We received the following question from a reader:
It has been 6 weeks now since I had my crown put on. For the 1st 2 weeks it was sensitive but after 1 month it still was hurting when i chew. I went back to my dentist 2 weeks ago and she ground down to adjust the crown and tested it the cold really hurts. Now its 6 weeks and I still can’t chew down on it. My dentist says she can’t take the crown off.
What can I do?
These are literally the classic signs that your crown is “too high”. And yes, the dentist can take it off, actually it is her responsibility to take it off and re-fabricate, if need be, a crown that fits your tooth properly.
Sensitivity after Dental Crown
Slight cold sensitivity or a minor toothache after having a crown done is quite normal. The process of preparing your tooth for the crown typically generates a moderate amount of heat and friction on the tooth and usually requires a few days for everything to return to normal. However, if the pain lasts well past a week, this usually indicates something else could be going on.
A Dentist Must Reproduce your Tooth as Best as Possible
Your teeth come together when you bite in a very specific, particular way. All the grooves, valleys, and cusps on your teeth fit the opposing tooth EXACTLY, to create a perfect bite and chewing surface. Believe it or not, there is a complete study of how your teeth come together, labeled occlusion, and dentists study this subject matter intensively in dental school, and continuing education.
When dentists place a crown, they take an imprint of your mouth, called impression, usually with you biting, in order to capture the detailed anatomy around the tooth. This is then sent to a lab, or fabricated in office, to create a crown that is perfect for the space.
Signs that a Filling or Crown are Too High
Sometimes a crown doesn’t fit your bite exactly. Actually this is more common than you think. If the anatomy of a crown is off by even a miniscule amount, YOU WILL NOTICE, and your body will notice.
If a crown or filling is too high, it aggravates the ligament, known as the periodontal ligament, which holds the tooth in the socket (Notice picture on right). When this ligament is aggravated, you could experience some of the following symptoms.
- Sensitivity to cold
- Pain on biting
- General sensitivity
Know Your Rights as a Dental Patient
When this occurs, a patient generally returns to the dental office to have the crown adjusted. The dentist will have you bite on paper, called articulation paper, to see which areas need to be adjusted. Usually after a couple of adjustments, everything should return to normal.
However, if after having a few adjustments the pain still exists, then the crown needs to be removed, and the dentist should place you in a temporary crown in order to observe the symptoms for a week or so. When you’re symptoms resolve, the dentist should then fabricate a new crown and place it permanently.
DO NOT let a dentist tell you this cannot be done. It is the dentist’s responsibility and role to create a good fitting and comfortable crown. Know your rights and demand to be treated fairly.
Save My Smile Team
Do you have a dental question of your own? Feel free to submit it here to our dentist-on-call.
We received the following question from one of our readers:
Can an implant,under general anesthesia, be placed if I am pregnant? Thanks for your time.
We DO NOT recommend this at all, and most dentists will not perform this procedure on a pregnant woman, especially under general anesthesia.
Type of Approved Dental Work During Pregnancy
During pregnancy, the only type of dental work that is recommended is preventive. This includes the following
- Dental exams
- Non-invasive dental cleanings
- Palliative treatments, including fillings, crowns, and possibly root canals and extractions, but only if in pain and if infection is present.
If you do not have pain or infection present, it’s best to wait after the pregnancy before having any serious dental work performed.
When to have Dental Work Performed when Pregnant
If dental work must be done, the safest time to have any procedure is during this second trimester.
Anesthesia During Pregnancy
Local anesthesia is acceptable during pregnancy in order to “numb” your gums, teeth, or other tissues in the mouth, however certain anesthetics used, such as lidocaine, cross the placenta after administration and must be administered in minimal amounts. Again, if possible, just don’t take the risk and postpone any dental work until after pregnancy.
Nitrous Oxide is NOT acceptable during pregnancy.
General Anesthesia is NOT acceptable during pregnancy as studies have revealed risks to the fetus while you are unconscious.
Dental X-Rays During Pregnancy
It is not recommended to have any type of dental xrays taken during pregnancy is not needed, this includes panaromic xrays, bitewings, and periapical xrays. This will not prevent the dentist from performing a physical examination if needed.
