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Dentist or Oral Surgeon?

I’m going to honest and just admit I avoid the dentist. I had a filling fall out. I avoided the dentist. Then I needed a root canal treatment. I did get that, but it was rather traumatic. So, I didn’t go back for the crown. Now my tooth was hurting so badly that I had to go to a dentist again. Though I did go to a different dentist. He told me the tooth is too far gone and needs to be removed. However, he said it’s extensive enough that I may consider an oral surgeon because he’d have to cut through both gum and bone. I like the idea of it not costing as much going to the local dentist, but wonder if it’s not safe and that’s why he mentioned an oral surgeon.

Patty

Dear Patty,

Someone asleep from dental sedation

I hate it when dentists say stuff like this. It makes patients uneasy. They wonder if they’re being unsafe choosing the more financially feasible option for them. I don’t know if your dentist phrased it that way because he’s uncomfortable with the procedure and he was trying to steer you another direction or if he’s perfectly comfortable doing it and just giving you non-opinioned options.

I’d ask your dentist a few questions before making a decision:

  • How comfortable does he feel with the procedure?
  • Has he done this type of extraction before?
  • What type of sedation does he offer?
  • What are the roots like? Straight and tapered or twisted with knobs?

The Importance of a Sedation Dentist for You

Based on what you’ve described of your oral hygiene habits, you have dental anxiety. It’s not uncommon. However, it wreaks havoc on your oral health, as you’ve discovered. If you were comfortable going to the dentist when your filling first came out, you wouldn’t be facing this difficult extraction and then facing pricey tooth replacement options.

Dental Sedation will change your life. However, at your level of anxiety (and especially for your extraction procedure), you will need something stronger than just nitrous oxide. You will need oral conscious sedation. This is strong enough to allow you to sleep through the procedure.

You will be able to have stress-free dental appointments from now on and even get all your teeth back in shape.

This blog is brought to you by Dr. Matt Roper.

Can’t Afford Pediatric Dentist; Are General Dentists Cheaper?

There are two pediatric clinics in our area. One has a great reputation but is expensive. The other is cheaper and where all the low-income families go (we’re low-income ourselves), but has a horrible reputation and I don’t know a child who likes it. I don’t want to send my son there. Would a general dentist be less expensive? Do they take children?

Bea C.

Dear Bea,

Four Smiling Children
Finding Affordable Pediatric Dental Care

We want the absolute best for our children. Few things are more discouraging than when we can’t afford it. However, being low-income doesn’t mean you can’t find affordable dental care, even pediatric care. Let me answer your two questions separately.

Are General Dentists More Affordable than Pediatric Dentists?

It depends. Each dentist determines his or her price independently. You may have some specialists which are significantly more expensive than your average general dentist. At the same time, you could have some who want to keep their prices down so affordable specialty care is available.

As you don’t have many options when it comes to pediatric care in your area, you have a couple of options. You may want to talk to the good pediatric clinic to see if they have affordable payment plans. Even if they don’t have in-office plans (like Dr. Roper does), many are willing to work with Care Credit, which is a medical card that offers low and even no-interest payment plans.

Do General Dentists See Children?

Again, it depends on the dentist. There are general dentists who enjoy working with children. They’re qualified to treat them and even had to do a pediatric rotation during their training. If ever something came up that required more of a specialist, they could give you a referral.

I’d start by talking to your dentist. It’s always convenient for the whole family to attend the same clinic together. There’s a medical advantage as well. The dentist will have a fuller picture of what your child’s genetic leanings will be when it comes to oral health.

If mom and dad are prone to decay even with good oral care, the dentist will know to keep a closer eye on the children’s teeth, which tend change quickly so they don’t end up with sudden large decay which could have been dealt with sooner.

This blog is brought to you by Dr. Matt Roper.

Will an Emergency Dentist Bill a Venue for Me?

