Archives for January 2020

Can Composite Bonding be Removed?

Posted on by .

I had composite bonding done on my front teeth to improve my smile, but now it actually looks worse. Is it possible to remove the bonding without damaging the underlying teeth?

Katie

Dear Katie,

Before and after dental bonding

There is a way to safely remove composite bonding from teeth. However, this only works if the composite is bonded to the teeth and not the soft dentin beneath the tooth enamel. Dentists often get requests for vampire teeth around Halloween. We use composite dental bonding because it is reversible.

Here are three ways to safely do it:

  • Sandpaper Disks: These are flexible and bend to the shape of the tooth, making them easier to use. They’re generally used to polish up the composite but can be time-consuming when talking about removing the enamel.
  • Carbide Drills: These are high speed and therefore faster than the sandpaper disks. It’s important light pressure is used so that too much material isn’t removed. However, they tend to leave streaks of material behind so your dentist will want to follow up with the sandpaper disks to remove all the remaining material and leave a nice polish.
  • Micro-etcher: This is also a slow method and best used as a finishing step.

Getting a Beautiful Smile

While a true cosmetic dentist can give you a beautiful smile with dental bonding, it is best used with something like a chipped tooth (as seen above) or for closing a tooth gap. This is because it is done freehand and more time consuming, so it is better on smaller areas. It also doesn’t last very long and will have to be redone every few years.

If you are looking for a gorgeous smile makeover, you would want to get porcelain veneers. These are the go-to for the top of the line smile makeovers and what gives celebrities that Hollywood smile. When well done and well cared for, they can last a lifetime.

This blog is brought to you by East Cobb Cosmetic Dentist Dr. Cristi Cheek.

Are Steriods the Right Option After a Root Canal?

Posted on by .

I had a root canal treatment which seemed fine at first, but then I started to have tooth pain several weeks later. I went to see the endodontist, who then prescribed me a course of antibiotics. That helped and she said I’d be fine now. However, a few weeks later the pain returned. She’s since placed me on a course of steroids, but I’ve gotten worse instead of better. I’m not sure what to do.

Adrian

Dear Adrian,

a woman holding her jaw from TMJ pain

While we do sometimes prescribe steroids with a root canal treatment, it seems like your endodontist doesn’t understand the science behind it. Steroids are an anti-inflammatory. There are times this is an appropriate treatment. Generally, with a root canal treatment, there can be some irritation at the end of the tooth root. This can happen for several reasons. The file could poke through the end of the root or some materials, such as the infected pulp, the disinfection solution, or the filling material itself can make their way out. This causes a vicious cycle of pain and inflammation, but there is not necessarily an infection.

The inflammation causes swelling of the tissues around the end of the tooth, This, in turn, pushes the tooth up causing traumatic occlusion (how the teeth meet together). That then aggravates the inflammation, causing more swelling, starting the cycle over again. Prescribing steroids, in this case, can help stabilize the body’s response.

Because sometimes there could be infected tissue being pushed through, a brief course of antibiotics is generally prescribed along with the steroids.

However, this isn’t your problem. The best dentists will find the cause before prescribing a treatment. In your case, it was the wrong treatment. We were dealing with an obvious infection here. In that case, prescribing steroids is the WRONG treatment. Steroids are an anti-inflammatory. However, that inflammatory response is necessary in the case of infection. It brings necessary white blood cells and antibodies necessary to fight the infection. By prescribing steroids your dentist actually hindered your ability to heal.

Root Canal Treatment Failure

Your situation sounds more a case of root canal treatment failure. This doesn’t mean your endodontist did the root canal incorrectly. While I’ve been harsh on her diagnostic and follow up treatment skills, you can do everything right in a root canal and it will still fail.

The canal system inside a tooth is complex. It is easy to miss a small canal. Plus, some shoot off at a 90-degree angle and there is no way for the tool to reach everything. When a tooth flares up weeks after the treatment, it means there is an infection present and the root canal didn’t succeed. This is why your antibiotic treatment she gave you after the first flare-up made your tooth feel better. It brought the infection under control.

However, without getting in there and ridding the tooth of the infection completely it will rear its ugly head again. This is what you’re experiencing now. In this case, steroids are a hindrance rather than a help. You have some options here. The first is to have another root canal treatment done to try to completely get the infection. You should be aware the risk of failure increases with each root canal re-treatment. That doesn’t mean it is a waste of time to try, just be aware of the statistics. Two other options are root canal surgery or having the tooth extracted.

If you do end up extracting the tooth, don’t wait too long to replace it. There are more than esthetics to factor in. Your other teeth will begin to shift into the empty space. You can ask your dentist about tooth replacement options, including dental implants. Then decide which is best for your situation.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Cosmetic Dental Work and Teeth Whitening

Posted on by .

When it comes to cosmetic dental work, you really need to go to a dentist who has invested time in the requisite training to create beautiful smiles. There isn’t a recognized specialty in cosmetic dentistry where you are officially now a cosmetic dentist. Any general dentist can do cosmetic work. This is where most of those smile makeover horror stories come in.

Let me illustrate with a proper understanding of teeth whitening. Most people understand that bleaching your teeth can get rid of years of stains, such as the pigments picked up from staining foods and beverages. However, it will also whiten the natural pigment of your teeth.

Unfortunately, many family dentists who dabble in cosmetic work don’t understand this either. Dentists traditionally used the shade guide seen directly below.

Classic shade guide

This matches the natural pigment of teeth and darker with various levels of staining. However, when people started whitening their teeth, that changed the rules. The lightest shade was now too dark to match to the new colors now being seen on teeth. The problem comes when a dentist inexperienced in cosmetic work doesn’t understand this.

A patient comes in for a smile makeover and decides on porcelain veneers. They tell their dentist they want a very white smile. The dentist picks the lightest shade on the guide thinking he’s safe. When the veneers are placed, they are much darker than the patient’s natural teeth. Why? Because he or she has done teeth whitening.

Getting Your Smile Done Right

So how does a dentist get the right color? A true cosmetic dentist will invest in the updated shade guide, seen directly below.

updated shade guide

This allows the cosmetic dentist to get a better match. This, of course, isn’t enough to give you a beautiful smile, but it’s the bare minimum for a match. Before seeing any cosmetic dentist, make sure you look at their smile gallery first. Just make sure they posted actual cases the dentist has done and not just stock photos. If the before and after pictures don’t blow you away, don’t waste your time.

If you do like the photos, then its time to check their reviews. This one way to find out what type of chairside manner the dentist has and how good they are at listening to their patient’s desires for their new smile.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.