White Spots On Teeth

I was eating at a restaurant and had a filling crack. Now I’m afraid to eat anything on that side and it has become sensitive.  When I went to get this fixed, my dentist says I need a crown now.  He’s suggesting a CEREC crown. How can this happen? Part of me is wondering if he just wants to practice with his new CEREC machine he’s been talking about for a while.

Dottie

Dear Dottie,

While fillings restore decayed portions of a tooth, they don’t restore its original strength. White composite fillings do a bit better because they bond directly onto the tooth, but it still isn’t a whole natural tooth. Bear in mind that I haven’t examined your teeth so I can’t give you specifics about your tooth.  I can give you some generalities.

Teeth Change Over Time

Every day your teeth endure hundreds of pounds of pressure from our biting forces. Over the years, those forces create tiny amounts of stress in the remaining natural tooth. Other factors can add to those stresses.

If you grind your teeth, chew ice, clench during stressful situations, or simply have a very large filling, that stress can eventually lead to cracks developing around the restoration.

The filling itself may still be perfectly intact. It’s the surrounding tooth structure that’s beginning to fail.

Larger Fillings Mean Less Natural Tooth

The larger a filling, the less healthy enamel remains to support your tooth.

This is especially true when an old silver amalgam filling has been in place for decades. While these restorations have served many patients well, they don’t bond to the tooth the same way a white filling does. As the natural tooth flexes under years of chewing pressure, small cracks can eventually develop around the edges.

How Do You Know If a Tooth Is Cracking?

Some cracked teeth produce obvious symptoms, while others can be surprisingly subtle.

Common warning signs include:

• Pain when biting down
• Sensitivity when releasing your bite
• Discomfort with cold foods or drinks
• A rough edge you can feel with your tongue
• A filling that suddenly feels “different”
• A tooth that occasionally hurts without an obvious cavity

Because many cracks don’t appear clearly on X-rays, a thorough clinical examination is often needed to identify the problem.

When Is a Filling No Longer Enough?

If enough healthy tooth remains, replacing your old filling may be all that’s necessary. Though your dentist should check to make sure there is not new decay or an infection.

However, once cracks begin spreading through the cusps—the pointed chewing surfaces of your tooth—a filling may no longer provide enough support. Each time you bite, those weakened sections can flex independently, allowing the crack to grow.

In these situations, your dentist may recommend a dental crown. Rather than simply filling the damaged area, a crown surrounds and reinforces the remaining tooth, helping distribute chewing forces more evenly.

Another reason for a crown is if the decay has spread to the point where it takes 30% or more of the tooth structure.

Don’t Wait Until the Tooth Breaks

One of the biggest mistakes patients make is waiting until a tooth fractures completely.

Early treatment can often prevent a crack from becoming severe enough to require more extensive care, such as root canal therapy or even extraction. If you’ve noticed pain around an older filling or feel like a tooth is beginning to split when you chew, it’s worth having it evaluated sooner rather than later.

Your dentist can determine whether your tooth simply needs a new filling or whether a stronger restoration, such as a CEREC same-day crown, would be the better solution.

Why a CEREC Crown?

While I don’t know your dentist, I wouldn’t think a dentist would suggest a crown on a tooth that didn’t need one just so that he could use his new toy.  If you have doubts about his integrity, you could get a second opinion.

As for CEREC crowns, their main benefit is that you can get your dental crown in just one appointment instead of two separate crowns forcing you to wear a temporary crown while waiting.

This blog is brought to you by a top-rated dentist in Baton Rouge, Dr. John Theriot.

I brush twice after every meal and floss, yet my teeth are still yellow. I added whitestrips. Still yellow. Is the only way to keep white teeth to go to a dentist every six month and have them whitened, the way my neighbor does? She makes me feel hideous whenever she smiles. What am I doing wrong?

Chance

Dear Chance,

First, you have a lovely name. Full of mystery. Second, let me assure you that you are not the problem. Most people assume yellow teeth means poor oral hygiene. While true sometimes, there is more to the story. Even people with excellent brushing habits, such as yourself, will have their smiles grow darker over time. While brushing is essential and keeps your teeth healthy, it can’t prevent every cause of discoloration.

