EVERYONE DESERVES A HEALTHY,
ATTRACTIVE SMILE

Could a Screw Post Save My Front Tooth Instead of Getting an Implant?

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My right front tooth recently broke at the gumline after a root canal. My dentist placed a temporary crown secured with a metal screw post. While I’m experiencing a constant dull feeling in my nasal cavity, I don’t have any pain. Is the screw post enough to save my tooth and prevent the cost of an implant? – Thank you. Erik from SD

Erik,

While screw posts are generally secure, they can exert significant stress on the root, potentially leading to fractures. The stress on your tooth may cause a dull feeling in your nasal cavity. However, we recommend monitoring the situation and waiting to see if the symptoms worsen.

A dental implant with components labeled - crown, abutment, implant screw

Dental implant

Unfortunately, teeth that break at the gumline are often challenging to restore. The constant forces on front teeth can compromise the stability of the crown and post over time. While it’s worth attempting a crown-and-post restoration, it may not be a long-term solution.

In hindsight, it might have been beneficial for your dentist to place a traditional post in the tooth before it fractured. The post could have provided a more stable foundation for the crown.

If a dental bridge is outside your budget, a removable partial denture (flipper) is more affordable and may be an alternative to a dental implant and crown. Meanwhile, you may consult a periodontist to discuss the advantages of planning for a dental implant and how to make treatment affordable.

Dr. David Pumphrey, an Atlanta periodontist, sponsors this post.

What Are the Best Dental Implant and Crown Brands and Materials?

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I consulted two dentists for ten dental implants on my upper teeth. I have questions about the best materials for dental implants and crowns. Can you tell me about these brands and materials?

A dental implant with components labeled - crown, abutment, implant screw

Dental implants – Astra brand from the UK. Zirconia implant abutments for better aesthetics

Crowns – Cercon smart ceramic zirconium crowns – isn’t zirconium clear? Is it as strong as PFM crowns? White-colored metal fused to porcelain or gold fused to porcelain. My dentist told me those two metals won’t show a black line at my gumline.

Thank you for your answers. – Clive from IL

Clive,

We understand your concerns. Getting natural-looking results with dental implants and crowns for your upper teeth requires much experience and skill from your periodontist and cosmetic dentist.

What Are the Best Dental Implant and Crown Brands and Materials?

The best dental implant and crown brands and materials are those selected by a periodontist and skilled cosmetic dentist based on your needs. Focusing on the dental crown and dental implant brands and materials rather than the dental artist is a mistake. If you want a beautiful smile but plan to micromanage your cosmetic dentist, you may be disappointed in the results.

Here is an example: You hire an artist for paintings in the hallways of a corporation’s office. You dictate to the artist details like these: which paints and brushes to use, lighting while painting and a specific brand of chair to sit in while doing the work. You would be stifling and distracting the artist. The preference is to choose a skilled artist and allow them to use the tools and materials required to get beautiful artwork.

After researching skilled cosmetic dentists, allow him or her to evaluate the condition of your teeth and understand your smile goals. Trust the dental artist to choose brands and crown materials for a healthy, personalized smile. A periodontist is a dental implant specialist qualified to choose quality implants based on your needs.

Additionally, you cannot learn enough about dentistry, the materials, and the mechanics and demands of your case to determine which brand and materials to request. You must evaluate the manufacturer’s claims, know how the materials work, and consult independent research.

Although you may choose dental materials or brands, would your dentist know the techniques required to use them to your advantage?

It isn’t true that porcelain fused to gold or a white metal won’t show a black line at the gumline. All metals used in crowns are white in color or gold. The line at the gumline may be black instead of gray, but it will still show through because it is the cement line. The bonding technique used with pure ceramic can eliminate the black line. Also, some techniques minimize the dark line, such as cutting the metal back at the margin, but they won’t eliminate it.

Zirconium oxide is high-strength and opaque white (not clear) but can produce highly esthetic results if a dental ceramist covers it with translucent ceramic.

