All posts by AllSmiles

Root Canal Treatment

Will I Need Root Canal Retreatment?

I had a root canal on my upper right canine almost a month ago, but the temporary filling came out. An abscess developed on the gum near that tooth. When I returned to my dentist’s office, he said I needed the root canal redone to treat the infection.

The abscess doesn’t hurt unless I press on the area. Should I be concerned about the abscess even if it isn’t painful? Would antibiotics clear the infection, or is root canal retreatment necessary? – Thanks. Marceline from ATL

Marceline,

Based on your description, a dentist or endodontist should evaluate the tooth for retreatment. The temporary filling came out, which may have allowed saliva and bacteria to contaminate the inside of the tooth.

During root canal treatment, the dentist removes infected tissue and bacteria from inside the tooth and seals the root canals with filling material and cement. That seal needs protection from saliva to help prevent bacteria from getting back into the tooth.

At the end of the root canal appointment, the dentist usually places a temporary filling to protect the tooth until the final restoration is completed. Depending on the tooth and its condition, that final restoration may be a crown or, in some cases, a permanent filling.

Temporary fillings are designed to be removed easily. If one falls out and the tooth remains open, saliva can seep into the root canal filling. Over several days, bacteria may contaminate the root canal system and compromise the seal.

Can Antibiotics Clear the Infection Without Retreatment?

Antibiotics alone cannot eliminate bacteria that have contaminated the inside of a root canal tooth. Antibiotics travel through the bloodstream, but a root canal-treated tooth no longer has normal blood circulation inside the cleaned canal space.

Antibiotics may reduce an infection that has spread into the gum and surrounding bone, so swelling or an abscess may temporarily improve. However, they do not remove the source of infection inside the tooth. Once you stop the antibiotics, the infection can return if the source remains.

Unnecessary or repeated antibiotic use can also contribute to antibiotic-resistant bacteria. For these reasons, antibiotics are not a substitute for treating the source of a dental infection.

Is It Safe to Leave the Tooth Alone If It Does Not Hurt?

The absence of pain does not mean the infection is harmless or has resolved. A dental infection can remain relatively quiet while still affecting the tooth and surrounding bone.

Leaving the tooth untreated can create several concerns. Although serious complications are uncommon, dental infections can sometimes spread beyond the immediate area. An untreated tooth may also continue to deteriorate from within.

Possible consequences include:

  • Continued infection around the tooth or in the jawbone
  • Loss of supporting bone around the root
  • Spread of infection into nearby facial spaces
  • Further decay and weakening of the tooth
  • Eventually reaching a point where the tooth can no longer be restored

Because this involves an upper tooth, we don’t recommend monitoring it and waiting for symptoms. A dentist or endodontist can evaluate the tooth, determine how much contamination has occurred, and advise whether root canal retreatment can preserve it.

Plano, Texas, female dentist Dr. Miranda Lacy sponsors this post. She caters to anxious patients.

Tooth Extraction

What If a Root Tip Remains After My Tooth Extraction?

In early July, I had my lower left wisdom tooth extracted. I wanted to see the tooth after the extraction, but my dentist wouldn’t let me handle it or keep it. My gum took about three weeks to heal and close.

Since then, I’ve had pain on the left side of my face, in my ear, and behind my eye. The facial and ear pain have mostly gone away, but the pain behind my eye continues. I’m wondering whether the entire tooth was removed. Could a tooth root fragment left in the socket become infected and cause this type of pain? – Thanks. Judith from OR

Judith,

After a wisdom tooth extraction with an open socket, infections are uncommon because the area can drain naturally. In contrast, infections are more likely when an impacted tooth requires stitches that close the gum over the site.

If a full root or large fragment remains in the socket, the gum can heal over it and trap bacteria inside the jaw. This situation can lead to ongoing discomfort or infection.

Does a Tooth Root Fragment Require Removal?

Ongoing symptoms deserve attention from another dentist, ideally an oral surgeon who can both diagnose and treat the problem. An X-ray provides clear evidence of whether any tooth structure remains.

This step helps determine:

  • If a retained root is causing symptoms
  • Whether the bone has healed over the area
  • How complex removal would be, if needed

If a significant root was unintentionally left behind, requesting a refund could be reasonable.

