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Braces ruined my bite, so my dentist says that I need crowns on all of my teeth.

I had braces when I was younger. I thought orthodontic treatment was supposed to fix my bite, but my current dentist told me that my bite was “off” and he says that I now need full-mouth reconstruction. There’s nothing about my bite that bothers me, though. And I can’t afford to get the number of crowns my dentist suggests I need.

Could I be missing something? Do I really need all those crowns to fix my bite, or is there an alternative?

— Grant from Sanford, ME

Hi Grant,

While it’s not unheard of for some people to have bite alignment issues after wearing braces, it doesn’t sound like that’s what you’re experiencing.

Most people who really need full-mouth construction are in pain or discomfort and need to have their teeth physically altered to take the stress off their TMJ. These people have bites that are so off they cannot chew, speak, yawn, or smile comfortably. And it isn’t as simple as placing a crown on each tooth. Full-mouth reconstruction requires both technical and artistic expertise to design crowns that are the perfect size, height, shape, and color for each tooth. When done well (and when it’s truly necessary) full-mouth reconstruction can be life changing.

What this means is that there should be a really compelling reason for you to get full-mouth reconstruction. We have no idea what your dentist saw in your mouth that made him feel obligated to recommend crowning all of your teeth. But, again, full-mouth reconstruction is an extensive and complex process which isn’t usually needed for people who don’t have any issues with the way their teeth fit together.

If you don’t feel like your dentist is giving you enough diagnostic evidence to justify the investment of a full-mouth reconstruction, then you should seek a second opinion.

In your particular case, you should consider seeking out a dentist with special training in TMJ treatment and full-mouth reconstruction. Such a dentist will carefully evaluate your bite, will let you know if there are signs of trouble, and can recommend more conservative measures to try correcting your bite before going the route of full-mouth reconstruction.

This post has been published on behalf of Dr. Heng Lim, an Owasso dentist who has received training in creating balanced bites at The Las Vegas Institute for Advanced Dental Studies.

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Dentist damaged my son’s tooth while removing his orthodontic retainer. Is a root canal necessary?

My son wore braces for a year and half and has had a fixed retainer on the inside of his lower front teeth for the past three years. The dentist was trying to remove the retainer recently, and it seems that he damaged one of my son’s lower teeth in the process. The tooth began hurting after the retainer was removed and it has since started to turn gray. My son can’t bite on that tooth and he says that it hurts when he wears his retainer. The tooth is also extremely sensitive, even to just plain water.

We went back to the dentist to get it looked at and he took an X-ray and did a cold test. He said that he suspects that the tooth is dying and may need a root canal. The dentist then referred us to an endodontist for specialist treatment. I’m surprised that the tooth might need root canal treatment.

Is there any chance it’s simply bruised and only needs a little time to heal?

— Sam

Hi Sam,

Unfortunately, when a tooth dies, a root canal is necessary to stop the pain and prevent the infection from spreading. A tooth is filled with living tissue that swells in response to infection and injury, just like tissue anywhere else in the body. The problem with teeth, however, is that there’s no room for the inflamed tissue to swell as it’s confined to the inside of the hard outer layers of the tooth.

If your son’s tooth is truly dead or dying, then a root canal is the best treatment to help him get relief.

A root canal is the only treatment option once the inside of a tooth is compromised by damage or decay.

And based upon the description of your son’s symptoms (namely, sensitivity to biting and cold temperatures) it sounds like your dentist did the right thing by referring your son to an endodontic specialist for a more definitive diagnosis. Those are classic signs of a dying tooth.

It’s worth noting that removing a permanent retainer should be a straightforward procedure with very little risk of damaging the teeth. If your dentist truly caused the injury to your son’s tooth, then he should pay for the root canal to repair the damage.

Additionally, while braces and retainers are only rarely connected with complications like the one your son has experienced, some people find that they get excellent results when they choose an alternative to traditional orthodontic treatment.

If you, your son, or anyone else in your family needs to see an orthodontist in the future, you might want to consider exploring a method such as facial growth guidance.

This post was published on behalf of Dr. Heng Lim, a whole health dentist in Owasso.

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How to get rid of a black triangle between teeth after braces.

I’ve had braces in the past, but a tooth shifted out of place, so my current orthodontist ground down part of my tooth by about 2 millimeters to fit the spring retainer he made. The problem is that shaving my tooth like that has left this weird black triangle between my teeth where the gums don’t fill in.

Is it possible to make the gums grow to fill in this space? I hate the way it looks!

Thanks for any advice you can share!

Gina from New Jersey

A photograph of teeth that have black triangles of empty space between them near the gum line.
One or more black triangles after orthodontic treatment can make you feel self-conscious about the appearance of your smile.

Hello, Gina

We can’t give you any definitive advice based on our limited understanding of your situation, however, we can share some basic information.

For starters, your orthodontist may have a plan to correct that gap. Your treatment is not yet complete, so you can continue working with him to find out what kind of results he hopes to achieve with the spring retainer or other orthodontic appliances.

Second, your gums are not likely to grow in enough to fill the empty space. Your gum line will follow the natural contours and spacing of your teeth because gum tissue doesn’t grow over nothing; it needs a foundation. Even if you were to surgically alter your gum tissue with a graft to fill in the gap, the tissue would shrink back to its normal contours over time.

Finally, closing up a black triangle like yours can be quite challenging, depending on the shape of your teeth. Sometimes teeth are left with these gaps even when they are perfectly straight and even when they touch evenly on the sides. So once your orthodontic treatment is complete, we recommend that you see an excellent cosmetic dentist who can apply just the right amount of natural-looking dental bonding to change the shape of your teeth and close the gap.

This post has been published on behalf of Dr. Heng Lim, an Owasso dentist who takes a comprehensive treatment approach to orthodontics.

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