Q: I am 30 years old and had been seeing the same dentist my whole life, then I moved and had to find a new one. I went for my first cleaning with the new dentist and was told I had 10 cavities. I was shocked since I had just gone for a cleaning 6 months earlier and there was no problem at all. In fact I have no history of having any problems with my teeth. How do I know if I really have that bad of a problem? My teeth never even bother me.
– January, Connecticut
A: Dentists trained in U.S. dental schools receive very similar dental educations. There are standardized textbooks, curriculums, and local and national exams to take. These exams are written, oral, and practical. Thus, a diagnosis should be the same everywhere. However, a treatment plan or treatment options can vary. These differences can depend on the dentists' abilities, knowledge, experience, confidence, ethics, concern and continuing education.
All dentists should agree on whether or not a cavity (a hole in the tooth) exists. But many dentists may disagree on when to treat the cavity, for there are different guidelines on this. Some dentists treat a cavity when it is only in the enamel (outer layer of tooth structure) whereas others would make note of this hole to watch and treat only if it gets deeper. Many others would wait until the cavity penetrated into the dentin (the second layer of tooth structure). This is a judgment call—there's no right or wrong.
The answer to your question is to get a second opinion from a well-respected dentist in your area. Word of mouth may be a good indicator but in seeking a second opinion, make sure you analyze several factors including :
Respect in community
Office staff
Office cleanliness
Technology
Education and continuing education
Reputation for honesty
Level of compassion and caring
Dr. James E. Jacobs
Friday, March 23, 2007
Pre-Emptive Removal of Wisdom Teeth
Q: My dentist recommends that my 17-year-old daughter have all of her wisdom teeth removed. She is not having any problems. Is this necessary?
– Donna, North Carolina
A: Third molars ("wisdom teeth") normally erupt around 18 years of age, but the eruption can range from 17 years to 21 years of age. Dentists have different philosophies regarding removal of third molars based on their experience in practice and the type of dentist they are, e.g. oral surgeon, general dentist, periodontist, orthodontist, etc.
I am a periodontist and for the most part, I favor saving teeth, even third molars. If there is pathology, decay, poor eruption pattern leading to bone loss, a cyst, or chronic infection, then I would agree there is a reason to extract third molars. Of course, there are some exceptions to all guidelines, so each situation must be handled individually.
Third molars that are preserved can help keep a patient's bite or vertical dimension of their face intact. They can act as a back abutment tooth for a permanent fixed bridge in places that implants sometimes can't be placed. And they are perfectly fine teeth to chew with as long as they erupt in proper alignment.
Premature extraction of third molars can be an option, but I would want to know what the justification is before I would agree with that plan of action. One can always seek a second opinion from another dentist if unsure. As a general rule, I would not perform pre-emptive extractions of third molars except on an individual basis. In other words, I would not do this to my patients or my children unless there was a clear indication for it.
Dr. James E. Jacobs
– Donna, North Carolina
A: Third molars ("wisdom teeth") normally erupt around 18 years of age, but the eruption can range from 17 years to 21 years of age. Dentists have different philosophies regarding removal of third molars based on their experience in practice and the type of dentist they are, e.g. oral surgeon, general dentist, periodontist, orthodontist, etc.
I am a periodontist and for the most part, I favor saving teeth, even third molars. If there is pathology, decay, poor eruption pattern leading to bone loss, a cyst, or chronic infection, then I would agree there is a reason to extract third molars. Of course, there are some exceptions to all guidelines, so each situation must be handled individually.
Third molars that are preserved can help keep a patient's bite or vertical dimension of their face intact. They can act as a back abutment tooth for a permanent fixed bridge in places that implants sometimes can't be placed. And they are perfectly fine teeth to chew with as long as they erupt in proper alignment.
Premature extraction of third molars can be an option, but I would want to know what the justification is before I would agree with that plan of action. One can always seek a second opinion from another dentist if unsure. As a general rule, I would not perform pre-emptive extractions of third molars except on an individual basis. In other words, I would not do this to my patients or my children unless there was a clear indication for it.
