Patient's Query
Hi doctor,
I have just been to see my orthodontist today. He usually creates spacing between my teeth for Invisalign with a handheld strip manually that is like sandpaper. I had a noise trauma in the new year, which made my ear sensitive to closer noise and tinnitus. My orthodontist today told me that he needs to use a drill to shape the tooth on the surface, which will take three seconds.
I also worry about noise from bone conduction. Please help.
Thank you so much for your guidance and support.
Hello,
Welcome to icliniq.com.
Sorry to hear about your noise trauma. I hope the sensitivity to the ears goes off completely.
The handheld strips are used when the amount of space to be created is very small, and if it is unable to do so, it can be created by the drill (airotor) to avoid creating excess spaces. The drilling process reshapes the tooth that may require three seconds or more depending on how many parts of the tooth need to be reshaped.
If it is just an edge or a small part, it will very well get over within five to seven seconds. If the process is a bit more, time may increase accordingly. The airotor will run in the mouth, and using ear plugs can significantly reduce the noise levels. Overall, the process should not take more than a minute (including inspection, drill to reshape, assessment, and final suction to complete).
The decibel level of an airotor can range from around 65 to 80 dB, depending on the brand used. As you have mentioned that it is related to Invisalign, you can be assured that the process will be small only. As a safety measure, I suggest you plug in ear muffs and proceed with the process. And if the need arises, you can always ask the orthodontist to stop the process midway.
I wish I could clarify some or all of your doubts.
Have a great day, and wishing a speedy recovery.
Thank you.
Patient's Query
Hi doctor,
Thank you for your reply.
With this drilling procedure, do you think the Peltor ear muffs that construction workers wear would be better than inserted earplugs due to occlusion effect or bone conduction? Also, with this shaping, it is one tooth that is stubborn; I have been on the same aligner for a very long time due to all this stuff going on.
As the tooth is moving slowly, he wants to drill, telling me it is a procedure done on the surface of the tooth to shape it rather than create space. Does this still work in the same effect that it will be able to continuously move that tooth?
He says if we do not do this, the tooth will not move. I am on tray eight, and there are 15 in total; this is my second set.
Please answer.
Thank you.
Hello,
Welcome back to icliniq.com.
Peltor ear muffs by construction workers and ear plugs for bone conduction are very efficient in blocking out the noises. I suggest you check their noise reduction ratings (NRR) for both. If both have similar NRR, you can go with either of those based on your comfort or even use both, if required.
Carry both to the dental office and decide based on the situation. I suggest you make sure the device has a good NRR of at least 25 to 30 dB. This will bring down the airotor noise levels significantly to the 50 dB range, which will be good enough for your ears without any harm.
Sometimes, the anatomy of the tooth is such that a particular edge or part of the tooth blocks out the tooth movement making the Invisalign inefficient (although Invisalign is the best in the world and has got a really good efficiency). If the tooth shaping process removes the hindrance, it will speed up the process you and your orthodontist are looking forward to. You would be able to switch your aligners more quickly and will be able to get to 15 aligners soon. If the process mentioned by your orthodontist assists in accelerating the tooth movement, I suggest you go ahead.
Better assessment can be done if you can share the photo of the particular tooth that your orthodontist is asking to reshape (one photo with aligners on and one photo without aligners) and also mention the tooth needed to be re-shaped.
I hope this gives you a bit more clarity on your doubts.
Feel free to ask all of your doubts.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
I hope you do not mind me writing you again. I have a few questions.
Mostly regarding our previous discussion, and I have just seen a follow-up question. So I have attached photos with and without the aligners. The tooth in question is my left lateral incisor. In the photos, this appears on the right side. However, the one that is more squished in. If you take a look, you will see it is twisting and almost as if it is trying to do a U-turn or something. What concerns me about this situation is that it was not always the case. I have been on Invisalign for a long time. The reason for the length is the COVID-19 pandemic.
I had a noise trauma, so I moved my trays extremely slowly. I still am moving extremely slowly, but this is because I do not want to ruin my teeth. My orthodontist said he wanted to use that drill to shape the tooth. Is that squished in the lateral incisor?
My left one shows up on the photos on the right side. Please tell me your thoughts on this, why, and what this will do for this particular case. My tooth has sadly twisted further. Before it was more straightening, can you tell me where exactly on the tooth he is gonna drill?
He did not tell me. And also, I have only seven trays left. He just wants me off them fast. Can you tell me, from your experience and knowledge and also by looking at my tooth here, what you think the outcome is? He will not make another Invisalign journey, but I am open to it with another dentist. What do you think?
I have only seven trays left, and this was predicted with how teeth were before. Can you tell me what you think about all this? Please, doctor, as I am in two minds over this and find it confusing just by the current position of the tooth. He said he would not do any more filing with hand files.
Thank you.
Hi,
Welcome back to icliniq.com.
I hope you are doing better than in our last conversations. Of course, you can ask as many questions till you get all your queries resolved. You have been on Invisalign for a pretty long time (almost four years), but do not worry. I assume you are being given a comprehensive plan of Invisalign, which covers all your expenses related to aligners for five years (except the freight charges). Looking at the dentition, I could make out the following points:
1. The left lateral is partially rotated. The side towards the canine (left side of left lateral incisor) still needs to come out a bit.
2. The entire lateral incisor still needs to come down a bit as there is still more difference in heights between the central and lateral incisor (difference should not be more than 1 mm)
3. The lateral incisor is peg-shaped. It needs a composite build-up towards the canine side to bring it to the proper shape. The lower edge of the lateral incisor should almost be flat except that the edges are rounded. In your case, it is slanting.
4. The right side lateral incisor edge is not flat as required. There is a minor irregularity in there.
As you mentioned that your orthodontist is speaking specifically of re-shaping the tooth and has given an approximation of three seconds, it is the right lateral incisor edge that he is talking about. The minor irregularity towards the left side of the right lateral incisor (towards the central incisor direction) is what he is focusing on. He will use the drill to flatten the irregularity, which will enhance the smile and looks, which should not take more than 5 seconds.
In case this is not the tooth he is looking for, it could be the left side lateral incisor - canine contact point, which he might be willing to break to create some more space for the tooth to come down. This would require up to 30 to 45 seconds with the drill followed by handheld strips. (However, you did mention that orthodontist is specifically asking for re-shaping and not space creation, so these assumption chances are minimal).
Towards the left lateral incisor, I am expecting it to rotate and come down further before treatment is finished. Once the Orthodontic part is done, you should also evaluate the difference in shapes between both the lateral incisors. In my opinion, you would require a composite build-up for the tooth. You must have access to your plan for Invisalign through your mobile application. You can always open the plan given to you and correlate the plan progress versus the actual progress by standing in front of the mirror and simultaneously checking with the plan. This will also give you an idea of what next changes in teeth you should expect by the time you reach your next tray.
I hope this addresses your concern.
Thank you.
I hope I could clarify some or all of your doubts. Do reach out for further information or clarifications.
Patient's Query
Hi doctor,
Thank you for the reply.
I figured the photos would help a lot and make it make sense. So I have given you some feedback.
To confirm, the tooth he told me he would work on is the left lateral incisor, but on the photos I sent you, it shows up on the right side. As you said, it is that lateral incisor that is shaped differently, more twisted or rotating, and higher up. I also noticed the higher, and it concerned me. At the start of my journey, this was similar on the other side and teeth, and they all became more balanced.
So with what I say to you, he tells me he will only work on that stubborn twisting rotating lateral incisor. He said he would only drill for three seconds, no longer. He did not explain where he would do it. You say edges. Sorry, the doctor, did you mean the edge on the side with that tooth? I worry this tooth is not going to move properly. Based on our opinion, do you feel I need any space elsewhere? I am worried that if I continue to use my trays, my teeth will squish further.
Even before seemed my other lateral incisor was coming out more. Also, with composite build-up, he would add some material to make it look more full. Do you think this tooth would rotate more if he drills like this? I worry because the seven trays I have left were predicted or how my teeth were before this extra twisting.
With the composite build, what is the process of this doctor, is there noise, and how long it takes?
Thank you very much.
Hi,
Welcome back to icliniq.com.
I understand your concern.
Now that we know the tooth your orthodontist is targeting, we can better discuss the drilling process. There can be three areas where he might need to drill:
1. Junction between lateral incisor and canine to break the contact point and create space.
2. The composite build-up is suggested at the lower edge, where the tooth edge is reshaped.
3. At the attachment, if any damage occurred to it. As I went through the previous conversations, I feel he is going to go for a composite build-up (adding composite material to the lower edge of the tooth to give a proper shape) to make it look fuller and, later, a bit of drill to remove any excess material if it gets added and polishing of the tooth. This seems the most probable situation to me.
Once the composite is added, there might be a rough surface, which needs a drill to polish up and takes about three to five seconds. You can ask if he will be using a drill to reshape along with composite build-up on the incisal edge of the lateral incisor. You should be fine with the ear muffs and plugs with the procedure.
Regarding the application access, you can and should always ask for your final approved progress from the doctor. It should be available on your invisalign mobile application as well. Do ask the doctor to share it with you via email and have a look at the plan. It helps you correlate the actual versus predicted progress, and you will know what to expect.
I hope this addresses your concern.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
I am writing to you again, following up on our previous discussion last week. I mailed my dentist about the situation and things we discussed to find out more because I was not certain about some things. He wrote me an email. I will just attach the photo for you because he says some things I do not understand. What does he mean by the ‘mesial aspect of the tooth?
You mentioned yourself breaking contact points. It seems that is what he is thinking, too, judging by his email. Also, I asked to see photos of the Invisalign progress or an application like you mentioned because, in all these years, I have never had access.
His response is in the email in regards to that. What are your thoughts? I did not get the photos, app, or access. Not sure what to make of that? What is your view on all this? Should I also seek a second opinion if I want to start fresh or again? I do not mind. Also, he mentioned when I responded back about the composite build-up, he said it would be more than likely. You say there can be a drill for this. Is there any suction or water? And the drill three seconds again? How he would remove attachments.
So I have attached the email to you of him saying where he feels he is going to do this. The mesial aspect of the tooth. He told me three seconds to drill on that. I worry, though, because with my teeth, that one, in particular, it moved more, rotating it used to straighten more slightly. So I am worried about the seven aligners I have left. Do you feel I need spacing in between any other teeth? He says no.
