Smile Solutions by Emmi Dental

“The Dentist ground down my good tooth!”

I hear this from my patient’s every day. They point to a tooth or refer to a previous dentist that “drilled on a good tooth”, so that must be the reason for the problems they are having.
I understand that sentiment 100%. I would think and feel a similar way if I was a patient and if I was not fully informed why the dentist “ground down” a good tooth. And when I say fully informed, I do not mean informing the patient that they need a different tooth smoothed down. I mean really getting the patient to understand that, most likely, the tooth that needs to be “ground down” is ultimately the villain or the cause of the other tooth. Let me explain further.
When a tooth breaks or is cracked, a dentist must look for the reason. Many times it is simply that the patient bite on something harder than the tooth and the tooth broke. But frequently, the reason the tooth broke is because the opposing tooth is stronger and has a very pointy chisel-like cusp that exerts too much point contact pressure. Think of the chisel-like cusp as a log splitter. It is hitting the tooth hundreds a time per day and eventually a small crack develops and increases until the tooth either breaks or hurts to chew on it.
In those situations, a dentist MUST smooth the opposing tooth or the new crown/filling will be under the same stress and will break just like the natural tooth. So the easiest solution is to smooth the offending cusp and recreate a situation where the new crown will be under normal biting forces.

Please remember, nothing in the mouth happens without a reason. If a tooth hurts, is rotated, has red gums and or a myriad of other problems, something is causing the issue. Our job as dentist is to figure out the cause and remediate it as best we can so the patient can function normally.

Please Call SMILE SOLUTIONS BY EMMI DENTAL ASSOCIATES 302-999-8113

My tooth was extracted, should I get a bridge or a crown?

 

Every day I discuss the option to fill a space. And if a tooth is on either side of the space, you have basically 4 options.

  1. Do nothing. It may not look good and it will eventually allow your bite and teeth to shift but this is an option that must be presented to you.
  2. Do an Implant to fill the space
  3. Get a partial denture to fill the space
  4. Or get a dental bridge to fill the space.

 

Each of these options should be explained to you in detail before you make a decision. It’s called informed consent.

Let me briefly describe each for you. Although leaving a space may not be good for your function or esthetics, there may be times you need to wait to fill the space. You may not be able to afford the other options or you just need time to think about it. Almost always you will do NO lasting damage to your teeth or mouth if you wait to fill a space. You have some time. Don’t be pressured to fill gap unless you want too.

The implant is the closest we can give you to replace a tooth with another tooth. However, there needs to be a few things in order to get the ideal implant. You need good bone, systemic health aids in healing, nonsmokers are much better candidates for implants then smokers. Plus we don’t have to drill down teeth on either side of the space. But it is usually more costly and takes longer to complete.

A partial denture is a time tested restoration. It may not be ideal but it is many times a good financial compromise because we can fill many teeth spaces with a single denture. It will take time for you to get used to have it in your mouth and it may put excess force on the teeth it is attached too.

And finally, a dental bridge is a fine alternative. This approach works well and last for a decade or two. If the teeth on either side of the space are heavily filled then it fixes them as well as filling the space. If they are virgin teeth then perhaps an implant is needed if you have enough bone.

I briefly discussed each option. For more detail, talk with your dentist to see which treatment fits you best.

 

Call Smile Solutions at 302-999-8113 for further questions.

How many dental visits should it take to get my denture or a crown?

 

We live in a modern world with lots of technology. This technology allows the speed at which we receive information or products to increase exponentially. Most people, like me, are used to getting whatever we are buying fast. And delays seem like an eternity.

We eat fast food, have our cell phone on all the time, we text people versus talking, order on Amazon for next day delivery, order groceries from Acme for home or office delivery. And the list could go on and on. So why would it be any different at the dental office? Well..it’s not. Most people expect fast painless services. They want cleaning to fit neatly in between picking u the kids or lunch times. Any traffic jam throws off their timing and creates stress. My dental office tries to run on time. However, human nature does not always cooperate. That patient that is stuck in a traffic jam makes me alter my schedule which affects other patient I am seeing, excetera excetera.

Why the long introduction to my topic sentence? I am just trying to set the stage for delivery of dental products such as crowns and dentures. The technology has greatly advanced however; there are still human interactions and material limits. So I expect to deliver crowns in two vists and dentures in 3-4 if all goes perfectly. Most times it goes very smoothly. However, occasionally something doesn’t fit perfectly and I want a new impression to correct the flaw. I feel bad because I too expect things to be done perfectly the first time. When that doesn’t happen, everyone may get frustrated.

The point of this blog is counter to our learned behavior of the last decade or so. Most times when a dentist returns a crown to the lab or takes another impression for a denture, it’s too making a better fit which benefits the patient.

