I took my five year old to the dentist, which is the first time my dentist said that a child needs to go in for a checkup. My son had a bit of trouble being still for him and they were not able to get x-rays. The dentist thought he saw a cavity but because my son was so wiggly they could not do anything about it. I took him to a pediatric dentist in the hopes my son would respond better. He did. The pediatric dentist confirmed the cavity. We scheduled his procedure and used sedation, which ended up going very well and my son doesn’t even remember the procedure. However, when the procedure was over the staff told me that the decay was worse than they first thought and that they had to do a pulpotomy. I don’t understand how they wouldn’t have known this ahead of time. Do they have the right to do treatment on my son without my permission?

Rita

Dear Rita,

There are several things going on here. I’m going to start with your last one. Let’s assume your child did need the procedure. Even then, they should have come to consult you. He was under sedation and therefore quite calm. There was no emergency. They should have sent someone out to tell you what they’d discovered and talked you through it and get your permission.

Should they have known ahead of time? It depends. Your first dentist had limited information. While this dentist had more, it could have been that between the evaluation and the scheduled treatment that the decay took a deep dive into the pulp. I am assuming that this was a back molar that they did the pulpotomy on because that is the only type of baby tooth that needs to be saved until your child is twelve years old.

I wanted to also address the statment your dentist made that children do not need to see the dentist until they are 5. That actually is not true. In general, if you wait that long, your child is more likely to have decay and end up afraid of the dentist. Taking your child to the dentist young, at about one to two years of age, is your child’s best chance of enjoying the dentist and having great oral health. Your dentist just didn’t want to see children until five, which tells me he is not good with children. That was played out in his inability to get cooperation from your son.

If you are comfortable staying with your new pediatric dentist, that is fine. But, if you are looking for a dentist you can both go see, look for a dentist who wants to see children early. That will tell you they are good at working with them.

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

I had six dental crowns placed on my front teeth. The whole thing has been quite the disaster. First, the temporaries felt like they had leakage, which made me worry there was an infection. He agreed to check. He took the temporary crowns off, did a fluoride treatment, and prescribed me an antibiotic for safe measure. When the crowns came in, the bite was completely off, which meant a lot of grinding them down. Then they said there was too much liquid going to the teeth. I wasn’t sure what that meant, but was relieved when he said they’d have to be sent back. I hoped that meant the next set would fit better. I went back to temporaries. The new crowns have arrived and I’ve had burning gums and sensitivity since putting them on. Sometimes it feels like there is a wad in my mouth What do I do? They’re supposed to be permanently bonded in three days.

Eliza

Dear Eliza,

I don’t think this is the best dentist for you. In fact, I believe he is in over his head. One of the reasons I think that is he gave you crowns instead of porcelain veneers. Unless you already had crowns on those teeth or there was something wrong with them, crowns would be a massive overtreatment. Crowns necessitate that a lot more tooth structure has to be removed. If the teeth are healthy, there is no point in doing that. While that is water under the bridge, it is indicative of his skill level. When dentists suggest crowns over veneers unnecessarily, it means they do not have a lot of cosmetic training. This rarely goes well for the patient.

The first thing I want you to do is to call them first thing in the morning and tell them you do not want them bonding these on permanently until two things happen. First, the crowns feel right. When crowns are fitted and placed correctly, they are completely unnoticeable. You can tell your dentist I said that if he tries to disagree with that.

Second, you know why your gums are burning. I’m wondering if he gave you porcelain fused to metal crowns and you are having some kind of allergic reaction. That is one of the first things I would ask. Ask him what the composition is of the crowns he gave you. If he says he doesn’t know, point out that the lab would have given him an identalloy certificate telling him the exact composition of the metal alloy. If there is any nickel in the makeup, that is the most likely culprit. Many people are allergic to nickel. You would need to switch to all-porcelain crowns.

In reality, on front teeth, you would want all-porcelain crowns anyway. The metal-based crowns will eventually develop a gray line at your gumline. This will be visible and unattractive. That is not something you’d want in a smile makeover.

The fluoride treatment he gave you was pointless. Leaking temporaries means that you have bacteria under there. Fluoride remineralizes teeth. It is not an antibacterial. The right treatment for that would have been peroxide or chlorhexidine. Both of those are antibacterials.

