Dr. Daniel A. Lieblong, D.D.S.

Using an implant to replace a single missing tooth is typically the best way. The first thing that must be done is to determine if you have enough bone to place the implant. A 3D cone beam X-ray is the best way to evaluate the bone to make that determination. The boney ridge will shrink away if you wait too long, so evaluating the bone is the most important thing. That being said, make sure that the other teeth are in good shape. It is in your best interest to make sure that you do not have issues with other teeth before focusing on this one missing tooth.

The difference between a tooth that simply needs a filling and a tooth that needs a root canal is basically how long you allow the decay to be active before you fix it. A root canal is required when the decay approaches or enters into the pulp canal. If you wait to fix a tooth until it hurts then you are waiting too long and increase your chances of needing a root canal or even losing the tooth.

You need to schedule an appointment to be evaluated. You should have a full mouth series of X-rays taken to evaluate your teeth thoroughly to determine their condition. Losing your teeth and starting to wear dentures is not an easy transition at 70, but may be necessary.

Red swollen gums are definitely not a good thing. You should go and see a dentist and be evaluated.

Yes, you should schedule an appointment to have the tooth evaluated. A broken tooth may not immediately cause pain, but most likely needs attention.

If you have a crack in your tooth, it will not heal on its own. It is important that you let a dental professional look at the tooth. There is a big difference between an enamel craze line and a crack. If the tooth has actually cracked, it may be necessary to cover the tooth with a crown to avoid further damage.

Sorry, but your question isn't clear. I will assume that you have places on your teeth, most likely at the gum line that is crumbling. If that is the case, I can only assume that you have severely demineralized teeth, typically caused by poor home care and bad food habits. If plaque is left on your teeth and you frequently drink sugary drinks or keep sugary treats in your mouth, the enamel of your teeth is being severely damaged. Initially you will see white demineralized places that eventually turn dark and break open. That is literally the damaged enamel falling apart, exposing decay below. This problem can be made worse by drug use. There is a type of decay commonly seen in those who use meth, which is a severe decay similar to what I described above. The damage must be repaired ASAP, or the decay will destroy the tooth beyond repair. It isn't uncommon to see these teeth decay off to the gum line. There is a similar type of decay, referred to as Mtn. Dew mouth, seen in people who drink large quantities of the soft drink Mtn. Dew. This is due to the
large quantities of sugar and acid in those soft drinks.

If this is not the type of enamel breakdown you are referring to, please be more specific and I will be happy to respond.

Daniel A. Lieblong, D.D.S.

A toothache never means anything good, but does not always mean an infection. You definitely want to see your dentist to determine exactly what the problem may be. I have no idea of your age or dental condition, but the first thing that I would do was to look into your mouth to see if you have all of your teeth, including wisdom teeth. Sometimes when wisdom teeth are erupting, it causes pain much like teething, but can cause the tissue over or behind the wisdom tooth to get infected. Treatment would be antibiotics, then remove the wisdom teeth. The next thing I would look at, assuming that you have all of your teeth, would be to look for obvious decay and or gum inflammation. If you are not a daily flosser, your gums could be the issue. If you have not had routine X-rays, you will need to have X-rays taken to see if you have decay between your teeth or other more serious problems. The biggest problem with your question is that we have no idea what the condition your teeth are in or how you have been dealing with routine maintenance.

Dr. Lieblong

This is a very good question than really should be answered case by case, depending on the tooth, its condition, and the availability of bone. If the tooth can be reliably treated and there is good remaining tooth structure, then a root canal and crown are a good option. If the tooth is acceptable, but not a great tooth, it would be a good idea to see a 3D X-ray to evaluate the bone to know if the tooth was removed, then there was sufficient bone for an implant. This is a situation where we are basically on the fence. If the tooth has a great deal of bone loss surrounding the tooth because of a longstanding abscess and the tooth is severely broken down, then removing the tooth and possibly doing a bone graft in the extraction site may be warranted. If the tooth has previously had a root canal and we are considering a re-treatment, then I tend to lean toward removing the tooth and placing an implant. If the tooth was severely decayed and the patient is very decay-prone, that will also push me toward removing the tooth and placing an implant. Careful evaluation is important in each case and a good, thorough conversation with the dentist is a must. I want patients to know everything about their options.

Dr. Daniel A. Lieblong

A tooth can discolor because of the processes going on inside of the tooth as it is forming the access. There isn't anything about the procedure of the root canal that typically causes the tooth to discolor. The discoloration is typically present before the root canal and is caused by the dying pulp tissue being left in the tooth for an extended period of time. Proper treatment on most root canal teeth is to place a full-coverage crown and that should deal with the discoloration issue.

