consistent with wearing the strips. There can be some problems with bleaching the areas between your teeth with the strips, but that can be solved. I should mention that the whitening mouth wash and tooth paste can help lighten your teeth, but it is a slow process and will produce only modest results.

The next upgrade in whitening is bleach trays made by the dentist (best method but I am a dentist ) or some kit you can purchase at the pharmacy or Wal-Mart. The dentist trays will fit the best and last the longest and will bleach all of your teeth, even the spaces between them. Also, the bleaching solution the dentist provides is strong, 22%  carbamide peroxide. An hour or two a day wearing the trays and you should be really white in seven days. A better method is to start with the Crest strips and then use the bleaching trays. This works well with super results. The bleaching pens that you apply to each tooth also work well with the trays. In short a combination of methods will provide good results.

The final whitening up grade is the Zoom and other light activated techniques which use a strong carbamide peroxide solution in the hight 20’s or low 30’s.The gums have to be protected with a coating and eye protection worn. These techniques produce results, but there are a coupe of caveats. First, sensitivity will be an issue with all bleaching techniques, but the high power ones can produce some problems. Next, all bleaching techniques require that you “refresh” the bleach every few months to maintain the results. Yes, your teeth will betray you and slip back to their orignal color.

There are a few tricks to work  with these problems. Trays are easy to use and can last a long time– years, so they can be worn any time you need a recharge. It is easy to get more bleaching solution from the dentist and keep some on hand. Next,before you bleach start using a toothpaste for sensitive teeth a week or two before you plan to bleach. A fluoride rinse can also help but has to be used daily. The dentist can provide treatments for the sensitive teeth if it is severe and chemicals that can be worn in the bleaching trays to make the teeth more resistant to the sensitivity.

All of these methods will work, but the most important thing to keep in mind is that old fillings and crowns in your front teeth will not bleach. They have to be replaced. If you chose to bleach, wait until you have the results you want and then have the fillings or crowns replaced to match your new teeth. Of course, you can  just have crowns or veneers put on your teeth and not bleach at all!

Anxiety in the Dental Chair 2 Tuesday, Jun 7 2011 

The previous blog talked about anxiety in the dental chair

in some general terms as to what can be done to help

the patient who is fearful. But there is some additional

information about what can be done, particularly by the


First, make sure you tell the dentist that you have some anxiety about your dental treatment, or that you are just plain scared or petrified of the thought of having dental treatment. This helps more than you will ever realize. Once the dentist knows you are not happy about sitting in the chair, he can begin the conversation to offer some suggestions on what can be done to help you. The worst thing that you can do is not to tell the truth. Men are the worst about this. They will not admit to any fear or apprehension about what is going to be done. Nothing is worse than starting a procedure and suddenly have the patient begin have a melt down. Everybody loses when that occurs. I have had to stop work on many people and tell them that we were finished with todays treatment and that they would have to return sedated to complete the procedure.  

In most cases they are relieved with this and return sedated and have an excellent experience and are glad that they learned there was an alternative. The dentist is much more comfortable working on someone who is relaxed and not jumping around groaning about how much they don’t like what is happening to them. So be honest and tell the dentist exactly how you feel about things.

Once you start the discussion, listen to the choices which are suggested to help you deal with the treatment. Ask questions and get all of the information you need to help you make a decision. Remember, treatment for dental work can range from no anethetic for the procedure to going to the outpatient surgery center for general anesthesia. That is a very large range. You can always start out on the low end of the spectrum. If the local anesthetic or nitrous oxide is not working for you, tell the dentist and let him or her know you need some help and that would be sedation.

Another situation that occurs some times is the local anesthetic not seeming to work as well as it should. There are a number reasons that this can happen. It can range from the dentist missing the block on a lower nerve (this is very common since the dentist can not see the target and it is very small and the actual location can vary), to infection around the tooth or teeth, or the anesthetic  does not work due to some chemical problem with the solution. When any of these things happen and the patient begins to feel some pain or discomfort it is bad for everybody.

There are ways around the situation. The dentist can use a series of different injections at different sites in the mouth in an attempt to block or numb the nerve at various locations where it is located. Using a selection of different local anesthetics for the injections can also help with this problem. If these fail, then sedation solves the problem in most cases.

If a patient is nervous and has alot of anxiety about the dental treatment, it can create problems with the anesthesia working. A relaxed and happy patient has a better experience and everything seems to flow smoothly.  So speak up and let the dentist know how you really feel. It will make everyone’s dental visit much better.