Why Do Teeth Turn Yellow?

There are a lot of reasons that your smile will lose its brightness. Here are just some of them:

• Coffee, tea, and red wine
• Tobacco products
• Dark-colored foods and beverages
• Natural aging and enamel thinning
• Certain medications
• Tooth trauma
• Genetics that influence tooth color

Some of these causes affect only the surface of your teeth, while others occur deep inside the tooth itself. The good news is that there are solutions for this, and you won’t have to do it every six months like your neighbor. She’s overtreating.

Can Brushing Alone Remove Tooth Stains?

Brushing removes plaque, bacteria, and food debris while helping reduce new surface stains before they settle into the enamel. However, brushing cannot reverse enamel thinning or remove deep internal discoloration.

Almost all whitening toothpastes can help polish away minor surface stains, but they do that by using abrasives which end up damaging the enamel on your teeth, causing them to pick up more stains. Plus, they don’t contain enough whitening ingredients to significantly change the natural shade of your teeth.

So why aren’t your whitestrips helping?

Products like Crest Whitestrips do whiten teeth but they are too weak to make a difference without buying a LOT of kits, plus they only cover the front six teeth. Most smiles are eight to ten teeth wide.

Advantages of Professional Teeth Whitening

• Stronger whitening ingredients. Over the counter products have to use weaker gel for consumer safety because you’re not under the care of a dentist.
• Treatment customized to your individual smile. Kits you can buy without a dentist will not be formed to your bite. Your dentist will make you custom fitted whitening trays.
• More even whitening results.
• Professional supervision to reduce sensitivity.
• Faster, more noticeable improvement.

If you’re in a hurry, in-office Zoom Whitening will give you dramatic results in just one appointment.

Can Existing Dental Work Be Whitened?

Professional teeth whitening works wonderfully on your natural teeth, but it will not change the color of your dental work. If you have crowns or porcelain veneers, etc., those will not whiten. They will have to be redone to match your new white color.

How Can You Keep Your Teeth Whiter Longer?

After whitening your smile, a few simple habits can help preserve your results:

• Continue with your brushing and flossing using a fluoride toothpaste.
• Make sure you go in for regular cleanings with your dentist.
• Schedule touch-up whitening as recommended. Keep your whitening trays. Your dentist can periodically give you a gel to do touchups. You shouldn’t need to do it more than once every two years or so with good maintenance.
• I recommend Supersmile Toothpaste, which is the only safe whitening toothpaste I’m aware of.

I hope this helps.
This blog is brought to you by a compassionate dentist in Baton Rouge, Dr. John Theriot.

I need to replace a tooth and my dentist is recommending a Maryland Bridge. Most people I know with a bridge get the regular bridge. Is there a benefit to the Maryland one?

Janie

Dear Janie,

Before we get into the Maryland Bridge, I want to make sure your dentist brought up a dental implant. This is the best tooth replacement option. It may be that an implant isn’t an option for you and that is why the bridge was suggested, but I want to make sure you knew about that option. Here is an explanation on whether to get a bridge or implant.

Maryland Bridge Versus Traditional Bridge

Unlike a traditional dental bridge that requires crowns on the adjacent teeth, a Maryland bridge uses small metal or ceramic “wings” bonded to the backs of the adjacent teeth. The replacement tooth, called a pontic, sits between them, filling the gap in your smile.

Because hardly any tooth structure needs to be removed to secure a Maryland Bridge, it’s a more conservative ways to replace a missing tooth.

When to Get a Maryland Bridge

A Maryland bridge makes sense for patients who:

• Are missing a single tooth
• Have healthy adjacent teeth
• Don’t want to grind down healthy teeth
• Are not a good candidate for a dental implant or are looking for a different treatment option

Was the “Maryland” Bridge Misnamed?

For many years, dentists were taught that the Maryland bridge received its name because researchers at the University of Maryland helped develop and popularize the technique.

However, recent historical information gave us the “rest of the story” about the restoration’s true origins.

