Frequently Asked Questions

Click on a question below to reveal the answer.

Q: Please tell me about implants. They sound scary, but more and more people seem to be getting them!

Dental Implants are a wonderful procedure choice.  When replacing a single missing tooth in most areas of the mouth, they are THE treatment of choice.  They can replace a missing tooth or teeth, and after the final crown is placed, it can be very difficult for anyone else to know it is not your own tooth!

Decades ago when dental implants were entering the profession, there were many, many types of implants designed, researched, and tried.  They all looked good in theory and on paper. Some worked, some failed.  OK, many failed!  But after years of study and use, the ones that don’t work are gone, and the ones that do work are here to stay.

Most implants are made of titanium alloys.  They are placed by a qualified professional in the same place as the roots of the missing tooth were previously.  After the bone heals around the implant (a term called “Osseointegration”) the implant is then restored with a crown, partial denture, or denture.

Implants are placed in a surgical setting, usually in the dental or oral surgery office, as an outpatient procedure.  They are usually no more uncomfortable than having a tooth removed.  The surgeon will explain everything to you, what you can expect, how long the healing will take, and when you can have the crown placed.

Before the introduction of implants, the most commonly provided procedure for a missing tooth was a bridge.  A bridge is a crown on the tooth in front of the gap, one to fill the gap, and one on the tooth behind the gap.  It is all one piece, and is bonded in like a single crown.  It can be metal, ceramic, or a combination. It looks, feels, and functions like a tooth.  We still use bridges in those instances where an implant may not be the best choice. But as there are pros, there are also cons to bridges, and Dr. Miller can explain those to you so you can make the choice you feel is right for you.

Obviously this is just a quick overview of implants, and there is a lot of information we can discuss. Make sure to ask the questions you want answered, and we will do our best to give you all the information necessary to make the best choice for you!

Q: My dentist says I have a tooth that needs a crown, but does not need a root canal. My last dentist said I needed a crown because I had a root canal. I'm confused!

I can understand why you are confused.  So let’s break it down.
It is important to know why the tooth is having a crown placed, and the condition of the tooth before the crown is placed.  You can also go to the Services and Care section of our website, and read about crowns and root canal treatments.

We place crowns for multiple reasons.  The major reasons are:
1.  a large previous filling that has broken down or has new decay, and needs to be replaced, but there will not be enough tooth remaining to support the stresses and forces of chewing.
2.  A broken cusp or a vertical fracture in the tooth, when the exam and your symptoms show that a filling just won’t be enough.
3.  A back tooth after having had a root canal treatment, or a front tooth after a  root canal treatment where there is existing damage to the tooth structure, or a large previous filling.

There are some other reasons, but for sake of this discussion, those are the big ones.

We do a root canal treatment when the living part of the inside of a tooth is irreversibly damaged, and your symptoms confirm the need.  Many teeth that need crowns do not have symptoms that indicate or confirm the need for a root canal treatment.  This is not to say it might not in the future, but at the time of treatment the root canal therapy is not indicated.

An adult can put tremendous pressure on their back teeth when chewing, clenching, or grinding.  I have read research articles that say we can put as much as 250-300 pounds per square inch on our back teeth!  And when we are asleep, that amount can increase 6-10 fold!
We have always known that placing a crown on a back tooth with a root canal treatment is indicated to protect the tooth from those big-time forces. But now we have studies that show that the more important reason to place a crown is to provide total coverage and seal over the tooth to prevent what is called micro-leakage.  This is the infiltration of saliva, acids, and bacteria that take place over time around a filling.  If these bacteria get to the root canal seal, then the seal may fail.  This may result in a root canal therapy re-treatment, or possibly (infrequently) loss of the tooth.

So, in answer to your question:  Almost every tooth that has had a root canal treatment will need a crown, but not every tooth that has a crown will need a root canal treatment.  Each tooth will be evaluated individually, and the treatment planned, determined, and discussed with you.

Still confused?  Ask Dr. Bob at your next visit.

Q: My dentist told me I have a cracked tooth, and that I need a root canal. But he said I may lose the tooth anyway. Can you explain that to me?