I’m in a bind. I’m a college student who grew up in a group home. Once I turned 18 I’ve been pretty much on my own. I went on a date where we went dancing. They had a platform which we were dancing on along with a bunch of other people. Apparently too many people because it collapsed. Outside of a few bruises and realizing my date cared more about his well-being than mine, I thought I was okay. But, this morning my front teeth feel loose. I don’t have a ton of money but I don’t want to lose my teeth. Would an emergency dentist charge the venue? I don’t know if I have enough to cover this. I don’t even know what “this” is.

Corra L.

Dear Corra,

A woman grabbing her jaw in need of an emergency dentist

First, I want to express that I’m sorry you’ve had to grow up in a group home. Hopefully, you have a good group of friends that help you feel you have some back up in this world. It is important that you see an emergency dentist. In the meantime, be sure not to wiggle them. I know it’s tempting, but you risk snapping your ligaments, which will derail your efforts to save the teeth.

I’m going to start by telling what to expect when you see an emergency dentist. They’ll check the tooth along with x-raying it to make sure no damage is done to the pulp. IF the pulp is damaged, you’ll need a root canal treatment and dental crown. Because you’re talking about your front teeth, be sure they only give you all-porcelain crowns (as opposed to the metal-based crowns). They look more natural and you won’t have to worry about a gray line developing at the top of your gumline.

If the pulp is fine, they’ll just need to splint your loose teeth to some stable teeth. It may just be a matter of giving the ligaments time to heal.

Affording an Emergency Dentist

Unfortunately, the dentists will not be able to bill the venue. Dentists can only bill those receiving the service or their guardians. However, save every receipt for every scrap of money this costs you. I’m sure they’ll be a lawsuit of some kind given that people were hurt and you’ll probably get the money back.

Even though the dentist can’t bill someone else, it doesn’t mean you’re trapped and can’t get the help you need. Most dentists went into the field because they wanted to help people. In fact, there are affordable dentists who will be willing to work with you. I believe, you especially, given your unique circumstances, will find dentists compassionate.

Some have in-house payment plans. Others use Care Credit. Either way, you should be able to get the care you need and then pay it out.

This blog is brought to you by Dr. Matt Roper.

Do I Need a Special Dentist for Invisalign?

I want to get my teeth straightened with Invisalign. Do I go to a special dentist like an orthodontist or cosmetic dentist or will my regular dentist do?

Charles I.

Dear Charles,

A woman placing her Invisalign aligners

There are certain things which require a specialist, but Invisalign isn’t one of them. In fact, not even cosmetic dentistry is a recognized specialty. Any general dentist is technically allowed to call themselves a cosmetic dentist. Obviously, a patient needs to be cautious about getting an advanced smile makeover done by just any dentist because skills vary from dentist to dentist, so you’ll want to check out why type of results they get before committing.

Even though orthodontist is a recognized specialty, a general dentist can do braces and other orthodontics if they’ve invested the time in training. Many have, and many patients find they save money by going to their family dentist for their braces.

Invisalign is different from all of those procedures. The treatment plan and design of aligners is done by computer with a special software program designed to make your treatment plan as efficient as possible. Results are likely to be the same across the board no matter which dentist you go to for treatment. If your dentist offers Invisalign, you’ll be safe to get it done from him (or her).

Bear in mind, not everyone is a candidate for every procedure. If you’re not, you have options.

Options to Invisalign

  • Traditional Braces: Most people are a candidate for Invisalign. Every so often, though, we run up against a case that has much more severe issues than normal with their bite. In that case, traditional braces may be the better route for you.
  • Porcelain Veneers: If there are more things you’re interested in changing about your smile than just some orthodontics, a smile makeover may be just the thing. While these won’t actually straighten your teeth, they can be designed to make your smile look straight. Additionally, they can change the shape, size, and color of your teeth at the same time.

I hope this helps. Talk to your dentist about your goals. Together you can come up with all your best options.

This blog is brought to you by Dr. Matt Roper.

Are CEREC Crowns as Reliable as Regular Crowns?

