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Dentistry/Tooth filing


QUESTION: I am a 42-year-old healthy white female with no significant dental or medical history. I have never had a cavity. Prior to invisalign the only thing my dentists office did was clean my teeth.  I few weeks ago my dentist said she needed to file some more of my teeth including my left front top tooth. Being an RN I asked her if this was safe she said " yes you have plenty of enamel" I  felt the slight twinge when she did it.  Now a few weeks later I presented with pain in that same tooth as well as a gray-discoloration.  When I contacted the office and asked to be seen she told me she could not see me until the next day. I asked if it was safe to wait that long she said it wouldn't make any difference. As the day went on the pain became increasingly worse to the point of nausea knowing that I have a very high tolerance for pain (I delivered my almost 9# son without any epidural, no Tylenol, no IV Nothing.  I called my son's orthodontist who said he thought I might have been abcess and did not recommend I go to a walk-in.  My husband called my dentist back and insisted that they see me which they did during their lunch.  Well I did indeed have a very bad infection and spent three hours in the chair while they attempted to clean out the pus and necrotic pulp from my tooth. I am on 10 days of antibiotics & painkillers and I am scheduled for a root canal on Tuesday.  It remains to be seen whether or not this tooth can be saved & whether or not the discoloration is permanent. He did not tell me exactly how bad the infection was and if the bone Was affected. When I asked the dentist who saw me if this problem could have been related to the filing his daughter my dentist did or the invisalign treatment he said "absolutely not". I have done some research and the bottom-line is I don't believe him. I never had any trauma or problems with my teeth prior to her messing around with them and the timeframe  between Her filing that exact same tooth And my developing this problem seems like more than a coincidence.  I would appreciate your thoughts very much thank you for your time. PS I never asked for the invisalign.  My slightly crooked teeth were really not that much of a cosmetic concern for me. I only agreed to go ahead with the invisalign treatment after being repeatedly pressured during my six month cleanings to get it, Being told that as time went on my problem would get worse and be more difficult to correct though it was not  causing me any problems at the time. I went for consultations with four different doctors, studied the invisalign website and read all promotional materials. II asked appropriate questions Re: risks complications side effects and what the procedure entailed. Everyone made it seem like this was safe and simple i just needed to where the aligners.  Nobody ever mentioned the need for the filing of teeth or the gluing on buttons etc.  I always try to make Informed decisions when it comes to my health and I really believe that Iwas not provided with adequate information to make an informed decision regarding this treatment.  I also now know that my dentist Is not have a ton of experience when it comes to invisalign.  She is a general dentist not orthodontist.  My biggest question is whether or not it's safe to continue being treated by her and also to continue with the invisalign and any additional teeth ?  I am still uncomfortable and very concerned and nervous about the future of my dental health. In addition I co not  have dental insurance and am a private pay out-of-pocket patient.  Now in addition to paying for my invisalign I have all of these additional bills for anesthesia, root canals, medications and possibly bleaching or veneers and who knows what else at this point.  I would sincerely appreciate your prompt reply to this inquiry I would be grateful for any insight you have to offer

ANSWER: Hi Melanie,
Sorry about your recent dental issues.  A tooth usually becomes necrotic for 2 reasons:  either trauma or a cavity/decay that goes straight to the nerve space.

In your case, it sounds like it's more related to trauma.  Orthodontics (formal braces or Invisalign) is a controlled form of trauma.  Also, if that tooth receives more force than normal, when you bring your teeth together, that would be another form of trauma.  Lastly, you may have had impact trauma (sports, accident) a while ago, though it sounds like you don't recall any event like that.

If you're not happy with the Invisalign results/process, you may want to see a specialist:  orthodontist.  With regard to the root canal, anterior (front teeth) are typically pretty straight forward, but if you are still having issues with pain/swelling, you may want to consider seeking out an endodontist (root canal specialist) for treatment.

With regard to the darkening/graying of the tooth, if the tooth is still discolored, the endodontist can do an internal bleaching procedure to lighten that one tooth after the root canal treatment.

