The Cosmetic Dentistry Blog

April 30, 2007

Cosmetic dentistry instead of a facelift

Filed under: Porcelain veneers — iowasmiles @ 1:53 pm

Dr. Hall,
My question concerns an issue of cosmetic dentistry versus plastic surgery. As I have aged, my upper lip has descended a few millimeters. Now when I smile, you don’t see as much of my upper teeth as you should. I don’t think I want to do plastic surgery to raise my upper lip. I am told that many surgeons don’t do the procedure, and the results vary greatly, and scarring is an issue. Thus, I would like to approach the problem from the inside.

When I’m not smiling, I look fine, good enough for me. So I am interested in having cosmetic dentistry for my teeth to make the upper teeth longer–a few milimeters or so. The result will hopefully be that when I smile then, you will see the upper teeth as you should. Will this work? My bite (with essentially longer upper teeth) would be different I suppose, but the concept seems doable to me as a layman. Please let me know your thoughts, and what would be involved to do this. My dentist here does not know. Thanks,
- Gary in Texas

Dear Gary,
You came to the right place with a question like this. Yes, your type of case is way beyond the expertise of any general dentist. As you said, your own dentist doesn’t have a clue.

But for an expert cosmetic dentist, this is what they do. Yes, this is possible to do and is done frequently. I am confident that any of our listed Texas cosmetic dentists would have experience with lengthening the teeth and would be comfortable doing this. It involves doing a smile makeover with porcelain veneers. Yes, they have to be careful because it does affect the bite, and if they don’t know what they are doing, the porcelain veneers will chip and break.

Good luck,
Dr. Hall

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April 29, 2007

Adjusting the bite after a crown

Filed under: Dental crowns — iowasmiles @ 6:55 pm

I recently had a dental crown put on my #18 tooth after having much tooth decay removed. This was about two weeks ago, and a few days after, I started noticing pain in the adjacent teeth in front of the one with the crown. It feels like those teeth have been moved slightly. They feel tight and misaligned so my bite is a little off, and it causes discomfort throughout the day. It feels a bit tingly or like something is stuck between my teeth. Is it possible that the crown has pushed these teeth, and if so, is there anything that can be done to fix this (inexpensively)?
- Patricia in Florida

Patricia,
Yes, it’s entirely possible that the crown pushed the other teeth forward a little which made your bite a little off.

I doubt the teeth could be moved back, once they’ve been pushed. But I would ask the dentist who placed the crown to adjust your bite. There should be no extra charge for that–adjusting the bite is part of the service in doing a crown.
- Dr. Hall

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Paresthesia from wisdom tooth extraction

Filed under: Wisdom teeth — iowasmiles @ 5:41 pm

I am 35 and my dentist convinced me to have all four wisdom teeth removed to allow for braces. I had the surgery 7 weeks ago and had a very slow and painful recovery. I currently have little or no feeling in the left side of my lower jaw, teeth, lip and chin. The area of the numbness has lessened very slightly but I am now experiencing what can only be described as a “zinging” sensation when my chin is touched on the lower left. The paralysis means that I mispronounce some words and I wake each morning with stiffness and pain in the lip. I feel like I am eating with somebody else’s mouth and am desperate to feel normal again. Is all this a sign of the traumatized nerve repairing or a sign of nerve death?
- Suzanne in Pennsylvania

Dear Suzanne,
You’re experiencing what is called “paresthesia” in the nerve that goes to the lower left jaw. This means that the nerve is healing, and in a few weeks you should have complete feeling back.

This nerve probably went close to the roots of your lower left wisdom tooth and was bruised during the tooth extraction, but wasn’t severed.

It can take as long as a year for this nerve to heal if it’s been damaged. Since you’re already starting to get feeling back after less than two months, I’m guessing your feeling will be back to normal in another two to four months.
- Dr. Hall

We thank our advertisers who help fund this site. Our cosmetic dentist referral pages list cosmetic dentists we recommend.

April 28, 2007

What’s the secret to truly white, white teeth?

