Dear Sir/Madam,
I regularly visit my dentist, but I have major problems with my teeth and I am thinking about how to proceed.
Some time ago I neglected my oral hygiene a little and developed some caries near the gums. My dentist treated the teeth, removed the damaged enamel in a U-shape along the gum line and restored the areas with white fillings.
The problem is that despite better hygiene, the teeth are still decaying at the gum line (after one year). I have also stopped taking medicines that were supposedly causing bad teeth, added Ca and Mg, and use an anti-erosion toothpaste, but the condition keeps getting worse.
I am somewhat worried about all this. I am 28 years old and would like to ask for your advice. Is there any protection against this problem (I brush twice a day, eat 5–6 small meals, follow a special diet with fewer carbohydrates — which can supposedly cause acidification of the body)? Perhaps some deep cleaning by a dentist (price?), coatings or restorations (porcelain, veneers) — because if this continues, I will soon lose my teeth. I would be very grateful for your advice (my dentist only recommends brushing, but that does not seem to be enough?!).
So I would like to know what solution you recommend considering my age and the condition of my teeth (I would like to keep my own teeth) — and also the price, since I am still a student and dependent on my income. I would also like to know whether any of these services are co-financed by insurance (above-standard treatment). I personally tend toward porcelain restorations, but I am not an expert, and my dentist does not want to hear about anything other than white fillings... If you recommend one of the procedures, would you recommend it for all teeth or only the 'visible' ones, and is it better to perform the procedures gradually — a few each year — or all at once, and what is the service life of the individual 'improvements'?
I look forward to your answer.
Kind regards,
Urška
Dentist Tomaž Rotar answers:
Dear Madam!
From what you have written, you apparently have less well-mineralized enamel. A poorer mineral structure of the enamel and continuously inflamed marginal gingiva, which acidifies the surrounding environment, contribute to rapid dissolution of the enamel (caries) at the tooth neck, which is also what you describe. Gingival inflammation (gingivitis) is eliminated with proper and regular oral hygiene, since its main and most often only cause is the presence of bacterial plaque. The dentist should monitor two parameters that are the main indicators of the cause of gingivitis: the plaque index and the sulcus bleeding index. The solution to the problem is sought in its causes: cleaning (the plaque index and bleeding index should both be 0) and improving enamel quality (topical fluoridation). If the lesion is already present, the preventive measures listed are of course insufficient. The lesion must be removed and a filling made. I am personally not enthusiastic about white composite materials, since in the long term they do not perform best. The fabrication of a crown or another prosthodontic restoration depends on the proportion of destroyed dental tissue. We could discuss this after a thorough clinical examination.
We look forward to your visit!