Smile Solutions by Emmi Dental
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
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.
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
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
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:
- 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.
- 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.
- 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
I just saw a new patient this morning that found my office by searching for the “Best Dentist in Delaware” on google. She was having a problem with a crown done by another dentist. We took x-rays and spoke with her about her tooth complaint and figured out the cause of the pain.
I sat down with her and explained it wasn’t the other dentist’s crown or work, although she said she felt they were rushed at the other office. It was just the trauma from having the tooth and fillings and other work on it since she was 12 and something I see all the time. We gave her the treatment options and she was very happy with us. She said that I explained her problem in a way she understood and took the time to do it.
So that last statement brings me to the main topic, what is the best dentist? Certainly, all patients want the best dental care that the dentist can provide and at a reasonable price. They want the office staff to be friendly and to have a clean office. Patients want to be treated as a person not as a procedure as we feel sometimes when going to government offices. And lastly, I think that the patient just wants to know the potential cause and potential remedies for their discomfort or pain explained in a understandable way in a friendly manner.
I think my staff at Smile Solutions offers great customer service and are the best staff in Delaware. We provide quality dentistry but do it in a friendly caring manner. The greatest dental care done abruptly or with no bed side manner may relieve the current problem but it doesn’t address the human side of the equation.
Smile Solutions by Emmi dental associates provides focused care on you in a friendly professional manner. Please call our office for a free consultation and we will prove it!
Also look at Delaware Today for Best Dentists in Delaware and you will find us there as well. 🙂
Call 302-999-8113 now for any dental concern you have.
Smile Solutions is a total family dental office. We provide services in all aspects of the dental disciplines that we can do as well as the specialist. We provide all the needs for your family from early child dental services to geriatric care for your parents or yourself. We have the best staff in Delaware in my opinion. They are friendly, courteous, knowledgeable and here to serve your dental needs. Our dentists have been voted bests dentists in Delaware Today several years in a row. We take more than the required continuing dental education courses. Our clinical staff is patient centered and bend over backwards to make your visits pleasant and we submit your dental claims for you. Our clerical staff works behind the scenes just as hard to track and make sure you get the maximum insurance benefits your plan offers. When your insurance company tries to deny rightfully allowed procedures we submit appeals on your behalf to fight for your benefits.
If you don’t get satisfaction at my office for any reason then you just let me know and I will personally investigate and correct the situation on those extremely rare occasions.
I instruct my staff to treat you as they would a loved family member. Call Smile Solutions by Emmi Dental Associates and test us.
The short answer is yes. However, the real question I think that you should ask is do “I” want dentures in a day? I am being somewhat facetious with my last statement so I will try to explain my point.
I would like to lose weight in a day, or get in shape in a day or bench press more in a day. Most things in life that are valuable or worthwhile take more than a day. Now, I can make a set of dentures in a day if certain things happen:
- I need a thorough exam to make sure dentures are what are required to fix the patients’ problem.
- I need to make sure the person has an established bite or vertical dimension that is functional.
- I need to make sure I can capture the bite accurately so the lab can duplicate in the dentures
- I need to take an accurate impression of gums and teeth.
- I need to pour models and send to lab
- The lab needs to mount the case at the proper bite
- The lab needs to remove the stone teeth from model and adjust gum tissue on model.
- The lab needs to set the teeth in the proper three dimensions so the look and function properly.
- The lab the needs to process in a stable material.
- The lab needs to finally adjust the bite after processing to minimize any errors from processing then polish and send to office.
- I need to try in your mouth and make sure all your teeth hit properly
- I need to remove any spots on the denture that rubs your gums too much.
If all these steps are performed well then I can make a set of dentures in a day. If I want to make a set of dentures in a day but these previous steps are not done ideally then I have to accept slight to moderate to major errors leading to poor fit, function or look of the denture in a day.
Some offices can do many of these steps in a day and for a very low price. At times, the price difference may be enough that the patient may have to overlook some irregularities and accept them as a compensation for a quicker delivery of a denture. At times, in my experience, all the stars are aligned and the denture looks very good and the patient got a reduced fee. Life is good on those days!
Please feel free to call my office for a free consultation to discuss dentures or any other topic in dentistry. Call 302-999-8113
Smile Solutions by Emmi dental associates will make every attempt to get you the best denture that you could possible get in our great State. We will go the extra mile to make sure you are satisfied. We first try to listen to your concerns and determine if a denture could meet those concerns. If a denture can be fabricated to meet your needs we will try our best to fulfil your desires.
Our motto is” we strive for perfection but will accept excellence.”
Many dentists do not even make dentures because they can be very subjective. I mean that the patient must like the feel and look even if the dentists would have made them more ideal or different. Sometimes patients want the denture to look perfect white and straight. Sometime patients want the denture to look more natural with slight rotations to replicate natural teeth. I must get in my head what the patient wants so I can instruct the lab to make the denture fit the patients’ needs.
I enjoy doing dentures even though they can be very challenging.
If you need a replacement or a new denture please call to have a free consultation.
Call 302-999-8113 and as for Dr Jeffrey Emmi