Dr. Mike Malone’s Blog

My new dentist says I have “peg laterals” and suggests that I have porcelain crowns placed to correct them. My old dentist always said I would need braces to close those gaps in my teeth. I am confused about what to believe! My old dentist retired, and I don’t really know this new one very well yet. What are “peg laterals”, and what is usually done to correct them?

–Anthony in Topeka

Dear Anthony -

It is hard to develop trust with a new dentist. I would suggest you talk honesty with your dentist about your concerns regarding these apparent differences in opinion about how to address your dental issue.

Simply put, “peg laterals” are when your lateral incisors (the teeth on either side of your front teeth, or central incisors) are too small. This discrepancy in size makes them resemble small “pegs”, hence the term “peg laterals”. Without an examination, I could not presume to tell you how your particular case should be addressed, but I can tell you that you should really trust the dentist you choose to help you.

In some cases, a porcelain crown can be used, if there is adequate space surrounding the peg lateral. If there is not, some orthodontic work might be necessary to create a space for a natural looking crown or veneer. In your case, it could simply be that your teeth have shifted, and therefore the professional advice you have received has changed.

Whatever the case, it is very, very important that you trust your dentist. If you are unable to have an honest conversation with him about the best way to fix your peg laterals, then it is definitely time to seek a different dentist. We strongly recommend you find the services of an expert cosmetic dentist to help you with this - make sure they are accredited through the American Academy of Cosmetic Dentistry, and that they have pursued specialized training above and beyond that required by general dentistry schools.

I have a back molar that needs to have a filling. I asked my dentist about getting a white filling, because it looks so much better than the ugly silver ones, but he did not seem to want to use a white filling in my back tooth.  What should I do? I hate the way the silver fillings look, and I heard something about them containing mercury.

–Addison from New Orleans

Dear Addison,

This is a tricky situation - you should always avoid pushing your dentist to do something he does not feel comfortable doing. Your dentist may be reluctant to put a white filling in your back molar because he is not confident in his ability to do the job properly. The placement of white composite fillings is not required training in dental schools, so a dentist must seek training above and beyond his dental school training to know how to effectively place a white composite filling, particularly in the back of the mouth.

That being said, if you are really sure you want a white filling, you will want to seek a dentist who is trained to place white composite fillings properly.

You are very right - white composite fillings are much more attractive than silver amalgam fillings. And you are also correct about the mercury - silver amalgam fillings are more than 40% mercury by weight, and whether or not that mercury is toxic to the body is a hotly debated subject in the world of dentistry. Some research seems to indicate that small amounts of mercury are released when chewing, but it has not been determined that the amount of mercury released is toxic. Many people choose to err on the side of caution and go with the white composite fillings.

Again, you should always avoid pushing your dentist into doing something he is not comfortable doing. This often has a less than satisfactory result. To locate a dentist in your area who is trained to place white composite fillings, check the referral list on mynewsmile.com.

For more information on white fillings, check out our website.