Dr. James E. Jacobs
Mercury and Old Cavities
Q: I've heard that my old silver fillings probably contain dangerous mercury, and I should have them replaced. I don't think insurance will pay for replacements —but I don't want to leave poison in my mouth! Is it really dangerous to leave old fillings in place? What are the options for replacing them?— Jill, New York
A: The safety of dental silver fillings (amalgams) is one of the hottest topics in dentistry today. Silver fillings are called amalgam restorations because they are an amalgamation of several metals (tin, zinc, copper, and silver) combined with elemental mercury. These metals are mixed together and then placed in the carefully prepared holes made by the dentist. Over the years, people have questioned whether the mercury portion of the fillings leaches, or comes out, and if so, whether the mercury affects their health.
It seems as if the answer is no. Recently a series of articles appeared in national publications, including the Wall Street Journal (September 12, 2006), questioning the safety and long-term efficacy of amalgams. However, an FDA advisory panel had reported on September 6 that there was no new scientific evidence to justify regulation of dental amalgams. The report was based on a review of 34 recent studies, which found "no significant new information," though the panel did say that more research is needed.
Immediately after the FDA announcement, the American Dental Association issued a news release welcoming further study on amalgam safety, while reiterating that "the overwhelming weight of scientific evidence supports the safety and efficacy of dental amalgam" and that amalgam should remain available for dentists and patients.
I have a number of amalgams in my mouth that my dad (also a dentist) placed there 30 to 40 years ago. I personally feel they are safe and would not remove them unless I had a crack or decay around them. Amalgams are amazing restorations and are relatively low-cost, especially given the length of time that they last.
However, fillings don't last forever; your dentist must check the integrity of them during your regular cleaning appointments. If it should come to pass that an old amalgam needs replacement because of a crack or decay, you do have options. Replacement fillings can be made of gold (one of the best materials for teeth but no longer stylish), tooth-colored bonding materials, or tooth-colored porcelain. Discuss the options with your dentist to determine which material is best suited for your mouth. People who grind their teeth may be better off with gold restorations since porcelain tends to fracture more easily. It also depends on how much tooth structure has been lost to decay and what type of bite you have.
Dr. James E. Jacobs
Cosmetic Dentistry
A smile lights up your face, as the old saying goes. Along with your eyes, your smile is the first thing a person notices when meeting you. So, when you hesitate to smile because of broken, discolored, or poorly spaced teeth, you may be sending an unintended negative message.
People choose to improve the appearance of their teeth for a variety of reasons. Some seek to correct imperfections that have bothered them since childhood; others believe that a better appearance offers a social or professional advantage. As people keep their teeth later into life than ever before, many wish to reverse the effects of years of wear and tear.
With the advent of new materials and treatments, a better smile is now within reach of a broader segment of the population. But most dental insurance does not cover cosmetic procedures unless they are performed to correct a broken tooth, so you probably will have to pay for these improvements out of pocket.
Bleaching The natural light ivory color of enamel can turn to yellow, orange, brown, gray — even blue or green. Causes of discoloration include staining from coffee or tobacco, injury that has damaged the pulp, ingestion of the antibiotic tetracycline or high levels of fluoride while the teeth are developing, corrosion from silver fillings, and the natural wearing away of the enamel with age. Although many stains can be successfully removed with a bleaching technique, bleaching may be uncomfortable for people with sensitive teeth or an exposed root. Several different bleaching techniques are available.
Chair-side bleaching Your dentist etches your teeth with an acid solution and then applies an oxidizing agent to the enamel. Your teeth are exposed to a bright light or a laser to hasten the lightening. It usually takes three to four sessions, each lasting about 30–60 minutes, to achieve the color you want. A newer technique, called power bleaching, uses a highly concentrated form of hydrogen peroxide as the lightening agent. It can deliver results in just one session. Bleaching is temporary, however. Your teeth will darken again within one to three years, and you may need to repeat the procedure. Costs vary, with some dentists charging a fee of between $75 to $225 a session and others charging a single fee of $300 or more.
Home bleaching (dentist prescribed) Your dentist will make a custom-fitted mouthpiece to hold the bleaching chemicals (carbamide peroxide or hydrogen peroxide). Then you perform the bleaching at home. Simply spread the chemicals into the mouthpiece and put it on for the recommended period (between 30 minutes and several hours) each day for a week or two. This procedure generally costs between $200 and $600.