You have asked a great question.  And  I have the answer – sort of…

Cracked teeth are a big nemesis of the dental profession.  Cracked teeth can present in many different ways, with many different sets of symptoms, and many possible outcomes.  We determine the best course of treatment based on your symptoms and condition, but the outcomes of that treatment are difficult to predict based on what the dental industry calls “Cracked Tooth Syndrome”.  This is the “nickname” we have given to encompass all of the possible outcomes.  It is not an official term, but every dentist knows what it means.

All teeth, especially back teeth, have natural anatomical grooves, cusps, and ridges.  This anatomy is what allows the teeth to “jigsaw” together for chewing and function.  However, this anatomy also predisposes the teeth to fracture, almost as if the grooves are perforation lines.  When you have decay (a cavity) we cannot leave the decay, or the tooth will eventually have a much bigger problem.  That may be a crown, a root canal treatment and a crown, or even loss of the tooth.  So we place a restoration (a filling). That filling will in most cases serve you for years.  But the tooth is now weaker than it was before the decay set in.  So now the tooth is even more prone to fracture.

Most fractures occur due to the normal wear, tear, and stresses that we place on teeth in normal function.  A healthy adult can place between 250 and 300 pounds per square inch on their back teeth during function.  Parafunctional habits like grinding or clenching can increase that pressure up to 1000% !  Adding to those stresses is the fact that most of us at one time or another chew things we shouldn’t.  Things like ice, popcorn old maids, corn nuts, roasted nuts, hard candy, or the accidental bone in a piece of meat.  During the course of these functions, we create small surface craze lines in the enamel.  These lines may never progress, and may never require any further treatment.  But sometimes these craze lines can progress, much like a small chip or crack in your car windshield.  Eventually, the fracture will progress to the point of symptoms or complete fracture. When this happens, you come see us at the dental office, and we determine the course of treatment best suited to your symptoms and your tooth.

Dr. Miller would love to be able to determine the severity of your fracture beyond a shadow of a doubt.  But in most cases that is not possible.  The only way to truly determine the extent of the fracture is to remove the tooth and examine it in a laboratory under light and magnification.  Unfortunately, we cannot screw the tooth back in after that! So Dr. Miller will attempt to determine the severity based on your symptoms and testing.
Based on the severity of your symptoms, we will recommend to you that you have:

  •  A filling.  We call this a restoration.  It most likely will be tooth-colored bonded composite, but may be a porcelain onlay or inlay.
  •  A crown.  This is the most likely treatment.  This may be gold, porcelain over metal, or an all-ceramic crown.  The purpose of the crown is to cover the tooth, cover the fracture, and hold the tooth together to resist further fracture due to stresses of function.
  • A Root Canal Treatment and a Crown.  If your symptoms are of a certain level,  it will tell us that the living part of the tooth (nerve, blood vessels, fibers) is irreversibly irritated or damaged, and will not heal without this treatment.  Once most teeth have Root Canal Therapy, they will also require a crown to protect them through the future.
  • Extraction of the tooth.  In cases of severe fracture, it may not be possible to treat the tooth with any reasonable chance of success, and removal of the tooth becomes your best option. 

Dr. Miller will diagnose your condition, and make his recommendation based on each individual tooth.  He will explain it clearly, and give you the chance to ask any questions that you may have.

Statistics that are available to us vary based on the individual studies, but generally are consistent:

  •  20% of ALL teeth that have a crown placed, for any reason, will eventually need Root Canal Therapy.  Add the presence of a crack or fracture, and that percentage goes up.
  • 40-50% of cracked teeth will become stable after placement of the crown.
  • 40-50% of cracked teeth will eventually need Root Canal Therapy, soon or in the future.  Sometime this is apparent to us before the crown is placed.  Sometimes it may not manifest for months or years.
  • 5-7% of teeth with fractures will be lost at some point (extracted), even after any or all of the other treatments have been done.

 

So you can see why we consider cracked teeth a nemesis.  We will do our best to give you the best outcome.  But ultimately, your tooth and your “personal biology” will make the final determination .  Your symptoms may resolve, may worsen, or may resolve and then return months or years in the future.  Any or all of these conditions are consistent with the consequences of having a cracked tooth.

Hope that answers your question…Sort of!

Q: What's the truth about dental X-rays? Are they safe? Do I really need them?

