Wonderful changes have developed in today’s dentistry. We are able to create restorations on teeth that look more beautiful, improve strength and leave a lot more of the original tooth than the old days. When patients look in the mirror, “Wow!” is frequently the first word out of their mouth. This is dentistry people love. When I finished my graduate training in 1983, I could do some pretty fancy dentistry, BUT– it was all too often done with ugly metal showing or porcelains that looked blah. Times have changed, thank goodness.

The ability to bond porcelain to teeth has been one of the great changes. The porcelain is bonded or fused to the tooth making them almost one. When restorations don’t have any metal underneath, light transmits through the teeth naturally; solving the problem of dark gumlines and dull looking porcelain. The cement between the tooth and porcelain creates a seamless interface that locks them together and allows natural light transmission. The third great thing this bond does is improve strength.

Old silver fillings and inlays weaken teeth. Porcelain restorations help reinforce the tooth they are fused to. It is one of the great material science advances in dentistry. Over the past twenty years, the quality and consistency of the material and technique have steadily improved. Years ago, many patients experienced post-treatment sensitivity or leaking and loosening or porcelain restorations. Today, these are infrequent occurrences even rare. I would say the porcelain work (and implants) we do today is the finest dentistry I have seen in my career. It makes dentistry very enjoyable for me and incredibly positive for my patients.

When teeth have a smaller cavity or old silver filling, they can be repaired with a porcelain inlay. Inlays are like inlayed woodworking. A precision porcelain piece is carefully inserted into the tooth where it has been shaped to remove the decay or old filling. The result is a tooth that just looks normal and is also re-strengthened.

If the tooth has a larger cavity, old filling, or stress cracks; today’s choice solution may be a porcelain onlay. An onlay is a restoration that covers the biting surface of the tooth an slightly wraps over the edges; sort of like an umbrella sitting on the top. By reaching over the edges of the biting surface, it effectively holds the tooth together. If a tooth has a crack, it is no longer being forced apart when you bite down. Or if the tooth had a weakened area, the porcelain helps strengthen it again. If the tooth has problems on the outer face or is very undermined in strength, a full porcelain crown does the same as above, but covers the whole tooth like a new outer shell layer. Beautiful again.

Porcelain restorations are not the cure-all though. Teeth under heavy pressure can have porcelain fracture. Full crowns on the back teeth are still usually done with a metal reinforcement layer underneath; called a porcelain fused to metal (pfm) crown. When properly done they too can have a near life-like look and are quite strong. Teeth that are under very heavy load, like way in the back on patients who clench or grind their teeth a lot, can fracture the porcelain on pfm crowns. This is the place where gold onlays or crowns are still useful.

The key to long term success and patient satisfaction is to clearly understand the patients preferences and priorities. Some people prefer stronger, others prefer prettier. In our practice we often have a few ways something can be done and choose the one that most closely matches the patients preference. We provide highly customized care. Is is care people choose for themselves, not imposed by us. We are here to help.

Dear Cathy,

Thanks for your inquiry about alternatives to root canals. I took the liberty to watch a Mercola video to learn where he was coming from.

Your tooth has a big filling. That means the tooth is weakened a bit because a traditional filling does nothing to reinforce the tooth. Teeth like that often get stress cracks over time because of fatigue. If the crack goes off at an angle, a part of the tooth might break away and is easily repaired. However, if the crack moves vertically up the tooth, it can move into the nerve area or even split the tooth in half.

To strengthen a tooth with a crack, the tooth needs to be held together. The most common way to do that is with a crown. A crown is like a new strong outer shell for the tooth ; binding it together. Often an insulating build up is done to clean up , and strengthen the deeper areas where the old filling and or decay was.

When the nerve of a tooth becomes involved, either from a fracture, decay bacteria, or inflammation from trauma; the tooth can slowly or abruptly die. As Dr Mercola describes, a root canal seals the main micro tubes inside the tooth; usually three on a molar. However, like a river system, there are microscopic tributaries or side canals that the cleaning instruments don’t enter. However, as the tooth canals are cleaned out, the tooth is repeatedly irrigated with a disinfecting bleach solution. That important irrigation cleans the auxiliary canals.

About ten years ago the technology for doing root canals dramatically improved. Post operative discomfort and infections are rare. Millions of people enjoy keeping their teeth, thanks to root canals. Do some fail? Sure, but that is fairly rare these days– IF, the root canal is done well.

Back to the crack. The further a crack goes up a tooth, the poorer the outlook. When you bite, it stresses the tooth. The gross majority are saved without a problem, but depending on the situation, it’s possible to overload anything– even a tooth with no prior treatment.

Alternatives: Dr Mercola says extract all root canal teeth. Or maybe your fracture is far gone. Or the infection has gone on so long that a lot of bone has been destroyed around your tooth. OK, the tooth is lost.

The tooth can be left as a space, replaced with a removable appliance, replaced as a bridge, or done as an implant. For an implant to work, you need enough bone. In most cases these days, it is the preferred way too replace a tooth because it is strong, you can floss it normally and it does not force you to treat the adjacent teeth.

It is a complex subject. A good look at what is happening, and an understanding of your personal preferences should help you solve your problem. The tooth sounds like it is feeding an on going infection. Antibiotics help you short term, but are unable to treat the infection at its source inside the tooth (no longer a blood stream to deliver the drug and the pulp tissue inside and it won’t regenerate or heal).

If you are interested in seeing me for an exam, please set up an appointment. You will probably speak with Ann. 734-971-3450

I hope this was helpful to you — and I learned about Dr Mercola. I do disagree with him fundamentally though. I have seen way too many happy patients who have successful root canals, including myself.

Sincerely,
Kirk D.