Please help.
Thank you.
Hi,
Welcome back to icliniq.com.
As we discussed the drill, we assumed he needed it to reshape the tooth. He has mentioned he needs a drill for interproximal reduction (a space-creating process), and he had previously denied using it for the space creation process. This might be the last point where space has to be created, and no other teeth might require it.
Hand files can also make the interproximal reduction, but the drill is a faster process. It also tends to overdo the process (meaning if 0.1 is required, it may end up doing 0.3 mm), while the hand file is better as we have full control over the amount of reduction.
The tooth drilled to create space will take longer than three seconds and involve noise, water, and suction (all three will have noise levels, and you have a history of trauma). Mesial contact of the tooth. Each tooth has two contacts. One towards the midline and another towards another side.
In your case of the lateral incisor, mesial contact means the one towards the central incisor. The point between the central and lateral incisor is the one the Orthodontist will be breaking to create space. There might be a minimum requirement of 0.3 mm to align the tooth properly. He is for sure going to use the drill to create this space which will involve noise and which will involve suction.
Invisalign always has the option that the patient can access the application approved for the treatment and can access it anytime until the treatment goes on. Of course, it is a software-predicted movement that tells us the points where forces are exerted, but also it shows an approximate location where the teeth will end up. It may not be 100 % accurate, but it is often accurate enough for the patient to take an idea. The orthodontist is surely denying you the Invisalign plan.
Regarding the second opinion,
You can, as of now, continue with the current orthodontist till the last seven trays continue. But you can deny the IPR process by drill and insist on hand filing if space creation is required. In my opinion, the composite build-up will definitely be required, and the drilling process will also give a good finish. Attachment removal is also done using a drill, and there is no alternative to it for removal of attachment (that I know of). Attachment removal using a drill will again require a water supply, suction will be needed to remove the water, and sound will be multiplied. (Drill, water, and suction).
You can put these points to your doctor and ask for alternatives that work best in your case.
I hope you get the best of services with satisfying results. We are always here to provide you with the best info we can.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
I have left you another review. I really appreciate this, honestly. It helped me out a lot.
Basically, he is changing what he often says, which leaves me a bit worried and confused, but he told me that 100 % he could not use hand file at all and only drill. He also said to shape the surface of the tooth. I asked how this would help move it. He is not giving me access to the invisalign check application at all.
Do you feel the tooth handle is good and workable? There seems to be a tiny space. My tooth rotating by itself. I will seek a second opinion before going ahead with anything just to see. I do not mind starting over with another. I can choose a three-month movement plan. Most of my work is done anyway.
I have been on invisalign, as u know, for four years. He tells me he wants me off fast and quick and said it is not good being on this long for the teeth or gums. I am confused because they also give us retainers to wear permanently at night. Do you think this is causing damage to me wearing invisalign for so long?
I am going to seek someone else opinion face to face and just see what they are thinking of my situation and have to say. Then I will make a decision. If any questions I will come back to you.
Thank you so much.
Hi,
Welcome back to icliniq.com.
Thank you for your kind words and appreciation.
Our job as health care providers is to reach out to people and help them as much as possible. Trust is what matters the most.
First, hand filing is always possible in almost any situation for front teeth. They provide better control, but the drawback is being slow compared to drill and requiring more functioning of hand whilst drill is quick, out of control at times, and reduces fatigue on hands. Hence, doctors tend to choose drills when a large amount of reduction needs to be done. But for your case, a hand file is the absolute best choice.
Second, you can surely take a second opinion. And since the majority of changes are already done, the newer plan will be a quick one, and a three-month plan will be great.
Third, no duration with invisalign does not harm you as long as you are maintaining your oral health properly when not on aligners. Keep it clean. Brush properly, floss twice a day, rinse your mouth properly to remove any food particles, and use mouthwash once a while to clean up everything. There is no harm with invisalign for four to five years.
Coming to retainers, it takes about one year for the bone to completely mature once orthodontic treatment is over. Till then, there are high chances of losing all the corrections achieved by aligners. So, wearing of retainers for the maximum possible time till one year followed by a gradual reduction in wear time to almost stopping the retainer wear by two years is suggested. The same hygiene instructions stand for retainers as well.
Patients always have a right to seek more information till they are completely satisfied and can always go for multiple opinions. If you get an appointment with a physical examination at the clinic, you will surely be able to get better treatment.
I hope this helps.
Thank you.
Patient's Query
Hello doctor,
Thank you for your previous replies.
I am writing you again because I want your insight and option on this.
So basically, two and a half weeks ago, I caught COVID for the first time ever. I had the usual flu-like symptoms, which also included nasal congestion. I felt better towards the end of the first week, but the congestion persisted. Then in the second week, the left nostril was unable to unclog.
I started to develop pain on the left side, around the eye, cheek, and tooth area, and I still have the pain. I am not sure if it is viral or bacterial, so I have taken the tablet Doxycycline. I am on day two, but I do not notice a difference yet.
So I went to the dentist because I told him all about this and the pain around two particular teeth. One normal tooth and the one next to the one with the filling, which is close to the nerve. But they all ache on that side sometimes. He did an X-ray, and it showed cloudiness around that tooth, which he says is common with sinusitis. Now I am so scared that it has spread. But I know sinusitis causes pressure like this.
However, the doctor did this cold air test, spraying on something and touching my teeth. I felt it was very intense pain on the tooth next to the filling tooth and not much or very slightly or delayed on the filling tooth, he said, which could indicate nerve dying and needing a root canal treatment. But also, could this be due to sinusitis?
I have not had that test done for a long time, so that it could have been there before. It has been a week since I developed this pain that only happens with all my sinus congestion occurs. Also, the eye and cheek hurt. I take the tablet Ibuprofen, which helps. But now I am so scared of what is happening with my tooth. Please tell me what you think. And as you remember my situation with my ears.
This doctor does drilling, but there is a dentist nearby who does laser if it comes down to it for a root canal. The current dentist says, first, let us treat sinusitis, and if there are no more symptoms, we will monitor the tooth. I am really nervous. Could you please guide me on this?
Please help.
Thank you.
Hello,
Welcome back to icliniq.com.
I am sorry to hear about the COVID-19 (coronavirus disease 2019) infection contraction.
Nasal congestion with cough is one of the most common symptoms, along with taste and smell sensation loss. However, I have a few questions,
1. Have you been prescribed any medication for COVID-19?
2. Did you have congestion after taking the medicines?
The tablet Doxycycline (antibiotic) is an efficient drug to treat sinus infections. It has been only two days since you started with these medicines. So I suggest you take it for a total of five days and look for any reduction in sinus congestion. And, regarding the associated dental pain, the molar tooth (back large tooth) is closest to the sinus and sometimes even penetrates the sinus border. But in that case, the sinus symptoms would be recurring frequently. Your case is acute, and there is a mild possibility of the sinus lining getting affected. Two teeth are mainly associated with pain, and one of them has a history of a previous filling.
The tooth that responded immediately seems intact, while the filled tooth might have developed secondary caries beneath the filling, which could have approached the pulp or caused a tooth infection. Secondary caries usually progresses slowly and might have existed for a long time. Due to the sinus infection or congestion, toothache symptoms would have responded, and you could feel both. This is just a possibility, as you mentioned that the tooth reacted.
But the provisional diagnosis remains as that of the acute sinusitis case. However, did the doctor mention any cavity formation in the filled tooth?
I would recommend waiting for two to three days until the nasal cavity clears out and observing for any toothache improvements. Also, I suggest you visit a medical practitioner for your sinus congestion and get an opinion from them. After sinus clearance, a repeat X-ray and clinical test would give us a better picture if the toothache was temporary due to sinus infection or if the tooth had some issue that came into notice due to sinus infection.
I hope this helps.
Feel free to reach out for further information or clarifications.
Get well soon.
Patient's Query
Hi doctor,
Thank you for your reply.
Yes, I am into a week of this infection. I hear of others constantly needing to change antibiotics and am slightly concerned. The tablet Doxycycline is suitable for all these infections, I believe. I took it recently for an ongoing UTI but stopped as I got a migraine. But I am willing to tolerate some mild side effects to heal this. But that will not create resistance, right? I took it for a bladder infection and not sinusitis.
I am not sure whether I should be taking Prednisone along with this to help open the sinus. I spoke to my GP, but they do not seem concerned as it is acute nor do they seem eager to do cultures or prescribe medicines. My GP said not to undergo a urine culture and advised me to continue the medicine.
I have eye pain also, but he checked and said it seemed fine. Also, I have tenderness all over the left side of my face. But it seems to have spread to the left side teeth. Sadly, I do not have a copy of the X-ray, but it looked like a cloudy patch sinking in slightly by those two teeth.
He said this is common cloudiness with a sinusitis issue. I do not even know yet if my sinusitis is viral or bacterial, but either way, I am on antibiotics for now and trying to do steam inhalation. I have pain and toothache all day, but taking the tablet Ibuprofen helps relieve the pain but not the congestion. The nostril on the nose's left side has so much congestion that I never had this before.
The dentist said nothing about tooth infection or cavity formation in the filled tooth. He would have seen it and told me if so, right? So I am just praying it is nothing bad and only sinus pressure. The doctor said it sounded like sinusitis; however, he wants to monitor it because the tooth with filling did not respond or had a delayed reaction to cold air for nerve testing.
That tooth was filled in four years ago. At that time, the dentist filling it told me it was deeper than he expected. I had that same tooth filled with metal filling when I was around 11. So he removed it, gave it a good clean, and then refilled it with a more extensive white filling. After a few weeks, I had an ongoing toothache and sensitivity to hot and cold beverages.
The pain and aches subsided, and I was told this was likely because the tooth was close to the nerve. It was sensitive to cold and hot foods for around six months or the first year. This slowly passed and calmed down. Then I did not feel much of anything (I could drink hot and cold on that side and no more toothaches).
Also, I had zero nerve problems at that time. Then I had COVID that turned into this sinusitis thing. Only when it turned into sinusitis due to pressure am I developing these tooth symptoms. Also, pain in the eye and cheek area on the same side.
He told me the tooth has some decay that was seen some years ago, and yes, I remember that is why it was dealt with and cleaned and refilled, etc., but now I am worried. It is the molar tooth third from the canine, the second one that hurts, and the third one is the filled one. The cloudiness shows it is around both teeth.
