Archives for October 2020

Does peroxide minimize Covid-19 germs during a dental visit?

Posted on October 22, 2020 by AllSmiles.

Last month I had a dental cleaning and Teeth in a Day consultation. I was concerned about the hygiene protocol for the dental office and wondered how they would handle it. When I confirmed the appointment, the receptionist told me to wait in the car when I arrived. They would text me when it’s time to come into the office. I was surprised, though, when I sat in the dental chair, that the hygienist handed me a cup with a solution of hydrogen peroxide to rinse out my mouth before treatment. She explained that it is a germ-killing precaution. I thought that this is a simple measure, but does it really work? Thanks. Natasha from Dallas

Natasha,

It is good to know that a medical or dental practice takes precautions to minimize exposure to the coronavirus. Your hygienist did the right thing before your dental cleaning appointment and Teeth in a Day consultation. Peroxide is an effective anti-microbial rinse.

Anti-Microbial Rinse for Dental Visits

Anti-microbial rinse kills oral micro-organisms. Dental offices use a higher concentration of peroxide than what you can buy over the counter. It quickly kills germs. The American Dental Association recommends at least 1.5% peroxide concentration, but most dental offices use an even higher concentration. Swishing it around in your mouth kills bacteria and viruses.

Dental hygiene schools teach hygienists to use an anti-microbial rinse before each appointment, but many dental practices didn’t implement it. Due to Covid-19, many states now require dental offices to use the rinse.

What About Aerosols?

Aerosols, or fine particles, are generated during many dental procedures, including cleaning. Dental cleaning equipment, including an ultrasonic scaler, releases aerosols in the air that can be suspended for several hours and circulate throughout the office. Anyone in the office can inhale aerosols.

But it is possible to control infectious aerosols released during dental procedures.

High-volume suction equipment. While your dentist provides treatment, a dental assistant can hold a high-volume suction hose near your mouth and face to reduce aerosols by about 95%. But during a dental cleaning, a dental assistant is not present with the hygienist, so this method is not practical.
Aerosol capture device. The device has a wide opening of a least one foot. The opening is positioned near your mouth to vacuum away aerosols into a filtered box.

If you decide that you want Teeth in a Day treatment to stabilize your denture, ask your dentist beforehand about the safety protocol during Covid-19. He or your oral surgeon will explain what they do to create a sanitary environment while placing your dental implants.

Gilberto Tostado, DDS, of San Antonio, TX, sponsors this post.

Why are my porcelain veneers falling off?

Posted on October 13, 2020 by AllSmiles.

After wearing temporary veneers for a week, I received my permanent veneers in early August. Within two weeks, an upper right veneer fell off. I called my dentist’s office, and he had me come in right away to bond on the veneer. Since that time, at least one veneer falls off every two to three weeks.

My dentist’s only explanation is that sometimes veneers fall out. He hasn’t explained why this is happening so frequently. I’m uncomfortable at work because I’m afraid that a veneer will fall off while I’m talking or in an inconvenient situation. And when a veneer does fall off, I can see that my naked tooth looks like a small spike but not as pointy. Before I agreed to porcelain veneers, my dentist told me they would last at least 20 years. Am I going to need crowns instead? Thank you. Justino from TX

Justino,

It is not normal for veneers to fall off. They shouldn’t fall off at all and certainly not every two to three weeks. We are sorry to hear about your dental experience. Although Dr. Tostado would need to examine your porcelain veneers and teeth, we will offer some insight based on what you’ve described.

Your dentist prepared your teeth for crowns instead of veneers

When a dentist prepares your teeth for porcelain veneers, they remove a half millimeter or less tooth enamel from the front of each tooth.

Crown preparation – Preparation for porcelain crowns is aggressive, as you see with your teeth. Some dentists grind down each tooth that needs a crown to ensure the crown fits over it. But aggressive preparation that reduces your tooth to a stub isn’t necessary.
- It seems that your dentist prepared your teeth aggressively as if preparing them for dental crowns. Now your porcelain veneers won’t stay on.
Porcelain veneer preparation – When a dentist prepares your teeth correctly, a crown can stay on with dental cement. But if your tooth is reduced to a stub, it increases the risk of your crown falling off.

Your dentist violated the standard of care because she prepared your teeth for porcelain veneers even more aggressively than a dentist would prepare them for dental crowns. Loose veneers allow saliva and bacteria in and promote decay. Your dentist is liable for the damage to your teeth.

What’s next?

