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Brian LeSage, DDS, FAGD, FAACD

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Archives for January 2021

Is a crown the only solution for a dark, front root-canal tooth?

Last summer, I fell and knocked out my left front tooth. My dentist saw me right away, put the tooth in the socket, and bonded it in place. He also did a root canal on the tooth. In a few months noticed that my tooth was getting dark. When I saw my dentist in December, he said that I might need a crown. After doing some online research, I wonder if a crown on a front tooth is wise. Is there an alternative to doing a crown? I wouldn’t be so fussy about this, but I completed Invisalign treatment in 2017 and got my teeth whitened. And it’s a front tooth that’s affected, so I am more concerned than I would be with a side or back tooth. Thanks for your suggestions. Khalid from Lincoln, NE



You were wise to research before agreeing to a dental crown for a front tooth. Although a crown can strengthen a front tooth against chipping, it will make the tooth more susceptible to lateral stress. If you have a heavy bite, it increases the risk of the tooth breaking off.

Minimizing Tooth Discoloration After Root Canal Treatment

After root canal treatment, a tooth may discolor. But before treating the discoloration, a dentist may x-ray the tooth to check for external root resorption, which can occur with tooth trauma.

What is external root resorption?

External root resorption is a condition that occurs when blood vessels and connective tissue from surrounding structures invade and damage your tooth roots. If you are experiencing external root resorption, your dentist must treat the issue before proceeding with cosmetic treatment.

Correcting tooth discoloration

If your tooth roots are sound, a highly skilled cosmetic dentist can minimize the tooth discoloration.

One treatment method includes these steps:

  • Clean out the crown and remove root canal filling materials and cement
  • If the tooth has begun to discolor, treat it with internal bleaching
  • Fit the tooth with a flexible fiberglass post and seal the opening
  • In a few years, if the tooth begins to discolor, use a single porcelain veneer to conceal the discoloration and match the color, translucence, and gloss of your natural teeth.
A single porcelain veneer held by dental forceps

A single porcelain veneer may conceal front-tooth discoloration

Your tooth requires aesthetic training and experience that most general dentists do not have. Schedule a second-opinion appointment with an accredited cosmetic dentist. He or she has proven skill in advanced dental aesthetics and passed rigorous oral and written exams. The cosmetic dentist will eventually need to examine and x-ray your tooth before explaining your treatment options.

Best wishes.


Accredited Fellow of cosmetic dentistry, Dr. Brian LeSage of the Beverly Hills Institute for Dental Esthetics, sponsors this post.


Painful deep cleanings and deep pockets that won’t go away

Before my hygienist did a deep cleaning two years ago, I had a one-year plan to get porcelain veneers. My plan failed because, since the cleaning, I have deep pockets that do not heal. I’ve switched dentists since then, but I still have pockets in my gums. My teeth are so painful and sensitive that I canceled my last cleaning appointment. I didn’t have any significant problems with my teeth before the deep cleaning. I want porcelain veneers to close a front gap and make my teeth look uniform, but my teeth were healthy. I was advised to ensure my teeth and gums were healthy before I received porcelain veneers. So, the hygienist did a deep cleaning, and now my mouth is ruined. Who can help me? Thank you very much. Kanai


Thanks for your inquiry. You have aggressive gum disease that the team at your dentist’s office is not controlling well.

Is a Deep Dental Cleaning Painful?

When a dental professional completes a deep cleaning correctly, it can be painful. A local anesthetic is used to numb your gums. When gums are inflamed or infected, it requires cleaning your teeth to where teeth and gums attach. After the cleaning, you might have some swelling and minor bleeding.

What’s Causing Your Tooth Sensitivity and Pain?

The tooth sensitivity and pain you describe have a source other than deep cleaning. You probably have an aggressive infection. Sometimes, deep cleaning can provoke an existing infection, and based on your description, you probably have a flareup.

What can a dentist do to help?

  • Antibacterial agents can help.
  • A dentist might prescribe antibiotics while you have deep cleaning appointments.
  • Your dentist can schedule four or more appointments, if needed, within two or three weeks.

When Your Dentist Can’t Control Your Gum Disease

When a dentist can’t control your gum disease, we recommend that you find another dentist. The problems you describe are appropriate for a periodontist (gum specialist) to evaluate. Although your teeth and gums might have been healthy in the past, you now have a severe gum disease that must be treated to prevent tooth loss.

Talk to the periodontist about:

  • Your oral health history
  • Your experiences with your previous dentists and the type of pain you feel
  • Your goal for a smile makeover with porcelain veneers. Although it might take some time to realize that goal, the periodontist will explain when you can expect to reach it.
A single porcelain veneer held by dental forceps

Healthy gums contribute to healthy porcelain veneers

As you get closer to restoring your oral health, look for advanced cosmetic dentists, and schedule two consultations. A highly trained and experienced cosmetic dentist will design a smile with veneers and ensure it is healthy. They will bond your veneers without irritating your teeth or gums. When your periodontal treatment is complete, you will have already found a dentist to complete your smile makeover.

Best wishes for a steady recovery.

This post is sponsored by Dr. Brian LeSage, an accredited Fellow of cosmetic dentistry in Beverly Hills.

Painful deep cleanings and deep pockets that won’t go away

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– Thích Nhất Hạnh

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