Tooth roots do occasionally fracture during removal, particularly in older patients whose roots may thicken over time. This complication can occur even with careful treatment and is not automatically the dentist’s fault.

Appropriate care depends on the fragment:

  • Small tips in risky locations may be left to heal naturally
  • Larger sections should be removed by the dentist or an oral surgeon

Patients should always receive a clear explanation when this happens.

Many patients like to see or keep their extracted tooth, and dentists often honor that request. If you couldn’t view the tooth after asking, seeking clarification or a second opinion is a reasonable next step.

Plano dentist Dr. Miranda Lacy sponsors this post. Dr. Lacy and her team cater to patients with dental anxiety.

Cosmetic Dentistry

Why Does Bonding on a Chipped Lower Incisor Keep Failing?

I broke a small piece off one of my lower front teeth about 11 months ago. Although the chip is small, it irritates my lip and makes me avoid smiling.

My dentist has repaired it with bonding several times, but each repair falls off within a few days. I am 17. Can a chipped tooth ever regrow on its own, or what would be the best long-term solution? – Thanks. Carlo from NV

Carlo,

Repairing a chipped lower front tooth is not always as simple as replacing the missing piece. The way the front teeth meet during biting has a major influence on whether the repair will last.

Why Do Lower Incisor Repairs Sometimes Come Off?

The repaired edge can be exposed to significant biting forces every time the mouth closes.

Many chipped lower incisors break because they repeatedly contact the backs of the upper front teeth. When composite bonding is placed, it must be positioned to avoid heavy contact during normal function. If the restoration is left in an area that receives excessive pressure, it may eventually separate from the tooth.

The position of the tooth can make all the difference. In the example pictured, the composite remained intact on tooth #24 but detached from tooth #25. The reason appears to be the position of tooth #25, which sits slightly farther forward than its neighbor. Because it protrudes more, it would likely contact the upper teeth first, placing greater stress on the bonded edge every time the patient bites.

Before and after lower chipped incsior photos
Lower incisors repaired with porcelain veneers
(photo courtesy of Dr. Ian Bell of Bellevue, WA)

How Can a Dentist Reduce Stress on the Repaired Tooth?

Balancing the bite is an important part of treatment.

Successful repairs often require more than replacing the missing tooth structure. They also require careful adjustment of the tooth’s position so biting forces are shared evenly.

This may involve:

  • Reshaping the tooth so it no longer contacts first.
  • Ensuring all the lower front teeth meet the upper teeth evenly.
  • Choosing a restoration that can withstand the patient’s bite.
  • Evaluating the bite after treatment to reduce the chance of another fracture.

In the example, Dr. Bell achieved this by placing two porcelain veneers and reducing the prominence of tooth #25. A similar result may also be possible with expertly placed composite bonding.

What If Specialized Cosmetic Dentistry Is Difficult to Access?

In areas where experienced cosmetic dentists are uncommon, smoothing the rough edges of the chipped tooth may provide relief by preventing irritation to the lip. While this does not restore the missing tooth structure, it can improve comfort until more comprehensive treatment becomes available.

Plano, Texas, female dentist Dr. Miranda Lacy sponsors this post. She caters to anxious patients.

Tooth Decay

How Could I Have a Decayed Tooth with No Outward Signs?

I had my six-month dental exam and cleaning last week, and it was time for X-rays. The dentist told me that my upper left lateral incisor has decay inside it and needs a root canal. I’m struggling to understand this because the tooth has never been filled, crowned, or otherwise treated. It doesn’t hurt, and I can’t see any signs of a cavity or external damage.

Also, my X-rays from last year showed no issues, at least according to my previous dentist. The tooth protrudes slightly and doesn’t contact my lower teeth when I chew. Interestingly, my dentist referred me to an endodontist who shares the same uncommon last name as my dentist. I’m suspicious. Can I have a decayed tooth without any visible signs on the outside of the tooth? Thanks. Hannah

Hannah,

Decay doesn’t originate inside a tooth. It always starts on the outer surface and progresses inward. Once bacteria reach the pulp, infection follows, often requiring root canal treatment.

If your dentist mentioned damage that appears to start internally, they may be describing something other than decay.

Understanding Internal Resorption

Internal resorption is an uncommon inflammatory condition in which the pulp begins to dissolve the tooth structure from the inside. Dentists don’t fully understand why it occurs, but irritation to the pulp seems to be a contributing factor.

