[DVY]

@Sugar- I recommend standard braces, not any of this shtick items. Don't rush a biological process. Braces is moving teeth and surrounding bony architecture .

Rapid palatal expansion is for teenagers whose palatal (aka roof of the mouth) suture hasn't closed yet. At late 30s, you can bet this will not work. Also it makes a gap between your two front teeth. I've heard of horror cases of patients having there teeth pushed out of the bone completely (sitting in soft tissue)

Accelerated braces may work, but its usually mapped using custom CAD/CAM technology which allows custom brackets and precise wire configurations. This sounds good in theory, but often the pressure/force is too much and the bracket or wire pops off. This slows down treatment a lot. Its also at least double cost. I'd skip.

Be very wary of these claims. Sure you can move the teeth quickly, but the side-effects are also terrible. When the orthodontist moves teeth too fast, the bone doesn't have time to catch up and you end up actually moving the teeth completely out of the bone. Your body can add to the table at a rate of 1cm/month (not 100% sure, but its a low #). You can move the teeth at 3cm/month (again approximation). The limiting factor is thus bone-remodeling capacity. For teenager its faster, for adults (stronger bone) its slower. BE VERY VERY CAUTIOUS!!!!

Moving the teeth too fast can cause root resorption (the roots get destroyed from the bottom up), gum problems, etc etc.

If you decide to go forward w/this process, take the gold-standard- regular braces. Please don't try to cut corners and save time. What happens is an outcome that is neither predictable nor desirable.

If you are unwilling to sit this through- likely 2 years- then do not pass go.

[kavakid]

You can at least stop cavities from progressing:

http://www.curetoothdecay.com/

Known scientific fact that grains/beans/seeds/nuts contain phytates and other poisons that block absorption of minerals as well as have other detrimental effects. Weston Price was a dentist in the 30s who found that tribes with no grains in the diet had virtually no cavities.

[Swooper]

As a guy who didn't vigorously brush his teeth as a kid, I now have teeth that are quite a bit off-white/yellowish. I do now brush twice a day religiously however. I have heard plenty of bad things about the side effects of whitening products on the market so I'm just wondering; is there any actual effective method of whitening teeth?

[TheBMan]

Couldnt have stumbled upon this thread at a better time:

So on Monday I started having pain under a crown on my 2nd lower molar. I had a root canal and a crown done approximately 20 years ago when i was in my teens. It wasnt an unbearable pain but it wasnt comfortable. I went to see my dentist, who is a buddy of mine. He did a couple of tests, took an xray, but didnt really know what was going on and sent me across the street to an Endodontic. The Endo looked at my xray and wanted to drill through my crown and redo/clean an old root canal, although he wasnt sure that was the problem. He also wanted $2200 to do that. I left and told him I would think about it. I took a couple of Amoxicillin's I had laying around the house that night and it definitely helped. I went to see my parents dentist the next day - my dad always talks about how good and honest he is - he never does unnecessary things. He looked at the same Xray and told me he didnt think the Endo was right and there was no need to drill through the crown and redo/clean up the root canal. He did a couple of tests, a couple of bite tests, then took out a grinder and lightly reshaped the tooth above where I was having the pain and had me bite down again, and it felt much better. He basically said he thought my bite had changed, that was what was causing the problem, and I should be ok. Have you ever seen anything like this before, and do Endo's have a reputation of doing unnecessary procedures? Thanks in advance.

[TheBMan]

Another question - the crown I mentioned above is 'short'. It doesnt come all the way down to my gumline. I've had it for 20 years or so and its not a big deal, but I am going to be in Belgrade in March and am thinking about getting it replaced over there since its much cheaper. If so what kind of crown is the best, and is that something that your average European dentist can do w/o much difficulty?

[Handsome Creepy Eel]

Question about flossing. My dentist has instructed me to floss as often as possible, seeing how I did not do it before and I had a cavity or two every year despite adequate brushing. I bought two packs of dental floss, one that is just the filament, and the other that has it strung on a plastic "fork for easier use.



I have the same problem with both: it's extremely hard to enter the area between the teeth! Trying to push the dental floss between some of my teeth, especially between incisors and canines, and between the two premolars, can be a nightmare. Getting the floss out after it has cleaned the area between the teeth and the gums is even more difficult and sometimes I feel like I'm pulling out the teeth with the piece of floss. My gums occasionally bleed slightly too.

Is this normal? And is it my teeth that are packed too close together, or I'm doing it wrong? Is there a non-invasive alternative to flossing (like supet-thin floss or this waterpik I'm hearing about?) that will provide the same level of protection?

[DVY]

@Bman- I would leave the 2nd molar crown alone unless there was something to fix. Don't go looking for problems. The tooth that hurt might have been a bite issues. Always progress from most conservative to least options. At least that my MO

@HCE- Yea man. Try glide or teflon sutures. They are much thinner. Try the waterpik too. Its wonderful for cases like this.

[Stun]

(12-14-2013 04:42 PM)DVY Wrote:  

@Sugar- I recommend standard braces, not any of this shtick items. Don't rush a biological process. Braces is moving teeth and surrounding bony architecture .

