Archive for June, 2010

Teeth very sensitive after removal of braces

Wednesday, June 30th, 2010

I had braces for two years, and have just recently had them removed. Ever since they were taken off, I have noticed that my teeth are incredibly sensitive to temperature. If I try to eat or drink anything hot or cold, it is really painful. I can also feel rough patches and dips on the front of my teeth, almost as if the enamel is gone. Could my orthodontist have damaged my teeth when she removed the brackets? I am also noticing that my teeth seem to be getting darker every day. I don’t drink coffee or cola very often, but my teeth seem to soak up every stain like never before.

What should I do? I did not go through two years of ortho to have ugly teeth!

Thanks for your time,

Savannah from Council Bluffs

Dear Savannah,

I don’t think your orthodontist caused this damage, though it is not unheard of that damage can happen during bracket removal. The patches you describe sound like areas of decalcification. These are areas where your teeth have lost some minerals, and those areas are porous, which is causing the staining you are seeing. Those spots may eventually turn brown, and even chip away, leaving pitted holes in your teeth. I am sure this is NOT what you envisioned as you went through orthodontic treatment, and that missing enamel is what is making your teeth so sensitive.

Teenagers are not always as diligent as they should be about brushing their teeth after eating, and when a teen has braces, the problem is magnified. The brackets allow food to sit against your tooth, and underneath the brackets, the acid in your saliva that helps digest food is busy working away at the surface of the tooth. The extent of the problem becomes really evident when the braces come off.

It is important to address the issue before it gets any worse. Bleaching will not help the stains. It will probably make them look worse, so I would not recommend going that route. If the damage is just to a few small spots, a treatment choice might be dental bonding. Freehand dental bonding is one of the most challenging cosmetic dentistry techniques from an artistic standpoint, and if it is not done well, you will not be happy. Make sure you chose a cosmetic dentist who is trained and experienced. Direct dental bonding requires a very high degree of artistry and technical skill that very few dentists possess.

If the damage is extensive and/or severe, you may be looking at porcelain veneers. That is a daunting prospect after two years of orthodontic work, but it is better to be prepared.

If you have friends that still have braces, you can be their cautionary tale. People with braces simply MUST brush after every single time they eat. At the very least, they must rinse thoroughly with water if brushing is impossible. It is very frustrating to go through all those years of ortho work, only to continue struggling with dental issues when you are done.

Should I wait to fix my child’s broken tooth?

Friday, June 18th, 2010

Last evening at t-ball practice my youngest daughter was hit in the mouth with a bat. One of her front teeth on the top broke right off, and the other one has a crack all the way across it. We took her to our family dentist first thing this morning, and he said he won’t have time to fix it for three weeks. Three weeks! That just seems crazy to me. Everything I’ve ever heard or read about damage to teeth says that you should “get to a dentist right away”. Well, what is the point of that if they aren’t going to fix it?

One of the reasons our dentist gave for the delay is that the root of the broken tooth needs time to “desensitize”. Is that customary? If it is, then I guess we will wait, but my instinct is to take her to a different dentist, one who will treat this with some urgency.

I hope you can answer this quickly. I don’t want to wait, but I’d like some expert advice about what to do.

Nora in Bar Harbor, Maine

Dear Nora,

Your instincts are correct – there is no reason to wait to address this.

If you have the piece of the tooth that broke off (and see this response promptly!), an expert cosmetic dentist might be able to reattach that portion of the tooth. If you don’t have the piece or it is too badly damaged, a likely procedure to repair both teeth is direct dental bonding.

For this reason, I strongly suggest you chose an expert cosmetic dentist for this procedure. Direct dental bonding requires more than excellent technical skills and training. It requires artistry. The bonding material must be color matched and placed with an eye to the gradients of color that comprise her natural teeth. Only truly gifted cosmetic dentists can do really beautiful direct bonding work.

You don’t say how old your daughter is, but because of your reference to t-ball I am guessing that she is under 10. Direct bonding is a great solution for younger patients. When she is older, she will probably need a single dental crown for the tooth that was broken, but your dentist will have to make that decision when the time comes. If the other tooth is severely damaged, both front teeth may need crowns.