Dr. David Pumphrey, an Atlanta periodontist, sponsors this post.

 

Life-Saving Advice About Seeking Toothache Relief

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A 2000-2008 study published in the Journal of Endodontics reported 66 deaths in the United States attributed to tooth infections. This translates to five to ten fatalities per year, highlighting the potential severity of neglecting dental issues and self-care for toothache relief.

Are Antibiotics Enough to Clear a Tooth Infection?

Antibiotics are not enough to clear a tooth infection. The medication targets living bacteria, but the dead tooth pulp is often the source of a tooth infection. Antibiotics cannot reach the infection in a tooth. Relying solely on antibiotics for toothache relief can contribute to antibiotic-resistant bacteria, complicating future treatment of various infections.

A Tragic Tooth Infection Case: Vadim Kondratyuk Anatoliyevich

The story of Vadim Kondratyuk Anatoliyevich is a reminder of the dangers involved. A 26-year-old father, Vadim, suffered from a worsening toothache while on a truck driving trip from California to New York. Despite seeking dental along the way in Oklahoma and receiving antibiotics, his condition escalated. Vadim’s brother arranged a plane trip home for Vadim, but the infection ultimately led to his death. The crucial takeaway from Vadim’s story is understanding the limitations of antibiotics for toothache relief and treating tooth infections.

What Should You Do for a Toothache?

A dental implant with components labeled - crown, abutment, implant screw

Dental implant

If you have a toothache, don’t ignore it, even if it feels mild initially. Do-it-yourself toothache relief is a temporary solution. Meanwhile, the infection will continue to spread. A dentist can perform root canal treatment to save the tooth. Sometimes, extraction is necessary.

Underlying health conditions can make you more vulnerable to infections, so intervention from a dentist is crucial to prevent a tooth infection from spreading. The best toothache remedy is treatment from a dentist.

Although you may lose time or money getting toothache relief or caring for a tooth infection, treating it can be life-saving. If you lose a tooth to infection, your dentist will discuss tooth replacement options based on your oral health and budget. A partial denture, dental bridge, or dental implant is a tooth replacement option. Safeguard your well-being.

Dr. David Pumphrey, an Atlanta periodontist, sponsors this post.

Could I Have a Tooth Cavity without Signs or Symptoms?

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My dentist gave me a diagnosis of a cavity within my right lateral incisor (#7) and a recommendation for a root canal. This surprised me for several reasons. X-rays from my previous dentist last year didn’t indicate any issues with this tooth. The tooth looks normal and has never had any dental work done, including no visible surface cavities. The tooth protrudes slightly at an angle in the front of my mouth, but it doesn’t hurt. Could I have an internal cavity without any outward signs? I haven’t found any clear information online addressing this specific scenario. My dentist referred me to a root canal specialist who shares the same uncommon last name as her I am concerned that I may not need a root canal after all. Thanks. Jerrie

Jerrie,

A dental implant with components labeled - crown, abutment, implant screw

We understand your concern and have a few suggestions and possibilities.

  • Don’t feel obligated to visit the recommended specialist. A second opinion is crucial with a potential conflict of interest and uncertainty about the diagnosis. Consider another specialist or even a general dentist for a fresh perspective.
  • Decay always starts on the surface and burrows inwards. Reaching the pulp triggers infection, necessitating a root canal.
  • Your dentist might be using different terms for a rarer issue called internal resorption when the tooth’s pulp breaks it down from the inside. While the reason for internal resorption remains a mystery, irritation may spark it.
  • Seek a consultation with a different endodontist for a blind second opinion. This unbiased assessment may give you confidence in the diagnosis or help you understand how to

 

Don’t hesitate to ask questions and express your concerns with the specialist until you fully understand the situation and your options. If you need root canal therapy, don’t delay. The procedure can save your tooth, preventing the need for an extraction and dental implant.

Atlanta periodontist Dr. David Pumphrey sponsors this post.

