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Advanced cosmetic and general dentistry

Pain after my white filling is getting worse

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Last October my dentist placed a filling in my left front tooth. In January, I returned to the dentist to correct a notch between my tooth that interfered with flossing. The dentist smoothed out the notch. But a few days later, I felt a shock in the tooth while I was eating. In two weeks, I returned to the dentist, and she took an x-ray. She said the tooth is fine but sensitive to the filling, and she advised me to take Advil. My tooth is still sensitive, and the pain is intense. What should I expect to get this resolved – another filling? Or might I need a root canal? This is delaying my teeth whitening treatment that I wanted to complete before my wedding in mid-April. Thank you. Avril from NH

 

Avril,

Your intense pain means that you should see an endodontist—or root canal specialist. Your dentist should be able to test your tooth and look at the x-ray for internal damage, but an endodontist will give you an accurate diagnosis.

Is Intense Pain After a Filling Just Irritation?

Intense pain months after a dental filling is more than just irritation. An irritated tooth improves, even though it may be gradually. Progressive pain that gets worse is a symptom of an infection.

Although your dentist may have done something wrong when placing the filling, it is more likely that decay under the old filling caused bacteria to get into the tooth pulp. Bacteria trapped beneath your new filling will cause a painful infection.

Root Canal Filling on a Front Tooth

Photo of teeth whitening trays in a case, for information on DIY teeth whitening from Lowell, MA dentist Dr. Michael Szarek.

Teeth whitening can irritate unhealthy teeth

Advanced cosmetic dentists understand that when performing a root canal on a front tooth, they must ensure no root canal filling is left inside the crown. Trimming the filling below the tooth attachment prevents the tooth from discoloring and turning dark.

If your dentist is not willing to refer you to an endodontist, check with your dental insurance company to see if self-referral is allowed. Otherwise, you might need to get a second opinion from a cosmetic dentist who can either resolve the issue or give you a referral.

After your tooth pain is resolved, you can begin the teeth whitening process.

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

My new porcelain veneers look old after 5 months

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In September, a well-known cosmetic dentist in a community about 50 miles away placed 8 porcelain veneers on my upper front teeth. I love my new smile because it looks natural and better than my teeth. Last week I noticed that my smile doesn’t look as glossy as when I first got the veneers. It looks like my veneers are beginning to have a matte finish. I’ve tried different toothpaste brands, but it’s not working. I’m afraid that I have done something wrong, although I was trying to be diligent about taking care of my veneers. My workload has increased since Covid, and due to the distance of the cosmetic dentist’s office, I’m unable to see her until mid-February. Can my dentist restore the luster of my veneers? Is there something I should do or avoid at home until my appointment? Thank you. Darren from CT

Darren,

You were fortunate to find a cosmetic dentist who gave you a natural-looking smile. Although Dr. Szarek would need to examine your veneers to determine why they are losing their luster, we’ll review two possible reasons.

Why Might New Porcelain Veneers Lose Their Gloss?

New porcelain veneers might lose their gloss or luster due to dental equipment that damages the glaze or because you received composite veneers instead of porcelain.

Damage to porcelain veneers

Although porcelain is denser than tooth enamel, a potent abrasive can damage the glaze and make your veneers look dull. Toothpaste alone would not make your veneers lose their gloss within five months.

  • Power polishing equipment – A hygienist must be trained to care for porcelain veneers. Otherwise, if they use power polishing equipment (e.g., Prophy Jet) on your veneers, it will blast away the glaze. Your veneers will look dull or look like they have a matte finish.
  • Acidulated fluoride – If a hygienist uses fluoride that contains hydrofluoric acid, it will etch the porcelain. Your veneers will look dull and more easily pick up stains.

Type of veneers you received

Although porcelain veneers are limited in how they can be damaged, composite veneers are not as durable. Composite is softer than tooth structure. Abrasive toothpaste, pumice polishing at the dentist, or alcohol-based mouthwash can cause composite veneers to lose their gloss or luster. If you received composite veneers, they will lose their gloss over time. And if you use the abrasive products mentioned, it will accelerate the loss of luster on composite.

Can Your Dentist Restore the Shine on Your Porcelain Veneers?

Yes, an advanced cosmetic dentist can restore the gloss on your porcelain veneers with these steps:

  • Polish your veneers with diamond polishing instruments and polishing paste
  • Finish with ultra-fine diamond polishing paste

Michael Szarek, DMD, an accredited cosmetic dentist in Lowell, MA, sponsors this post. Dr. Szarek’s office is convenient to Dracut, Pelham, Andover, Wilmington, Burlington, and Windham.

Before-and-after porcelain veneers photos from Massachusetts accredited cosmetic dentist Michael Szarek, DMD

Before-and-after porcelain veneers photos from accredited cosmetic dentist Michael Szarek, DMD

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.