Anxiety in the Dental Chair Monday, Jun 6 2011 

Most people are not very happy to come and sit in the dental chair for treatment.  Their reasons are numerous, but can fall into a few main categories;

1. Childhood bad experience

2. Adult bad experience

3. General fear based on stories and other tales of dental horrors.

I have found that the easiest and quickest method of dealing with these problems is some sedation. By sedation I mean nitrous oxide, or some oral medication like Halcion that is taken before the appointment. The goal of these treatments is to relax the patient or in the case of Halcion, to actually induce a very light stage of anesthesia which also results in amnesia.

Nitrous Oxide has been around for a long time –1800’s– and is a very safe inhalation gas particularly with the modern analgesia machines. It provides the patient with a relaxed warm feeling which helps most people tolerate the dental appointment with little difficulty. The patient should not feel like they are spinning around in the chair. That is too much of the Nitrous Oxide and the flow needs to be reduced.

Halcion and the other oral drugs used for sedation in dentistry provide a different sort of analgesia. With these medications, the patient will be drowsy, or in some cases asleep, and have little or no memory of the visit to the dentist. For patients who are very nervous, or terrified of the particular procedure, such as pulling teeth or having a root canal, this is the way to go. They know nothing, feel nothing and do not remember their visit. This makes them very happy.

The oral medications are safe in that they do not depress the heart rate or breathing. Intravenous medicines do depress the heart rate and breathing, so the patient has to be monitored and watched closely. Oral Surgeons and a few other dental specialist use intravenous medications for sedating their patients, but most general dentist use the oral medications.

With any form of sedation, other than Nitrous Oxide, the patient must be under constant supervision and care once they leave the office. It can take several hours in some cases for the patient to recover from the procedure and medication used. In fact with the oral medications, the patient will have to be brought to the office for treatment by a family member or friend. The oral medications begin to work within  fifteen minutes in some cases which makes  the patient unable to drive or take care of themselves. When the oral sedation medicine is combined with pain medications, the patient will be very sleepy.

Sedation is a great way to deal with anxiety and fear in the dental office. The patient can have a great deal of work done quickly and efficiently, and remember little if any of the time spent in the office. It is cheaper than using the operating rooms at the hospital with general anesthesia, yet can provide an experience which even the most fearful will be able to deal with quickly and efficiently.

Root Canals that go bad Tuesday, May 31 2011 

Often, I have patients that are reluctant to have a root canal. Either they have had a bad experience or later lost a tooth that had a root canal, or a friend or family member has. With a 90% success rate, this does not happen often, but it can. The reasons are not numerous and the most common one can be controlled.

Most teeth that have had a root canal and fail have extensive decay into the root surface. This has happened because the patient failed to have a filling, or crown placed on the tooth. They left the office and felt better, and never returned to complete the treatment. The access hole in the tooth, which is drilled to allow entrance into the nerve chamber, has to be sealed with some sort of permanent filling. When the root canal is completed, a temporary filling is placed which after a few weeks crumbles and allows food and bacteria into the tooth. Decay starts, which naturally does not hurt since the tooth had a root canal. But,  in a short time there are problems.

The most common problem is that the tooth breaks since it has been weakened by the root canal and the decay. This could have been prevented with a filling or crown. The other reasons for failure are more nefarious.

The root of the tooth can be fractured. This can happen before the root canal or after the treatment has been completed. A fractured root is difficult to diagnosis since the fracture is microscopic. It is only discovered after the fact when the patient is still having problems with the tooth despite having a root canal. In most cases, the only option is to remove the tooth. Root fractures are not very common, and are a small percentage of the reasons for failure.

The next reason is a recurring infection. This can be caused by the dentist not completely cleaning out the root and some tissue is left in the tooth which creates an infection and pain. The other part of this recurring infection situation can be a nerve that was not treated when the root canal was finished. The nerves can be very small, and some times difficult to locate. The good news is that in most cases the tooth can be retreated with a new root canal.

The other procedure for re treatment of  the root canal is apical surgery. This means that the root of the tooth is exposed surgically and a small portion is removed. The area is cleaned out and a small filling placed in the tip of the root. The area is then sutured closed. In most cases this would not be the first choice for treatment of the problem with a failed root canal since it is drastic. However, it is effective and can solve the situation.

