Dr. Daniel A. Lieblong, D.D.S.

It would be normal to have gum pain after a filling that extended into the gums or in between teeth.   When dealing with decaythe major issue is that the decay is always in a location where the patient does the worse job in their home care.   Typically apatient that does not floss will have decay between their teeth, which will require a lot of work to be done between the teethand down to the gum line, placing a matrix of some type to form the filling and a wedge to keep the filling inside of the preparation.The worse the patients home care, the more tender and inflamed are their gums.    If you want to minimize sore gums, flossproperly and thoroughly every day.   This will prevent decay and gum issues between your teeth and minimize you dealingwith "Sore gums".   

That is a loaded question. Is it possible to place 4 implants at the same time with good, sufficient bone? Yes. To know for certain we would take a 3D x-ray to evaluate the bone in the proposed implant sites. I would never consider placing implants without proper evaluation and diagnosis.

If teeth are so mobile that they are a real concern of falling out during a deep cleaning, it is too late for any chance of treatment success. It is time to re-evaluate and reconsider more appropriate treatment.

The key for a successful root canal treatment beyond the obvious, of a well done procedure is having the tooth properly restored with a crown. The biggest reason for failure of a root canal is failure to restore the tooth. This results in potential for infection, fracture, etc.

No, you do not have to be put to sleep to have a tooth extracted. I have been doing extractions of all levels of difficulty for more than 36 years and have never put a patient to sleep.

There is no question that the bad teeth need help. They are probably beyond what root canals could help. You need to have your MD and your DDS discuss your case to determine what is best for you. Ignoring the bad teeth is WRONG!

If you have active periodontal disease and do not aggressively have it treated and improve your home are 100%, it is very likely you will lose your teeth. There are also contributing factors such as smoking. Trying to successfully treat periodontal disease on an active smoker is almost impossible.

At the age of 15, the reason for your "gaps" is a simple thing called growth. You are probably in your last major growth spurt. Everything is growing, all of your bones, including your upper and lower jaws. One thing that does not increase in size with growth are your teeth. Once teeth are completely formed, they do not change size. Some young people have very crowded jaws that look like there is no way they have room for their teeth to come in, but as the jaws grow, the teeth slide into place. Others have smaller teeth that, as they grow, create spaces. All of this is part of your genetics. The old saying "Mom's teeth and Dad's jaws" is more true than you might imagine. As the world becomes smaller and people from every nationality mix and blend their genes, the differences in teeth and jaw sizes seem to become more obvious. The best way to deal with the generalized spacing is through orthodontics.

There are multiple issues that you refer to. First: apple cider vinegar is very acidic and can harm your teeth unless you are following its consumption with excellent home care. You should always rinse thoroughly with water after drinking ACV, floss and brush. I see patients all the time who are complaining of extreme cold sensitivity and the first question I ask them is: Are you drinking APV? Almost always the answer is yes. Next question: canker sores. I have not seen what you have in your mouth, so it is impossible for me to know exactly what is going on, but typically there is some sort of trauma that starts the process of forming a canker sore. There are some people that tell me that acidic foods stir them up, so your ACV could be part of the issue. If you implement the home care regimen that I suggested, you should be able to remove that from the factors. The third issue is your wisdom teeth. At 17, your wisdom teeth are in the process of coming in and the tissue over them commonly gets sore, from it being squeezed between the upper and lower wisdom teeth as they erupt, and that could be a part of your discomfort. My suggestion is to follow the home care regimen and get your wisdom teeth out. They are probably at a good position to remove them and leaving them longer may only make their removal more difficult and more expensive.

Dr. Lieblong

As my father-in-law used to say: “enough time and money and you can do anything”. Every situation is different. Many times when a patient presents with an unsalable front tooth, we evaluate with 3-D x-ray to evaluate the bone around the bad tooth to see if there is enough bone for an implant. If so, and the patient is financially prepared, we work to carefully remove the bad tooth and immediately place an implant with a temporary crown on it. The temporary has to be created in such a way that it is totally out of occlusion and the patient is severely warned not to chew in that area. In posterior areas we rarely place temporary crowns, even on Situations where an immediate implant is placed.

Food cannot get under a properly cemented crown on a healthy, decay free tooth. Is it possible for a tooth under a crown to decay and then get food or debris into the area of decay? Yes!

I have been placing zirconium crowns for quite a few years, since they have been available. I have not had one crown break. I chose the monolithic crown, being one solid piece of zirconium. There are layered zirconium crowns, which add potential for separation/breakage of the surface layer. I have not had that happen, but I don't recommend them in the posterior.

If existing dentures are in good condition, it is possible to use implants and some attachment like “locator attachments” to secure an existing denture. Even in a more complicated implant restoration like “All-on-4,” an old denture is modified to use with the plan to create a new restoration later.

Daniel A. Lieblong, DDS

Obviously, you have a serious dental problem. The information that you provide does not give sufficient information to diagnose the exact problem. The antibiotic that you took has temporarily diminished the activity of the infection, but did not fix your problem as the source of the infection is still active in your mouth. You must seek proper dental care to actually deal with the problem. You need a complete X-ray evaluation to determine the extent of you problem and make a plan to fix all of the components of your dental problems. Sorry, I don't have any magic answers for you, but quit putting off getting help, dental infections can cause death. I don't want to scare you, but encourage to you quit putting this off for your own sake.

Dr. L.

For a simple cleaning, no anesthesia is necessary.

Yes, unless there is a serious problem with the implant, there should not be a problem replacing it.

The minute that you finish brushing and flossing the remaining bacterial plaque begins to multiply and grow. Frequent intake of sugar feeds the plaque and speeds its growth. Typically, it takes 6-8 hours for the growth of plaque to get to the point it does damage to your teeth, which is why we encourage brushing multiple times a day.

Temporarily you can take 3-200mg ibuprofen then 3 hours later 1-500mg Tylenol and repeat as often as needed. The real solution is to have the wisdom teeth removed. You probably need to see a dentist soon, who may choose to put you on antibiotics prior to having them removed.

There is no certain answer as it depends on the condition of the tooth. If the tooth is in good condition without any decay then the crown should be able to be re-cemented. If there is decay around the margins where the crown and the tooth meet, or on the tooth under where the crown covers the tooth, then that crown should not be permanently cemented back on the tooth. In that case, it may be possible to place a new crown, but there are times when there is not enough good tooth structure to place a new crown on. In that case, the tooth may have to be extracted.

TMJ is a very real issue but unfortunately most dentists do not have the training to help you diagnose or treat TMJ. Discuss the issue with your dentist and see if he treats TMJ or knows someone who does. If you don't have a dentist, that would be the first thing to accomplish. It is critical that you have healthy teeth prior to treating you for TMJ.