Dental X-rays are safe.  The studies overwhelmingly prove that.
And yes, you really need them.

Why are they safe?  The technology and equipment used to take and record dental X-rays (Radiographs) is constantly improving.  In the 30+ years that I have been doing this, the changes are astonishing.  The quality of the X-ray units has improve by leaps and bounds.  The amount of radiation necessary to expose an X-ray is minimal, several hundred percent less than 30 years ago. The units have shielding and columnation (the aim and control of the X-ray beam) that is very precise.  There is little or no scatter radiation anymore, as there was decades ago.  Lead aprons are no longer necessary when taking routine dental X-rays.  We have the aprons available for people with other risks, or women who are pregnant.  But they are not used routinely anymore.
We use digital sensors now instead of film.  The sensors are greatly more sensitive, and much less radiation is needed to expose the image. Then the computer software used with the digital X-rays allows us to glean so much more data than from a small film.

What X-rays do you need?  We take only X-rays that are necessary for the proper diagnosis and treatment of your oral health.  There are some X-rays that are taken on a regular basis to compare to previous X-rays.  There are some that are taken to identify, locate, or rule out specific problems.  And there are some X-rays that we take during the course of treatment to monitor and guide our treatment protocols.

Without the proper X-rays, we cannot complete a thorough examination and diagnosis, and may miss some type of simple problem or concern that could become a major problem or concern in the future.  We will only recommend and take the X-rays needed for your oral care, and no more.  We will tell you why we are taking them, and what they show.

Q: Is Fluoride safe? I hear some people say it does more harm than good.

Yes, fluoride is safe. The effects of fluoride on the overall health of peoples’ teeth has been clinically proven for years. Fluoride is quite possibly the best thing to ever happen to dental health.

Systemic fluoride, which means fluoride you take into your body, helps with the development of teeth from the “inside”. This fluoride is obtained through most cities’ drinking water, through fluoride supplements, and to a lesser extent through dietary sources.

Fluoride in toothpastes and rinses, and topical fluoride applied at your dental office, provide protection from the “outside”. Many people have the misconception that adults do not need fluoride. Topical fluoride contact with your teeth, and with the edges of fillings and crowns, provides added protection to help prevent decay. The more edges of fillings and crowns you have (we call these “margins”), where the material meets the tooth, the more advantage and benefit you will gain from fluoride.

Remember those bulky styrofoam spongy fluoride trays we used when we were younger?  GONE!
Remember the foams and gels and lousy flavors?  GONE!
Remember having to wait 30 minutes to eat or drink after the fluoride treatments?  GONE!

We now use fluoride varnishes that are painted on your teeth  with a small brush.  No trays, foams, or gels.  The varnish sets up in seconds, and you can eat and drink within five minutes of placement!
And the varnish continues to provide fluoride coverage for hours after application, MUCH longer than the old foams and gels.

Too much fluoride ingested into your system as a child can cause discoloration or pitting of the enamel surface of your permanent teeth. This is why we strongly suggest that children do not swallow toothpaste (as well as the fact it will quite likely make them nauseous). If your home drinking water has fluoride, that is usually sufficient for your children.

If you do not have enough fluoride in your water, we can prescribe supplements that will provide the proper amount of fluoride for your children.

Q: What are Sealants? Are they really necessary?

Sealants are a resin coating applied to the grooved surfaces of permanent back teeth to significantly reduce the incidence of decay in those teeth. We like to apply sealants to permanent 6-year and 12-year molars as soon as they have come in (erupted). Occasionally we will recommend sealants for various other back teeth.

The chewing surfaces of your back teeth, especially the molars, have grooves we call fissures. These fissures may not appear deep to your eye, but at a microscopic level, they are narrower than even the bristle of a toothbrush. But these grooves can be like four-lane highways to bacteria! By cleaning and then sealing over these grooves, we can reduce the chance of you developing decay on those surfaces by as much as 80-90%! You can still get cavities if you don’t take care of your teeth, but this is a wonderful method of help. Note that sealants only protect the chewing surfaces. They do not help between your teeth. So, YES! You still have to floss!

