Michael A. Conrad

Single implant restorations generally last longer and do not require cutting down adjacent teeth. However, if those adjacent teeth are heavily restored and would benefit from crowns, a bridge may be an acceptable option. But, to be clear, some patients refer to a "bridge" as the same as a removable partial den ture. Dentists refer to a "bridge" as a fixed, non-removable restoration consisting of crowns that are attached to artificial teeth or "pontics". A bridge replacing one or two teeth would require at least 2 crowns on the ends of the bridge with 1 or 2 pontics in-between. The crowns are cemented to the teeth and support each other and the artificial teeth. But crowns require cutting down the supporting teeth so as to have sufficient space for the materials of the bridge. In the case of large spans of missing teeth, implant bridges can also be made. Implants on both ends of such a bridge can support 1 or 2 pontics in-between. Single tooth replacement with an implant versus a bridge will be similar in cost. Implant treatment in that case will be kinder to those adjacent teeth and also be much easier to clean. If you are a smoker or bad diabetic, implants may not be a good choice. Those conditions contribute greatly to implant failure. Of course they also contribute to periodontal disease which can also cause bridge failure. Both implant restorations and bridges require meticulous cleaning for long life of the restoration. Both options are substantial financial investments that require more care by the patient. Dr. Conrad

First you will receive some local anesthesia to get you numb for the procedure. When everything is ready, the dentist or assistant will place a dental dam over the tooth. That is a square of a rubber-like material that is about 5" x 5" with a hole for the root canal tooth to pop through, It is stretched over a frame, making the entire thing look like a tent over your mouth with a tooth sticking out. It does not prevent you from breathing in any way, but is a big safety factor when using the tiny instruments necessary for the treatment. It also keeps the water and debris from the drilling and other parts of the procedure from getting in your throat and is necessary to keep saliva from contaminating the tooth during the procedure. It also helps you to keep your mouth open. The dentist will have consulted x-rays to determine where the pulp of the tooth can be accessed for removal. Once the pulp (blood vessels and nerves) is infected and begins to die (or completely dies), there are only two treatments that will completely address the problem- extract the tooth or remove the pulp (root canal). A small hole is drilled in the biting surface of the tooth to find the pulp chamber and the individual openings leading into the roots. Once completely visualized, the dentist will measure the length of the canals that run through the roots with an electronic instrument. Small instruments resembling needles are used to do that and, eventually, they will also be used to remove the pulpal contents from the roots. Sometimes that removal is done by hand, and sometimes a mechanical device is used to do that, or a combination of the two methods is used. Once all the bad pulp has been removed and the canals are cleaned, a special filling material is placed to fill and seal the canals. X-rays will be taken at various stages to verify different steps. Once the root canal treatment is finished, a temporary filling will usually be placed in the area that was drilled, the dental dam is removed and you can leave. Usually, the procedure leaves the tooth a little tender to biting for a few days, so Ibuprofen and Tylenol (alternating every 2 hours) make the recovery more comfortable. The length of the procedure is determined by the number of canals and their condition. In older patients with teeth that have been heavily filled or even crowned for a long time, the canals can become calcified, making it more difficult to do the procedure and not only lengthening the treatment but requiring additional appointments. A single-rooted tooth may take less than an hour, and a multi-rooted tooth may take 90 minutes or more with multiple appointments. For the patient, once the anesthesia has taken effect, a root canal is like a longer, boring filling procedure. Generally, the treated tooth will require a permanent filling and a crown for maximum strength and longevity. Delaying or refusing that final treatment can result in a broken tooth and the need for an extraction. You have a new patient question! All you have to do is reply to this email to answer. All questions and answers are for informational purposes only.

It depends on how your implant is scheduled. If you are getting your crown on the implant the same day as the implant is placed, you must wait approximately 3 months before you can eat normally on that. If your implant is placed and allowed to heal for 3 months before the crown is placed, you won't have anything to chew on for those 3 months and must avoid hard and crunchy foods over the surgical site. But when the final crown is placed, you can eat normally right away. Dr. Conrad

As it's true for many of the questions that I receive, it all depends. There are so many factors that enter into how long a veneer lasts. Porcelain is longer lasting than composite veneers. I have some patients who have had their veneers for 20 plus years. Other patients may break or dislodge their veneers in one to three years. Sometimes they can be rebonded, sometimes they have to be redone.If a veneer covers only the existing front surface of the tooth and does not extend beyond the original length, it will generally last longer. When the veneer makes the tooth longer than it originally was, that extra long edge can promote debonding or even fracturing of the veneer if the patient is not careful. No matter which type of veneer is done, it is a good idea to have a night guard made to protect the veneers from night-time grinding.If the veneer does extend beyond the normal edge of the tooth, the patient must be very careful when biting into things with the front teeth. Veneers are very strong, but biting into barbecued ribs or other bones or even hard apples is not a good idea.Talk to your dentist to come to  a decision about what type of veneer is best for your situation. Dr. Conrad Sent from my Verizon, Samsung Galaxy smartphone

