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Advanced cosmetic and general dentistry

Never Had a Cavity. How Does a Dentist Fill a Tooth?

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I never had a cavity in my life. Now I have 2! At least that’s what my dentist says. I admit I am a little skeptical because I’ve only had two appointments with this dentist, and I am seriously thinking about getting a second opinion. Dentists’ offices make me a little nervous, so can you tell me the steps of getting a tooth filled? Thanks, Samuel from Omaha

Samuel –

If you are skeptical about whether you have cavities, it is best to get a second opinion.

But if you need fillings, a gentle dentist can make filling a cavity a quick, pain-free process.

How Does a Dentist Fill a Tooth?

Molar teeth with composite fillings

A cosmetic dentist makes composite fillings look natural

A dentist fills a tooth by cleaning it, removing the decay, and cleaning it again. Below are typical steps that a dentist will use for a direct composite filling:

  1. Apply topical anesthetic to the injection site
  2. Numb your tooth and the area around it with a local anesthetic
  3. Your dentist may use a bite block to keep your mouth open. Insert a small rubber dam in your mouth to isolate your tooth. This will prevent your jaw muscles from tiring out while you try to keep your mouth open.
  4. Use a tool (drill, laser, or air abrasion) to remove the decay from your tooth quickly. You will not feel anything because your tooth will be numb. A dental assistant will work with your dentist and use a suctioning device to remove the debris from your mouth.
  5. Use an air/water unit to clean your tooth.
  6. Use a liner to protect the tooth nerve—mainly if the decay is close to a tooth nerve.
  7. Use a blue gel to create tiny holes in the tooth, to which dental composite will bond. Your dentist will remove the gel.
  8. Apply a bonding agent to the tooth and spread a preselected shade of dental composite over it
  9. Shape the composite and harden it with a curing light
  10. Check your bite to ensure the filling is not too high or too low
  11. If your bite (the way your teeth fit together when you bite or chew) is correct, smooth and polish the composite. Otherwise, your dentist will make further adjustments to ensure that your filling aligns with your bite.

Michael Szarek, DMD, an accredited cosmetic dentist in Lowell, Massachusetts, sponsors this post.

Is swallowing ground porcelain crown particles harmful?

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Two weeks ago, my dentist placed a porcelain crown on a top right molar tooth. My bite was off, so my dentist ground down in crown in some places. Neither she nor the dental assistant rinsed my mouth. I felt some sandy particles go down my throat. What else could it be other than porcelain powder? Isn’t porcelain glass? I was upset with myself for not asking them to rinse my mouth. Should I be concerned? Thanks. Amari

Amari,

There aren’t any safety concerns about swallowing porcelain power because porcelain is biocompatible. Although there is some glass in porcelain, it’s not glass. And dental porcelain is made of the following components:

  • Feldspar (a mineral)
  • Silica (sand)
  • Kaolin (clay)
  • Some glass (mostly silica)
  • Coloring agents

When a dentist grinds down a porcelain crown, the sharpness of the glass particles is reduced. And the particles shouldn’t harm your throat or stomach.

A dental crown hovering below an upper front tooth

Although porcelain is biocompatible, your cosmetic dentist should prevent you from swallowing it

Although ground porcelain isn’t a health concern, it’s unpleasant for you. And it’s bad for a dentist to be negligent and allow you to swallow debris or anything else from a dental procedure. Although dental materials are safe for oral use, they are not designed for swallowoing.

Skilled cosmetic dentists—and all conscientious dentists—use high-volume suction to rinse your mouth and remove debris regularly. What’s left in your mouth should be rinsed and spit or suctioned out. Carelessly leaving stuff behind in your mouth is poor service and a good way to lose your confidence in your dentist’s concern for your comfort and oral health.

The good news is that you’ll be okay. You didn’t mention any past negative experiences with your dentist. But if you continue to experience them in the future, you might want to ask yourself if it’s worth it.

Michael Szarek, DMD, an accredited cosmetic dentist in Lowell, MA, sponsors this post.

If a Porcelain Veneer Falls Off, Should It Be Replaced with a Crown?

