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Pediatric Dentistry

Do I Need to Get My Baby Tooth Pulled?

I have a baby tooth that never came out. Now I have an adult tooth that is sort of coming out just in front the baby tooth. Do I need to get it pulled? If so, will it hurt? I haven’t been to the dentist because my parents do not have a lot of money. I just need to know what to do and what to expect.

Emma

Dear Emma,

happy girl in a dental chair

I’m sorry you are faced figuring this out on your own. Yes, this baby tooth will have to come out. The good news is that baby teeth come out much more easily than adult teeth. If you don’t get it extracted, then the adult tooth is going to come in very crooked. If you go to a pediatric dentist, they are used to doing things for young children and will likely have ways of making things easier.

They should put a numbing medication on your gum before giving you the shot that numbs out the gums deeper into the tooth. Most people hardly notice. However, if your nervous, which you probably will be because you haven’t been to a dentist before, then ask them to give you some nitrous oxide. This is administered by a nose piece and it is a special medicine you just breathe in. It will relax you so that you won’t be tense during the numbing process.

So, your parents know, there are affordable dentists out there who are willing to work with patients in difficult financial situations. You may have your parents look some of them up and see if one of them is willing to work with you.

You may find that you have more work that needs to be done with your teeth, but don’t stress about that. You can have that done a little at a time.

I really appreciate your maturity and how you are proactive about taking care of your oral health. This type of responsible attitude will serve you well in many areas of your life.

This blog is brought to you by Phoenix Dentist Dr. Hillary Peck.

Root Canal Treatment

Can You Have a Cavity Without Outward Signs?

I went to my new dentist for a regular check up. She suggested that I need a root canal treatment because of a cavity inside a tooth. She wants to send me to a root canal specialist. I should mention at my last dental appointment, in which I had x-rays done, there were no signs of any problems. There is no sign of decay on the outside of the tooth either. Can you have a cavity without any signs? This feels like a red flag to me. I have a second red flag when I saw the name of the specialist was the same as hers. I jokingly asked if all dentists in that area had that last name. She told me it is her husband. So, I feel maybe she is just sending work his way. Can a tooth have a cavity with no signs of decay on the surface?

Natalie

Dear Natalie,

Example of internal resorption
Internal resorption in a lower premolar. X-ray courtesy of East Hill Endodontics, Kent, WA.

When it comes to decay, there must be an external point of entry. The decays starts on the outside working it is way in. Even then, the only time a root canal treatment would become necessary is if the decay get’s down deep enough in order for it to turn into a dental infection.

It’s possible your dentist could have been referring to something different known as internal resorption. Though, if that is the case, she should use more precise language in order to help her patients understand exactly what is going on with their bodies. Internal resorption happens as a result of an inflammatory response, which generally means that there must have been some trauma to the tooth. The result is that the pulp of the tooth begins to eat away at the tooth from the inside. I’ll be honest that we don’t yet know why this happens.

Given the concern about a conflict of interest and a sketchy diagnosis based on the terminology she used, I recommend that you get a second opinion. Your dentist is required to give you a copy of the x-rays when asked for. Take these to another dentist. Don’t tell them who your dentist is or what the diagnosis was. Just ask them what they see and would recommend based on the x-rays provided.

I hope this helps.
This blog is brought to you by Phoenix Dentist Dr. Hillary Peck
Click here to learn about how she makes dentistry affordable.

Dental implants

Missing Lateral Incisor

I have always had a missing lateral incisor. My dentist provided me with braces in order to move the teeth into a proper position. Then, once my orthodontics were completed I was given a dental flipper. It’s been okay, but I would really like something more permanent. My dentist is recommending I get a dental bridge. I’m not crazy about that idea because he told me that it means placing dental crowns on two more teeth. Is there something else you can recommend for me?

Camille

Dear Camille,

A comparison of a dental bridge next to a dental implant

I am glad you wrote. There is definitely a better solution. The best tooth replacement is a dental implant. This puts a prosthetic tooth root into the bone. Then, after a period of time where the bone integrates with the implant, a dental crown will be placed on the implant. This is the closest thing to having a natural tooth in your mouth.

A dental bridge would only make sense if you were not a good candidate for a dental implant, but you didn’t even mention that your dentist brought up implants, so I don’t think that is the problem. There is a possibility that, because of how long that space has been empty, you may need some bone grafting done first because of the mineral resorption. It will be worth it.

The other reason for getting a dental bridge would be if something was wrong with your adjacent teeth. Then, you could take care of two problems at once. If one of those aren’t an issue, then I would stick with the dental implant.

It sounds like your dentist is steering you toward a dental bridge because he does not know how to do a dental implant. Don’t try to push him into doing it. This requires post-doctoral training. You don’t want him doing a procedure because he doesn’t want to admit he doesn’t have the experience. It’s not a recognized specialty, so technically any dentist can do it, but you really want a dentist who knows what they’re doing. There are some dental implant horror stories and you do not want to be one of them. Simply find a different dentist to do this procedure. It doesn’t mean you have to switch dentists completely.