So think about the times that it takes longer to get a product that the dentist is trying to give you the very best service and product possible. And eventually you will be happy with the crown or denture. If not, then have a friendly discussion with the course of treatment to get the reason for the delays and not meeting your expectations. I am sure there is a good reason, even if it is not the answer you wanted.

 

As always, call Smile Solutions 302-999-8113 for any questions or concerns.

How do I get a cavity under my crown? How long does a crown last?

I replace crowns many times a month due to decay. I probably get asked how a crown “gets decay” on it about 25% of the time.
This is very reasonable question if you are not familiar with the actual process and design of a crown cemented to a tooth.
First, a crown does not get a cavity. The cavity starts on the root at the crown/tooth junction. That is why you must still floss and brush crowns as good or better then you brush your teeth.
Second, any tooth structure can get decay regardless of your age. I do fillings on 70, 80 and 90 year olds all the time. In fact, as we age, our dexterity decreases so our ability to clean the root decreases therefore decay is a natural result.
Third, as the tooth approaches the gums and it’s diameter decreases. That means that the nerve is closer to the outside surface of the tooth. So, a small cavity may be 6 mm from a nerve on top of a tooth, it may be only 2 mm away from the nerve on the root of a tooth.
The location of the cavity under a crown will dictate the treatment for the tooth. If the cavity is on the outside near the cheeks, it may be able to be patched and not remake the entire crown at this point. If it is in between then the crown and adjacent tooth , the crown should definitely be replaced.
Have your dentist take intra oral photos to show and explain where the decay is located. Don’t forget that it’s better to have weaker teeth and be a fanatical cleaner then to have great teeth that you don’t take care of.

Crowns typically last between 5 and 20 years. Some crows may fail sooner and some may last longer. The longevity of a crown depends on several factors.

  1. How often the patient brushes and flosses well.
  2. How often the patient gets a dental cleaning
  3. How large the microgaps are and the cement used to fixate the crown to the tooth
  4. How much load is applied to the tooth. Grinders and bruxers get less time due to excessive force over long periods of time.
  5. And how much tooth structure remains under crown to hold it in place.

If a patient waits too long before crowning a tooth then more tooth structure will be lost as additional fillings are placed.  Ask your Dentist if they will still have enough tooth structure to crown in the future.

Call Smile Solutions by Emmi dental for more information. 302-999-8113

Why did my dentist miss the decay on my tooth if I come in twice a year?

A patient the other day asked me this question before we were ready to do a couple fillings on him. I get this question in a few different ways. It may come out as, why did your associate not see this last time? Or, I just had x rays last time, was it there then? Or, did this grow in 6 months? Or, if a new patient, I just went to my last dentist and I did not have any cavities!
This is a somewhat complicated situation to explain in fewer than 175 words. However, I will give you a brief explanation and if you need more detail please email me from my website or talk with your dentist.
First, a cavity can only be seen on an x ray once it has dissolved 20-30 % of the tooth structure so it may not have been obvious last visit. And cavities can grow fast on some patients!
Second, some teeth have rotations and mal alignments that cause cavities to be very elusive from standard x-ray positions.
Third, determining when to drill or not to drill is an art and science based on years of experience. It’s not black and white. 10 dental school professors would give 6 different potential cavities based solely on x-rays. Experience counts!
Fourth, honestly, sometimes it could have just been missed. We are not perfect and at times we overlook a cavity. When that happens I just fess up. It’s not negligent, it’s just human. That is why we try to take them every 6 months and both hygienist and Dentist look at x-rays to help the dentist diagnosis suspicious areas.
And lastly, ideally I would like to take 10-14 x-rays every 6 months to make sure I see every inch of a every tooth. However, “your” insurance carrier would not cover that so your out of pocket expense would be much greater. And honestly, most patients would be pissed off. So we try to stay with the 4 back x-rays and 2 front x-rays twice a year because that is all that is allowed. I hate to say it’s the game we all play but realistically, most people accept what an insurance company allows.
For more information please call 302-999-8113 or go to my website, DrEmmi.com

Why does my tooth hurt after my crown? It never hurt before.

You can replace the “crown” with any procedure that a dentist may perform. It seems perfectly logical to ask why it did not hurt before the procedure but it hurts now after…

I would think the same thing if I were not a dentist.

The first thing to understand is that a tooth is like any other physical mechanical object. It is acted on by forces, extremes in temperatures, bacteria, trauma from biting and chewing. All of these forces and adverse stresses cause breakdown. A tooth has a certain life cycle. It goes through stages. A tooth gets a small filling, then a larger filling, then a crown or root canal, perhaps another crown or root canal, if it can’t withstand the forces then it gets extracted an a dental implant replaces it.

My job as a dentist is extending the tooth’s life cycle for as long as you need it. Your job is to clean it as often as possible to maintain its health.