At my last check-up, my dentist said I need three crowns. I wasn’t too surprised I needed them, but he’s pretty insistent I get CEREC crowns. My insurance doesn’t cover those and they’re more expensive. I’m not sure I want to invest in something more expensive just because it’s the newest thing unless I know it’s as reliable as the regular crowns. Do you have an opinion on this?

Louis A.

Dear Louis,

A CEREC Machine
When Should You Get a CEREC Crown?

A lot of whether or not a dental crown is reliable depends more on the dentist than anything else. Some dentists get better results than others. However, there are times when a CEREC crown is better than a traditional one. There are times it’s the other way around as well.

Because they’re computer milled, CEREC crowns often fit better. They do well in front and side teeth, but aren’t always strong enough for back teeth. For those, you may prefer a zirconia crown or a porcelain fused to metal crown.

Their biggest benefit is you can have your three crowns done in one visit, without a temporary crown. Other than that, everything else truly depends on the skill of your dentist.

If you decide you want a CEREC crown, your dentist can bill the insurance for the regular crown and you just pay the difference, which isn’t too substantial.

Some Considerations with CEREC Crowns

Placement is the biggest issue. If it’s going to be visible and you’ve ever wanted to whiten your teeth do the teeth whitening before you have the crown milled. If it’s a visible side tooth, that should be sufficient for an attractive looking smile.

However, if it’s a front tooth, you’ll want a traditional crown. CEREC crowns are milled out of a single block of porcelain which, though beautiful does not have all the subtleties necessary for a front tooth. You’ll want something sculpted from various blocks so that the right level of translucency comes across at the appropriate parts of the tooth. Otherwise, it can look a little flat compared to the tooth next to it. You’ll know it’s a little different without knowing why. It will still be attractive, just not as attractive as it could have been.

Again, each dentist’s skills vary in this area, so ask to see sample before and after pictures of their work.

This blog is brought to you by Dr. Matt Roper.

General Anesthesia for Cavities?

I’m so worried right now. My two-year-old has two really large cavities. My dentist said it’s because I breastfeed her at night. I was curious about that because my pediatrician told me it was the best thing for her, even her teeth. But, now the dentist tells me she needs two possible crowns. He doesn’t think she’ll be able to do it so he’s suggesting general anesthesia. I can’t fathom it would be safe to do in a dental office. I don’t guess I can just leave them, but I don’t want to put her at risk.

Emily

Dear Emily,

It’s completely normal for you to be concerned about your child’s safety. I want to address a few things you brought up to bring you some peace of mind. First, is the cause of her cavities. I think either your pediatric dentist didn’t communicate well or you misunderstood what he meant. Breastfeeding does NOT cause cavities. Your pediatrician is right, breastfeeding is better all around for your daughter, including her teeth.

What he likely was trying to convey is that letting your child fall asleep breastfeeding (or bottlefeeding) is bad for their teeth. That’s because they stop sucking fully and the milk pools around their teeth.

Another issue would be how effectively you’re brushing her teeth. She’s too young to do it well herself even if she insists, as some children do. In addition to the two issues mentioned above, genetics play a factor. Though, the size of your daughter’s cavities means some extra brushing needs to be done.

Dental Sedation versus General Anesthesia

Your dentist likely isn’t doing general anesthesia in his office. It would more likely be done in a hospital with a full complement of caregivers, just like with general surgery. Surgery is routinely done on children while under general anesthesia and though there are risks with everything, is considered quite safe.

Dental sedation is different and would be suggested if your daughter was a little older. It is done in the dentist’s office. This is very effective with slightly older children. They will generally fall asleep but they’re not unconscious.

Either way, make sure someone will be monitoring your child’s vital signs all the way through the procedure.

This blog is brought to you by Dr. Matt Roper.

Affordable Dentist for a Full-Mouth Reconstruction?

