What happens to my tooth when I have to have fillings, crowns, bonding or any other restorations?

What happens to my tooth when I have to have fillings, crowns, bonding or any other restorations?


To perform dental restorations, the diseased tooth structure and all the old filling material/crowns/etc. have to be removed.  Any time a dental drill contacts a tooth, the drill’s rotation causes some tooth trauma.  Lots of water and slower drilling speeds are used to minimize trauma to the tooth’s nerve.  Unfortunately, there is no alternative to drilling on a tooth to remove old restorations (dental lasers cannot cut old fillings or crowns).  Sometimes the actual drilling on the tooth causes postoperative sensitivity and the tooth becomes more sensitive to cold.  This is usually temporary but may last for several months.


Teeth that have had a lot of fillings or crowns may also experience more sensitivity after treatment.  The difficulty with assessing the health of these teeth, is that we cannot remove them and look at their nerve tissue under a microscope without permanently removing them from patients.  Teeth with lots of dental history have had a lot of nerve trauma over their life span.  Sometimes these teeth appear to still be healthy and respond well to our nerve tests when in reality there is dead nerve tissue already present and we cannot see it inside the tooth.  These teeth may eventually demonstrate signs and symptoms of necrotic nerves and need root canals.  We always try to determine nerve health prior to restoring teeth, but sometimes it is just not possible to be accurate due the long dental history of some teeth.  That being said, we still only recommend root canals for teeth with apical periodontitis (signs and symptoms of dead nerves) or when clinical judgment dictates a root canal now would be more successful with great access versus later with a new crown present.


Lastly, some teeth which receive dental work have one or more fractures in the tooth enamel which progresses into the dentin.  When the enamel structure is disrupted from a fracture, the tooth no longer flexes uniformly.  Once the the fracture is covered, the tooth may still experience biting pressure sensitivity.  This may mean the new restoration is high and this may be easily adjusted.  Alternatively, the tooth structure is flexing in a new and different way with the new restoration.  Often, the nerve does not initially respond well to this new movement.  That is when you get the “zinger” when you bite just right.  If the restoration is correctly adjusted for the bite, this zinger eventually dissipates with time.  The time depends on so many factors like the bite force, the wear patterns on the other teeth, the occlusal scheme, the size of the restoration, the age of the patient, etc.


If every tooth and every patient were the same, dentistry would be easy and boring!  Hopefully, this helps to explain why some teeth have discomfort after dental work.


As of 5/11/2020 our dental office is open for all dental treatment. We are excited to welcome patients back to our office for continued care and treatment needs. Our current hours are Monday-Thursday from 8am-4pm.

Our office has made every effort and then some to continue our pursuit of excellence in following OSHA and CDC guidelines for delivery of dental care. We have a long history of the highest standards in this regard; therefore, you will notice changes from our previous routines to ensure your continued safety. We will continue to create social distancing for patients in our dental office with our new routines. Here are our additional protocols for patients:

1. Our staff will prescreen patients prior to scheduling appointments.
2. We have extended our appointment times in order to decrease patient-to-patient interactions.
3. Patients must wear masks upon entering and exiting our building.
4. We ask that patients call us upon arrival and we will contact you and meet you at the door and escort you to your operatory.
5. All patients are screened for body temperature, BP/P, oxygen saturation.
6. All patients fill out a COVID-19 screening health history prior to any dental treatment.

While many of you are ready to return, we realize some patients would like to postpone any dental care. We are happy to honor any wishes of our patients with regards to dental treatment.

Additionally, there are many new protocols for our personal protective equipment to ensure staff safety and we have enacted new protocols between patients to reduce dental aerosols and prevent cross-contamination. Many of these new protocols are utilized by hospitals to sterilize patient rooms and treatment areas between patients.

Again, we are happy to be back and taking care of our family of patients.

