The Cosmetic Dentistry Blog

April 11, 2013

Finding a cosmetic dentist in the Cayman Islands

Hi there Dr Hall,
Many thanks for such helpful information on your website. Your support is greatly appreciated! I currently reside in the Cayman Islands, my front right tooth slightly overlaps my front left tooth. Is there anyone you could recommend in Grand Cayman, so many cosmetic dentists I don’t know where to start. I have visited one, whom suggested getting all my teeth whitened, then 2 zirconia crowns on both front teeth as sister teeth. Are there any other options to compare, or does that sound wise. I am 34 with 2 young kids and finally want not to be too embarrassed to smile.

Many thanks
- Denise

Denise,
What you’re telling me about what this dentist wants to do makes me nervous. The idea that he or she wants to do zirconia crowns on these front teeth rather than bonded porcelain makes me think that he or she is not comfortable with bonded porcelain. Bonded porcelain would be preferable to zirconia. Zirconia is great for back teeth or bridgework, but I wouldn’t recommend it for an esthetically critical situation on your two front teeth. And I would think the ideal treatment would be porcelain veneers anyway, not crowns at all. Doing two or more crowns on front teeth can put you at risk of breaking them off from lateral stresses.

I don’t understand all these cosmetic dentists you are talking about. I just googled cosmetic dentists in the Cayman Islands and looked at several websites and couldn’t find anyone I would trust with even the simplest cosmetic procedures, much less something as involved as what you are telling me. Even in the United States, fewer than one dentist out of fifty could do a beautiful job on your case. I would be surprised if you could find a dentist in the entire Caribbean area who could do a nice job on this. Quite frankly, I would fly in to Miami and have someone there do this. Dr. Sam Sadati near West Palm Beach is one I know personally who would do beautiful work for you. You could have your teeth whitened there locally and then get the two veneers or whatever your case requires done in Florida.

Why spend money to give you a mediocre cosmetic result and then possibly end up with damaged front teeth besides? Spend a little extra for a couple of trips to Florida and get it done right.
Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

March 2, 2013

Do you need a crown on a front tooth with a root canal treatment?

Just had a root canal on the tooth right next to the front tooth. Is it necessary for a crown to be put on ? Can a post only be put in and if so, repair the discoloration with a porcelain veneer ?
- Ann from New York

Ann,
There’s a simple answer to your question and a more thoughtful answer, and I’ll give you both.

The simple answer is that dentists were taught in dental school that if a tooth has a root canal treatment, it is weakened, and thus it needs a crown to strengthen it and prevent tooth fracture. Plus, after a root canal treatment, a tooth will turn dark, so a front tooth should have a crown to preserve its appearance.

The more thoughtful answer differs from this approach in two ways. First, on the “likelihood to break” issue:
- Yes, a tooth is weaker after it has had a root canal treatment. But there is a difference between back teeth and front teeth. Back teeth, because they have a flat chewing surface and cusps are prone to splitting – the chewing force comes down between the cusps and this pressure tends to force the cusps apart. A crown will prevent splitting of the tooth. A front tooth, however, doesn’t have these forces. The risk with a front tooth is that chewing creates a horizontal force that may break off the tooth. A crown, since it requires removing 1-2 millimeters all around the circumference of the tooth, will actually weaken it against these horizontal shear forces and make it MORE likely to fracture.

On the discoloration issue, yes, teeth with root canal treatments will discolor. However, if the root canal cement and the root canal filling material are carefully cleaned out of the inside of the crown of the treated tooth, that discoloration will take years to occur and will be mild.

My preference for a front tooth would depend on the amount of healthy tooth structure remaining in the tooth. If, say, 70-80% of the tooth is healthy tooth structure, I would recommend restoring the tooth simply with a translucent or white fiberglass post and composite. Then, when the tooth begins to discolor, that could be corrected with a porcelain veneer or a crown at that point. If substantial amounts of tooth structure are missing, I would use the same white or translucent post with an all-ceramic crown.

Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

June 9, 2012

Why can’t my dentist get this color right on my implant crown?