Before-and-after porcelain veneers photos placed by Dr. Gilbert Tostado

We recommend that you find a skilled cosmetic dentist to restore your smile. Allow the dentist to examine and x-ray your teeth and document the issues with them. Use the information to pursue a refund from the dentist who prepared your teeth for porcelain veneers. Ask your new cosmetic dentist if they are willing to help you get a refund. Your current dentist’s malpractice insurance should cover whatever your new dentist must do to restore your teeth.

San Antonio dentist Dr. Gilberto Tostado sponsors this post.

I needed a root canal but my dentist overlooked it

Posted on October 8, 2020 by AllSmiles.

In August, my dentist put a crown over one of my upper right molars. The tooth was cracked and had an old silver filling in. The dentist had problems getting my tooth numb, so it felt like electric shocks when she was drilling.

When the dentist checked my bite with my crown, I told her that it was uncomfortable and hurt to bite down. She adjusted the crown twice while I was there. And when I still wasn’t happy with it, she told me to give it a couple of weeks. It hurt to floss around the crown. I gave it a couple of weeks, and nothing improved. In mid-October, I called the office again, complained, and insisted on a new crown. My dentist adjusted the crown instead and started talking about two more crowns that I needed.

I declined getting two more crowns until I knew that the first one was okay. My dentist asked me to wait two more weeks after adjusting to the crown. Shouldn’t a crown fit correctly when I leave the dental office? Anyway, the crown still wasn’t right, so I had another appointment with my dentist. She removed the crown and said I need root canal treatment. I am wondering if this is an issue my dentist should have noticed before placing a crown. Now she says that the tooth has a periapical abscess.

My dentist has not offered a refund or admitted that she misjudged the condition of my tooth. I want to get a refund before switching dentists. Do you have any advice? Bronwyn from Tennessee

Bronwyn,

Although Dr. Tostado would need to examine your tooth and see your x-rays for an accurate diagnosis, we will explain what we can, based on the information you gave us.

A cracked tooth with an old filling

When a tooth cracks, it often needs treatment in addition to a crown. If a tooth has internal damage, putting a crown over it won’t make the injury go away.

A cracked tooth is t risk for root canal treatment.
Some sensitivity after getting a crown is normal, but it shouldn’t linger. And you should not feel pain.
A crown that is made and placed well will blend with your bit without you noticing it.
Your dentist should have told you that you might need a root canal in the future.

Based on your conversation with your dentist, it seems that she was more concerned about completing all your dental work rather than getting it right.

But getting a refund, I think, is going to be tricky in your situation. To do that, you would need

Can You Get a Refund from Your Dentist?

It is possible to get a refund from your dentist if you can prove that your dentist didn’t meet the standard of care that she promised. You have several ways to try to get a refund. Although you may not have a case against your dentist for wanting to continue treatment with two more crowns, your new faulty crown might give you a good chance.

A lawsuit – A lawsuit requires that you can prove your dentist’s negligence. Your description sounds like your dental was negligent, but the details you gave us aren’t enough to determine if she is liable. A malpractice or consumer rights attorney can decide that for you.
Complain to the dental board – Although you can file a complaint, the Tennessee state dental board might consider your case as a dental procedure that went bad. Although it seems that your dentist doesn’t know how to adjust your bite, she did not drastically deviate from protocol.
Online reviews – You can tell your dentist that you will leave negative online reviews about your experience. Check her current online reviews. If they are mostly positive, a negative review will concern her. Otherwise, it might not have an impact.

Periapical Abscess and Root Canal Treatment

A periapical abscess is a collection of pus at your tooth root that results from an infection. It means that the pulp—living tissue, vessels, and nerves—inside the tooth is dead. Dead nerves inside a tooth mean that you won’t feel any pain inside the tooth from root canal treatment.

After root canal treatment, a dentist must ensure the crown fits well to avoid TMJ issues

But an upper molar tooth is more challenging to treat. An endodontist (root canal specialist) can treat your tooth, and you won’t need an extraction. If you ask a dentist to extract the tooth, you will need to replace it. Otherwise, your teeth will begin to drift, disrupt your bite, and possibly cause TMJ (temporomandibular joint) issues. TMJ symptoms affect more than your teeth. Symptoms can include:

Earaches
Headaches
Jaw stiffness, clicking, or pain
Neck pain
Dizziness
Painful talking, yawning, or chewing
Tinnitus (ear ringing)

Our Recommendation

It seems that you are uncomfortable with your dentist. We recommend that you get a second opinion from a dentist with advanced training in occlusion and bite. The dentist will understand how to achieve harmony between your teeth so you can speak and eat comfortably.

And you may need a referral to a root canal specialist to save your tooth and avoid the need for a dental implant or partial denture.

We wish you the best. Please let us know the results.

Gilberto Tostado, DDS, of San Antonio, TX, sponsors this post.