I know you're frustrated; you're doing the right thing in terms of educating yourself.  The next step is for you to decide if you want to see a specialist for these procedures.  While your dentist is probably very competent, it seems like the trust isn't there, which is very important to the patient-doctor relationship.

Hope this helps,
KG Amin, DMD

Austin Center for Endodontics (Root Canal Specialists)
Austin Center for Endodontics

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QUESTION: Thank you for your prompt reply.  I sincerely appreciate your insight.  Please tell me...Could my problem have been caused by my dentist removing tooth much enamel when she reduced it??? (She filed that exact same tooth a few weeks prior).  Please tell me is that possible?  Is it likely? Should she have asked for my consent prior to doing the reduction/filing of the enamel and made me aware of the possible complications.  If I choose to continue with invisalign am I at risk for further damage to my teeth?  Is it standard practice to have no informed consent what so ever (either verbally or written) when performing these types of orthodontic procedures?  I need to make some decisions regarding my care and again I would be very grateful your prompt reply.  PS I called my dentist today at 11:30 am (the emergency number) and again at 3:00pm.  I left messages both times and she did not call me back until after 4:30pm.  I ended up back in the office.  She opened the temporary filling and left it open overnight as "the gases from the bacteria were putting pressure on the bone and ligaments and causing my pain" (this is what she said)  She increased my antibitic to 1000mg q 6 hrs from the 500mg qid I was on and recommended I start probiotics tomorrow.  I have to go back there tomorrow. I asked how far the infection had spread she said she could not tell at this point.  I do not think that she did anything intentional to harm me and I realize that we are all human and thus we all make mistakes but knowing I never had any problems with my teeth prior to this it is very hard to beleive that these events are not somehow related.  FYI this same dentist broke off a file in my sister in laws tooth which is still there because they could not remove it without sacraficing the tooth.  Maybe she is not proficient at filing? Looking forward to hearing your thoughts.  PS I purposely did not put my personal information in the question as directed by this website.  But I did notice that you put my first name in your reply??? Is this private or can anyone log on and see this?

To Answer your questions in order:
It is possible that this problem was caused by the occlusal adjustment (removal of enamel); however, usually an abscess can take a while to develop.  If the adjustment was done a few weeks ago, it is unlikely that she caused it.
Usually, informed consents are given and signed before every procedure.  That's up to how the dentist chooses to practice, but I get a consent signed before every procedure.
Invisalign should not damage all of your teeth; I would not allow this one experience to discourage you from proceeding with Invisalign.
I never leave teeth "open"....all the bacteria in your mouth are in your saliva.  Leaving the tooth open allows more bacteria to enter the tooth.  I suggest you make an appointment with an endodontist (root canal specialist).  Files can separate, but it's rare consequence of root canal treatment.

If you elected the message to be private when you created it, then it will be private.  I have no control over that:  please contact if you have questions.

Best of Luck,
KG Amin

---------- FOLLOW-UP ----------

QUESTION: Thank you so very much for taking the time to respond to all of my questions.  I value your expert opinion.  I am thankful that professionals such as yourself are willing to offer some valuable insights & information to patients like myself & others.  It is truly helpful.  Last ? About how long does it take for an abcess to develope?  I began treatment this past summer.  I cannot pinpoint the exact date of the filing from my memory though it should be documented in my chart I am guessing around 8 wks ago but could have been 4 to 12 or more.
With much gratitude,

No worries; I'm glad to help.

So, it's hard to estimate how long it takes an abscess to form:  too many factors--your immune system, type of bacteria, etc.  If I had to estimate, it would be 12+ weeks.  Again, there's really no scientific research proving that, one way or the other.

Best of Luck,
KG Amin


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Ketan Amin, DMD


Graduating from Harvard School of Dental Medicine, I received a broad understanding of both medicine and dentistry. I continued my training at New York University, as a dental specialist in endodontics, which concerns root canal therapy, related surgeries, as well as diagnosing and managing various forms of pain occurring in the head and neck


Dentistry; Specialist in Endodontics (Root Canal Therapy).

American Association of Endodontics American Dental Association American Academy of OroFacial Pain

Harvard School of Dental Medicine-Doctorate in Dental Medicine (DMD) New York University College of Dentistry-Certificate, Endodontics

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