The Cosmetic Dentistry Blog

November 30, 2007

A snap-on smile

Filed under: Cosmetic dentistry costs — iowasmiles @ 8:29 pm

I have some spacing between my teeth but I cannot afford expensive cosmetic dentistry. Is there anything I can put over my teeth to give the illusion that they are straight? Something that is a quick fix–something in the realm of dentures?
- Carissa from Massachusetts

Carissa,
Something inexpensive and temporary to fix the spaces between your teeth would be a “Snap-On-Smile.” And I believe almost any dentist, without special training in cosmetic dentistry, could help you get one of these. It requires a simple impression, a choice of shade and smile design, and then your dentist sends it to a laboratory in New York where they make it.

As its name implies, you can put it in and take it out when you want to. Expect it to last 3-5 years, if you wear it all the time. And expect it to cost about $1000 to $1500, which is about the cost of one porcelain veneer.

Another alternative, which may not be too expensive, depending on how many spaces you have, would be direct tooth bonding. You can read more about this on our tooth bonding page. This involves just adding tooth-colored composite to the sides of the teeth. But you need to go to an expert cosmetic dentist to have this done, because it takes artistic talent. This will last longer than the Snap-On-Smile.
- Dr. Hall

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November 26, 2007

What about JK Veneers?

Filed under: Finding a cosmetic dentist, Porcelain veneers — iowasmiles @ 11:58 pm

Your web site provides a great deal of information for those of us considering porcelain veneers. With this being a major investment, I want to research it as much as possible. Your site provides information on MAC Veneers and Lumineers. Is there anything you can tell me about JK Veneers, which I’ve read about on some other sites. Thank you, Dr. Hall!!
- Dawn in Iowa

Dawn,
I’m going to suggest that you take a different tack in your research.

It’s not the porcelain that makes the beautiful smile. This is art, not engineering, that you are talking about. There are beautiful and ugly Lumineers smiles, beautiful and ugly MAC veneers smiles, beautiful and ugly Da Vinci veneers smiles, beautiful and ugly Cerec veneers smiles, and beautiful and ugly JK veneers smiles. It’s the dentist and the lab technician that the dentist picks that make the beautiful smile, not the porcelain.

When I choose whether or not to list a cosmetic dentist on my site, I do it on photographs of the final results of their work. And I’ll tell you that I can’t tell, from the photographs, what brand of veneers they are using, and I never ask, and I never will.

If you were asked to commission a painting for the entrance of the building where you work, would you pick the brand of paint or the brush? No, you would pick the artist and let the artist use the materials he or she wanted. But with dental porcelain, you have marketing entering the picture, and these dental porcelain companies trying to sell their porcelains by going direct to the consumer. And dentists are then attracted to the marketing schemes because they can sign up with the porcelain companies to get a piece of the action. For example, a dentist can sign up for the Lumineers course, and then get on the Lumineers list. So they play along with this notion that certain brands of porcelain make the most beautiful or longest-lasting smiles. Don’t get taken in by this.

What you need to do is pick the artist and then let him or her use the dental lab and the porcelain that work best for him or her.

And I think you’d be making a mistake to go to a dentist and specify the brand of porcelain you want him or her to use. If you start questioning them on their materials and telling them how they should do your case, you are going to become an annoying patient and you will not motivate them to do their best work.

I see you’re in Iowa. Check our list of Iowa cosmetic dentists. There are very few good cosmetic dentists in Iowa, so the choice is pretty easy when you know where to go.

Find a dentist/artist that you feel comfortable with, and then let them use the laboratory and the materials that they are the most comfortable with. I’m sure they each will have a ceramist that they have developed a close, trusting relationship with and that they will want to use to produce the most beautiful smile they can. And they each have a porcelain, I’m sure, that they’re partial to.

