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

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

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

I had a root canal many years ago and since the crown falls out all the time and it bleeds and smells really bad.

Sometimes you get a letter with questions that touch on numerous issues.  I received one such letter this past week and I would like to share it with you.

Hello Dr Barzilay,
I had a root canal many years ago and since the crown falls out all the time and it bleeds and smells really bad. After telling my dentist over and over again they referred me to a specialist who just found out that the dentist who did the first root canal missed a canal and it got infected that's why i was having so much pain. My question is if i get a crown on it again will it keep falling out? Or did it fall out because it was infected. Also my appointment to get my crown on isnt until 2 weeks from now how do I keep this clean from getting infected again I have a huge hole there it is my number 3 tooth. Thanks

Wow, these are great questions I thought I would put up this letter on the blog for discussion.  There are a lot of important issues that have been brought up here that deserve discussion and many things that I have seen throughout my years of practise.

1)  Why has this crown been falling off since it was placed.  A properly place crown does not fall off.  If this  crown has been falling off since it was placed we can only assume that it was not placed properly.  Meaning that perhaps the underlying tooth is too short to give retention to the crown and if so it may be necessary to lengthen the underling tooth or find retention by another method.  Another reason the crown could come off would be if the tooth was rotten underneath but we will assume that this was not the case since it was coming off from the beginning and a new crown would not have decay underneath.  My question here to the writer would be, how many years ago was the crown done? and what does falls out all the time mean?

2)  Bleeding gums and a bad smell around a crown can mean that the crown is loose and bacteria is getting in around the crown causing inflammation of the gums. ( when you touch inflammed gums they bleed).  Also, if the crown is loose and bacteria and debris are getting between the tooth and the crown you can get decay of the tooth and supporation of the debris leading to bad odour.

3)  Is the crown falling off related to the missed canal and pain you were having?  No.  The missed canal will not cause the crown to come off.  It most definetly may be the cause of your pain among other possible reasons (such as a moving crown or a cracked tooth).

4)  If you get a new crown on the tooth, will it keeping falling out?  You must get a new crown on the tooth and if it is done properly should not fall out as the original should not have fallen out.  Remember, the crown holding onto a tooth is just related to the physical properties of the tooth.  In other words, if the crown has what to hold it will hold.  If it doesn't have what to hold we have to start thinking about either making the tooth longer so there is more of what to hold or perhaps extracting the tooth and placing an implant as a regular crown will not hold.  You have to ask your dentist flat out "will this crown hold?"

5)  Now this last question is really important.  The patient say she has a huge hole there and wants to know how to keep it clean so it won't get infected.  Her appointment for the new crown is in two weeks.  Sometimes a hole is a result of the temporary filling being compressed into the crown space, in which case you may be getting bacterial leakage and you should go back to the dentist to top up the temporary filling.  This is simple and not a problem.  If for some reason there is no temporary crown or filling then that is a problem as bacteria can percolate through exposed root canals and cause reinfection of the canals.  Speak to your dentist regarding this.  The last issue here is also, as I have mentioned in point 1,  if  you are going to be having a new crown done in two weeks, ask your dentist what is different that now that will make the new crown stay on.


All the best

Dr. Ron Barzilay

Enjoying dentistry in Hamilton Ontario

www.rondentist.com

Feel free to post your comments and follow my blog.

My Tooth Hurts But My Dentist Can't Find the Problem- Good Chance It is a Cracked Tooth

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

Don't forget, you can become a follower of this blog!

One of My Permanent Front Teeth is Dark

Many times a patient comes in with a front tooth that is dark in comparison to the tooth beside it.  It may be grey or black or dark yellow.  The patient has usually had this tooth discoloration for many years, some from childhood.  They were used to it and it never bothered them until someone said something and now they are asking me.

Generally the discolorations that we are talking about are intrinsic.  That means they come from inside the tooth. 

A tooth that is yellower than the front tooth beside it is usually a result of a blow received to the tooth.  The cells around the nerve of the tooth perceive some sort of challenge and reply by laying down new dentin.  The dentin is the yellower inside of the tooth between the transparent enamel and the pulp of the tooth.  Once you have a lot more of that yellow dentin there, we see the tooth as being yellower than the tooth beside it.
How do we treat this?  We bleach just the one individual tooth and the results are quite good.

A tooth that is grey or black in color has usually had a root canal treatment done to the tooth.  Sometimes some of the root canal filling materials are left in the top part of the tooth, the crown.  It results in discoloration of the crown giving a grey or black color.
The treatment here is an internal bleach of the tooth.  The root canal chamber is openned and any excess rootcanal material is removed.  The tooth still has to be bleached as color has generally leached into the dentin.  A bleach consisting of sodium perborate and hydrogen peroxide is placed in the tooth for a number of days and if the color is not quite right it is repeated.  After the bleaching the tooth is closed with a new white filling.

In both situations these are both relatively simple solutions and work quite nicely, however not all situations are alike and depending on the situation other solutions, such as veneers or crowns, may be required.

I have touched on only two specific types of discoloration.  There are many other reasons for discoloration and best that you consult with your dentist to see why your tooth has discolored and how it can be made to look more aesthetic.

If you have any question, just send me an e-mail and I will reply.
You can also follow my blog at your leisure.

All the best
Dr. Ron Barzilay
A denitist having fun doing dentistry in Hamilton Ontario.

http://www.rondentist.com/