Filed under: Tooth whitening — iowasmiles @ 9:30 pm

Dr. Hall:
Nice site. I happened on it looking for information about Lumineers.

My question pertains to tooth whitening. I have done many cases of tray-take home bleaching. I NEVER get white-white results. I do use Nite White. I disucss adjunct whitening toothpastes and certain habitual dietary controls. What is your secret (and technique) for white/white results?
- a dentist in California

Dear Dr. —
The secret to very white results isn’t whitening toothpaste or diet or anything other than the whitening procedure. It’s purely a function of the amount of time they whiten. Keep wearing the trays with the Nite White for as many hours of as many days as possible.
Even Zoom whitening won’t get teeth whiter than persistence and simple tray bleaching.
Dave

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What is the whitest shade?

Filed under: Finding a cosmetic dentist, Lumineers — iowasmiles @ 9:25 pm

Dr. Hall
I recently had Lumineers applied to my 2 front teeth for cosmetic reasons to brighten my teeth. The surrounding teeth are naturally very “bright white” and the cosmetic dentist and hygenist told me that I had the lightest shade. What is the lightest shade?? They appear darker than the other teeth. He said to stop using the at home tooth whitening. He said, “Don’t whiten your teeth anymore and they will match up.” How true is that? My teeth are still going to be darker in the front. They will never match I don’t believe. What am I to do?
- Toni from Tennessee

Dear Toni,
I’m not sure why you are referring to a cosmetic dentist that you went to. What makes you say he is a “cosmetic dentist?” Just because he said so?

I am suspicious and wondering if he is really what I would call a cosmetic dentist, because you are telling me he and his hygienist said they gave you the lightest shade. When they use terminology like that, that sounds to me like it’s coming from a general dentist, not a cosmetic dentist.

To a general dentist, B1 is considered “the lightest shade” because that is the whitest color that teeth tend to ever be without bleaching. But when you bleach your teeth, you can usually get them whiter than “the lightest shade.” So I don’t usually hear expert cosmetic dentists talking about “the lightest shade.” Most expert cosmetic dentists, when they do a smile makeover with porcelain veneers, will encourage their patients to go beyond the lightest natural shade, because almost everyone wants a bright, sparkling smile, and usually B1 simply isn’t white enough.

Read about the difference between a general dentist and an expert cosmetic dentist, and this will help you understand better what is going on with the advice you’re getting.
- Dr. Hall

Click here to find a cosmetic dentist.

Bonding or porcelain crown for a chipped tooth?

Filed under: Crowns for front teeth, Tooth bonding — iowasmiles @ 9:12 pm

Dr. Hall,
I read extensively on this site about tooth bonding and I’ve been told by my general dentist that the bonding won’t hold and she had recommended a porcelain crown.

My question is this: Can my chipped front teeth be corrected with “tooth-bonding” and will they hold for an extensive time with my cautious care?

Thanks,
Val from New Jersey

Dear Val,
Many dentists are uncomfortable with direct bonding and will try to discourage you from doing that. But it generally holds up very well, and would be my choice for a chipped front tooth, in most cases.

There could be any of several reasons that your dentist wants you to do a crown. She may not be very good at direct bonding (it requires some artistic talent to do it well), she may not carry all the shades, textures, and varieties of direct bonding materials (most general dentists only keep an inventory of “general purpose” bonding composites, and don’t stock the highly specialized materials required to do beautiful and long-lasting work in the front of the mouth), or she may want to do the higher fee procedure, or it could be that you have an unusual bite that would break off the bonding and maybe the porcelain crown really is the best procedure.

I’d recommend a second opinion from an expert cosmetic dentist – one of the New Jersey cosmetic dentists we recommend.
Dr. Hall

We thank our advertisers who help fund this site. Our cosmetic dentist referral pages list cosmetic dentists we recommend.

April 25, 2007

Go to a cosmetic dentist to fix your one dark, weak, front tooth

Filed under: Testimonials about our recommended dentists — iowasmiles @ 10:42 am

Hello Dr. Hall,
I had a fall from a bicycle when I was seven years old and damaged my front tooth. No root canal was ever done and the pulp just disappeared. Over the years the tooth has become dark and my dentist has tried very hard to place tooth bonding material over the tooth to balance the color, but it is not right.