Rapid palatal expansion is for teenagers whose palatal (aka roof of the mouth) suture hasn't closed yet. At late 30s, you can bet this will not work. Also it makes a gap between your two front teeth. I've heard of horror cases of patients having there teeth pushed out of the bone completely (sitting in soft tissue)

Accelerated braces may work, but its usually mapped using custom CAD/CAM technology which allows custom brackets and precise wire configurations. This sounds good in theory, but often the pressure/force is too much and the bracket or wire pops off. This slows down treatment a lot. Its also at least double cost. I'd skip.

Be very wary of these claims. Sure you can move the teeth quickly, but the side-effects are also terrible. When the orthodontist moves teeth too fast, the bone doesn't have time to catch up and you end up actually moving the teeth completely out of the bone. Your body can add to the table at a rate of 1cm/month (not 100% sure, but its a low #). You can move the teeth at 3cm/month (again approximation). The limiting factor is thus bone-remodeling capacity. For teenager its faster, for adults (stronger bone) its slower. BE VERY VERY CAUTIOUS!!!!

Moving the teeth too fast can cause root resorption (the roots get destroyed from the bottom up), gum problems, etc etc.

If you decide to go forward w/this process, take the gold-standard- regular braces. Please don't try to cut corners and save time. What happens is an outcome that is neither predictable nor desirable.

If you are unwilling to sit this through- likely 2 years- then do not pass go.

Ugh, I was worried you would say that. Thanks for the lengthy reply.

I guess I will do braces as some point. Maybe I can get the clear/white ones.

[Sonsowey]

I chipped the very edge of my front bottom tooth. My dentist told me it was too little of a chip to do anything about, that any filling wouldnt adhere. When I drink certain hot liquids it hurts and feels sore.

Is there anything I can do to reduce sensitivity besides sensodyne toothpaste?

Greatly appreciated

[DVY]

@Sonsowey- Ask him to apply a dentin desensitizer. We use zarosen in our office.

[rekruler]

Dvy, this thread is gold! It's really awesome you are taking the time to answer questions it'd otherwise take good money to have answered.

As it happens, I just came back from the dentist. I had a root canal on the #3 tooth (upper right 2nd molar) done about 8 years ago, never had a crown put on. The only issues I've had with it was food getting stuck in that area, not sure whether it was getting stuck in a small crack in the tooth itself of the inter-teeth space. In any case, over the past couple of days I've had aching pain in the upper jaw and my right cheek is all puffy, indicative of an infection (possibly from some captive food?). The dentist took an xray and said that there is indeed an infection, ground the tooth down a bit so that it wouldn't grind upon biting, and gave me a referral to see an oral surgeon to perform an extraction. This guy is not my usual dentist but a random dude who I could get an appointment with on short notice. I kinda thought it was a bit shady when he checked the "perform xray" box on the referral form instead of the "forward xrays" box that was also available. When I asked him why I needed my brain irradiated twice in the space of 3 days he just smirked and said he'll have the receptionist forward the xrays to the surgeon. Kinda weird that this wasn't his default course of action.

Anyway DVY, in your experience, does an infection in a tooth that had the nerve removed usually lead to extraction as the standard of care? This particular dentist didn't seem to be very interested in outlining alternative modalities, but I would definitely rather keep the tooth if at all possible. Better spend $2000 on aggressive treatment that my insurance will cover than $4000 for an implant it won't.

[DVY]

@rekruler- this is usually an infection. Id get it removed. Pretty standard procedure.

If its a 2nd molar (#2), you don't need an implant. if its a 1st molar (#3), you can just do a 3-unit bridge from #2 to #4.

Don't overthink this. Get it out first then decide on options. Pain+swelling usually indicates a real issue.

[Kieran]

Hi again DVY,

My orthodontist has been correcting my midline discrepancy. Last visit he said that my canines were in the correct position, and so the midline should find it's own place. However, my right lateral incisor is smaller and narrower than that of my left, and so if the canines are in their correct position, then the midline will be slightly off relative to the lower teeth. My question is, is it better to line up the midline of the central incisors with the midline of the lower teeth accurately, or to have the canines etc. lined up correctly with the lower teeth, but with the midline slightly off? I've actually been continuing to wear elastics on one side to move the midline a little further, but I thought I better check that this is okay.

Thanks and sorry to have so many questions.

[DVY]

2 ways to handle it

1) More conservative- Fix it up as best as you can, then leave it alone. Midline isn't that important (from an esthetic point of view). Canine function is basically chewing function. Your ortho guy is being very reasonable.

2) Another option- Line up the midline and the canine, but leave a gap for the right lateral incisor. When the braces come off, you add a filling to bulk up the tooth.

Either way is acceptable, and 99.9% of non-dental people won't notice the differences. You can ask him about both options. 2nd option needs coordination w/a general dentist. Filling should be 150-300 dollars.

[Kieran]

Thanks, second option sounds best as I'm planning to have crowns after and that would give the best possible result.

[Rotisserie]

+1 rep, great thread.