And as far as durability and other physical issues, I don’t think there’s a significant difference between the brands and how they function in the mouth, when it comes to porcelain veneers.
-Dr. Hall

November 23, 2007

Unhappy with new porcelain veneers

Filed under: Porcelain veneers, Smile design — iowasmiles @ 11:16 am

Dr. Hall,
I had porcelain veneers put on in July of this year. I am not happy. The canine teeth look crooked and there is a little line above my left front tooth that may be my natural tooth surface showing through. The dentist said that he didn’t want to do anything about that because it was so small and that he could barely see it. I am now so unhappy. I am afraid that I am going to get decay on the top of the front tooth, and I spent so much money. I had old bonding that needed to be replaced so I had to do something to my teeth, but now I am just as unhappy and insecure as with the old bonding on. What should I do? I don’t want to be a difficult patient, is he right about the little bit of tooth surface is it not a big deal? What should I do?
- Elizabeth from New York

Elizabeth,
I don’t think you’re at a risk for tooth decay in that spot that’s maybe showing your natural tooth. I can’t be sure without seeing it myself, but as long as there isn’t a groove or a ledge that will catch plaque, your tooth isn’t vulnerable there. So your dentist is right on that point.

But it sounds like you aren’t happy with the appearance of your new smile, and I’m disappointed that your dentist didn’t let you know exactly how they were going to look before the porcelain veneers were bonded on. Good cosmetic dentists will always make sure you see exactly how they will look first, often even letting another family member or a friend look at them with you. General dentists tend to give you a mirror while you’re upside-down in the chair and let you see them for a few seconds and then go ahead and bond them on.

If there are things you don’t like about how they look, I would ask your dentist to re-do those things, like the crooked canine teeth. Share my e-mail with him if you want, and tell him I said that you paid for a beautiful smile, and if it doesn’t look beautiful to you, it’s not good enough.

A good cosmetic dentist, for example, wouldn’t say, “That’s so small, I can barely see it, so I’m not going to fix that.” Instead, he or she would say, “That’s so small, I can barely see it. Are you sure you want me to change that?” Because a good cosmetic dentist is first of all a good listener and knows that the patient needs to love the smile.

This is at the heart of a key difference between a good cosmetic dentist and a general dentist who likes to dabble in cosmetic dentistry. The good cosmetic dentist understands that he is treating the self-image of the patient, and that if the patient isn’t happy with how the smile looks, then the treatment is a failure. This is basic. Good cosmetic dentists have many procedures in place to insure that when you go home after the treatment is over, that you love your smile and that you smile with confidence. That is what cosmetic dentistry is all about, and if your dentist doesn’t understand that, then you can help teach it to him by being a “difficult patient.” He will end up being a better cosmetic dentist, thanks to you.

When I was young and only a couple years out of dental school and just learning cosmetic dentistry, I had several cases that when I did them, they looked okay to me, but they weren’t good enough. So I completely re-did them at my expense until they were beautiful. This is part of the learning process, and it’s what helps cultivate a great reputation for doing gorgeous work.
- Dr. Hall

Related information:
Read about smile design.
Read about how some cosmetic dentists use a smile imaging computer to test various smile designs, to help insure that the patient loves the results.

My dentist says porcelain veneers won’t work for me.

Filed under: Finding a cosmetic dentist, Porcelain veneers — iowasmiles @ 8:14 am

Dr. Hall,
Years ago I had bonding done on the four front teeth upper and lower. I am not happy with my teeth, the bonding looks worn. I asked my dentist about veneers and he said they would not work because of the work I already had done. He wants to use crowns. Is that true?
- Penny from New Jersey

Penny,
I had to chuckle when I read your question, because I have seen this type of comment SO many times from dentists.

Your dentist isn’t right. You are a perfect candidate for porcelain veneers, if you’ve had dental bonding before. And PLEASE don’t let this dentist put crowns on you. He’d have to grind your teeth down to stubs to do crowns, which would be okay if that’s what you needed, but you don’t need that. But I want to help you understand what is going on.

As dentists, we are trained in dental school to exude confidence toward the patient. When the dentist is confident the patient is more comfortable. If the patient thinks the dentist isn’t confident, the patient’s anxiety level skyrockets. So you’ve asked your dentist to do porcelain veneers, and he really doesn’t feel confident doing porcelain veneers. He wasn’t trained in dental school to do porcelain veneers and, like almost all dentists, isn’t really that gung-ho about cosmetic dentistry. But he knows how to do crowns. But he can’t say, “you know, I don’t really feel comfortable doing porcelain veneers.” He just can’t. So he deflects the question by saying “porcelain veneers won’t work in your situation.” He’s doing what he was trained to do.

