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Teeth Whitening

White Spots On Teeth

My daughter had braces. When they came off there were white spots on her teeth. Our dentist suggested we have teeth whitening done to even out the whitening, but that just seems to be making it worse. What do we do?

Carolyn

Dear Carolyn,

Teeth Bleaching Trays

Dear Carolyn,

Your dentist may mean well, but he or she doesn’t have a good understanding of how teeth whitening works. While a cost-effective way of helping stained teeth look younger, brighter, and more attractive, it is not useful for uneven color. This is because it will whiten your teeth evenly. Her teeth will be whiter, but so will her white spots.

The spots that developed are areas of decalcification. Those are cavities. They are pretty common after braces. Teenagers don’t always get between all those wires and brackets effectively.

One thing you can try is a product called Tooth Mousse. It is designed to help remineralize those spots. That would be my first go-to.

If that doesn’t work, then you can go to a cosmetic dentist and have both microabrasion and dental bonding done on those spots.

This blog is brought to you by Phoenix dentist Dr. Hillary Peck.
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Pediatric Dentistry

Five Years Old’s Teeth Rotting

I need some advice, My five year old daughter has some problems with her molars. Two of them have small cavities and two of them have lost about 30% of their structure. I want some advice of what to do about this before I take her to a pediatric dentist. Will they have to be removed? She’s awful young to have to lose teeth. She is saying that it hurts when she chews so I know I need to bring her in.

Laurie

Dear Laurie,

young boy smiling with toothbrush

I love that you are trying to figure out the best thing for your daughter. At her age, all of her teeth are all baby teeth and she needs them for many years to come. It is important you get her to see a pediatric dentist as soon as possible. This is especially true for her back teeth. They need to stay in her mouth until she is about twelve years old.

The molars with the small cavities will definitely be able to be saved. The ones where you estimate there is 30% loss of structure, I hope can be saved with a dental crown.

If they cannot be saved, it will be imperative that your dentist place a space maintainer there. If the molars are just removed, the remainder of her teeth will drift into that open space. then, when her twelve year old molars try to come in, there will not be enough space. This will lead to crowding and expensive orthodontics.

The extent of her decay is a little unusual for her age. It may be time for a bit of tough love on your part. She can brush her teeth twice a day just like she is supposed to, but if she is a frequent snacker it will sabotage her oral health. This is because one of the biggest proponents of oral health is our saliva, which contains bacteria fighting minerals. If she is a frequent snacker or drinks a lot of juice, does not give her salvia enough time to do its job.

I would limit her to one or two snacks a day and make sure she is not drinking a lot of juice or sodas.

One other thing. I know you are trying to get all your ducks in a row before seeing the pediatric dentist, which is admirable, but don’t put it off. These cavities can easily turn into a tooth infection, which will be a dental emergency.

This blog is brought to you Phoenix Dentist Dr. Hillary Peck.
Click here to read our Dental tips for Parents.

Affordable Dentist

Can’t AFford This Affordable Dentist

I needed a dental crown. It was my first one and I don’t have much money. I decided to look for someone who was affordable. I did the scientific process of asking Uncle Google to find me one. Most affordable dentists were close to the same price, but I found one that was several hundred dollars cheaper than the rest of them. I thought I’d found the holy grail of dentists. But, in the five years since I’ve gotten this crown, it has needed to be replaced three times. Is that normal for a dental crown? Online it says they should last five years, but maybe that is just dentists trying to get people hopeful?

Penny

Dear Penny,

As you are unfortunately learning, not all affordable dentists are created equally. I call it the difference between an affordable dentist and a cheap dentist.

Some dentists lower their prices a great deal more than other dentists in order to draw patients in. This is usually because they are either new dentists who have not built up their patient list yet or they are a dentist that has trouble keeping patients and use their low prices to get new ones.

The problem is the cheaper the prices, the harder time they will have making ends meet. Some, less scrupulous dentists, will use substandard materials in order to make up the profits.

As for how long a dental crown should last, five years should be the minimum. Some crowns, when well taken care of, can last around fifteen years.

With the number of times you have had to replace this dental crown already, you have already paid what you would have with one of the other dentists who cost more. My guess is this affordable crown has cost you even more than that. Then, factor in all the time you’ve spent getting a new crown and I think this has been a bit of a disaster.

At this point, my recommendation is you bite the bullet and go to a different dentist to prepare your new crown. Make sure you check their reviews to see if patients have had a good experience with them or not.

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

Root Canal Treatment

Dental Disaster in Mexico

I went to Mexico to have two dental crowns done because it was supposed to be a lot cheaper than having it done in the United States. In two days the first crown fell off and I had to go back. When I did, they told me I needed a root canal before they could replace the crown. I had some doubts about that becuase the tooth wasn’t hurting but they seemed certain it was necessary. Then, it starting have senstivivity to hot and cold. Now I can’t even eat with it. I called them and they told me I needed to come back in. These trips are pretty extensive so I decided to just get a second opinion with a local dentist. He said the tooth did not need a root canal and is actually cracked and needs to be extracted and replaced. My question is, do you think it is reasonable to ask them to apply the cost of the unnecessary root canal they did toward the cost of the extraction and dental implant?