Shannon Allison, DDS

Sunday, April 26, 2020 Update

Dear Patient Family,


Based on the latest updates from Governor Cooper, the American Dental Association, the North Carolina Dental Board and the North Carolina Dental Society, we plan to open our office on May 11th.  This is subject to change based upon future recommendations.

Our office is available to each of our patients for dental emergencies.  We continue to have office hours on Mondays and Wednesdays for emergencies.  Our first goal has been to triage over the phone to determine if a patient needs to be seen in our office for emergency care.

We have made some changes in our office which will enhance the safety of our patients and staff. As we have routinely, our dental office will be in the forefront of providing the best care for our patients in a clean and safe environment.

Those patients whose appointments have been cancelled will be rescheduled. You will be contacted for an appointment. Please know that our number one priority is having the best experience for each of our patients.  If you have any questions or concerns, please feel free to email me at pinehurstdentist@gmail.com or call or text me at 910-639-0491.  Additionally, you may contact our office directly at (910) 295-4343.

We look forward to seeing you at your next appointment.  I will keep you updated with any changes.  Thank you for allowing us to take care of your dental needs.


Yours in Better Dental Health,


Dr. Shannon Allison




Right now many patients are not able to receive regular dental care as we are limiting our current treatment to dental emergencies due to COVID-19.  Now more than ever is a great time to raise awareness among our patients of the importance of paying attention to how your mouth and tissues feel and to let patients know the importance of contacting our office for an evaluation when an unknown area presents itself.  Even though we have limited patient care, we are able to look at lesions using teledentistry.  Patients may text pictures to our office cell phone (910) 639-0491 or by emailing pictures to pinehurstdentist@gmail.com.  

Common Oral Lesions

Oral lesions are often found at routine dental appointments, at times a surprise to the patient! Many areas are asymptomatic, benign, and not a cause for concern as the majority are traumatic in nature or just a variation of normal. Below are the most commonly seen lesions in our dental practice:

Traumatic/ Irritational Lesions

These lesions are usually white (leukoplakia) or red (erythroplakia) and may be created by constant irritation or abrupt trauma like a pizza burn. The chronically irritated areas may be from biting mucosal tissue or rubbing from a dental appliance (denture, broken tooth, orthodontic wire).

Treatment consists of removing the irritation and evaluating for resolution after 2 weeks of healing. If still present, a specialist will need to evaluate the area and possibly do a biopsy for diagnosis.  A biopsy of the lesion is the only way to confirm that it is not malignant in nature if there is no resolution.

Traumatic/ Irritational Fibroma

This pink nodule usually occurs in areas of chronic biting or friction, most commonly inside the lower lip or cheek. This lesion is benign and will at times appear to deflate, and then enlarge again with future biting. Mostly annoying in nature, the patient can elect to monitor or have it removed. Removal does not guarantee that another fibroma could form.

Apthous Ulcer

Commonly called canker sores, these ulcerations are the most common recurrent lesion in the mouth. They are the body’s immune response to stress, illness, and trauma, or are from spicy or acidic foods. Their appearance is round with a depressed center and they are usually found inside lips and cheeks. Ulcers usually resolve on their own, but warm salt water rinses ease the discomfort. For patients with frequent ulcers, selecting a toothpaste that does not contain Sodium Laurel Sulfate (SLS) could reduce the frequency.

Fever Blisters/ Cold Sores

The recurrence of these lesions are due to stress, sunlight, fever, certain foods, trauma, or change in hormones. These lesions are actually recurrences of HSV-1. What starts as mild tingling, burning, or itching produces fluid filled blisters that when popped create an ulcer. Dental treatment is not recommended until the ulceration has dried and crusted over. This reduces the chance of spreading the virus to other mucous membranes. Topical over the counter and prescription ointments decrease healing time. Prescription oral antivirals are not curative, but lessen severity and duration of lesions for those with frequent outbreaks.

Lichen Planus

Lichen planus is a chronic immune system reaction that appears as a fine white lace-like pattern. It is most commonly found on the inside of the cheeks. This is most often asymptomatic and benign. Patients that experience burning or irritation when eating or brushing are prescribed a topical corticosteroid for pain management.

