I’ve also noticed that there are rough patches on the front of my teeth where my brackets used to be, and they surfaces of my teeth kind of dent inward. On top of all that, my teeth seem to get darker every day. I drink a little coffee, but not enough to be causing this kind of discoloration!

What I am wondering is if my orthodontist screwed up and damaged my teeth when he removed my brackets. What should I do? I didn’t go through two years of braces to start having all these problems.

Theo in Baton Rouge

Dear Theo,

It is extremely unlikely that your orthodontist caused this damage. Removal of brackets is a routine procedure, and an orthodontist would not stay in business long if he was not capable of doing it properly.

I can tell you what I think is going on, but you aren’t going to like the answer. It sounds as if you have areas of decalcification on your teeth where the brackets were. Some of those spots might also be hiding areas of decay, and if the enamel has been damaged that explains the extreme sensitivity and rapid discoloration.

What likely happened is that you might not have been as careful as you should have about brushing and rinsing after eating or drinking. The brackets caught the food and let it sit there for hours, while the acid-producing bacteria in your saliva worked both at the food and at the surface of your tooth. This type of damage is usually not detected until the braces come off. This kind of situation really calls attention to one of the major advantages of Invisalign invisible braces: they can be removed to eat and brush.

That is likely what happened. Now, what you should do about it: consult an experienced, expert cosmetic dentist to assess the situation and give you options. Depending on the degree of damage, he or she may be able to repair the spots with direct dental bonding, but if it is too severe, you may need porcelain veneers. Don’t try simply bleaching your teeth. It will make them look worse.

Thanks for your help on this,

Max in Oregon

Dear Max,

You are right to be concerned about getting at least something in place before too much time passes, even if it is just a temporary partial denture (also called a dental “flipper”). In as little as a week or two, your teeth could move significantly. I am a little surprised that your dentist did not give you some kind of appliance to wear while you decide on a more permanent solution.

Even just a single missing tooth can wreck havoc in your mouth. The teeth adjacent to the empty socket tend to “tip in” to the space, and the corresponding tooth in the opposing jaw will “super erupt” to try and meet a tooth that is no longer there. All of these movements can cause a misalignment in your bite, which can lead to TMJ problems including headaches and facial pain. You are also at increased risk for gum disease, which could threaten the health of all your remaining teeth.

Usually you have two options for replacing a single missing tooth. You can do a dental bridge, which is two crowns with a false tooth suspended between them, or you can do a dental implant.

What I want to know is do I have to have those second molars pulled, or can we put some kind of a crown on them until his permanent teeth are ready to come in? I’ve also seen where other dental websites talk about white fillings, porcelain onlays or dental bonding to fix teeth that have been chipped or damaged. Which would you suggest for a child his age?

I’m also wondering if I have to send him to a pediatric dentist. We’ve had two different dentists, and my son refuses to open his mouth for them. Do you think I will have to have him sedated for treatment? That seems so extreme, but my son now says that one of his molars hurts when he chews, so I think I have to take action.

I appreciate any insight you can give me.

Thanks,

Ellen

Dear Ellen,

Yes, I do believe that you need to visit a pediatric dentist, and yes, it is likely that they will need to sedate your son to get this dental work done. So you’ll need to locate a good pediatric dentist that practices sedation dentistry. Even though he only has baby teeth right now, those teeth are still important. He needs them, not only to eat, but to maintain the proper spacing for his adult teeth. If he does have to have those molars pulled, your pediatric dentist should suggest the use of space maintainers. Without them, his permanent molars will drift forward, and you’ll almost certainly be looking at fairly pricey orthodontic work when his permanent teeth are in.

In young children, the goal of most dental work is usually short-term maintenance, so the pediatric dentist may place a stainless steel crown. This will cost considerably less than a porcelain crown.

Of concern here is also the behaviors that led to this problem in the first place. Decay to the degree you describe has to have been fed all day, every day. I would lay good odds that your son is a “grazer,” in other words, that he eats pretty much continuously all day. If this is the case, you’ll need to find a way to change that eating pattern, or your son will continue to have serious dental decay problems all his life. At this point, he really needs to be eating only every three or four hours, and because of his problems, you should have him brush his teeth every single time he eats. If he cannot brush, have him rinse his mouth out with water.

The fillings have since worn completely away, and the teeth underneath where they used to be are not a pretty sight. I need to have fillings done again, but my regular dentist won’t do silver fillings. She said that many dentists won’t do silver fillings anymore, because of the mercury. Problem is that I don’t trust those white fillings to last, or to not cause me pain. What should I do?

Ron from Atlanta

Dear Ron,

The white fillings were not the problem–it was the technique used to place them. Placement of white fillings is still not taught in most schools of dentistry today, and it was certainly not part of the regular coursework “many years ago”. Placing white fillings, particularly in back teeth, is more challenging than placing amalgam fillings, because the area must be kept absolutely isolated from saliva or other fluids.

