Sunday, December 20, 2009

Broken tooth...what to do?

Dear Dr. Ellie:

Thank you so much for personally writing back to me regarding fluoride rinse. It was informative and helped me. I am on your system of rinses and while I was in Rochester I purchased zellies at Wegmans. I am using only the products you recommend.

I have a situation with one of my teeth and I am trying to choose the best option. I have a tooth that has a large filling in it. About a month ago, a very tiny piece of tooth broke off. At the time, I thought I had lost a filling. After going to the dentist, and having it x-rayed, he told me it was actually a tiny piece of tooth. He gave me two options: 



Option 1: Restore the tooth with a filling or

Option #2 : Cover the tooth with a crown. He told me he did not recommend option #1 as he was concerned the tooth could crack in the future without the protection of a crown. He said most of the tooth is a filling. He also sounded like the was concerned the tooth already had a crack but he could not see it. He also told me the root in my tooth is calcified and looked like the root of a 70 year old! I don't know why but could it be because of such a large restoration being done in the past? He said it was very deep and wondered if I had had a pulpectomy done. I'm not sure what a pulpectomy is.

I have not known what is the best option for this tooth. The Dentist also pointed out that if I needed a root canal it could be difficult because of the calcification. Also, if there is a crack and it has gone into the root, he said I would lose the tooth. I went back to the dentist this past week for a cleaning. The dental hygienist took bitewing x-rays and told me I better do something about the tooth in question soon because she said she saw dental decay under the filling. I told her the Dentist had not told me there was decay under the filling. After my cleaning, I asked the Dentist if there was decay under the filling. He held the x-ray up to an office light (as we were standing by the receptionist's desk) and said that there could be and then said that the dental hygienist had looked at it with a better view of light. Well, I would like to know is there or isn't there!!


I am thinking of taking a wait and see approach while I am on this system. If there is decay under a filling, can being on this system reverse that? Or is the crown my only option. I am afraid of disturbing this tooth and then needing a root canal and losing it. If I choose to wait and see, are there any specific symptoms that would suggest the tooth could really be a problem?

Thank you so much. I apologize for the length of this email. If you got through it all, you are a saint! I look forward to your response.


Best regards,
M



Hi M,
Here goes! I am going to cut and paste from your questions below to try and explain the answers as clearly as possible.

Option 1: Restore the tooth with a filling
A big filling has only the remaining part of the tooth to support it. When fillings are large, biting can cause the filling to push against the "supporting" walls of the enamel. This may cause the walls to break. If you decide to opt for a filling there is always a chance of this kind of break.

So, if you do not crown this tooth it will be vital to strengthen the remaining enamel as much as you can. If you use my Complete Mouth Care System, and protect your teeth with Zellies after meals and snacks, you will strengthen and protect this remaining part of the tooth and reduce your risk but there will always be a chance of a piece of tooth breaking: ( I have large fillings that "should" be crowned but they are now over 40 years old and just fine!)

Option #2 : Cover the tooth with a crown.

Your dentist told you the root of your tooth is calcified and looked like the root of a 70 year old!
Teeth are a bit like trees: you know how a tree grows layers and layer, and increase in thickness around their trunk as they age. As teeth age they produce more and more dentin the part of the tooth under the outer enamel coating. Unlike a tree, teeth do not get bigger and thicker ( thankfully!) but the growth and thickness occurs towards the inside of the tooth.

This means that the live part ( where there are nerves, cells and blood vessels) gets squeezed and smaller and smaller. By the time some people reach their later years, the inside live part of their tooth has virtually disappeared.

This is why treating a cavity on an old tooth can often be done without an anesthetic there are almost no nerves left in the tooth! Whereas, for a young tooth, the nerves are very near the outside of the tooth ( a real problem with all the bleaching that young people are doing with their teeth these days).....another topic!!

Sometimes a cavity or infection in a tooth manages to reach the cells and nerves in the inside of the tooth ( sometimes this is because a cavity's on a part of the tooth close to the nerves for example on the side of a tooth at the gum level where little thickness separates the outside of the tooth from the inside).

If the inside of a young tooth experiences infection it may react by "thickening" itself to try and block off the infection and protect itself!

The tooth uses this aging mechanism to lay down layers of tooth gradually pushing the nerve and the live parts away from the hazard of the infection or cavity. This self-help can protect the vitality of a tooth if it occurs in time and it basically "seals" off the infection. Your tooth may have done this.

Obviously if you opt to do a root canal on a tooth that has reduced access it leaves little or no space for the dentist! The tooth has virtually taken care of the problem by itself and most times this is a very successful solution. Your dentist is correct that a root canal could be difficult because of the calcification and if there is a crack you may need to lose the tooth.

I am not in a position to comment on your last question about the X rays. I can tell you that shadows on X rays simply mean that the X rays have travelled through the tooth fast. This does not necessarily mean that there is no longer any tooth there it may be that the tooth is soft and allows the X rays to go quickly through to the other side. I would suggest that if you start using my Complete Mouth Care System and eat enough Zellies after every meal, clean your toothbrush etc.....you can start to reverse this situation.

I cannot tell you that you will reverse it completely or stop the need for future treatment but you may especially if the "shadow" is a "question mark".

Decay is the dissolving of a tooth and then bacteria gaining access to this soft part of your tooth.
These bacteria then channel their way into the deeper layers of your tooth...
( You may enjoy my book Kiss Your Dentist Goodbye available on Amazon it describes all of this!)

So......if you are using all of my system, you will kill off the harmful burrowing bacteria and start to strengthen and rebuild minerals that were lost out of your tooth.

While the tooth is healing there may be slight sensitivity but cold or hot sensitivity should go away within a few seconds. Symptoms of continued pain for minutes or longer indicate the nerve is irritated and that you may need to consider a root canal etc.

I agree that a wait and see has benefits and I am very happy that you are using my system of oral care. I believe that this will really help you to regain the tooth parts that you have lost in a relatively short time. Maybe in 6-9 months the dental office can take another X ray and see if the "shadow" has gone away it will lighten and appear whiter on the film as minerals deposit into the tooth. Minerals reflect the X rays and make this tooth appear whiter on the film

Sorry that the answers are long but you asked!
Thanks for your patience I apologize that it has taken me a while to answer your questions.

Wishing you a very Happy Holidays,
Best Wishes,
Ellie
26 Corporate Woods
Rochester, NY 14623

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