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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.

Dental Fillings

White Fillings in Children

I have a question about white fillings. My son needs his first filling. I am really uncomfortable with the silver fillings because of the mercury in them. I asked my dentist about getting him a white filling but he said they don’t work well in children. Why is that? Will the silver ones be dangerous for him?

Mallory

Dear Mallory,

Let’s start with your last question first. Are the silver fillings dangerous? The American Dental Association still says that silver amalgam fillings are safe. Understandably, though, many patients and parents are uncomfortable with the high mercury content.

While composite (white) fillings are a tad trickier with children, that doesn’t mean they are not able to have white fillings. The struggle is because the composite material has to stay completely dry while it is being placed. That can be tricky for wiggly little ones.

If having a composite filling is important to you, I have found that using some nitrous oxide allows the children to completely relax if their nerves are making them figity. Most of the time they end up sleeping through the procedure.

That being said, I wouldn’t push your current dentist into this. The technique for placing composite fillings is completely different from placing amalgam fillings. I have often found that dentists who try to steer you to a different procedure are actually doing that to keep from admitting they can’t do the one you want. If you pressure him into the other procedure, he will likely not do it correctly.

I suggest that you look for a dentist who advertises as a mercury-free dentist and then see if they are also a pediatric dentist. They don’t have to be a pediatric specialist. Instead, they can be a general dentist who enjoys treating children. They are qualified and do a pediatric rotation so your children will be in good hands.

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

Pediatric Dentistry, Uncategorized

Two Sets of Teeth in Youth

I have two sets of teeth for some of my teeth. I mean that I have both the baby teeth and the adult teeth in my mouth at the same time. How do I fix this? I’m 16 and want a pretty smile before I leave for college.

Kaycie

Dear Kaycie,

teenager smiling with braces

If you have been under the care of a dentist this whole time, you need a new dentist. This should have been addressed a long time ago. You don’t have to see a pediatric dentist. It can also be a general dentist, especially at your age. Though, I would look for a general dentist who also treats children. They tend to be more patient.

To get your mouth in proper alignment, the first thing you will need to do is have every baby tooth that has an adult tooth erupted also extracted. Make sure whoever you end up with does a full set of x-rays so you are sure which teeth have the adult teeth.

From there you have three possible scenarios.

Scenario 1: All Your Adult Teeth Have Erupted

In this situation, you have all of your adult teeth and they have all erupted. If that is the case, the solution is fairly simple and can be done in two steps. Step one is for you to have your baby teeth extracted.

Once that is completed, step two is to have your teeth straightened with orthodontics. You are not limited to metal wires and brackets and more. These days, Invisalign can handle most cases. If you’re unfamiliar with Invisalign, they use clear aligners to straighten your teeth.

Scenario 2: Not All Your Adult Teeth Have Erupted

If you have the adult teeth, but they still haven’t erupted, your dentist can open the area to make it a bit easier. In most cases, they’ll come in after that.

Then, once they are in, you can then get orthodontics done as suggested in the previous scenario.

Scenario 3: You Don’t Have All Your Adult Teeth

In some cases, a patient will have genetically missing teeth. That means there never was an adult tooth to replace the baby one. When this happens, you will still need orthodontics to open up the space where all the teeth are in their proper positions. Once that happens, you will start with a temporary tooth replacement, such as a dental flipper, in order to keep the opening in the right place.

When you are older and your jaw is fully developed, it will be time to get a more permanent replacement. The ideal tooth replacement is a dental implant, so that is what I’d recommend. Though, your dentist can give you all the options.

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

Affordable Dentist

Can’t Afford Next Treatment

I had a Maryland Bridge, but ended up being allergic to part of it. I can’t use that anymore and my dentist is inisisting my only option now is a dental implant. I priced that originally and couldn’t afford it. Surely there is another option, but my dentist is insisting this is it.

Carol.

Dear Carol,

A dollar sign hatching out of an egg

I’m sorry that you have had such a hard time with this tooth replacement. It is unfair of your dentist to insist on the most expensive treatment. While everyone wants the best option, sometimes our budget precludes that. What disappoints me is your dentist is ethically bound to at least make you aware of all your options, even if he won’t do them.