Dr. Daniel A. Lieblong

X-rays show things that cannot be detected any other way. For example: decay between the teeth, an abscess at the tip of the root of a tooth, a root fracture, etc. There are times that X-rays are required to provide an insurance company with the information to gain payment for your treatment. As for a crack, there are times that a crack cannot be seen in an X-ray, but when a tooth has symptoms of a crack and the proper treatment is a crown, the insurance company will require an X-ray when a predetermination is requested. Today, most offices are using digital X-rays, which require a fraction of the radiation that traditional film used, so they are very safe. Today in dentistry, we use 3D X-rays to show things that traditional X-rays cannot show. Don't be afraid to ask about having X-rays taken, but realize that taking X-rays are part of the standard of care and a dentist is required to provide the standard of care for you and you cannot sign away your rights to the standard of care. In other words, even if you sign a note in the record demanding that X-rays not be taken and that you will not hold the dentist responsible, that is not legal or appropriate. I will and have dismissed patients who refuse to allow us to take X-rays when the standard of care justifies them.

A good general dentist should always be your go-to person for dentistry. If you have a specific problem associated with your periodontal structures, gums, roots of teeth and supporting bone, then seeing periodontist may be necessary. General dentists today should be comfortable with the basic diagnosis and treatment of periodontal issues, but if a problem persists or does not resolve as expected, you can expect to be referred to a periodontist. Some general dentists are very well equipped to treat even complex periodontal issues, but depending on your periodontal health, seeing a periodontist may be necessary. In my practice, if your issue has been properly treated and you have not responded as expected we will refer to the periodontist. Don't be afraid to talk to your dentist about the possibility of referring you to the specialist if you have concerns, but most patients hate being sent from office to office unless there is a good reason. Having a good general dentist is your most important contact for overall dental health.

Daniel A. Lieblong, D.D.S.

Typically, a child's fear of a dentist comes from others, parents talking negatively about dental appointments, procedures, or anything negative related to a dentist. First of all, don't wait until your child has a problem before you take them to a dentist. Children should have their teeth cleaned and checked at least twice a year from at least 2 years of age. At that point, they don't typically have that fear and by the time they need any real dentistry they are comfortable being at the dental office and it isn't traumatic at all. If you wait until a child has a tooth ache before you take them to the dentist, they always relate the tooth pain with going to the dentist, when in reality it was the dentist that took the pain away. I have dealt with children of all ages and the thing that makes most situations worse is the parents and how they deal with their children. Coddling a child, when what the child really needs is a firm parent to support the need for dental care, makes everything worse. There is a reason that most dentists do not allow parents in the room while they are doing dental work. It is like having a babysitter take care of your child. When you get home, the sitter tells you how good your children were and your seem surprised. The kids don't know what they can get away with with the sitter and don't push too hard, while they know how to push your buttons and just how you will handle it. The same with the dentist. They typically behave fine, especially when the dentist talks to them and explains what he going to do. I talk to the kids and find out what they are afraid of and deal with their fears with facts. Even young children are mostly in fear of what they don't know, so teaching them helps a lot. There are just some children who will not behave and don't communicate why, that is why there are Pediatric Dentists, who have tricks and medication if necessary to deal with problem children. Some dentists are better at dealing with children than others, there is not a question about that. Talk to your friends and see who they go to and how their children deal with their appointments. We have televisions over every chair and sometimes putting a cartoon on while they are in the chair is magic. I have had parents bring children from many miles away to see me. One in particular was about 14 years old and sobbing and refusing to let me even look in her mouth. She had been to many different dentists who all just refused to see her and over the months her dental problem had become very serious. Mom was at her wits end and I explained to her that I wasn't going to baby her daughter and was probably going to be pretty firm with her, stressing the potential for life threatening issues without treatment, which was true. I told the young lady that her temper tantrums had only allowed her dental problems to get much worse and that I was not sure that her tooth could be saved at all, and if she didn't allow me to help her that she may end up in the hospital and have to be dealt with in the operating room. I shocked her, but in reality it was fact. She had refused care for so long that her tooth was horribly decayed and infected to the point that the bone around the tooth was being dissolved by the infection, and this was a permanent tooth. She finally opened up and quit crying. I explained everything that I was going to do, from the topical anesthetic to the injection, the hand piece cleaning out the tooth and I made her watch me during part of the root canal procedure. She did great. The next time she came in it was a totally different scenario. Now she comes in for an appointment and there are no issues at all. So, what was the difference? First: Mom understood the situation and didn't "enable" her. Then I was firm, factual and upfront with the fact that her childish behavior had done nothing but cause her problems to be much worse. When we got finished with her first appointment, I got a hug, and a thank you from the girl. She knew that I cared. It would have been easier and much quicker to simply walk away and let her have the temper tantrum, but I knew that was not in her best interest. Not all dentists are the same. Children who misbehave are stressful for dentists, hygienists, and assistants. Parents who enable their misbehaving children only make things worse. Realize if you don't help the dental team provide care for your child, the alternatives are much more difficult and expensive all the way around.
#1, take your children to the dentist for regular cleanings and examinations to prevent the biggest problems and create a good environment.

Daniel A. Lieblong, D.D.S.

Soreness in your gums is nothing to ignore. Many things can cause your gums to be sore, like not flossing or brushing effectively. Gum disease is dentistry’s “silent killer,” as real gum pain doesn’t usually occur until the later stages. Go see your dentist and get checked out before it’s too late.