This blog is brought to you by Phoenix Dentist Dr. Hillary Peck.

Affordable Dentist

Does This Root Canal Need to Be Re-Done?

Can you help me figure out the most affordable option for me? I had a root canal treatment on my upper right canine. Recently the filling came out and I now have an abscess on the gum. I went back to the dentist’s office and he says I need to have a second root canal treatment. If the abscess is not painful unless the area around it is pressed, could I just take an antibiotic? I just paid for this first root canal.

Stanley

Dear Stanley,

Illustration of an abscessed tooth

I am sorry this happened to you. At this point, you definitely need the root canal treatment. When a root canal treatment is done, the filling placed is not meant to be a stand alone. It is just there as a temporary measure. A follow-up appointment should have been scheduled for you to have a dental crown placed. Without that, then your saliva will slowly seep through the filling and it will end up falling out, as yours did. It won’t take long after that for bacteria to build up and cause another infection. Again, as yours did.

An antibiotic won’t be a good solution. The infection has to be physically removed. All an antibiotic will do is hold it at bay for a very short period of time. Then, when the medication runs out, you will be in an even worse situation than you started with.

If your dentist never told you about the need for a second appointment and dental crown or scheduled you too far away for it to be helpful, then he or she should take some responsibility for what happened. If you just didn’t follow through, then you’ll have to bear the brunt of the cost.

If your dentist’s fees are too high, then you could always shop around for a more affordable dentist. That could take some of the pressure off of you. What you don’t want to do is put this off, because then you will end up with a dental emergency.

This blog is brought to you by Phoenix Dentist Dr. Hillary Peck.

Pediatric Dentistry

Discolored Baby Tooth?

My four year old son took quite a tumble. Now one of his front teeth is chipped and discolored. Should I whiten it or is there something else I should be doing? If he loses the tooth, do I need to get a space maintainer?

Elsie

Dear Elise,

Young boy smiling holding his toothbrush

I am glad you wrote. I can tell that you are a good mother and want to make sure you are doing the best for him. In this case, there is no need to do anything. Teeth whitening will not work on a tooth discolored from trauma. Even if it would, I wouldn’t recommend it for a child. They’re not likely to keep the trays in and that tooth will not last long anyway.

Unlike the rest of us, young children are not bothered by things like a discolored tooth. In fact, on the school yard, an injury is like a badge of honor, especially for boys. The grosser the better.

If the tooth falls out, you will not have to worry about a space maintainer. It is close to the time in which he would lose that tooth anyway, so you don’t need the added, unnecessary expense. The one time that your son would need a space maintainer would be if he lost a back molar. These have to stay in his mouth until he is around twelve years old. If that tooth was lost, you’d have to keep the space reserved. Otherwise, in the amount of time until his permanent molars come in, the other teeth will drift or tip into the opening causing overcrowding.

Unless the tooth develops an infection, I’d just leave it alone. If it does get infected, his pediatric dentist can just remove it.

This blog is brought to you by Phoenix Dentist Dr. Hillary Peck.
Click here to learn about affordable dental care.

Affordable Dentist

I Can’t Afford to Improve My Smile

I went to see my dentist about improving the look of my smile. My children are all grown and I want to enter back into the work force. My smile has yellowed over the years. Plus, my teeth are crooked in some places. My dentist suggested I get porcelain veneers and said that it would fix both problems. Unfortunately, this is way too expensive for me. Is there an affordable way to improve my smile?

Amy

Dear Amy,

Teeth whitening trays
Teeth Whitening Trays

I am glad you wrote. While porcelain veneers are a great way to get that Hollywood smile, it is certainly not the only way to improve your smile. No matter what your budget, it is always a good idea to get all of your options before making your decision.

A great option for you, that will save you thousands of dollars, is to use a combination of Invisalign and teeth whitening. If your dentist does not offer Invisalign, you can go to another dentist or to have that done. Just be sure to ask your dentist for some professional teeth whitening gel.

You can wear those in your aligners , which enables you to straighten and whiten your teeth at the same time. That will save you additional money.

When it comes to porcelain veneers, you would only want an expert cosmetic dentist to do them, and would definitely NOT want to price shop. However, both teeth whitening and Invisalign can be done by any dentist that offers them. I would call around and find an affordable dentist that offers what you need.

This blog is brought to you by Scottsdale Dentist Dr. Hillary Peck.

Lumineers

Are Lumineers Reversible?

I want to get a smile makeover and went to see my dentist. He suggested that I use Lumineers because that means I won’t have to take off any tooth structure. I like that idea but he hasn’t done many of these cases. I know that because I asked. If I don’t like the way it ends up, is it reversible?

Abigail

Dear Abigail,

Image of a Lumineers advertisement

I am glad you wrote before going through with this procedure. I am always leery when a dentist recommends Lumineers. This particular brand of Lumineers is highly marketed to inexperienced cosmetic dentists as being easy to place. Unfortunately, that is not true. While they are considered no-prep veneers, very few smiles look good without some type of tooth preparation. Instead, they look bulky.