Pam

Dear Pam,

What a disaster. While I am sure it is reasonable, I don’t know if you really want them doing that. A dental crown is one of the first things a dentist learns how to do in dental school. He couldn’t even do that right. Then, they gave you an unnecessary root canal treatment. AND, they didn’t even do it right because you should not have had any sensitivity to hot or cold.

Dental implants are one of the most advanced procedures in dentistry. If they can that wrong, it will cause you serious, permanent injury. What if they place it on a nerve? Or you get an infection in your jaw that causes you to lose bone?

In your place, I would bite the bullet and have this done in the United States with a reputable dentist with dental implant training and experience.

I do not know what the laws are in Mexico as far as getting a refund for malpractice, but you can at least try.

Dental tourism is always a gamble. Sometimes it works out. The problem is in the cases where it doesn’t, it is always a disater and in many cases people end up with permanent problems.

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

Root Canal Treatment

Can You Have a Root Canal Done a Third Time?

I had a root canal treatment done about nine years ago. It had to be re-done a few years after that. Now it is bothering me again. Is it possible to do a root canal treatment a third time?

Mary

Dear Mary,

You can re-do a root canal treatment quite a few times. However, you may want to evaluate whether or not that is your best course of action. Root canal treatments are tricky under the best of circumstances. It is estimated that even when a dentist does everything perfectly, there can still be a 15% failure rate. Why is that?

While there is between one and four canals in a tooth, depending on the type of tooth, there are branches that stem off from the main canal. These can take crazy twists and turns. In some cases, they are literally impossible for us to clean out and seal properly with the current technology we have. If a dentist can’t reach all the pulp, there is a significant chance of re-infection.

In addition to that, the chances of a successful re-treatment go down with each attempt. This will be your third treatment. A second option is root canal surgery. However, some patients are not candidates depending on where the nerves lie.

While a good dentist always tries to save a tooth, the honest answer is some teeth are not saveable despite everyone’s best efforts. In that case, the only thing left is to get a tooth extraction and then a replacement.

If that happens, the two best replacements to look at are a dental implant or a dental bridge. Both will serve you well. Just speak with your dentist about your particular circumstances and he or she will help you make the right decision.

Best of Luck!

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

Pediatric Dentistry

Broken Front Tooth in Child

My seven year old daughter broke a front tooth after a fall. The dentist said it is not anything to worry about and he can schedule me for six weeks from now. I really want this taken care of immediately and asked him for a referral. Instead, he told me that the nerves needed time to settle before anything could be done and no one would see me sooner. Is that accurate?

Karen

Dear Karen,

No, there is no reason to wait. My only guess as to why he said that is he wanted to keep you at his practice. That being said, I do want to check something. Did he do an x-ray and tell you everything is fine and he can do the repair in six weeks or did he just tell you everything was fine when you tried to schedule an appointment without actually seeing her? If he didn’t examine her, I would feel more at ease if she at least had an x-ray done to see what you are dealing with.

If there is no damage to the pulp, then a cosmetic fix is all she will need. This can be solved with dental bonding, but you’ll want to go see a cosmetic dentist for that.

If the pulp was damaged, there may be a point where she’ll need a dental crown because the tooth will start turning gray. However, that is a wait-and-see situation.

Find a different pediatric dentist for your daughter. You can even see a general dentist who treats children. They all did a pediatric rotation and she will be in safe hands.

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

Dental Fillings

Should I Remove My Amalgam Fillings?

My dentist is suggesting I replace my amalgam fillings. He told me there is nothing wrong with them, but he thinks it is best to replace them with composite fillings. I am wondering if I really need to do this. I don’t have money right now, but he hinted they will go eventually and it’s better to change them when everything is okay. What is your opinion of this?

Jenn

Dear Jenn,

Before and after mercury free fillings

No, you don’t have to change out these dental fillings. While I am grateful that your dentist was honest enough to tell you that there was nothing wrong with your fillings, I am suspicious of the low-key pressure he is putting on you to replace these fillings.

Composite fillings are better than amalgam fillings, but if they are not cracking and are not leaking it is not necessary. Your dentist could just keep an eye on them and then let you know when they truly needed to be replaced. It is not fair for him to pressure you like that.

If it gets to the point that you do need them replaced then I want you to make sure he knows how to do a sanitary amalgam removal. These silver amalgam fillings have mercury as their main ingredient. There are special procedures and equipment that need to be in place in order to keep you from inhaling any mercury vapors or swallowing any pieces of the filling.

