Michael A. Conrad

If the caries has not penetrated the dentin of the tooth, I use a tiny dental bur called a "fissurotomy" to open up the fissure and remove all the decay in a very conservative manner, then it is sealed up with a flowable composite containing fluoride. If it has penetrated to the dentin, more aggressive treatment is indicated requiring an actual restoration or "filling." If this is a recurring problem, your dentist can prescribe an extra-strength fluoride gel to use.

Dr. Conrad

Yes, it usually does, but it generally takes a long time. It is caused by the premature loss of the blood clot in the socket and an infection that results. Your general dentist or oral surgeon can treat it and it usually goes away in a matter of days. It often occurs a few days after the surgery when the area was feeling pretty good, then a severe pain develops. It is more common on the lower jaw than the upper. You'd think that it would be the opposite, that the clot on the upper jaw would simply drop out due to gravity. But the lower jaw has a far more limited blood supply, so the clot is often weaker and more easily dislodged. Even if you follow all the post-operative instructions to the letter, about 30% of surgery patients get dry sockets anyway. If you don't follow all the instructions, your chances of getting a dry socket increase tremendously. If you have a dry socket, get treatment. It's not worth the long wait with pain until it heals naturally, and the treatment is usually simple.

Dr. Conrad

Lower molars are notorious for pieces of tooth or bone breaking off during extraction. Sometimes as you describe, it is necessary to go back in to retrieve an unwanted piece of tooth. In rare cases, a portion of the root may remain after the extraction and the surgeon may elect to leave it in place, since trying to retrieve it may be risky to other teeth and/or nerves and blood vessels.


Bone can break during extraction. Sometimes that small break is clean through and the piece can easily be seen and removed.


Other times, however, the bone fractures but doesn't detach. Over time it will eventually dislodge and try to come out through the gum, just like a splinter. Often that is on the tongue side of the extraction site. Patients have been know to remove the "splinter" themselves, but your dentist can do that as well.


Also, removing a tooth can result in a sharp contour to the bone that will eventually smooth out on its own. It can be very irritating to the tongue. If is too much of a problem, your dentist can remedy it, but that may involve some minor, additional surgery.


Dr. Conrad

Certainly it can be fixed. Four options come to mind.

1.  Braces- orthodontics can close the space when appropriate. It depends on the type of space and is not always possible or affordable.

2.  Crowns- can not only close the space in ideal circumstances, but can also restore the teeth to a more pleasing color and shape.

3.  Veneers- like crowns, they can close the space and change tooth color and shape. They do not require as much tooth shaping and preparation.

4.  Cosmetic bonding- an application of tooth colored filling material (resin) to reshape the front teeth, closing the space.

Veneers and crowns may turn out to be as expensive as orthodontics. Bonding is generally the most affordable, though not as long-lasting as veneers or crowns. However, no matter if you choose veneers, crowns or bonding, be careful that the final result doesn't give you extra large, unnatural teeth. Sometimes the space is simply too large to leave you with a normal looking smile. Your dentist can discuss these options and make recommendations for the best treatment for you.

No, the materials are not toxic and have been used for many, many years. But, of course, there are people who have an intolerance to certain materials and cannot use them. If you have an extremely rare reaction (allergy?) to one type of material, there are many others that can be tried. But the odds are overwhelmingly in your favor that you will not have any reaction to denture materials.

Dr. Conrad

That can be extremely painful. But are you talking about an actual abscess with an existing wisdom tooth, or an infection resulting from a wisdom tooth extraction? What you're describing seems to be the second.

I feel like I should change my name to "Dr. It All Depends." Because it does depend on what type of infection you're experiencing. If it is a severely infected tooth that needs definitive treatment like extraction or root canal, then the antibiotics will not clear up the infection until the cause of the infection is addressed. If it is infection following an extraction or root canal, then different antibiotics may be needed or new treatment such as more oral surgery.