If your current dentist does not place amalgam fillings, then logic dictates that she is probably well trained and expert at placing white fillings. She would have a difficult time staying in business if she wasn’t! So I have to think you can trust her to do a good job with the white fillings to replace the ones that were in your wisdom teeth. Also, dentists as a group tend to be very ethical, so if she is recommending white fillings for your wisdom teeth, then she knows she can do a good job placing them for you.

The subject of the mercury in amalgam fillings in an ongoing controversy in the field of dentistry. The most current research cannot conclusively prove one way or the other whether or not the small amounts of mercury vapor released when you chew are harmful to the body. Many dentists (and patients) are choosing to err on the side of caution, and are just avoiding the amalgam fillings altogether.

Beyond the mercury issue, white fillings are much more cosmetically attractive than amalgam fillings. This may not be a top priority to you in the very back of your mouth, but an added selling point is that white fillings create a stronger structure after placement. The composite material actually bonds to your tooth, creating a stronger, more stable structure overall.

I hope you can trust your dentist to place those white fillings for you. The technology to place them has evolved a great deal, and hopefully you can trust your dentist’s skill and training.

Good luck.

I wear an upper bridge, which is anchored by two dental implants I had placed by my former dentist (he retired). I was thinking I needed at most two more implants with crowns to cover my missing teeth (seven in all). But when I tried to explain to them what I wanted, the clinician quite literally waved my opinion aside. I started to explain, and she cut me off and waved her hand as if to indicate that my opinion had no value, and said, curtly, “We will need to just extract your remaining upper teeth to go forward with our treatment plan.” And then the push was on to schedule surgery.

The more I think about it, the more upset it makes me. She was so condescending! She did not care at all to hear what I had to say about my own treatment.

I went to Clear Choice because they have a reputation for being the best, but now I am starting to think that they just have the best marketing department. The two implants I have and the bridge cost me over seven thousand dollars. Clear Choice didn’t care at all about working with me for my individual situation. All they wanted to do was get everything out of the way and do it their way, regardless of the expense, or of what I wanted.

Dylan in Cheyenne, Wyoming

Dear Dylan,

Sadly, your story is not uncommon. I’ve had many patients tell me that they came away from an appointment with a Clear Choice clinic feeling like they were not being offered any choices at all.

Each patient, each situation is unique. One-size-fits-all dentistry is never the answer. I hope you will seek a second opinion for your additional dental implants. Did your former dentist leave a referral list, or have a partner? That might be a great place to start. Be very careful that you choose a dentist who is fully trained and experienced with dental implants. Of all dentistry procedures, dental implants have perhaps the most potential to go seriously awry if not performed by a qualified expert.

Good luck to you.

He was rather abrupt in his reply. He said that he and his partner will only do porcelain fused to metal crowns, period. I tend to grind my teeth, and would prefer not to wear a night guard, and for these reasons he will not even discuss porcelain crowns with me, saying they will not hold up.

My dentist and his partner both have very impressive credentials, and their prices certainly seem to indicate that they are top-of-the-line. I’ve never had any reason to doubt him before, or question his judgment, but everything I’ve read about crowns indicates that porcelain fused to metal crowns on the front teeth never look realistic.

Is it true that occasional teeth grinding without a night guard rules out ceramic crowns for me, such as Zirconia? I have been wanting to get this done for years, and I want my teeth to look good when we’re done. Can you offer any advice?

Wilson in Sacremento

Dear Wilson,

My advice is to get a second opinion.

Even under intense stress, Zirconia crowns are strong enough to work on your front teeth. As an additional selling point, Zirconia crowns can be made thinner than porcelain fused to metal. This means that less of your teeth must be shaved away to place them, which will leave your tooth structure stronger.

Despite your dentist’s excellent credentials, he may not truly be committed to excellence in appearance-related dentistry. His credentials may really indicate that he excels at making things work well, rather than worrying about how they will look. Many highly educated dentists seem to consider the cosmetic aspects of dental repairs to be beneath their notice. Your dentist’s insistence on porcelain fused to metal crowns on your front teeth indicate strongly that he is more concerned about function than he is about the artistic quality of his work.

I strongly advice that you make no effort to push your dentist or his partner to do something they do not want to do. This is almost always a mistake.  You do not have to sacrifice form for function–a skilled cosmetic dentist can certainly come up with a functional solution for you that will be beautiful as well. Rather than pushing your dentist to place something he is not comfortable with, you should consider finding a dentist whose abilities and aesthetic sense are more in harmony with your preferences.

One more thing: I ask you to reconsider the use of a night guard. As you get older, your teeth can break off at the gumline from continued grinding. If you bend on using the night guard, you may find that your current dentist will be willing to reopen the discussion about the types of crowns he will place for you.

I want to get this fixed right away! I am fine with going to a new dentist, but I need to know what he is talking about with the root being sensitive. Is it customary to wait, with this kind of injury? The appointment he offered us is nearly 4 weeks away.

Thanks for you advice,

Celeste in L.A.

