Dr. Noah's Dentistry Blog

Questions About Dentistry Answered

Did I Crumble a Tooth?

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My husband and I are in a disagreement as to whether or not I need an emergency dentist. I think I can wait until my appointment on Tuesday, but he thinks I need to be seen right away. I had a root canal treatment almost two weeks ago. I had a business trip so put off getting the crown. My dentist gave me a temporary filling to hold things over. Everything was okay until dinner last night. I was eating Chinese food and started feeling something grainy. I discreetly reached in and some whitish crumbly material was the culprit. My husband thinks my tooth crumbled. I think it’s actually just the temporary filling. If I’m correct, I can wait to see the dentist, right?

Melinda F.

Dear Melinda,

First, let’s see if we can’t figure out who’s got the right end of the stick. If there’s a way for you to peek at the tooth, do so. If the tooth looks intact, but there’s a hole in the center, then you’re talking about the temporary filling falling out. If there’s any disintegration to the tooth, then you’ve got a crumbling tooth.

If it’s just the filling, you can likely wait until your appointment. You may want to take the precaution of getting some temporary dental filling material. You can find it at many pharmacies. Bear in mind, it’s only meant to be used for a few days. So, keep the appointment you have with your dentist to get your dental crown.

If you wait too long after a root canal, the tooth will become brittle and could end up crumbling as your husband suggested. If that happens, they’ll be nothing to crown and you’ll be looking for tooth replacement options.

On the other hand, if the tooth has started crumbling, the sooner you get in to see a dentist the better. In fact, I’d call your dentist right away and let him not what happened. He’ll want to crown the tooth right away if it’s still possible.

This blog is brought ot you by Dr. Ryan Noah.

Can I Go to an ER If I Can’t Afford a Dentist?

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My insurance covers ER visits but not dental visits. I think I have an infected tooth and wondered if I could just go to the ER to cover it?

Andrew M.

Dear Andrew,

Unfortunately, a hospital ER will not treat dental conditions. They’re not trained for it. The most they’ll do is give you some pain relief and possibly an antibiotic. Though, with dental situations, an antibiotic isn’t enough. A dentist has to get in there and remove the infected tissue from the pulp of the tooth.

This isn’t something you’ll want to put off. The longer you wait, the more the infection will spread. Your jaw is very close to both your heart and brain. If the infection gets to there it will be life threatening.

In your place, I’d look for an emergency dentist. They’ll see patients in your situation fairly quickly, even if you’ve never been a patient there. If you tried to schedule a regular appointment, as a new patient, with a dentist it would likely take several weeks. That’s entirely too long for the infection to spread.

Because of your financial situation, it would help if the dentist also advertises as an affordable dentist. Not only are their fees generally a bit lower, but almost all of them have payment plans.

This blog is brought to you by Dr. Ryan Noah.

Smile Club or Professional Orthodontics

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I’ve been trying to do save up for orthodontics for a long time. I’m getting close, but just read something about Smile Care Club. It’s a lot less expensive than the orthodontics. Is it okay for me to use that and then save the rest of the money for something else?

Lisa A.

Dear Lisa,

The best thing about the Smile Club is the cost savings. I just want you to think about it ahead of time. They have you send x-rays, but there are some things, such as gum disease, which is very hard to discern by x-rays alone. It usually takes a physical exam as well.

Gum disease is serious and can creep up on you silently. If you get this type of orthodontics while having gum disease, it will make the situation significantly worse. That puts you at risk of losing your teeth. In that case, instead of spending a little extra money up front, you’ll end up spending thousands to replace lost teeth.

The other thing to bear in mind is things which can go wrong during the treatment. Sometimes, as teeth are brought together, there needs to be some mild shaving to ensure they come together well. In that case you’d need to see a dentist. You’d want it to be a dentist invested in your case, but you won’t have one of those.

Smile Club keeps up with you by photos and phone. I feel one on one monitoring in person is the safest way to go, especially for the patient. This is designed to be a mail order substitute for Invisalign. You’d be better served getting actual Invisalign and the personal attention you both need and deserve during your treatment.

This blog is brought to you by Dr. Ryan Noah.

Is Orthofill a Scam?

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I was looking at the Orthofill website. They seem to have a lot of regular people saying it worked for them. It’s so much more affordable than braces. All I really need to do is close a gap in my front teeth. This seems like a much more reasonable option. However, my dad always says if something seems too good to be true, it probably is. I just want to make sure I’m not getting myself scammed when I just want to close a gap. I’m not opposed to spending money, but I don’t want ugly braces and I kind of wanted something that worked faster than braces.

Mandy P.

