Archives for September 2021

My twelve-year-old was playing with her younger siblings on the monkey bars and ended up breaking her front tooth. I scheduled an emergency appointment and my dentist suggested a root canal treatment and dental crown. I wanted to get a second opinion on this because my daughter is distraught over how her smile looks right now and doing this wrong will make things worse for her. What do you think?

Penelope

Dear Penelope,

I am very glad you wrote. It was good you scheduled an emergency appointment for your daughter and that your dentist found she needed a root canal treatment. However, his cosmetic fixes have me concerned. this will not serve the appearance of your daughter’s smile well. We don’t usually recommend crowns for children or teens on a front tooth repair for a couple of reasons.

First, her teeth are still developing. That means as the area grows and expands the crown will get pushed down, leaving the margin very obviously exposed. This will look funny and put her at risk of decay. Second, a root canal treatment tends to make a tooth brittle. On a back tooth, a dental crown will help this. However, because of the difference in biting forces on a front tooth, a crown will actually weaken the tooth. What she needs instead is some dental bonding. Even then, you have to be quite careful who does the repair.

A Tale of Two Dentists

Cosmetic dentistry is not a recognized specialty, nor is it taught in dental school. This means any general dentist can practice and call themselves a cosmetic dentist regardless of the training they’ve actually received.

This discolored tooth had a root canal treatment and dental bonding done from an injury, such as the one your daughter sustained. First, this dentist did not factor in that root canal treatments can turn a tooth dark. There are ways to prevent this, but it takes cosmetic training not many dentists have received. Second, if you look at the lower left of the tooth you can see the dental bonding repair. Not only is it not blended well, but even though it is slightly lighter in color than the remainder of the root canaled tooth it is significantly darker than the adjacent natural teeth. This is likely because the dentist who did the work only stocked your standard composite materials. To do excellent cosmetic work requires specialized materials. Compare the photo above with the one directly below.

One of these front four teeth has had extensive cosmetic work done. Can you tell which one? I doubt it. I’m guessing you will want your daughter to have the results from this second image. To get that, you’ll need to take her to see a dentist who is accredited by the American Academy of Cosmetic dentists. AACD accredited dentists are the best cosmetic dentists in the world.

This blog is brought to you by Lexington, KY Dentist Dr. Fred Arnold.