I have attached a few older pictures taken four years back for your reference. I have not had professional cleaning for a long time now. However, I did great with my electric toothbrush and flossing, but I now use a regular brush, so I am planning to go back to what I did before. I am going to fix an appointment for manual cleaning next year. I had some red gums four years ago that was fully healed. The dentist did not seem too concerned. He would have said if it was damaged, right?
Please give your suggestions.
Thank you.
Hi,
Welcome back to icliniq.com.
Based on all the records and history mentioned, I feel it is most likely the sinus infection that has caused tenderness all around the left side, and the tooth is reacting to that (attachment removed to protect the patient's identity).
For tooth:
As you mentioned that you had two fillings in the past, and the second one was bigger and deeper than the first one. I assume we are quite close to the pulp (i.e., the nerve supply of the tooth), which has caused the delayed response. Regarding cleanliness, I would suggest getting a full mouth cleaning once and later maintaining it with regular brushing twice a day with floss sessions.
Most likely, it is a sinus infection. As you mentioned, the GP (general practitioner) is not worried about the side effects and is more about culture and medicine. I, too, agree with them. With cultures, we get information about the root cause, and medicines can take care of it. That would help you relieve the symptoms. By following home remedies, you can continue declogging your nose and sinus and continue with steaming sessions.
I hope this helps you out.
Hoping for your speedy recovery.
Patient's Query
Hi doctor,
Thank you for the excellent and detailed response.
I feel that the sinus infection has improved overall; however, there are still times when I experience pressure or a throbbing sensation either high in the left nasal area or within the left maxillary sinus. This occurs even though I no longer have significant congestion or mucus.
My ENT has prescribed a one-month course of Doxycycline. The area still feels inflamed or swollen at times, and I occasionally experience mild tooth pressure or slight pain. The symptoms tend to fluctuate and are nowhere near as severe as before, but they are still concerning.
I sought a second dental opinion and requested a CBCT scan; however, the dentist declined due to concerns about radiation exposure. For my own peace of mind, I would really like to have a CBCT performed both to rule out any abscess and to assess the overall health of my teeth, gums, and jaw, and to determine whether I truly require a root canal on the tooth with the large filling. That tooth showed a delayed or reduced response to cold thermal testing, which is why root canal treatment was mentioned.
Importantly, I had no dental symptoms before contracting COVID, which was followed shortly by a secondary sinus infection. I never experienced any issues with that tooth before this sequence of events. This is why I am feeling anxious and would really appreciate your reassurance and insight.
I admit that I have not had a professional dental cleaning for several years, initially due to COVID, and later due to my noise-related trauma. I regret postponing it. I also wore the same Invisalign aligner for several months, cleaning it mostly by brushing morning and night, but it is now visibly worn. I have not worn the aligner for nearly three weeks and feel that my teeth may be shifting. While I would like to begin a new Invisalign treatment plan, I first want to resolve these current concerns.
I am feeling alarmed and worried that I may have caused permanent or irreversible damage. When I look in the mirror, I notice slight gum redness around some teeth, suggestive of gingivitis, although I had no symptoms. I experienced gingivitis in 2018, which resolved with professional care, but I am concerned that this time I may have left it too long.
I have also noticed what appears to be gum recession on a premolar next to the canine, with more visible root surface than I recall seeing in photos from July or September. I am worried it may also be starting on a front tooth.
The slight red tint visible in some of the photos is from a plaque-disclosing tablet I used to detect tartar and plaque, although it did not reveal much accumulation. I attempted to use a home sonic scaler while wearing hearing protection, as I struggle with the occlusion effect from ultrasonic scalers at the hygienist. I mainly felt vibration rather than high-frequency sound, but I am unsure if I am using it correctly.
I am very concerned that I may have caused serious, irreversible damage. I hope that with thorough professional cleanings, my gums can heal. However, I am unsure whether what I am seeing represents mild gingivitis, more significant recession, or early periodontitis. I sincerely hope that manual cleanings, even if they require multiple longer sessions, will be sufficient.
I will attach the photos for your review.
Thank you for your time and guidance.
Hi,
Welcome back to icliniq.com.
Thank you for your detailed feedback.
Happy to read out that some of your symptoms have healed but at the same time, its not completely gone. As you mentioned that you still feel swelling and inflamed sensation in the nose and sinus region, it is due to sinus congestion and mucus build up which might be to some extent but not high enough like previous times wherein your situation was worse than current one.
CBCT is comparatively having higher dose of radiation compared to OPGs and individual tooth x-rays but are still much safer to get done. Radiation exposure becomes trouble or lethal when you undergo the exposure on a daily basis and higher dosage, unlike the situation wherein you get the CBCT done once a lifetime or may be a couple of times more. But regulations differ from country to country.
So, please follow according to rules and regulations followed in your local region. The molar tooth already has a filling and could be a reason for delayed response. Yes, CBCT will give us a very precise and clear picture not just about that particular tooth but also for all the other tissues involved and it will be very precise and insightful. As you mentioned that previously, you never had any such issue with the tooth, it could well be both the conditions occuring simultaneously.
Nasal and sinus congestion, the cause for heaviness and tooth nerve involvement, the cause for delayed response. On a general advice, one should visit the dentist once in six months for a regular check up. In such cases, cavities (if any) are caught up early before reaching the root canal stages. Regular teeth cleaning is done especially in the areas where tooth brush access is difficult under normal circumstances.
Oral hygiene is also important and we should take care of it. Invisalign is something which shouldn't be stopped abruptly. You should change your aligner trays as scheduled or may be stretch it for a while longer than the prescribed time, but important here is wearing it continuously. As you have not worn it for almost three weeks now, teeth definitely have shifted. The current set might not fit in or may be exerting a bit more pressure.
If it doesn't fit, switch down to 1 or 2 sets prior to this and wear them for 10 days. That will re-align the teeth and again you can resume your Invisalign treatment. That's a good observation you had for your gums level. Gums are movable tissues and they respond to various stimuli. Teeth cleanliness is one such stimulus. Gums levels keep changing and never the same.
Once you get a deep scaling done to clear out all the deposits, the gums will heal and again re-gain the normal levels. Home scalers aren't the high frequency scalers that are used in clinics. They are comparatively smaller and easy to use but then they are meant for DIY and at home levels. Efficiency wise, it will be low as it is done by the patient himself / herself and not knowing exactly where to do it and also difficult to access all the areas.
Gums recession at your age is pretty much reversible. Once, scaling and polishing is done and you maintain your dentition, definitely gums will revert to better levels. All the gums inflammation will be reduced and you will feel better. Periodontitis is something that cannot really be judged just by the photos. It has more to do with the bone levels.
Mostly, with proper care and cleanliness, bone conditions can also be reversed. Seeing the pictures attached, you are definitely not having any signs of periodontitis here. It's just a mild gum inflammation here. As your history of noise trauma is present, you can opt for manual scaling / hand scaling which will clear off the teeth from all the deposits It will eventually improve the bone levels and gum levels as well.
Hope this resolves some / all of your queries and gives you a better picture.
Do reach out for further explanations and related queries.
We will try our best to portray your treatment options as much as possible.
Have a nice day.
Get well soon.
Regards.
Patient's Query
Hi doctor,
Thank you so much for coming back to me with this.
Yes, I have noticed that sometimes it does not feel like sinusitis, while at other times it feels more like pressure. I have also observed that when I lie on my right side, I tend to feel more pressure in my tooth, particularly on the left side where the main issue seems to be.
I am planning to look for another dentist who would be willing to perform a CBCT scan. I’ve already had four or five standard CT scans this year for other medical reasons, and I hope that’s still within a safe range. I understand that a CBCT scan involves less radiation than a conventional CT scan, and I feel it would provide reassurance and peace of mind.
In the meantime, I plan to resume Invisalign treatment. However, I am a bit concerned because my current tray is nearly a year old. I have been disinfecting it using cleaning tablets in warm water, but it appears worn and has developed some white buildup. Could you recommend an effective and safe way to thoroughly clean it to minimize any bacterial risk?
Recently, I have been using Listerine mouthwash and an Oral-B Braun electric toothbrush. I have ordered ultra-slim sensitive brush heads because I was starting to notice some gum sensitivity and mild aching, although I do feel the electric brush cleans more effectively. Could you also advise on the most suitable type of dental floss to use?
I am arranging for a thorough manual dental cleaning soon. I admit I am feeling a bit anxious about what might be found. The long root I showed you in previous photos has a red line along the gum (which I assume may be gingivitis), extending upward along the root. I’m hoping this will improve with professional cleaning. I hadn’t previously noticed the gum recession or root exposure and had no symptoms at the time, so I did not think much of it. I sincerely hope I have not left it too late.
I have also sent a few additional photos. I have noticed that the molar with the large filling appears slightly discolored, and the adjacent tooth seems to have a small space between the teeth that I hadn’t observed before. The shape also looks slightly different to me, although my dentist did not raise any concerns and simply recommended another cleaning. The gum on that side also appears somewhat pale. Occasionally, I notice small white patches on the gum on the right side, though not consistently. I am being especially careful with brushing now.
Thank you so much for your continuing advise and assistance. I'll try to schedule a CBCT scan and am hopeful that with thorough cleaning, possibly over several sessions, things will improve. If you could propose a powerful but safe product for cleaning my Invisalign tray, I would be grateful, since I intend to use it until I'm ready to start a new Invisalign treatment phase after completing the essential cleanings and any further treatment.
Warm regards.
Thank you.
Hi,
Welcome back to icliniq.com.
Thank you for your kind words and thoughtful feedback. It is truly appreciated.
When you lie on your right side, it is possible that sinus contents may shift toward the left side due to gravity, potentially creating pressure in the area near the tooth. That could explain the sensation you are experiencing.
You are absolutely welcome to seek a second opinion from another dentist; there is no harm in doing so. A CBCT scan involves lower radiation compared to a conventional CT scan. It is generally safe as long as you are not undergoing repeated high exposure within a very short period of time.
Since you have already undergone CT scans without issue, there does not appear to be a medical contraindication to having a CBCT, unless there is a separate health condition that would specifically prevent it.
Regarding Invisalign, the material is not intended to be used for such an extended period once it has been in regular contact with saliva. Even though the material is durable, wearing the same tray for close to a year is not recommended. To maintain hygiene, rinse it daily under plain running water to prevent debris buildup. Additionally, once every seven to10 days, gently clean it with a soft brush and toothpaste. Some degree of discoloration over time is unavoidable.