Dear Mandy,

I’m glad you wrote. People see their gap closing and think “Problem solved.” What they don’t see is that the gap will eventually open back up. The bands don’t actually work on your teeth the way true orthodontics would. They tip your teeth toward one another. You’d get the same results if you wrapped small rubber bands around your front teeth.

There have been horror stories with these too. Bands have wormed their way underneath people’s gums causing horrific damage to the patient. As the bands are most often worn during sleep, you wouldn’t even know it was happening.

Orthodontics aren’t the only solution for a tooth gap. There are cosmetic solutions, such as dental bonding as well. That will use a composite solution to fill in the gap on your teeth. If there are other things you’d like to change on your teeth, porcelain veneers are a great solution. They can completely remake your smile. You mentioned the only thing you were interested in is the gap, so this probably isn’t your solution. I just wanted you to know it was available.

Also, if you’d like to close the gap, not just cosmetically, but actually. There is a way to do it without bulky metal wires and brackets. Invisalign can do the same things as braces, without anyone knowing you’re wearing anything. Faster too.

This blog is brought to you by Dr. Ryan Noah.

Canker Sore or Cancer?

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My husband is convinced he needs an emergency dentist for a canker sore. He thinks he has cancer. Is there anything I can do to calm him down?

Meg A. – New Jersey

Meg,

A lot of that will depend on how long he’s had the canker sore. Often they heal within two weeks. Much past that and it may actually be a sign of something more serious. Then, the sooner he sees the dentist, the better. It could also be a virus or cancer (as your husband fears).

Canker sores are developed for many different reasons—biting one’s cheek, friction from a dental appliance, injury, stress, and even allergies. There are several remedies which could give him some relief. There are oral pain relievers. They’re not extraordinarily strong, but they can give him some temporary relief while he eats. At least this way he gets the nourishment he needs. You can also find pads to cover the sore, but you can imagine how well that works in an environment like your mouth.

If your husband regularly sees the dentist, it’s probably just a canker sore. Dentists do a check for oral cancer during your check-ups, so he’d have seen any early warning signs. This should bring your husband some comfort. If it does turn out to be more than a canker sore or virus, be assured when they’re caught early the prognosis is generally very good.

This blog is brought to you by Dr. Ryan Noah.

I’m Being Bullied By My Dentist

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I’ve lost several teeth. I don’t have much money, so I thought I’d get a removable partial denture. My dentist insists I get dental implants. He keeps telling me I’ll ruin my life with dentures, but I don’t want to go into debt for a procedure I can’t afford. He won’t shut up about it. Is it really that horrible a decision?

Brooke – Texas

Brooke,

This type of behavior from a dentist really galls me. While dental implants may be the top of the line treatment, it also comes with a top of the line price tag. Not everyone can afford that. And dentists need to understand that.

There is something called phased treatment that affordable dentists are very willing to suggest and provide. You can start off with a removable partial denture. Possibly you could even afford to have it anchored with a mini implant. Then as you have the money you can switch to a full implant. Depending on how many teeth you’ve lost, you may only need one or two.

While his methods are a bit bullish, he likely only has your well-being in mind. Dentures can be uncomfortable and reduce your chewing capacity no matter how well made they are. Then, there is the loss of jaw bone minerals that come from not having a tooth root anymore. With dental implants, the body is tricked into thinking that root is still there and you retain all your minerals.

In your place, I would just tell him this is what you can afford and that’s that. If you’re interested in working toward another treatment, you can tell him that. It may shut him up. But, either way, it’s your mouth, your budget, and your choice.

This blog is brought to you by Dr. Ryan Noah.

Can an Orthodontic Disaster Be Fixed?

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My mom had me see an orthodontist while I was younger and the orthodontist had two of my teeth pulled because I didn’t have much space. I’m not quite sure why, but he went with the two nearest my two front teeth, which means that my pointier teeth are closer to the front than they should be, if that makes any sense. I’m 26 now and my teeth have shifted some, so now there’s a big gap between those teeth and my front teeth too. It looks so bad. I’ve been considering going in and seeing if an orthodontist will give me braces again to close the gap, but that’s not really what I want. If possible, I’d like the pointier teeth shaved down or moved or something instead. After all these years, is it still possible to correct what the first orthodontist did?

Thank you,

Tammy

Dear Tammy,

It sounds like you had your lateral incisors removed, which isn’t very common because people wind up with the problem you currently have- it never looks quite right. Plus, the canines play a crucial role in the side to side motion of chewing, protecting the back teeth from undue stress, so those are not usually moved much. With that said, what’s done is done and now you want to see about fixing it.

You’re probably right about not just having the gap closed again. Even if you see a really good cosmetic dentist, it would be difficult for him to make your canines look like lateral incisors. The teeth are built so differently. If there isn’t enough space to replace the lateral incisors that were taken, you may have to go that route anyway, though. If you do have a considerable amount of space, you may be able to go through another round of orthodontics to straighten things up and shift the gap, so you could have something like dental implants, a bridge, or partial denture made.