At Miller Comfort Dental, we go a step beyond standard sealants. We clean and etch the grooves, and then use a bonded liquid material more similar to filling material, called “flowable composite”, to seal your teeth. We do this at no extra charge beyond a standard sealant fee. We feel that the strength and lifespan of this type of sealant is far superior to standard sealant material. And we guarantee those sealants for life. If we place your sealant, and it chips or fails, we will replace it for you at no charge.

Sealants are painless and quick to place. You can eat and drink immediately after you leave our office. And most insurance providers will cover the cost of sealants for your children through 14 or 15 years-of-age. And even if they aren’t covered, the cost to you for four molar sealants is about the same as the cost of only one tooth-colored back tooth filling. And without sealants, we can almost assure you will develop one or more cavities in those teeth.

Q: Are Crowns supposed to be permanent? I had to have one replaced recently.

That is a question that has a lot of different aspects to the answer.

Let me start by addressing the word “permanent”. When we place a filling or a crown or a partial denture or a denture, or any of the numerous services we provide, most are considered permanent. However “permanent” does not mean “for life”. If means for the lifespan of the particular service and material used. An example would be a silver amalgam filling. One of my textbooks back in school told us that the expected lifespan of a silver filling is 10-12 years. In real life, I see some silver amalgam fillings that are 35 or 40 years old. They are still there, and still providing a good service. But they are not as strong or well-sealed as they once were, and quite probably should be replaced.

Likewise, I have seen silver amalgam fillings that need to be replaced after just a few years. What is the difference?

There are many factors involved: How well you take care of your teeth; What and how you eat; unconscious habits like grinding or clenching; Conscious habits like chewing fingernails or pens or toothpicks; How well were the original fillings done; There are also traumatic injuries, and cracked teeth.

Think of your car, or your refrigerator, or your favorite pair of shoes. If you get 10 years and 200,000 miles out of your car, you will quite probably buy the same make again. If your refrigerator lasts 15 years, you will think it is a great ‘fridge. And if you wear those comfy shoes until they fall apart, you’ll go buy another pair, and wear those out too!

But if a crown or a filling only lasts 21 years, you will likely think that is a bad thing, and wonder why it didn’t last longer. Yet it actually provided you YEARS of quality service.

Crowns are made from several different materials in today’s dentistry, for several different reasons. We can make all-ceramic crowns for your front teeth, and all-ceramic crowns for your back teeth. They are beautiful, but may not be as strong as some other materials. We can make all-metal crowns, with varying percentages of high-noble metals (like gold) depending on the location and need. These are MUCH stronger crowns, but obviously not tooth-colored. We can make crowns that are porcelain on the outer surface, and metal or zirconium on the inner surface. Again, stronger than all-ceramic, and more beautiful than all-metal. And remember, porcelain is glass, so you must consider what you chew and do with porcelain much more than you have to with all-metal.

As far as the lifespan of these crowns is concerned, it varies just like the lifespan of a filling. It will depend on many different factors, and those factors will vary from person to person.

So are they “forever” permanent? Probably not. But can they last for a long, long time? Absolutely! And we can help you be certain you are caring for them properly to increase their lifespan.

Q: Why do I need to come to the dentist every six months?

We recommend that most people have their oral conditions examined twice a year. And in some patients, based on the condition of their teeth and mouths, we recommend visits every three or four months. This has basis in the time frames that it takes for detrimental conditions to re-establish, and begin causing damage in your mouth. This may include tartar build-up, plaque build-up, active decay history, home-care quality, and countless other factors. But the simplest explanation is that in the general population, six months is the average time that allows us to monitor your oral health, and keep you healthy throughout your life.

Q: Are Mercury-containing silver fillings dangerous? Should I have my old ones removed and replaced?

Easy answers: NO and NO, but read the long answer!

