Are Steriods the Right Option After a Root Canal?

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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.

Best Dentist Won’t Treat Me

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I’m in a group of friends who have much bigger budgets than I do. There are times that is uncomfortable. They want to take trips as a group that cost more than I really should be spending. They’ve all gone to this fantastic cosmetic dentist and have been encouraging me to go as well. The guy is the best cosmetic dentist in our area. I saved up and was finally ready to go. Truthfully, I was thrilled. They’ve all got some beautiful smiles and I felt like I’d finally have one too. When I went there, I had a good experience… at first. I loved his treatment plan. We’d do ten porcelain veneers on my top teeth after whitening the rest of my teeth. Unfortunately, the price was way more than I was anticipating. I asked about alternatives and he essentially said, if I don’t do his treatment plan, I don’t deserve to be there. I left humiliated. I don’t want my friends to know what happened, but still want to get an improved smile. Do you have any recommendations?

Patricia

Dear Patricia,

blonde woman giving a thumbs up in a dental chair

Being the best dentist requires more than just creating beautiful smiles. You have to treat your patients with respect. You have to give them options and work within their budget requirements.

My guess is, because he recommended ten porcelain veneers, you have a wide smile. However, you can save money by whitening your teeth and then doing six veneers. Yes, ten would be ideal, but you can still get a stunning smile with less. The teeth whitening will ensure the teeth match. Not everyone can do the ideal treatment.

I’ve known patients who’ve had just two veneers done and were perfectly thrilled with their teeth. There are always options. Always.

Finding a Cosmetic Dentist Who’ll Work with You

I’m going to suggest you look at other dentists. He likely won’t be the only dentist who gets beautiful results. Check out the smile galleries of some local cosmetic dentists in your area. Pick the top few whose work you’re thrilled with. Then, check out your top contenders on the review sites. You’ll want to make sure these dentists have a good chairside manner and work well with patients.

Some things to look for is a dentist who advises but listens to his patients; a dentist who listens to his patient’s desires and helps them achieve the smile goals they have without shaming them about their budget.

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

Dentist Keeps Pressuring Me to Get Porcelain Veneers

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I have a lovely dentist but he is really into cosmetic dental work. Every time I go to an appointment he keeps telling me how beautiful my smile will look with porcelain veneers. First, I can’t afford anything close to porcelain veneers. Second, he is starting to make me feel quite uncomfortable about my smile. Now whenever I see my smile, all I see are how much darker they are than when I was younger. I just can’t afford to make them look younger. Is it really the norm now to get porcelain veneers?

Susan

Dear Susan,

Dr. Cheek with patient

I’m going to say two things right off the bat which make me uncomfortable with what your dentist is doing. First, you should never feel pressured into any procedure, let alone one that isn’t a medical necessity. Second, a dentist’s job is to make you feel good about your smile. This may not be the right dentist for you. While it is great that he is pursuing his passion for cosmetic dentistry, it sounds like you are more into basic dental care. The best dentists help their patients meet their goals with their teeth. They don’t try to create needs which aren’t there.

As to your question about norms, it really depends on quite a few things. For instance, your area of work. More people in Los Angelos will get porcelain veneers placed on their teeth than in many other cities. This is because of the emphasis for celebrities to have perfect teeth. Another example would be pageant contestants. These groups have a higher than normal percentage of smile makeovers.

However, in more “normal” cross-sections of society, it isn’t the norm.

You Don’t Have to Get Porcelain Veneers for Younger Looking Teeth

Now that your dentist has given you doubts about your smile, it is likely going to bother you for a while. However, that doesn’t mean you have to have a complete smile makeover to get that younger look for your teeth.

Teeth whitening is simple and inexpensive. Not only that, just whitening your teeth, takes off more than stains, it takes years of your appearance.

In your place, I’d just do that and tell your dentist you are content with your smile. If he still doesn’t let the idea of porcelain veneers go after that, it will be time to get a new dentist.

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

Dentist Said to Crown Instead of Veneer My Teeth

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I’m really disappointed right now. I’d been looking forward to getting my teeth re-done for a while. I’ve always wanted a pretty smile. I’d been saving up for four years. When I finally was sure I had enough, I went to my dentist. He said porcelain veneers don’t work and what I should get is dental crowns. I don’t want to get those. I have perfectly healthy teeth. Plus, I’ve seen some patients who’ve had crowns at my clinic and I’ve never been impressed with how they’ve looked. It’s not what I was hoping for with my new smile. Do porcelain veneers work?

Lucy

Dear Lucy,

a porcelain veneer being placed
Porcelain veneers are a great option for smile makeovers

Your dentist is wrong. Porcelain veneers work. In fact, they are the go-to procedure when you want a beautiful smile makeover. My suspicion is the reason your dentist is trying to steer you away from this is his lack of experience.

Doing smile makeovers isn’t something taught in dental school. Instead, a dentist needs to invest post-doctoral time studying them. In fact, the best dentists will always keep up with their field. You definitely don’t want a dentist who does the bare minimum of their required continuing education. You want a dentist who is passionate about their field and keeps up with the latest developments.

Getting Your Smile Makeover

If you want a beautiful smile, you’re going to have to go to a different dentist– one who has invested time studying cosmetic dentistry.

The trick here is there isn’t a recognized specialty in cosmetic dentistry, so anyone who calls themselves a cosmetic dentist is simply a general dentist who offers cosmetic services.

So, how do you separate the ones who do a good job from those who just get average (or worse) results? I’d start by looking at their smile gallery. This should be a page on their website which has before and after pictures of cases they’ve done. You may want to call and double check they’re showing cases the dentist has done and not just stock photos, though.

If you don’t like what you see there, move on. If you do like the type of results they get, take one additional step. Check their reviews. It’s always helpful to see what patients who have actually been to their practice think of the experience.

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