Addressing Dental Concerns: Braces, Cavities, and Treatment Options

Q: Addressing Dental Concerns: Braces, Cavities, and Treatment Options

Hello JJ： <br>1. <br>If the area of tooth loss is significant, even if filled, it may collapse. <br>It is recommended to evaluate the possibility of a dental crown. <br>However, if there is insufficient tooth structure remaining after preparation for the crown, it is advisable to

Braces and cavities related issues?

1.
The upper left first premolar appears on the X-ray to have the area between the crown and the gum line filled on the left, right, and middle sides, but there is currently a phenomenon of detachment.
It is not painful, but it feels rough when using dental floss, likely due to uneven detachment.
If we continue to fill it, is there a possibility of it splitting in half from the midsection towards the root in the future? Is it necessary to place a crown? If so, will the subsequent procedures involve root canal treatment, placing a post, reducing the original tooth structure, and then placing a crown, essentially "destroying first and then covering up"?
2.
The upper right central incisor has a large portion that has broken off and has already been fitted with a crown, but it is only at the temporary cement stage.
The new crown cannot be removed, and I have had to wait (I have tried two or three times within two months to remove it, but it won’t budge, and it hurts when tapped.
The dentist seems unsure of what to do and doesn’t want to tap for too long).
If it cannot be removed, does this increase the risk of future cavities? Additionally, although the tooth has undergone root canal treatment, it feels "sore" when pressure is applied or when consuming hot or cold foods, but there is no pain.
What does this mean? If it unfortunately develops a cavity in the future (since it has no nerve and I might not notice until it's too late), will I need to extract the tooth, get an implant, or create a bridge involving the two adjacent teeth? What should I do? It seems the dentist is also unsure.
3.
Do adults who are afraid of developing cavities need fluoride treatment? Or is it sufficient to rinse after eating, brush in the morning, brush before bed, and floss? Thank you for addressing these questions; I greatly appreciate your help!

JJ, 40~49 year old female. Ask Date: 2020/12/27

Dr. Zeng Guanghui reply Dentistry

Hello JJ:
1.
If the area of tooth loss is significant, even if filled, it may collapse.
It is recommended to evaluate the possibility of a dental crown.
However, if there is insufficient tooth structure remaining after preparation for the crown, it is advisable to consider placing a dental post to enhance the stability of the crown.
2.
If the crown is only temporarily cemented, it will not be stable.
It is recommended to consult a dentist for permanent cementation.
3.
It is advisable to brush your teeth, use dental floss to clean between the teeth, and then rinse with a fluoride mouthwash for better results.
Director Tseng Guang-Hui, Department of Dentistry, Nantou Hospital

Reply Date: 2020/12/27

More Info

Dear Patient,
Thank you for your detailed inquiry regarding your dental concerns. It’s clear that you are facing multiple issues with your teeth, and I appreciate your thoroughness in outlining your symptoms and treatment history. Let’s address your questions one by one.

1. Regarding the first upper left premolar: If the filling at the crown and gum junction is showing signs of wear or has fallen out, it’s essential to have it evaluated by your dentist. Continuous filling without addressing the underlying structural integrity of the tooth can lead to further complications, including the risk of the tooth splitting or fracturing. If the tooth is significantly compromised, a crown may be necessary to restore its function and protect it from further damage. While it may seem like a destructive process to remove part of the tooth to place a crown, this is often the best way to ensure the tooth remains functional and to prevent more severe issues down the line.

2. Concerning the upper right incisor: If your temporary crown is stuck and causing discomfort, it’s crucial to communicate this to your dentist. A stuck temporary crown can lead to increased risk of decay underneath, especially if food particles can get trapped. If the tooth has been treated endodontically (root canal), it may still be sensitive due to residual inflammation or pressure from the temporary crown. If the tooth does develop decay in the future, it could necessitate extraction and replacement options such as implants or bridges, which can be more complex and costly. Regular follow-ups with your dentist are essential to monitor the situation.

3. Fluoride treatments: For adults concerned about cavities, fluoride treatments can be beneficial, especially if you have a history of dental decay. While good oral hygiene practices—such as brushing twice a day, flossing, and rinsing after meals—are crucial, fluoride can provide an additional layer of protection by strengthening tooth enamel and making it more resistant to decay. Discuss with your dentist whether fluoride varnish or other preventive measures are appropriate for your situation.

In summary, it’s vital to maintain open communication with your dental care provider. If you feel that your current dentist is unsure about how to proceed, seeking a second opinion from another dental professional, particularly one who specializes in restorative dentistry or endodontics, may provide you with more clarity and options.
Your dental health is paramount, and addressing these issues sooner rather than later can prevent more significant problems in the future. Please ensure you keep up with regular dental visits and follow your dentist's recommendations closely.

Best wishes for your dental health, and do not hesitate to reach out for further assistance.

Sincerely,
Doctor Q&A Teams

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