The Cosmetic Dentistry Blog

May 10, 2010

A seriously botched $25,000 smile makeover

Filed under: Crowns for front teeth, Smile design, Uncategorized — iowasmiles @ 10:06 am

Dr. Hall,
Recently I had $25,000 worth of porcelain crowns on both my top and bottom teeth-paid up front. I went for my consultation, picked my smile style, and told the consultant that I wanted a white bright smile that looked natural. I was given something to lighten my bottom teeth. I also had a metal bridge replaced so that it would match my upper teeth. All top teeth were crowned. After extensive xrays and mouth impressions, I was fitted with a temporary set of teeth. I was told that by wearing the temps, I would be able to see how my teeth would look, the shape and size, and color, in case I wanted to make any changes in my porcelain crowns. I was also told that I was the one who had to be happy. Two weeks later, when my crowns came in, the first thing I noticed as they were on the table was that they looked dark. I commented on this, but the girl who was to put them on said that they would look different in my mouth. When she put them in (not cemented) she told me to be careful when I sat up to look in the mirror because they were not in yet. From the moment I looked at them, I said “They are too dull!” I continued to say this, even as they were falling out and I! could see I had no teeth left on top. By the way, I went in because my front teeth had been bonded years ago and had been chipped away by my bottom teeth. Other than that, I had strong, white teeth. As I continued to say I did not like them, she said suggested we go outside in the natural light with a mirrow. Even on the outside, I kept saying I did not like them and that they looked dull. She told me that my eyes were playing tricks on me because I was used to the white temporaries and that once on, I would see a difference. We went back in and I looked in the big mirror above the sink in her lab. One of my front teeth feel on the floor and she picked it up and watched it off…. I was about to cry. Then the girl who cleans the teeth stepped in and said how I would love them once they were in and polished up. Never once did the doctor I paid the money to come in to see what was going on…Never once was I offered an option like, “Do you want them whiter?”

I was so frustrated and upset. I felt pushed against the wall about the matter, having no teeth in my mouth and being convinced that I was seeing things. Needlesstosay, she cemented them in. After they were in, the doctor came in and started trying to level my top and bottom teeth. Once he found out I was unhappy, I had to tell him, he told me to wear them a week and come back and he would finish … He said we want you to be happy.

After a week, I went back. In the light I had also discovered that the bridge I had replaced did not even match the other teeth. The girl said, You have a metal bridge (4 teeth @ $1700) so it’s going to be different. I explained to the doctor that I had tried to tell the girl befo! re she put them in I was unhappy with the color… He said ” Well we have to be fair to everyone, the lab, the workers ,,, no way can we redo what we have done.” He then said maybe he could remove the stain on my porcelain crowns to match the white bridge. I am suppose to go back in a week. He said if the lab used a certain stain, this might be possible. I am so upset. I trusted these people. I don’t know what to do. My husband is going to go with me this next visit. I have to go back. I can’t eat with the crowns because they have not been level and are very painful. Any suggestions? Thanks for any help!
- Sandi from Texas

Sandi,
If I am sizing up correctly what was done to you, based on the story you have told, you are the victim of seriously unethical cosmetic dentistry. You were told that they would be sure you were happy with your smile makeover, but it sounds like they had no intention of actually honoring that promise.

Again, if I am sizing up this situation correctly, and if it happened the way you told me, you are dealing with very pushy people, and you are going to have to take a different tack if you are going to get anywhere. You have to be willing to get a lot more serious with your complaints and maybe get some legal help. Are you up to standing up for your own rights?

If these teeth were put in over your objections, then this is classic malpractice. A fundamental principle of health care is that all treatment is rendered with informed consent. When you didn’t consent to the treatment, and they put in the teeth anyway, legally, that amounts to assault. But if you are going to get anywhere, you have to have some steel in your spine and be willing to stand up to these people. And just having your husband go in with you to the appointment isn’t good enough.

