MY TOOTH HURTS BUT MY DENTIST CAN'T FIND THE PROBLEM

 This is a repost of a blog I wrote in 2012.  I am reposting this because it happens so often I just want to refresh your memories or to just sharpen the point. So please have a good read:

A patient comes into the office and says that he is having discomfort on one side. He has hasn't eaten on that side for months if not years.  The culprit tooth has a small filling in it or no filling at all.  In the x-ray the tooth looks perfectly normal.

I am most definetly starting to think CRACKED TOOTH!!

I place pressure on each cusp separately.  On one of the cusps, as the patient opens from pressing, then the tooth starts to hurt.  Yes it is a cracked tooth.

Can you see it on the x-ray?  No you can't since the tooth is fractured and not broken.  When it is fractured the two sides are close together and an X-ray will not pick up the fracture.

Why is it hurting if the sides are still together?  This is because, as you bite down on the tooth, the sides of the tooth are flexing.  At that point fluid moves in and out of the tooth causing pain.

So how do you fix it?  This is the easy or hard part.  It all depends where and how far down the root the tooth is fractured.  To fix this problem you need a crown on the tooth.  By shaving the tooth down and then covering it with a crown (or cap) all the forces of biting will be directed internally and the fractured parts will be held together thus stopping the pain.  To test this, we place a temporary crown on the tooth first.  If the symptoms disappear then we can go ahead with the permanent crown and have reasonable confidence in the outcome.  If the fracture goes further down the root and beyond the crown then the symptoms may persist.  We may need to do a root canal and the symptoms may then disappear.  But overall the prognosis is now guarded.  When the crown does not encompass the entire fracture the tooth may still be flexing and the long term prognosis is questionable.

Does this happen a lot?  Actually it happens quite a bit, even teeth that have never had a filling in them get fractures.  This is called wear and tear.  If you never use your teeth this will never happen to you.  Since most people use their teeth quite a bit and of course many of us also grind our teeth which makes this worse, quite a few of us will experience this throughout our lifetimes.

If you have any questions, you can always send me a note.

All the best

Dr. Ron Barzilay
Hamilton Ontario

www.rondentist.com

Oral appliance therapy - your dentist may save your life!!

What is oral appliance therapy and can my dentist really save my life?

Obstructive sleep apnea is a sleep related breathing disorder that involves a decrease or complete stop in airflow despite an ongoing effort to breath.  It occurs when the muscles relax during sleep, causing  soft tissues at the back of the throat to collapse and block the upper airway.

Well let's think about it, air flow stop, that sounds like suffocation.  For people with OSA this can happen a few times an hour to 40, 50, 60, or more times an hour while you sleep and it can be pretty serious.

If left untreated will have impact on your cardiovascular system, increase chance of motor vehicle accidents, psychiatric and behavioral issues, quality of life and productivity issues, endocrine and and neurocognitive issues.

A cpap (continuous positive airway pressure) machine can treat this but this machine is strapped onto you and the compliance is not great, perhaps around 50%.  If you can wear this machine then  your success is close to 100%.  If you can't get used to wearing this then you need to find another solution.

This brings us to the dentist, your dentist can fabricate an appliance (mandibular advancement device) for you that stops your tongue and jaw from falling backwards as you sleep and opens your airway to help you breath.  Many people can tolerate this much better and it again lets you breath while you sleep and perhaps saves your life.

Any questions you have don't hesitate to leave a reply on the blog.

Regards and all the best

Dr. Ron Barzilay

Hamilton Ontario Canada

www.rondentist.com

Another LOST TOOTH After a Root Canal Treatment

 So today I had to take out another tooth after the patient had a root canal treatment.

So many times patients come in and tell me how they had a root canal treatment and later had to have the tooth extracted as if this was caused by the root canal.  Sometimes root canals do fail and the tooth is lost but most of the time this is not the case.   The overwhelming amount of teeth that I extract after root canal treatment is because after the treatment the tooth was not restored properly.  That means that after the root canal a proper filling was not placed in the tooth and a crown was not placed on the tooth.

After root canal treatment the teeth are weakened and are prone to breakage and this happens a lot.  Unfortunately when this happens many times there is nothing left for us to do but extract the tooth.

So a little bit of friendly dental advice, get the crown after the root canal and protect your investment.

