Q: My dentist says I have a cracked tooth and need a crown, but it is not hurting. Why would I need the crown?

A: Craze lines and cracks are usually indicators of a larger problem, like clenching, biting on hard objects, or large amalgam fillings that need to be replaced. Even though not all cracks are painful, they don't get better and could (and usually do) result in further damage to your tooth. It is best to treat a crack early, when treatment will be more predictable, as opposed to waiting for the tooth to start hurting or fracture, where you will be bound by your circumstances. A crown functions to restore the tooth and provide much needed stability to protect it from further damage.

Q: I recently went to the dentist and he said I have pocketing in my gums. I've never had this problem before now. What does this mean?

A: Healthy gums have probing depths around the teeth of 1-3mm. If you have periodontal disease, bacteria between your teeth and gums has caused loss of the attachment around the teeth which results in inflammation (bleeding) and pockets, anywhere from 4mm-6mm and deeper. Usually if caught early enough, your hygienist can clean shallow pockets. In conjunction with your diligent home care, this will help you begin to resolve the issue.

Some pockets are so deep they require deep scaling which can take several visits to the dentist to clean the whole mouth. Sometimes this is severe enough for your dentist to refer you to a periodontist, a dentist who only treats gum disease. Depending on the severity of the pocketing, the periodontist may want to treat your disease with gum surgery.

Like cardiovascular disease, periodontal disease is usually painless and can progress significantly in a short time. However, with patient compliance, it can be prevented and/or managed with regular brushing, flossing and visits to your dentist.

Q: I have old amalgam fillings. Will I get mercury poisoning? Should I have them removed?

A: There is absolutely no credible evidence whatsoever of amalgams leaking mercury into the body at toxic levels and to date, no one has won any case in court over it. Here are a few facts about amalgam fillings and mercury: Mercury vapors are around us all the time. There's more mercury in a can of tuna than a filling, and actually, after the amalgam is placed, the mercury in it becomes inert. Over the life of the filling, it will breakdown. For a patient with an average of seven fillings, this breakdown will result in a daily intake of 0.3 micrograms of mercury. The World Health Organization states a safe daily threshold of mercury exposure is 300 to 500 micrograms!

If your old fillings are still intact, keep them unless you want more cosmetic fillings. Amalgam fillings do tend to cause cracks and fractures over time, however, and this leads to crowns. I would check the ADA website for more information regarding mercury in amalgams. You can also read more in the ADA Newsletter, March 7, 2005, Volume 36, No. 5, cover story "Study Backs Amalgam".

Q: I refused x-rays last time I went to the dentist. Are they harmful?

A: Any type of radiation in large doses is not good for you. However, the amount of radiation received from "background" sources (sun, appliances, etc) per year is about 180 times what you receive from dental bitewing x-rays! In other words, radiation form dental xrays is insignificant. When radiographing teeth, there is minimal tissue that the x-rays have to penetrate, so the level of radiation needed is very low. Dentists cannot properly and completely diagnose any treatment you may need unless they can see the complete picture. If it's a financial matter, just remember that x-rays are less expensive than having to get alot of dental work that could have been prevented if the dentist could've originally seen x-rays. Next time your refuse x-rays, you're really refusing comprehensive care and taking treatment into your own hands.

Q: My dentist told me I need my wisdom teeth extracted, but they're not bothering me. Why do I need this treatment?

A: Third molars (aka: Wisdom teeth) can cause many problems if not extracted, like periodontal disease, cysts, tumors, jaw fractures, tissue inflammation and decay. Even when they "fit" in one's mouth, they are usually very difficult to keep clean leading to decay and tooth pain. It is best to get them out early (late teens, early twenties) when healing is optimal.

Q: I changed dentists recently, and at the new patient exam, my new dentist checked my jaw and jaw muscles, spent a long time looking in my mouth and even wanted me to return for a second "consult" visit, where he told me I needed a bunch of work I didn't think I needed. Sure, I have old fillings, but they never bother me. My old dentist never did all this. I feel like I'm being swindled and am thinking about going to someone cheaper anyway. What's with all the extra stuff?

A: Your old dentist may have just treated problems as they arose, or just treated a tooth at a time, instead of treating the whole mouth, or better yet, the whole person. While this is acceptable, it is not comprehensive in nature and therefore not the best approach. The best initial exam will consist of checking anything that pertains to the health of the whole mouth and therefore the whole person. This could include jaw joints, jaw muscles, soft tissues, checking your bite, etc... By offering several options to restore or replace old work, even though these teeth may not bother you now, the new dentist is probably trying to treat more than one problem and/or prevent future problems from arising. I would encourage you to ask your new dentist as many questions about your treatment as possible. I'm sure they would be happy to explain what they propose to treat and why, so that you'll have a clear understanding of why the health of your mouth matters. Chances are, your old dentist did not involve you in any of these decisions.

As for finding a "cheaper" dentist, you'll always be able to find someone cheaper than the other guy, but unlike shopping for tires or TV sets, a bargain where the health of your mouth is concerned does not always work in your favor. Also, make sure you're comparing apples to apples. For example, a dentist in a rural community is going to be less expensive than one in a more populated area, where "usual and customary" fees are generally higher. Besides, if you look at the price of a crown over its lifetime, it's a very economical investment. Bargain hunting may only shift the focus away from what's in your best interest to what will only get you by.

