The Cosmetic Dentistry Blog

May 31, 2007

Maintenance for porcelain veneers

Filed under: Porcelain veneers — iowasmiles @ 4:45 pm

Dr. Hall,
I am considering porcelain veneers, but I am concerned about the long-term cost they require – what is the approx. cost of maintenance? I am 29 years old now. Thank you.
- Michele from New York

Dear Michele,
There really isn’t any special maintenance cost, beyond what would be required for your teeth. That’s one of the very nice things about porcelain veneers–when done properly they are bonded to your teeth and you can be tempted to forget you have them.
It becomes more important to have regular dental checkups and have them cleaned. And you do need to be careful about which dental office you go to for maintenance–they need to know what they are doing. Many family dentists aren’t familiar enough with porcelain veneers and could do things that would damage them. For example, they shouldn’t use ultrasonic scalers, shouldn’t use power polishing equipment, or coarse abrasives because they could scratch or chip the veneers.
For more information, see our page on care of porcelain veneers. I would suggest Supersmile toothpaste as a great way to keep your teeth and veneers sparkling. We also have a page on general cosmetic dentistry maintenance that has some additional information.
And then, for long-term purposes you need to understand that no dentist will promise that the porcelain veneers will last forever. While their lifespan is excellent (after almost twenty years of doing porcelain veneer smile makeovers, I never found a case that wore out and needed to be replaced), a dentist simply can’t promise that. So consider that they may need to be replaced in 15 to 20 years.
- Dr. Hall

Additional information:
Dr. Bonnie Rothwell has a good post on her web site about how long porcelain veneers will last.

May 28, 2007

I’ve had an infected wisdom tooth socket for months

Filed under: Infected teeth, Wisdom teeth — iowasmiles @ 6:39 am

I had all 4 of my wisdom teeth removed last year with only one issue on my back left tooth # 17? i believe, where there was a little “pocket” where my bone should have been. this has led to a complication that my orthodontist pointed out as when she poked the gum where my wisdom tooth was, green puss started oozing out (small amount, but had a very foul smell) my breath has been mildly bad because of this bacteria or infection of some sort, and it almost seems as if the bacteria seems to want to move to other areas of my mouth as my plaque smells of this bacteria. Do you know what kind of bacteria it is and how i can get rid of it? I have tried squeezing the bacteria out of the pocket, however it keeps reproducing itself. i regularly use listerine. Also, my dentist blew some air with a tool over that area, and they could see i suppose a small green area. help!!!
- Crandall in California

Crandall,
You need to get rid of this bacteria that are causing your tooth infection. And what you’re doing isn’t working. And I can’t help but think this is awfully putrid smelling.
Your on a little bit of the right track with the air. These bacteria that nestle in sockets like this are “anerobia” bacteria – oxygen is poisonous to them. The Listerine clearly doesn’t seem to be getting the job done.
I’ve deal with these infections many times, and I would recommend, in your case, a heavy-duty two-pronged attack. One, you attack them right in the socket. But you need a gentle rinse of hydrogen peroxide, like the kind that is used to help whiten teeth. Get a bottle of 3% hydrogen peroxide from the drug store, and mix it with a mild salt solution, half and half. Then you need your dentist to give you an irrigating needle so you can poke directly into the socket and gently pump in this hydrogen peroxide. Do it after every time you eat, because that’s when this hole fills up with gunk.
Then I’d attack them through the bloodstream with a prescription of Clindamycin, 150 mg four times per day for a good ten days.
I’m pretty confident the smell and infection will be gone by then. Then back off and irrigate the socket just once a day as it fills up with tissue.

You can read more about hydrogen peroxide and oral yeast infections.
Dr. Hall

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May 25, 2007

What to do about enamel erosion on the inside of the teeth

Filed under: Tooth bonding — iowasmiles @ 3:10 pm

Dr. Hall,
I have severe enamel erosion on the inside of my teeth. What would protect my teeth better, bonding or caps? Can you recommend a cosmetic dentist in Simi Valley, CA.
-Tami in California

Tami,
For the inside of your teeth, you would need porcelain crowns. Bonding just wouldn’t hold up well enough on the inside of your teeth to do the job.