Doing dentistry in Hamilton Ontario

All the best

Dr. Ron Barzilay

https://thehamiltondentist.com/

www.rondentist.com

 Back in 2022 - Another Broken Tooth

HI Everyone,

Well I took a long break from writing this blog over Covid but it is time to get back to writing.  

Covid is still raging on and I haven't gone skiing in two years but we definitely have been doing dentistry for the last two years.  It has been done with a few more precautions than before but basically people are having the same problems and at the end of the day need treatment.

So the latest emergency I had was a patient who had broken a tooth.  I had told this patient that they needed a crown on this tooth for a number of years.  Not because this tooth had already had a root canal treatment  but because this tooth was a back tooth that the patient had been grinding on for years and now I could see the fracture areas starting to become visible.  I had warned the patient but you know how it is, if it doesn't hurt then why do I need the crown. or if it isn't broken why fix it.  Well at the end of the day you have to believe and trust the person who is telling you these things or else you may suffer the consequences.  The consequence here was minor.  We were able to fix the tooth and then put on a crown so it wouldn't break any further.  Of course it could have been worse and the tooth could have been lost.

Moral of the story, do what needs to be done and if you are not sure get a second opinion but don't wait for bad things to happen.

All the best

Still doing dentistry in Hamilton Ontario Canada

Dr. Ron Barzilay

www.rondentist.com

Do I need a Crown after Root Canal Treatment

Do I need a Crown after Root Canal Treatment

This is not the first time I have written on this subject and I keep getting asked this same question.
I understand the question.  People have had their root canal treatment and their tooth no longer hurts so why should they have this expensive treatment called a crown.  I mean they have just paid enough for the root canal. and the filling.
Well, this past week, another patient of mine came in who had his root canal done a few months ago and the tooth was cracked.  Nothing I could do and I had to extract the tooth.  Only problem was that this tooth was his last molar on one side and it held his partial denture.  Now that the tooth is gone he has a real issue holding that denture.  We have repaired the denture to have it hold better but a solution that will let him hold the denture at least the way it was is going to be expensive.
Yes you need the crown after the root canal treatment.  It will save you money in the long run.

Enjoying dentistry in Hamilton Ontario Canada

All the best

Dr Ron Barzilay

www.rondentist.com

PS. any questions, just send them as a comment

My Insurance! My Insurance! My Insurance! - Do you know anything about your insurance?

This is a true story.
A patient of ours was in the other day.  We had just made  new dentures for him and his wife.
We said we would send it to his insurance company to see if they would pay but he right away knew that they would not pay since he didn't have coverage for dentures.  Of course, shortly after that we heard from the insurance company that he has no coverage for dentures (major coverage).
He did tell us that he pays $170 dollars a month for only dental insurance for himself and his wife.
$2040 dollars a year for him and his wife and there was no major coverage.
My staff were flabbergasted.  They almost never have fillings to do and their cleanings amount to about 2 months of their premiums
So they pay their premiums faithfully every month but never get value.  In other words, in their case, it is not worth it to get insurance. Pay your dental bills out of pocket and they would be left with a larger sum of money in their pockets.
   Is this the case for everyone?  Of course not but it was the case for them.  Many people when they come to see me, say that they haven't been to the dentist for years because they didn't have dental insurance so they couldn't afford it.  I always explain to them that dental insurance costs money and that if they put that same money aside to go to the dentist they would be surprised by what value they get.
    The morals of the story?
 1. Check what you are actually getting when you buy dental insurance.  How much does it cost and is it really worth it.
2.  You can still go to the dentist even if you don't have insurance.

All the best

Dr. Ron Barzilay

Having fun practising dentistry in Hamilton Ontario Canada

www.rondentist.com

PS. If you have any questions just send a reply to the post.

Sometimes a small change can make a big difference

This patient came in and nothing really bothered her.  I suggested that we could make her smile look a little more aesthetic especially where she had some discoloration and old fillings on the roots on her upper left side.  They were visible in the smile.

I took out the old fillings and placed some white fillings.  We also covered up some of her discolored roots and then we got this....

She was very happy with the result.  It didn't take us very long to do and a much nicer smile.

Doing this is really a lot of fun.

Having fun doing dentistry in Hamilton Ontario Canada

If you have any questions don't hesitate to ask.

All the best

Dr. Ron Barzilay

www.rondentist.com