I HAD A ROOT CANAL - WHY DOES MY TOOTH STILL HURT?

I HAD A ROOT CANAL - WHY DOES MY TOOTH STILL HURT?

I have heard this question many times from new patients coming into the practise or from emergency patients having problems with a tooth.  Of course the answer is never simple and always depends on the circumstances.
When someone has had a root canal treatment the tooth is now altered and may not feel exactly the way it did before.  The questions we must ask:  Is the tooth functional?  Can you eat on it without discomfort?  If you answer yes to both then there is no problem.  If the answer is no then there is a problem and that is what we will deal with in this blog.
Lets start with the simple.  If you just had a root canal yesterday and your tooth is hurting it is most likely some post op discomfort and it will most likely resolve shortly.  You can even get some swelling after the treatment which may need an antibiotic but then will resolve.
What we really want to discuss here is the tooth that had root canal treatment a while ago and you still can't eat on it.  General success of root canal treatment is in the very high range.  If a root canal treatment does not succeed there can be a number of reasons which in general amounts to bacteria still being in the root canal system.  This can happen because there may be an extra canal (or two) which we didn't find.  It can also be because the root canal system is so convoluted that we couldn't clean out the entire root canal system well enough.  Another reason that a root canal may fail is due to a fracture in the tooth which may never have been noticed.
So probably the more important question in all this is what can be done?
This question usually involves a discussion with your dentist because the answer is not always black and white.  If the root canal looks like it was done poorly then you would consider redoing it.  The results could be very good.  If the root canal looks like it was done well then you have to consider the cost benefit of redoing the root canal or apical surgery (all in an attempt to stop bacterial leakage into the surrounding tissues) versus extraction and implant placement. I have simplified things but as I said earlier this will involve a discussion between you and your dentist as to the proper course of action depending on your individual circumstances.

Having fun doing Dentistry in Hamilton Ontario

All the best
Dr. Ron Barzilay
www.rondentist.com

PS you are welcome to follow the blog and leave comments

How to make your Dentist HAPPY!

Dentists are just ordinary people and like ordinary people something's make them sad and something's make them happy.  Something's make them angry and something's make them smile.
Why is it important to make your dentist happy?  Well I guess I could tell you that he is the guy holding the needle so it is not a bad idea to make him happy (just kidding) but that is not true.  Your dentist is a professional and even if he is angry he will never hurt you and he will always act for you benefit.  Then why even worry about whether you dentist is happy or not.  I guess it is the same reason we try to make anyone happy.  Because it is the right thing to do!!  But here is a little secret that many people don't know.  If you treat people well then they will treat you well.  If you are nice to your dentist he will be nice to you.  If you don't miss appointments or cancel at the last second he will be more inclined to stay late for your emergency.  If you are just plain nice then the whole office will always bend over backwards for you in just about everything.  No this is not a secret but for some reason (and it is so simple) most people don't know this. 

So what makes a dentist happy you may ask?  Well here are a few things:

Remember your appointments especially if you just booked it yesterday.  Don't be a habitual appointment no show.
Remember to shut off your cellphone when going into treatment.  Nothing worse than the cell phone buzzing throughout treatment.
Brush your teeth!  Next time your dentist asks you why you are not brushing don't say "It's a time thing!"  We know that anyone can find two minutes in the morning and two minutes in the evening, which is much less time than you spend watching TV or checking your Facebook everyday.
Remember to do the treatment that has to get done.  Nothing worse than you showing up a year later with a toothache and now we have to extract the tooth which we told you then was just a small filling.
Nothing is worse than this happening to your child because you didn't book the appointment, better it should happen to you.
Remind your children we have coloring books for coloring and the reception carpet is not part of the coloring book.  Yes we do love children and see so many of them but we just ask them and you to respect our home as you would respect your own.
Oh yes, remember to pay your bill. 

There are more things but I think you get the general idea.
"Remember to treat your dentist, or anyone, as you would like to be treated yourself."