Dear Dr Hall,
I was not happy with the color of the crown attached to my implant, so I returned to my dentist who said he thought it was fine and sent me away to “think about it.” I returned and he very reluctantly agreed to re-do the color. I recently had the revised crown attached again, but the color is worse – it is now quite noticeably darker. Both times I visited the lab for color assessment. And both times the dentist did not bother to check the color before attaching the crown. I am very disappointed, but do not want to return to this dentist as he obviously is not able to improve. He also had considerable difficulty with attaching the crown which resulted in considerable discomfort and left me wondering whether the attachment to the implant has been damaged. Post-procedure, I cannot eat on that side of the mouth at all. This implant has cost me a considerable sum. I would like to know what my options would be for correcting the color of this crown, and if the attachment has been damaged, would I need to get a whole new crown and implant, and who should pay for this? Is it possible to place a veneer over the crown? Thank you for your help.
- Mary from Australia

Mary,
Your case is a great illustration of the great difference between dentists when it comes to aesthetics. Only about 2% of dentists, from my experience, are very good at aesthetic dentistry, and I have people all of the time having a hard time believing that and wanting to know why. (And that 2% is in the US – probably less in Australia). But dentists become dentists because they like to fix things – they’re just not into works of beauty.

Your dentist clearly has a low degree of interest in the aesthetics of his work, and that is the reason this isn’t working. And you have given clear indication here in your e-mail of his indifference. Any dentist who is seriously trying to do beautiful cosmetic dentistry will be very attentive to your opinion and if you thought the color didn’t match well would not try to tell you that it was fine. Such a dentist would actually make sure the color was right in your eyes before cementing the porcelain crown and would not hesitate to send it back to the lab. But your dentist did not have enough confidence in his own color-matching skills to match the color himself but instead sent you to the laboratory. And then, after being burned once and having to re-do the crown, rather than trying it on and making sure you liked the color this time before permanently cementing it, he just puts it on.

You have figured out that you cannot rely on this dentist to get this right. If you want this done right, you have to find a dentist who actually wants to be good at aesthetic dentistry. I wish you had told me where in Australia you are and I could give you some guidance on that, because good cosmetic dentists are few and far between in Australia.

When a dentist sends you to the laboratory technician for the “color check”, that is a pretty good sign that the dentist knows he or she isn’t very good at tooth color, and those cases often end up looking very poor. All the technician can do is look at the tooth that needs to be matched and take notes about the color. Then he or she dismisses you, goes into the laboratory, and tries to follow the notes that were made. The dentist is supposed to have a higher level of skill than the technician, and should know how to make those notes and instruct the technician. And nowadays, with digital photography, it is very easy for a dentist to hold up a shade guide tooth to your tooth and snap a color-correct photograph and e-mail it to the technician, with notes. The technician can then use that photograph and the notes during the fabrication of your crown, and this is often the best way to get an accurate match.

Do not – absolutely do not try to get a veneer placed over the crown. The crown is difficult enough by itself. Get the crown re-done. If that is done correctly, it will not damage the implant at all. Trying to do a veneer over it and get the color right makes it all the more complicated. Besides which very few dentists know how to properly bond a veneer onto a porcelain crown. That could turn this from a simple bad dream into a true nightmare.

If you need any more help with this, please write back.
- Dr. Hall

P.S. – I see you found our website by searching on “dental catastrophe.” I had not thought of that search term before, but it is appropriate!

Click here to read my blog posting about how to ask for a refund from your dentist.

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

May 19, 2011

My dentist won’t do the crowns unless I do the braces

Hi, I went to dentist today to inquire about replacing the crown on my two front teeth. They were put on about fifteen years ago and are discolored and embarrassing. I was told I need full ortho braces before I can get the crowns replaced. I do not have the money for that and I don’t see why I can’t just get new crowns and do the other stuff later. My front teeth in question are a little crooked and bucked out but not that terrible. What should I do?
- PJ from Wisconsin

Dear PJ,
I don’t like it when dentists put these restrictions on their treatment – they will only do the perfect treatment or nothing. People have budgets and sometimes less than ideal is the only thing within their budget.

You certainly should be able to get these crowns replaced without doing the orthodontic treatment. You could forgo the braces entirely, or you could do it later. The dentist should still be able to do great crowns and get them looking great.

I would find another dentist who is a more sympathetic and understanding type who will work with you and your budget.

And I would be sure to do all-porcelain crowns on your front teeth. Otherwise they will tend to look fake and will end up showing a dark line at the gumline. Make sure your dentist feels comfortable with this type of crown. Don’t press your dentist to do a certain type of crown – but ask what type the dentist recommends, all-porcelain or porcelain fused to metal. And if he recommends porcelain fused to metal, you’re in the wrong office. Just quietly exit and find a dentist who loves doing the all-porcelain.
- Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

April 7, 2011

Which looks better and is more durable, e-Max or Lava crowns?