Very few dentists are really good in cosmetic dentistry. It’s not a legally separate specialty, so any dentist can say they’re a cosmetic dentist. So that removes a lot of the incentive for pursuing the special training. (It takes several years beyond dental school, going to various courses around the country, to get this training and several years also to get the experience needed to be a good cosmetic dentist.) In addition, cosmetic dentistry is an art, and the overwhelming majority of dentists chose the field because they like to fix things. You have a cavity, a broken tooth–they fix it. But you want a new smile, so you need an artist. And there are so many advertising claims out there, and no regulation.

My advice is to check our list of New Jersey cosmetic dentists. All of these dentists are artists who chose to become dentists, and they do beautiful work. We have checked photos of the work of every one of them to insure that, and being an accredited cosmetic dentist myself, I know what to look for. So pick one and go there. You’ve had this bonding for so long, it’s looking dingy, and you deserve to have a beautiful, sparkly smile now.
- Dr. Hall

Related information:
See a similar question from a visitor whose dentist said that a bridge with a natural-looking ovate pontic wouldn’t work for her, because the dentist wasn’t comfortable doing it.
Read about the difference between a general dentist and a true cosmetic dentist.

Response from Penny:
Thank you for the quick response and for the great info. You know, it didn’t feel right about the crowns. I’ve had crowns done and I am aware about the procedure and was not happy about that. I will call Dr. ______ on your list. If he was only a little closer but I think it will be worth it. Thank again.
- Penny

November 20, 2007

A real tough wisdom tooth extraction

Filed under: Wisdom teeth — iowasmiles @ 9:50 am

Dr. Hall,
I have a severly impacted wisdom tooth with a large cyst over it for some time now. It never bothered me until about 3 weeks ago. I’ve seen a dentist and am planning to have it removed, he explained the procedures to me which I can deal with. My question is what other alternative is there besides wiring my jaw shut. I am a smoker for over 50 yrs now and have difficulty breathing at times.

One dentist told me they could screw a piece of plastic brace type thing to the outside of the jaw. In this day and age there must be a few alternatives to wiring. I would appreciate any info you can give to help me.
- John from Connecticut

John,
I suspect there really isn’t an alternative to wiring your jaw shut. I don’t know your particular situation, but I’m guessing from your e-mail that, since you’ve been a smoker for over 50 years that your age is over 60. And I’m going on faith in your surgeon. I’m guessing that there must be some serious risk that your jaw will break because of the difficulty of the surgery. And after being there for many years, the cyst has very possibly grown to where much of the bone in that spot is gone. Which means that your jaw has to be wired shut to stabilize it while it heals. That’s the only way to insure that all your teeth will come together like they’re supposed to when you’re all done.

But your question provides a great illustration of the desirability of getting wisdom teeth out, the sooner the better. Don’t put this off–it will only get worse.

There are some voices that say, “Why worry about wisdom teeth? Don’t get them out until they start bothering you.” But those who do this surgery know that the risks and complications multiply quickly once patients pass their mid-twenties. If you had had this wisdom tooth out when you were young, this would have been much, much easier. But now it could become life-threatening.

Get this done and over with, because the risks will only increase the more you delay.

- Dr. Hall

Further information on wisdom tooth removal.
Read about tooth infection.

November 16, 2007

Filed under: Fractured teeth — iowasmiles @ 5:44 pm

Dear Dr. Hall,
My wife has a tooth that has been sensitive for quite a while, and nothing the dentist did helped. It’s a lower molar, and has a large amalgam filling in it. Well, they just told us it is cracked, between the roots, and said that it has to be extracted.