For flossing, waxed floss or silk floss is recommended, as they are generally stronger and less likely to shred or break during use.
Please try not to overthink the upcoming cleaning session. Professional cleaning is primarily focused on removing plaque and tartar deposits. Even if something is identified, it is always better to detect and address it early rather than allow it to progress. Early intervention leads to better outcomes.
Regarding the molars, although the photos are not extremely clear, they are sufficient to provide some guidance. The first molar appears to have an amalgam (silver-colored) filling. The adjacent molar looks slightly yellowish, though this could be due to lighting or camera settings. After a professional cleaning, the true tooth surface will be more clearly visible, free of plaque or staining. In some cases, chromogenic bacteria can attach to plaque and cause discoloration.
On the left side, the wisdom tooth appears to be positioned slightly out of alignment. Since wisdom teeth are often not essential for chewing and can make oral hygiene more difficult, extraction may be considered if it is contributing to cleaning challenges. Removing it could make it easier to maintain hygiene in that area.
We generally do not recommend using strong or harsh cleaning solutions for Invisalign trays. If you are able to share a photo of the tray, I may be able to provide more specific guidance on how best to maintain it.
If you have any additional questions or need clarification on anything, please feel free to ask. I hope this helps reassure you.
Wishing you a great day.
Regards.
Patient's Query
Hello doctor,
Thank you for taking the time to explain everything to me. I really appreciate your guidance.
When I visited the dentist recently, he pointed out a tooth with a filling that might have some decay. He looked at older records and images from 2018. At that time, I had Invisalign treatment and had a larger X-ray taken, possibly a panoramic scan, but I don’t think it was a CBCT.
During that visit, the dentist said I needed two fillings and a cleaning because of mild gum inflammation. One was a small filling on my right molar, and the other was on a tooth closer to the nerve. That tooth first had an amalgam filling when I was about 11, which was replaced in 2018. The dentist removed the old filling, cleaned out the decay, and put in a white composite filling. Now, though, it looks discoloured.
At a recent check, the tooth did not react much to cold testing, and we have not done any new imaging yet. I have not had major symptoms from that tooth before. My current discomfort started after a sinus problem, probably from a viral infection that caused congestion, a secondary infection, and sinusitis. Even though I have taken antibiotics, the inflammation sometimes continues, even when my nose feels clearer.
For example, when my sinus area feels more inflamed or swollen, I notice more sensitivity or pressure in my teeth. Lately, I have also felt that the upper gums on my left side are warmer than on the right.
The dentist said that if needed, I might need a root canal for that tooth in the future, and maybe a crown after that. I feel a bit unsure about having major dental work right now. My main goal is to get a CBCT scan, have a professional cleaning, and deal with the sinusitis first. I am also worried about the tooth not responding to the thermal test, especially since the tooth next to it reacted normally.
Since I have not had problems before, a’m worried aboutneeding severale procedures,likes root canals. As Ithink about my options, could you suggestd quieter or more comfortable dental ools or techniques? Ffor example, electric drills instead of air-driven ones,slower-speed toolns, or even laser dentistry for hard tissuework. I know these mighty take longer, and Iame willing to acepte that if itmakes things more comfortable.t.
Also, would it be reasonable to ask the dentist to work in short intervals, like a few seconds at a time with breaks? I think this would help me handle the procedure better.
I have also looked into dental clinics that offer CBCT scans, but some only provide them for certain cases, like implant planning. Is it okay for me to ask for a CBCT scan as a new patient, or should I wait for a dentist to recommend it?
Lastly, I have read that root canal treatments can sometimes lead to complications, including sinus problems, especially when the upper teeth are close to the sinus cavity. I assume that using proper imaging, like a CBCT scan before and after the procedure, would help lower these risks and make sure everything is handled safely.
Thank you again for your time and support.
I will continue using my aligner trays and hope to resolve these issues over the next few months, so I can return
to my Invisalign treatment.
Hi,
Welcome to icliniq.com.
I understand your concerns.
The X-ray from your 2018 Invisalign treatment was likely either an OPG (orthopantomogram) or a lateral cephalogram. An OPG provides a panoramic view of all teeth, or a lateral cephalogram, which captures a side profile including dental, skeletal, and soft tissue structures.
Discolouration of a filling could occur if a composite filling is partially lost, exposing underlying material, though this is uncommon. Normally, all previous material and decay are removed before placing a new composite filling. Composite fillings are durable and resistant to chipping, but over time, they may become off-white or slightly yellow due to exposure to saliva and dietary factors.
Your description suggests the tooth may have a mild infection, possibly related to the nerve or surrounding bone. This could explain why your symptoms worsen during sinus inflammation.
Your dentist is correct that a crown is recommended after root canal treatment (RCT). The procedure removes the nerve, clears infection, and fills the canal, which can leave the tooth more brittle and prone to fracture, especially in molars and premolars that bear significant chewing forces. A crown restores strength and function, so it is strongly advisable to have one placed after RCT.
For further evaluation, consider a CBCT scan. If that is not available, a localized periapical X-ray focused on the affected tooth, with clear visibility of the root area, can also assist with diagnosis.
Dental technology has advanced significantly, with newer equipment available to reduce noise and improve patient comfort.
CBCT scans are most commonly used for implant planning because they provide detailed information about bone levels, tooth position, and available space. However, they can also be used effectively for diagnostic purposes when needed.
Based on your description and images, your wisdom tooth appears fully erupted and not embedded in bone. Extraction in these cases is usually straightforward and may not require bone drilling; local anesthesia and simple instruments are often sufficient. This can be considered a secondary concern and addressed later.
The roots of upper molars are often close to the sinus, and deep dental procedures in this area can sometimes affect the sinus. However, with careful planning and proper technique, this risk is well managed. A pre-treatment CBCT scan is valuable for visualizing the sinus lining and root tips, which helps plan treatment accurately and minimize complications.
I hope this addresses your concerns. Have a nice day.
Thank you.
Patient's Query
Hello doctor,
Thank you for your continued help and guidance. I greatly appreciate your support.
I would like to clarify your earlier point about a possible tooth infection. My dentist did not express concern about the discolouration, focusing instead on the thermal test, which showed a delayed or minimal response. He recommended monitoring the situation after the sinusitis resolves.
In your opinion, could the colour change be due to natural ageing of the filling material, or might it indicate decay rather than infection? The tooth is not particularly painful, but the adjacent premolar had a strong response during the thermal test.
Additionally, my gums have felt sensitive since I began using an electric toothbrush, and the left side feels warmer than the right. I am unsure if this is significant.
If I do end up needing a root canal or further treatment, I may not be in a position to proceed financially for another month or two. Would it generally be safe to wait for that period? I am currently taking doxycycline as well.
I have researched dental options, especially clinics offering laser dentistry. I read about a patient with similar hearing sensitivities who had a positive experience with laser treatment, as it avoids the vibrations and bone conduction of traditional drills. This is important to me, since prolonged drilling could worsen my hearing issues, including tinnitus and sensitivity.
With that in mind, I wanted to ask:
Is laser dentistry a viable and effective option for procedures like root canal treatment?
If conventional tools are used, is it possible to perform treatment at a lower speed with frequent breaks, such as 5 seconds on and 5 to 10 seconds off?
Would a crown placement also be possible using Is crown placement possible using quieter or lower-impact techniques? The treatment may not be as effective, although they do not offer it themselves. I’ve read mixed but often positive feedback, so I would really value your perspective to ensure I’m making the right decision.
I am also concerned about the possibility of residual or “trapped” infection after a root canal, as I have read about treatment failures. Would a CBCT scan before and after treatment help ensure all infection is addressed and reduce the risk of complications?
I appreciate your patience with my questions. Since I may need to wait a couple of months before treatment, I am trying to plan carefully. My immediate goal is to arrange a gentle or manual cleaning.
Lastly, I have noticed occasional jaw clicking when opening my mouth wide, which I suspect may be related to the electric toothbrush.
Thank you again for your support and understanding.
Hi,
Welcome back to icliniq.com.
I read your query and can understand your concern.
The discolouration may be due to changes in the filling material over time rather than an infection, though this cannot be confirmed yet. Since the adjacent tooth is uncomfortable, a cavity or another underlying issue is possible.
A CBCT scan or other radiographic imaging will help identify the exact cause. The premolar’s positive response to thermal testing suggests it is healthy, while the molar’s lack of response is concerning. Imaging will provide further clarity.
Electric toothbrushes should be used gently, as their vibrations can sometimes irritate sensitive or inflamed gums. For now, please switch to a manual toothbrush until your symptoms improve.
It is important to prioritize both clinical needs and financial considerations. If a cavity is confirmed, addressing it first is recommended. Managing dental issues may also help improve your sinus symptoms.
While laser dentistry reduces the need for traditional drilling, some noise from the dental chair compressor and suction will remain. Using ear protection, such as earmuffs or earplugs, can help minimize discomfort during treatment.
Performing procedures in very short intervals, such as five seconds on and off, is possible but disrupts workflow and significantly prolongs treatment, reducing efficiency and effectiveness.
Laser dentistry has shown promising results, although the evidence is somewhat mixed. Its Laser dentistry has shown promising results, though evidence is mixed. Its effectiveness depends on the the type of laser, the clinician's the experience, and the condition being treated. Some studies support its use, while others are less conclusive. Imaging provides a comprehensive view of all teeth and surrounding structures, allowing for accurate diagnosis and treatment planning. If multiple issues are present, they can be identified and addressed systematically.
Root canal treatment failures are uncommon. CBCT scans before and after treatment provide valuable, comparisons and help assess whether the canals have been adequately treated.
For now, you can focus on getting a professional cleaning and a CBCT scan. Based on the results, further treatment such as root canal therapy and crown placement can be planned. If a root canal is performed, placing a crown is essential to protect the tooth and ensure long-term success. Please do not leave the treated tooth without a crown. Possible care based on knowledge and experience.
I hope this helps.
Please revert in case of further queries.
Thank you.
Patient's Query
Hi doctor,
Thank you for your prompt response. It has been very helpful during this situation.
I wanted to provide an update and request your advice. This morning, after our discussion, I tried wearing my aligners again (tray number 8). I cleaned them thoroughly with a cleansing tablet in warm water, then brushed and rinsed them.