Obviously, you had allowed this tooth to decay severely, which required a great deal of damaged tooth structure to be removed. The decay was probably close to being in the pulp/nerve. It is no surprise that the tooth is cold sensitive, but should be getting less sensitive as time goes by. If the sensitivity is not getting better, you need to go back to the dentist, as a root canal may be necessary to deal with the issue. As for the bleeding, that is most likely from the gums not the tooth and is a sign that you are probably not flossing and taking care of your teeth as you should, which is why you had the deep cavity in the first place. Start flossing and brushing.

Most times an abcess can be seen on x-ray. My concern in your question, is that you are referring to a 9 year old son. I can only assume that you must be looking at a primary tooth. Dealing with an abscess on a primary tooth is a much easier, cheaper and quicker treatment as compared to a root canal on an adult tooth. One question we hear often is: "It's a baby tooth, shouldn't we just pull it?" Typically, the answer is: NO. Primary teeth are important to hold the space of adult teeth and should be saved until time for the tooth to be lost naturally if possible. If the problem with an abscess is on adult tooth at 9, you have a much more serious problem and it requires a much more complicated treatment due to the fact that the tooth root is not completely formed. Unfortunately you have not given me enough specific information to know exactly what we are dealing with. Feel free to get back to me when you have more information.


Dr. Lieblong

No one "likes" getting an injection to anesthetize "numb" for dental work. Unfortunately for most restorative procedures it is much more comfortable to be numb while having the work done. In my office, if a restoration is expected to be small and minimally invasive, I will give the patient an option to begin without the injection and see how they do. If they have any discomfort, we will stop and numb them up. On small cavities there are times that we can use "Air Abrasion" (a tiny sand blaster) to remove the damaged tooth structure without the need for an injection. The common thread to avoid an injection is the size and location of the decay. You can always try to go without the shot and if you are fine, great. The key for a dental professional, is that we do not want to work on a patient jumping around because the tooth in hurting. As long as you are comfortable and have no real pain, we are happy to go without the injection.
Just talk to your dentist before you begin the procedure.
Daniel A. Lieblong, D.D.S.

The most common reason for sensitivity is poor home care. The plaque left on the teeth will result in etching of the teeth, inflamed gum and gingival recession, which will expose the root surface of the teeth, which is much more sensitive. Unless the poor homecare is resolved, decay will occur where the plaque is left. Soft drinks can increase sensitivity, as they are full of acid that also etches the teeth. If you combine poor homecare and bad habits, like sipping soft drinks, keeping sugary candy in the mouth, it compounds the problem resulting in increased sensitivity and decay. Simple fact: every time you put something sweet in your mouth, take a sip of soda, etc. you have fed the plaque, which will produce acid for 20 minutes. Take a sip every 20 minutes and you are constantly bathing your teeth is acid. NOT GOOD! Nursing on a sweet beverage over a long period of time is the worst way to enjoy a soft drink, but very common. You would be better to have a soft drink with a meal, drink it all, and brush you teeth after the meal to break the acid production cycle. Between meals drink water! Diet drinks are not an answer to this problem as they have more acid in them than do the sugary version, but the sugar adds to the decay process. If the sensitivity is recent and severe it is also possible that you have cracked a tooth. Go get it checked out to know for sure.

what the problem is. Great homecare is the daily investment in your teeth that will pay off for life. FLOSS First then brush!


Dr. Lieblong

The damage that you did to your teeth and jaws is real and without treatment permanent. Wearing down the teeth is something that does more damage than just to the teeth that are worn. As your teeth wear down they allow the condyle (the part of the temporomandibular joint "TMJ" that is like the "ball" of the joint) to be forced higher into the Fossa (the socket) than it should be. Now as your jaw functions that mal position results in your symptoms. A 3D x-ray can show us the exact position that your joint has moved to when you bite all the way down and help guide us to know how to correct the position of your jaw with a splint. The long term fix will be to use crowns to support your jaws in your correct position, but long term splint wear is necessary to assure that the correct position had been determined. Unfortunately, the TMJ dysfunction goes thru cycles where it is gets worse and gets better, but as time goes by without treatment the worse cycle keeps getting worse.


Daniel A. Lieblong, D.D.S.

There are a lot of things to consider when deciding how to deal with a space between your front teeth.
First thing is the relationship between the upper front teeth and the lower front teeth. There are times
that the best treatment is to orthodontically close the space. There are times that closing the space by placing
crowns on the teeth is the best choice. The things to consider are: how wide will be the two front teeth if all the space
is closed by simply making them wider, should you consider crowing all 4 front teeth to share the width so that the front
teeth don't appear so wide. In my office we do all aspects of dentistry. We do orthodontics and we do crown and bridge, as well
as every other area, so we are able to completely evaluate the options and help you decide. I wish I could just say one
way was better than the other, but I do not have enough information to know that for sure.


Dr. Lieblong