Hi Dr. Hall,
I am about to go through a procedure that will hopefully change my smile. I currently have a metal crown in the front right tooth and it looks TERRIBLE. In addition to that the left front tooth has a very bad discoloring but also has deep fillings, and next to it, the tooth also has major fillings. My dentist initially recommended that I restore my smile with Lave Crowns, and then decided that he would use e-max crowns.

Is there a difference between these two products? I keep on searching the web to see which is better but I usually find sources that support both products. In addition to this I want the product to look as natural as possible. Is one better than the other? My dentist told me that the e-max crowns usually cost more, but that he would leave it as the same price as the Lava Crowns (which – according to him -cost less). Is this also true? And my last questions would be, what is the durability of each of these? Please help.
- Angie from California

Angie,
The key questions in how these crowns are going to make your front teeth look are not going to be anything about which brand of ceramic crown your dentist uses. The key questions are going to be, “How artistic is your dentist?” And, “How artistic is the dental lab that your dentist has chosen?” Both questions center around your dentist, because an artistic dentist will make sure that the dental lab he or she uses produces highly esthetic work.

The Lava Crown and the e.max Crown are both fairly similar. Both have a high-strength zirconia core that is milled rather than cast and then have a layer of porcelain over them. Lava comes from the 3-M corporation, and the outer layer is usually a baked feldspathic porcelain. The e.max crown comes from Ivoclar, and it can be covered with either a baked feldspathic porcelain or a pressed ceramic. I don’t think either of them is the very most esthetic crown. If it’s esthetics, I would lean toward a pure feldspathic porcelain that is bonded to the tooth. Both e.max and Lava are high strength, and I couldn’t tell you which is stronger. Pure feldspathic porcelain isn’t as strong, but it will last as long in the mouths of most people as long as you don’t have an abusive bite. Some esthetic dentists think the pressed ceramic is the most beautiful, but more lean toward the feldspathic porcelains. Some esthetic dentists will choose one or the other depending on the demands of a particular case.

But again, the key ingredient is the dentist. Let me ask you this. If you were asked by your community to commission an oil painting for the foyer of a local concert hall, would you research the brand of paint, or would you focus on the selection of the artist and let the artist pick the paint he or she felt most comfortable using? I think you would pick the artist. But you’re approaching the creation of a life-like reproduction of your two front teeth as if it is some commodity to be purchased at a discount store, and all you have to worry about is the brand. Dentists vary greatly in their artistic abilities. 98% of dentists have very little artistic inclination – they chose a career in dentistry because they like to fix things. Some dentists rise to the top in artistic abilities, and they become renowned among celebrities who will fly across the country to see a particularly artistic dentist. On the mynewsmile website, I cater more to the general public and I search out from among the top 1% of artistic dentists and list them here for the benefit of my visitors. I have a lot of e-mails from disappointed patients who make the same mistake of thinking the dentist on the corner, by virtue of having a dental license, is an artist. It doesn’t work that way.

As far as a choice between e.max and Lava, I think probably more cosmetic dentists use e.max, but they tend to use it for teeth that aren’t right in the front – it’s used more for premolars and some molars. I have an e.max crown on one of my premolars. But, done well, in the right hands, it can produce a nice result for front teeth. Depending on the amount of discoloration in your one front tooth, Lava or e.max can help block out some of the unwanted color. But I would still prefer straight feldspathic porcelain in that situation with a great lab technician who knows how to use opaquing porcelains. I think e.max may tend to cost a little more, but that’s going to depend mostly on the laboratory that’s doing it. Costs for both will vary greatly depending on the laboratory technician that is using it.

Dr. Hall

We thank our advertisers who help fund this site.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

March 1, 2011

Perfectly matching a crown on a front tooth

Dr. Hall,
I recently got a porcelain veneer crown on a tooth that I chipped when I was 10 years old. The first permanent crown that was put on did not match my other teeth, so I had to get it redone. I just got my 2nd one put on and after everyone in the office said it looked great, the color is still off and it is darker than my other teeth. I know a perfect match is difficult, but I would rather it be whiter than darker because that would be less noticeable. I was wondering if I were to get the crown redone again, if this would have any long term side effects on what is left of my tooth underneath my crown? Please let me know what advice you can offer and if it would be safe for me to try to get another crown remade.
- Kyle in Ohio

Kyle,
I’m not sure what you mean by a porcelain veneer crown. I think you may be referring to a porcelain fused to metal crown – because that has a metal foundation and has porcelain veneered over the metal. To get the best match to a natural tooth, it’s best to use an all-porcelain crown, because that can be made to have the same translucency as a natural tooth. But if your dentist hasn’t brought up doing an all-porcelain crown, then I wouldn’t mention it. That’s a recipe for trouble if you start pushing a dentist out of his or her comfort zone – rarely will they admit to a patient that they’re uncomfortable with a newer technology.