Long answer: Mercury-containing silver fillings are known as “amalgam” fillings. They are an amalgam, or mixture, of several metals mixed in proper ratios to create a hard, durable, and long-lasting filling material. The metal in highest concentration is silver, while mercury provides the “liquid” portion of the mix.
Methyl Mercury, or “quicksilver”, in its pure form is toxic. But when mixed, or amalgamated, with the other metals in the proper amounts, it becomes non-toxic. Once the metal hardens, there is negligible if any risk. There is more mercury vapor from industry in the air we breathe than there is from a set filling.
A great example is the chemical chlorine. If I give you a glass of liquid chlorine, like Clorox, and you drink it, we will all be attending your funeral. But if you mix that same pure chlorine with the chemical sodium in the proper ratios and conditions, you have Sodium Chloride – table salt. A relatively non-toxic item.
Silver fillings are no longer the filling-of-choice, and have not been for many years. But silver fillings have been around for decades, and we routinely see 20, 30, 40 year old fillings. Some of these fillings are still doing their jobs. And some of these fillings are no longer well sealed, or are breaking down, and need to be replaced. And bonded, tooth-colored composite resins have more advantages, probably fewer long-term drawbacks, and of course look a lot nicer. These bonded composite fillings are now one of the materials-of-choice when a filling is the treatment you need.
As far as removing and replacing old fillings: Any time you work on a tooth, you irritate that tooth. It is believed that irritation to a tooth is cumulative, and enough irritation can cause the living tissue in the tooth to die. And there is no way to measure and truly know the level of irritation a tooth has endured. So unless the benefits of replacing the filling clearly outweigh the negatives, you do not need to replace your old fillings before their time. At your request, we will gladly replace your old silver fillings with beautiful tooth-colored fillings, but only after you understand the pros and cons. And when they do require replacement, tooth-colored fillings are a great option.

Q: What is a Root Canal? I've heard they're terrible!

Ah, the big, bad buzzword that all the comedians and TV shows jump on to scare the heck out of all of us. People immediately cringe, picturing Black and Decker variable speed hand drills, and tell us horror stories of people they know that have had one.
In reality, Root Canal Therapy, as we call it, is one of the most frequent, common, and valuable procedures we perform. The dental term is Endodontic Therapy. In cases where it is indicated, it allows the patient to keep the tooth for years, and possibly the rest of their lives, instead of having that tooth removed.
I use the example of car ownership. 100 people buy a new car model, like an Impala or a Taurus. 96 people get a good car, 4 people get a lemon. Who do you hear from? That’s right, the four who got the lemons. That means there are 96 people out there that are happy. The same is true with Root Canal Treatments. And three out of that four waited too long to get the treatment done after the dentist suggested it, resulting in more difficult treatment.
Each tooth has one, two, or three roots. Each root has canals, or “tubes”, in it that contain the living nerves, blood vessels, and fibers of the tooth. When that tissue, called the pulp, is damaged or irritated, it stimulates your immune system to try to eliminate the problem. We can remove that tissue, disinfect the tooth, and seal the root, to allow the immune system to say, “Hey, we can keep this tooth in your mouth.” So we do Therapy on the Canal inside the Root – Root Canal Therapy.
Pretty easy to understand, and not so scary once you know what it is!

Q: Is using an electric toothbrush really that helpful, or are they just gimicks?

An Electric toothbrush, or a mechanical or power toothbrush as we refer to them, is an excellent addition to the quality of your home care. We highly recommend that everyone use one.

The most common brands available are the Sonicare by Phillips, and the Oral B by Braun. Both are excellent. They work in slightly different ways in that the motion of the brush head is different with the different brands. But they both do an excellent job. Which brush you use depends on your own personal taste. Ask us, because many times of the year, we have coupons you can use to lower your cost.

The Sonicare system uses “ultrasonic” vibration to move the brush head back-and-forth over 30,000 times per minute. That’s a lot of movement! There are several different models, each step up having added features and capabilties. There is also a children’s model.

The Oral B system uses a rotary-style movement, more similar to the feel of having your teeth polished in a dental office, along with a back-and-forth vibrating motion. Again, there are different models, each step up adding features and capabilities. And there is a children’s model.

There are some other models and brands on the market, and some of them may work just fine. But the research and obvious quality of the Sonicare and the Oral B brands make them the ones to choose.

Ask us the next time you are in to help you choose the one that we think will be better for you, or stop by for some advice.

Sonicare also has added a new product called the Air Floss that at first impression appears to be a wonderful new device. It will be especially helpful in cleaning around braces, and bridges, and implants. It will not completely replace flossing, but will likely be the next best thing to it. It will also be very helpful for people that cannot effectively floss due to decreased dexterity in their hands, or due to medical conditions. Ask us about it.