According to Stewart “Chip” Halbauer II, his father, Dr. Stewart R. Halbauer, developed the original concept years before the University of Maryland researchers refined and expanded the technique. Dr. Halbauer practiced in Cincinnati, and his family has shared documentation supporting his role in the restoration’s early development.

Even today, many websites and some AI-generated summaries still repeat the older version of the story, giving credit only to the University of Maryland. Many dentists believe Dr. Halbauer deserves greater recognition for his contribution to restorative dentistry. Some have even suggested the restoration could more accurately be called the “Halbauer Bridge.”

Why Does the History Matter?

Dentistry has always advanced through innovation. New techniques are developed, improved, tested, and refined over time. Giving proper credit to those who contribute to these advances helps preserve the profession’s history, integrity, and honors the dentists whose ideas continue to benefit patients today. Plus, going to original sources, helps us to build on advancements properly. It helps if we get those original sources correct.

Whether the restoration is called a Maryland bridge or someday becomes more widely associated with Dr. Halbauer’s name, the goal remains the same: replace a missing tooth while preserving as much healthy tooth structure as possible.

Bottom line, the big difference is the amount of tooth structure you remove. If you don’t need a crown on one of the adjacent teeth, than a Maryland Bridge makes great sense.

This blog is brought to you by a friendly dentist in Baton Rouge, Dr. John Theriot.

I just got back from my daughter’s pediatric dental appointment and I’m a bit frustrated. Yes, she likes sweets. So do I. He wants me to put a filling in her teeth with cavities. She is seven and these are baby teeth and are going to fall out anyway. When I pointed that out he said that they are molars and acted annoyed. That doesn’t change the fact that they are baby teeth. This feels like a money grab to me and I don’t appreciate his condescending attitude either.

Lorraine

Dear Lorraine,

I can tell you are frustrated. I will say that this particular dentist may not be the best fit for you and your daughter. You need a pediatric dentist that is willing to answer your questions without making you feel judged. It’s your daughter and you want to make informed decisions.

While I know that this is a baby tooth, and it will fall out, there are a couple of reasons to do this filling. Molars need to stay in place until your daughter is around twelve years old, so they are not likely to fall out any time soon. You don’t want the decay to progress. This leads me to the second reason. Decay has a ways of turning into a tooth infection.

These are painful and have to be treated. At your daughter’s age, that would mean an extraction if it is not a. molar. For molars, you’d want to save them if at all possible. This would mean a pulpotomy, which is a child’s version of a root canal treatment. If the tooth is too far gone for that, it would have to be extracted.

If that happens, make sure the dentist places a space maintainer there. Otherwise the other teeth will shift into the open area. that will lead to crowding of her teeth and mean braces as she gets older.

Bottom line, this would need to be treated. If you don’t trust this dentist I recommend you get a second opinion. The last thing you want is for your daughter to end up with a dental emergency.

This blog is brought to you by a gentle dentist in Baton Rouge, Dr. John Theriot.

I want to whiten my teeth but my dentist charges a pretty penny. I’ve noticed there are a ton of whitening kits that you can buy just at Walmart or pretty much everywhere, even online. Why are they so much cheaper?

Stanley

Dear Stanley,

There are two main reasons that over the counter whitening kits are cheaper than what you would get with your dentist. The first is the strength. Over the counter kits are limited in the strength of the whitening gel that they provide. This is for the safety of the patient, who are using it on their own and not under the care of a dentist.

Because of that, you will not save as much money as you think, if any. You will have to purchase a LOT of kits to get the same amount of whitening you would get from a dentist. I would bet if you did the math you would end up paying more by the time you finished getting all the kits.

A second reason is that you are not under the care of a dentist. Before a dentist gives you professional teeth whitening they will do a careful examination of your teeth. This is to make sure there aren’t any places where you could end up with problems from the whitening, such as exposed dentin or damaged fillings.

I’ve read a couple of cases about people who ended up needing a root canal treatment after getting an over the counter kit. Another woman I know of ended up having a lot of pain with her over the counter whitening because she didn’t realize that some bonding she had done had a small exposed part.