Dr. Conrad (Dr. IAD):)

I certainly would not change your dentist at this point. There are many factors that can cause a veneer to fail. Remember, they are only bonded to a flat surface. Any quirky tooth movement may break that bond and the veneer can come off. If you are a grinder and clencher at night, you should be wearing a night guard to protect the veneers while you sleep. But there also could have been an unknown variable when bonding, such as an inadvertent moisture contamination, and the bonding could have been compromised. Remember, the veneer is a very thin facing of porcelain, and though veneers in general can last a long time, you must be careful with them. Despite all our efforts, they are never as strong as a solid, healthy real tooth. I would treat this incident as an unknown one, unlikely to happen again- that is, unless there is some sort of damaging habit or the lack of a night guard.

Dr. Conrad

It depends where the cavity is on the affected tooth. If the dentist cannot access the area with the braces on, portions of them may need to be removed temporarily by the orthodontist to allow the cavity to be fixed. Then the braces can be put back on.  t is rare, but remember, it is vitally important to limit sweets and acidic food and drink while in braces, and use additional fluoride to protect you while you're wearing the braces.

Dr. Conrad

It is best to avoid hot liquids and food immediately after surgery, especially if you still are numb. It's too easy to burn yourself. But in general, take care of the implant site. Be careful, it needs to heal and not be stressed. After all, it's a very expensive procedure and you don't want to do anything to jeopardize it. At best, we recommend gentle, warm salt water rinses beginning the next day.

Dr. Conrad

Only a few days to a week if they've been recently and properly adjusted. If it persists longer than that, get help, something needs to be fixed.

Dr. Conrad

A dry socket will usually resolve on its own, but it can take weeks for some people. It is better to get professional help to make it go away in just a few days. Dry sockets can be quite painful, and there's no sense having to endure one longer than necessary.

Michael A. Conrad, DDS, PC

I have patients that respond very well to either Invisalign or conventional braces. After clear aligners are prescribed and made, the greatest responsibility for getting the desired result lies with the patient who must adhere to the rules and proper sequence of using the aligners. For conventional braces, the patient responsibility is also to follow the rules, but he or she must show up for appointments for the orthodontist to continue care through adjustments and monitoring.

What is most important is the person providing the diagnosis and treatment. I recommend going to this website from the AAO (American Association of Orthodontists) to read the positive and negatives about both options:
https://www3.aaoinfo.org/blog/braces-vs-clear-aligners/?gclid=CjwKCAjw9uKIBhA8EiwAYPUS3IwSM68plY5A8MzoAmZUmMqxmAvhP_RPXXWO3hx8xj7AxCvpPP1AexoCz6sQAvD_BwE*/

Michael A. Conrad, DDS, PC

Let's be clear: Plaque is the soft substance that forms on teeth from the bacteria that live there. Plaque can be removed with a toothbrush and floss. Once it has been around for too long, likely over a day, the calcium in the saliva begins to harden it into tartar (dental calculus), and it will not be removable with the brush or floss. Eating lots of candy will not form tartar. Long-term lack of proper brushing and flossing and inadequate plaque removal will form tartar. It can only be removed with scaling (scraping) or ultrasonic cleaning. I would like to say, "If you have a steady hand, lots of manual dexterity and can work in a mirror, go ahead." But I can't say that. It can be dangerous to the gums and teeth. If you are forming that much tartar, you need to modify your diet, increase your brushing and flossing, and seek professional care. Plaque and tartar cause tooth decay, gum disease, and very bad breath. Which is more important: lots of candy or teeth? You decide.

As usual with many questions that come my way, the best answer is, it depends. Since all decay comes from some sort of acid attack, how it spreads and grows is determined by:

*1. Type of acid exposure **

*2.  Duration of acid exposure **

*3.  Frequency of exposure **

*4.  Frequency of personal oral hygiene (brushing and flossing) **

*5.  Efficiency of personal oral hygiene **

*6.  Type of personal oral hygiene **

*7.  Frequency of professional oral hygiene.*

Someone who brushes for 30 seconds 10 times a day, but never flosses may have a more rapid progression of tooth decay than someone who brushes 2 minutes or longer at least twice a day and also flosses. Someone who has a sugary diet throughout the day will have more rapid decay than someone who may not brush as well, but has virtually eliminated sweets and acidic food and drink. The secret to avoiding decay is *limiting* acid exposure, frequency, and duration, while *increasing* the frequency and efficiency of personal and professional oral hygiene, Some very small beginning cavities can actually be halted and sometimes reversed by proper care.