However, let’s address your actual question. Are they reversible? If by reversible you mean the Lumineers can be removed and your teeth will go back to normal and you can get your money back, the answer is no.

If by reversible you mean that you can redo them with a different dentist and pay for it twice, then sure!

Your best bet, in a situation like this, is to find an experienced cosmetic dentist who can do the job well. Most of them will not recommend Lumineers, but a different brand of porcelain veneers. However, if you want to give your dentist a chance, there is a way you can give him some experience without risking your smile makeover turning out badly.

If your dentist is willing to only permanently bond the Lumineers or other brand of porcelain veneers on AFTER you approve them and are thrilled with them, then you should be okay. Here’s how that can work.

Your veneers come back from the lab. Then, your dentist places them with a temporary try in paste and you get to look at them in a variety of different lightings. If you don’t love it, then he sends it back to the lab to make changes. He should be willing to do this as many times as it takes. The upside for him is that it gives him a LOT of practice.

This blog is brought to you by Phoenix Dentist Dr. Hillary Peck.

Affordable Dentist

One-Day Versus Traditional Crowns?

I need to get a dental crown but am a bit short on money. I’ve been looking at both traditional crowns and those one-day crowns. I’m hoping the one day crowns are less expensive because they only take one appointment, but it is for a front tooth, so I want to make sure the one-day crowns are just as good as the old-fashioned ones.

Sara

Dear Sara,

Dental crown being placed on a tooth

I’m glad you wrote. The truth is that both a traditional crown as well as a CEREC crown will cost about the same amount. Yes, it is true that the CEREC crown takes only one appointment as opposed to the traditional crown, however the CEREC machine costs a dentist about $150,000. That is a huge expense to cover, so dentists will generally spread that out in the cost of the crowns.

The quality of the crowns is about the same either way. However, because you are needing this crown on a front tooth, I highly recommend that you get a traditional crown. Same day crowns are milled out of a single block of porcelain. Our natural teeth have variations in their color and opacity. That is why with traditional crowns dentists use more than one block of porcelain so they can get all those subtle differences in there.

This doesn’t mean you still can’t get an affordable dental crown. The key, however, is not in the type of crown as much as the dentist that makes the difference in the price. If you are looking for an affordable dental crown, I would look for an affordable dentist. They are much more likely to have reasonable prices, as well as allow you to make payments instead of paying for everything up front. You can generally find them by doing an internet search for the term “affordable dentist”. I hope this helps.

This blog is brought to you by Phoenix Dentist Dr. Hillary Peck.

Lumineers

How Do I Find a Lumineers Expert?

I am planning to get a smile makeover and have seen a lot of advertisements for Lumineers. The cost is pretty high. I’m assuming there is some kind of way to tell if there is expertise. I saw there are certified Lumineers dentists. I just wanted to make sure before I dropped thousands of dollars.

Emily

Dear Emily,

Image of a Lumineers advertisement

I am glad you wrote. You show a good sense of critical thinking, which is a rapidly depleting resource these days. Being Lumineers certified does not necessarily equate to being an expert. It means the dentist completed a seminar with the Lumineers company. It says nothing about their technical knowledge or expertise.

You should also be aware that Lumineers is just one brand of porcelain veneers. This particular brand is highly marketed to inexperienced cosmetic dentists as being easy to place. While they may be easy to place, that says nothing about them being easy to make both natural looking and beautiful.

Whatever dentist you go to, make certain that they are willing to place your porcelain veneers with a temporary try in paste first. If you’re not happy with them, they should send them back to the lab to make changes before permanently bonding them on.

If they are serious about cosmetic dentistry, they should also have a brag book of sorts with before and after images of patients who they have done work for.

This blog is brought to you by Phoenix Dentist Dr. Hillary Peck.

Affordable Dentist

Can’t Afford What Dentist is Insisting On

I am losing two teeth. My dentist is insisting I get dental implants to replace them, but I honestly cannot afford that. He told me that if I don’t get dental implants, I would need to find another dentist. What do I do?

Fanny

Dear Fanny,

A comparison of a dental bridge next to a dental implant

I don’t like it when dentists give patients ultimatums like this. While, yes, dental implants are the best treatment for a missing tooth, not everyone can afford the top of the line. There are other, perfectly acceptable options to replace your tooth. In fact, your dentist is ethically obligated to give you all of your options. If he wants you to go to another dentist, I would oblige him.

If you can’t afford a dental implant, the next best option would be to get a dental bridge. This would require placing a dental crown on the two adjacent teeth and suspending a false tooth between them.

If even that is too much money for you, then you can look at a removable partial denture.

My suggestion is you look for someone who advertises as an affordable dentist. They are generally much more understanding about things like budgets. Some of them even have payment plan options to help you get the procedure you need.

I am sorry this happened to you. However, I am hopeful with a more compassionate dentist, you can get the care you need without having ultimatums placed on you.

There are plenty of great dentists out there. Don’t limit yourself to the one who cares more about his bank account than yours.

This blog is brought to you by Phoenix Dentist Dr. Hillary Peck.