 

Could a Cavity Develop Beneath My Dental Crown?

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I got three upper crowns in early 2020. One of the three crowns has a cavity beneath it. The tooth has been hurting, but I was very surprised when my dentist told me that I had a cavity beneath the crown. I thought the crown was going to protect my teeth from future decay. How could this happen? Will I need a root canal? Will insurance pay for this if I need a new crown, although it is relatively new?  – Tristen from Macon, GA

 

Tristen,

It is unusual to have a cavity beneath a crown after almost four years. A dentist would need to examine your crown and tooth to determine why you have a cavity. But we can provide some basic information about a cavity beneath a crown.

How Can You Have a Cavity Beneath a Crown?

A dental implant with components labeled - crown, abutment, implant screw

Get prompt treatment for a cavity beneath a crown to prevent the need for a root canal or a dental implant if you lose the tooth.

Having a cavity beneath a crown is unusual, but it can occur. What are some possible causes?

  • Tooth infection not removed – If a dentist covers a tooth with a crown without removing decay thoroughly, you might develop a cavity.
  • Gap at the margin – Your dentist must ensure the margin where your tooth and crown meet is closed and smooth. Even a small gap allows bacteria to creep in. Plaque can build up and promote decay.

If you feel pain or discomfort in the tooth, without treatment, you may need a root canal treatment to remove an infection. Without a root canal, the infection will progress, causing tooth loss and more costly treatment for tooth replacement, such as a dental implant.

Check with your insurance company regarding coverage toward replacing the crown. Many insurance plans expect the crown to last at least five years. If replacement is needed sooner than that, the insurance company will ask for documentation from your dentist to determine if they will provide benefits.

Dr. David Pumphrey, an Atlanta periodontist, sponsors this post.

Is My Tooth Dying Beneath the Crown?

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Does this persistent pain in my tooth beneath the crown mean that it’s dying? In early August, I received 3 same-day crowns on my bottom right teeth. When I chew on that side of my mouth, one of the teeth hurts, and I feel nerve pain. I returned to the dentist twice. Each time he shaved the tooth and said that the problem was from the way that I chewed. Before I got the crowns, I did not feel any pain. Why is my dentist blaming this on me? Could the way I chew affect same-day crowns differently than my natural teeth? I am annoyed. Thanks for your help. Myra from SC

 

Myra,

You would need an exam and X-ray for an accurate diagnosis. However, it is unlikely that your sensitivity and pain are because you have a same-day crown. A dentist uses precise CAD/CAM technology, which makes them easier for the dentist to fit.

Why Do Your Same-Day Crowns Hurt?

When your same-day crowns—or any new crowns—hurt when you chew, there are two possible causes.

  • Your bite is too high – If a dental crown is higher than the surrounding teeth, the upper teeth hit it first and harder than the other teeth when you chew. Your tooth will become sensitive.
  • Your tooth is infected – If a tooth is infected, the ligament connecting your tooth and jawbone can become inflamed. When you bit or chew, the tooth is tender and sensitive. Or the inflammation may cause a constant toothache.

Lingering Pain After a Bite Adjustment

A dental implant with components labeled - crown, abutment, implant screw

Dental implant

If your pain and tingling continue despite your dentist adjusting the bite twice, your bite is probably not too high. It is time for your dentist to x-ray your tooth and see if it is infected.

Signs of a tooth can be subtle on an x-ray. If your dentist cannot see an infection, you may need a second opinion from an endodontist (root canal specialist). The pain you describe sounds like you have an infection that needs prompt attention to prevent the condition from worsening and requiring extraction and a dental implant from a periodontist (gum, bone, and implant specialist).

Ask your dentist for a referral to an endodontist. Or, if you can self-refer to a specialist, schedule an appointment promptly.

Dr. David Pumphrey, an Atlanta periodontist, sponsors this post.