In the absence of decay, trauma sometimes explains that irritation. A tooth that protrudes slightly may absorb more force over time. Even so, this diagnosis is rare, which makes confirmation essential.

How to Confirm the Diagnosis

Before moving forward with treatment, consider a second opinion from an endodontist. This step helps remove bias and increases diagnostic accuracy.

To do that effectively:

  • Obtain copies of your X-rays.
  • Avoid sharing prior diagnoses or dentist names.
  • Let the specialist interpret the images independently.

The Importance of X-Ray Angles

External root resorption can look very similar to internal resorption on a single X-ray. Taking images from significantly different angles often reveals whether the defect lies inside the root or on the outer surface.

Plano, Texas, female dentist Dr. Miranda Lacy sponsors this post.

Ceramic Crowns, Uncategorized

What Type of Crowns Should I Request for My Front Teeth?

I need to replace the crowns for my two front teeth, which I got in 2002. They are discolored, and I was never happy with them because the color was off, and they looked too thick. What type of crowns should I ask for? – Thanks. Trevor from San Diego

Trevor,

Patients often compare crown materials and want to know which one looks the most natural. While materials do matter, the experience and artistic ability of the dentist and ceramist are usually more important.

All-ceramic crowns can produce lifelike results. When designed and fabricated correctly, they can closely resemble natural teeth in color, translucency, and texture.

For front teeth, several ceramic options provide strength while delivering excellent esthetics.

The Challenge of Restoring a Dark Front Tooth

A darkened tooth beneath a crown creates an additional cosmetic challenge. The goal is not only to cover the discoloration but also to make the restored tooth blend seamlessly with the adjacent tooth.

To accomplish that, the dark color must first be neutralized. Different dentists and laboratories use different techniques depending on their experience and preferred workflow.

Materials Commonly Used for Cosmetic Crowns

There is no single “best” material for every patient. Several options can work beautifully when used by an experienced team.

Some of the most common choices include:

  • Feldspathic porcelain
  • Lithium disilicate (e.max)
  • Zirconia with porcelain layering

Each material has strengths, and all can be modified to block underlying discoloration. The final appearance depends largely on how the material is designed and layered.

How Dentists and Ceramists Create Natural Color

Creating a natural-looking crown requires more than selecting the right shade. The dentist and ceramist must work together to manage both the dark tooth underneath and the appearance of the final restoration.

This process may involve:

  • Using an opaque composite buildup on the tooth.
  • Adding an opaque layer inside the crown.
  • Layering translucent porcelain to recreate natural depth and vitality.

The goal is to prevent the dark tooth from showing through while maintaining a realistic appearance.

Trust Experience Over Material Selection

A dentist who consistently achieves beautiful results with one material will usually deliver a better outcome than someone working with a material outside their comfort zone. Cosmetic dentistry combines science and artistry, and experience matters.

When restoring a highly visible front tooth, choose a dentist with proven cosmetic skills and let them select the material that works best for your case.

Plano dentist Dr. Miranda Lacy sponsors this post.

Zirconia Crowns

Why Does My Dark Tooth Still Show Through a Zirconia Crown?

I had a root canal on my upper left front tooth in 2006. Since then, I’ve needed three crowns on that tooth. The first two had metal backing, and the most recent one is zirconia, which my dentist recommended as the best material.

Last fall, my new dentist recommended a crown and a veneer for the adjacent tooth. He said it would help correct the tooth width discrepancy and give me a more uniform smile. I agreed because I wanted a better smile

The result was disappointing. The tooth beneath the crown is very dark, and now the crown looks gray. The veneer doesn’t match the crown or my other teeth.

My dentist attempted to correct the color by placing something inside the crown, but it didn’t solve the problem. He said the discoloration of the root canal tooth is too severe to fully hide.

I can’t believe that there isn’t a reliable way to fix this issue. Is my situation unusually challenging? Thanks. Kim from Nashville

Kim,

Zirconia crowns are strong, but they don’t have the most natural appearance on their own. Especially for front teeth, cosmetic dentists usually enhance zirconia by layering it with porcelain.

Masking a Dark Tooth Requires Precision

The primary challenge in your situation is not the crown material but the darkness of the tooth beneath it. Covering the tooth takes planning, skill, and teamwork between the dentist and the lab.