However, I am concerned because they no longer fit properly, especially on the upper teeth. I realize I made a mistake by discarding my previous trays and do not have a backup. The aligners have been out for approximately 2.5 to 3 weeks. When I tried them about a week after stopping, they fit well, but now they feel misaligned.
Would you recommend continuing to wear the aligners despite the improper fit, or could this cause unwanted or incorrect tooth movement? Alternatively, would it be better to pause Invisalign treatment, address the current dental and sinus concerns (including cleaning and any necessary treatment), and then restart Invisalign from the beginning?
Regarding the tooth next to the slightly discoloured filling, I noticed increased sensitivity during nerve testing. I also feel the most sinus pressure in that area.
Could sinusitis be contributing to this discomfort? The pain is mild but occurs occasionally. I have started using Listerine mouthwash daily and have noticed some increased sensitivity.
I will arrange a CBCT scan soon. Additionally, could procedures such as crown placement or laser treatments be scheduled in shorter intervals or performed in a way that minimizes loud noise?
Over the past few nights, I have noticed mild pressure or tightness on the left side when I wake up, sometimes extending toward the ear. This usually eases as the day progresses. Last night, I experienced increased sinus pressure. Although the antibiotics have resolved the more acute symptoms, some inflammation remains. It has been just under three weeks since the sinusitis began, and most symptoms are still localized to the left side.
Thank you again for your patience and guidance.
I am hopeful that I will be able to resolve everything soon.
Hi,
Welcome back to icliniq.com.
I read your query and can understand your concern.
Invisalign moves your teeth by applying steady pressure. If you stop wearing your aligners, your teeth may shift back. Since you have not worn your aligners for about three weeks, your current set (number 8) may no longer fit properly.
To ensure safety, always keep your last two sets of aligners. For example, if you are using aligner number 10, retain numbers 8 and 9 as backups.
At this stage, try wearing your current aligners and use chewies to improve their fit. The lower tray appears to fit better than the upper. Do not be concerned; wearing them will not move your teeth incorrectly, as the treatment is designed in planned steps. Your teeth were intended to reach this position during your treatment.
If the aligners begin to fit better within the next two or three days, you may continue wearing them. If not, you can pause your Invisalign treatment, address your dental and sinus concerns, and resume treatment later.
Fortunately, Invisalign allows for adjustments with additional aligners, so you will not need to start over. If your teeth are not tracking as planned, your orthodontist can order new aligners after taking updated scans and provide a revised set.
Regarding your symptoms, sinusitis may be causing the pressure and discomfort in your teeth. Since the pain is intermittent, it is more likely due to sinus pressure than a dental issue.
Root canals can sometimes be performed with lasers, while crowns are typically prepared using dental drills. Your dentist can make the procedure more comfortable by working in shorter intervals and providing breaks. There are also ways to reduce noise during treatment.
Your symptoms, including increased pressure at night and improvement during the day, strongly suggest a sinus issue. Lying down can cause sinus pressure to build up and affect your teeth and gums, while standing during the day helps relieve it. Please continue your prescribed doxycycline as directed by your doctor and schedule a follow-up review.
In the meantime, please schedule a professional cleaning (scaling) and a CBCT scan if possible. These will help determine your next steps for treatment.
I hope you recover quickly.
Thank you.
Patient's Query
Hi doctor,
So I’ve still been wearing the trays as you mentioned see how I go etc. I’ve taken new photos for you and also some with top tray out just so you see things as they currently are. One lateral incisor that has slight lil gap never use to have that btw but I noticed with this treatment it did and it’s showing more. That’s the tooth that orthodontist use to create hand filing space but told me he wants to drill the surface of the tooth which I told him I need to think about. Then in email he told me lpr but he is wanting to shape it.
During this year in emails he kept telling me to continue changing trays when earlier in year said we’d create hand filing space. I did this and it set my teeth back. Particularly that tooth. It’s squished in more but last year looked much more straight! Then he’s telling me he wanting to drill the surface to shape the tooth? Said it’s impossible to hand file ? What’s your thought based on this and that tooth.
Btw doc I had more teeth aligner I think earlier last year. Not sure if it same thing but I remember paying more money for 15 new trays?
He was happy to do it but now telling me he wants me finishing fast and won’t do more and said drill to shape or nothing. I’m a little concern here. I am gonna see other dentists too maybe the ones I see for the RCT (if that’s needed) and the cbct and cleans to see if they also will offer these treatments. I will tell any new dentist my background history.
He said we do this for some patients and it doesn’t create any buck smiles it just brings the first few sets of teeth out to align into straightened smile. Sometimes since I wasn’t given much lpr spacing this year my bite feels a bit off ?? Can this all be correct later if I do Invisalign with another doc? I hope I don’t need any teeth out. Altho I don’t mind having the wisdom ones out. My aligners btw don’t feel too bad anymore but sometimes I get slight aches or course but also some tightness like bite feels a bit off. When I take them off and put them back on it doesn’t feel like it’s gripping my teeth to insane levels anymore it just feels much less.
But still things feel a bit odd. Also last night for hours and sometimes during day on left side I feel it more and get this random slight burning sensation in left ear, left side of head, down throat and left teeth did kinda. Am I safe in what I’m doing like I know the teeth will be trying to shift etc but I worry I’m forcing them in wrong place or messing with nerves ?? I don’t want to cause nerve damage or make the bones in jaw and teeth misaligned. Even if that was case can Invisalign correct this later ??Took some pics.
Wisdom tooth on side where that filling is, sometimes it feels a bit different to me as if it’s going into one of the molars almost and I get this sense of slight inflammation sensation around that side and throat when swallowing. This all pretty normal or seems bad?
Overall though I think it’s fitting better. Pls let me know what you think based on pics. I know it’s difficult with pics I’m sorry it’s not 100 percent clear. In meantime I try to see a new dentist to get a cbct.
I hope I can be fixed Doc it’s been long time for me and with setbacks but I’d love straight teeth really,,,
is it possible and my bite look ok to you with how precious ortho wanted it?
He didn’t wanna remove any teeth nor wisdom ones. I hope if I do Invisalign again front ones won’t be goofy or buck!??
Thank you so much for your patience help and guidance.
Hello.
Hope you are doing better with your sinus pressure issues.
Yes, Invisalign is a system that needs to be worn effectively to see the results. I remember discussing about hand filing vs the drills used to reshape the tooth considering your noise trauma. Based on the current photos, there is space near the lateral incisor (peg lateral incisor).
It needs a composite buildup to look similar to other side lateral incisor. What happens in composite build up is: Tooth conditioning is done, which is washed away, followed by composite application which is given the desired shape till it is not set (hardened) and once, the shaping is done, it is hardened via a LED machine. Following this, sometimes, final finishing touches are required to the composite filling which is done via drill and it does involve sound.
Along with will be a suction running, that adds up to the sound. During this procedure, you surely will be requiring ear muffs to reduce the sound levels. Sorry, this is a process which will not be very efficient with hand file, and since this is an esthetic zone, I would advice you to use sound protection equipments and go for drill.
If you decide to change the Orthodontist for the treatment, make sure he/she is certified with Invisalign to do the treatment. You can surely change the doctor to get the desired results you require (ofcouse, after having a proper discussion and knowing all the pros and cons) As we discussed previously, Invisalign will try to align the teeth to specific positions. The teeth have moved a bit towards those positions, hence the pressure to put on and off the Invisalign, and tightness have reduced.
The random sensation towards whole of left area can be substantially evaluated only with the assistance of radiographs. Technically, things should be better and medicines (doxycycline, as prescribed) should be working towards remedy of pain and pressure issues. Wisdom tooth on the filling side is buccaly placed (towards the cheek area). In normal circumstances, we get it extracted as they are not very much useful in regular functioning, possess cleanliness issues and may cause ulcers on cheek area due to its angulation.
I feel Invisalign is now fitting a bit better as compared to what we saw last time. May be in coming times, we will achieve even a better fit than now. Yes, you can look out for CBCT options. CBCT integration with Invisalign software planning was under progress and it might have been completed successfully.
This is varying worldwide from region to region. So, the Orthodontist you will visit will be able to tell you if that region is now equipped to use CBCT for Invisalign treatment planning as well. Your teeth aren't so badly placed based on current photos. They can be aligned further with Invisalign.
No need to worry on that. It can surely be done. You can carry on without teeth extractions (except wisom teeth, which can be extracted as it is buccaly inclined) Patient always has the right to see the plan from the company, put in their inputs and ask for modifications and once, they feel what they are looking for it shown, should approve the plan. Patient should also be actively involved in treatment planning. Make sure that plan is shown and discussed with you before approval is sent for Invisalign production.
Always a pleasure to help you with all your queries.
It boosts my confidence to see patients like you giving genuine feedbacks to the responses.
Have a great day.
Thank you.