If he doesn’t know the procedure for a sanitary amalgam removal, then look for a mercury-free dentist.

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

Porcelain Crowns

Porcelain Crowns Turning Yellow

I had porcelain crowns made a little over six months ago. They were so beautiful and shiny when I first got them. Now, they are dull and turning yellow. Do you know what could have happened? I do everything I am supposed to. I brush. I floss. I don’t even drink coffee. I’d really like them to look like they looked six months ago.

Laurie

Dear Laurie,

I want you to know this is not your fault. Porcelain crowns should last you several years. I can think of a couple of things that happened here, but you are going to need to have another dentist look at them to determine which one it is.

The first thing that comes to mind is an error on the part of the hygienist. You mentioned this happened a little after six months ago. That is long enough for you to go in for a cleaning appointment. If your hygienist used something like a power prophy jet, then it would have removed the glazing off the porcelain. This is what protects the crown from picking up stains and gives it that shiny look.

Another thing your hygienist could have used is acidulated fluoride which will also damage the glazing by etching it.

A second possibility is that your dentist told you that you were getting porcelain crowns, but actually gave you a different type of material that wears down and stains more quickly. It is not ethical, but there are dentists who do it.

Getting an Unbiased Second Opinion

Go to another dentist to get eyes on the dental crowns in order to find out the real problem. The key to getting a true, unbiased second opinion is to not tell the second opinion dentist who originally did the work. The dental world is a small world. It is very likely the two dentists know each other.

You don’t want the second opinion dentist to feel conflicted about saying something negative regarding a colleague’s work. If he asks who did the work, just tell him you want his unbiased opinion so you will keep the name of the dentist to yourself. He or she should understand that.

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

Pediatric Dentistry

Does My Son Really Need a Pulpotomy?

My pediatric dentist wants to schedule my son, who is only 6 years old, for a pulpotomy procedure. Is this really necessary for a baby tooth that is going to fall out anyway?

Susanna

Dear Susanna,

I am glad you wrote. I never want parents to allow their child to have a procedure they don’t understand. For those who may not know, a pulpotomy is a child’s version of a root canal treatment. It is only useful if the tooth is a molar.

While most baby teeth can come out early with no serious repercussions, back molars need to stay in place until your son is around 12 years old. Otherwise, the adjacent teeth will begin to shift or tip into the empty place. Then, when his adult molars erupt, you are looking at a lot of crowding and expensive orthodontics. Every parent wants to avoid braces if at all possible.

So, if it is a back tooth, you will either want to get the pulpotomy or extract the tooth and then have a space maintainer placed to keep the area open for the adult teeth.

If it is not a back tooth, then you will not need the pulpotomy. However, it is also important that you deal with the tooth. I am assuming that he suggested this treatment because the tooth has an infection. These are considered dental emergencies so you will not want to leave it.

Infections spread. If you think about how close your child’s jaw is to his heart, lungs, and brains, you can see how these things can turn life-threatening quickly.

If your pediatric dentist was not willing to explain why he or she thought you needed one, I feel strongly you would be better served with a different dentist for your precious son. Parents are the ones responsibile for their children and they deserve to have all the information in order to make the best possible decisions for their children.

If you can’t find a great pediatric dentist in your area, there are plenty of general dentists who love to treat entire families, including their children. Each of them has done a pediatric rotation and will be qualified to provide their dental care.

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

Dental Fillings

Dentist Wants to Replace all My Fillings

I have quite a few fillings in my mouth and my dentist says they all need to be replaced. I’m having a hard time fathoming that they all need to be replaced. Is this really necessary?

Mandy

Dear Mandy,

A lot of my response will depend on a few factors. Are they silver amalgam fillings or white composite fillings? If they are amalgam fillings, is he planning on replacing them with more of the silver fillings? I would not let him do that.

As fillings age, they start to deteriorate. If you have amalgam fillings, it is possible they have started to leak. This is dangerous for both you and your teeth. These also tend to crack or erode faster as well. The main ingredient in amalgam fillings is mercury, so you don’t want to let this deteriorate in your mouth.

Additionally, eroding or leaky fillings will allow bacteria to seep in. This leads to tooth decay. These usually go unnoticed until it develops into an infection. Then you have a dental emergency on your hands and will need a root canal treatment.

If your dentist is wanting to replace them with composite fillings, I would feel better about that. These are better for your teeth and completely mercury-free. They also bond directly to your teeth, which will strenghten them.

Make Sure You See a Mercury-Free Dentist

If you are getting your dental fillings replaced, you definitely need to do it with a mercury-free dentist. They know how to do a sanitary amalgam removal. Mercury is a known toxin, so you do not want to accidentally swallow any mercury or inhale any mercury vapors.

Mercury-free dentists have the proper equipment and understand the porcedure to keep you from mercury exposure.

This blog is brought to you by Phoenix Dentist Dr. Hillary Peck. We offer pediatric services.