And good cosmetic dentists are simply not common enough to find one in every community. My recommendation if you’re in Simi Valley is to see Dr. Dell Goodrick in Santa Clarita, which isn’t that far. He does beautiful work. Otherwise, there are also really good cosmetic dentists in Pasadena and Beverly Hills. See our list of Southern California cosmetic dentists.

And for the benefit of other readers, loss of enamel on the inside of your teeth is an unavoidable consequence of bulimia, in addition to a shortening of your teeth. Expert cosmetic dentists are trained to treat bulimia, and they are trained to be extremely confidential about your case.
Dr. Hall

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

May 22, 2007

Unhappy with appearance of porcelain veneers

Filed under: Finding a cosmetic dentist, Porcelain veneers — iowasmiles @ 8:44 am

Dr. Hall
My girlfriend had two crooked front teeth from an accident when she was young. She has always wanted to straighten them but hasn’t been able to afford it. I told her I would help her and found an orthodontist on the island where we live. He told us he was skeptical as to whether the teeth would stay in place due to ligament damage.

We went to a dentist supposedly specializing in cosmetic dentistry who suggested porcelain veneers and put us on a payment plan. $6000 later Natalie has six new front top teeth. Unfortunately neither of us are pleased with the shape or size of her new teeth. They look very large and unnatural. Can something be done at this point? Does the dentist have any obligation to help us? Should we see someone else? We are really unhappy with the results, and I am disappointed that we were never shown a model of what they would look like. Thanks for the tips.
Aloha
- Eric in Hawaii

Eric,
You are showing that you have insight into the problem you have by referring to your dentist as someone “supposedly specializing in cosmetic dentistry.”

Cosmetic dentistry isn’t a legally recognized specialty, and thus any dentist, with no special training at all, can claim to be a cosmetic dentist. This dentist doesn’t have a legal obligation to help you just because you don’t like how they look. As long as the porcelain veneers are functional, that’s ordinarily the extent of his legal obligation.

There are two really good cosmetic dentists in Hawaii. One of them isn’t accepting new patients. The other is Dr. Wynn Okuda in Honolulu. I’d suggest you see him and see what he thinks of your case and what he can do to help.
- Dr. Hall

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May 18, 2007

Empress Crowns and Dental Insurance

Filed under: Dental insurance, Finding a cosmetic dentist, Porcelain crowns — iowasmiles @ 10:14 pm

Hi. I am a 52 yrs young woman, needing several crowns due to huge fillings loosening, root canal treatments and the like. I have been prepared for 1 crown so far and asked the dentist for all porcelain crowns, wanting to rid my mouth of ANY metal as the work continues on. They told me it would be an Empress crown. My insurance company pays for Porcelain/ceramic substrate crown at a certain rate. Even though the Empress crown is all porcelain or ceramic my dentist says that the Empress is not coded on the insurance form and he will have to charge me over $1000 for the crown. (The insurance says the charge for code 2740 porcelain/ceramic substrate s/b $370). I am not sure if I am being told the truth by the dental office. It just doesn’t make sense to me. Can you comment on this affair? Thanks. PS. I do have some budgetary issues, so if I need 8 or so crowns, the cost does count!
- Pam in Florida

Pam,
I think you are being given correct information by your dental office. There is no special code for Empress–Empress is a brand. And $1000 is on the low end of fees for dental crowns so that’s a reasonable deal. Dental insurance isn’t like auto insurance or life insurance or medical insurance, which is designed to cover risk. Dental expenses are pretty predictable, so think of your insurance as a benefit plan where they are helping you a little with the costs. So unlike medical insurance where the higher the cost the more you need to rely on the insurance, this is a case where the higher the cost, the more the insurance company wants to protect itself, so it can make a profit. From what you said, you implied that the all porcelain crown was your idea, not the dentist’s. I need to warn you about this. This is very risky, doing an all porcelain crown, if the dentist didn’t recommend it. Many dentists are not very good at the sophisticated bonding techniques for placing all porcelain crowns, and you could be pushing the dentist out of his or her comfort zone. Good cosmetic dentists will really resist doing porcelain fused to metal crowns on front teeth, because they’re ugly. So if your dentist didn’t recommend all porcelain, I’d take that as a signal that you’re in the wrong office, if that’s what you want. 
- Dr. Hall

Related information:
Read about one-visit Cerec crowns.