You will have more success with a dentist that understands budgetary limitations. If your dentist doesn’t look for someone who advertises as an affordable dentist. They’ll be more willing to offer you the options that work for your pocketbook. Most are even willing to accept payment plans.

Affordable Options to a Dental Implant

The first thing I would suggest to you is a zirconia or porcelain bridge. This is a false tooth suspended between two dental crowns. These are metal-free and won’t give you the same allergy issues that you faced with your last treatment.

If that doesn’t work for you financially, there are allso removable partial dentures. You’ll just need to make certain your dentist knows you will want metal free clasps.

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

Dental Fillings

Do Amalgam Fillings Stain Teeth?

I have two amalgam fillings that cover about 70% of my tooth. I want to remove them and replace them with composite fillings. He said the amalgam stains teeth and they won’t look nearly as good. Is that true? Should I leave the amalgam fillings on?

Meredith

Dear Meredith,

While there is some staining of teeth with amalgam fillings, they will always look better with composite fillings. Always. In addition, while amalgam fillings simply rest on the tooth, composite fillings are bonded directly to the tooth which strengthens the tooth and puts it at less of a risk for fracture.

I suspect your dentist said that to disuade you from switching. This is likely because he is uncomfortable placing composite fillings. They are placed with a completely different technique than he or she is used to placing the old amalgam fillings.

I don’t recommend you push him into doing it though. There are horror stories of patients who ended up needing a root canal treatment after a dentist placed them incorrectly. Even if it isn’t that bad, you could end up with other issues.

If you want this done right, I suggest going to a dentist who is familiar with placing them. You can do an internet search using the term mercury-free dentist. These dentists only place composite fillings and have the technique down pat.

I have one other concern I’d like to address. You mentioned your current fillings cover 70% of your tooth. In that case, your dentist really should have done a dental crown to adequately protect your tooth. This additional information puts me more in doubt of his abilities. You may want to start looking for another dentist, who can better meet your needs.

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

Affordable Dentist

I think I was conned by an “affordable dentist”

I needed a couple of teeth replaced. The quote my dentist gave me for implants was higher than I could afford, especially because he said I’d need some bone grafting done first.  I called around to several dentists and they all said the same thing.  I was about to give up and settle on a removable partial denture, which was heart-rending for me.  Right before I scheduled the procedure, a friend recommended her dentist who didn’t require bone grafting.  I talked with him and he said he could do the procedure without the grafting and at half the price the other dentists quoted. I was so excited!!  Now, here I am many thousands of dollars later and both my implants have fallen out!! The whole thing, right out of my mouth.  Was I taken in? Are there no affordable dental implants and he was just trying to get my money?

Bella B. – Cincinnati

Bella,

The problem isn’t looking for an affordable dentist. There are affordable dentists out there who do great, quality work. Then, there are those who do just about anything to draw in business, yet keep their profits up. Those aren’t affordable dentists as much as cheap. 

 It sounds to me like the one you chose, said what you wanted to hear in order to get your business.  Mind you, I say that without having examined you, which may be unfair.

However, if both implants just fell out of your mouth, that hints to me one of two things.  1. You DID need bone grafting surgery.  Your teeth are held in your jaw by the bone that surrounds the root.  Without enough jawbone, your implant procedure was doomed to fail. 2. If you did have enough jawbone to begin with, then it is likely your dentist didn’t leave enough time for osseointegration (Time for the bone to form around your implant).

If I were in your place, I would go to a skilled implant dentist and have them look at your case.  They can likely tell you what is going on.  If your dentist was negligent, you may be able to get some money back in order to have the procedure done correctly.

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

Affordable Dentist

One Dentist is $500 Less

I need a dental crown so I started calling around. I’ve called three dentists. One of them is significantly less than the others, by like $500! It seems like a great deal but I’m wondering how he can be so much less. Are the other two just hiking their price up?

Fran

Dear Fran,

We all want a good deal, don’t we? The thing to be aware of is there is a difference between affordable dentistry and cheap dentistry. You didn’t mention the two different prices, just that they were $500 apart. Let’s say for argument’s sake the less expensive dentist is $400 for a dental crown but the other dentists you called are $900.