Do you think there is a possibility of healing the crack? Or does the tooth have to be extracted?
- Loren in Iowa

Dear Loren,
I’d have to see the crack to tell you for sure, but from what you told me it sounds like the tooth could be saved. If the crack is in what we call the furcation–between the roots–and if the tooth hasn’t yet separated into two pieces. The problem would be getting a dentist who would be willing to try that. It would need a crown, and either a gold dental crown or a porcelain fused to metal crown. If the pieces haven’t separated yet, that would be all you would need to do. When they do separate, it becomes more complicated, but if you catch it within the first couple of days, I outline a procedure in my article, “Saving Fractured Teeth,” for getting them to knit back together.

Dentists are a very cautious bunch who rely a lot on the opinion of other dentists. I’m still waiting for another American dentist to take up my research and try to duplicate it. It usually takes several independent studies for a blockbuster idea like “you can actually save teeth with vertical cracks” to become accepted. It would take a dentist who is the pioneering sort and who would be willing to stick his or her neck out in the pursuit of truth. There aren’t many like that, unfortunately.
- Dr. Hall

November 12, 2007

Porcelain veneers turning gray

Filed under: Porcelain veneers — iowasmiles @ 7:00 am

Dear Dr. Hall,
I’ve had twelve porcelain veneers placed on my front teeth. They were very pretty the first few days, but then the top six took on a gray cast thoughout the teeth with the cuspids getting even darker. The bottom six are still white at the top, but gray at the gum line and the gray looks as though something is seeping upward. My dentist thinks that he should replace the veneers with crowns. He believes that it may have something to do with hydration. I read the question Lesley from Texas (a bad experience with Lumineers) had with her veneers discoloring and your thoughts were that her dentist may have used a chemical that keeps the gums from bleeding when impressions are taken. Does this chemical stay on the teeth under the temporaries for two weeks or more until your permanent restorations are placed? I would greatly appreciate any feedback you may have.
Regards, Paula from Texas

Paula,
Oh, please don’t let your dentist replace these porcelain veneers with crowns. There is something wrong with the veneers–something your dentist didn’t do right. Porcelain veneers are the most beautiful restoration there is. They don’t turn dark in a couple of weeks unless the dentist did something wrong. To do crowns he would have to grind the teeth down on all four sides. And if he doesn’t know how to do porcelain veneers right, I worry what will happen if you let him do the much more aggressive treatment of crowns. Leaving them as veneers, if he can’t get them right, another dentist will be able to come in and rescue you.

And I doubt it’s the lab. Only if the lab did something really unethical, like not really use porcelain, or omit the glaze, could you have this immediate darkening.

The staining from ferric sulfate is a gray-brown stain, and it tends to be splotchy. And yes, that is the problem–the chemical DOES stay embedded in the dentin indefinitely.

I am very worried about your case, and what your dentist is doing. First, he did something wrong and is indicating, by what went wrong and his reaction to it that he doesn’t understand much about porcelain veneers. (A HYDRATION problem?? I don’t know what he means by that.) Second, he’s not fully owning up to it. Third, he wants to go to crowns, which is a very bad idea. If he doesn’t know how to do porcelain veneers, then I’m sure he doesn’t know how to do bonded all-porcelain crowns, meaning that he will do porcelain fused to metal or Lava crowns, or some other crown that he can cement conventionally, all of which will be way too aggressive a treatment for what you need, will weaken your teeth, and may well end up ugly.

I recommend that you see a true cosmetic dentist from our list on our Texas cosmetic dentists page, and get this done right.

If you’re the type that has the gumption to stand up for yourself, I would demand that this dentist refund your money. But if not, at least don’t let him put crowns on you.

From your description of the discoloration, it could be ferric sulfate, or it could simply be that the teeth got contaminated with saliva or gingival fluid during the bonding process. (Maybe this is what he means by a “hydration problem.” :) ) Did he use ferric sulfate? (Brand names are Viscostat or Astringedent, and it can be applied to the gums as a gel or it also comes impregnated in the retraction cord.) If so, then that’s what this is. The dentist rinses the teeth and thinks that all traces are gone, but the chemical gets embedded in the teeth and can be invisible until after the veneers are bonded on, after which it reacts with the bonding chemicals and turns a gray-brown and shows through. If he has used that on your teeth AT ANY TIME, he needs to swab some concentrated hydrogen peroxide (30% concentration) directly on the teeth, with the veneers removed. (3% hydrogen peroxide isn’t good enough). This will remove all traces of the discoloration.