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Gum inflammation from crown work

Filed under: Gum disease, Porcelain crowns — iowasmiles @ 9:46 pm

Dr Hall:
I had a crown put on my front right upper tooth and a veneer on the front top left. After this was done, my gums became inflamed, and they have not come back to normal after many months. I’ve seen a new dentist, a periodontist (who treated the gumline to try to fix), and most recently, a prosthodontist, because my new dentist and the periodontist were stumped about how to resolve this, as they think the Empress porcelain used on the crown is fine and that perio surgery might not resolve the gum inflammation and could risk cosmetic damage, so they said. The prosthodontist saw me yesterday, and she said it’s likely not a fixable problem. That the dentist that put in the crown went too deep and close to the bone, and that could be causing the gum inflammation. Furthermore, she stressed that if my gums aren’t treated it’s a health risk to me as inflammation there can lead to worse diseases, but I am not getting any solutions! She said perio surgery could possibly resolve this, but that cosmetic damage to the papilla(?) – the gum area between my two top front teeth – is quite possible as a result. I am so upset. I don’t want a health risk issue but don’t want to damage my smile via perio surgery (and there’s no guarantee the perio surgery will resolve the gum inflammation anyway!). Any ideas? THANK YOU.
- Mark from Maryland

Mark,

The porcelain crown and porcelain veneer have violated the biologic width of your teeth–they are too deep under the gums. The porcelain in Empress crowns is very gentle on the gums, so that’s not the problem. It’s interesting that this stumped your dentists for so long. This isn’t a widely understood phenomenon, because it’s a relatively recently researched concept. But I’m disappointed that they’re being so timid with recommending a solution. Your case is an interesting study in the “dentist personality.” They’re saying you should have the gum surgery, but it’s like they don’t want to say it too directly for fear of being sued. The prosthodontist wants to call the change in appearance of the papilla between the teeth “cosmetic damage.” But the damage has been done already, and I think you should have the surgery. Yes, that won’t look perfect, but it doesn’t look good now, and your present condition certainly isn’t healthy. You have gum disease on these two teeth. I don’t think you should just let that go. And I don’t think your prosthodontist thinks you should just let it go, either. She just wants to be sure you feel thoroughly warned so she doesn’t get flak when you see the results.

It’s not right to say there isn’t a solution. It would be more accurate to say there isn’t a perfect solution.

I hate that when they say, “there’s no guarantee.” Of course there’s never a guarantee, but what’s the point of dwelling on that? Ask what results you’re likely to get, and then go on recommendations. No wise dentist is going to “guarantee” anything.

Meanwhile, I would think an antibacterial rinse such as Peridex would help reduce the inflammation some. But be careful. Peridex stains the teeth, and if you use it, you should also brush with Supersmile toothpaste, since that’s the only toothpaste known that keeps this stain from forming.
- Dr. Hall

Related links:
Click here to ask Dr. Hall a question.
Click here to find an expert cosmetic dentist.

May 17, 2007

Invisalign to close tooth gap

Filed under: Invisalign, Tooth bonding — iowasmiles @ 8:24 pm

Well I have a small/medium sized gap in my front teeth, can invisalign close it?
- Sara in California

Sara,
Invisalign could probably close your tooth gap, but it would be easier, faster, cheaper, and better to have direct tooth bonding. But you would need an expert cosmetic dentist to do this.
Check out the information about this procedure on our tooth bonding page.
- Dr. Hall

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May 5, 2007

Listed with Technorati

Filed under: Uncategorized — iowasmiles @ 8:06 pm

The mynewsmile.com blog is now listed with Technorati:

A Cracked Porcelain Veneer

Filed under: Porcelain veneers — iowasmiles @ 8:41 am

Dr. Hall,
I got porcelain veneers across my top eight teeth last fall. I love them – my teeth were very small and the procedure lengthened them considerably and made them even and straight.