The dentist must communicate both the final shade and the color of the prepared tooth. This involves photographs and detailed instructions. Some dentists apply an opaquer before sending the case to the lab, while others rely on the ceramist for that step.

Why Do Experience and Teamwork Matter?

Achieving a natural result with a crown on a dark tooth depends heavily on experience. Not every dentist or ceramist regularly handles complex color masking.

Strong dentist–ceramist teams have these advantages:

  • Experience with difficult shade-matching cases
  • Use of customized layering techniques
  • Close collaboration to refine color and translucency

Many cosmetic dentists work with specialized ceramists who focus on aesthetic cases. The results are a higher level of detail and artistry.

How Cosmetic Dentists Create Depth Instead of a Flat White Crown

Overusing opaquer can solve one problem but create another. If too much is applied, the crown may appear unnaturally white and lack the subtle variations seen in natural teeth.

A more refined approach includes:

  • Placing opaquer in deeper layers to block dark color
  • Adding translucent porcelain on top to simulate enamel
  • Building depth to help light reflect naturally

Whether the opaquer is applied to the tooth or within the crown, the goal is to hide the darkness while preserving a natural look for the crown.

Challenges of Blending a Veneer with a Crown

Your dentist’s recommendation to use a veneer on the adjacent tooth reflects a conservative approach. Veneers require less removal of natural tooth structure than crowns.

However, matching a veneer to a crown can be challenging. It requires precise color control and a high level of technical skill to ensure both teeth look consistent in shape, shade, and translucency.

Plano, Texas, female dentist Dr. Miranda Lacy sponsors this post.

Oral Health

I Think My Energy Drinks Are Causing Gum Disease

I think energy drinks are running my teeth. My work and family schedules are full, so I need to stay up for the kids when they get home from school. I haven’t seen a dentist yet this year, but I’m afraid that my habit will cause me to need dentures prematurely. My gums are bleeding. What can I expect when I’m able to get a dental appointment? Thanks. Justyn from Cincinnatti

Justyn,

Sugary drinks don’t automatically cause cavities. The trouble starts when you let the liquid sit in your mouth instead of swallowing it. Decay often develops around the necks of the back teeth, especially on the inside surfaces of the lower molars, where saliva doesn’t rinse as easily.

When you take small sips throughout the day and hold the drink in your mouth, you give bacteria more time to feed on sugar. Even after a dentist treats these areas with fillings, continuing the same habit can lead to new decay forming around the edges of those restorations.

Before changing what you drink, it helps to understand how you drink it. Small adjustments can significantly reduce the damage without requiring you to give up beverages you enjoy.

  • Take larger gulps instead of frequent small sips
  • Swallow promptly rather than holding the drink in your mouth
  • Limit how long sugary liquids contact your teeth

Why Bleeding Gums Need Prompt Attention

Bleeding gums usually signal gingivitis, the earliest stage of periodontal disease. Like tooth decay, gingivitis results from bacteria accumulating along the gumline. When you change how you feed those bacteria and keep the area clean, the gums often heal.

Some people avoid brushing near bleeding gums because they worry about causing harm. Gently but thoroughly brushing the gumline removes the bacteria that prevent healing. Combined with flossing and regular professional cleaning, this approach typically resolves the problem.

Plano, Texas, female dentist Dr. Miranda Lacy sponsors this post.

Tooth Extraction

What Should Be Done If My Tooth Root Broke After Extraction

I had an upper first molar extracted, and it didn’t go smoothly. A piece of the root broke during the procedure. My dentist referred me to an oral surgeon to remove the remaining fragment, but the appointment isn’t for three months.

I feel uneasy about delaying treatment that long. Could waiting cause complications? Should I go ahead with the surgery, or is it sometimes okay to leave a small root tip alone? – Thanks. Kanyn

Kanyn,

Root fractures during extractions are not rare. Some roots have sharp curves or thin ends, making complete removal challenging.

If your dentist stopped rather than attempting a difficult retrieval, that decision is likely to reflect caution. Recognizing limits and referring when necessary protects you from avoidable complications.

Is a Three-Month Delay Appropriate?

The body begins healing immediately after an extraction. Within weeks, new bone begins to form in the socket. After three months, the healing can make surgical access more involved.