The bottom line with this one is you’ll want to see an orthodontist and a dentist who specializes in cosmetic dentistry to do an exam and x-rays. Every case is a little different and it’s difficult to know how much space you have to work with. With something this extensive, you’ll probably want to get a couple of opinions, so you can get a good feeling for what’s best and you’ll want to see someone who has preferably handled a case similar to yours before. You can fix it and make it look better than it did before, but it’ll never be quite the same as it would have if those teeth weren’t extracted.

This blog is brought to you by Dr. Ryan Noah.

If My Teeth Shift, Do I Re-do Invisalign Treatment?

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I had an Invisalign treatment when I was in my late teens. I’m in my mid-20s now and my teeth seemed to have shifted. Do I need to re-do the Invisalign treatment?

Missy L. – Pennsylvania

Missy,

First, I’d like to assure you it is normal for people’s teeth to shift. If they didn’t, orthodontics would never work. However, genetics plays a large factor in how much shifting people experience.

It’s likely your dentist provided you with a retainer to wear temporarily after you completed your Invisalign treatment for a specific period of time. If your teeth are shifting you may want to wear that retainer again.

The only reason I would re-do the Invisalign treatment is if your teeth shifted into a position you don’t like. Otherwise, a retainer should do the trick.  Some people have teeth which constantly shift. For those patients, I often recommend a permanent retainer. This is permanently fixed to the back of your teeth. You’ll be able to keep your teeth in proper alignment without worrying about people seeing your retainer.

Talk to your dentist or orthodontist. When they look at your bite, they’ll be able to tell you which treatment is preferable in your case. It’s likely, because your Invisalign treatment was completed in your teens, you’re going to a new dentist. Your old dentist should be able to easily provide any records or information your new dentist need about your Invisalign treatment.

This blog is brought to you by Dr. Ryan Noah.

Is There an Inexpensive Smile Makeover?

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I’ve always wanted a smile makeover. Every year I think I’ll get one with my tax refund, but every year something else seems to break down, whether it’s my car or an appliance at home, to commandeer the money. It’s equally disappointing every year. Is there an inexpensive smile makeover?

Alice V. – New Hampshire

Alice,

I wouldn’t say it’s a complete smile makeover, but teeth whitening is the most inexpensive way to make a significant difference in the cosmetics of your smile. It’s affordable with most budgets and takes years off your appearance.

Another benefit is it doesn’t require an expensive cosmetic dentist. Your family dentist can perform the service quite well for you. Your biggest decision will be whether you want in-office or take-home teeth whitening.

With in-office, everything is done in just one appointment. Your teeth will get as white as they’re capable. Often, the color will settle just a little after the first week, but they will still be extraordinarily white.

Take-home whitening is different. You’ll wear the whitening gel for a minimum of 20 minutes each day, using custom made trays. Often that is repeated for a week or more depending on the level of whitening you’re hoping to obtain,

This blog is brought to you by Dr. Ryan Noah.

Why Do I Need a Retainer?

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I just spent four years wearing braces. Do I really need a retainer?

Beth – Kansas City, MO

Beth,

There’s an important reason for retainers after braces. They’re designed to keep your teeth in their new position. If you don’t wear it, your teeth will shift quickly. Retainers are even more important if you’re still growing into adulthood because your growth causes your teeth to shift even more.

Another reason a retainer is necessary is because your new bite needs to stabilize and it may take some time for all of the tissues and the bone to reorganize. Shifting of the teeth occurs naturally so retainers are needed to help keep them in place. Relapse of the teeth is very high the first month after the removal of braces and it usually takes about one year for teeth to stabilize completely after orthodontic treatment. If you had spaces in between your teeth before braces then it takes longer to keep the dentition stable. The rule of thumb is you wear your retainers as long as you wore your braces. So if you wore braces for four years then you wear your retainer for four years.

The good news is not all orthodontic patients need to wear their retainers 24/7. Your orthodontist will recommend what retention plan is best for you. Patients with removable retainers are recommended to wear their retainers on a constant basis for at least the first six months and then usually just at night while they sleep for a few years. Yet some orthodontic patients need only wear their retainers for the first week on a constant basis then after that just at night. A lot of orthodontists apply fixed retainers that are cemented in place to stabilize the teeth which are usually worn for at least five years. This is commonly used for adolescents because it’s common for teenagers not to wear their appliance, plus there’s the possibility of wisdom teeth causing shifting of the teeth while trying to erupt.

Hope this helps. This blog is brought to you by Dr. Ryan Noah.