One Opaque Tooth

I have translucent teeth expcept for one of my top front teeth, which is opaque. When I look at pictures of my youth, both top front teeth were white. I did not fall or have any trauma to the tooth. I am not having success with whitening my translucent teeth to bring them up to the opaque tooth. Having this one opaque tooth ruins my smile. Would an in office whitening procedure work? My teeth are healthy, I don’t like the idea of shaving them down for veneers. Any suggestions?
– Pam from Connecticut

Pam,
Teeth bleaching or whitening will not help your teeth match any better. In fact, it may make your smile look worse. Bleaching doesn’t work for any unevenness of color – it tends to accentuate unevenness. It will make your tranlucent teeth more translucent.

My recommendation would be to find an excellent cosmetic dentist and have the one tooth bonded or one porcelain veneer so that it matches the others. It won’t really require grinding the tooth down – at the most it would require a very slight amount of tooth preparation on the one tooth. There’s really no other way to get them right, if they look different.

But you need an excellent cosmetic dentist. The way you are describing this sounds very tricky – the dentist and the laboratory would have to be able to mimic the translucency of the translucent tooth without making the veneer or bonding actually translucent. It can be done – but it’s not a job for your typical family dentist.

Fixing a broken front tooth on a 12-year-old

My grandson recently had a bicycle accident and his front tooth was broken. Broken in the gum area. He currently has a splint on the 2 teeth surrounding it and this broken one. The dentist is saying that her next step is to have his tooth removed and put a flipper on it. He is only 12yrs.old and I am concerned that there could possibly be some alternative to saving/repairing the tooth instead of replacing it. It has been approx. 5 or 6 weeks since the occurrence. He is having no problem with the tooth right now with the splint on it. Could the broken tooth possibly fuse on it’s own over time? Is it too soon to determine if the tooth will die or not?
– Candace from New Hampshire

Candace,
I’m not sure I understand exactly the situation here. I think you are saying that the root of the tooth is fractured and that this fracture is down in the bone where it can’t be seen.

Usually when the root of a front tooth is fractured down in the bone like this you can’t save the tooth. In some cases, if the fracture is close enough to the root tip, the root tip could maybe be surgically removed and the rest of the tooth could be saved by doing a root canal treatment. But that would be tricky. Only in very rare circumstances would the broken root fuse back together.

How this tooth is replaced is also a concern. And on a twelve-year-old boy, this is also tricky. A dental implant will probably be the most esthetic tooth replacement, but generally we don’t put in dental implants for front teeth in young people until the jawbone has finished growing, which can be around age 18-20. This is to make sure that the companion natural tooth and the dental implant are the same height. If the bone continues to grow after the implant is placed, the natural tooth will move with the bone and the implant will stay in the original position.

When your grandson gets this all fixed, it will also be important to have the replacement tooth, or the repaired tooth, match his existing natural tooth exactly in shape, color pattern, and translucency. This is no easy task, even for an experienced cosmetic dentist. If it were my son or grandson, I would want the very best cosmetic dentist I could find to help with this. It might cost 10-25% more, but it would be worth it to have this looking good and not have it be an embarrassment to him.

Links – This posting comes from the office of your Naperville dentist, Dr. David Newkirk. A broken front tooth would be classified as a dental emergency, and if you called our office, we would see you that day to evaluate it and see what we could do.

Cost of porcelain onlays

Today my dentist says I need an “onlay porcelain/ceramic 3 surface” on tooth no.3 and one on no.2. He needs to remove the old amalgam fillings before puting on the onlays. Costs; $2,600.00. Is this a fair price, here in Edmond, Oklahoma? Thank you for your time!!
– Ed from Oklahoma

Dear Ed,
$2600 for two onlays, including the buildups that have to be done underneath them, I’m guessing is about average for Oklahoma, maybe a little bit higher than average. There are excellent dentists who would charge considerably more than that. Some would charge double that. The average cost would be somewhat higher here in the Chicago area.

Generally, dentists who recommend and do porcelain onlays tend to be at the higher end of costs, because onlays are considerably more difficult to do than crowns and require more precision. So a dentist who recommends an onlay would tend to be one who is very demanding of himself or herself – kind of a perfectionist type. I’m not saying that’s an absolute rule, but it’s a tendency. Probably 90% of dentists would do a crown on a tooth that’s broken down to the extent that it needs an onlay. A dental crown is much simpler, and works okay, and the fee is usually about the same. But a well-done onlay conserves healthy tooth structure and is gentler on the gums. So the motivation to do an onlay is usually simply the satisfaction of doing a better service for the patient.

I’m not saying that your dentist is an excellent dentist simply because he’s recommending a porcelain onlay, but I’m saying that it’s a good sign that he maybe is.