Here’s the problem: on my right lateral incisor, there is now a crack which is noticable, about a fifth of the way up the tooth, going all the way across. I can feel it with my fingernail. I am worried that it is going to fall off.

I paid for my dental work with an inheritance. I picked the best cosmetic dentist I could find, price was no object, and I felt like I received a great smile. But I’m uninsured, normally not wealthy, and I can’t afford to keep going back to them for regular dental work when I can go to a clinic for a cleaning. I’m afraid that if I go back, they’re going to keep charging me and charging me. They’ve called me to try to set up regular dental appointments after I “broke up” with them after the cosmetic work, but I don’t pick up because I’m very nonconfrontational.

What are some ways it is possible to have a veneer crack like that? What could cause it? Is there any way they could claim that it was my fault? There’s just no way… I treat these new teeth like an investment, and I haven’t been punched in the mouth.

Help! I don’t know what to do.
-Juniper in Chicago

Juniper,
Even a cracked porcelain veneer, if it is bonded on well, is unlikely to fall off. However, your description suggests that this horizontal crack is up near the incisal edge of the tooth, and, especially if your tooth was lengthened, there could be not much that is holding this on.

I’d go back to the dentist and have him look at the crack and see if he can fix it–it sounds like he needs to replace the one veneer. While no cosmetic dentist will promise that their veneers last forever, this veneer shouldn’t have cracked after just six months. I wouldn’t be surprised if he’d fix it for you for no extra charge. At least ask him.

I doubt he would blame it on you. Usually, “porcelain veneer abuse” results in chipped veneers, not in cracks where the entire veneer remains on your tooth. This kind of crack happens occasionally to ceramic restorations, and it may be due to stresses in the material. So be brave and call them.

Just be up front with them–tell them their fees for cleanings, etc., are higher, and you don’t have the budget for that on a regular basis, but one of the veneers is cracked and you’d like Dr. Bock to look at it and want to know if you’d be charged for that. From having dealt with many patients, I can tell you that there are a number of patients who are up front and frank about financial issues like this, and this never offended me. You wouldn’t be out of place to bring that up.
- Dr. Hall

A related subject: cost of porcelain veneers

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May 2, 2007

Porcelain veneer fell off

Filed under: Porcelain veneers — iowasmiles @ 11:00 am

Hello. In 1994 I had ten porcelain veneers on my upper teeth due to severe tetracycline stain. I am very happy with them. Yesterday, one of my two front veneers split in two lengthwise and fell off. My dentist’s office had me come in and they have temporarily glued the piece back on which is very uncomfortable and I am very afraid it is going to fall off again. They are making me wait another 5 days to have a temporary tooth put on. To me, obviously, this is an emergency. I was told however at my dentists office that it’s not considered an emergency because it’s cosmetic. Would other dentists consider this type of situation an emergency? Also, would it be best to replace the broken veneer with another veneer or should I do a crown? Will the pores of the tooth hold another veneer?

Thank you very much for your time!
- Val in Ohio

Val,
I think that offices that do a lot of cosmetic dentistry understand the nature of an “esthetic emergency.” In our office, we gave them top priority.

I would not go to a porcelain crown. Yes, you can have a new porcelain veneer bonded on and it should hold as well as if it were original. The dentist needs to thoroughly understand bonding chemistry, though. It would be good to remove all of the old bonding material, just to be sure you’re starting with a fresh surface, but even that isn’t absolutely necessary, if the surface is treated properly.

You don’t have to have this re-done by the same dentist that did them in 1994. An expert cosmetic dentist will be able to match it nicely, maybe even better. If you’d like to try someone who understands the nature of an esthetic emergency, try one of our Ohio cosmetic dentists. You’ll find them all excellent and very understanding of this type of emergency.
- Dr. Hall

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