But these last instructions are for you to print out and give to your dentist only if you can’t bring yourself to switch. You’ll be much better off having someone else finish this for you, in my opinion.

Dr. Hall

Click here if you would like to ask Dr. Hall a question.

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November 6, 2007

Assaulted, her front teeth are loose. Will she lose them?

Filed under: Traumatic Injury — iowasmiles @ 10:37 pm

Dr. Hall,
I was recently assaulted by my ex-boyfriend, the father of my child. He punched me directly in the mouth. Now both of my front teeth are loose; one is more loose than the other. I went to the e.r. and they took a cat scan. They said that there were NO fractures. I am 26 yrs. old and I am scared to death that I will loose my two front teeth. Is there a good chance that my dentist will be able to save them? Also if they can be saved, what long term effects can this have on me? He also completely ripped the piece of skin that holds my upper lip to my mouth. At the e.r. they said there was “no point in stitching it, some people have that piece of skin and some don’t, if it’s not there it’s not a big deal.” Do you agree with that statement?
- Carrie

Dear Carrie,
I’m sorry to hear what happened to you. I feel for you.

If the roots of the teeth aren’t fractured, they need to be stabilized in the correct position in the next day or two. Your dentist needs to bond these two teeth into a fixed position, making sure that the position he fixes them into is the correct position, and then the bone will heal and they should be fine.

The ER is right that this piece of skin that was ripped is no big deal. It may grow back anyway. Sometimes, because it pulled at the gum tissue, we would try to clip this piece of skin and it would grow back anyway.

Long term, again as long as the roots aren’t fractured, you should be able to keep these teeth and everything will be fine. And then I would go back to the dentist after two or three weeks and have him check to see if the nerve of either tooth is damaged. If it is, you’ll need a root canal treatment. If that is the case, tell your dentist not to leave any gutta percha or root canal cement in the crown of the tooth. He or she will understand what that means. Leaving this in the crown of the tooth causes the tooth to go very dark in time. If the gutta percha and cement is removed, it will go dark very very slowly–over a period of years, and you can deal with that much later down the road.

Some dentists think that every tooth that has a root canal needs a crown, to strengthen it, but if there are no large fillings in any of these teeth and one or both needs a root canal, I would advise you not to get the crown, because a crown on a very front tooth that is otherwise intact and only has a root canal–a crown in that situation will actually weaken the tooth.

And if you need help with any treatment, the American Academy of Cosmetic Dentistry has a program to help victims of domestic violence. If you want help like this, look up the “Give Back a Smile” program of the AACD. You may not need anything until later, if either tooth turns dark. But I’d check out the program and see what you have to do to document that the problem was caused by your ex-boyfriend assaulting you, and be sure that’s in place so you can later take advantage of the program if that comes up.

Dr. Hall

Read related information at www.mynewsmile.com:
The difference in having a root canal on a front tooth as opposed to a molar
A dead tooth turns dark and can crack.
Read about a case where a front tooth broke off because a dentist did crowns on front teeth that had root canal treatments.

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November 1, 2007

Are veneers painful?

Filed under: Porcelain veneers — iowasmiles @ 11:04 am

Is the procedure for veneers painful? Is it painful after the procedure?
- Cathy from North Carolina

Dear Cathy,
The porcelain veneer procedure is one of the easiest on the patient. Sometimes it can even be done without any anesthetic, because only a small amount of tooth structure is shaved away. Sometimes it can even be done without any shaving.

When the porcelain veneers are bonded on, if the dentist isn’t well trained in this procedure, he or she can have trouble with removing the excess cement, and this can become difficult for the patient. But expert cosmetic dentists who do a lot of porcelain veneers will tend to have special equipment and materials to help this step go smoothly and quickly. They will remove the excess bonding material while it is soft and can simply be flossed away.
- Dr. Hall

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