The Cosmetic Dentistry Blog

Dr. Hall,
I got 8 porcelain veneers about a month ago. I wasn’t impressed by the waxon models, but they promised that it would look better. Before they put veneers on, they let me look at them on my teeth without attaching them all the way. I didn’t like them at all. The shape is not what I expected them to have, color is almost stained, gaps are between every tooth along the gum line and some teeth just slightly touch and have gaps. The dentist said that we can put them on and see if I still don’t like them. Even now I am not happy with the result. Dentist told me that the lab person got kinda mad at him for listening to my complaints and it’s the best that can be done. But if I really-really wanted, I could start the whole process with the same cost. Is there anything I can do? And is it true that, if I don’t like the result, they are not required to fix it. Thank you very much for your time.
- Max from Colorado

Dear Max,
I’m not sure I’m hearing you right. It sounds like this dentist went to the trouble to make a wax simulation of what your porcelain veneers would look like, and you didn’t like it, but he went ahead and had them made anyway. And then, after the lab made them, they tried them on, and you still didn’t like them, but they bonded them on anyway. What was the point of the try-on? And what kind of dental laboratory technician would get mad at a dentist for listening to the complaints of a patient? The patient, after all, is ultimately paying the salary of both the dentist and the laboratory technician. The whole scenario you’re painting for me just seems weird.

One of the most prominent distinctions between a true cosmetic dentist and a general dentist who does cosmetic dentistry is that the true cosmetic dentist will always have procedures in place to make sure that you like the work before it is finally bonded on. It sounds like your dentist went through the motions of doing this, but without the intention of actually making you happy.

Unfortunately, you gave your implicit consent to the appearance of the porcelain veneers by allowing him to bond them on. And, with cosmetic dentistry, most of the dental profession doesn’t appreciate it at all, so the standard of care is that it needs to look only halfway decent and it needs to function okay. As long as your porcelain veneers function, I think you’re stuck.

Whatever you do, don’t have this guy re-do them. Either I am missing something fundamental in what you’re telling me or this guy doesn’t mean what he says. You have no assurance that the second time will be any better. In fact, you can pretty much count on it coming out the same.

There are some excellent cosmetic dentists in the Denver area. Check our list and go to one of those and see what they think.
Dr. Hall

Click here for referral to an expert cosmetic dentist near you

Dr. Hall,
I just got 6 porcelain veneers on my front teeth,this was the second time in about 3 weeks. The dentist made them the first time and they looked awful. The second time he sent them to the dental lab. I was allowed to tell the lab man how I wanted them. I picked a very white shade, when my dentist went to put them on, the teeth were yellowish,especially the 2 front teeth.The lab man said the dentist told him to add a little color. The dentist would not say anything about them. the lab man said they could polish some yellow out, but the dentist would not do it and said the porcelain would come off. Is there any kind of whitener i could use to bring the stain off? it looks like a coffee stain . what about super smile toothpaste or teeth bleaching gel?

Thank-you,
- Jane from Ohio

Jane,
I wish I had a better answer for you. Teeth bleaching or whitening toothpaste won’t work. It sounds like the yellow was put on a superficial stain, which means an expert cosmetic dentist could polish the color out or grind it out, and re-polish the porcelain veneer so that it would look good. (Don’t ask your dentist to do this.) But that has to be done carefully.

Here’s the problem – your dentist may be a great guy, honest, and careful, but he isn’t an artist. And in dental school they teach dentists to be somewhat condescending toward patients on appearance-related issues. The dentist knows best, and the fact that you want these bright white, unnatural-looking teeth is evidence of that. They just don’t get it.

I think you’re well within your rights to ask that this be done a third time. You’re the one who has paid for a new smile, and the dentist going over your head to overrule you on the color of your smile, and then to bond these porcelain veneers on without your getting a good look at them–that could well be considered malpractice. What it violates is the doctrine of informed consent, a fundamental principle of malpractice law. He put yellow porcelain veneers in your mouth without your consent. I think a judge and a jury would stand behind you in that.