During pregnancy, as hormones fluctuate constantly, a condition labeled pregnancy gingivitis is fairly commonplace. This involves the gum tissues becoming red, inflamed, and bleeding easily while pregnant. Regular visits to the dentist to receive a dental cleaning will ensure no type of buildup under the gums. Fortunately, this condition usually resolves on its own after pregnancy.
All in all, to answer the particular question asked, we do not recommend having an implant placed while pregnant. The procedure itself is invasive and introduces a foreign object into your gum tissues, meaning your body can react in a number of ways. It’s just not worth the risk. If you are replacing a front tooth, we would recommend to have a flipper or temporary placeholder made so that your smile isn’t compromised. If it’s a back tooth, it’s best to just wait it out.
Good luck with your decision,
Save My Smile Team
We recently received a question from a reader that read the following:
I noticed that I have a white ”spot” on my front tooth, its kinda small but I still noticed it.
What is it?
A white spot or several white spots on your teeth, particularly front teeth, can come from several sources including fluorosis, signs of a very early cavity, or an acidic diet. Essentially, the determination is whether the white spot has been there all along, or if it just appeared.
Early Cavity / Decalcification
If the white spot recently appeared, this could be signs of a very early cavity if the spot is located near the gum line, or near the adjacent tooth. The first stage in cavity formation is decalcification of the enamel. This means that plaque was somehow allowed to stay on the tooth for an extended amount of time. The acidic reactants released from the plaque causes the enamel to begin the process of decalcification as a means for the bacteria to penetrate the tooth structure. But no worries, just begin to take really good care of that area and it should remineralize on its own. However, in order to fully regain color, you make have to undertake whitening your teeth.
Braces and Decalcification
Sometimes, after individuals have completed orthodontic treatment and have his/her braces removed, they may notice white spots or circles on their teeth around where the bracket was located. As mentioned above, this indicates that plaque was not adequately removed and was able to penetrate the enamel in these areas. In other words, you didn’t brush and clean around the braces well enough to keep your teeth all the way clean.
Having an acidic diet can cause white spots on teeth as well. Just try to keep a well-balanced diet. If you do drink soda or consume other acidic foods frequently, like citrus fruits, just be sure to swish around with water afterwards to keep your mouth neutral.
Now, if the white spot has been there your entire life, then this means fluorosis. This means that as a child, while your adult teeth were developing, you consumed an excessive amount of fluoride, and your body’s cells incorporated that fluoride into your teeth. If that’s the case, it means this area is MORE resistant to decay than other areas of the tooth.
How to Reduce appearance of the white spot on your tooth
Just stay hydrated, consume plenty of fluids, keep the area clean and it should naturally reduce its appearance over time.
Whitening your teeth can also help reduce the appearance of the spot as the other areas will blend more nicely once whitened.
Save My Smile Team
We received the following question from one of your readers:
My tooth started hurting. Then my dad found out my tooth was crooked. Was it because my bite plate or my retainer? Is that what my retainer was supposed to do?
The Facts about Wearing a Retainer
Wearing braces or having a dentist shift around your teeth is a life-long commitment. What this means is that even when the braces are off, it’s up to you to continue to wear your retainer to ensure that your teeth do not shift back into their original place.
The purpose of a retainer
A retainer is a device that uses wires or acrylic to wrap around your teeth to ensure your teeth do not move, or if they have slightly moved, it will slowly push them back into their proper space.
Teeth continuously move throughout life. This is due to forces from various places including your tongue, lips, and cheek muscles.
Imagine this, let’s picture a fence post in the ground. If that fence post is exposed to strong winds, rain, and snow everyday continuously, eventually it won’t be as sturdy as it was when it was first placed.
Your teeth endure various pressures and forces during the day and even when you sleep at night. The forces are ultimately what determine the position your teeth “settle into” in your mouth. If this has been actively interrupted with braces or other dental work, then force is needed to make sure your teeth stay in the new position.
What happens when teeth shift from not wearing a retainer
If a couple of your teeth shift from not actively wearing your retainer, as in this particular situation, nothing major is expected to happen.