Michael A. Conrad, DDS, PC

I'm not sure about the specifics of your question. But, in general, dentures will have either acrylic or porcelain teeth. Before acrylics came along and were fully developed, porcelain was the only option. It looks great, but has some disadvantages. It is fragile and can break easily if the denture is dropped. The teeth are held in place mechanically, usually by a pin, so they can dislodge from the pink denture base. In addition, porcelain is often harsh on opposing natural teeth and can cause their premature wear. If upper and lower dentures have porcelain teeth, you may get the "click/clack sound" - hence the nickname, "plates." Acrylic teeth are bonded to the pink denture base because the materials are basically the same. They now look great and it is impossible to tell them from the porcelain ones. They are not as durable, and will wear more than the porcelain ones, but they are kinder to natural opposing teeth and will not fracture as easily. If you are talking about standard dentures, those are your tooth options.

Now, if you are talking about implant dentures, there are a few types to discuss. The first, best and most expensive and extensive are implant-supported, screw-attached dentures, most commonly called All-On-4 dentures. They are attached to a minimum of 4 implants and screwed in place. Only the dentist can remove them. The teeth can be in porcelain (zirconia) or acrylic. You can also have "Snap-in" implant dentures. They are more reasonably priced than the screw-in types, and are attached to posts that are part of the implants. Usually, those attachments are called "Locators." The dentures are removed by the patient regularly, but stay in without the need for adhesives. The attachments need routine maintenance, but it is minor and easy for the dental team.

Both types of implant dentures are much smaller appliances than their regular denture relatives, because there is no need to cover as much of the mouth for retention, since the screws or snaps provide that. So, while a conventional upper denture must cover the roof of the mouth for suction to keep it in place, that is not necessary with implant dentures.

Lots of options, and lots to think about. Conventional dentures are the cheapest, but they require covering more of the mouth. Implant-supported dentures are the most expensive, but are the most comfortable and easiest to tolerate. If you are a candidate for implants and have the financial means, they are often the best option.

Michael A. Conrad, DDS, PC

If it is hot enough to burn your gums, tongue and throat, it is certainly hot enough to harm the pulps of your teeth. Remember, the pulp (nerve, artery and vein) just fits into the spaces inside the tooth - the pulp chamber and the root canals. Any trauma, which would include extreme temperature, can cause swelling of those tissues. If the swelling is extreme, the pulp can be strangled because it has nowhere to go. That will cause pulpal death and, ultimately an abscess. In addition, extreme temperatures could also contribute to teeth cracking.

Michael A. Conrad, DDS, PC

If you are talking about local anesthesia or nitrous oxide (laughing gas), you will not be drowsy at all. If you are talking about general anesthesia (IV sedation), you may be a bit groggy for 10-30 minutes, but will be remarkably awake shortly after the procedure ends. If you are talking about other forms of anesthesia such as those done with oral sedatives, it could take hours to fully recover.

Michael A. Conrad, DDS, PC

There's nothing wrong with wetting the brush first. But a little water may help get rid of the plaque that has accumulated. Just make sure not to use regular toothpaste. It has abrasive particles to clean the stains off real teeth, and those particles are too abrasive for acrylic dentures. It's also a good idea to brush over a sink filled with water or a towel, just in case you drop the dentures. That way, you can prevent damage.

Michael A. Conrad, DDS, PC

YES! The cause of enamel loss, other than injury, is acid attack. That acid either comes from the bacteria in dental plaque digesting carbohydrates in your mouth or from acid that you put in your mouth. The pH scale measures the levels of acids and bases on a scale of 0 to 14. Acids start at the lowest value and bases are the highest. Neutral pH is 7, like pure water. Acids dissolve things, and enamel is particularly susceptible. Hydrochloric acid and sulfuric acid have pH values of 0 and 1.0 respectively. Stomach acid comes in at 1.2, and lemon juice is quite low at 2.0. Repeated exposure to lemon juice will erode your enamel, not to mention contribute to acid reflux, which is a major cause of enamel and tooth loss. Sucking on lemons is a certain tooth destroyer, and drinking lemon-flavored water, though weaker because of dilution, is also enamel destroying. It just takes longer than the pure lemon.