You should be fine in 3-5 days at the site of the graft. If the graft is being taken from another area of your mouth, that may be more sore and last somewhat longer. The important thing is to follow all your instructions to the letter to ensure rapid healing. You will have to take it easy when eating and avoid hard and crunchy food until you get the OK from your doctor. Dr. Conrad

It depends on a few factors. A single rooted tooth will be back to normal usually in a few days, but a tooth with 2, 3, or 4 roots may take a bit longer. It has to do with how much work has to be done to remove the pulp of the tooth and fill the canal. If the tooth has been infected, that may also delay healing. I usually tell my patients to take ibuprofen every 4 hours for the first 3 days. They should also avoid chewing on the root canal tooth as much as possible. Usually the soreness from root canal treatment eases off every day and often is comfortable after 7-10 days. Doing a root canal can irritate the surrounding tissue that feels pain and pressure. If that happens, your tooth will be very tender to biting and chewing. That's why the ibuprofen helps. Aspirin is good for that as well, but Tylenol and Aleve don't really help that type of discomfort. If the soreness persists for longer than the 7-10 days, see your dentist. Sometimes all it requires is a minor bite adjustment on that tooth to make you feel better sooner. Of course, we always let our patients know that strange infections can develop after root canal treatment. Sometimes our work for the good of the tooth actually "stirs things up" and the patient can experience swelling and pain. That is when you must contact your dentist immediately. But that rarely happens. In fact, I can't remember the last time it did happen. Good luck and don't worry. The procedure is basically like a long filling appointment, and when you're numbed, it can be boring to the point of actually falling asleep in the dental chair! Dr. Conrad

It depends on the material selected for the veneers and how much of the tooth they cover. There are stronger materials that can be selected. Sometimes the strongest materials aren't the most natural looking. That selection will be influenced by what effect you are going for. If the veneer simply covers the front surface of the tooth, they are very strong and resistant to breakage or loosening. If the veneer must replace the biting edge of the tooth as well, they may be more susceptible to loosening or breaking. With the stronger materials that is less likely, but still a concern. If more of the tooth needs to be covered with a veneer, a full crown is better for strength. In general, you have to be more careful in your food choices with veneers compared to crowns. But crowns require removal of more tooth structure, meaning veneers are the more conservative option. Financially, the cost of a veneer vs. a crown is often identical. Dr. Conrad

Take-home whitening shows good results in as little as 2 weeks. In-office whitening can show immediate results, but tends to relapse sooner. When we do in-office whitening, we recommend that the patient also follow up with take-home products to intensify and prolong the new, lighter shade. I usually say that, if you just remembered you were getting married this weekend and forgot to get your teeth lightened for the wedding, we could get you in for an in-office treatment that would make you look great for the wedding photos. But it might fade sooner, and you would have to touch it up with the take-home products. Take-home whitening usually involved taking impressions for the fabrication of custom trays that are filled with the whitening gel and worn for about 20 minutes a day. They can be messy, and they often lead to tooth and gum sensitivity (which are temporary). In-office whitening rarely causes sensitivity, but can take up to an hour and cost much more. Frankly, we have not been using either method for some time. We've discovered a new, OTC method that has proven to work faster and with no sensitivity. And the price is lower than we can charge. Patients and family are really liking it, and those who have tried the older methods especially notice a positive difference. Though I am not affiliated with the product in any way whatsoever, I have been recommending Snow Teeth Whitening for almost 2 years. My patients get the results they want at a lower price, and there is no extra work for the office staff. It's a "Win-Win" product for us. You can look it up and see if it is right for you. Some things to remember about what ever type of whitening you choose. If you have any tooth-colored fillings in your teeth or any crowns or veneers, they will not lighten. If those restorations no longer match the new, lighter shade, you will need to replace them. That adds to the cost of the whitening . Also, during the whitening process, your teeth may be more susceptible to staining, so you need to avoid smoking and eating and drinking dark foods and liquids (Colas, Red Wine, Blueberries, Coffee, Tea, etc.). Good luck with your decision!

Of course you can. Just remember that anything with small seeds (strawberries, raspberries,  etc.) will get caught in the braces. And citrus fruits are acidic. Make sure to rinse well after eating them. A water pik is good for cleaning around braces in addition to brushing well.Increase the frequency and quality of your cleaning while in braces and you'll be just fine. 