And yes, it is possible to get a perfect match on a single front tooth,  so that you couldn’t tell, even at very close range, any difference between the crown and the other natural tooth. But this requires extra training and talent that most dentists don’t have. This is why I publish this website – to help people find excellent cosmetic dentists that can do this work.

Dentists generally choose that field because they like to work with their hands and they like to fix things. So they approach things from an engineering mentality. They aren’t good at subtleties of color. And tooth color is very complex. There is a lot of variation in all the colors that are within a single tooth – from the gumline to the biting edge there is a color gradient, plus there are spots where the color is slightly different. Add to this that tooth enamel is fairly translucent and the dentin underneath it is only partially translucent. So matching a tooth gets very complex.

When everyone in the dental office was trying to tell you that this tooth matches so great, that to me is a big red flag. Really good cosmetic dentists don’t act that way – they listen to the patient. So when we would try on a crown, we would ask the patient what they thought. I would pay close attention if there was any hesitation on the part of the patient, and I would insist that they be happy with the result. I would never tell a patient that a tooth or a smile looked great if they didn’t think so. And for a single front tooth, even for an excellent cosmetic dentist, it may be three or four try-ins before the lab would nail the color exactly.

On the other part of your question, it shouldn’t hurt the tooth at all to do this again, as long as the dentist knows what they are doing and is reasonably careful. But don’t try this with a general or family dentist. I would say that about one dentist in maybe fifty or a hundred could do this well.
- Dr. Hall

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

September 28, 2010

Ugly Porcelain-fused-to-metal crowns.

Filed under: Crowns for front teeth — Tags: , , — mesasmiles @ 6:59 pm

Dr. Hall,
I had porcelain fused to metal crowns on my front top teeth over 20 years ago, and they now look terrible because you can see the dark line when I smile, and i have a very big smile. Is there anything that I can now do to change this? Would lumineers work for me? Your advise would really be appreciated. thank you, Joan from New York

Joan,
What you need would be very simple for an expert and artistic cosmetic dentist, but I can’t emphasize strongly enough how important it is that it be an expert cosmetic dentist. Be sure you understand fully the difference between the dentist on the corner who says he or she does cosmetic dentistry and the dentist who is truly artistic, who knows how to create beautiful smiles. See our page, What is a cosmetic dentist?

You need new, all-ceramic crowns, with no metal in them. And this is a great opportunity for you, because if you do this right, you can have an absolutely gorgeous smile.

- Dr. Hall

Links: Read more about porcelain crowns.
Click here to find a cosmetic dentist.
Click here to ask a dentist a question.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

July 9, 2010

A CEREC crown on a front tooth

Filed under: Crowns for front teeth — iowasmiles @ 2:28 am

I recently broke a front tooth and had it fixed through the Cerec method. As I was going out of town the next day I agreed to this procedure and was told it would be a permanent crown requiring only the one office visit. The next day when I had reached my destination at the home of a friend I was visiting the crown came off. Needless to say I was frantic to find a dentist who could at least put the crown back on. My friend was able to contact her dentist who was familiar with the Cerec procedure and said he uses it himself. Apparently the bonding was bonded to my tooth and not sufficiently to the crown itself so he rebonded it. Upon returning to my home five days later I went to see my dentist and told him what had happened. He said he would redo the whole thing. After reading the very informative information provided on you website, I realize my dentist is probably not as experiened in this procedure as is necessary. The present crown is a bit longer than my other front tooth and the color is lighter also. I have another appointment with my dentist to discuss this whole situation before any further work is done. My main concern now is since the crown was rebonded by my friend’s dentist and is probably permanent, what risks might I be facing to other teeth if and w! hen the crown is removed and the procedure is repeated. I am now thinking of having the regular procedure of making a mold and temporary crown and going back for the permanent crown. I’m not even sure if I should continue with this dentist as I feel the original work was not done correctly; try to seek a refund and find another dentist or just what. I know these coments are long, but I hope you can find the time to give me your opinion. Thank you very much.
Shirley from Texas

Shirley
I don’t think I can advise you what to do, not being able to see the situation myself and not knowing anything else about your dentist. But I’ll try to be helpful.