Patient's Query
Hey Doc!I’ve got some big news and updates for you. So, today I have just arrived home from travelling to the cold climate country dentist place that uses progressive stuff like cbct (I got rejected everywhere near me or they don’t like or don’t use) and this place is using laser dentistry for also hard tissue like I mention before. So, first appointment with them happen today. I saw both the dentist himself and hygienist. The hygienist gave me full proper manual clean. Zero noise and zero issues. Manually done and she did a polish at the end after putting stuff that taste like tooth paste rubbed on teeth. I had mild protection on for that and it was just like my electric toothbrush noise wise so I was impressed. The teeth feel and look better already. She used another manual tool to go under gums and get tartar off. Cos we are in process of healing gingivitis they want me back for a check and another manual clean in 3 months. Also in 3 months the dentist himself wants to remove my attachments on my teeth from previous Invisalign. He said he will use laser for me. He did everything today to turn noise off or low and I appreciate it. So he looked at my bite jaw took pics put some thing in my mouth that took image of my teeth I saw it all on the screen was like cartoon almost. Of course the issue or main concern was that tooth with big filling. He didn’t see anything sinister. Remember first normal X-ray showed a big cloud that’s no longer their and both maxillary sinus cavities clean and black. He did see tho on that tooth slight cloudiness at top near root. Or rather shadiness described by him. He said this can indicate some pathology that is going on. You also remember my tooth next to canine on that side with gum recession. I also have some bone thing that clicks at the top right at the top you can see it and feel it and when pressing on it it clicks. Doesn’t cause me any concern or symptoms but the cbct scan he said and also X-rays showed slight slight bone loss he said but tissue all intact. He doesn’t think this is sinister or perm damage. He says just need to continue to be cleaned twice a year and maintime. Nothing advanced. He just said obviously bone or gum can’t regrow but I don’t have a periodontist disease right Doc?? They told me gums will heal and return pink again. Some loss was also shown at the bottom. Tiny bit. We did cbct only of the top jaw and teeth. He said he doesn’t feel a need to rush for a root canal treatment as of yet and that he rather keeps an eye on it. This what my other dentist close to home said. Pain all went with sinus infection when it fully healed. He said only on the left side and not the right that my sinus tissue or layer is in the root of those teeth. Which explains the pressure n pain and everyone has different anatomy. But this worry me because what happen then if I need root canal and when they put filling stuff in it enters my sinus tissue ?? Doc, so this where we at. I will be returning end of April to them for another manual clean to fully heal gums and have tartar at complete 0. Then he will be removing attachments with laser to prevent noise for me. His suggestion. He also said that we will then discuss Invisalign. So he btw, is wanting to not bring those front teeth more forward Doc. He told me that because that tooth with root exposing can’t tolerate it otherwise it could risk coming out bone placement or something I can’t quite remember. I hope that makes sense to you sorry. He wanting to heal gums fully before anything which I’m so happy I did today! I’m glad the healing is gonna now take place. I will maintain at home too. Invisalign on hold a little bit and I’m using that retainer (last tray still). He tells me tho that the crown would create noise and need drill. He said I may be better off without it and just have root canal. I told him if it’s gonna make tooth more secure safe and healthy and last long I’d like crown but if we can do compromise he said will take longer if I need him quieter drill and shorter bursts I’m happy to pay more for this. What’s your view ? He didn’t seem to eager in crown doc. He don’t want to do root canal yet just to monitor. But said his gut feeling is that somewhere down the line I’ll need it. Also on that cartoon type scan thing my front teeth on ends looked bit gray and other teeth he says can be some wear but he’s not concerned at all about it. With regard to straightening the teeth he said again doesn’t want those teeth comping forward. This where I’m a little confused or concerned because previous orthodontist told me he needed those teeth coming forward and the two dentists seem to want to do diff thing. Sooo. I ask him about spacing and how we gonna achieve straight teeth like that if old dentist needed them forward. He said we don’t even need to create spacing ??! And no molars removed thank god. He also, like you, mentioned those wisdom teeth (only top ones , not bottom) to likely be removed won’t need drilling but it just gets in the way and way they’re positioned etc. So what’s ur view on all this?? Particularly about the crown thing and how to begin Invisalign again. Cos he ain’t wanting to create no space and not wanting to move teeth forward. But other dentist did and told me too crammed needed spacing and needed to come forward. This doc said he will also align my bite better. Pls let me know your thoughts on all this. Cos I’m gonna be taking this new path this year and with maybe more things. Thank you so much doc!!! I’m just so glad I got first clean done too. I will maintain she told me to use these Tepe floss things that got spikes and regular thin floss and electric tooth brush didn’t seem keen on mouthwash she told me to use curasept for two weeks That’s my news Warm regards
Hello. Hope you are doing well. Just by reading your query, I could sense a feeling of happiness and content in your voice. Glad that you are now getting the desired treatment tailored to your needs and medical conditions. Happy to hear this. Good to know that you got a proper hand cleaning process done today along with post clean polishing session. Gums react to the conditions and hygiene status of the mouth. If there is tartar and other deposits present, they tend to inflame and swell, which we term as gingivitis (and graded according to severity) and this condition is mostly reversible, if caught early, and maintained well. Secondly, when the irritating or causing agent is removed, the healing process starts and it depends from person to person, amount of deposits, age of the person and maintenance done by the person to actually accelerate the process. Hence, a follow up after 3 months is essential. The scan also reveals us that the sinuses are clear now and infection suspected near the tooth is also almost over. The slight shadiness needs to be kept in observation though, till its completely over. Yes, bone re-growth on own is actually debatable as some claim it happens, if we maintain, while some say, it stays constant and not re-grows if we maintain. MAINTENANCE is important and regular cleaning is important. As it is concerned only to a particular area as of now, definitely, you do not require an aggresive approach for a periodontist to intervene along. If the condition worsens, definitely you will need a consult. But you have got a manual cleaning today, things should improve. On the left side, you have a lowered sinus floor which is touching the root of the tooth. To resolve this, you might have to undergo a sinus lift procedure done by a qualified Oral and Maxillofacial Surgeon who does it and the floor of sinus is modified so that it doesn't come near the root of the tooth. Mostly, the root canal fillings and packed and fixed at that particular point. If trouble will come, it will come right at initial level wherein the canal cleaning is done. So, there itself, we can opt for a sinus lift procedure before completing the root canal. Regarding Invisalign, it is always advised to get a complete clean up 1st and let the gums settle before we go for the scan. I agree to the doctor. There are bone limitations. Beyond which if we take the teeth, either teeth won't move at all or bone loss might occur causing tooth root to expose and tooth will lose support and eventually fall. So, respecting bone limitations is equally important. In my opinion, shadiness is still persisting. We should observe for sometime but its been some time now. So, a 50-50 chance. We might go for it or it might resolve on own. For crown, its safer with crown but its not that without crown, tooth won't last at all. It's like an added protection. But for crown sound will be there. A good thing to decide for Invisalign would be to have a look at the CBCT (if possible) that will give us a clear picture on everything; alignment, bone, tooth position relative to bone, space required, amount of crowding, etc. Curasept is the brand name which manufactures gels, mouthwashes and toothpastes with similar main ingredient (chlorhexidine) which is used in other mouthwashes as well. So, the purpose remains same. Once again, very happy to hear the positive news from you. Keep maintaining the conditions and have a regular follow ups. Feel free to connect anytime for any concerns. Rate the response and feedbacks as you feel apt.. Kind regards
Patient's Query
Hi Doc!Left you feedback and thanks for helping me with this current situation of mine, I do find it very helpful and I’m very grateful. Apologies for my slow reply, I have tried chasing up with my dentist since our last conversation about my scan results, doesn’t seem like he is sending me them which is frustrating because I’d love you to go thru them with me. If I do get hold of them, I will send them your way of course. But I wanted to write about things in meantime. I’ve been brushing twice daily with oral b electric toothbrush and holding on gum line. I tried flossing and using tepe but the thin floss I used was stingy and got stuck in my teeth and the tepe I struggle to use too. I think I need to look on YouTube but I’ve ordered the orginal satin floss so will it be ok it’s arriving in couple days I haven’t done since my cleaning Thursday. When he inspected all teeth heard him call out numbers and say random words like partial this and that and eroding something. I heard diff numbers some 4s 5 and even 7. Worried my pockets got big. I never had symptoms so I’m in shock. He didn’t seem overly concerned tho. When the hygienist clean me she said this isn’t bad case at all and is easy to maintain. She told me bottom tooth could do with a filling cos has small cavity. I notice it for long time it’s literally by edge of tooth like an orange or dark brown small little mark. I thought it was a stain at first. Again.. no symptoms. Yet dentist didn’t mention it at all?? I’m worried I’m not gonna be treated Doc. I’m really happy I had that clean but since now I’m wondering if I needed a deep clean to cure the gum disease and stop anything progressing ?? I also heard of Lanap and bone can regrow in couple years. My main concern tho is I just want all bacteria of gum disease to be fully eradicated. He didn’t go through with me thoroughly. He also was very laid back at the end and seem to put the ball in my court telling me it’s up to me what I do and if and what I want etc which worry me. I worry he doesn’t want to treat me cos of my fears with noise but he knew all this before and I’m happy to pay more. I had cbct. And he said was bit of bone loss. Wasn’t sure what cause was either the ortho treatment since it’s been since 2018 he said he saw some bone loss on bottom teeth and I’ve since notice tiny tiny tiny black triangles but nothing major that would bother me. However I’m worried tho. And then that top tooth with bigger gum recession and has red gum around it. Also I notice myself tiny bit of recession on one top tooth and I don’t want it to recess further tho I wondered if I need deep clean and based on pockets. He didn’t explain anything about it to me tho. He is talking about Invisalign. And say next time I come again another basic manual clean and he will remove attachments with laser getting me prepared for Invisalign. Said he doesn’t know what the root canal marking thing was. And said keep eye on it.With the root canal thing. As I told you before I feel some pressure if I touch that tooth and the tooth next to it (closer to canine way) and I no longer feel my sinus pressure anymore since I healed. Since last couple days and since seeing them and taking care at home I noticed and particularly at night when sleeping some ache there in those two teeth not so much ache but it’s some type of sensation that feels deep in there and if I press on them two teeth they don’t feel right. Not necessarily pain but some pressure or slight tenderness if that makes sense I think I’d like to sort health side out first then do Invisalign. I am also nervous it’s too late. I see him again end of April. I’d like laser of course. You mentioned about sinus lifting, I’m really hoping I don’t need any of these procedures. And if I did is it possible with a laser to cut into the bone. Im not sure exactly what he mentioned but sounding like my teeth in sinus. Im not sure how it’s possible, my sinus for most part feels ok now. Is it safe for me to have root canal right to the top and to remove all bacteria without puncturing sinus and the stuff filled won’t leak out? And I don’t know why the tooth feels strange like pressure next to the root canal tooth. He didn’t say anything. I hope no infection spreads to jaw. That would been seen right? He only looked at the tooth that needs a filling and that tooth that gum recessed so I’m not sure what’s going on with the tooth next to tooth with the fillingI want to get this all behind me and to heal from it and focus on the Invisalign once we done all this. But the path doesn’t seem to clear right now. What is your suggestion doc? And with cleaning. Should I still stick with manual basic clean or should I try get a deep clean somewhere else faster?? My mother thinks I should get the tooth pulled cos issues can come from root canal. I heard the same too but then I don’t want dental implants either. I wish I could show you my scans. I will try my best to get a hold of them. Im having a lot of indecisiveness about all this now Doc. And regarding my new dental place. Nothing was really set out clear for me and was kind of put on me he doesn’t know exactly what shadowing is and that makes me nervous. Especially since I feel pressure on them two teeth only if I touch them and some weird dull aches around that side sometimes. Can’t always pinpoint and if for example for me to explain it a bit like this When you take off Invisalign when it’s newer if you touch teeth they can feel tender or pressure somewhere. That’s how it feels in both them teeth but not as intense I don’t know what to do from here. Regarding the cleaning situation and the root canal. He’s looked at my cbct but I’m unsure why I feel it in my other tooth too. I don’t want it to be complicated if I know the root canal will eradicate everything and not leave hidden bacteria or cause sinus problems or leak through then I’d happily go ahead with that soon and get it out the way. Please let me know your thoughts Doc. Warm regards