The pain that the reader above experienced is rare. This pain originates from abnormal biting forces/pressure. If a tooth endures more pressure than normal, overtime pain will develop. This can easily be solved by either wearing your retainer or visiting the dentist to have the tooth adjusted. This pain is similar to if you received a dental filling that is “too high” and needs to be adjusted by the dentist.
In conclusion, discuss the commitment needed for braces and after braces care with your dentist or orthodontist to ensure you take the right steps to keep your teeth healthy.
If you have a question, feel free to submit one here.
Save My Smile Team
I noticed recently that my two bottom teeth at the front have a gap, like my gum has worn away. And my gum is very sensitive. Not painful, I can just feel it when I touch it. My teeth are clean, and I use a mouthwash. It’s making me panic that my teeth are going to fall out, as I have googled it! Maybe not a wise idea. Is there anything I can do? It’s a very dark gap n food does get stuck there. Please help x
Thanks for submitting your question. Good news is that there is definitely no need for panic! It’s frightening when your front teeth are involved, but based off of your information provided, it sounds as if it’s probably nothing major.
Now, there are a few things that can help us guide you to the correct answer/solution for your problem.
Are your teeth mobile?
If you can push your teeth with your tongue or a finger, then it may be a sign of periodontal disease. We wrote up an involved article concerning perio here.
Teeth continuously shift and move throughout life
However, if your teeth are not mobile, more than likely your teeth just shifted somewhat. Our teeth constantly move throughout life. They respond to pressure from your tongue, from your cheek/mouth muscles, and various other forces. As we age, noticing a gap here and there that wasn’t present before is completely normal.
If you’ve noticed that your gum tissue has worn away, more than likely it can be the result of aggressive tooth brushing, especially since you said your teeth are “clean”. Remember to only use a soft bristle toothbrush and light strokes. This will also explain why your gums are sensitive only in that one area. Definitely, make sure your brushing the correct way.
Stain between gap
And to address your last concern, you stated that the “gap is dark”. Surprisingly, the most common area where teeth capture stain is the backs of your front (both upper and lower) teeth. If the gap recently opened up, stain from the backside and in between the teeth have become more visible.
The only way to remove surface stain from your teeth is to get a professional cleaning.
Hope this helps and keep us posted!
Save My Smile Team
Yesterday we received this letter from a reader concerning the changes her teeth are going through while using the Invisalign system:
Hello, I am currently going through the Invisalign process. It’s been about 7 months since I’ve been doing this but just about the week before thanksgiving I woke up one morning and noticed one of my main two teeth on the bottom is shorter than the other I’m not sure exactly what happened. But I told my orthodontist and all she said was its going to come back out but I don’t think so. It really bothers me because I feel like everyone can notice it and its hurting my confidence because I don’t want to smile. What can I do to fix it? Or make it be the size of my regular teeth again or come out?
Let’s start by talking about the Invisalign process as a whole.
The Invisalign Process
The Invisalign process involves a series of clear custom fitted trays, or aligners, that slowly move your teeth into an ideal position.
How does this work? Each tray is slightly different, so every 2 weeks, you wear a new tray, and your teeth are shifted to where you and your dentist want them to be. Oh…and by the way, you have to wear the trays 22 hours out of the day. Good news is most simple cases last under a year!
Like with wearing braces, your teeth go through many changes as they are moved around. In this particular situation, your tooth may appear short at the moment, but eventually it will come back into alignment, believe us, don’t worry!
Watch your Invisalign video
At the beginning of your treatment, your dentist should have emailed you a video of how your teeth are going to move with each tray. Fast forward the video to where you are now in your treatment (which should be aligner #4) and look at your teeth in the video. Does your tooth look short in the video? If so then you are right on track.
If your dentist did not give you a video, simply call the office. They will very easily email it to you. Each Invisalign case has a custom video so the patient, you, can make sure your treatment is right on schedule.
Short-Term Solution to Invisalign Changes
However, if you want a temporary solution for making your tooth look longer, the dentist can place tooth colored material, known as composite material, into your invisalign tray. This will give the appearance that your tooth is longer while you are wearing the trays.
We do this all the time for our patients who have a space and will like it to be filled in while wearing their trays. Very easy to do and it doesn’t mess with your treatment time.
Good luck with your treatment and leave us a comment below to keep us update!