A tooth is never as strong or as good once it has been restored in any fashion. Every filling wears down. Each time a tooth gets a cavity, the nerve is stressed. Each time the tooth is drilled on it stresses the nerve. Each nerve and each person’s tolerance is different. Sometimes a simple filling cause enough trauma that the tooth becomes extremely sensitive.

So in an ideal world, anytime that a tooth has a large cavity or filling that is breaking down from the excessive load, a root canal could be done prior to any crown. That would be ideal dentistry in many situations. However, the reality is that a root canal could double the cost of the procedure. So many times, we as dentists, try to walk the thin line of attempting to restore the tooth that doesn’t hurt without a root canal. Sometimes it works and sometimes it still needs additional treatment.

 

The moral of the story is that a tooth that needs a crown has probably been filled with a large filling that has recurrent decay which is due to marginal separation from excessive load on the tooth. That tooth is not a great tooth, even though it doesn’t hurt you! And  a “not great teeth most often eventually need a root canal” regardless of the timing.

If you need further clarification please call for a free consultation with Dr. Emmi 302-999-8113.

 

Why do I need a crown?

Our job as dentists is to extend the function of your dentition beyond the time you need the use of your teeth. That sounds a little extreme but the reality is that I don’t want my patients to have to “gum it” when they get old. So every patient that comes to my office I look at them here and now but also in 5, 10, 20 years from now.

I could easily patch and fill most dental problems. And in the short term my patients would feel like they received a good service. I fixed the problem and I did it “at a lower cost”. However, the issue is not now it’s many years from now. I see teeth problems that should have or could have been dealt with decades ago but instead the tooth was patched instead of fixed.

It is hard to tell a 70 year old that they need to have a set of dentures that most likely will not function nearly as well as their own teeth. The extent of decay or wear is so extensive that restoration is near impossible or if it is restored the long term prognosis is very poor.

So when a patient is dealing with other old age related ailments or infirmities they are forced to have to deal with a partial or full denture. And I know from many years of experience that the level of disappointment related teeth is exaggerated in the later years of life.

So that brings me to the main point of this blog. A good dentist should look at every tooth and try to save it for multiple decades and they will mean to restore it with the most appropriate strongest procedure to ensure continued function. The life cycle of a tooth is a small filling, then a larger filling, then a crown or root canal, then a new crown and eventually a dental implant. I try to slow this gradual progression down as much as possible, so the patient never has to experience an extraction or denture.

A crown will be recommended when the tooth has too much filling already or when the filling cannot sustain the forces placed on that tooth. A crown protects 360 degrees around the tooth so forces can be redistributed more evenly to prevent further breakdown.

What should Dr. Emmi blog about next?



If you need a second opinion please call my office, Smile Solutions 302-999-8813

Should I trust my dentist? Evidence based dentistry.

I don’t get this question asked to me in a direct fashion but I sense it is lurking in the background of patient’s minds. And honestly, it is no different then what people think when they get there car checked or HVAC system checked. I know that I even think to myself, “Do I really need a new HVAC or circuit board in my car”, when I am told that I need to replace an expensive item.

I can’t speak for the mechanics but in dentistry we have what they call “evidence based treatment”.  That is just a fancy way to say that there is a cavity in a tooth and that it needs to be treated in the correct fashion. We have intra oral cameras nowadays so the dental hygienist, dental assistant, or the dentist simply takes a picture of the tooth. Generally speaking, if the image has a big black spot then you have a cavity. If that black spot is under or near a large filling then a crown or root canal may be needed.

The big thing is that there should be dialogue between the dentist and the patient. And most of dentistry is very obvious. If the tooth hurts it needs a root canal, or extraction or some sort of gum or crown work. A picture goes a long way in that explanation process.

The big question is the treatment. Reasonable dentist will differ on treatment options.  The only thing worse than telling a patient they need an expensive root canal or crown is trying to save them money and having the filling break  or fall out prematurely. The patient almost always says “YOUR filling hurts or fell out”. I prefer to solve the problem and not have to address it again for at least a decade.

Lastly, two dentists may differ on treatment options. So if you go to two dentists they may differ in the treatment or even the diagnosis. They both may be reasonable. It is just that dentistry is an art and a science. I mean that it takes experience to anticipate and plan treatment based on hundreds of previous treatments that worked or  that did not work and knowing the reason why each had that particular outcome.

If in doubt, ask for intra oral photos and an explanation. It should sound reasonable. And if another dentist disagrees, show them the black spot on a tooth from the picture and ask them to explain. When all else fails, ask the local dental board or dental society to give their judgement, otherwise you may falsely believe the dentist not doing any treatment only to find out years later you errored in judgement.

 

Please feel free to call my office for a free consultation or second opinion.

Call Dr. Emmi at Smile Solutions 302-999-8113.

