I am 73 years old and have one of those precision partial dentures you have talked about in the past. In the past 3 months I had a root canal done on my upper canine due to decay. My partial is on the top and it is attached to my front six teeth that are capped and tied together. Since I have decay in the canine I now have a space between the gums and the cap. I have been told that the only thing that I can do is replace everything. Is there any other option you can think of? Your quick response is greatly appreciated since I need to do something soon. Thank you.

The scenario you just explained is one that I have come across in the past. In many cases, the only way to fix the problem is to remake the dental work as you have been told. In some cases the decay is not too extensive and the dentist can clean out all of the decay, place a post in the tooth that had the root canal and pack the cap with a filling starting from the top of the tooth until it comes out the bottom and then finishing it off as good as possible under the circumstances. This solution can last for years or it can end up being a temporary repair to buy some time. It is much less involved than remaking the whole case and significantly less costly.

I have bones that are growing out of my lower jaw, under my tongue. They are so large, that they are almost touching. They cause no discomfort. My dentist said, however, because of them I could never wear dentures. What are they? Should they be removed and if so, what is the procedure?

The outgrowths of bone you are referring to are called mandibular tori. Depending on the type of denture and the position and size of the tori you may or may not have to have them removed. If you are referring to a full denture it is very likely that you will need to have them removed. If, on the other hand, you need a partial denture, removal may not be necessary. I have made many people partial dentures with tori present.

In the event that you need to have the tori removed you will need to see an oral surgeon who will separate the tissue on top of the tori and smooth it down with various instruments. Once completed the tissue is placed back in an ideal position so your dentist can make you a denture. Your dentist can recommend whether or not you need the tori removed. If you are in doubt you may want to seek out a second opinion. In many cases, the oral surgeon who you will be referred to can offer you that opinion.

I was in a discussion the other night with some friends and we couldn't agree on how many teeth there are in the mouth. Can you clear this up for us?

There are 32 teeth in the adult mouth. On both the top and bottom there are 4 incisors, 2 canines, 4 premolars or bicuspids and 6 molars. There are 20 teeth in a child's mouth up to the age of about 6. On both the top and bottom there are 4 incisors, 2 canines, and 4 molars. After the age of about 6, they will start to get their adult teeth in. In some cases, these adult teeth will replace baby ones and in others, they will not.

I have recently been told by my doctor that I have a very bad sinus infection. At about the same time of my sinus infection I have developed pain on both sides of my upper jaw. Is it possible I also have a problem with my jaw?

This is a great question and one that we get asked quite often. Your upper teeth are very close to and sometimes right into the sinus. When you have a sinus infection there is a build-up of pressure in the sinus that can directly affect your teeth. I am pretty certain that the pain in your teeth is a result of the sinus infection and the pressure that is built up. However, you should see your dentist to be certain that there is no underlying dental problem that has been brought to the surface because of this.

I am 54 years old and would like to have a nicer smile. Right now I have dark teeth and some ugly fillings. Can you give me some options on how I can proceed with this?

This is usually a pretty straight forward scenario with a couple of options, depending on the specific situation you might have. I will give you my ideas and hope that they will apply to you in some way.

In most cases, a patient with dark teeth would benefit from home whitening.  In order to accomplish home whitening, your dentist would make a duplicate model of your mouth by taking impressions. On these duplicate models, he or she would make a tray that fits snugly on the teeth. You would place the gel in the tray onto your teeth. This would be done for an hour each day. I should comment that the tray is very comfortable and not bulky at all. You would do this for approximately 5-14 days. You would then return to the dentist for an evaluation, at which time both you and your dentist would decide if that is all that is needed or if you need to continue.

Once your teeth are whiter you can go ahead and remove the old fillings that are discolored and replace them with ones that match the newly whitened teeth.

If the fillings were too large to be replaced your dentist might recommend porcelain veneers. Porcelain veneers are like fake fingernails. The biggest difference between the two is that with porcelain veneers the dentist removes the same amount of tooth that the veneer will replace. The amount removed is about 1.5 mm on the face of the tooth and extending between the teeth.  This is done so the end result is one that looks natural and not bulky. Veneers are a very strong restoration once cemented onto your teeth.