Also, "usual and customary" fees are simply fees that insurance companies have assigned to dental procedures to help them decide how much to reimburse patients. Each insurance carrier arrives at these numbers independent of the other based on their own formulae. In the end, the fee assigned is simply the opinion of the insurance carrier and is not deduced using the same criteria a dentist would use in setting his/her own fees. So "usual and customary" should never be used as a basis for how a dentist should charge for his or her work.

Q: My dentist wants to "equilibrate" my bite before he starts my work. All I need is a couple of crowns, so why all the fuss?

A: The mouth is a system involving your teeth & gums, your muscles, and your jaw joint (TMJ). When one part is not working properly, it affects the rest of the system. For instance, if your teeth are not coming together exactly the way they should, it can lead to many problems such as TMJ pain, cracked teeth, loose teeth, muscle soreness, headaches and uneven or unusually heavy wear on your back and/or front teeth. By equilibrating, premature contacts or interfering contacts will be conservatively ground down so that your teeth will come together optimally and in proper conjunction with your muscles and TMJ. This will ease current problems, prevent possible future ones and make the dental work you receive last longer and more predictably.

Q: Why should I replace missing teeth?

A: Your mouth is designed for all your teeth to be present and working together. Not only will you be able to chew better by replacing missing teeth, but your appearance, health and function could be improved as well. If missing teeth are not replaced, other teeth will shift into their place, possibly leading to decay, periodontal disease, and a permanent change in the way your teeth come together, which could affect your jaw joint and jaw muscles negatively.

Q: When should I first bring my child to the dentist?

A: Usually around three years old, when their baby teeth should all be in and their attention span may be better for sitting for a few minutes to be examined. The first few visits are of vital importance, since this could affect the way your child views dentists and dentistry for the rest of his or her life. Sometimes, during the first visit or two, the dentist and his staff will do nothing more than talk to the child and get to know him/her and do nothing having to do with dentistry.Once that trust is earned, more thorough examinations can be performed later on. It is also very important for parents to make sure they are always very positive about their own dental visits when speaking of them in front of their children. To make a child irrationally scared of going to see the dentist is to seriously disable them for the rest of their life.

Q: I recently had a hip replaced, about 1 year ago. Last week I went to the dentist for a cleaning, and they wanted to give me some pills before my cleaning. They said it would help my hip from getting infected. I've never heard of this, and I don't like taking pills anyway. What does my hip have to do with my teeth? Have you ever heard of such a thing?

A: Yes, this is done regularly, but many practitioners have recently begun to revise their approach to this. The idea is that when you get your teeth cleaned (or repaired), it can stir up bacteria that makes it into your bloodstream and can infect the artificial joints. If you take antibiotics 1 hour before, the amount of medicine in your bloodstream will be great enough by your cleaning time to fight off any threatening oral bacteria stirred up during the treatment.

Recent articles have come out questioning the actual benefit the antibiotics have on the artificial joint, saying that the bacterial load from the mouth is greater all the other days of the year the patient is NOT getting their teeth cleaned, so how bad could 45 minutes at the dentist be. They also call into question the fact that the risk from a bad allergic reaction to the antibiotics is greater than a joint infection. Some articles have cited the bacteria most likely to infect a joint are not even oral bacteria at all. With all this in mind, until more definitive guidelines are presented and agreed upon, most offices will continue to prophylactically administer antibiotics 1 hour before your dental appointment, especially if the joint surgery was performed within a 2 year period of your cleaning. Ultimately, whether or not you need to take antibiotics before your dental appointments is up to your physician.

Q: My long-time dentist just sold his practice. Even though the staff has stayed, I'm not sure about the new guy, and I don't like change anyway. Besides, I need to go to a crown "specialist" since I have a lot of old crowns and I'm not sure this new guy could take care of any problems. What should I do?

A: Great question. Ultimately, you should end up with someone you trust, period. If you don't trust the new guy, then leave--you will both be better off. But before you make your move, consider giving him at least one chance. By switching dentists, you're not just changing the dentist, but also the hygienists, the assistants, the front desk personnel, the location, the parking, etc, etc, etc... Talk about change! If you stay where you are, then barring any major dental work with the new guy, not much has changed for you. This beats starting all over with a whole new office. In other words, both dentists would be new to you, but if you stay put, nothing else changes. Besides, your old dentist probably would not have sold his practice to someone who would not do his best to take care of his patients.

By "crown specialist", I'm assuming you mean a prosthodontist. All dentists are taught to prepare teeth for crowns the same way. A prosthodontist will not prepare a tooth any differently than a general dentist. While it's true a prosthodontist has had extra training in full-mouth rehabilitation and complete dentures, unless you are a candidate for these things, you will probably not benefit enough from his training to justify leaving the practice. It's like killing an ant with a cannon--effective, but not necessary in most cases.

Q: Does flossing really matter?

A: Yes! Flossing is a way for you to reach the places your toothbrush cannot. Bacterial plaque can get in between your teeth and cause decay or periodontal disease, which is the loss of attachment of your gums and bone to your teeth. The only way to remove plaque is mechanically through flossing. Periodontal disease is a "silent" disease, meaning it is usually painless and can cause great damage in relatively little time. The best way to avoid it is to brush and floss daily and visit your dentist regularly.