My judgment would be that you will need to help this dentist see that he is legally on thin ice in order to get him to fix this. I would suggest getting a lawyer to write a letter that promises that you will sue them unless they totally redo this for you and honor the promise they originally made that you had to be happy with how they look before they would put them in. Or, if you don’t want to do that, you could take this e-mail and that might help open their eyes. Then, if they don’t agree, you could go to a lawyer.

For additional help, there is a great cosmetic dentist in nearby Tyler, Texas that could give an opinion on this work. He is Dr. Robert Burnett. And besides being a great dentist he is a great guy. If it were me, I wouldn’t settle for this dentist re-doing the work. I wouldn’t ever let him touch my teeth again. Instead, I would demand that he pay me to have the work re-done by someone more compassionate and skillful. At this point, do you trust him? I wouldn’t.

Good luck,
Dr. Hall

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March 29, 2010

Staining from PerioPlus Periodontal mouth rinse.

Filed under: Tooth staining, Uncategorized — iowasmiles @ 11:40 am

Hi Doctor Hall,
After 2 days of using Perioplus Maintenance rinse (after gum surgery), I’ve noticed some staining on my brand new dental work , constisting of crowns and bridgework. Is there anything I can do to bring the color back to the original? Help! Thank-you , Diane

Dear Diane,
I had to do a little research for this one, because I haven’t heard of this product before. And I confirmed my suspicions. They downplay it and don’t even mention it on the product label, but this product contains chlorhexidine. They call the label a “nutritional” label, and since chlorhexidine is an antibacterial agent and not a nutritional ingredient, I guess that makes it so they don’t have to disclose that.

This is not to be too critical – it’s just that I think they should mention that on the label. Chlorhexidine is an excellent anti-bacterial agent, and has been prescribed by periodontists and general dentists for years as Peridex. I had occasion to prescribe it a number of times. It attaches to the soft tissue and protein pellicle on the teeth and has a long-lasting antibacterial activity that very effectively fights gum infection and inflammation. But it has a nasty side-effect, which is brown staining on the teeth and dental work. That may be why they’re a little timid about admitting this.

There is an easy solution, and that is Supersmile toothpaste. Supersmile has an enzyme – calprox – that dissolves away the protein pellicle and as far as I am aware, is one of only two ways to eliminate and prevent this stain. An aggressive pumice polishing of the teeth by a dental hygienist, or Supersmile toothpaste – those are the two ways to deal with this stain. Whenever I gave a prescription of chlorhexidine rinse, I insisted that the patient purchase Supersmile, because that brown stain can become positively ugly.

You can buy Supersmile directly from the manufacturer (Robell products in New York City). Or we offer it for a discount on our website. We’ve dropped the price to where we just cover our costs, because it is such a unique toothpaste with unique benefits. It does get rid of this stain, when used on a daily basis, and it is also great for maintaining cosmetic dental work.

Thanks,
Dr. Hall

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January 11, 2010

I want to bleach my non-veneered teeth.

Filed under: Porcelain veneers, Tooth whitening, Uncategorized — iowasmiles @ 5:39 am

Dr. Hall,
Will over the counter bleaching products (Crest whitestrips, etc..) ruin or damage my veneers? Since getting my veneers my other teeth have yellowed and there is now a noticable difference in the color of my veneers and natural teeth. I would like to bleach my teeth to match the veneers, but I don’t want to damage my expensive veneers.
- Vanessa

Vanessa,
Of the over-the-counter whitening products, Crest Whitestrips and imitation products by some other manufacturers, are the only products I would recommend, and only for limited situations. These strips hold the peroxide in a gel that is attached to the strip. When the strip is affixed to the tooth, it allows this peroxide to penetrate the teeth and whiten them.

Other products with rinses and powerders, or just toothpastes, are on the teeth too briefly to penetrate and do any good. Some of them have acids like citric acid in them that etches the surface of the tooth slightly, and then this etched, roughened surface picks up the white pigment that you follow with. I have tested some of those products, and they do damage the teeth. They make them temporarily whiter, but then within a few days they relapse to being even darker than they were before, because the enamel has been roughened and now picks up more stain.