There may be times that your dentist recommends you have a crown because there is hardly any tooth left. A crown strengthens the tooth because it is a cover that goes completely around the tooth.

You should also know that any combination of the above procedures can be used together. In either case, what you are looking for is very possible and predictable when planned appropriately.

I had extensive dental work done 10 years ago on all my teeth. I am embarrassed to say that since then I haven't been to a dentist and now have problems. Can you make any comments that may help me feel better about going to the dentist to get this looked at?

First, let me say that current day dentistry is not like it was 10 years ago. There are so many things that can be done to make your visit a very positive one. These things include different anesthetics, different techniques for many of the procedures we do, and finding a dentist that will spend the time necessary with you to explain what is going on and what your options are.

Based on what you have written you may have decay starting under the crowns that were placed 10 years ago. The reason that things do not hurt could be that you had root canals done and therefore the nerves are out of the teeth. I would urge you to find a dentist that you are comfortable with and listen to what his or her suggestions are. Don't feel bad about asking questions because it is the ability for you to ask a question and get an answer that will make you feel comfortable with the dentist you choose.

Do you know where the term wisdom tooth came from?

I need to tell you that I didn't know the answer to this question so I did what a lot of us are doing these days - I went to the Internet. After e-mailing about 6 dental schools and various other organizations I received only one response. The answer they gave me is the one I thought of as well. I am still not sure that it is correct but it is all that I have. They said that the age that the wisdom tooth (or third molar) comes into the mouth is 18 years of age and by that age, a person should have acquired some wisdom, hence, the name wisdom tooth.

I have silver fillings on my upper right. I brush and floss every day. Lately when I floss on the upper right between my fillings I get an odd taste. What could be causing this?

The most probable reason for this taste is decaying food remains. Although you are flossing, you may very well have broken a piece of tooth and/or filling and during chewing you are forcing food between the teeth and below the gums which you cannot reach with daily flossing. This food gets trapped and the body breaks it down causing an odd taste and maybe even an odor which is released when you floss. If there is no broken tooth or filling, you may have an open contact between two teeth which will cause food to get trapped, also causing this taste. You can determine if you have an open contact very simply. If you get a snap when placing the floss between the teeth you probably do not have an open contact. On the other hand, if upon placing floss between your teeth it passes freely, you have an open contact that needs to be repaired.

If neither a broken tooth or filling, nor an open contact are the culprit for packing food, you may have a ledge where the filling meets the tooth, also causing food to get trapped.  If your floss shreds when you pass it between your teeth, chances are that you have a ledge that needs to be repaired.

I have had a gum boil in one of my molars twice in the past 6 months. I went to the dentist and she gave me some antibiotics. The boil went away only to come back recently. My dentist told me that there was an infection in the bone because of gum disease and that the tooth needed to come out. Once it was out she suggested a bridge between the tooth in front of it and the one behind it. First, how come antibiotics do not take care of the situation and second, does what I am telling you make sense?

This is a good question that comes up a lot. The reason the antibiotics do not fix things for good is that the antibiotics take the number of bacteria in the area down significantly to make things comfortable but they do not take away the source or reason for the infection. Unless the source of the infection is removed the area will not heal. Some things that could cause what you are going through are a crack or fracture in the tooth or root, periodontal disease (an infection of the gum and bone that supports the tooth) or an infection in the pulp or nerve of the tooth. There are times when the source of the infection can be removed and there are times that the only thing to do is remove the tooth, as has been suggested to you. I am sure that all options have been thought of and discussed with you. If this is so this makes perfect sense. An extraction and a bridge to follow is exactly what I would do. It is important to wait until significant healing has taken place before the impression is made for the bridge. If this was done prematurely you could end up with an area where a lot of food will pack and be uncomfortable. I have had an article in the past that addresses this. I will mail it to you. Thank you for this question - it is one of those questions that everyone has but doesn't usually ask.

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