Does Shaving Down Teeth for Porcelain Veneers Cause Sensitivity?

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Some people who experience sensitivity in their teeth wonder if the sensitivity will increase after a dentist shaves down their teeth in preparation for porcelain veneers.

Porcelain Veneers and Tooth Shaving – The Real Concern

Photo of dental forceps holding a single porcelain veneers, from the office of accredited cosmetic dentist Dr. Szarek of Lowell, MA.

A porcelain veneer only covers the front of a tooth

If a dentist has mentioned shaving down your teeth for porcelain veneers—run. Your teeth don’t need to be shaved down to receive porcelain veneers. A veneer only covers the front of a tooth. However, if you are receiving porcelain crowns, your teeth will need to be tapered because a crown completely covers a tooth.

Preparing Teeth for Porcelain Veneers

Most advanced cosmetic dentists will preserve as much tooth structure as possible when you receive porcelain veneers. Your dentist will determine if preparation is needed depending on several factors, including:

  • the type of veneers you are receiving
  • the position of your teeth
  • your smile goals
  • your dentist’s technique

No-prep veneers

If you’re receiving ultra-thin porcelain veneers, your cosmetic dentist might determine that your case does not require preparation of your natural teeth. One example is that if you want your teeth to look larger, thicker, or more pronounced, preparation might not be required.

Minimal-prep veneers

Skilled cosmetic dentists conservatively prepare teeth for porcelain veneers while leaving at least 90% of tooth enamel intact. There are several advantages to ultra-conservative preparation.

  • Comfort – It only removes a small fraction of tooth enamel, which is non-sensitive tooth structure.
  • Bonding – It does not affect the dentin—the layer beneath the enamel. When tooth preparation reaches the dentin, it’s tricky to get the porcelain veneer to stay bonded. And sensitivity can result.
  • Health and appearance – Bonding to enamel instead of dentin provides a seal that keeps bacteria out and prevents microleakage. When bacteria can leak in and affect the dentin, it will cause the veneers to look dark, and infection can occur.

Look for an advanced—preferably accredited—cosmetic dentist to place your veneers. Your dentist will ensure that if preparation is needed, it will be minimal.

Will You Experience Sensitivity?

If your teeth are healthy and you receive no-prep or conservatively prepared veneers, you probably won’t feel any sensitivity after your veneers are placed. Patients who receive more aggressive preparation might temporarily experience mild sensitivity to heat or cold that lasts a few days up to a few weeks.

The dentist you select impacts the extent of preparation of your teeth, sensitivity issues, as well as aesthetics. We recommend that you find a dentist with advanced training in aesthetic dentistry. Look for a nearby accredited cosmetic dentist.

Accredited cosmetic dentist Michael Szarek, DMD of Lowell, MA sponsors this post.

5 Reasons It’s Not Too Late for Dental Implants

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A lot of people think that it’s too late for dental implants if they’ve already been wearing dentures for many years. But what are the facts?

1. Time Doesn’t Matter

It doesn’t matter if you’ve been wearing dentures for ten months, ten years, or longer. You can still be a candidate for dental implants.

2. Delay Can Result in Dentures That You Can’t Wear

Without dental implants to stimulate your jawbone and prevent further shrinkage, over time as your jawbone continues to shrink, it won’t be possible to keep a denture in your mouth. Your dentures will progressively lift, slip around, and fall out. Dental implants can slow down the progression of bone shrinkage and improve your experience with dentures.

3. Bone Grafting Can Help

Although it’s not too late for dental implants, long-term denture wearers usually need bone grafting for several reasons:

  • Jawbone progressively shrinks when all your teeth are missing.
  • Dentures that rest on your gums accelerate bone shrinkage.
  • Grafting builds up the bone and provides support for dental implants.
  • The tissue for bone grafts can come from another part of your body or artificial bone.
Photo of angled dental implants for information on why it's not too late for implants in Lowell, MA

Angled dental implants can eliminate the need for bone grafting

4. Angled Dental Implants Might Be an Option

All-On-4 or All-On-6 implants are placed at angles to increase contact with your bone and decrease the chance of implants becoming displaced due to lack of bone density. The technique eliminates the need to build up the bone with grafting. Your provider will tell you if it is an option for you.

5. The Right Provider Can Help

A general dentist, an oral surgeon, or a periodontist (a specialist in gum health) can perform implant surgery. Carefully select a provider who has the following qualifications:

  • Advanced training in implantology
  • Advanced technology to provide 3-D images of your oral anatomy to ensure optimal placement of the dental implants.
  • A history of dozens of successful cases of placing implants for patients with bone shrinkage

 

It’s not too late for dental implants. We suggest that you schedule consultations with at least two implant dentists. Each dentist should discuss your options and the results you can expect. He or she will answer your questions about this dental procedure.

 

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