I never got to go to the dentist as a child. I saved up for two years to go now that I’m in college, just to see what I’m dealing with. He said my mouth was in horrible shape and I needed something called a full mouth reconstruction. I knew there’d be some problems because I’d never been, but I was surprised with how dire my outlook was, especially since my teeth have never bothered me (except for how they look). The way he described the reconstruction sounded like I’d really benefit and my teeth would be pretty, but the price is way above anything I can afford. My roommate said I should ask about affordable dentists. She said that’s what her parents always used. They have less frills but you still get care. Can I get one of those for the reconstruction I need?

Mindy L.

Dear Mindy,

Dollar sgn hatching out of an egg

How admirable that you’ve made such an effort to see a dentist. I wish more older adults were as conscientious as you are. Before we get into a reconstruction I want to caution you. Something feels off about this to me.

While I’m sure there were some issues, if you’ve experienced no pain at all, I doubt you really even need a full mouth reconstruction. You should have been in massive pain. I’d love to hear more specifics of why he said you needed one. I don’t want to see you taken advantage of by someone disreputable.

I’d like you to get a second opinion from another dentist in the area. Some dentists will even give you a free second opinion.

Getting a Second Opinion for Affordable Dental Care

When you go in, don’t tell them who the first dentist was or what his diagnosis was. Just go in and tell him you’re looking for a second opinion on a diagnosis you received that seems questionable to you. Tell him you’ll be happy to tell them the dentist and diagnosis after they give their unbiased opinion.

If it turns out he misled you, please turn the dentist into the ethics board. Most dentists are honest and it’s the bad apples that make life harder for the rest of us.

However, if it turns out you do need a full-mouth reconstruction, that’s not something you price shop for. It is one of the most technically advanced procedures a dentist can do. You don’t want it to simply go to the lowest bidder. There are other ways of making this more affordable.

Instead, talk about ways of phasing out treatments. If planned correctly, it doesn’t have to be done all at once. Get the work done on a schedule of most urgent to least. Also, be clear you want to save as much natural tooth structure as possible.

Fillings before crowns. Crowns before extractions. If you need an extraction, dental implants are the ideal replacement but are pricey. However, it’s worth it to get a temporary cheaper one while you save up the good one, especially as young as you are.

This blog is brought to you by Dr. Matt Roper.

Can an Emergency Dentist Help with an Excruciating Canker Sore?

I’ve had what I think is a canker sore for a week. It’s excruciating. I don’t know why I get these. I wasn’t able to eat last night. Can an emergency dentist help me?

Melinda B.

Dear Melinda,

A Man in pain and in need of an emergency dentist

Because you get them all the time, it wouldn’t be a bad idea to see a doctor or dentist to find out why. Sometimes what we think are canker sores are actually a virus or cancer in disguise. That being said, I don’t think an emergency dental visit is necessary. Though I will add it concerns me that you can’t eat at the moment.

Have you tried any over-the-counter remedies? There are gels and pads you can put on them to try and numb them out. The pads are hard to keep on because of the moist nature of our mouths. You can also try some salt water rinses.

Canker Sores tend to run themselves out in about 10-14 days, so it looks like your almost there. If it goes much beyond that a dentist visit is in order.

If you get regular cleanings and check-ups from your dentist they should be screening you for oral cancers, so I wouldn’t be too concerned if they hadn’t mentioned anything.

Avoiding Dental Emergencies

If you’re someone who avoids the dentist, you could be inadvertently shooting yourself in the foot. Our mouths are loaded with bacteria so doing what we can to keep them clean and healthy with preventative care could help stave off some of these sores.

I do understand that many people have a phobia when it comes to going to the dentist. If this is you, don’t feel bad. Many Americans share your feelings. There is a way to have anxiety-free appointments these days.

Ask your dentist about sleep dentistry. It will enable you to get the oral health care you need, while resting comfortably in a chair. Most people use the time for a nap. Though I will warn you you’ll feel groggy throughout the day and will need someone to drive you to and from your appointment.

This blog is brought to you by Dr. Matt Roper.