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Last December, my dentist placed 6 porcelain veneers on my front teeth. Two weeks after my dentist bonded the veneers, one of the incisor veneers fell off and broke while I was eating. The tooth was quite sensitive. My dentist said that he needed to adjust my bite. He shortened the opposite bottom tooth and the porcelain veneer. My dentist applied chemicals to my tooth that hurt so bad because it was already sensitive, despite his claims that the fix would be painless.

Last week, the same veneer fell off while I was eating. I feel the same sensitivity in my tooth. I called my dentist’s office to report the problem, and he returned my call and asked me to schedule an appointment for a porcelain crown because my bite must still be off. My dentist hasn’t looked at my tooth, and he wants me to get a crown. I’m suffering from sensitivity in the tooth, and I’m very skeptical about returning to my dentist. Is it normal for a cosmetic dentist to replace a veneer with a crown that keeps falling off?  – Omar from CT

Omar,

Two things aren’t normal about your situation. Porcelain veneers don’t commonly fall off, and it isn’t reasonable to grind down your tooth to replace the veneer with a dental crown.

Your dentist’s explanation about why your porcelain veneer is falling off doesn’t sound logical—especially since your dentist adjusted your bite, and the veneer fell off again. When a dentist properly bonds a porcelain veneer, it might chip or crack—but not fall off.

Why Do Porcelain Veneers Fall Off?

Improper bonding – Porcelain veneers require skill and proper bonding techniques. A dentist needs post-graduated cosmetic dentistry training to understand which tools and materials are needed for successful bonding. We are skeptical that your dentist has received the proper training to give you a long-lasting smile makeover.

Aggressive tooth preparation – If your dentist aggressively prepared your tooth and removed too much enamel, it would cause sensitivity in your tooth and make it a challenge for the veneer to stay in place.

Switch to an Advanced Cosmetic Dentist

If you take the veneer to an advanced cosmetic dentist—preferably accredited— he or she will ensure your tooth is prepared correctly and bond the veneer back in place. A cosmetic dentist who can save your tooth from a crown and ensure your veneer is secure.

Michael Szarek, DMD, an accredited cosmetic dentist in Lowell, MA, sponsors this post. Dr. Szarek’s office is conveniently located near Dracut, Chelmsford, Tewksbury, Billerica, Westford, Andover, Lawrence, Wilmington, Bedford, and Burlington.
Below are porcelain veneers photos of one of Dr. Szarek’s patients.

How to Resolve It If Your Dentist Grinds Your Crown Down to the Metal

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In the late 1990s, my cosmetic dentist in NJ gave me a beautiful Maryland bridge. It’s held up well even though I grind my teeth at night and rarely wear my night guard. I’m not bragging about going without my night guard – my former dentist’s work is impressive. Even my current dentist in CT admitted it. In mid-April, I had some dental work completed. I couldn’t delay getting two crowns.

In the process of trying to adjust my bite with the new crowns, my current dentist reduced the Maryland bridge tooth. A few days later when I was looking at my teeth in the mirror, I noticed a silver dot showing through that same tooth. I scheduled an appointment for my dentist to look at the tooth, and he said the metal is finally showing through because I don’t wear a nightguard. He covered the dot with composite filling, but the metal is showing again. Could the metal suddenly show through the Maryland bridge tooth, although I didn’t have any problems before? Thank you – Tamar

Tamar,

Your dentist doesn’t want to admit that grinding down the tooth in your Maryland bridge caused the metal to show through. If he admits it, he’s obligated to replace your bridge. It is possible that after he thinned the bridge that your teeth-grinding habit exposed more of the metal. But the evidence suggests that the problem occurred after your dentist adjusted your bite.

When Your Dentist Grinds Your Crown Down to the Metal

Get a second opinion – Many dentists will give you a second opinion at no charge. How will a second opinion help?

  • Ask the dentist if there are signs of grinding on the porcelain where the metal is showing. A dental bur leaves distinct marks on porcelain, and it will be easy for the second-opinion dentist to see the marks.
  • Return to your dentist with the report form the second-opinion dentist. But don’t accuse your dentist of intentionally grinding down the porcelain. It’s a mistake that many dentists have made in the past.