Geographic Tongue

Also known as migratory glossitis, this inflammatory condition is named for the map-like appearance of the tongue. These “islands” are created by a central redness of atrophied taste buds surrounded by elevated white to yellow curved borders. The arrangement waxes and wanes and rearranges its pattern. While usually benign and asymptomatic, some experience burning when eating spicy or acidic foods.


A papilloma is a firm, wart-like enlargement of epithelial tissue caused by a viral infection. These lesions are slow growing, painless, and often benign. Sometimes a biopsy is needed to confirm diagnosis.


Also known as thrush, this overgrowth of candida albicans, aka yeast, is most frequently found on the tongue, palate, and inside of cheeks. These white patches are easily wiped off, revealing a red ulcerated surface. Factors that encourage this overgrowth are smoking, chemotherapy, diabetes, dry mouth, antibiotics, dentures, and corticosteroid inhaler use. This is treated with topical antifungal lozenges.

Angular Cheilitis

This superficial scaling at the corners of the mouth is also a fungal infection. The corners of the mouth collect saliva and dry out the top layer of skin creating small cracks. Licking these areas to soothe them creates warmth and moisture needed for fungus to grow and multiply. A topical antifungal ointment can be prescribed to treat the areas. Prevention by applying Vitamin E or petroleum jelly to form a barrier is most important to prevent reoccurrence.

Regular dental exams are the best way to evaluate your oral health. Should you notice a lesion present, please contact our office. Our goal is to determine a differential diagnosis and monitor the lesion. We want to ensure resolution of the lesion or recommend further follow-up with a biopsy.

Take great care of yourselves and your teeth! We look forward to seeing you in our office!

Patient Newsletter: April 2, 2020

April 2, 2020

Dear Allison and Associates’ patient family,

In cooperation with President Trump’s directive for “Stay at Home” practices and in compliance with the American Dental Association recommendations, our dental practice will continue to be closed except for emergency dental treatment. We anticipate closure of our dental office until at earliest May 4th, 2020. Hopefully, our nation is able to “flatten the curve” and reduce the number of simultaneous COVID-19 infections. It seems like our community is doing a good job of minimizing unnecessary activities and social interactions. It is a difficult time for everyone here and worldwide, but we must continue our efforts. We all look forward to returning to our busy lives even with the changes that this pandemic will cause in our future lives.

Any patients which are having their appointments rescheduled, please be assured that we will make every effort to reappoint you promptly for your dental appointments. Our entire team is dedicated to increasing our office hours in order to take care of your dental needs. All patients being rescheduled are being placed on our priority list for new appointment times in the future. We have not yet set our schedule for our increased office hours as the COVID-19 situation changes every day. We do not want to be presumptuous. Just know that we will be there for you in the future.

For those of you who do have a dental emergency, we are available Monday and Wednesday from 9:30am-12:30pm. Please call our office number, (910) 295-4343, or our emergency cell number, (910) 639-0491, for prescreening prior to an appointment. If you are unsure whether or not you need to be seen, please call either phone number. We may also accept pictures via text to help you with your concerns. As a reference, the following conditions constitute dental emergencies which often require an office visit:

  • Uncontrolled bleeding
  • Cellulitis or a diffuse soft tissue bacterial infection with intra-oral or extra-oral swelling that potentially compromise the patient’s airway
  • Severe dental pain from nerve inflammation
  • Pericoronitis/soft tissue inflammation from wisdom teeth or wisdom tooth pain
  • Surgical post-operative osteitis, dry socket dressing changes
  • Abscess, or localized bacterial infection resulting in localized pain and swelling
  • Tooth fracture resulting in severe pain or causing soft tissue trauma
  • Dental trauma with avulsion/luxation/tooth loss
  • Denture adjustments or repairs when function impeded for cancer patients
  • Final crown/bridge cementation if the temporary restoration is lost, broken or causing gingival irritation
  • Snipping or adjustment of an orthodontic wire or appliances piercing or ulcerating the oral mucosa

