Smile Solutions by Emmi Dental

I’m scared to go to my dentist office? Is it safe to go to my dental office? Is it Corona V safe?

The coronavirus pandemic of 2020 has certainly caused many issues with anxiety and fear of going about our normal lives. The changes that we have had to endure so we don’t get infected are monumental. I believe that all our future interactions will be seen through the lens of being wary of getting infected, at least in the short term.

The good news is that the dental office went through this same fear which led to universal safety precautions during the AIDS virus scare. Our training is such that we assume everyone is infected therefore we are completely protected which serves to protect the patients as well. Our dental license in Delaware requires OSHA training before each renewal.
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“The Dentist ground down my good tooth!”

I hear this from my patients 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.
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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 the gap unless you want to.
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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, 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.
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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 a 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 than 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 its 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.
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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 of 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!
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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 a root canal, if it can’t withstand the forces then it gets extracted and a dental implant replaces it.

My job as a dentist is to extend 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.
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Why do I need a crown?

Our job as dentists is to extend the functionality 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 to teeth is exaggerated in the later years of life.
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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 patients’ minds. And honestly, it is no different than what people think when they get their 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 intraoral cameras nowadays so the dental hygienist, dental assistant, or 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 a dialogue between the dentist and the patient. And most of dentistry is very obvious. If the tooth hurts it needs a root canal, 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 dentists 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.
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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 lifetime. 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.
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