Dr. Mike Malone’s Blog

I went to see my dentist because one of my molars had suddenly become really sensitive to everything, even air. It is winter here, and when the cold wind blew into my mouth it really hurt! Hot food or drinks were bothering it, too.

Anyway, my dentist diagnosed the problem in like two seconds, and I am kind of wondering how accurate that diagnosis can be. He is always in a really big hurry, and this time was no exception. He rushed in, barely listened to what I was telling him, then started squirting my tooth with air while asking impatiently if it hurt. Then he put some “desensitizing bonding agent” on the tooth, and the pain went away, and he said that it should heal on its own, then he was gone. I only know what he put on it because I asked the hygienist.

The tooth in question has a really large white filling, and when I went in I wondered if that was the problem. Could he really do a thorough diagnosis like I described? I could really use some advice.

Brent in Minneapolis

Dear Brent,

Sometimes it really is quite easy to diagnose pain issues, and from what you’ve written, yours fell into the easy-to-diagnose category. An unprotected, sensitive spot on a tooth will react to blown air with pain, and a desensitizing agent will help with that. If the pain only lasts for a moment and then goes away, that is an indication that the irritated nerve or pulp of your tooth has the chance of healing on its own. If the pain had lingered, your dentist would probably have recommended a root canal procedure, as that would have indicated irreversible damage and a need to remove the nerve.

The real issue here is that you do not trust your dentist. Your letter indicates that you do not appreciate your dentist’s abrupt manner, but more seriously, you do not trust him to provide you with thorough, careful dental care. Good dental care requires trust.

If you want to try and salvage this professional relationship, I would recommend an honest conversation with your dentist. If he responds with impatience or acts annoyed, I think you will have to find a new dentist.

We are having a lot of problems with my 10 year old daughter’s teeth. The permanent teeth that have come in are extremely yellow, and very blotchy. Our dentist says the blotchiness was caused by too much fluoride. I thought fluoride was good for teeth! She has braces right now, so we have a little time to figure out how we should fix the discoloration and blotchiness. We are trying to address these issues now, because she is very self-conscious about her teeth, and we want to start making positive changes before she hits puberty.

Thanks for your help,
Rochelle in Baton Rouge

Dear Rochelle,

The blotchiness is caused by fluorosis, and it is indeed a symptom of too much fluoride while your daughter’s teeth were forming. Most communities have to add fluoride to their water, but some naturally have too much fluoride, and if it is not detected and removed, extended use can cause fluorosis. This can also happens when people drink untreated well water that is naturally high in fluoride. Fluorosis can even be caused by years of swallowing too much fluoridated toothpaste.

Whatever the root cause, if your daughter’s fluorosis stains are severe, you will probably have to treat them with porcelain veneers. In mild cases of fluorosis, the spots can sometimes be treated with bonding to cover only the affected spots. Severe staining will require more extensive coverage, and that indicates that porcelain veneers would be the treatment of choice.

The good news is that there is no minimum age for porcelain veneers, so you could conceivably get something in place when her braces come off. If you do choose to pursue veneers when she is in her early teens, make very sure you choose a highly skilled cosmetic dentist who has experience doing veneers for teenagers.