How long after my root canal should I wait to restore my tooth?

This is not a question with a simple answer. Teeth after root canals should be protected with either a permanent filling, crown or onlay.

Usually I restore anterior teeth with sufficient tooth structure using a simple composite filling. Posterior teeth are usually restored with crowns or onlays, after a core is placed to replace missing tooth structure.

After I complete a root canal, I usually place an IRM filling to seal the access opening. This provides a good seal, which is required to insure that the tooth's canal doesn't become contaminated. This filling must provide an interim restoration until the patient is ready to restore the tooth.

If there was no preexisting infection of the tooth, and the patient can afford it, I start the process to fabricate a permanent restoration, right away. If the tooth had a prior infection or the patient can not afford an immediate restoration, sometimes we wait for 6 months to a year.

I make sure that if the final restoration is not to be completed quickly, that the patient is made aware that if the interim filling dislodges,they must return and that they should refrain from eating hard substances with that tooth until they do complete the ultimate restoration.

One possible cause of root canal failure is recontamination of the canal system and if a patient loses their temporary restoration, this can occur in as little as thirty days.

My crown broke, What should I do?

If your crown breaks, you should call a dentist and get an appointment as soon as you are able. Hopefully your dentist will see you within a day or two. If they can't see you within a week, I would call a different dentist or better yet ask them 'nicely' if they can refer you to a good dentist who will be able to see you sooner.

It is best to see a dentist soon, because it is often hard for a patient to evaluate the extent of his damage. Sometimes, a patient without much pain has sustainned a significant injury to a tooth. Fortunately, most times having your crown break isn't such a big a dental emergency. Most times when the patient is seen the crown either needs to be replaced or smoothed.

Some times the remainder of the crown is sharp and can irritate or cut the tongue.
If the underlying tooth is exposed, sometimes the tooth is sensitive to air or cold liquids. That means the pulp inside the tooth is still alive(a good thing!). Although this is anoying and can be a pain, nothing will happen to the tooth in twenty four to 48 hours. Teeth do not decay in one week. It takes time for decay to develop

Occasionally, when a patient calls and says "my crown broke", what actually has occured is the tooth under the crown has broken off and the crown has come out. This can be a bigger emergency. When the patient does come in, the remainder of the tooth has decay and sometimes it requires endodontic treatment. Often these teeth do not hurt, since the pulp is already dead. Some teeth have sustained vertical fractures and in a worst case scenario the tooth needs to be removed.

My bonding is getting stained. Does it have to be redone?

This is a commonly asked question. Usually when a patient has stained bonding,and it still is stained after their cleaning, I try and polish off the stained bonding with a fine diamond bur. Often the stain is partially or wholly superficial and when I use the fine diamond to gently abrade the stain, it disappears.

Occasionally, the stain is either in a crater like porosity or has crept under the bonding. In that case often its better to redo the bonding. If I do redo the bonding, I usually discuss the patient improving their brushing technique, since poor brushing technique can contribute to the development of porosity's in bonded restorations. The acidity of the patients plaque can create the porosity's.

Bonded restorations look better and last longer in 'clean mouths'. In clean mouths, bonding can maintain a reasonable appearance for 10 years or more!

Should I have pain after having a cavity filled? If I do,what should be done?

Although I wish that this was not so, sometimes patients do experience discomfort after having a filling done. Sometimes the pain is associated with a bite that needs to be adjusted. If the filling that was placed hits just slightly before the other teeth hit it can cause pain and sensitivity.

If a patient calls with pain after a filling is placed, I always ask if they bring their teeth together does that provoke the pain. If it does I ask them to return for a bite adjustment. Often this 30 second adjustment is all that is needed. The tooth becomes comfortable within 24-48 hrs.

Infrequently, the bite adjustment doesn't work and in that case if the pain is not severe, I will suggest giving the tooth some time to calm down(one week to one month). If the patient is still bothered at that point and there has not been an improvement I suggest taking the filling so that I may have a chance to reexamine the tooth without the filling.

After removing the filling, I study the tooth with a bright light and magnification and look for either internal cracks or for possible microscopic exposures of the nerve. If none are found I place a sedative 'temporary' filling to see whether that helps. If I do find an internal crack in the tooth that may be responsible for the patients sensitivity, I often recommend making a crown for the tooth and having it placed temporarily in the mouth to see if the tooth becomes 'happy'.

