Question: Hi Dr.Glasmeier,

My son is 9 years old and has a big space between his front teeth and it seems bigger than his siblings' spaces. I want to know if this will resolve on his own or he is going to need dental work to correct this space?

Answer: Spacing between the two front teeth (known as a "diastema") is a very common finding not only in children but adults as well. Children who have baby teeth with type of spacing is actually a good situation however if this occurs with the eruption of the permanent teeth, this is quite different.

There are many different factors that can contribute to abnormal spacing between the two front teeth. The one I most commonly see is what is called a "low frenum attachment". The frenum is the soft tissue that attaches the inside of your lip to the gums above or below your teeth. Normally the frenum attaches high up above the tooth but it can also much lower on the gums between the teeth. When the gum attaches between the teeth, it can result in a diastema(space between the teeth).

When this occurs, typically two things must happen to close the space:

1. Patient needs to be evaluated to determine whether or not

orthodontics(braces) will be necessary to close the space or if they can be

closed by other means (e.g. veneers).

2. Patient will likely require a frenulectomy, where the soft tissue attachment

between the teeth is removed or reduced. There are multiple ways this is

accomplished but the most common is with a laser. With a little local

anesthesia and a laser, this procedure can be accomplished in several

minutes pain free and with little, if any postop pain. Most children have no

pain or discomfort the next day!

So back to your question, yes it can be treated but he needs to be evaluated the best way to accomplish this. Consult your dentist for the course of treatment necessary!

Best of luck!

Dr.G

Question: Dr.Glasmeier,

If there is no plaque, what are the chances of getting only gum diseases. Also, how does floride toothpastes help,if any, to avoid gum swelling or minor gum problems like gum bleeding?

Answer: Great question! That is complicated question because plaque is only

factor that can contribute to gum disease. There are many other things that can contribute to gum disease such as:

1. Poorly fitting dental restorations

2. Medical History (Smoking, diabetes, autoimmune diseases)

3. Genetics

4. Grinding and clenching teeth, etc.

These are only a few of factors that can promote gum disease. The big misconception is that your hygiene is the only thing that determines gum disease and this is simply not true! Regarding fluoride toothpaste and its effects on gums--the fluoride is more geared for preventing cavities and minimizing thermal sensitivity that can develop on the teeth. The abrasive additives in the toothpaste in combination with brushing is what helps reduce plaque/tartar from forming on the teeth than can setup problems with gum disease. So to answer your question, the fluoride is more for the teeth than the gums. There are prescription mouthrinses that made to help prevent and/or control gum disease but most of them are prescription.

Hope this helps!

Dr.G

Question: Dr. Glasmeier,

I had composite fillings done 2 weeks ago. Soon after, I was put on amoxicillin for an infection on the top tooth that was filled. Now that I have finished the medication, I still have aching in not only the top but also the bottom teeth that were filled. Is this normal? I've never even had to take OTC pain meds after a filling in the past, and now that I no longer need Vicodin for the terrible infection pain, I am still taking ibuprofen for the aching. Is this normal? Should I go back to see my doctor? Thank you!

Answer: Hi there, yes if it has been two weeks then you should return to your dentist for further evaluation. Typically composite fillings, aka "tooth colored fillings" can present with some localized soreness to biting along with some brief cold/sweet sensitivity. However, this type of sensitivity should resolve typically within 7-10 days. I am a little confused why an antibiotic was given for a tooth that received a filling unless that tooth has become infected. If this is the case, then you will need additional treatment beyond an antibiotic, such as a root canal.

Re: pain on top and bottom teeth..is it possible your bite could be "off" or "high" from the new filling. Sometimes if the bite is changed by a "high" filling, it can cause biting sensitivity that can progress to thermal sensitivity. I would go back to the dentist and have them evaluate the bite but also rule out that you are developing an infection around that tooth.

Good luck!

Dr.Glasmeier

Hello,

I have no idea what to do. After receiving a cosmetic dentist referral from Lumineers, ten months ago I had eight top teeth done for about $8500.00. Three days after the Lumineers were applied, one fell off. Since then I've had all but one of the original set of eight replaced, mostly due to the Lumineer breaking. I pretty much expect that last one will also fracture before long. I have been in the dentist chair 17 times and never known a single month in the last ten months - not once - when I had all eight Lumineers on at one time. I have always been waiting for a replacement or I was on my way into the office to get a mold taken to get the replacement.