You asked a great question earlier about how he could afford to charge so much less for their dental crowns. Usually, when one dentist is significantly less expensive than other dentists in the area there are usually one of three reasons:

They are a Brand New Practice

Maybe this dentist is fresh out of dental school and he needs experience. He lowers his prices to barely above cost to draw in patients. We all start somewhere and if you are willing to give the new guy a chance with the hope of saving money, then go for it.

They Have Trouble Keeping Patients

Like in every field, you will have some dentists who are terrible at their job. Maybe they barely passed dental school and don’t apply themselves to improving. Maybe they have a terrible chairside manner and patients just don’t enjoy being around them.

When you keep losing patients, you have to find ways to constantly draw in new ones. You can certainly do that by having your prices several hundred dollars less than everybody else.

If they’re not a new dentist, I would certainly check their reviews to see what type of experience other patients have had with them.

They Use Cheap Materials

It is hard for a dentist to pay for their overhead if their prices are barely above cost. Do make up profits, some dentists will purchase cheaper materials in order to make money. The one who suffers in those cases are the patients.

Is It Really Cheaper?

Let’s say you go with one of the last two dentists to save money. You get a dental crown for $400. It seems like a good deal, but only lasts you three years before you have to replace it. You get another one for $400, plus the cost of time off work. It only lasts you another three years. Again, $400. You’ve now paid $1200 and lost work three times.

Compare that will a dentist who initially charges $900 but his crowns last you $15 years. In this case, you have actually saved $600 by originally going to the dentist who costs more.

I’m not saying you have to go with a more expensive dentist to get quality. I am just saying do your homework on the dentist to make sure you are getting affordable and not cheap.

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

Pediatric Dentistry

Dental Flipper for a Toddler

My son, who is 3 years old fell and lost his two front teeth as a result. I spoke with my pediatric dentist about getting him a dental flipper and he refused. I looked online for the do it yourself kind, but they only make those for adults. What would you recommend for me to get him a flipper? I am worried about his teeth shifting.

Morgan

Dear Morgan,

young boy smiling with toothbrush

I wish your pediatric dentist would have explained things rather than just refuse. Parents are always better off knowing the reasoning behind the recommendations and decisions their child’s caregiver is putting forth.

Reasons Children Can’t Have a Dental Flipper

You noticed that there were only DIY flippers for adults. That is because it is dangerous for children to use a Dental Flipper.

First, they are removable. Just as we are careful with the size of toys we let our children play with, we try to do the same thing with any type of removable device. Otherwise, it is a choking hazard.

Second, they are removable. No, I didn’t make a mistake typing that twice. It is a rare toddler or even older child who will keep in an orthotic device. It is much more likely it will be removed and lost in a short period of time.

Third, they stay in by clasping onto other teeth. Your son’s jaws and teeth are in a constant state of growth right now. This means he will outgrow the flipper quickly and often.

The Really Good News

I know you are worried about your son’s teeth shifting which can lead to overcrowding of his adult teeth. That shows you pay attention to your son’s dental health. The good news is, with his front teeth that won’t be an issue.

When we talk about the importance of tooth retention in children, it is with their baby molars. This is because the adult molars don’t come in until the child is around 12-years-old. In that amount of time and given the placement, the teeth will shift.

If it ever happens that a child of yours does need to have a molar removed, getting a space maintainer will be important.

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

Uncategorized

Bleaching Non-Veneered TEeth

I just had four porcelain veneers placed and while I do like them, they are much whiter than my natural teeth. The difference is pretty obvious when I smile. I think I need to whiten my natural teeth but don’t know if that will damage my brand new veneers.

Cathey

Dear Cathey,

tooth bleaching trays

While any teeth whitening you do will not affect your porcelain veneers, I am a bit surprised your dentist didn’t have you do the whitening beforehand.

When you have porcelain veneers done, unless you have enough veneers to cover each tooth that is visible when you smile, which is almost always more than four teeth, it is standard operating procedure to whiten the teeth ahead of time.

One of the reasons we do the whitening first is because it is much easier to match porcelain veneers to teeth than it is to match your whitening to already established porcelain veneers.

This does give me some concern about your dentist’s knowledge of cosmetic work. One thing that will be especially important is when you go in for your next cleaning that they do not use anything like a power prophy jet or acidulated fluoride on your teeth.

This will completely remove the protective glazing from the veneers which will ruin them.

Best of luck and feel free to get your teeth whitened without the worry of damaging the veneers.

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