 

 

How do I know I really need a filling or have a cavity? Is my Dentist telling me the truth? Who should I believe?

This is a very difficult situation to explain. I see it everyday day in my practice. Patients come to our office and tell me their other dentist told them they have a cavity and need some sort of dental treatment. They ask me if “they really have a cavity”. Their obvious implication is that the other dentist is lying to them for some reason.  How do patients with no dental knowledge beyond feeling pain or seeing a brown spot or a broken tooth know what is going on in their mouth?  You have to get a good dentist with integrity.

It is also a difficult situation when a new patient comes to my office from another dentist that does not fully explain the long term condition of their teeth to them. I am left to gently explain that, although they have no pain, they have extremely large fillings. And all extremely large fillings will fail under constant load. That failure may be marginal leakage leading to decay, that failure may be a chip or cracked tooth, or nerve pain, or some other consequence of a heavily restored tooth.  As their new dentist, I have to tread lightly but be honest and explain the issues they should think about to have the best chance to maintain their teeth for a life time. This may be new information to them.

What should a patient do when one dentist says you have a cavity and another says you do not have a cavity? Obviously this is a confusing situation. Why is there any doubt?  A cavity is a cavity and there should be no difference between two dentists, right? The answer is not always.

Unfortunately, a cavity can be deceptive. It can hide and be obscured by old fillings, location or just not be obvious by eye or xray. Many times I see a small cavity in a tooth that I think will be small and find after drilling that it is much much bigger than originally thought. So, if we would have “watched” that small cavity it could have turned into a large cavity requiring a crown or a root canal. The previous situation is also a challenge for me and other dentists. What if I want to be “conservative” and not do small cavities and that cavity turns into a major expensive restoration? How do I answer the patient when they ask me, “why didn’t you see and fill that cavity before it got big. It’s hard to explain that I wanted to make sure it was the not too small but not too big either.

In summary, I believe most dentist are trustworthy and try to do the right thing for their patients. Fortunately, today we have many different technologies to help us diagnosis decay. If you get contradictory opinions ask for an explanation why they think it is decay; ask for an xray or inta oral photograph for evidence. If you see a brown spot then most likely you have at least a small cavity. And finally, infrequently a patient goes to their old dentist “that they had since they were 4 years old” or another dentist and he or she says that “that you do not have a cavity”. That dentist may be inaccurate. It’s sort of reinforcing to have them say you are “fine” if you “want” to be cavity free. However, the only true way when you have a true difference of opinion is to go to a State Dental Society or State Dental Board and ask them what “would a reasonable dentist do in this situation”.

Please call SMILE SOLUTIONS 302-999-8113 for a free second opinion. Ask for Dr. Emmi

Why do I need so many dental x-rays?

I get asked everyday ” why do I need dental x-rays”. I tell the patient that “it is the only way I can see between the teeth”.  Dental decay can be the fastest growing oral pathology.

What needs to occur in your mouth to get a cavity? To get a cavity you need three things:

  1. You need to have bacteria in your mouth. All people have some bacteria in the mouth. All of us need a balance of the good and bad bacteria so our oral cavity functions well. Too little bacteria and we will get an over growth of yeast. So a healthy mouth needs some bacteria.
  2. The bacteria need a food source. The bacteria can digest most of the foods we eat. So anything other than water eventually allows bacteria to digest then secret acid as the byproduct of their digestion which causes dental decay.
  3. The last thing that is needed for dental decay is time. I mean that if bacteria have enough time they will digest the food source then excrete acids which can start the decay process.

As you can see, we all have bacteria, we all need to eat and if left alone this will lead to tooth decay. We can’t control the bacteria or the need to eat. We can control the time that the bacteria is digesting the food. So ideally, every time we eat we should brush, floss and rinse to stop the decay process. Some people are lucky and have less aggressive dental decay bacteria and can neglect the cleaning process and still not get decay. They are the lucky ones. However, as in life , not everyone is that lucky.

Our job as dentists, Hygienist and staff is to try to look for the small decay and remove so that they don’t turn into large problems which could lead to tooth loss. We need x-rays to complete that mission. The radiation absorbed by dental x-rays is minimum and less if wearing a lead shield. The amount of radiation is less then we get by walking outside for any extended time and much less then flying cross country or sun tanning.

In summary, unless you brush and floss after each time anything other than water gets into your mouth, you should have x-rays to look for decay. And remember that serial x-rays gives us the ability to tract if the decay process is progressing into a situation needed to address. I will discuss the actual technical process of taking, reading and interpreting dental x-rays in a later blog. The reality is that a slight angulation change can obscure the view so serial x-rays help expose past decay process hidden by normal variations in dental x-ray taking process.

 

In you have any concerns or questions please call my office. Smile Solutions 302-999-8113