Your best option would be to get a refund from this dentist and go to a true artist/dentist to get this smile makeover done–the kind of cosmetic dentist we recommend on our website. That way you would not only get the color you want, but you would get an absolutely gorgeous smile in every respect. But better than nothing would be to get this dentist to do these porcelain veneers a third time.

I would go back to your dentist and tell him that you believe he violated your right of informed consent by putting on these yellow porcelain veneers when you gave explicit instructions about the color you wanted. Explaining it in this way should have a strong effect on him, because it will sound like something important he learned in his dental law class. So tell him you either want a refund, or you want him to take them off, have new ones made, and this time you insist on getting a good, long look at the new veneers on your teeth before they’re bonded on. Bring in a friend or a family member to help you look at them before they’re bonded on. And then, when you’re satisfied with the color, make him promise that he’s going to bond them on with clear bonding resin and not do anything sneaky like add tints to the bonding resin.

Good cosmetic dentists will go to great lengths to make absolutely certain that you love your new smile before they bond it on. So if you have any friends who want porcelain veneers, tell them to go to a mynewsmile.com recommended cosmetic dentist, so that this doesn’t happen to them.
- Dr. Hall

Click here for referral to an expert cosmetic dentist.
Click here to ask Dr. Hall a question.

Dr. Hall,
I went to a dentist here in New Jersey to have a bridge to replace a missing molar. After the two adjacent teeth were prepared, the dentist took an impression of my lower teeth. After it set, he was unable to get the mold off my teeth. It took about a good half an hour of spraying all kinds of stuff in my mouth, rocking and pulling while i was thinking that all my teeth was going to be pulled out, or my jaw broken. My question: Have you seen this happen before and should I continue with this dentist or should I see another dentist.

Thank you very much,
Len in New Jersey

Dear Len,
I wouldn’t quit going to this dentist over this. I’ll bet many dentists have had something like this happen in their practice, especially if they use certain precise impression techniques.

What happens is that there is a stiff putty that is used in certain impression techniques, and it is used with a lighter-body wash impression material. The putty pushes the wash into fine crevices in order to pick up the tiniest details in the impression. If your teeth or your jaw have undercuts, or if you have another dental bridge in your mouth somewhere, it’s possible for the putty to get into the undercuts. If it does, it can be very hard to remove. It’s nothing the dentist did wrong, really. It’s just kind of embarrassing and it can really throw the schedule off.
- Dr. Hall

Related links:
Read about dental crowns and porcelain crowns.

This post was prompted by an e-mail from Dr. Jeffrey Segal, the CEO of Medical Justice Services, not by a visitor question. But the topic is very relevant for many of our visitors, and that is, what is the impact on the dentist of your asking for a refund for dental work when you’ve had a problem? So I wanted to post this.

One of the reasons dentists don’t want to give refunds is that refunds can go on their record at the National Practitioner Data Bank. They want to avoid this. I recommend giving the dentist an easy way to give you a refund.

Oh, and you need to know that most dentists aren’t aware of this rules, so it may help you to educate them as to the latest rules. If you want to go to the original source for this information, see Dr. Segal’s article on refunds to dental patients.

If your demand for a refund is oral and not written, and if the dentist makes the refund himself or herself, rather than going to their insurance company or the corporation the dentist works for, then the refund does not have to be reported. If the demand is written, it needs to be reported. If the corporate entity writes the check, then it also has to be reported.

If I were asking for a refund, and I were getting some resistance from the dentist, I would say something like, “Look, I’m willing to make this easy for you. I’m making this request orally, which means you do not have to report this to the National Practitioner Data Bank. I don’t want to have to go to a formal request or go to a lawyer and make this messy. Let’s just keep it simple.”

- Dr. Hall

Click here for referral to an expert cosmetic dentist.
Click here to ask Dr. Hall a question.