Root fragments that require removal are usually addressed within days, not several months.

Why Is an Upper First Molar Different?

Upper first molars sit close to the sinus cavity. That anatomy increases the stakes.

Because of that relationship, surgeons must weigh several risks:

  • Sinus involvement: Retrieval attempts can displace the root into the sinus.
  • Surgical complexity: Removing a root from the sinus requires delicate surgical care.
  • Increased difficulty with healing time: The longer you wait, the more bone forms around the fragment.

What Should You Do Now?

Seek a second opinion promptly, ideally from an oral surgeon. If imaging shows a very small fragment sitting safely near the sinus, monitoring may be reasonable. If not, removal should occur within the next few days.

Plano, Texas, female dentist Dr. Miranda Lacy sponsors this post. She caters to anxious patients.

Cosmetic Dentistry, Uncategorized

My Dark Tooth Still Shows Through the Crown

I injured an upper tooth when I was 16 and had a root canal, which left it discolored. Over the years, I’ve tried to improve its appearance with my general dentist, but each step became more invasive. I’m now left with a discolored crown and an irritated gum line.

I feel worn down by the process, but I don’t want to rush into more treatment without understanding my options. My goal is a tooth that looks natural and feels comfortable.

I’ve had one consultation with a local cosmetic dentist. I’ve considered whether an all-porcelain or a porcelain-layered zirconia crown would yield the best result, but I also understand that the dentist’s experience and comfort with the material matter more than the material itself. What question can I ask to anticipate the results from this dentist? Thanks. Yadira from Chicago

Yadira,

Cosmetic dentistry relies heavily on judgment, proportion, and an eye for detail. While a dentist may train extensively, not all pursue the artistic side of dentistry. Those who do usually showcase their work.

Looking at completed cases on a dentist’s website gives you more insight than reading about techniques or materials.

Ways to Evaluate a Dentist’s Aesthetic Work

A dentist’s smile gallery serves as a practical screening tool. It allows you to assess whether their outcomes align with your goals before you ever schedule a visit.

As you review photos, consider the following carefully.

  • Do the restorations look natural rather than uniform?
  • Do the teeth reflect subtle color variation and depth?
  • Would you feel confident having similar work done on your own smile?

A Balanced View of Cost, Insurance, and the Role of Materials

Practices that emphasize affordability and insurance participation often operate under financial constraints that limit time, materials, and lab collaboration. High-level cosmetic dentistry usually requires flexibility in all three areas.

When it comes to crown materials, an experienced cosmetic dentist can achieve excellent results with layered zirconia, e.max, or feldspathic porcelain. Just as you wouldn’t judge a painter by the brand of paint alone, you shouldn’t judge a cosmetic dentist by material choice without seeing their work.

Plano, Texas, female dentist Dr. Miranda Lacy sponsors this post.

Gum Disease

How to Treat Swollen and Bleeding Gums During Pregnancy

Why are my gums still puffy after delivering my baby in February 2025? Will I need to get a gum contour? Thanks. Melody from WY

Melody,

We understand your concerns. The following information can help you determine whether at-home care will be enough and when to see a dentist.

Why Are Gums Irritated During Pregnancy?

Expectant mothers often experience pregnancy gingivitis, a condition that heightens gum sensitivity to plaque. This inflammation often leads to tenderness and increased bleeding during your daily routine. Because your case involves substantial swelling, you should take extra care to manage the inflammation immediately.

What Can You Do at Home for Pregnancy Gingivitis?

Diligent oral hygiene usually resolves most cases of gum irritation. You can implement several simple changes to your daily routine to help soothe your gums and reduce swelling.

  • Focus on the gum line: Clean the area where the tooth meets the gum carefully with a soft-bristle brush.
  • Prioritize flossing: Ensure you reach the tight spaces between teeth every day.
  • Monitor peroxide use: Rinse with 3% hydrogen peroxide only occasionally, as daily use for over two weeks can lead to an oral yeast infection.

When Should You See a Dentist?

Consult your dentist if your hygiene routine does not improve gum swelling and irritation. Delay gum contouring or other surgical work until your gums are healthy. Addressing the source of the irritation prevents the swelling from returning after a dental procedure.

Plano, Texas, female dentist Dr. Miranda Lacy sponsors this post.