Bleaching pulp-damaged teeth When the pulp is dead or injured, the tooth will darken. To correct this problem, your dentist can rinse the pulp chamber with a bleaching agent while performing root canal therapy. If the stain persists or the tooth darkens after the root canal procedure is completed, your dentist can reopen the pulp chamber and fill it with bleach for several minutes under a heat light. This process may have to be repeated several times. Alternately, the dentist can fill the pulp chamber with bleaching solution and cover it with a temporary filling. In this case, you'll need to return after a few days to have the bleach removed and the tooth permanently sealed. Costs vary; some practices charge between $300 and $400 per tooth.
Over-the-counter bleaching kits These kits operate on the same principles as the professional products. You start with an acid rinse, then apply a hydrogen peroxide gel, and finally coat the tooth with a whitening pigment. Many over-the-counter tooth whitening strips or kits cost as little as $15 to $40. Although many consumers opt for this bleaching method because it is less expensive than other techniques, the Food and Drug Administration raises several concerns about the use of these kits. Without professional diagnosis, it's hard to determine the source of discoloration and the effectiveness of the bleaching agent, so good results cannot be ensured. In addition, there is not yet enough information to determine the long-term safety of these products.
People choose to improve the appearance of their teeth for a variety of reasons. Some seek to correct imperfections that have bothered them since childhood; others believe that a better appearance offers a social or professional advantage. As people keep their teeth later into life than ever before, many wish to reverse the effects of years of wear and tear.
With the advent of new materials and treatments, a better smile is now within reach of a broader segment of the population. But most dental insurance does not cover cosmetic procedures unless they are performed to correct a broken tooth, so you probably will have to pay for these improvements out of pocket.
Bleaching The natural light ivory color of enamel can turn to yellow, orange, brown, gray — even blue or green. Causes of discoloration include staining from coffee or tobacco, injury that has damaged the pulp, ingestion of the antibiotic tetracycline or high levels of fluoride while the teeth are developing, corrosion from silver fillings, and the natural wearing away of the enamel with age. Although many stains can be successfully removed with a bleaching technique, bleaching may be uncomfortable for people with sensitive teeth or an exposed root. Several different bleaching techniques are available.
Chair-side bleaching Your dentist etches your teeth with an acid solution and then applies an oxidizing agent to the enamel. Your teeth are exposed to a bright light or a laser to hasten the lightening. It usually takes three to four sessions, each lasting about 30–60 minutes, to achieve the color you want. A newer technique, called power bleaching, uses a highly concentrated form of hydrogen peroxide as the lightening agent. It can deliver results in just one session. Bleaching is temporary, however. Your teeth will darken again within one to three years, and you may need to repeat the procedure. Costs vary, with some dentists charging a fee of between $75 to $225 a session and others charging a single fee of $300 or more.
Home bleaching (dentist prescribed) Your dentist will make a custom-fitted mouthpiece to hold the bleaching chemicals (carbamide peroxide or hydrogen peroxide). Then you perform the bleaching at home. Simply spread the chemicals into the mouthpiece and put it on for the recommended period (between 30 minutes and several hours) each day for a week or two. This procedure generally costs between $200 and $600.
Bleaching pulp-damaged teeth When the pulp is dead or injured, the tooth will darken. To correct this problem, your dentist can rinse the pulp chamber with a bleaching agent while performing root canal therapy. If the stain persists or the tooth darkens after the root canal procedure is completed, your dentist can reopen the pulp chamber and fill it with bleach for several minutes under a heat light. This process may have to be repeated several times. Alternately, the dentist can fill the pulp chamber with bleaching solution and cover it with a temporary filling. In this case, you'll need to return after a few days to have the bleach removed and the tooth permanently sealed. Costs vary; some practices charge between $300 and $400 per tooth.
Over-the-counter bleaching kits These kits operate on the same principles as the professional products. You start with an acid rinse, then apply a hydrogen peroxide gel, and finally coat the tooth with a whitening pigment. Many over-the-counter tooth whitening strips or kits cost as little as $15 to $40. Although many consumers opt for this bleaching method because it is less expensive than other techniques, the Food and Drug Administration raises several concerns about the use of these kits. Without professional diagnosis, it's hard to determine the source of discoloration and the effectiveness of the bleaching agent, so good results cannot be ensured. In addition, there is not yet enough information to determine the long-term safety of these products.
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