Having fun doing Dentistry in Hamilton Ontario
All the best to everyone.
Dr. Ron Barzilay
www.rondentist.com

If you have a comment let me know and you are more than welcome to follow this blog.

Discussions while Ziplining in West Virginia

While on vacation in West Virginia  I was zip lining and the guy beside me happenned to be a dentist from Manasus Virginia.  We started to talk and he asked me "what piece of equipment could you not do without?"  I answered, my air compressor since it powers my drills.  I thought about it later and then I realized that there is no one thing.  How can I practise without my gloves?  How can I practise without my magnifying glasses and the list goes on and on.......
Dentistry is complicated and multifaceted and doesn't fit into a small bag.
This is a good thing because we do so much today on so many different levels.
I guess you never know who you will run into or what you will talk about while ziplining!

All the best!
Dr. Ron Barzilay
www.rondentist.com

My Insurance pays for a cleaning every 9 months. Do I need a cleaning more often?

My Insurance pays for a cleaning every 9 months.  Do I really need a cleaning more often?

I have heard this question many times.  The answer is quite simple.  Insurance plans are financial arrangements between the employer/patient and the insurance company.  One insurance plan allows cleanings every 9 months, one plan allows every 6 months, one plan every 3 months.  Other plans allow a certain amount of cleaning per year.  Yet other plans allow unlimited cleanings.  This variation occurs across the broad spectrum of treamtments done by dentists among the thousands of dental insurance plans that exist.

We as dentists treat patients and your needs as patients.  The dictates of insurance companies are really between the patient and that company.  What the patient needs to remember is that if you go the route of "I only want what is covered" then you have to be prepared for the consequences.  For those people with naturally "good" teeth there may be no consequences as they never really need much in the way of cleanings and dental work.  Most of us are generally not that lucky and if we don't maintain our teeth then we suffer.

So, yes the answer is quite simple, if your dentist says you need it then you need it!  You have to ask yourself, "How important are my teeth to me and what am I willing to do to keep them?" 

All the best

Dr. Ron Barzilay

www.rondentist.com

A Hamilton Dentist having fun in Hamilton, Ontario.

Sometime a Single Tooth Goes Dark

Here is an exchange regarding a single tooth going dark.  I hope it is useful to anyone out there with a similar question.

Dear Dr Barzilay, I live in PA, so I am not inquiring to be a new patient. I have been searching the internet looking for treatments for teeth whitening options, specifically one tooth. One of my front teeth seems to be getting darker than all the rest. I have not had any damage to the tooth or root, no root canal, just darker than the rest. I have never had white teeth, so I am not looking for magic, just suggestions. I am 56 years old and in good health. If you can give me any kind of suggestions or if you have anything in Canada that we do not have in the US, I would greatly appreciate if you can tell me. Thank you very much. Sincerely, C

HI C,

Whitening of the one tooth really depends on the reason it has darkened and how dark is it?  There is always a reason it has darkened relative to the other teeth.

Sometimes you will have received a blow to the tooth and you will not even remember it.  The nerve has been damaged and the nerve as a defense mechanism lays down more internal tooth structure which makes the tooth appear yellower than the other teeth.   In some cases as a result of a blow the nerve dies and the tooth darkens and a root canal treatment is required before any whitening.  You really need to see a dentist to tell you why the tooth has darkened.  That will dictate the treatment.  Sometimes we can bleach the individual tooth from the outside.  Sometimes if there has been a root canal (which you may or may not need) we can bleach it from the inside.  Sometimes you need a veneer or a crown on the tooth.  It really depends on the reason the tooth has darkened so my main suggestion is to see your dentist and find out why the tooth has darkened and he/she will tell you what can be done.

 

All the best

Dr. Ron Barzilay

 

 

Dr.Barzilay,

I had my teeth professionally whitened a few years back, but to tell you the truth I don't think it made much of a difference. I have not had a root canal on the tooth in question.  It just seems a bit darker.  My dentist says it is just age.