A small percentage of teeth even when all is said an done remain 'unhappy' and do require a root canal to remove the pulpal tissue. Root canals, when performed properly, have a very high rate of success and will give these patients back their 'happy' tooth.

I am in need of bonding and bleaching. In what order do I do them?

This is a question that comes up in different forms almost every week in my dental office. Bleaching should usually come before any anterior tooth colored restorations. Bonding must be matched in color to the existing color of teeth and it will not change color even after bleaching. So it only makes sense to whiten your teeth first and then match the lightened color of the teeth.

After bonding, the shape of your teeth may be altered and custom trays may not fit as well. It may be necessary to make a new tray to fit your new teeth. Bleaching touch ups are usually needed every 6 months to one year.

How can I save money on my dental bills?

Although the aphorism 'cheap is expensive' can apply, there are ways to save money on dental bills.

The best value in dentistry are recall appointments. These regular cleanings and exams at by the hygienist and dentist will prevent problems from occurring and will tend to pick up problems before they worsen. Being proactive does in the long run save money and your teeth!

Although it is tempting, when money is tight, to spread out the time between cleanings, It is my observation that when my patients do this, they tend to show up in a year or two in pain, with problems that would have been addressed at an earlier time and less expensively, if only they had kept to their recall schedule. Sometimes, in the case of 'gum problems' , the patients have experience bone loss, which would not have occured if they had been on a 'tighter' recall schedule.

In my practice, I recommend frequent recall appointments for patients over forty years of age(every three or four months). To help with out of pocket expenses, some of the patients request only two exams per year and this saves the cost of the additional exams.

Staging care is another way for patients to save out of pocket expenses. If has multiple carious teeth and will need multiple crowns to restore them, it is much better to 'excavate' the decay in these teeth and place long term intermediate fillings in the teeth, than to only address one tooth and leave the others to worsen. Patients who have intermediate fillings can restore the teeth as their finances and insurance allows.

If a patient, who could only afford one crown, had that done, but didn't address other problems because of finances, the condition of some teeth would worsen and it may be neccessary for their dentist to deal with a subsequent toothache at a later time. Root Canals, or Implants are very expensive and if staged treatment had been implemented, these procedures probably would be unnecessary!

Is getting the Flu Vaccine a good idea?

Probably it is a good idea for almost everyone to get the Vaccine. I received my flu shot just yesterday.

According to New York City Department health Information brochure from September,"Every adult who wants to be immunized should receive and annual influenza vaccine. In July 2008 the CDC recommended that all children aged 6 months through 18 years be vaccinated. Aside from children less that 6 months of age, almost every one is recommended to have the vaccine.

I have been missing a molar for over five years, do I have to replace it?

The answer is it depends. If it has been 5 years since your extraction, probably any shifting that could take place has already happened. I like to look at the occlusion of the teeth on the side of the missing tooth. Often it is such that when the mouth is closed the opposing teeth come together so that the do not allow shifting.

If the occlusion allows for further shifting, then I would strongly recommend replacement of your missing tooth. Also if your space detracts from your smile, then tooth replacement tooth would be a good idea. Missing upper first molars are in the 'smile zone' and should often be replaced to maintain an esthetic smile. Lower back teeth are not seen when smiling and while their replacement may improve a patients ability to chew, they do not affect a patient's smile.

What is an Implant Abutment?

Abutments are commonly used when restoring implants. The abutment is a screwed in post that allows a dentist to fit a crown or a bridge to an implant. They are used in combination with cementable crowns or bridges and although there are other ways to attach crowns to implants, they are the most commonly used alternative and my favorite.

Abutments can be made of titanium, gold or zirconium. They can be ordered 'stock' from an implant company, or custom made in a laboratory. In my practice I usually use Atlantis abutments that are made using a cadcam process and designed on a computer.

Fees can vary for abutments. Generally, prefabricated abutments are less than custom abutments, but custom abutments can be better since they often allow the dentist to have the abutment contoured to provide the best placement for the crowns margin. They also can compensate for implants that are not placed parallel to the eventual crown.