Below is a photograph of three crowns on back molar teeth. The porcelain was adjusted so much that the metal shows through.

Lower molar teeth with metal showing through the crowns

An advanced cosmetic dentist can try to conceal metal showing through a crown or replace the crowns

Will You Need a New Maryland Bridge?

Your dentist bonded composite over the metal, but you didn’t mention if he prepared the surface of the metal first. Without preparation, the composite won’t hold.

Panavia is a dental cement that bonds to metal if a dentist takes these steps:

  • Grind away a little of the metal to allow room for the cement
  • Etch the metal with a micro-etcher, or small sandblaster
  • Prime the metal, coat it with a thin layer of opaque Panavia, and cure it
  • Place the correct shade of composite would over the cement and shaped and polish the composite

There is no guarantee that the composite will adhere to the metal for an extended time. But perhaps an advanced cosmetic dentist can use composite to resolve the issue with metal showing through on your Maryland bridge Schedule an appointment with an accredited cosmetic dentist to discuss your options.

Lowell, MA, accredited cosmetic dentist Dr. Michael Szarek sponsors this post.

Should Your Cosmetic Dentist Use a Crown or Veneer After Root Canal?

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When I received a root canal from my cosmetic dentist in 2018, she wanted to place a porcelain veneer over the toot, but I declined. The tooth is dark now, and I’ve relocated to Burlington, which is 400 miles from my former dentist. My new dentist recommended a crown for the tooth because he said a veneer wouldn’t work anymore. I didn’t realize that he would have to file down the tooth for a crown. I know it’s probably too late, but was my dentist too aggressive in recommending a crown? Elyssa from Burlington, VA

Elyssa,

Dental schools train dentists to restore a tooth with a crown after root canal treatment. Your dentist was likely doing as he was taught. Crowns require shaving your tooth to ensure it fits without negatively affecting your bite.

When Do Cosmetic Dentists Use Crowns After Root Canal?

  • Extensive damage – If a tooth has a lot of its structure missing, dentists place a crown. After root canal treatment, a tooth can become brittle, and the risk of fracture increases. A crown protects the tooth.
  • Back teeth – Daily, back teeth are subject to the pressure of biting, chewing, and grinding food. If a back tooth is severely damaged, broken, or split, a crown will prevent further damage and withstand the forces of biting and chewing. Less pressure is exerted on the front teeth.

Do Front Teeth Need a Crown?

An impact on your front teeth is usually lateral. So front teeth are most likely to snap off at the gumline. A dental crown removes about a millimeter of structure around the entire tooth and can weaken it.

Although most dentists prepare teeth more aggressively, the photo below shows very conservative preparation for a dental crown. The tooth will be stronger and less likely to break.

What About a Porcelain Veneer After Root Canal Treatment?

After root canal treatment, some cosmetic dentists choose to restore a front tooth with a porcelain veneer whenever possible. Only 0.5 mm of the enamel is removed.

Most general dentists don’t place veneers on front teeth after root canal treatment because it requires more skill. The dentist and the laboratory technician must understand how to conceal the darkness of the tooth and make the veneer look natural. Most general dentists like the skill and artistic ability to provide aesthetic results.

The photos below are an example of the amount of tooth structure that dentists with conservative porcelain crown preparation vs. conservative porcelain veneer preparation.

Photo of prepared tooth that was shaved for a dental crown

Dental crown preparation

Photo of a tooth that was conservatively prepared for a porcelain veneer

Porcelain veneer preparation

What Causes Discoloration After Root Canal Treatment?

Rather than darkness from the tooth drying out, root canal filling materials inside the tooth can darken it. Advanced cosmetic dentists prevent premature darkening with the following steps:

  • Clean out the filling materials
  • Place a white fiberglass post into the root
  • Seal the opening with tooth-colored composite

The technique delays discoloration for five or ten years and prevents the need for a veneer until then.

 

Michael Szarek, DMD of Lowell, MA sponsors this post.