I am now 50 and very self-concious of it. There are many surface cracks and my dentist is worried it will crumble if we do any reduction to fit a porcelain veneer. Any ideas? Please.
- Helen in California

Helen,
The problem is that your dentist isn’t a cosmetic dentist. Cosmetic dentistry is a very specialized field. Your family dentist sounds like an honest and nice person–if he or she weren’t he or she would have tried to sell you some expensive treatment.

But this tooth will be very easy for an expert cosmetic dentist. I did several cases like this myself. I would tell you how it’s done, but I’m afraid you would be tempted to go to your family dentist and ask him or her to try to do this for you–and that simply won’t work. I can tell from what you’re telling me that your dentist simply doesn’t understand cosmetic dentistry. It takes years for a dentist to learn cosmetic dentistry. Just go to a true cosmetic dentist and that will solve your problem.

Check out one of our recommended Southern California cosmetic dentists. Any of them will know how to fix this and it will look beautiful, and soon you will forget that you ever had a damaged front tooth–it will look exactly like your other front tooth. Have the cosmetic dentist fix this tooth for you, and then go back to your regular family dentist for everything else, because your family dentist sounds like a kind and honest person.

Helen’s response later that day:

Dear Dr. Hall,
Thank you for such a speedy response. I will call tomorrow and set up an appointment.

Helen then wrote the following month:

Dr. Hall,
I just wanted to say thank you for your referral to Dr. Goodrick in Santa Clarita, California. He is a wonderful and compassionate professional, who has the patient’s best interests at heart. For the first time, in so many years, I will have that smile I have missed.

I want to thank you from my whole heart!
Sincerely,
Helen

We thank our advertisers who help fund this site, but see our referral pages for our recommended cosmetic dentists.

April 21, 2007

Porcelain crowns on lower front teeth.

Filed under: Crowns for front teeth — iowasmiles @ 2:42 pm

Dear Dr. Hall,
I recently had root canal treatment performed on my bottom two front teeth. My dentist indicated that I will need to have crowns put in. But the two bottom front teeth have very short roots, and there may be issues of strengh and stability of these teeth. It order to address these two issues it was suggested by my dentist that I have four porcelain fused to gold crowns put in. Two crowns would be for the two bottom front teeth with short roots , and crowns for each tooth beside these teeth. The stability would come from metal the lab would use to connect all four crowns together. I was also told that you would not see the metal, and that the crowns would appear like four individual teeth.

I asked my dentist if the procedure can be done using all procelain crowns instead of porcelain fused to gold since all procelain crowns have a more natural appearance and there was my concern about the black line appearing on the gumline if the gums recede? She insisted that porcelain fused to gold crowns was the best method for this situation.

My question is: Is it possible to have this procedure done with all procelain crowns? Do I have any other options?

Awaiting your response. Thank you,
- Nancy from Quebec

Dear Nancy,
As we say on our web site, all porcelain crowns look much more natural than porcelain fused to metal crowns. With the metal in them, they tend to get a black line at the gumline.

But you need to be very careful about pushing your dentist to use a material or procedure he or she may not be comfortable with or disagrees with. It’s much better to find a dentist whose philosophy you’re comfortable with and then trust their judgment.

In the case of lower front teeth, where she wants to splint the teeth together, there are several factors that weigh against using all porcelain crowns:
1. The black line at the gumline rarely shows with lower front teeth, on most people.
2. With gold metal on the back of the crown, the dentist will have to grind away less tooth structure on the tongue side of these lower front teeth. Since these lower front teeth are so small, that’s a significant factor.
3. She can join the metal in each crown into a strong metal framework.

So I would tend to agree with your dentist in this situation, just based on what you’re telling me, without doing an exam myself, which admittedly limits me here. If you aren’t happy with that, though, I wouldn’t push your dentist, as I said, but would get a second opinion from our Montreal cosmetic dentist, and see if there is a more esthetic way to do it.
- Dr. Hall

We thank our advertisers who help fund this site. Our cosmetic dentist referral pages list cosmetic dentists we recommend.