What I am going to suggest is you have them use temporary cement, which they already should have done, and then you go to another dentist to get a second opinion on these crowns.

This blog is brought to you by Marietta Dentist Dr. Cristi Cheek.
Click here to learn about our free virtual smile makeover consult.

 

I need to replace a tooth due to an injury and my dentist said because I am a diabetic I am not a candidate. I wasn’t aware that diabetes was a contraindication for dental implants and I’m pretty sad. I guess I could get a dental bridge, but just wanted to get a second opinion on the topic before settling.

Felicity

Dear Felicity,

I have good news for you! Being a diabetic does not mean you cannot get dental implants. What it does mean is the following:

• You are at a higher risk for dental implant failure as well as other complications.
• You will need extensive diagnostics done. I would not skimp on any of them. In fact, make certain your dentist includes a CT scan.
• You will want a dentist with extensive post-doctoral training in dental implants. Just dental school is not enough.
• Make sure your dentist is committed to doing extra care throughout the procedure to keep an eye on how things are going.

Why Did Your Dentist Say No to Dental Implants

If you are able to get a dental implant, why did your dentist try to dissuade you from the procedure? In my experience, when I dentist tries to convince a patient to not get what is considered by dentists to be the superior treatment option, it is because they are not really qualified to do the procedure but don’t want their patient to know that. Instead, they steer you toward something they feel more comfortable doing.

Do not pressure him into doing this procedure. You are better off going to a different dentist, even if it is just for this one procedure.

Bottom line— you can get a dental implant, just pick the dentist carefully.

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

If 2020 has taught me anything it is to be more independent. I did get a great smile makeover this year, which was the one highlight. I want to take good care of it. I’ve made my own homemade mouthwash and I just want to run it by you and make sure it is safe for my porcelain veneers. Here is my recipe:

6 oz. water (boiled and filtered)
6 oz. hydrogen peroxide (3%)
1 tsp. sea salt

Avery

Dear Avery,

I love that you had a 2020 smile makeover. Way to brighten a horrible year! I also love your independent spirit. While none of the ingredients you listed will do any harm to your porcelain veneers, the hydrogen peroxide will end up being a problem in the long run. Peroxide is great for killing off bacteria. You would think this would be a plus, however, it kills both the bad and the good bacteria. This will lead to an oral yeast infection, which will be quite unpleasant for you. I would suggest you use this mouthwash about once a week, but not on a daily basis.

As for other types of mouthwashes, the main thing you want to do is avoid any that have alcohol as an ingredient. This will disintegrate the bonding on your porcelain veneers. There are a few brands out there that do not have alcohol.

However, the best thing you can do for your smile makeover is to use SuperSmile Toothpaste. This is specifically designed for cosmetic dental work. It will keep them sparkling while safely removing any surface stains. I highly recommend it to any patient with cosmetic work.

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

I finally have dental insurance. I’ve been working on getting my gums back to health. I’ve had advanced periodontal disease for a bit now, which has caused me to lose eight teeth. I have dentures right now, but really want to get dental implants. Is this possible?

Larry

Dear Larry,

You have made a great choice in wanting dental implants. They are far superior to dentures for several reasons:

• They return your chewing capacity. Even the best fitting dentures will reduce your chewing capacity by 50%. With dental implants anchored to your dentures (called implant overdentures) you will be able to once again be able to eat anything you want.
• Implant supported dentures do not move around. You will never have to worry about them moving or falling out.
• They prevent facial collpase

Dentures and Facial Collapse

When your teeth were first removed, your body recognized that you no longer have teeth roots that need to be supported. As a result, it begins to resorb the minerals in your jawbone to use elsewhere in your body. While it does this in an effort to be as efficient as possible with your body’s resources, it has the unfortunate effect of shrinking your jawbone. After ten years, you will no longer be able to keep your dentures in place. Eventually, you won’t be able to wear them at all because your jawbone has virtually disappeared. This is known as facial collapse. Not only does it make it impossible for you to have teeth, but it also ages your appearance by decades.

Getting Dental Implants After Dentures

Once your gum disease is under control, you should be able to get dental implants. There is a possibility, depending on how much bone you have already lost, that you may need to have a bone grafting procedure done. This is because you need plenty of healthy bone to integrate with the implants. Without that, the procedure will fail. Once that is completed, you should be good to go.

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