We have taken extra precautions to disinfect our dental office between patient visits. In addition to the standard OSHA sterilization and disinfection guidelines and Universal Precautions/PPE, we have put the following procedures and protocols into place:

  1. Patients are prescreened on the initial phone call
  2. Patients are asked to wait in their cars on arrival and call us when they arrive. We will then call patients once we are ready for them to be seen. We do this to prevent unnecessary contact among patients and staff.
  3. Patients are asked a series of questions to reaffirm we may see them and that their risk is low of being infected with Coronavirus.
  4. Patients must rinse prior to dentist exam to decrease bacteria and viral load in the oral cavity.
  5. Our staff wears masks for every patient interaction to protect us and protect our patients.
  6. Our treatment rooms are thoroughly disinfected between patients with agents which deactivate the Coronavirus and we alternate treatment rooms to allow agents to work longer in the environment.
  7. Our entrance/exit areas and waiting rooms are disinfected between patients entering and exiting.

If you have any questions or concerns, please call our main office number (910) 295-4343 or email us at pinehurstdentist@gmail.com.

We truly hope to see you all soon! Take care of yourselves.

Dr. Shannon Allison

COVID-19 Patient Letter – March 23, 2020

March 23, 2020

Dear Allison and Associates’ Patient Family,

I hope my first newsletter finds all of you healthy and safe. These are unprecedented times in the history of the world. Even though throughout history we have dealt with other diseases such as Bubonic Plague, Spanish Influenza, H1N1, HIV, Ebola, SARS and MERS, I feel the COVID-19 outbreak is different. I do not think our societies have been as interconnected and reliant on each other as we are now and the effects of COVID-19 are more profound than with previous diseases. I know everyone is doing his/her part to limit social interactions and to help minimize the rates of COVID-19 spread. Hopefully, the USA does a great job as a country and we defeat this terrible invisible opponent sooner versus later.

This virus has had unique consequences for every single small business and dentistry is no exception. In particular, the risk of transmission is very high in a dental practice due to the uniqueness of our working environment. As a result, the American Dental Association has recommended all dental offices across the USA to stop nonessential/elective treatment and recommended we only see patients for emergency treatment. The duration of this cessation of all nonemergency treatment is extremely fluid: at this time, it is recommended through April 6th. I feel it will be longer as the USA starts to see increases with the number of COVID-19 cases. I hope I am wrong. For any patient with dental appointments between now and April 6th, someone from our office will contact you to cancel your appointment. All patients affected by this are being placed on a special QUICK CALL RESCHEDULE LIST. Our plan in the future once we recommence patient care as usual is to increase our office hours to meet the demands of our patients’ needs. Our entire staff is on board with increasing our patient care hours in order to provide you with the best dental care possible as soon as we are able.

I want all of our patients to know we are here for you if you have a dental emergency. We have a reduced staff working every Monday and Wednesday from 9:30am-12:30pm. Please call before you come to the office. We will be able to give you a designated appointment time. Once you arrive at our office, please call our office number, 910-295-4343, to let us know you have arrived. When we are ready for you, we will call you on your cell phone. We are not allowing patients to wait in the waiting room so as to follow social distancing protocols. We have some updated medical/social history questionnaires for patients to answer before we begin treatment. If you are sick with anything, please do not attempt to come to our office. I will be happy to call you personally and discuss your dental problem. Also, patients may reach me after hours on the office cell phone (910) 639-0491. I am providing a link from the American Dental Association to help you determine if you are having a dental emergency:
Our goal in seeing patients only for dental emergencies is to reduce the aerosols which we create during our routine dental procedures. These aerosols contain lots of bacteria and viruses naturally. Since COVID-19 is spread mainly via respiratory transmission, we as a profession must be extremely cautious and selective with our patient treatment for the safety and well-being of patients, ourselves and our community.