Nerve damage during wisdom tooth removal

Filed under: Wisdom teeth — iowasmiles @ 7:02 am

Dr. Hall
I recentley had an impacted wisdom tooth removed surgically, it has been 3 weeks and the side of my tongue is still numb with no feeling and I can’t open my mouth very wide and it still hurts, is this common and what should I do?
- Duncan from Florida

Dear Duncan,
The nerve that goes to your tongue (the lingual nerve), as it comes into your mouth, goes very near the wisdom teeth, and it can be damaged during a surgical wisdom tooth removal. It doesn’t travel the same course in everybody, and sometimes it even travels directly on top of the wisdom tooth, making it difficult or impossible not to damage it.

So your next question would be will it heal, and how long it will take. That answer depends on how badly it was damaged. If the nerve was stretched or bruised, it takes about a month or so for it to recover. If it was crushed, it may take up to a year to recover. If it was cut, then the cut parts of the nerve are likely never to grow back together. Sometimes, with a cut nerve, there will be some growth in the nerve over time back into the area it used to go to, but usually not.

There is also a microsurgical procedure to try to repair the nerve. It’s a difficult surgery, but sometimes it works. You could ask about that, if that’s important to you.

I’m hearing you saying that you have no feeling at all in the side of your tongue. At this point, three weeks after the surgery, the nerve damage could be any one of these things I listed. If you just have kind of a numb feeling, but there is tingling feeling in the side of the tongue, that’s an indication that the nerve is damaged but is repairing itself.

Not being able to open your mouth very wide at this point is a different issue. Inability to completely open your mouth is called trismus, and it can mean several things. Usually, it’s just that the swelling during the healing was pressing against muscles and keeping you from opening all the way. But if this inability persists, and the general swelling has gone down, I would look for the possibility that you have a resistant node of infection deep in the tissues pressing on some of your muscles. I’d recommend getting a strong dose of antibiotics to take for about two weeks–something like Clindamycin that is really powerful against resistant bacteria in the mouth.
- Dr. Hall

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April 19, 2007

Lumineers fell off, one cracked

Filed under: Lumineers — iowasmiles @ 6:24 pm

Dr. Hall,
Do you have any tips on trying to get at least a partial refund from a dentist that put 8 Lumineers in less than 6 months ago and I’m now having them replaced by a cosmetic dentist? I signed some things that are going to put me at a disadvantage. The dentist that did these is right out of school.

I just wish I had seen your web site BEFORE I allowed this dentist to convince me she was an expert on doing these. I became concerned when she had trouble getting the first ones on. I went home and the front tooth Lumineer fell off. Now one has cracked and then fell off in less than six months. I had to hide in my house for eight days waiting for the replacement. So I finally decided I had to find a cosmetic dentist. I was scared to have her do anymore.

So I’m doing all 8 over again. My gums had to be lasered because the poor placement caused inflammation. Sounds like I will have a much better mouth, but at double the expense almost.
- Norma in Virginia

Norma,
There’s a possibility you might be able to get some or all of your money back, since a couple of the Lumineer porcelain veneers fell off and then one cracked and they caused gum inflammation. If it were just that you didn’t like how they looked, you’d be in a weak position, because the legal standard of protection for cosmetic dentistry is pretty low. There are too many dentists who will say that the work is fine if it just functions well, regardless of whether or not it looks beautiful, so looking crummy doesn’t get you anywhere in the legal system. But if they fall off and crack, and they’re contributing to gum disease, then you may have a case. I don’t know if you’ve asked nicely at this point, or what you’ve discussed with this dentist. But what you’ll probably have to do is threaten to sue and see if that softens her position.

It will help if the new dentist will back you up and will be willing to say that the first job wasn’t up to standards. But many dentists are reluctant to do that with another dentist in their community, since it doesn’t help make friends. And be sure you have good photos of the poor work.
- Dr. Hall

We thank our advertisers who help fund this site. Our cosmetic dentist referral pages list cosmetic dentists we recommend.

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