Another link:
Dr. Newkirk also provides emergency dentistry in Naperville.

Can I order my own crowns?

Are there any laws, restricting me from ordering my own crowns or veneers in the state of Louisiana ? Why is there virtually no affordable comprehensive dental care in the USA? I am a Lupus patient, after many years of treatment my teeth have also suffered. I have done a good job of caring for my teeth through the years. I still have my back molars on three sides and financially unable to continue the treatment, even after spending thousands of dollars for restorative work at the dental school. All I want is to restore my smile. Can you help me and millions of my fellow Americans? I really don’t want dentures.
Mary from Louisiana

Mary,
The laws on ordering dental crowns, veneers, or dentures, is that the dental laboratory by law is restricted from doing anything, only under the direct authorization of a licensed dentist. They are not permitted to do anything directly for a patient without a dentist being involved.

The reason for those laws is that the bulk of the work is in preparing the tooth for a crown and then taking an impression that accurately reproduces the prepared tooth, and then in fitting the crown to the tooth. If there is the slightest gap of even 1/100th of an inch between the tooth and the crown in any one place, food particles and bacteria will leak in and decay will destroy the tooth.

And unfortunately, dental care is expensive. You mentioned that you have been going to the dental school. Since dental schools have students working on you, they don’t need to pay those students and they don’t need to make a profit. Still, as you say, the costs are high. That is because the equipment and materials involved in dentistry are very specialized and are manufactured to very high standards, so they are expensive. But in many cities there are charity clinics and programs that will help people in financial difficulty. Check with your local dental society or ask at the dental school if there are any such programs where you live. And if you find such a place, realize that there are some people who are being very generous in order to make those programs available. My impression is that dentists, for the most part, are caring and generous people who truly want to help others.

Can my upper teeth be whiter than my bottom teeth?

I have a simple but VERY important question: my bottom front teeth, after teeth whitening, have settled somewhere between color A1 and A2 on the Vita Shade Guide. My bottom posterior teeth are all A2 (I have Empress porcelain crowns on teeth #18, #19, #20, #29, #30 and #31 and they are all color A2). Here’s my question: how white do you think I could go on my top front ten teeth (veneers) and it still look natural? I want white teeth, but I don’t want it to look unnatural in relation to my bottom teeth. I would really appreciate your expert opinion.
Scott from South Carolina

Scott,
You can get away with the posterior teeth being a full shade number darker than the anterior teeth, and you can get away with the lower teeth being a full shade number darker than the upper teeth. The reason is that the posterior teeth are in the shadows, and would naturally look darker. And the lower teeth in a normal bite always appear behind the upper teeth, plus they’re a little less prominent, so they will also naturally look darker.

You could probably get your lower teeth a little whiter if you wanted and they would still look fine. But let’s say you leave them at around an A 1 1/2 – halfway between an A-1 and an A-2. You could have the upper teeth maybe half a shade lighter than A-1.

But you worry me a little, in that you don’t feel confident in asking your dentist about this. Or maybe you haven’t selected a cosmetic dentist to do these porcelain veneers for you yet. Either way, be very careful. Very few dentists are true artists who are passionate about appearance-related dentistry. So select your cosmetic dentist with care.

Also remember that after tooth bleaching, your teeth are a little extra-white, and they take a couple of weeks to settle into their final, true shade. When we’re matching the shade of a bleached tooth, we always give the shade a couple of weeks to stabilize.

My tooth feels like fire, even to tap water.

What is a desensitizing agent? I had a large filling removed from a molar & re-filled & now it is so sensitive, even tap water feels like fire.

– Shirley from Texas

Shirley,
From the description you give of the intensity of your pain, it sounds like the tooth that was filled is infected and will need a root canal treatment and then later a dental crown.

Here are some guidelines to see if you need your dentist to help you with this pain:

If the tooth is getting more hypersensitive with each passing day, it is probably infected. If it is gradually getting better, it will probably recover.
If your tooth is momentarily sensitive from cold water, but it’s only for a couple of seconds, and as soon as the tooth warms up it feels fine, then it will probably recover. If the pain lingers more than a few seconds, it is infected and will need a root canal treatment.

If the tooth begins hurting spontaneously, where you get a sharp pain without any cold stimulus, it is infected, and will need a root canal treatment.

If the tooth gives you a sharp pain and then all of a sudden the pain goes away, cold doesn’t bother the tooth any more at all, the tooth is probably infected and needs a root canal treatment. What has probably happened is the tissue inside the tooth has died, which takes care of the pain, but now the infection begins spreading out the end of the root of the tooth and into your bone, causing an abscess. That needs to be fixed.

I hope this is helpful.

Naperville dentist.