Not just nervous, completely pretrified

[Dr Pav Khaira]

No dentistry lasts forever. If natural teeth don't last forever, how can our materials compare? The huge difference is that good dentistry lasts much, much longer than poor quality dentistry. The average life span of a crown is 15-20 years. Some last 5 others last 65. There are too many variables to take into consideration to say dentistry lasts forever, IMHO

Kindest regards

[toothfairy]

A decent porcelain crown is said to last 10 - 15 years, but it will be past it's best in terms of aesthetics at about 10 max if not sooner. Gold crowns can last much longer providing the gums and teeth are kept healthy.

Amalgam fillings can and do often last a lifetime. It's also unhealthy to remove them if not absolutely necessary unless you have a special shield to protect you from breathing in the mercury. If a dentist wanted to change any of my fillings I would go for a second opinion.

A dentist once wanted to remove my wisdom teeth despite me having absolutely no problems with them. I said thanks but no thanks and still have them 16 years later nicely sealed and sans decay. The secret to healthy teeth is to avoid unecessary dental work and maintain a high standard of dental hygeine and a healthy diet. If you smoke - stop - it rots your gums. Don't drink fizzy or sugary drinks or if you do then use a straw. Invest in a sonicare - they're great.

[Dr Pav Khaira]

May I ask if you are a dentist? Many of your opinions are seriously flawed. Veneers and crowns when done correctly to not cosmetically fail after 10 years. When done well they can last much longer. Amalgam is a beautiful material when used appropriately. It does not however seal the margins of the tooth. The key to good dentistry is excellent home care and excellent dentistry. The problems arise with poor quality dentistry and inadequate homecare.

The track record for amalgam is far longer as it has been available for over 100 years. The use and benefits of correctly bonded porcelain restorations is rapidly being verified as one of the best restorations available when used appropriately and executed with precision.

There are many reasons you may have needed your wisdom teeth taking out even if they were not giving you pain. I had mine removed as they were becoming cystic and I had no pain whatsoever

Kindest regards

[toothfairy]

I didn't need my wisdom teeth out. No other dentist has suggested I have them removed. Some dentists see money as a motivator and find reasons for work that is not necessary. Are you denying that happens in the profession?

A second opinion is cheap and always sensible.

[Dr Pav Khaira]

I'm not denying it at all. It happens in every profession. You have honest plumbers as well as dishonest ones. And if in doubt as I have said many times don't have the treatment done. What I would say is that it is all down to the practicing ethos of the individual. I can say for the dentists here who I know that they genuinely care and undertake very high quality work.

Amalgam is not dangerous for a patient, rather the dentist and his team as we work with it day in a day out. All of my colleagues here undertake the highest precautions when removing amalgam fillings. All evidence to show amalgam is unsafe is seriously flawed. However, there are many superior materials that can be used but the skill set required is significantly higher than the manipulation of amalgam. I would be happy to have any of the colleagues I know here undertake work for me.

Go to 10 dentists and you will get 10 opinions. There are lots of factors to take into consideration. As Popadoopus has also said, those involved in the forum here take great care to educate themselves properly so that we can undertake advanced treatments. Porcelain placed by someone who is unaware of its manipulation and methods for bonding it can expect rapid failures. Similarly, by your argument, porcelain placed well by someone who knows how to use it can potentially last a lifetime. We always talk averages. And on average, amalgam lasts 10 years. On average porcelain lasts 10-15 years.

I replace many amalgams. The reason for this is I use a microscope for diagnosis and pick up many cracked teeth. A recent audit has shown me that since I have introduced the microscope and have found these fractures, the number of my clients calling with broken teeth has dramatically reduced.

I do appreciate your input and feel you have made some very valuable points, but the picture is much larger than what appears at first glance. I will be going to the States several times this year to study. That is how much I genuinely care about providing the highest quality work for my clients.

