March « 2008 « The Cosmetic Dentistry Blog

March 29, 2008

Should I have my baby tooth extracted?

Filed under: Children's dentistry — iowasmiles @ 9:41 am

Dr. Hall,
I have baby tooth that won’t come out and there is another tooth pushing on it, and it’s coming out the side of my gums. It doesn’t hurt but my dentist says that he should pull it out. So this has me thinking about a few things.
1. What will happen if I do NOT get it pulled? and
2. Does it hurt to get a tooth pulled? I know that a numbing agent is used, but when they inject the agent, does the needle hurt (mind you I am terrified of needles)? I am 14 years old a pretty scared. Thank you for your time and any help would be appreciated.
- Amanda from Michigan

Amanda,
My you write well. You sound better and write more clearly than many adults who write to me.

If you don’t get this tooth extracted, you could make the permanent tooth crooked and you’d have to get that fixed with braces later. So you really should have it taken out. It’s so much easier to prevent these problems than to fix them later. Generally the rule is that if the permanent tooth starts to show in your mouth and the baby tooth hasn’t fallen out yet, that you should have the baby tooth extracted.

And generally when you have a baby tooth pulled that is just about to come out, it doesn’t take a lot of novocain. Most dentists will use a novocain ointment to numb the surface, and then they’ll give you the injection. Depending on the situation, and who the patient is and which tooth is coming out, sometimes the injection doesn’t hurt at all and sometimes it hurts a little. Sometimes the patient doesn’t even know they’re getting an injection. My best advice is not to think about it–that’s when it goes the best.

I hope this is helpful.
Dr. Hall

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March 26, 2008

Can my teeth be longer with Lumineers?

Filed under: Lumineers, Smile design — iowasmiles @ 10:08 am

Dr. Hall,
My teeth are straight with absolutely no gaps. They are a little discolored because of age. I wanted bigger and whiter teeth so my dentist recommended Lumineers. I have already had impressions and it was sent to the lab. They came back with that they could whiten the teeth but not really make them much longer or bigger. The dentist called the company again and they said they could make them no bigger. What is up? I am sitting here looking at their brochure right now and they say they can make your teeth bigger. The before and after pictures show that they can. The dentist has now suggested bonding the 6 upper teeth that she was going to use Lumineers on. I have already had 2 appointment and spent over $400. What do you think is going on??? What should I do?
- Donna in Kentucky

Dear Donna,

Big red flags here. You asked me what I think is going on. I am pretty confident that what is happening is that your dentist doesn’t know what he is doing.

What is this where the laboratory is telling the dentist that the teeth can’t be made any bigger? The dentist is supposed to be a doctor. The laboratory technician is just a technician. It’s the dentist that is supposed to give instructions to the laboratory, not the other way around. Unless, of course, the dentist doesn’t know anything. You mean to tell me that your teeth can’t be made any longer or bigger but this dentist didn’t know that when you first consulted with him?

Go get a second opinion from one of our Kentucky cosmetic dentists. I don’t know why the lab is saying what it is saying, and I couldn’t tell you from this distance about what can and can’t be done with your smile. If you check our smile design page, you’ll see that with porcelain veneers, such as Lumineers, there are a lot of options as far as how to shape the teeth. Maybe you have some special circumstance–an expert cosmetic dentist like the ones we recommend on our web site could tell you more.

Good luck.

Fortunately, it sounds like not too much damage has been done in your mouth so far. I’d let him keep your $400 and count yourself lucky that’s all you’ve lost.

- Dr. Hall

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

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March 20, 2008

How can I get my porcelain veneers white again?

Filed under: Porcelain veneers, Tooth whitening — iowasmiles @ 9:22 am

Dr. Hall,
How can I get my veneers as white as they were when I got them? It seems I have coffee stains on them.

- Jack in New York

Dear Jack,
The porcelain used in porcelain veneers has a glaze on it that is like glass and is pretty stain resistant. If this is well-maintained, I wouldn’t expect them to stain. There are a couple of possibilities to explain why they’re staining.
1. You could have done something to break the glaze, by being exposed to abrasives in the air or using a harsh toothpaste.
2. Or your dental office could have used harsh polishing techniques on your porcelain veneers, such as pumice paste or air-powered cleaners.

But now that they’re stained, there are a couple of things you could do.
1. I would start with trying Supersmile tooth-whitening toothpaste. It is excellent at removing surface stain, particularly coffee and tobacco stains. Now if the stain is deeply embedded in the porcelain, it won’t get all of that out, but if it’s on the surface, it will.
2. Tooth whitening, either the laser tooth whitening or the tray tooth whitening, will bleach the stains.
3. The best thing to do would be to find a truly expert cosmetic dentist, such as we recommend on this site, and have her or him polish these veneers back to their original shine. This will remove the stain you have an make them more resistant to further stain. They can’t bring back the glaze, but they can come close to it.
- Dr. Hall

Further information about cosmetic dentistry maintenance techniques, including how to care for porcelain veneers.
Or, we have a page that explains specifically about the care of porcelain veneers.
Click here for referral to an expert cosmetic dentist.
Click here to ask Dr. Hall a question.

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Is a post and core necessary?

Filed under: Dental insurance — iowasmiles @ 8:15 am

Dr. Hall,
I need a crown, and my dentist wants to do a “post and core” also. My insurance will cover the crown, but not the “post and core.” Is the “post and core necessary?”
- Marilyn in Pennsylvania

Dear Marilyn,
I could give you a whole discussion about dental insurance companies, but why don’t you just click the link and check out our pages where we explain how they operate.