Dear Celeste,

There is no medical reason to delay this treatment. If you have the piece of the tooth that broke off, a skilled cosmetic dentist might be able to reattach it.

Which brings me to the most important point: You should be very careful to choose an expert cosmetic dentist to do this treatment for your child. Most dentists do not have the skills and training to repair/replace your daughter’s front teeth so that they look natural and match each other in terms of translucency, color and size. As your child is 10, I am assuming these are her adult teeth that have been damaged.

From what you describe, I think direct dental bonding will work best to effect this repair of your child’s tooth if you do not have the piece that was broken off, or if it is unusable. Direct dental bonding requires tremendous skill and artistic ability, so be very sure that you have chosen the right dentist for the job. Ask to see pictures of his or her work, and check credentials carefully.

When you daughter is older, she may need a crown on one or both of the teeth, depending on the extent of the damage. In that situation, too, you will want to make sure the dentist you go to has the proper training and artistic skills to do a beautiful job.

Best of luck to you in locating someone to help you and your child.

Ella-
I don’t know if these two teeth are hopeless or not, but I can maybe be helpful.

Just because a tooth is infected and the gum is red doesn’t mean that it can’t be saved. Most cases of tooth infection can be treated - with root canal treatment, or gum disease treatment.

I am suspicious. If you have serious gum disease, I believe I would be hearing different things from you. Now I wasn’t there to hear what they told you, so I don’t know this. I’m just trying to plant questions to help you get more complete answers.In the case of serious gum disease, this should have been stated clearly, and there should have been a very direct discussion about what to do about ALL your teeth, not just two. If this isn’t what happened, then it means that either 1) you don’t have serious gum disease, and therefore these teeth don’t necessarily need to be extracted, or 2) they were negligent in dealing with your gum disease. So I would seek a second opinion.

Another link:
Naperville emergency dentist - Dr. Newkirk

At the recommendation of my dentist, I’ve tried every whitening product on the shelf, but the situation just keeps getting worse. The areas around the spots are getting whiter, while the spots are getting darker. When I brought this to my dentist’s attention, he said he could try to grind away the material of my tooth until the discoloration is gone. I don’t claim to be a dentist, but this sounds like a terrible idea! He has no idea how much he might have to grind, and I have this horrible mental image of a mouth full of misshapen lumps where my teeth used to be.

Please help me figure out an alternative. Would professional teeth whitening help where the over-the-counter products have failed? I admit, I am pretty obsessed with getting this fixed. I hate my teeth. They create the wrong impression, and I feel like they are hurting my efforts to get a job. I just graduated from college (summa cum-laude) and my confidence is at an all-time low.

Please help.

Brianna from Charleston, SC

Dear Brianna,

You are wise to be uncomfortable with your dentist’s suggestion to grind away at your teeth. Not only will this probably still be ineffective at removing the spots, but he could do considerable irreversible damage to your teeth, too. I strongly suggest you seek the services of an accredited, experienced cosmetic dentist. You should not have to continue to be part of your dentist’s learning curve regarding stains and teeth whitening products.

If all those over-the-counter products did not work for you, it is extremely unlikely that a professional teeth whitening procedure will work. Both systems use the same whitening agents—the at-home systems just take more time. When your first attempts were not successful, your dentist should have been able to tell you that.

Depending on the kind and degree of severity of the spots, there is a chance that a procedure called “microabrasion” could help. If not, other treatment options open to you include dental bonding or porcelain veneers. Both procedures should absolutely only be done by an accredited, experienced cosmetic dentist.

Most general dentists are not at all qualified to do this kind of work, so it is very important that you locate the right dentist to help you.

Thanks for your advice,

Neil in Bethesda, MD

Dear Neil,

There are only a few teeth whiteningproducts that would be appropriate in this situation. Crest Whitestrips or other products that are similar are the only products I would consider both safe and effective. The active agent in the whitestrips is peroxide, which needs to be left on the teeth to penetrate and whiten them. The strips do a pretty good job, usually.

Whitening toothpastes, which are only on the teeth briefly, really don’t do anything at all. Some whitening products can actually make the problem worse over time. They contain acids that slightly etch the surface of your teeth, which allows the white pigment in the second step of the treatment to adhere to your teeth. Tests indicate that these products actually damage your teeth, and when the pigment wears away, the roughened enamel will pick up even more staining, making your teeth darker than they were before the treatment. If you are going to do this yourself, I would strongly suggest sticking with only the whitestrips type products.

There are, however, several reasons the whitestrips might not work for you. First, they are designed to work on the front six teeth, which are the teeth you have veneers on. You could try trimming them to fit, but you might wind up with strange gaps and uncovered areas. The whitestrips also take quite a while to really show dramatic results, as the peroxide solution that is legal to sell over the counter is so much weaker than  what is used in a dentist’s office. This could mean purchasing quite a few kits, and quite a lot of your time spent messing around with this.

It would almost certainly be worth it to get this procedure done in your dentist’s office. The bleach used in the office will not harm your veneers, and is simple enough that no special training is necessary, so your general dentist could take care of this.