Yes, as long as it is a good antibacterial mouthwash. But get the gums checked out. Swelling is not good and can come from a variety of factors, some that are minor and temporary, some that are serious and need urgent attention. If the mouthwash hurts your gums when you use it, that is a sign that things are worse than anticipated and need treatment right away. In that case, stop using the mouthwash. See a dentist! Dr. Conrad

For great information about cleaning your aligners, go to: [ https://www.mansfieldorthodonticsma.com/post/the-dos-and-donts-of-cleaning-your-invisalign-trays-caring-for-your-aligners | https://www.mansfieldorthodonticsma.com/post/the-dos-and-donts-of-cleaning-your-invisalign-trays-caring-for-your-aligners ] Dr. Conrad

In my experience, zirconia is the best. It looks great and there are no problems with the denture wearing. Dr. Conrad

If there is sufficient bone, certainly. That is done all the time. Dr. Conrad

They are safe, but are not for everybody. It usually takes a certain type of bite for them to be an acceptable option. If they would interfere with you closing your mouth because they would be in the way, then they would not be indicated. Check out clear aligners such as Invisalign or others. Dr. Conrad

Basically, you should be able to eat pretty much what you want. But stay away from caramels or food like that on that crown. Sticky food can pull off crowns with the best bonding or cement. But zirconia crowns are the new standard for hardness and durability. Usually the underlying tooth would break before the crown would, they are that strong. Which is not to say that you should make a steady diet of jawbreakers and ice, just to test how strong they are! Dr. Conrad

No idea what could be causing it. You didn't specify exactly where it was located (top/bottom, back/front, right/left), so I'm at a loss. Despite all your oral hygiene care, things can happen that are out of our control. A tooth with a large, deep filling or even a new deep cavity can abscess, and the fistula could be the result of that. Also, a tooth can fracture, killing the nerve and causing the same thing. Gum infections can also cause fistulas as can prior tooth injuries. Patients with fistulas rarely have much, if any, pain. The fistula is a "pressure release valve". As pus/infection builds up, if the pressure is not relieved there will be tremendous pain. But once the pressure forces its way out and forms a fistula, the pain is usually gone. But even if there is no pain, the presence of the fistula means there is constant infection that can cause bone/gum/tooth damage. But I have no idea regarding the items you listed as coming out of the fistula. Very odd, and troubling. In any case, if you cannot get treatment and or satisfaction from that oral surgeon, seek care from another. If you're close to a dental school, have someone in their Oral Medicine department check it out. Don't delay. What you describe sounds serious. Dr. Conrad

Hopefully you washed and rinsed it well after dropping it. If you have no symptoms after 5 days, you're probably in the clear. Get a new toothbrush and don't let that happen again! You may have dodged a bullet with infection! Dr. Conrad

Two things you should avoid for now. 1. No more colloidal silver. There are other, safe r options for treating a cold sore That is certainly where the metallic taste came from. Perhaps you used too much. 2. Stop the oil-pulling. You obviously overdid it with that. While t here is scientific evidence of some benefits of oil pulling with coconut oil, high-quality evidence is somewhat lacking. How much salt did you use? The rule of thumb is 1/2 tsp of salt in 8 oz. of warm water , 3-5 times a day. But that is used for inflammation and infection, not a bad taste. However, the salt water rinses (if the appropriate dosage) would have helped the sore alone. Too much salt will dry out and irritate the oral tissues. If you have irritated your mouth with the salt water and silver, spicy and/or salty foods and alcohol will continue to irritate it. And here is information about your dangerous use of colloidal silver: Colloidal silver is a mineral. Colloidal silver products were once available as OTC drug products, but in 1999 the FDA ruled that they aren't safe. Colloidal silver can kill certain germs by destroying proteins, which is why it was previously used in wound dressings. But silver has no known function in the body and is not an essential mineral. Taking silver by mouth can cause the skin to turn a permanent bluish color. It can also cause brain function problems. Colloidal silver has been used for infections, hay fever, skin conditions, and many other conditions, but there is no good scientific evidence to support any of its uses. It can be unsafe when taken by mouth, applied to the skin, or inhaled. Stick to mild, bland food for 3-5 days. Stay away from excessively hot or cold food and drink. Alcohol also dries out the mouth, so stay away from that. If you want to attempt to use salt water, try it in the dosage I provided. if that makes your symptoms worse or they don't improve, stop using it and get to a dentist or oral surgeon. Dr. Conrad

Avoid very hot drinks, as they can warp the retainers ( and burn you !). Also avoid very dark drinks such as coffee, tea, dark sodas, red wine and dark juices. All of those can lead to staining. Dr. Conrad

Yes. But zirconia is not always the best for every area of the mouth. It is best for the molars that take the brunt of chewing. Toward the front of the mouth, perfectly acceptable materials in regard to strength often give a better looking result. That is because zirconia tends to be more opaque and not as natural looking in some cases. Dr. Conrad