Going to Costa Rica for Dental Implants and Have Nothing to Lose

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I’m going to Costa Rica for a dental implant and have nothing to lose. Why pay more after seeing two implant dentists in the U.S. and experiencing dental implant failure twice? I decided to try this out with one implant, and if it works, I return for another. I’m tired of running from implant dentist to periodontist without any success. This drama has been going on for three years. Many American dentists are against dental tourism, but I want to try. I’ve compiled a list of questions for my video consultation. I hope to write again to let you know about my surgery and recovery. I live nowhere near your office, so you can’t convince me to visit your specialist. Thanks. Midge from CO

 

Midge – Dental implants can be more affordable in Costa Rica and other countries than in the U.S. However, you must consider if the savings are worth the commitment and risks. We understand your frustration from dental implant experiences in the U.S., but we encourage caution regardless of your provider’s location.

What to Consider Before Getting Dental Implants Outside of the U.S

A dental implant with components labeled - crown, abutment, implant screw

List questions and schedule consultations before choosing a dental implant provider

Whether you decide to receive dental implants in the U.S. or outside of it, consider the following factors:

  • The education, credentials, and qualifications of the implant surgeon and their team
  • Is your new dental implant team qualified to identify the causes of your previous dental implant failures and resolve them?
  • Will you need bone grafting before getting dental implants? Is the new team skilled in bone graft procedures?
  • The quality of the dental implant fixtures
  • What does the dental practice do to ensure successful implant placement and avoid mistakes?
  • Does the country have strict regulations on dentistry?
  • What is the cost of travel and accommodations?
  • How many follow-up visits require you to return to the country where you received the implants?
  • What would you do if there was a problem with the implants?
  • What would you do if your circumstances changed during treatment and you could not return to Costa Rica for follow-up care?
  • Who will restore your dental implant with a crown?
  • What are your total out-of-pocket expenses?
  • Have you reviewed the Centers for Disease Control and Prevention’s medical tourism guide?

Before choosing a dental implant provider out of the country—or in the U.S.—we recommend thoroughly investigating the provider and its services.

Atlanta periodontist Dr. David Pumphrey sponsors this post.

Why Is My Bite Still Off with a New Crown?

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Is my bite still off? One of my bottom left molars was hurting. My dentist covered it with a crown in August because she said it could be fractured. The tooth feels fine now, but the two teeth in front of it hurt when I bite down, even on food as soft as rice.

I asked my dentist to adjust the crown because I thought it could crowd the two teeth before it. She adjusted the crown, but the teeth still hurt. The pain decreases if I put pressure on the teeth with my fingers, but the pain quickly returns. My dentist said she has never had a patient case like mine. I have two other crowns, and I do not have problems with them. I think that something is still wrong with my bite. What could be causing my tooth pain? Am I going to need an extraction and implant? – Thanks. Jason from Memphis, TN

Jason,

Your description sounds like your bite is still off.

Pain from decay or infection in your teeth will not improve if you push down on them, so decay or infection is not the problem. A poorly placed crown can push your teeth out of alignment and cause pain.

A dental implant with components labeled - crown, abutment, implant screw

A problem with your bite should not require tooth extraction and a dental implant

If your dentist adjusts your bite correctly, you can clench your teeth and put pressure on them without discomfort. Your dentist might need to adjust other teeth, too. She may be hesitant about adjusting your teeth if she only worked on the tooth that has the crown. Sometimes, small shifts in one tooth affect others, and adjusting adjacent teeth is the only way to align your bite correctly.

A misaligned bite can cause a variety of problems, including:

  • TMJ disorder
  • Headaches
  • Neck pain
  • Nighttime teeth grinding
  • Jaw pain

Nothing you have described indicates that you may need an extraction and dental implant. Get a second opinion from a dentist with advanced training in occlusion and bite if your dentist cannot resolve your concerns.

Atlanta periodontist Dr. David Pumphrey sponsors this post.

Will I Need Bone Grafting for Implant Dentures?

