Steven Eli Chamish, DDS

Invisalign aligners should not smell.  To reduce the odor, first, make sure your teeth are thoroughly brushed and flossed. Do you have any sinus/allergy issues? That may be a contributing factor.  Then make sure your aligners are clean. If they still smell, let your dentist/orthodontist know and if necessary, have them remade.

Do braces self tighten? The answer is NO. If you're thinking of having orthodontic treatment using braces, your doctor will place brackets on your teeth and place a wire which will be held in place by them. The wire moves your teeth and the brackets direct them. Every so often, you will return and see your doctor who will place a larger diameter wire in your brackets after removing the ones you're wearing. As the wire is bigger and slightly less flexible, you will feel some pressure until your teeth start to move. That's what tightening really is. So, if you want straight teeth and an attractive smile, visiting your orthodontist or dentist every 4-8 weeks (depending) is part of the process.

Dear Reader, Can you eat solid foods with a crown? The answer is YES. A crown reproduces the enamel of your tooth. The new zirconia crowns are as hard or even harder than enamel.  Crowns strengthen and protect your natural tooth. Even old-school porcelain fused to metal crowns is very strong.  So, eat away and enjoy.

I don't know what type of gum surgery you had (there are several), but generally, you will feel moderate discomfort for about 3 days.  Research shows taking Tylenol plus Advil can offer as much pain relief as Percocet without the unwanted side effects. I would call your periodontist or the dentist who performed your surgery and let them know how you feeling. They can tell you the Tylenol-Advil protocol if it's appropriate for you based on your medical history, or prescribe something to get you comfortable. Hope you feel better.

When it comes to TMJ, most pain is due to inflammation.  The best anti-inflammatory medications are NSAIDs like ibuprofen ( Motrin, Advil) or naproxen (Aleve). If your joint is sore, you might want to consider a muscle relaxer since many times, clenching, especially when sleeping is the culprit. I'd suggest a visit to your dentist to have your TMJ evaluated, and if he/she feels it's appropriate, prescribe a muscle relaxer in addition to the pain meds. You may also want to consider looking into a bite guard to be worn while sleeping. BTW, I had a terrible TMJ problem and have been wearing a guard for over 40 years.  You can get an over-the-counter guard at your local pharmacy or have one custom-made (like mine and my wife's) from your dentist. TMJ problems can worsen with time and require invasive procedures if untreated. Please visit your dentist ASAP.

Great question since gum grafts is becoming very common.  When you can eat solid food after a graft depends as there are different types of grafts. Generally, you should stay away from the area for at least 14 days before eating your regular diet. In some cases, it may be necessary to wait 21 days. I would talk with your periodontist/dentist as they would be in the best position to determine how long you would have to wait, base on the type of graft. Hope this helps.

Immediate dentures, where your natural teeth are removed and the denture is immediately placed are a great service. There are some drawbacks. First, there is no way to try them so it's difficult to evaluate esthetics or phonetics. The second drawback is your gums are going to shrink so you will probably need a reline in six months or so. Finally, in my opinion, immediate dentures may have a lot of adjustments, so the denture is pretty ground up. What I have done for the last 30+ years, is to use an immediate denture as a "healing denture" or transitional denture. Once everything has healed and you've had a chance to evaluate the esthetics, a final denture is made. It fits far better and any esthetic concerns, like the shape, size, or color of your teeth, can be changed. BTW, I have never had a patient regret this two-step approach (and I do a lot of dentures). I would talk to your dentist to discuss their approach/philosophy regarding immediate versus final dentures.

Dear Reader, Great question.  Unfortunately, if your implant truly failed, where it's not healed to the bone, removing it is the only option. The good news is another can be placed. Depending on the condition of your jaw, it may be able to place another during the same appointment as the removal. If not, your doctor may choose to perform a bone graft and place the new implant at a later time. Hope this helps.

Dear Reader, It is normal for your teeth to hurt after "tightening" your braces. It usually occurs the next day and may be sore for another day or two. Ibuprofen (Advil, Motrin IB, etc) or Tylenol will help you feel better until the teeth settle in. The discomfort happens because the wire is engaging the brackets  (braces) more deeply. This causes the teeth to shift and place pressure on the ligaments that attach to your teeth. The good news is that it's temporary. But remember, the next time your braces are tightened, your teeth will be sore again.  If it is too painful, tell your orthodontist.  He or she may relieve some of the pressure. Hope this helps.

Dear Reader, Great question. First off, your surgeon (dentist, oral surgeon, or periodontist) will be using a CBCT (cone beam computerized tomography) machine versus a traditional CT machine. Much, much less radiation!  Disclosure: I have a CBCT machine in my office and use it to help me in implant placement. While a good doctor can place implants without one, a CBCT gives a 3-D image of the jaw instead of a flat 2-D image you get from traditional dental x-rays. Being able to measure height, width and depth can help the surgeon select the best size implant for the site. Also, there are areas we wish to avoid, such as major nerves, blood vessels, sinuses, cysts, voids, etc. A CBCT can identify these critical areas. While I placed implants without a CBCT for many years, there's no way I would do it without one now. If your doctor is thinking about using a surgical guide, a CBCT is a requirement to have it made. For my patients who are concerned, it usually comes down to radiation or finances. Since the radiation is minimal, that should not be a concern. If it's financed, talk to your doctor and maybe you two can work something out.  Implants can fail, so if you want the best chance at a great result, I would strongly recommend having the CBCT.  
Hope this helps.

