Expert: Jeff Dalin DDS - 7/26/2005

Question
Dear Dr Dalin,

One week ago, my daughter fell and fractured her upper front tooth diagonally. Half the tooth was involved. The dentist "glued" it back on. He used a glass ionomer adhesive.

He told us to return in 2 months as he needed to do further work to the join. He told us that he would grind away about 0.5mm above and below the join front and back of the tooth and fill it with composite.  He said this was a form of lamination and that it would strengthen the tooth.

Today, we went to a cosmetic dentist who told us to leave the tooth alone and that any further done to it could affect the nerve.
This dentist told us there are better adhesives available that the glass ionomer.

We do not know what to do

What are the advantages and disadvatages of proceeding with the first dentists recommendation

Your input would be appreciated

Regards, Anne


Answer
Anne,
You raise some interesting questions here. First off, there is no specialty called Cosmetic Dentistry. Any general dentist can do cosmetic dentistry. Some do more of it than others, but nobody can call themselves a cosmetic dental specialist.
Now for the specifics...glass ionomer is an okay cement but not the strongest of adhesives for what was done. I am kind of surprised that the piece has stayed back on. I prefer to just create a new part of the tooth with plastic. It seems to look good and stay well. The first dentist is trying to do a combindation of glass ionomer and plastic over the top to reinforce it. This might work okay.
As far as the nerve health goes, as long as you are not drilling down deeper into the tooth, it should do fine (as long as the initial traumatic injury did not damage it already). Merely "grinding" on the surface should not do any harm.
Now for the toughest question: which dentist to listen to. I might go get a third opinion and see which one is the one that most agree with. I cannot give you any definitive answers here without seeing your daughter in person. I cannot diagnose over the Internet. Sometimes it is best to go with the dentist you feel the most comfortable with. What is the worst thing that could happen? The repair may not hold. And you can always do something different at that time.
I hope I have given you some useful information here. Feel free to recontact me if you have further questions.

Jeff Dalin, DDS
jeff@dfdasmiles.com