Thanks again for your help!
C

 

 

Hi C,

On a single tooth that has darkened I have done bleaching on just that tooth.  Bleaching trays but you only place a drop of material on the tooth that has darkened.  I have had good results.  If you use trays and place material in the whole tray then all the teeth will whiten and the tooth that was dark will whiten but will always look darker than the others since they have also whitened.  Try placing a single drop of whitener on that specific tooth in the tray. (otherwise it is a veneer or crown which if it is a front tooth then they are always hard to match and then you are most likely going to be doing a  good number of  teeth to insure color match).

All the best

Dr. Ron Barzilay

www.rondentist.com

Thank you! I am going to try bleaching just the one tooth rather than all of them. I will keep you updated!

C

 

Dental Tourism - So Doctor what do you think?

So Doctor what do you think of my teeth?
A patient asked me that about the dental work he had done on a visit to Eastern Europe.  He was very proud to tell me that they paid for his flight, hotel, vacation and teeth.  But now he wanted validation from me that the work he had done was good.  Well it wasn't!  He may have had a new bright smile from ear to ear but the quality of the work was poor and it was just a question of time before this would fail.
I understand people who want to get a good deal or can't afford the work here but the same rule applies everywhere.  BUYER BEWARE!
Usually there is a reason that dentistry is cheaper in third world countries. 
You need to ask yourself a few questions before you go there.
1.  If I have a problem, can I afford to fly back there for them to fix it and will they charge me?
2.  If I have to fly back there to fix something did I really save anything?
2.  If I can't go back for a fix who will fix it for me at home and at what cost?
Truly, at the end of the day, you get what you pay for.  Most people do understand this since most people go to their own dentist where if there is a problem with the work there is someone standing behind the work ready to make it right.
If you want to take a chance and go for some dental tourism that it is your decision.  We will always be here if you need us.
A very smart man once said " things that are very cheap usually end up very expensive.

All the best
From a dentist enjoying Dentistry in Hamilton Ontario

Dr. Ron Barzilay

www.rondentist.com

Why does this crown keep falling off?

I have had patients who have been to other dentists and from time to time I get a patient who comes in with the same story.  "Dr., I had this crown done a number of years ago and about once every year or two the crown comes off and the dentist recements it.  Is this normal?  Why is this happenning?"

Well if the crown keeps coming off it means that either the glue holding the tooth is not strong enough or there is not enough tooth to actually hold onto.  Is this normal?  Probably not.

Lets first talk about the glue, there are weak cements used if we want to take a crown off at a later date and there are stronger cements so that even if we don't have that much tooth under the crown then hopefully a strong adhesive or bonding cement will still hold the crown on.  Unfortunately, if the dentist is  using a strong cement and the crown keeps coming off then you are in trouble.  Most likely there is not enough length of tooth under the crown.  If we don't have much tooth under the crown, that can be a real problem since even with strongest adhesive cements you still need something to cement to.  The forces of eating and chewing are really quite great.  The tooth is subject to  forces that pull and push the tooth in every direction and this is happening hundreds of times a day.
If you have a short tooth to begin with and then it must be even shortenned further to prepare the crown you may not have enough tooth structure to retain the crown.
This may be the case but should be planned for before placing the crown such as lenthening the crown before placement or placing retentive devices into the preparation.  A tooth that has been on for many years and now is falling off there is a different problem there.  A tooth that has only been on for a short period of time most likely the tooth is not long enough and the cement now matter how good just can't hold it.
What should you do?  Go back to your dentist and ask him what should be done as it is not right to have this crown coming off every 1-2 years.  He does have the solutions just ask!

All the best

Dr. Ron Barzilay

Doing dentistry in Hamilton Ontario

www.rondentist.com

Dr. why do I have to fill out all of these Questions?

Many times a new patient will come to the office and start filling out our medical questionnaire and half way through get angry and flustered.  They then come to the front desk and ask:  What do all these questions have to do with my teeth?

Well that is really a great question and the answer goes something like this.

