What does it mean if my tooth hurts after I have a temporary crown placed?

This is a question that I am frequently asked. It is common for freshly prepared teeth to be sensitive when a new temporary is placed. For many years dentists cemented temporary crowns in with sedative temporary cements that contained eugenol . Eugenol is an abtundent and it can calm down an irritated pulp, but it can interfere with bonding agents. In the last ten years, as composite cements have become more popular, dentists have been using less eugonol based temporary cements.

Accordingly the number of sensitivity complaints have probably gone up. Preparing a tooth for a full coverage crown can create irritation in a pulp and create temporary sensitivity. Most times it goes away eventually. Occasionally teeth do not calm down and may require endodontic therapy.

Other common possible causes of sensitivity of teeth with temporary crowns can be high bites or incompletely covered preparations. These can be easily corrected by a dentist. If you do have sensitivity after having a temporary placed it is a good idea to let your dentist know.

If I have a patient who still has this sensitivity when I am trying in the permanent crown, sometimes I choose to cement the permanent crown with a temporary cement, just to allow the tooth to calm down prior to permanently cementing the crown. If the tooth remains 'unhappy' even with the permanent crown temporarily cemented endodontic therapy is an option that may have to be eventually considered.

What are the top 100 dental industry blogs?

I am pleased to report that The 'Ask Dr Spindel' dental blog has been cited as one of the top one hundred dental industry blogs. The posting can be found at http://dentalassistingschool.org/top-100-dental-industry-blogs/ and lists what the author feels are the best dental blogs.

The list not only includes top dental blogs but also lists a generous helping of other dental industry websites, pod casts and and relevant Internet articles. The author has made a comprehensive list that may be of interest to anyone seeking dental information or just needing a 'dental information fix'.

Where in the world is Laurel Touby?

I am experiencing a serious case of jealousy. My patient, Laurel Touby, just came in and announced that she is taking a sabbatical and travelling for the next six months. She is planning to post blog entries along the way and I will, for the moment, live vicariously by reading her posts. She will be posting her adventures on her blog at: culturetripping.com.

We are now using Dexis!

We spent the afternoon being trained by Camille Burford. She did a great job at training my staff and myself and we are ready! We are all very pleased and she did a thorough job of making a potentially dry subject interesting! We give Camille an A+!

It is easy to use, almost instantly produces an image on our laptop and seems to require over 50 percent less radiation to produce a clinically diagnostic image. I particularly like the software features that allow drawing on images and X-rays are easily duplicated and emailed for second opinions or consultations with specialists

Does an X-ray always show whether a tooth needs a root canal or not?

Although radiographs often do show a widening of the ligament at the apex when an endodontic infection is present, not all teeth that require root canal treatment do show this tell tale sign. Some non vital teeth do not show any sign at the apex of an infection, but if challenged with an ice cube probe, feel no cold sensitivity. Teeth that are non vital, whether they show an area of infection present at the apex, should have endodontic treatment.

Also some teeth, especially those with an acute pulpitis, do not show any apical pathology yet, but patients can be in acute pain. If this pain is not associated with a high bite from a recent dental restoration then often it is best alleviated by starting a root canal. Some of these teeth have beginning abscesses in their pulps but the pathology has not reached the apex yet.

When I do start a root canal on these teeth, sometimes a small bleb of pus can be seen, overlying an otherwise still vital pulp. Other times the pulp is entirely necrotic. Most dentists would agree that these teeth should have root canals even without any evidence of a radiolucency around the apex of the tooth.

Is it possible to over whiten teeth?

I think so. Some patients persist at whitening their teeth for longer than is needed. They feel that no matter how white their teeth get it is not enough. I call this phenomenon 'bleaching anorexia'. When they show up at recall and ask me what I think, I recommend that they stop whitening their teeth.

Overly whitened teeth can look unaesthetic. The good news is that slowly over time even overly whitened teeth do fade and look more natural. Sometimes I just have to cut off a patient's supply of bleaching gel!

Can I get my medical insurance to pay for Arestin?

Good news! My favorite Arestin representative,Tricia Walters, was just here and it turns out that some medical insurers are covering Arestin on prescription plans. She stated that Medco has been allowing pharmacies to dispense Arestin to dental offices. Patients then only have to pay their co-pay and a small fee per application to their dentist! This is good news.

What are the best treatment options for a tooth with a root perforation?

Small perforations near the apex often can be successfully treated, by sealing with an appropriate material. Often a reparative cement is applied to the perforation using a cement called Mineral Trioxylate Aggregate(MTA). This can be applied internally or externally to seal the defect. It can work well.

Larger perforations can be difficult to repair succesfully and in general, if the perforation is close to the crestal bone(far away from the apex) the perforated tooth is considered to have a poor long term prognosis and the best treatment option may be an extraction and implant placement, before an infection occurs.