Hello. Hope you are doing well. Very kind of you to share the details as and when available for a better quality of discussion. Highly appreciated and glad with the respect shown. Using floss, brushing twice a day and maintaining overall dental hygiene is important. Yes, using floss is a technique and eventually, you will get used to it. It is okay if you don't floss for a couple of days, but make sure you rinse well and brush twice. After every meal, give about a minute or two for dental health. This would also help you. And once floss arrives, start using them. Every tooth has been assigned a number for easier identification. There are different identification systems being used in the world. So, those numbers were actually the teeth concerned. And whatever finding he/she found with each tooth were noted. It does not necessarily mean the doctor meant about pockets. It could be any other finding also. Sometimes, a small cavity could be misdiagnosed as a stain and vice versa. A very small cavity is actually a confusing scenario wherein you need to weigh your chances. Whether removing the small cavity lesion and filling it up with composite is beneficial or harmful? At times, the instruments used are larger than the cavity and they would rather cut out vital non affected tooth along. So in such a case, we are actually causing harm. Such things should be discussed and evaluated. Good to hear that you are happy with the initial cleaning process. Gums diseases are mostly dealt in phases. After 1st phase of initial cleaning, deeper cleaning is done depending on the requirement. 1st phase cleaning mostly involves superficial cleaning whilst 2nd phase involves deep cleaning beneath the gums. You can observe for a couple of weeks and depending on how well you are able to maintain, 2nd call of deep clean can be taken. CBCT gives us a good evaluation of bone levels as well as roots. Yes, bone loss occurs due to overlong orthodontic procedures but they are again manageable with good cleanliness and other measures. You already have undergone cleaning process and regular maintenance should actually stop the progress of the bone loss. Yes, you can go for a manual clean again for removal of previous attachments so that newer scan and treatment plan can be discussed based on current situations. Regarding root canal, we had suspicion whether it was a sinus issue lingering or the tooth issue. Now that sinus is cleared and tooth is still tender, it is definitely an peri-apical lesion. When you touch it, pain comes and it is specific, which is also another sign of root canal requirement. I would advice to get a root canal done to clear off the infection lying underneath. In such case, it would be better to get the infection dealt first followed by Invisalign. So, cleaning process along with initiation of root canal seems a good plan. For initiating the root canal process, a smaller individual tooth xray or RVG would be required which will give an idea if you really require sinus lift procedure or not. Based on this, root canal treatment can be done. Most cases, if sinus puncture is there, the patient would be having a chronic sinus issue for years together. On reading the overall scenario, it would be better if you could check on the credentials of the doctors you visit and reviews about them. Sinus close to root or may be even puncturing, is not a regular case. It would be better if you could get a certified Endodontist look at it and explain it for root canal. For cleaning, yes, once in a while, deep cleaning is required. It is for everyone and not just for you. Once these issues are dealt, you can look for remaining of Invisalign process (newer scans with desired results) Please provide your valuable inputs or feedbacks/suggestions for the same and we can discuss accordingly. If you could get scans data, it would be a more qualitative discussion. Warm regards
Patient's Query
Hi DocI have a question for you regarding my situation. I still have not done root canal yet as I’m not financially able to and I’m having some thoughts. I’ll ask your advice on it if you could kindly let me know your thoughts. First thing that’s currently concerning me is. A few days after I saw that dentist and had the manual clean and polish I started to get slight ache on that filling tooth side and even intermittently on lateral incisor and still do from time to time. Then came some burning sensation and ever since I’ve had burning mouth and my throat feels difficult or more like raw to swallow. sometimes I get sensation of slight inflamed or swelling of jaw and aural fullness. I’ve been tested for yeast cos my tongue had a slight yellow coating and I’ve been tested for bacteria and nothing. I’m now worried that it’s the dead tooth infection spreading to my tissues jaw and throat and mouth. I’ve had this for about two weeks now. The dentist I saw who did cbct scan didn’t seem overly concerned tho. He said he saw some shadow above that tooth. And it’s been left. I can’t afford anything yet and they know this. No antibiotics even my local dentist said no because doesn’t feel it’s sinister but I’m really worried it’s spread to my face and throat. I don’t know what to do about it honestly. I saw my local dentist who said he wants me in for root canal again I said I need to save and again I’d want to go to the person to do laser. But he did nerve test again with cold air or something and I didn’t feel the nerve test in that tooth. Both dentists say the color of my tooth is likely due to previous amalgam. Online it says dead tooth or infection. I’m worried it’s abscessing and I can’t really feel it and it’s spread?Another question is I ultimately got to come up with decision. I’m thinking do I go for the root canal, or do I opt for an extraction and eventually get a dental implant ?? I’m worried of a root canal failing or trapping in bacteria and not fully eradicating it? And if I did decide to have extraction how do I avoid sinus communication or puncturing ?? Would a dentist be willing to fix it there and then and a bone graft and sinus lift. Can I do a bone graft and sinus lift and dental implant solely with laser and no drills??Please let me know your thoughts on all this Doc. I’m now very uncertain about which one to choose but more concerned right now with these symptoms. Warm regards
Hello. Sincere apologies for responding late to your query. Sorry to read about the deteriorating condition of the tooth. It could very well be possible that the infection is spreading out. For any bacteria to grow and expand, it needs space. So, after infecting the tooth, it took a way via the roots to the jaw bone. It could also be possible that this tooth is the cause for the sinusitis infection you had for a month or so.
As already seen in CBCT, a shadow was present around which is surely infection. Before it spreads further and affects more area in the vicinity, we need to get rid of it. As you already mentioned about two possible option of root canal and implant.. We always prefer that natural entity should be preserved for as long as possible. But accuracy of root canal would matter and if all the infection is not cleared, the root canal might fail.
Regarding extraction, it will be a complete removal of tooth and the infection will be drained out as well. But then you will lose a tooth. And re-evaluation will be required if there has been any trace of infection left. That might affect the implant process. And Implantologist needs to evaluate the bone levels and sinus floor as well for the success of the implant.
Economy wise, root canal will be lighter on the pocket and a natural structure would be present in the mouth. Dental implant would cost you more but chances of infection being cleared out is more. Except for the sinus floor issue. These are the certain points you have to keep in mind before taking a final call. But whatever you decide, I would recommend to decide ASAP. We need to tackle the infection early before it gets bigger. I would be glad to answer any questions or leading queries. Have a great day ahead and you get to the best of your health soon.
Regards
Thank you.
Patient's Query
Hi DocSaw my local dentist today he had look around and at throat and didn’t give antibiotics doesn’t feel it’s infection nor spread. I fully explained my financial situation and both dentists are well aware that I’m gonna have to save up money for either root canal or extraction. What’s your personal thoughts on this? Root canal or extraction and implant ? Either way I’m gonna go to laser dentist. Can sinus lift and bone graft and flap be done solely with laser ? Im saving up. May do the root canal but can’t have crown for a while and need to find someone willing to use a quieter slower speeding drill and in short bursts. How will I know all infection or all decay is out?Im gonna attach you some photos. I put flash on and also did a video for you. On the side that need root canal you’ll see that tooth but you’ll also see on that side the premolar that has gum recession. My local dentist today pulled up the normal X-ray when had the sinus thing. He said can’t see too much compared to 3D so wants me to see Invisalign dentist about it cos so much work done. He said he sees some gum inflammation and near my filling tooth. He didn’t see signs of infection I told him that I had a manual clean to start the healing process. But it’s around 3 weeks today Doc and still red?? In last when I had this I had to have a few sessions as you know I’m due another cleaning in April. The video I took for you I’m trying to show you the bone thing at top. He touched pressed hard a lot on it today it hurt. But it never hurts if it’s left. Laser dentist in the cold climate country told me on cbct scan that tooth cannot move any more forward with Invisalign because there is bone loss. Is this bad or likely Invisalign. He didn’t know what it was and why and says Invisalign usually cause bone loss at bottom which I have slightly at the bottom too. So now I’m worrying what is this?Local dentist told me to see my ortho and that to get me finished with this cos I been on it long but as you know I’m not happy about it. I threw away the other aligners cos I was planning on doing Invisalign with laser dentist. Is it possible ? Obv we deal with the root canal tooth first and the cleaning then we do this. He said he won’t be making that tooth move forward also said he won’t be creating space, so how’s Invisalign possible ?? I explained my worries to dentist today about worrying if infection spread he said this is rare but listened to me and looked and felt under jaw. My symptoms are burning mouth and tongue and mostly on that side, developing saliva sometimes aural fullness on both sides as result and sore burning throat difficult to swallow things sometimes feel inflamed and swollen. But it can ebb and flow. Lately it seems a bit better slowly since taking antifungals Nystatin solution. I didn’t mention but I was on high dose antibiotics for a chronic uti infection. Fosfomycin. I was also on doxy and trimethoprim. I handle antibiotics well but this all happened being off them for almost three weeks and start after manual clean. My thrush tests came back clear but sometimes our nhs tests don’t test for all types So I’m gonna continue the antifungals and it could maybe be some overgrowth of bacteria from microbiome I’m not sure but sometimes on that left side it feels slightly a little inflamed it’s hard to explain. But the burning mouth and throat worried me. Nobody is concerned so he didn’t give antibiotics. He doesn’t think it’s spreaded and I pray it hasn’tI’ll say this whether it’s relevant or not, as I’ve mentioned it to both dentists too. Medication wise I’m having to be on long term high dose / full dose antibiotics to treat a chronic embedded uti. The treatment could be six months to a year. It seems a lot but it is very successful. I’m not on anything right now and likely