This is just a short over view of the root canal and what can be done to save a tooth which has died or had some trauma which has caused the nerve to die. If you need a root canal it is important to follow through on the treatment. Don’t stop after the root canal! Have the core and crown completed in order to ensure that the tooth does not break or begin to decay again.

After the Root Canal Wednesday, May 25 2011 

So, you survived the root canal. It was not that bad and you almost fell asleep twice during the procedure. The rubber dam was a bit inconvenient, but it did keep the chemicals out of your mouth, and they do taste bad. The tooth feels great and you can even chew on it.  What next?

If the tooth had a large filling, or a great deal of decay, it will need a crown and possibly a buildup or post and core. What are those things? The buildup and post and core add strength to the tooth and help support the crown. One of the big problems after a root canal is the tooth breaks or fractures. This happens a great number of times. You feel good, the tooth is happy and you do not want another visit to the dentist. But that is exactly what you do need. Without support and internal strengthening, the tooth is going to break or fracture. It is very sad to see someone who has spent a lot of money on saving their tooth, only to have it break and have to be told that it cannot be saved. It could break in  a month or a year or two later, but at some point, there will be problems. Get it fixed, or at the very least have the buildup completed before something happens that will cause you even greater problems.

A tooth that already had a crown can be treated differently. If there was not a tremendous amount of  decay, or the crown was recently placed, a filling or post and core can be put in the tooth and this will solve the problem. If the crown was old and there was a huge amount decay, it might need a new crown in addition to the buildup. A tooth that is part of a bridge can be saved in this manner also, However, if the decay is severe or the tooth does not look good, a new bridge might be in order.

Get the tooth fixed properly and you will not regret spending the money for the root canal and other work. The tooth will hold up and give you years of service. Brush and floss and treat it like your other teeth with TLC and you will be very happy and so will the tooth.

First post Tuesday, May 24 2011 

Since this is my first post on this blog, I decided to use that as the title. Maybe not very inventive, but accurate. The name of the blog reflects the fact that I am a dentist and also a private pilot. I have been a dentist far longer than I have a been a pilot –over 30 years, verses 18 years. So the topics will be more dental with flying stories added for some variation.

I do a lot of root canals in my practice. According to some information that the dental supply company I deal with generated, about two to almost three times as many as most general dentist. The new tools for doing root canals sure have helped–electric handpieces that reverse when a file begins to bind in a canal, apex locator, and all of the rotary files that can be used as well as the ultra sonic tips that can placed in the various machines to assist with difficult situations. Much better than when I started dentistry.

Most patients are afraid of root canals which is understandable. They have a bad reputation and can be difficult. But most are uneventful and even boring.  Who wants to hear about the easy root canal, when you can listen stories about the pain , suffering and problems that  your friend experienced at the dentist office.

What I have found over the years, is that most people do very well with the root canal if they follow directions for post operative care, and the tooth has not been “sick” for some time. By “sick” I mean infected, swollen, and been a problem for months. These are the teeth that will give the patient and dentist problems. Some time spent explaining  the procedure and what to expect certainly helps a great deal also.

The single biggest factor in doing the root canal is what the dentist call “profound anesthesia”. This means the patient is really, really numb. Some times getting to that point can be challenging, but methods exist to achieve that goal, and it is a very important part of the procedure. For someone is who very fearful, or possibly had an unpleasant experience, I suggest sedation. In my office we use  pills which produce excellent results and are very safe. With sedation, the patient has no memory of the procedure or even being at the dental office.

Another factor in the successful outcome of the root canal is not chewing on the treated tooth for several days. The root canal creates bruising  of the periodontal ligaments which hold the tooth in the bone. These need some time to recover, and if left alone, will heal in a short time and the patient can then chew on the tooth. Of course some pain medications whether prescription or over the counter can be used to help the situation along.

Keep in mind that over fourteen million root canals are performed every year and have over a ninety percent success rate according to the American Association of Endodontist. That is a lot of teeth that are being treated and saved instead of tossed in the waste basket.

Next time, what to do after the root canal to make the tooth last will be discussed.

Hello world! Monday, May 23 2011 

Welcome to After you read this, you should delete and write your own post, with a new title above. Or hit Add New on the left (of the admin dashboard) to start a fresh post.

Here are some suggestions for your first post.

  1. You can find new ideas for what to blog about by reading the Daily Post.
  2. Add PressThis to your browser. It creates a new blog post for you about any interesting  page you read on the web.
  3. Make some changes to this page, and then hit preview on the right. You can alway preview any post or edit you before you share it to the world.

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