I hope you can also admit that there are many exceptionally skilled dentists out there who do the highest quality work. And that their results will last much longer than average whether they use amaglam, gold or porcelain.

this again all comes down to how much you trust your treating dentist

Kindest regards

[toothfairy]

Agreed that there are many skilled and decent dentists out there. However, it is difficult (if not impossible) for someone new to an area to find out which dentist has a good cosmetic reputation (particularly if the people you know have not had cosmetic work). Dr Khaira, I'd say anyone who takes the time to answer questions as thoughtfully as you do is bound to take just as much care in the mouth. Sadly not all dentists have the same motivation to do a perfect job with which the patient is satisfied.

Anyone who can be a truly successful dentist must be greatly admired. By truly successful I don't mean building up an imposing practice with plumped cushions and deep pile carpets with a shiny jag on the drive. I mean building up a large number of happy (smiling) patients who recommend you with glowing accounts. It takes a unique blend of left and right brained intelligence, an aesthetic eye, people skills, patience, understanding attention to detail and dexterity to do the job well. Excellent communication skills are a must too.

Mercury vapour is dangerous for anyone to breathe in (it can cause all sorts of symptoms and is one of the atmospheric pollutants blamed for MS attacks). Both patient and dentist can be protected by shielding airways, but how often does this happen in reality?

The ten opinions is also true. So what should the patient do? I'd say look after your teeth and get checks ups but question any radical treatment plan if you are not in pain. Having ten opinions and doing nothing is better than having your teeth uncessarily drilled - you cannot ever reverse a drilled natural tooth and nothing artificial can ever truly replicate its perfection and strength when healthy. If you have a real problem you will be in pain sooner rather than later. My theory is that if you don't notice your teeth there is nothing wrong with them. If you notice something (twinges etc) that means you should get it checked. Watchful waiting is the ideal solution if unsure.

A lot of people these days rush into cosmetic work having seen makeovers on tv and I'd say they should be more careful and more aware of the risks and limitations as well as the responsibilities. The private dental profession has never been well regulated in the UK and cosmetic work used to fall under the sale of goods act ("fit for purpose" etc) rather than any medical legal framework. Not sure what the situation is now as dentists seem more aware of the possibility of legal action and take more steps to avoid negligence claims.

[Dr Pav Khaira]

I like your thoughts and insight. I would agree that it is nearly impossible for patients to tell which are good dentists. This is often done by word of mouth from existing happy clients.

Its not however just as simple as "if it ain't broke don't fix it". Aprox 95% of dental problems give no pain whatsoever. If everyone refuses to have anything done it will have quite serious repercussions at a later date.

I agree that elective dentistry should not be undertaken lightly, but know that when executed well the results can be outstanding and last an extremely long time. I'm 29 years old and would have no hesitation to have veneers put on my own teeth (by the right person, of course!).

My primary concern is with regards to those having these procedures done on the cheap or abroad. I spend a significant amount of time correcting substandard work. Some of it is superb but I don't often see that.

With regards to the luxury pratices, I have one. I believe its a good idea for quite complex reasons that I won't get into. My emphasis is to undertake the highest quality work and reduce the number of clients I see.

[Baj]

gently bringing the thread back on track.

Well, had the first stage of the root canal done today... and didn't have enough anaesthetic, so had couple of "OUCH" moments, ended up having 5 jabs include 1 or 2 inside the canal itself... eventually did the trick tho still hurt when it was being done. I appreciate the comments of "should be completely painfree", but if the dentist gave a jab right on the nerve and i could still feel mild pain (tho put-up-able) i guess there's not much more could be done.

Didn't take the sedatives, was really nervous but I guess better than last time...

[Mikey]

I have heard that nervousness/anxiety can counteract the local but im not positive so it might be in your best interest to take the sedative

[Dr Pav Khaira]

Baj, the likely cause of the discomfort is the infection in the tooth caused the anaesthetics not to work as well as it should. This can happen at certain stages of infection when a root canal is required.

I'd like to reassure you it is not common and your dentist did the absolute right thing even though some discomfort was felt. Take the sedatives if you need them, thats what they are there for!