will be changing to antibiotic Cephalexin at some point next week. If I handle it well and it works, I’ll be sticking with it for a long time. Of course I’ll be having regular checkups with teeth. I take probiotics too and can take oral probiotics. My question is, will the antibiotic cefalexin be effective and stop infection from spreading if it was about to spread? So that I can be on that which is useful to me whilst I save money for this tooth thing. Lastly, I totally forgot to mention this to you and both dentists of mine because it never really left an imprint on me. As you know that filling tooth had first amalgam filling at age 11 or 12. Then it had that removed and cleaned out fully then replaced with white composite filling in 2018. Dentist at time said it’s close to nerve he didn’t expect it. Said it can be sensitive for a while. It was. I had lot of pain with it and to hot n cold for a few months actually. I was on painkillers constantly for a few weeks. Things settled. I had some slight sensitivity that lingered I’d say for close to a year. Then this is what I didn’t even remember until recently looking at old emails to my ortho. I wrote to him in march and April 2020 during pandemic complaining of intense pain in that filling tooth. It happened in march then came roaring back in April. Then it fully stopped so I left it with zero symptoms zero worries. I wish I saw dentist before cos to me that sounds like it was likely related to tooth becoming dead? I worry then cos I’ve left it for three years Doc! I had no symptoms. The recent sinus thing was due to covid it literally happened because of congestion but as soon as sinus healed and is now clear on cbct no more tooth pain. Only now if I touch it slightly and brush with electric tooth brush along that side there is some slight pressure. Not so much pain tho but pressure if I touch firmly on it. Sometimes the tooth a little next to it too. So that’s all the info I’ve got at the moment and I’m gonna share you the photos and video if it lets me upload otherwise I’ve taken new pics right now for you as well as bottom showing you that slight mark on a tooth. So right now I have no options but to save my money. Dentists and doctors won’t give antibiotics and aren’t too concerned but my urologist is gonna give me cefalexin to take long term at full dose so hoping this would stop anything even if tooth is dead it would stop it spreading to jaw and soft tissues ? I worried thinking I had cellulitis in roof of mouth jaw and neck but nobody thinks this and said it would have rapidly spread. Thanks for all your help Doc! Totally appreciate it I’ll leave you reviews because you’re so helpful during this current situation of mine. I’d be so happy to have you as my dentist. Take care
Hello. Thank you for your reviews and compliments. Appreciated. Natural tooth is always natural and artificial will always be artificial. Although I prefer to always try and preserve the natural one, sometimes, it is better to go for the artificial one. As discussed, root canal would be my initial idea. But considering the noise trauma, infection severity and instruments needed, implant might weigh over root canal. Look for the possible advantages and drawbacks along with the possible options that suits your physical and mental well being. Yes, root canal will require all the infection and decay to be removed followed by filling with an inert material. I am not aware of complete sinus lift procedure done solely with lasers. You might still require drill and some other equipment along with laser for the whole process. During the procedure, you will have to get a small xray of the area to check if there is any infection still left or is it completely drained out. Yes, there is some gum inflammation present but that is much better now. It could also be a result of the manual clean you had. There is some inflammation near the filled tooth with a suspicion of a mild swelling. It could also be due to the angle of the photos and swelling might not be there at all. Photos are deceiving at times and a clinical check is the only way this could be cleared. But I am worried about is the infection at bone level. If it is there, we need to get it cleared ASAP. Due to technical reasons or so, I did not find any video attached neither I am aware that video can be shared here or not. Nonetheless, bone loss is something that occurs over a period of time and also with age. Invisalign or any orthodontic treatment involves tooth movement and tooth movement occurs with loss of bone on 1 side where tooth is planned to move and deposition of bone from where the tooth has moved. This is the bone remodeling process. Prolonged orthodontic treatment process might cause some amount of bone loss which is usually improved when the treatment is over and cleaning is done. Regular maintenance halts the bone loss process and over a period of time, bone is regained ( varies from patient to patient and age factor as well) Yes, please always share your medical and drug history to any doctor treating you for any reasons. Patient might at times feel it is irrelevant and medical history might not affect dental treatment and vice versa but they forget that in both the cases, both the medicine courses will be going into same body systems and they will interact. Cephalexin is a good antibiotic and if you tolerate it well, you can use the same for tooth related issue as well (after discussing with the treating doctor as well) Do mention about all the drugs being taken for various medical reasons. This will assist the doctor to modify the drugs needed for dental purpose. As you mention about the history of amalgam filling and its refilling, it could be a reason that during pandemic, infection hit the nerve and probably killed the tooth in that phase. It is a possibility. Either way, we definitely need to go for root canal or extraction so that it does not spread and we get a long term solution for it. Please let me know if I missed out answering any part of the query or need re-explanation for any point. I would be happy to do it as long as you need clarifications and you are not left in any dilemma. Appreciate your reviews a lot. Thank you for putting your faith and trust. Kind regards
Patient's Query
Hi DocI’ve paid and requested for video call with yourself I selected it for 10am English time so I’m not sure why it ain’t gone through. I’d really like to do that video call but it asks me to pay again despite having the receipt. Is there anyway you can call from your part and arrange the time here? If you let me know what time suits your time that will be fine and what date I don’t know if you work weekends Monday is fine too. I prefer to speak face to face about some things. I’m nervous lately so I took myself to emergency hospital my blood work is normal no wbc or infection markers. I do have slight ache on that tooth side in cheeek area so we know it needs dealt with. The symptoms that concerned me is the tongue mouth and throat burning. Sometimes it’s less. I feel likely from the inflammation irritated nerves. I was very scared it was spreaded or cellulitis. Hospital assured me no. Doctor there misdiagnosed my gp strep throat test as positive so he given me Penicillin V. I never took it before cos family had rash but I’ve been taking two 250mg tabs together four times a day so far today been ok. Is it effective for tooth infection too ? He only have five days My local dentist isn’t willing to do a new cbct scan and tells me to just see my ortho and book root canal. I told him right now I can’t afford that and I wanted the scan to see if anything spread. Do you think I’ll be ok?? I pray this hasn’t spreaded to bone I don’t know how I’d cope. I don’t want jaw surgery or anything as such. I hope it isn’t complex. I keep getting cold nerve sensations on my back too. Anyway I’m looking around different local dentists I wanted to have a cbct scan next week followed by extraction. Then we can do Invisalign and after that an implant or even a mini implant and that would give me time to find laser dentists. I just want to eradicate infection first but I’m concerned they would cause sinus communication or orafistula with no scan ir whatever. What you feel i should do? I found a dental practise that is cheaper and I can afford to get the extraction maybe asap. But I am worried of what I mentioned. Then I’d really want cbct. I really hoping it isn’t spreading and that I can be cured or with meds if need be I don’t want jaw surgery or any such thing. Nobody seems concerned at the moment. Slight cheek pain ache in that side lately and these weird burning mouth and throat symptoms then the cold back sensations. Sometimes slight tingles higher up in face. So if you are able to try to video with me I’d really appreciate that. I’m not sure what happened there but we can discuss all this in detail and you think I should just make a decision and opt to get extraction? I just hope it hasn’t spread to other teeth and they are able to clear out all infection without leaving any or puncuturing sinus. I don’t know who would be able to Warm regards!’
Hello. It was unfortunate that video consultation did not happen. I did receive the request but we could not connect. It could be due to timezone difference as well. Today 18th Feb at 10 am English time (India 3:30 pm) try connecting. This particular response is much delayed as I was traveling to another town for consultation and poor network coverage during the journey. Apologies for that. Yes, Penicillin is an effective medicine even for tooth ache. You can continue that but keep a check on allergic reactions, if any. If some do occur, kindly stop the medicine and take a medical consult. For dental issues, yes Penicillin is effective. Yes, you will be fine. We just need to make sure to control and eradicate the infection. This hopefully isn't as complex and you won't be requiring any jaw surgery. From what I know and the related case details, it should be fine as soon as we get the root canal / extraction done. The area will be relieved and within a couple of days, everything will be alright. Regarding extraction, don't worry. The oral and maxillofacial surgeon is an expert and will extract it with caution making sure of sinus floor. You can get a CBCT done next week prior to extraction and do share it with the surgeon so that he / she can check the relevant details needed for extraction. Once extraction is done, we can plan for implant (mini implant is not a prosthesis and is used for orthodontic purpose. It won't be used here) and Invisalign. And if you need some time gap between those, that can also be done. Don't worry. We will be able to sort it out and clear out all the infection. Regarding video consultation, try contacting the customer support. We can try for it on 18th Feb at 10 am (India time 3:30 pm) Kindest regards
Patient's Query
Hi DocThank you for your video call. I’ve left you positive feedback as it’s been very helpful to me and very informative. I’m attaching photos for you because I looked with a mini dental mirror into my mirror behind front row of teeth. I’ve got the burning as you know and salivary glands in both sides can feel swollen. We know I’ve got the dead tooth to come out hopefully soon. But this symptoms bother me. I also have burning swollen throat sensation. I noticed in the mirror these bumps above teeth and sometimes there is mild aches on the teeth intermittently or burning. All I see on google is I need operations and into my jaw to access it. I’m nervous of what this is. Could you be able to tell?Warmest regards
Hello . Hope you are doing well. Thank you for your review. As seen in the photos, what I assume is the gingival abscess that has formed just at the back of the upper front central teeth. It looks like a gingival abscess from the initial look. It could occur due to cavity formation or sometimes, even due to trapping of some food particle or improper hygiene, or some localised trauma to that area. You might have bit something hard that lower front teeth hit the upper palate area and abscess formed. However, we would require a clinical examination and may be assisted with a radiograph to figure out the exact etiology. As discussed on the video consultation, you are looking for another CBCT prior to getting the extraction done (or root canal . You can decide on this). When the CBCT is done, we will have to closely look onto upper front teeth and its bone to assess if there has been any new cavity formation from the last time the scan was taken. Neither of the previous radiographs showed any lesion there which could have directly caused the abscess. So, my assumptions are trauma or food entrapment. If there would have been any cavity, it would have been detected in some or other scans. So, I am more hopeful on there is not a cavity developing inside. Regarding its treatment, initial would be finding the reason for its development. Next step would be a cleaning in that area followed by abscess drainage and antibiotic therapy. Since you are already on antibiotics, we should not administer any more antibiotics separately for this purpose. Identification of the reason is important here. So, as you get the scan done, do share it here and we can try identifying the root cause. Hope this gives you an idea on how we are approaching this newly developed situation. Do reach out for further related queries. Kind regards
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Answered byDr. Mayank Khandelwal
Medically reviewed byiCliniq medical review team
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