Dear Reader, Thanks for the question.  I don't know what kind of graft you had (e.g. ridge preservation, onlay, ridge augmentation, etc.) but many times the pain comes not from the bone but from soft tissue being cut and manipulated. Gum has a ton of nerve endings.  Also, there is a super-thin membrane called periosteum which covers the bone and is loaded with nerve endings as well.  This also gets cut and scraped during the procedure.  Depending upon the size of the graft area and how aggressively the tissues were manipulated, you could have pain for 5 to 7 days. It would then taper down.  Usually, after 10 to 14 days you should feel fine.  I normally see graft patients 5- 7 days after surgery, then two weeks after that to make sure they are healing well and have little to no pain. If you don't feel any improvement by the fifth day, I would contact your dentist/periodontist/oral surgeon, and have them check things out. Hope this help

Dear Reader, To answer your question;  Yes, you can get Invisalign treatment if you have crowns on your front teeth.  However, they need to be single crowns on individual teeth and not attached as in a bridge. Good luck with your new smile. Hope this helps.

Dear Reader, Great question.  The answer is YES, you can get a wisdom tooth filled if it has a cavity.  A wisdom tooth is just a nickname for the third molar. While you get your first molars at age 6 and the second molars at age 12, the third molars erupt somewhere between 17 and 22 years of age. That's when you should be "wiser" with age. If your third molar (aka wisdom tooth) is erupted and functioning, then there's no reason to remove it.  If it has a cavity and can be restored, then fill it.  Of course, since they're so far back in the mouth, you should spend extra time making sure they're thoroughly brushed and flossed. Hope this helps!

Dear Reader, If you have gum pain, see a dentist.  Pain is a sign of inflammation and/or infection.  Dentistry is the specialty of medicine that deals with oral conditions and diseases.   Please call your dentist or a periodontist, who is a specialist in treating gum disease. Hope this helps.

Dear Reader,

Great question. How soon can you get an implant after a tooth extraction? If the socket in your jaw is intact, you could have an implant placed in as little as 8 weeks. If the socket was damaged (depending upon the extent), again it could be placed in 8 weeks, although additional procedures may be necessary. I suggest you speak to your dentist or the oral surgeon who removed your tooth to give you a timeline.  

Hope this helps,

Steven Chamish, DDS, FAGD, FIOCI

Dear Reader, 

When you say a dental "bridge" is it something removable, like a partial denture, or is it non-removable where it is cemented in place? If it is the removable type, I'd return to your dentist and have him/her adjust it so it doesn't rub against your gum. If it is the non-removable type, is it a temporary bridge and you're waiting for the final to be placed. If so, sometimes the teeth and/or gums can be painful due to the trauma at the time of shaping the teeth and getting the impression. If the final bridge has been placed, it should be painful, especially after three days. I would return to your dentist and have the bridge and area examined and treated.

Hope this helps,

Steven Chamish, DDS, FAGD, FIOCI

Dear Reader,

How long a tooth hurts after being filled depends upon many factors. For example, the size of the cavity. The deeper the cavity and the closer to the nerve, the longer a tooth may be symptomatic. What type of filling was performed? Was it silver amalgam or tooth-colored composite? Amalgam fillings can transfer hot or cold from food and drink. Tooth-colored fillings involve a number of chemicals which can irritate the pulp ("nerve"). Was a liner placed between the filling and the tooth to insulate the pulp? As you can see, the answer in not so simple. However, most teeth recover in a day or two. If your pain still persists after 2-3 days or begins to increase, I suggest you contact your dentist and let him/her know. Then, if necessary, it can be addressed. I've been there. It's happened to me and the situation was taken care of.

Hope this helps,

Steven Chamish, DDS, FAGD, FIOCI

Dear Reader,

Thanks for the question. Gum disease is easily treated in an outpatient setting. No need to be hospitalized. Patients are typically treated in their dentist's or periodontist's office. Most procedures require local anesthesia to numb the area during the treatment. The number of visits for treatment can vary so I would talk to your dentist or periodontist to develop a plan. Therapy in an outpatient office setting is quicker, easier and far less expensive than in a hospital. The sooner you get started, the sooner your treatment will be behind you.

Hope this helps,

Steven Chamish, DDS, FAGD, FIOCI

Dear Reader,

Yes, you can certainly use mouthwash if you have periodontal disease  I recommend Listerine to my patients because the essential oils it contains does kill bacteria that contribute to periodontitis and gingivitis. Please understand that mouthwash is an adjunct. The only way to get periodontal disease under control is professional therapy to remove the toxins and bacterial/calcified deposits on the crowns and roots of your teeth. Talk to your dentist/periodontist and hygienist to see what mouthwashes they may recommend, in addition to great brushing and cleaning in between your teeth.

Hope this helps,

Steve Chamish, DDS, FAGD, FICOI

Great question. I suppose it depends upon what is making the tooth uncomfortable in the first place. If the bite doesn't feel right, then the crown usually can be adjusted. Same if the tooth feels too tight against adjacent teeth. If the tooth is sensitive to heat or cold food or drink, that may not be able to be adjusted. The crown may have to be removed and possibly replaced. Sometimes, the final cement can irritate the tooth and cause it to be sensitive. I would speak with your dentist to determine the source of your discomfort and have it addressed. I'm hoping he or she will be happy to address your concerns.

Hope this helps,

Steven Chamish, DDS, FAGD, FIOCI