Dr. Matthew Bronk, DMD

You should go back to your dentist. There is any number of reasons that you're having pain. The most common reason is that the crown is high. Hyper occlusion can be remedied by your dentist adjusting the crown and doesn't take long. Bottom line is that you need to go back and see your dentist. Some sensitivity is expected for a few months but it shouldn't wake you up at night.

It depends on the difficulty of the case, and some cases may not be amenable to Invisalign. There are a lot of variables. My wife is an orthodontist and these are her words. If you are going to be VERY compliant (ie wearing the trays at all times except when eating and brushing, for 22 hours per day), then it's possible for Invisalign to be as fast as conventional braces. Otherwise, if compliance might be an issue with the trays, then conventional braces are the way to go. Her practice charges the same amount for either pathway.

Dr. Bronk
Board Certified, Oral and Maxillofacial Surgery

Return to your dentist asap. He/She will assess the occlusion and if the crown is loose. Remember that a new crown is not going to feel exactly like the old tooth, but it should not be loose or in hyper-occlusion.

Dr. Bronk

It's normal to have some sensitivity following a tooth restoration, especially cold sensitivity. If the tooth is throbbing all the time, however, you should go back to the dentist who placed the restoration. This is VERY important because only that dentist knows exactly how close the decay was to the pulp chamber. If the restoration is large (i.e., there was a lot of decay), the tooth may require a crown or even a root canal and a crown. This will be determined by your dentist. There is one other possibility that can occur occasionally and that is a restoration that is too high in an area. As a dentist who used to do fillings (I'm an Oral Surgeon, so I have not done fillings in 20 years), there have been times when I had to adjust the occlusion (i.e., reduce) of the restoration I just placed. Traumatic occlusion to a new restoration can definitely make your tooth very sore/tender. If you are merely having cold sensitivity that lasts 5 seconds or less after you drink something cold, then I'd give it a few months (sometimes up to 6). I had a restoration done in dental school and the cold sensitivity finally went away, but it took almost 7 months. I just didn't drink anything really cold. If I did, that was a quick reminder!
Hope this helps.

Have a good weekend,

Dr. Bronk

Hi there,

Yes, you can diagnose tooth decay from a radiograph. In fact, generally, the way you diagnose interproximal decay (between teeth) is with an X-ray, specifically a bitewing X-ray. That coupled with clinical correlation will give you the most accurate diagnosis. However, many times we will not be able to physically see the decay clinically and that is why we rely on X-rays.

Hope this helps,

Dr. Bronk

So, nothing tops well taken care of enamel. It's the hardest substance in the body and its resilience is also due to the fact that live teeth (i.e., no root canal) can flex, somewhat. Having said that, there are now some incredible composite restorations with excellent properties, but NONE of them are as tough and resilient as enamel with no decay. If you are prone to decay (i.e., poor oral hygiene, lower oral pH due to meds or other reasons), then a restoration (filling) is going to be superior to your natural tooth structure because bacteria don't attack restorations, they like teeth/tooth structure. I'm sorry if my answer is confusing, but...it depends on your individual situation.

Hope this helps,

Dr. B

Yes, they will reattach to the bone, at the level of the bone, they do not attach to the teeth, but may seem to if you have/had calculus (i.e., tartar). That "attachment" to teeth via the calculus is not a good thing. Keep your gums and teeth clean by flossing then brushing EVERY night. At 29, you won't get bone back, but you can maintain the level where it is with really good brushing and flossing habits.

Hope this helps,

Dr. Bronk

If the tooth is a posterior tooth (i.e., a molar or premolar), it can fracture due to the opposing arch occlusal forces. This is for 2 reasons: 1) the tooth is much less flexible/more brittle now that it doesn't have nutrients getting to it internally; 2) due to the access of the canals, though the pulp chamber the tooth doesn't have the same amount of uniform hardness structure and thus, a filling in the middle of the tooth can act like a fulcrum and cause the tooth to fracture. If you've had a root canal treatment (RCT) on a posterior tooth, I definitely recommend a full coverage restoration (crown) shortly after the completion of the RCT.

Hope this helps,

Dr. Bronk

Hi there,

You (most likely) can replace regular dentures with implants. You would likely have what is called an "all-on-four" or 5 or 6 implants per arch (upper jaw and lower jaw). This is called an implant-retained denture. Depending on what the Oral and Maxillofacial Surgeon along with the restoring dentist or Prosthodontist deem the necessary # of implants to stabilize the denture. Some possible disqualifiers are smoking, poorly controlled diabetes, bisphosphonate medications. These are relative contraindications, and the surgeon you go to may still do the surgery. I won't place implants on smokers anymore as the failure rate is on the order of 18%-20%...almost 1 out of 5 implants fail in smokers. In diabetics who are fairly well controlled, I will place them and just let them know that they are at slightly higher risk for implant failure than a non-diabetic pt. In diabetic pts with a Hemoglobin A1C over 8, I will usually wait until their #'s are below 8. Just so you're not shocked, the total cost of upper and lower all-on-four (implant-retained dentures) can be in the $40k to $55k range with everything needed to be done, including lab fees, CBCT, surgery cost and denture fabrication and placement. Your cost will vary depending on whether or not you require bone grafting, sinus lifts, and any other tissue augmentation. Most people who have the means to do this procedure and are good candidates, have been very pleased with the results. Deciding on whether or not you are a good candidate or not will be up to you first, then your Oral and Maxillofacial Surgeon and Restoring Dentist after their evaluations have been completed.
I hope this helps answer your question.

Have a good weekend,

Dr. Matthew J. Bronk, DMD

Invisalign is doctor treatment planned and followed by a dentist with orthodontic experience or an orthodontist. It is another tool to align teeth, just as braces are a tool. All of these methods are recommended as a method to a beautiful smile as long as a qualified provider is guiding that treatment.

First, is it a lower (mandibular) tooth or an upper (maxillary) tooth? If it's an upper tooth, the likelihood of dry socket is remote. If it's a lower, then signs are usually new onset of greater throbbing pain about 3-5 days after the extraction. The pain will usually radiate up to the ear on that side, but not always. If your pain began in that 3-5 day after surgery range, and it's a lower tooth, the likelihood that it's a dry socket is high. Here's the good news: unless it's waking you up at night, thee is no need to treat it. If it's a dry socket, it will heal on its own. If you,
however, have any signs of infection, trismus etc., then You SHOULD GO SEE YOUR ORAL SURGEON. That is my disclaimer because I didn't treat the patient. If in doubt, always go see your surgeon. He shouldn't charge you extra for a follow-up and it will bring you peace of mind.

Dr. B