The best way to get your teeth whitened is through your dentist with professional strength gel that works fast.

Whichever way you decide to go, make sure you get your teeth cleaned before you start the whitening. A good dentist will insist on this. Otherwise your results will be splotchy and uneven. You want to start the whitening on the cleanest surface possible.

This blog is brought to you by a friendly dentist in Baton Rouge Dr. John Theriot.
Click here to learn about how to get a complete smile makeover.

I had a car accident, which caused some serious damage including to one of my front teeth. I had to have surgeries for the bodily damage first. During this time, they discovered I had sarcoidosis. This has never been symptomatic and is inactive. The tooth is painful and I need to do something about it. I was hoping to get a dental implant, but my dentist said that I am not a candidate because of the sarcoidosis. Is there a good alternative to dental implants? I am a public speaker and my smile’s appearance is important.

Laurie

Dear Laurie,

First, I am sorry about your accident and all the medical procedures you’ve had to have as a result. The thing is having sarcoidosis does not necessarily keep you from getting a dental implant. While in some cases that is true, yours is inactive and has always been asymptomatic.

That being said, I would not pressure your dentist to do the procedure. This is an extremely advanced procedure. Your dentist may have said that you are not a candidate because he is uncomfortable placing them. I would go to an advanced implant dentist and have them make a determination. I would look for someone who is a fellow with the International Congress of Oral Implantologists. You are a high risk case and you want the top implant dentist you can find.

An Alternative to Dental Implants

If for some reason you find out that you cannot have a dental implant, there are other options. Your next best option would be to get a dental bridge. This places a crown on the two teeth on either side of your missing tooth and then suspends a false tooth between them. This won’t require any surgery and can give you a sturdy tooth replacement.

I would not give up on the dental implant quite yet. Find an expert implant dentist and get evaluated. It is the best tooth replacement option.

This blog is brought to you by a skilled dentist in Baton Rouge, Dr. John Theriot.

I plan to get dental implants and my dentist mentioned that I would need some bone grafting for the areas before it would be safe to get the implants. My dentist has done dental implants for 15 years, but he’s only done bone grafting for four years. Would I be better off with an oral surgeon?

Kristin

Dear Kristin,

You don’t necessarily have to go to an oral surgeon for either bone grafting or dental implants. However, that depends on the dentist and their training and experience. I have known many general dentists who do very advanced and complicated surgeries.

If your dentist has been doing bone grafting for four years, he probably knows what he’s doing. Though, you might feel better finding out a bit about his training. There are institutes who do great dental implant training. Though you don’t seem worried about his credentials there.

There are also institutes who do post-doctoral training in these more advanced surgical procedures, too. Some of them are:

• International Congress of Oral Implantologists
• Misch Implant Institute
• American Academy of Implant Dentistry
• Engel Institute

There are other training institutes as well, but these are some of the more well-known ones. The best implant dentists are fellows with the International Congress of Oral Implantologists. If I were in your place, that is what I would look for.

This blog is brought to you by a compassionate dentist in Baton Rouge, Dr. John Theriot.
Click here to learn about metal-free dental care.

I was never able to get braces as a child. My parents did their best but they couldn’t afford it. As a result, as an adult I have crooked teeth. I also have two bicuspids that are still baby teeth. There are no adult teeth beneath them so I have done my best to ensure they would be as healthy as possible. I’m guessing they’d need to come out. Will I need dental implants are can Invisalign work around missing teeth? I really don’t want braces at my age.

Andie

Dear Andie,

I understand about the situation with your parents. Most are doing the absolute best they can. Life is expensive and we can’t always afford things we want, even when they are good and important for us. I’m glad you’re not angry about that. As for your missing teeth, Invisalign is a fantastic way to straighten your teeth without anyone even knowing you are wearing orthodontics. They are invisible even at a conversational distance. Plus, they have very high patient satisfaction rates, which means they live up to the hype.

In general, Invisalign is pretty good about working around missing teeth. You didn’t say which bicuspids are still baby teeth. I agree that they’ll likely need to be pulled. You don’t want to spend all that money straightening your teeth and then have one or both of them need to come out later and throw off your bite.