I've nearly lost my job for all the time I had to take to accommodate the dentist's schedule, I've suffered unbelievable embarrassment when one will break and fall into someone else's drink or plate of food while out in public and I've always had a gap of one tooth or another while it was on order. The dentist tries to be nice, but he has reminded me a million times that "something like this has never happened before." A member of his office staff says he's only done 10 sets thus far (he told me hundreds during the consultation.) I know I am stuck with this office as far as the Lumineers warranty goes, and thus far none of the second set have cracked or popped off. I have absolutely no faith in this product and know I have no recourse, if the first set of Lumineers was defective as Lumineers keeps an ironclad "no compensation for anything" policy after 30 days. But this has gone on for ten months and will continue for another one (at least) as I have another replacement to get a mold taken and ordered yet. I could not be more unhappy with the whole Lumineers experience.Do you have any advice for me? Any at all? I would be so grateful, you just don't know.

First Lumineers, or also known as "no prep or no drill veneers" are a nice conservative way of reshaping and correcting color and esthetic issues with teeth that are in otherwise healthy condition. They require little to no drilling and no injections/anesthesia.

Answer: Sounds like there are some bite issues that are preventing the Lumineers from being successful. I don't do many Lumineers unless the conditions are right. You have to have a certain bite to be able to do those. There are other things that can cause them to fail, but they are fairly foolproof since there is no tooth preparation and the procedure for cementing them in very easy. I doubt its the Lumineers as much as you not necessarily being a good candidate for Lumineers. I would get a second opinion before you have them redone and would investigate whether or not you grind your teeth as this could be contributing to the problem as well. Not everyone is a candidate for no prep veneers and the dentist should be evaluating not only the physical appearance of the teeth but also analyzing your bite and ruling out that you grind or clench your teeth.

Good luck!

Dr.Glasmeier

What is a filling?

A filling is a material that your dentist uses to fill a cavity after the tooth decay has been removed.

To fill a tooth, I will:

* Numb your teeth, gums, tongue, and surrounding skin. I will first put a jelly substance directly on the area to start the numbing process and then inject an anesthetic to complete it. Sometimes we will give you nitrous oxide gas (laughing gas) to reduce your pain and help you relax.

* Sometimes we use a small sheet of rubber on a metal frame (rubber dam) to target the decayed tooth and to stop liquid and tooth chips from entering your mouth and throat.

* Drill out all the decay and replace it with a filling.

Fillings can be made from many types of material. Talk to your dentist about which type would be best for you.

* Amalgam is the easiest material for a dentist to use. It is the fastest and least costly choice. Amalgam is a mixture of mercury, silver, tin, or other metals. I do not use this material anymore due to patient preference and because it is expensive and difficult to expose of.

* Composite resins are tooth-colored fillings. This process is sometimes referred to as "bonding" if it is on a front tooth. This is standard nowadays for the cosmetic dentist. It is the most esthetic(cosmetic) material and the newer materials have longevity comparable to the amalgam silver fillings. Composite resin is easier than gold for a dentist to work with and generally is less expensive than gold.

* Ceramics are costly tooth-colored fillings. They require special equipment and may require dental lab support. You may need several appointments. These are used in much larger fillings where the tooth is in between needing a filling or a crown.

What To Expect After Treatment

After I filled the cavity, your lips and gums may remain numb for a few hours until the numbing medicine wears off. Avoid chewing on your numb lip or cheek to avoid injuring your mouth.

Why It Is Done

You need a filling when tooth decay has caused a hole (cavity) to form on a tooth surface. If you don't get a filling, the cavity will get worse and lead to more severe problems, such as bone loss.

How Well It Works

A filling repairs the tooth and stops tooth decay. Over a long period of time, you may need to replace a worn-out filling.

Your filled tooth may be sensitive to heat and cold for days to weeks after you get the filling. Talk to your dentist about toothpastes that may help you with this discomfort. Tell your dentist if your teeth are too sensitive after you get a filling, because you can usually treat this problem.

Risks

There is almost no risk involved in having a cavity filled.

Some dental work can cause bacteria in the mouth to enter the bloodstream. These bacteria can cause infections in other parts of the body. People who have difficulty fighting infections may need to take antibiotics before and after dental surgery. Such people include those who:

* Have heart valve problems, such as endocarditis.
* Were born with heart defects.
* Have an impaired immune system.
* Have liver disease (cirrhosis.
* Have artificial joints, such as a hip that has been replaced.

What To Think About

It is important to start treatment before tooth decay becomes worse. More severe decay may cause pain and tooth loss and may require a costly crown, a root canal, or tooth removal (extraction).

Some dentists now use a laser system to remove tooth decay and prepare the tooth for filling. The laser is quiet, does not vibrate like a drill, and is usually painless, so medicines to deaden pain often are not needed. Laser treatment is a relatively new choice for dental treatment. Two dental laser systems have been cleared by the U.S. Food and Drug Administration (FDA). These systems are under review by the American Dental Association. I do not use this type of system at this time due to it being a relatively new technology but the current research shows much promise in this innovation. Depending on the size, I can use air abrasion, which is a drill-less instrument to remove the cavity before filling. This is preferred as it is less noisy and more comfortable but only used when the filling is relatively small.