The WhiteStrips have a disadvantage in your case in that they are designed to cover only the front six teeth. However, you don’t want the very front veneered teeth covered – you want to cover the teeth that are further back. There might be a way you could cut them and get them to apply to the correct teeth, but that’s a lot of monkey business to have to go through. And the whitening with the WhiteStrips goes very slowly, because the peroxide bleach in them has to be fairly weak in order to be sold over the counter. And the Whitestrips kits are expensive, and could end up costing more than if you did this in a dentist’s office.

If it were me, I would go to a dentist and get your teeth bleaching done right. Dentists use a much more powerful version of peroxide and it will cover the right teeth. Some offices even offer free or greatly discounted bleaching to new patients. I don’t advocate shopping for deals for cosmetic dentistry, but basic bleaching is simple enough that it’s hard for a dentist to screw up, so there I might price-shopping. But absolutely don’t price shop for fillings, porcelain veneers, dental implants, or any involved treatments.

I hope this is helpful.

The bleach will not harm the veneers. They won’t change color. There will be a slight lightening of your veneered teeth, but since that will come from behind the tooth, it won’t have a noticeable affect on how they appear from the front.

Dr. Hall

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December 26, 2009

Asking about Snap-On Smile

Filed under: Uncategorized — iowasmiles @ 7:34 pm

I know there is a dental apparatus that can be placed directly over your teeth, similar to a mouth guard, with the exception it is a covering over your existing teeth, giving an appearance of a different (nicer) look than your existing teeth. What is this called? And is the procedure relatively short time-wise, with no pain and relatively inexpensive? Please email information. Thank You.
- Mark in New Jersey

Mark,
What you’re asking about is called a “snap-on smile.” It’s a temporary smile makeover that can be snapped over your existing teeth. It’s used sometimes for theatre, or for weddings. It’s not very durable, but it can create a nice temporary improvement in your smile. It of course makes your teeth look larger and bulkier, and it needs to be removed in order to clean it after every time you eat.

There is a dental laboratory in New York that makes these appliances. Your dentist needs to send a model of your teeth to the laboratory and they send back your Snap-On Smile in about two weeks. There is no preparation required on your teeth—it just snaps on to your unaltered teeth, so there is no grinding or novocain required. I would recommend having an expert cosmetic dentist to order the appliance in order to get the best results.

September 30, 2009

Infection after wisdom teeth removal

Filed under: Uncategorized — iowasmiles @ 9:17 am

Hi,
I am 48, had two wisdom teeth on left side removed. They said I had a small infection in around my teeth, otherwise my teeth are in decent shape.

About a week or two after the surgery this large lump in my lower jaw persisted and grew more painfull. They put me on a second round of antibiotics. That did not help. I went back, they opened up the area and cleaned it and put me on more antibiotics. I have one more day on antibiotics. The lump is smaller. It’s 10 days later and the pain is very little though that area is still a little tender. I don’t think opening it up again will help.

uggestion? Thankyou.
David in Tennessee

Dear David,
I wouldn’t think you’d need the area opened up again, but of course, I can’t see it for myself so I can’t give you a definitive answer. But it looks like everything else is working and you just need a little more antibiotics. But I would for sure let your dentist know that you haven’t completely healed from your infection yet and you need more antibiotics. Your symptoms should be gone for about three days or you should keep taking the antibiotics to avoid a relapse.

If you’ve killed off most, but not all, of your infection, you are at risk of the infection coming back. And when it comes the second time, it is harder to get rid of it because the bacteria have started to develop a resistance to the antibiotic.

And another comment about your situation. You’re one of many illustrations as to why you should get your wisdom teeth out when you’re young. Complications are rare when the patient is 25 or younger and has his or her wisdom teeth out, and they increase exponentially as you get into your 40s and beyond. Usually, when wisdom teeth get infected, it’s because there was never enough space for them to fully erupt, and this is something that is easily predicted when you are around 20.
- Dr. Hall

August 11, 2009

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Filed under: Uncategorized — iowasmiles @ 8:32 pm

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