1. Not sure if anyone's asked, but would you brush your teeth before or after breakfast? Seems like the obvious answer would be after, but I read somewhere that mouth microbiota produce more acid upon waking, which causes deterioration like you've explained with soda and other acidic foods/drinks.

2. I've price-shopped a few orthodontists. This is probably better suited for a PM, but I'll ask on the off chance this could be useful to someone. I have an overbite that esthetically gives me a weak chin. I understand regular-ass braces would be best to correct this as best possible without surgery. However, I have a baby 'tooth,' the 2nd bicuspid/premolar on the upper right side, where the adult tooth never felt like coming down.

3 different orthodontists have told me I will have to make a decision about this when I decide to get braces. They've guaranteed the 'baby tooth' will eventually fall, so I should either take it out and put in a fake tooth, and then get braces, or take the corresponding tooth on the other side out as well, then it would actually easily 'correct' my overbite… but result in an even more sunken-in jawline by pushing the upper teeth further back.

Would you recommend replacing the tooth with another fake tooth, or removing the corresponding tooth on the other side?

3. Finally, I feel I already know the answer to this, but is there ANY possibility that braces improve my jawline without corrective surgery at my age (mid 20s)? Goddamn my stupid decision to not get them as a teen.

[DVY]

1- I usually say b4 because its a habit. Ideally, its always after meals. Honestly, the most important thing is brushing thoroughly at night. Morning brushing (for me) is mostly about breath odor control.

2- Not really understanding your description. Id need to see the cephalogram/pictures/ x-rays (ask your ortho guy to email you them). Most take them for consultations. Really depends if you have an retrognathic(bad occlusion) upper jaw or lower jaw. Don't recommend orthognathic surgery (cutting and splitting the jaw) except for the rarest and most extreme cases.

[DVY]

Like ^^ or the bottom one.

[Basil Ransom]

Eel, I just got a Waterpik water flosser. I had a dentist appointment very recently, and I tried flossing a couple times after but I said to myself, there is no fucking way I am going to do this on a regular basis.

I bought the waterpik, and now I use it more reliably than a toothbrush. I can't testify to its efficacy, at least not yet, but it's very easy and pleasant to use as opposed to worrying about slicing your gums. If it's even half as effective, the water flosser will be a big improvement because I'll use it.

[DVY]

@Basil Ransom- Bingo! Ease of use> Efficacy. No matter how good a product is, if said product is difficult to use properly its basically pointless.

Thats why when people ask whats better floss or waterpik? I say floss, but waterpik is easier to use which makes it better than floss ESPECIALLY for people with manual dexterity issues. Very practical solution to inaction.

[Vroom]

Hi DVY,

I had one of my front teeth crowned a few years back, and the cavity for the rod has been a little infected ever since. It's not bad - it doesn't hurt, and the only evidence of it is a tiny white dot on my gum. I used a course or 2 of antibiotics to no avail, but after spending 2 grand or so getting the crowns done in the first place, the dentist decided he couldn't do anything about it, and just referred me to a specialist, who no doubt would charge me another few grand. I can't afford that shit, and since it doesn't really give me any trouble, I just left it. Years have gone by, but the little white dot is still there.

Is there anything I can do to help it heal properly?

[CaptainChardonnay]

Q1. In regards to Hydrogen Peroxide, a couple months ago after flossing then brushing, I would get a bottle, pour some into my mouth, swish it around and then spit it out into my sink and then rinse my mouth with water before going to bed.

Is this bad because I don't dilute the HP?

If so how should I use hydrogen peroxide properly to clean and whiten teeth?

Q2. In regards to drinking apple cider vinegar with meals, I usually pour a shot glass of ACV, drink it and then rinse my mouth out with water before eating meals after brushing my teeth in the morning.

In what order should I be doing this to best protect my teeth and enamel (Right now its, wake up, brush teeth, ACV shot, rinse mouth out, eat breakfast)?

Q3. It has probably been asked before but should you brush before or after eating? I've heard mixed things about this so I've been brushing before.

Q4. Using a Waterpik after each meal is ok?

[DVY]

@Vroom- you have an infection, but its a sleeping infection. This means its there but not getting bigger/worse. Leave it be for now. I've seen cases like this go for another 5-10 years. when and if it fails, get an implant or bridge

@Cpt Chardonnay- I've answered all this before
1) Dilute it half and half, then rinse with it. No need to rinse w/water after. hydrogen peroxide can give some people sensitivity. Def. dont use the 6% peroxide. Regular peroxide is 3%
2) You are fine
3) Most important is to brush at night carefully, so food doesn't sit next to gums. Saliva flow is down at night which minimizes self-cleansing
4) Fine.

[Dirtyblueshirt]

Any thoughts/advice on dental insurance? Better value, easier to work with, etc. Looking at Delta and Met right now. Would like to hear from the perspective of someone who has to deal with these companies constantly.

[kavakid]

After shopping around online for a few days, I found some great tooth repairing toothpaste on Amazon.

"Tooth Builder" by squigle inc.

Contains xylitol (kills bacteria by starving them).

Also nanosized calcite and water soluble calcium to fortify dentin.

Haven't used it yet, but sounds amazing. We will see....