Whether or not you will need dental implants to replace them will depend on their location. Bear in mind that I haven’t actually examined you. But, as a basic rule in cases like this, if they are both adjacent to one another that will give you an asymmetrical bite, which could lead to other problems. If they are one on each side, I don’t think you’ll need to worry about replacing them.

The good news is that even if tooth replacements are necessary, you can still straighten your teeth first to get them into proper alignment, leaving a space for the missing teeth. There are also inexpensive tooth replacements you can get while waiting on your dental implants.

This blog is brought to you by a friendly dentist in Baton Rouge, LA Dr. John Theriot.

I had been avoiding the dentist for a while. A friend told me that I need to try dental sedation because it changed her life. I scheduled an appointment and told my sister about it. She sent me this article from the NY Post that some guy who had oral conscious sedation and died from complications. Now I am worried that it isn’t safe. Are you familiar with this?  Is sedation more dangerous than dentists let on?

Francine

Dear Francine,

I’m going to start by saying that oral conscious sedation has been proven to be quite safe. I am familiar with the news story you were sent. I had to do some extra digging because the article was vague and incomplete. During that digging,  I learned a couple of things that should put your mind at ease.

First, the practice that did the procedure did not use oral conscious sedation. The article just said anesthesia, but there are many types of anesthesia, including just a local numbing shot. This practice used general anesthesia on this patient, which is the riskiest of the options.

Second, the patient had been smoking cannabis before the appointment. The dentist claimed he didn’t know and the patient seemed fine. Any type of drug or even an alcoholic beverage can impact how sedation medication works, including general anesthesia.

My suggestion, if you are still concerned, is that you see a sedation dentist who is DOCS certified. These dentists invested in extra training with dental sedation. It’s not required, but they go above and beyond to learn all they can for their patients.

You will find that oral conscious sedation does change people’s lives. Patients who’ve been terrified to see the dentist for years and only going in for dental emergencies, finally find a way to get all of that work done without anxiety or pain.

This blog is brought to you by a compassionate dentist in Baton Rouge, Dr. John Theriot.

I have had white spot lesions  for years, but I really wanted to fix them. I still do. Originally, my dentist said I should be happy they are healthy. But, I pressed him and he finally agreed to help. He suggested a tooth mousse and then follow up with teeth whitening after a few months. Things don’t seem to be improving. Am I missing a step?

Angela

Dear Angela,

You are not missing a step, nor should you feel ashamed of wanting a beautiful smile. It sounds like your dentist means well but is your basic bread and butter dentist and is in over his head about your particular situation. You should know right away that teeth whitening will not help in this situation. What it does well is whitening teeth (obviously), and it can make someone’s smile look decades younger. However, it will whiten your teeth evenly, which includes the white spots. Because of that, they will still be whiter than the rest of your teeth.

What I will give him some points for is the tooth mousse. This can be useful in helping with decalcification. But it will not work well on its own.  If you only have a few white spots, than you can have dental bonding done. This uses a composite resin to cover the white spots and can be made to blend into the remainder of the tooth’s surface. Bonding does have to be replaced every few years because they will eventually pick up stains.

However, If the white spots are more extensive, then you will be better served with having porcelain veneers placed. They will cover the entire surface of your tooth. They have other benefits as well. First, they are much more stain resistant than dental bonding. In fact, they are more stain resistant than your natural teeth. Second, they last significantly longer. When well cared for they can last decades as opposed to years. Third, these are what the Hollywood celebrities use for a complete smile makeover. They can change the shape, size, and color of your teeth all at the same time.

One word of caution here. I would not have your family dentist do this. Teeth whitening is the easiest of the cosmetic procedures a dentist can do, yet your dentist had no understanding of how it works. Both of these options  I gave you for your white spots are advanced cosmetic dental procedures. For these, I would go to an advanced cosmetic dentist. Otherwise, you’ll be disappointed in the results and end up a cosmetic dentistry horror story.

This blog is brought to you by a caring cosmetic dentist in Baton Rouge, Dr. John Theriot.