Most people will never have a problem in the dental office but we in the dental office have to be prepared in case of emergency and we have to make sure that we don't do anything that will cause a medical emergency in the dental office.  This starts with a thorough medical history of our patients.  We want to know that our patients are not allergic to any antibiotic that we may need to give them, we want to know that they have not had a bad reaction to the local anaethetic that we need to put the tooth to sleep.  We need to know that our patients are not allergic to our gloves etc.  We want to know if our patients are taking any medications for an underlying condition as our anaethetics could react adversely with those medications or a medication that we may prescribe could act adversely with a medication that they are taking.  We want to know if they have an underlying condition so that we can determine if they are suitable for treatment in a dental office or may require referral for treatment in a hospital setting.  We would want to know regarding underlying conditions so that in case of emergency we are better suited to help them.  The different possibilities are endless but knowing as much as possible about our patients medical history will help us avoid any unfortold medical emergencies and if they arise will help us better deal with them.  In our office we take blood pressure readings for all new patients and at recall appointments for our existing patients.  15% of the population walks around with undiagnosed hypertension and we have literally come across a number of those patients.  Incidentally we have had patients whose family phycicians have told them that their dentist saved their life.  We also take blood glucose for our diabetic patients to see how controlled their diabetes is.  The examples and their importance are endless.  I hope you got the picture!

What do all these questions have to do with your teeth?  They have so much to do with your teeth and your overall well being!  Thit is a great question, thank you for asking so we could have the opportunity to explain this to you!

All the best
Dr. Ron Barzilay

having fun doing dentistry in Hamilton Ontario

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www.rondentist.com

It's ok to pull that tooth Doc, I already stopped my Blood thinners!

Doc, it is OK to pull that tooth, I have already stopped my blood thinners!

WELL WHO ASKED YOU TO STOP YOUR BLOOD THINNERS?

Alot of patients coming into the office, are on blood thinners and have a lot of questions.  Some patients come into the office and are on blood thinners and already have the answers.

Most people who are taking blood thinners are taking them to prevent blood clots in their blood vessels that could end up moving and blocking major vessels or structures.  The ensuing loss of oxygen to the blocked structures could have major consequences for the patient, including death.

This is a concern in dentistry since almost every procedure we do may cause bleeding.  From fillings, to cleanings, to extractions, to periodontal surgery, to root canals and so on.  In dealing with the thousands of patients that we have here in our office we must always be careful with those patients who have bleeding tendencies. 

Bleeding tendencies can be subidivided into those patients who have natural bleeding disorders and those patients whose bleeding is caused by medication that they are taking to "thin" the blood.  In this blog I am talking about those patients taking blood thinners as those are the majority we see.
 Many patients are taking Warfarin type medications and many are taking Aspirin.  Those patients taking Warfarin medications can have a largely increased clotting time.  Those patients on Warfarin have a test done called INR (international normalized ratio).  This INR is a target goal for coagulation depending on the underlying condition so that a patients' dosage is adjusted to the target goal.  In most situations a dentist can still work without having the patient stop his medication.  This will depend on the patient specific factors such as the INR, patients overall health, expected bleeding and the length of the procedure.
Many patients are on low dose Aspirin.  This usually does not represent a problem and most dental procedures can go ahead without any change.
Patients on Heparin are usually in a hospital setting so that is really not an issue but today there is is LMWHs (low molecular weight heparin) which allows the use of Heparin type medication outside the hospital setting and this may require stopping a patients medication.

After all this, the question really is what should you the patient be doing?  The answer is very simple.  Speak to your dentist, he will have the answers and if he doesn't he will be in touch with your physicians to dicuss the proper treatment for your specific situation.  In most cases you will not have to ask your dentist as your dentist will be discussing it with you.  In consultation with your physician he will tell you wether you need to stop medication or continue.  Most important never do anything on your own. Stopping your medication even for a short time on your own may have a very negative affect.  No matter what you read on the internet or heard on Oprah.  Speak to your dentist, because every situation is different and there are no cookie cutter solutions.

All the best

Dr. Ron Barzilay

enjoying dentistry in Hamilton, Ontario Canada

www.rondentist.com