Save My Smile Team
“I have a toothache and my tongue hurts in the same spot as the tooth. What is causing this and is there anything I can do at home to treat it.”
Causes of Tooth Pain
There are several causes of tooth pain. The more common causes include:
- Tooth decay/cavity: this can cause an inflammation of the pulp, thus causing pain
- Enamel loss due to abrasion: some tooth structure may be lost due to brushing too hard or grinding your teeth for example, exposing dentin and causing tooth pain
- Pulpitis: this is an inflammation of the pulp, and is a common cause of tooth pain.
- Periodontal disease: the periodontium is the collective structure that surrounds and holds teeth in the bone. When this is affected by bacteria, etc, teeth may be exposed because of gum recession and bone loss, and may be painful.
Causes of Tongue Pain
- Pain from teeth: pain from teeth, especially from an infected tooth, may cause tooth pain (this kind of pain is called referred pain)
- Anemia: insufficient iron or B vitamins in the diet can cause the tongue to become red and ‘bald’, where the small bumps (papillae) on the surface of the tongue may be lost, and may be painful.
- Cancer: many forms of cancer manifest in the oral cavity, and the tongue is often affected.
- Heavy smoking: one of the less known side effects is tongue pain (or sometimes numbness).
Proper dental hygiene
Regular brushing and daily flossing are always encouraged as ways to prevent many of the causes of tooth pain. It’s always best however to consult with a dentist for a comprehensive evaluation and treatment, as the causes for each individual vary. The doctor will be able to evaluate your history, take dental radiographs (dental x-rays), etc. The cause of your pain may most likely be an infected tooth, but we encourage you to see a dentist to have it taken care of. Good luck to you!
“About six months ago I went to the dentist and he did some kind of drilling. He put a [filling] behind my tooth in the front row on the bottom. After getting the drilling done, I couldn’t eat or drink anything! It hurt so bad. A month later the pain was basically gone. It’s starting to come back again. But even worse[than before]. I don’t want to go through anything painful, (filling, etc,.) The tooth mostly hurts on the top and whenever I drink cold milk or hot coffee. Or eat something hot or cold. I am totally scared of the dentist. I have got a filling before, they numbed me and stuff, but it still hurt! I DON’T WANT TO GET ANOTHER ONE HELP ME!”
There are several reasons why dental drilling may be necessary. These include:
- Dental drilling to remove decay and then place a filling in that area
- Dental drilling to prepare a tooth or teeth for a cap (crown)
- Dental drilling to clean and fill the pulp if a tooth needs root canal therapy
The description you gave sounds like you received a front tooth filling. Sensitivity to cold sometimes indicates the beginning of tooth decay. There are two areas of a tooth that a dentist may have to go through when doing dental drilling, in order to treat your front tooth cavity. These are enamel (which is the outside area, what you see when you look at your teeth) and dentin (which is directly below the enamel). Dentin has holes in it and fluid which when disturbed carries pain sensations to the pulp (the center of the tooth that has nerves and blood vessels).
Reasons that you may have a tooth sensitive to cold include:
- A tooth with a cavity/decay. Decay that may go deep into dentin and be the cause of a tooth sensitive to cold
- Filling is close to the pulp. A filling that is placed in the area where the decay has been removed, if the decay was deep. This sometimes results in a tooth that is sensitive to cold, and may be prevented by placing a dental liner over the dentin before filling the tooth.
From the details of your question, your tooth pain that occurred after your filling may have been due to the fact that your front tooth cavity was deep and close to the pulp.
What is a Solution to Pain After a Filling?
Tooth pain after a filling is not at all uncommon, however prolonged pain may be an indication that a liner may have helped. A dental liner is a thin layer of material that a dentist places under the filling so that your tooth won’t be sensitive to temperature. It insulates the nerve of the tooth and protects it. It would be a good idea to get a new radiograph (x-ray) of the tooth to see if there are other issues, and have it addressed from there on. Your dentist may choose to either re-do the filling, or if the decay is deep, perform a root canal.
Remember, don’t allow your dental fear to stop you from taking care of your oral health. No dental treatment should be painful. If you feel any pain during a procedure, don’t hesitate to let your dentist know that you need more anesthesia. We hope this helps you!