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I had never heard of a buccal bone until I told my dentist that I was thinking about getting implants for my denture. My dentist is doing a treatment plan for my dentures and implants. I cannot afford implants right now, so we are doing the work in phases. Although I trust my dentist, I am concerned that he might be adding services that I do not need. My dentist says my buccal bone is thin, and I might need a bone graft before I get implants. Does what my dentist is saying my sense? And how do I know if my buccal bone is thin?

Thank you for your question.

What Is the Buccal Bone?

The buccal bone is a component of the bone structure that contains tooth sockets and supports your teeth.

How Does the Buccal Bone Affect Dental Implant Placement?

You will need enough jawbone volume to support dental implants and stabilize implant denture or hybrid denture. If your buccal bone plate is thin or weak, it will not support dental implants for the long term. Your dentist recommends a bone graft procedure to ensure your implants have enough bone to fuse with and remain stable.

It takes three to four months for a graft to heal before you can receive dental implants. Your dentist will factor that time into your treatment plan.

What If You Refuse a Bone Graft?

If you refuse a bone graft, your dentist or oral surgeon will likely refuse to place dental implants because implants that lack bone volume can loosen or fail. Also, if irritation results in an infection, it threatens your oral health.

How to Know If Your Buccal Plate Is Thin

You can ask your dentist to show you the 3D CT scan of the bone and its thinness. You can send the digital scan to a skilled implant dentist or oral surgeon to examine and give you a second opinion.

 

Atlanta periodontist Dr. David Pumphrey sponsors this post.

Can I Get a Refund for Dental Implant Failure?

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My upper left first premolar cracked last spring, and my dentist couldn’t save it. After four lidocaine injections, my tongue and palate felt like they were burning. My dentist gave me a mouth rinse prescription for the burning. In November, my dentist placed an implant, but it was painful. We waited four months before I got the final crown, and screwing that on hurt, too. Two months later, the implant crown fell off. My mouth has never stopped burning.

My dentist has caused me so much pain that I went to another dentist for a second opinion on the implant. He took an X-ray and said my gums and bone around the implant were infected. The dentist removed the implant and did a bone graft. Now I am waiting for a new implant. I have burning mouth syndrome that won’t ease up regardless of what I do, even with sedation. I probably need some PSTD therapy. This is a nightmare. Can I sue my first dentist or get a refund for dental implant failure, stress, pain, and suffering? I’m not looking for a bunch of money, but the principle matters. I don’t want this to happen to another patient. Thanks. Ahmed

 

Ahmed,

You’ve had some traumatic dental experiences! Your dentist had difficulty numbing your mouth due to your high anxiety level. Burning mouth seems to be associated with traumatic dental experiences. Your dentist’s prescribing a mouth for it is disappointing.

Did Your Dentist’s Procedure Cause Dental Implant Failure?

Dental implant model with separate components, with the implant screw in the bone and abutment and crown above, and the final implant

Precise planning and placement help dental implants fuse with the bone and prevent dental implant failure.

Dental implant failure can have several causes, but improper procedure is not always the case. Many dentists lack enough post-graduate training for dental implants or cannot manage challenging cases. Although you are experiencing burning mouth syndrome and your dental implant crown fell off, those factors don’t automatically mean your dentist was at fault. You would need a second opinion and a CT scan to identify the cause of your dental implant failure.

We hope you are in the hands of an advanced implant dentist or periodontist (gum, jawbone, and dental implant specialist). You didn’t mention whether your dental implant was loose before your new dentist removed it. Hopefully, a dentist would not have removed an implant that was not loose and possibly could have been saved.

If you want to ensure your new dentist’s treatment plan is on track for your oral health, we recommend consulting a periodontist for a third opinion. Based on the second and third opinions,  you may choose to ask for a refund or tell your previous dentist about the findings if they point to the dentist’s negligence or a mistake.

 

Atlanta periodontist Dr. David Pumphrey sponsors this post.

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