CEREC Crown Disaster

Everything I’ve read about CEREC crowns and their procedure leads me to think my dentist was way off on how she handled my particular case. What’s done is done, but I just need to make sure the sensitivity I’m feeling is normal and will go away after some healing or if I have a problem. When the dentist did my crown, she said my tooth was in too bad a shape to get a good image so she was just going to pull one from a CEREC database. I wasn’t too worried because the advertisements all talk about how perfectly these crowns fit. Well, it didn’t. It was too big all around. She spent well over an hour grinding down all the sides of it. Not only was that remarkably uncomfortable, but it doesn’t even look like a real tooth anymore. It looks more like a box. Plus, every time I eat or drink something cold it zings me. Will that end after a period of time or do I have a problem on my hands?

Dirk B.

Dear Dirk,

Gilbert CEREC Crowns
A CEREC Machine

You have a problem. You’re also right that this seems to be a disaster. CEREC crowns should be able to be placed in minutes. I have no idea what your dentist meant by your tooth was in too bad a shape to get a good image. It’s only teeth which are in bad shape that need a dental crown to begin with. I have no idea why she couldn’t get a clear image.

The only thing I can think of with an image database is when she input into the CEREC machine which tooth she was going to crown. It will give her a basic image to work from, then she’ll put images of the surrounding and opposing teeth so the computer can design a crown with a perfect fit. It sounds like your dentist had absolutely no idea what she was doing.

Get a New CEREC Crown

The sensitivity to cold concerns me. It sounds like your dentist left an open margin. That not only causes some pain when you drink something cold, but it also allows food and drinks to get trapped in there. You don’t want to leave any opening for decay. A mistake like this can cost you your tooth. Then, you won’t be trying to get a crown, but a complete tooth replacement.

You need to get a new CEREC crown made. But, you’ll want to go about this in a way that won’t cost you any more money. You’ll first need to get a second opinion from a dentist verifying everything I’ve said so you have ammunition. Do NOT tell the second opinion dentist the story you told me. Just tell them you want them to look at your crown. Also, do NOT tell them who your dentist is. You don’t want any friendship or misplaced sense of loyalty to cause them to waver in their true opinion. If they pressure you to know, tell them you’ll let them know AFTER they give their opinion. Tell them you just want their pure, untainted thoughts.

Once what I suspect is confirmed, don’t just ask for a refund. Your dentist should also pay for any expenses you incur to fix her botched job.

I hope this helps.
This blog is brought to you by Dr. Matt Roper.

Why Can’t My Dentist Get Me Numb?

I need serious help. At this moment, I’m living off of extremely strong painkillers. My dentist had to send me home with them because he doesn’t know what to do. He tried on five different appointments to get me numb. But, after at least seven shots and some kind of paste on my gums he still couldn’t get me numb enough to do my root canal. What gives? I’m miserable and my dentist feels horrible. He’s even refunded my money.

Scott T.

Dear Scott,

Gilbert Sedation Dentist

What a difficult experience. I’m sure you’re in tons of pain, so I will make this quick. I know exactly what is going on here, because a colleague of mine (and a dentist himself) had the same problem whenever he went in for treatment.

Believe it or not, this dentist suffered from dental anxiety. Between you and me, I think it was frightening for him not to be in charge of the procedure.

What many dentists don’t realize is that dental anxiety and Novocain (along with other numbing medications) are not a good mix. The anxiety ups your metabolism which in turn burns off the numbing agent. The higher the anxiety, the faster it burns it out.

There’s a simple solution. You need dental sedation. You’ll simply take a pill before your appointment which will completely relax you. Be aware that it relaxes you so much, you’ll need someone to drive you to and from your appointment along with someone to stay with you until you’re steady on your feet again.

Whenever a patient with dental fear uses sedation, it enables the numbing medication to do its job. You’ll experience a stress-free, pain-free root canal treatment.

Best of luck to you. Dental emergencies are the worst.
This blog is brought to you by Dr. Matt Roper.