“I have a tooth where i would like to save the portion not damaged by bacteria. i am only being presented an option of root canal. can i opt to have a pulpotomy — usually this is only for <16.
I would like to preserve my radicular pulp/ dentin. (not symptomatic)”
Pulpotomies are oftentimes performed on primary teeth, or in emergency situations on adult teeth to alleviate extreme pain. If it is a primary tooth, then we would encourage you to pursue the pulpotomy option. However, if this is a permanent tooth, and you elect to have the pulpotomy, there is a chance that symptoms will return later on (anywhere from 1 week later to 1 year later).
In a situation like yours, it’s best to remove the entire pulp tissue, thoroughly disinfect and sterilize the canals, and fill with a therapeutic material to ensure the bacteria will not return. We encourage you to have a root canal, but in the end, the decision is entirely yours. The article below will detail decay, pulptomies, pulpectomies, and full root canal treatment. We hope this helps you in your decision.
What is Tooth Decay?
Tooth decay (also called caries or cavities), is a very common and preventable oral disease. Basically, it happens when naturally occurring bacteria in the mouth produce acids after interacting with food (especially carbohydrates) left on teeth. This eventually wears away teeth over time if not treated. The type of treatment necessary after bacteria have caused damage to teeth depends on the extent of the decay. These include:
- Dental filling (this involves removing the decay and replacing the lost tooth structure with amalgam or dental composite material).
- If the decay has been long-standing and has compromised an extensive amount of tooth structure, an extraction may be recommended. The missing tooth or teeth may be replaced by a dental implant, dental bridge or removable partial denture as necessary and recommended by a dentist.
- Tooth decay may be extensive enough to cause a dental. A dental abscess is serious enough to warrant immediate treatment.
- If the decay has extended to the pulp, a root canal treatment may be necessary
What is Root Canal Treatment?
After a root canal therapy, a crown (also known as a cap) is usually placed over the tooth to protect it. This is necessary because the canal(s) have been cleaned and filled, and the tooth is more susceptible to fracture (it’s more brittle). The canals formerly contained the blood and nerve supply for the tooth, which nourished and maintained the tooth.
What is a Pulpotomy?
A pulpotomy is a type of root canal treatment procedure that is usually performed on primary teeth. It involves the removal of the tissue from the pulp chamber of tooth. Pulpotomies are necessary if the pulp has been violated, either by decay or a tooth fracture. Pulpotomies are different from the root canal treatment done on permanent (adult) teeth in that only a part of the pulp is removed. A pulpotomy procedure may be recommended for a few reasons, including:
- Pulpotomy in children may prevent unnecessary loss of teeth due to a possible infection (the procedure is therefore preventative).
- Pulpotomies may be recommended to save the tooth, hence the space needed for adult (permanent) teeth to erupt.
- A pulpotomy procedure may give a developing permanent tooth a chance to fully develop, after which a conventional root canal therapy is done. This is called apexogenesis.
The success of the procedure depends on the extent of the decay and the patient’s own immune system.
What is a Pulpectomy?
More often than not, if the aim is to prevent the early loss of baby teeth, all of the pulp may be removed from the tooth. This procedure is called a pulpectomy. A pulpectomy procedure may be recommended in the following instances:
- When a tooth has a deep decay.
- When a tooth is fractured, causing exposure of or damage to the pulp.
- Where there is large dental filling.
Whether or not the tooth is symptomatic is a part of assessment that a dentist uses to diagnose the tooth’s condition. If the tooth is asymptomatic with a large decay extending into the pulp, this may be a necrotic pulp (meaning the pulp tissue is dead). Pulp necrosis is one sign that a tooth will need a root canal treatment.
We hope that this was helpful!
“I have two root canals one on my upper left and the other on my upper right. I have experienced episodes of pain in both since having the procedures done ~5 yrs ago. The most recent episode was a continuous sort of throbbing pain that persisted for three days before I decided to go to my dentist. Each time one of these pain episodes occur my dentist takes x-rays and pokes around but is unable to provide an explanation and prescribes antibiotics. A few days after taking the antibiotics the pain has dulled and goes away. I no longer feel that this is an effective method in dealing with a persistent problem. Antibiotics are discontinuing the pain, antibiotics attack and eliminate bacteria, so bacteria are a likely culprit to causing the pain. Is a pain causing but not so severe bacterial infection able to be seen in an x-ray? Should I request that my dentist remove the crown for a more thorough examination or is episodes of pain treated by antibiotics a part of the territory of living with a root canal? Lastly, am I supposed to even feel anything being that the pulp tissue is removed?”