The safety and well-being of our patients continues to be our primary concern. We will continue to monitor the status of COVID-19 nationally and within our community and keep you up to date regarding our plans to reopen for business as usual.

I urge you to contact us if you have any questions or concerns. Again, we can be reached by office phone at (910) 295-4343, office emergency cell phone (910) 639-0491, or by email to pinehurstdentist@gmail.com and will respond as soon as we can. Please take great care of yourselves and we hope to see the end of this pandemic very soon.

Dr. Shannon Allison

Microscope Enhanced Dentistry

Our journey with Microscope Dentistry started in the summer of 2011.  I have been using surgical loupes with magnification from 4x to 8x during dental procedures. What if we could see more? A tooth is only 14mm wide for a molar, and a front tooth is 11mm long. This is approximately the size of a nickel. If we are looking at such small structures, wouldn’t it be better if we could see more detail? I enjoy taking the time and performing high quality dental treatment with the microscope.

Microscope Dentistry How Much Can The Naked Eye See?



Which tooth is it?

Cringeworthy toothbrush facts you NEED to know. Like, yesterday.

Ever wonder how often you need to change your toothbrush head? Some people think it is every six months when they go in for a dental check-up. Wrong! The American Dental Association actually recommends you change your toothbrush or toothbrush head every 3 months. While every 3 months may be recommended, you may even need to change it out sooner if you happen to contract the flu, a cold, sore throat or even a mouth sore.

Now you may be thinking in the back of your mind that 3 months is way too often. Let us take a deeper look into why this is so important.

There are 1.2 billion bacteria particles within your toothbrush bristles. While most of these aren’t harmful, it’s still pretty overwhelming. While there is a slim chance of being re-infected with a cold or flu, the bacteria that remain can actually turn into ANOTHER virus causing you to become ill.
When a toothbrush is too old, the bristles become frayed and less effective. This means you are actually leaving plaque on your teeth, defeating the whole purpose of brushing in the first place.
The plaque you are not able to remove with an old toothbrush causes you to build up tartar. This can damage your gums and bone and result in your gums separating from your teeth. Worse case scenario: you end up actually loosing your teeth because of it.
Your toothbrush collects mold if you keep it in a covered container or in the shower due to trapped moisture.


Sanitize your toothbrush by soaking it in alcohol or dipping it in boiling water.

Let your toothbrush air dry.

Stand it in upright position away from the toilet. When using the toilet, make sure to close toilet lid before flushing to prevent fecal matter from getting into the air and depositing onto bristles. See the “Mythbusters” experiment (yes, this has been proven).

RADIOGRAPHS: How they help US determine how unique YOU really are!

Picture this: you go in for your very first dental visit and sit down in the dental chair. The dental assistant or hygienist explains that she needs to grab a few radiographs before she stars. What do you think to yourself? Do you think about all useful information they can get from the x-rays or do you think about the bad reputation radiographs have and think “I’m going to glow in the dark after all this?” (Yes, we actually get that a lot for some reason.)

What many people do not understand is how beneficial radiographs are for us and how little radiation you actually get from them. There are many things you cannot see looking clinically in the mouth that you can see on a radiograph. Dental anomalies are unusual conditions that can be spotted with the help of our radiographs. They help us give you the best dental treatment based on your uniqueness. Let’s face it, everybody is unique in their own way and your teeth are no exception.

Did you know that you could have holes in the roots of your teeth? Did you know you could have more teeth than what is considered “normal?” Did you know teeth can grow sideways and underneath your gums? Did you know not everybody will have every permanent tooth that people are expected to have? You may or may not know these things are possible, but they are. We could have a pretty good idea and make pretty good speculations, but what we do not know for sure is what is really going on below the gum and in the jaw bones without the use of our many different forms of dental radiographs.

“Why x-rays? To see is to know…not to see is to guess…and we won’t guess about your health.”