Matching a crown to a single front tooth is tough to do. Is this tooth that broke one of your two front teeth? If so, it’s not surprising that the color is off. Usually it takes a lot of back and forth and custom coloration to match a single front tooth. Now a CEREC crown is milled from a single block of ceramic that comes from the factory. To match this factory shade to your front tooth, it would have to be custom stained and would take quite a bit of skill. I know of dentists who have CEREC machines but don’t use them for single crowns on front teeth. Others are artistic enough to pull this off. Is your dentist capable of this? I don’t know. It doesn’t inspire confidence that the crown wasn’t bonded properly in the first place, and that both the shape and color are off. But it is nice that he is offering to redo it for free. Sort of makes me think that he’s honest and a nice guy, but maybe in a little over his head. But I could be wrong in that – I’m just trying to figure things out based on what you’re telling me.

I would be inclined to get a second opinion from one of our expert cosmetic dentists in Texas.
- Dr. Hall

About David A. Hall

June 21, 2010

Unhappy with her two crowns.

Filed under: Crowns for front teeth — Tags: — iowasmiles @ 8:56 am

Hi Dr.Hall,
When I first decided to get braces, all I wanted was to get my front lateral incisors (on front) straightened. Instead, my orthodontist gave me 2 options: (1) Two porcelain crowns on the incisors or (2) have my dentist remove the incisors and then close the gap thereafter. When these options were presented, I felt that I did not have my original choice to just straighten the incisors, so I ended up choosing the porcelain crowns. Since this cosmetic change in 2004, I remain unhappy with them because I was never given my first choice–just to straighten my teeth without any additions or removals. And because I was in my 20s and didn’t know much about the differences between Empress or metal or no metal bond, now I regret my decision in having these fake things on me. My questions for you are: (1) How long will these crowns last before I have to replace them? (My dentist at the time said I would have to replace them every 10 years.) (2) Should I reconsider removing these crowns in the future (about 2014);get braces again; and follow through with the 2nd option I was given back in 2004 (where I have the lateral incisors removed and have them remove the gap this way? (I heard that if I do it this way, the muscle memory in my teeth would make it more difficult to maintain the straight teeth.) Is this a common procedure? How would this look? Would my bite get worse if I do it this way? What are the pros & cons of making this change? When I first picked this orthodontist, I chose him because he did not want to perform any surgery and he was COST EFFECTIVE. However, having gone to him is costing me more in the long run bc I was told that I would have to replace these crowns over time. Please help. I don’t want to make the wrong decision again. (Every time I mention my concerns to a dentist, they always say, “You worry too much. Your teeth are fine.” It’s obvious they are not cosmetic dentists bc they don’t understand how the patient feels emotionally and financially about it all. This does not help the situation. So, please don’t say that to me either.)

Thank you.
Sincerely, Alma
PS: At this time, all I know is that I have porcelain crowns and I am not sure if they have metal or not. This may be Empress…these cost me $1450 in 2004. I would have to contact my previous dentist or lab technician who did this and get back to you if this will help. I currently do not have any gray lines showing where the crowns are at this time.
- Alma from California

Alma,
I don’t know, not having seen your case, but I’m guessing that you had what we call “peg laterals” – where the lateral incisors are malformed. In such a case, crowning or veneering those laterals is by far the best choice. I’m glad you didn’t have them take out the laterals. Some orthodontists recommend that but the results almost always look very unnatural.

The comment you’re getting from your dentist telling you not to worry about how your teeth look shows that he or she is definitely not a cosmetic dentist. This is what most dentists believe – that patients’ appearance concerns are trivial. And I believe that this is the problem with your two crowns. Had you had them done by an excellent cosmetic dentist, you would have been thrilled with how they look.

Your initial choice was reasonable – do the crowns. Where the procedure broke down was in the artistry of your dentist. But once you have crowns on any teeth, you’re committed to having crowns on them forever, so you need to make the best of the situation.

You do not need to wait until 2014 to fix these. Most dental insurance plans provide replacement benefits for crowns that are over five years old, which would have been 2009 for you. And once you have them replaced, they could last 10, 20, or even 30 years – there is no fixed lifespan for crowns.

My recommendation is to go to our list of California cosmetic dentists at www.mynewsmile.com and find a dentist who is truly passionate about doing beautiful work, and get these crowns replaced. I’m confident you’ll absolutely love the result if you go to an expert cosmetic dentist such as we recommend.

Good luck,
Dr. Hall

Click here for referral to an expert cosmetic dentist.

Followup: Alma sends her thank-you for our response.

About David A. Hall

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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