To specifically address your question, if the problem is alleviated by antibiotics, that’s a sure sign that there is a bacterial re-contamination. This can be caused by a number of reasons that are outlined in our older article, called Failed Root Canal. However, it is not normal for you to be feeling pain 5 years after a root canal. The purpose of a root canal is to completely remove the source of infection, thus removing the source of pain. It sounds like there may have been a missed canal (lateral canal, or a small canal at the apex), or a leaky crown, but the bacteria has found some kind of way to reinvade and re-infect the area. It may be best to visit an Endodontist to have him/her reassess your tooth. The Endodontist specializes in only root canals and has the technology to more closely examine your tooth condition. Below we have detailed information regarding root canals.
What is a Root Canal Treatment?
A root canal treatment (also called root canal therapy) is a procedure that is done in order to attempt to save a tooth, usually after it has become badly decayed or infected. If the affected tooth is not treated, the infection or decay will usually spread to the tissues surrounding the tooth, including the bone.
Does a root canal hurt?
In most cases, the procedure is not painful, though there may be some sensitivity afterwards. Most cases of discomfort are felt if there was pain before the procedure (it goes away as the tooth heals), or if there is any complication such as a missed canal. One of the wonderful things about a root canal treatment is that the source of the pain is removed, the canal(s) thoroughly cleaned and disinfected, and the canals filled to prevent re-invasion of bacteria. Many patients retain their root canal treated teeth for life.
It’s important to note too that in most cases where there is discomfort after, the source is not in the tooth itself but in the periodontal ligament (PDL) surrounding the tooth. The infection in the tooth often spreads to the PDL (and in some cases the bone), which by itself is the cause of much sensitivity and discomfort.
What to do after a root canal
The root canal procedure has a success rate ranging between 68-95%. It is a welcome procedure for patients who have the opportunity to try and save their tooth or teeth. After the procedure is completed, a few things to know and expect:
- If there was tooth pain or an infection before the procedure, you may have some sensitivity for a few days after. This is because the tooth is healing from the tooth inflammation that was present before. Your dentist will most likely prescribe NSAIDs for the pain and inflammation. Antibiotics are used to treat oral bacterial infections, in cases where a tooth or teeth may have developed an infection.
- Avoid chewing on the tooth being treated until a permanent crown is placed. This will help you to avoid damaging or re-contaminating the tooth.
- Ensure that you complete the procedure by having a crown (cap) placed over the tooth. This helps protect the tooth from being exposed again to bacteria, and provides structural support and protection for a tooth that is no longer as strong on its own.
Pain years after root canal
Though not very common, there can be root canal pain years later. Reasons for pain after a root canal procedure include:
- Tooth fracture.
- A failed dental restoration (usually a crown) that has allowed bacteria to invade the tooth, causing a re-infection.
- The material sealed inside the canal(s) break down, allowing bacteria to recontaminate the tooth.
- Missed canal – not all canals were located, cleansed, and sealed during the procedure
Failed root canal
After root canal pain, a dentist will re-examine the tooth including the crown to determine the condition of the tooth and what needs to be done. It is sometimes tricky to isolate the problem, but two common approaches to relieving the recurrence of inflammation and infection include:
- A root canal retreat. Re-treatment is sometimes successful, and involves thoroughly cleaning and refilling the canals.
- Endodontic surgery may be needed in other cases. The most common endodontic surgery used to attempt to treat this is an apicoectomy (also called root-end resection or root resection). Basically, the tip of the root and the infected tissue around the root tip are removed. A small filling may be placed at the root tip to seal the root canal.
In extreme circumstances, the tooth may be non-restorable and will need to be extracted. Comprehensive evaluation is necessary for diagnosis and treatment of each patient’s case. Depending on the extent of the infection, changes are sometimes seen on a dental radiograph (dental x-ray) that indicate the presence of an active infection.
We hope this information was helpful to you!