Your dental insurance company is trying to economize. They’re not really that interested in your health or in the long-term, because people change jobs a lot. And while some dentists are opportunists, the great majority are really sincerely trying to take care of you, in my experience.

Many dental insurance companies want the dentist to just put a crown over an old filling and be done with it. However, we were all taught in dental school that when we do a crown we should clean out all the old filling material and build up everything fresh so that we know that any decay or other problems that may become visible when we do that are taken care of. Plus the post and core help reinforce the tooth so it doesn’t break later, and help hold the crown on.

Bottom line – I’d listen to your dentist and not your insurance company.

- Dr. Hall

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March 15, 2008

Do cosmetic dentists have to be accredited?

Filed under: Finding a cosmetic dentist — iowasmiles @ 8:47 pm

Dr. Hall,
I see that some of the dentists you list are accredited in cosmetic dentistry and some aren’t. Does every dentist have to be accredited by the American Academy of Cosmetic Dentistry?
- Victoria from New York

Dear Victoria,
Cosmetic dentistry is a completely unregulated field, and that goes to the heart of why we have published this web site. Any dentist can say that he or she is a cosmetic dentist. But in my opinion, only one or two percent really have the artistic inclinations and the training and skills required to create beautiful smiles.

The American Academy of Cosmetic Dentistry does have an accreditation program that is fairly rigorous. To become accredited, a dentist needs to pass a written examination and a clinical examination that involves five cases of five different types of cosmetic treatment. Any dentist who has passed this accreditation examination is a qualified cosmetic dentist. But the AACD has no authority to require cosmetic dentists to take this examination, and there are some excellent cosmetic dentists who choose not to go through this grueling process. Others are in the process of becoming accredited, and have the requisite artistic talent and training but haven’t yet demonstrated it to the AACD.

Whenever we list cosmetic dentists who aren’t accredited, we require them to show photographs of their work that demonstrate the appropriate artistic skills, and we ask about the courses they have taken to receive their training in cosmetic dentistry, so that we may assure our visitors of the quality of the work they receive from any listed dentist. And since I myself am an accredited cosmetic dentist, I know how to evaluate the work to make sure these dentists have the necessary artistic skill.

I hope this is helpful.
- Dr. Hall

Links that may interest you:
Find an expert cosmetic dentist
Ask Dr. Hall a question
Read about porcelain veneers – the flagship cosmetic dentistry procedure
Read about smile design – the artistry of creating a beautiful smile

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March 7, 2008

My new porcelain veneers have lost their shine

Filed under: Cosmetic dentistry mistakes, Porcelain veneers — iowasmiles @ 10:39 am

Dr. Hall,
I recently had 6 porcelain veneers placed and was unhappy with the bulkiness from two of the veneers and my dentist reshaped the veneers by filing down the veneers and when he did it changed the color from a pearl/grayish white to a whiter lighter color, which I like however, now the veneers are dull, no shine. Is there anything that can be done to add shine. And will my veneers now stain? I thought that veneers where the same color all throughout and was surprised the color changed with the filing/reshaping.

Help!
Candace in Ohio

Dear Candace,
Your question is a great springboard for making the point about the unforeseen difficulties that can occur when you don’t have an expert cosmetic dentist doing your smile. When dentists aren’t passionate about the appearance of the work (and well over 90% of them aren’t), they don’t take the trouble to learn all of these important details.

This dentist bonded on porcelain veneers that were too bulky, and you didn’t like the color. A true dentist/artist will make sure, before they are bonded, that they are beautiful in your eyes, and this won’t even come up. I hear this all the time in my e-mails. The patient got home, studied his or her smile in the mirror, and wasn’t happy. This is because dentists are trained that they know best, and it’s not in their nature to let the patient be in charge of whether or not they like how their smile looks. This mistake doesn’t happen with a true cosmetic dentist.

So you came back and told him the front two were too bulky. Now I’m not absolutely sure of this next point, but it seems to be true from what you’re telling me, that this dentist was then on unfamiliar ground. He ground the color off, which may have surprised him, too. And now he doesn’t know how to bring back the gloss. And yes, with the glaze gone on the porcelain veneers, they will pick up stain quite readily.

The dentist can bring back the shine with meticulous polishing techniques using diamond-impregnated ultrafine polishing wheels or pastes, with which he is probably unfamiliar. But even if he does that, you’ve still got two problems that I think are serious. 1) The color of these two adjusted veneers (you didn’t say if he ground down just these two or all of them–I’m guessing he just did the two) is probably flat now. I doubt that they have the natural color gradient that teeth are supposed to have. 2) You don’t like the color of the other four veneers, and they now don’t match these two.

I would recommend a second opinion from a true artist/dentist on our list of Ohio cosmetic dentists. And I think you should get a complete re-do of this case until you are truly thrilled with how they look, because you paid for a beautiful smile and you didn’t get it. But you will maybe be satisfied with just getting these polished.

Dr. Hall

Related information:
MAC Veneers are one brand of porcelain veneers that have the color on the surface
Find an expert cosmetic dentist
Click here for a list of Ohio cosmetic dentists.

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March 4, 2008

One missing lateral incisor, and a deformed one

Filed under: Dental implants, Porcelain veneers — iowasmiles @ 9:13 pm

Dr. Hall,
I was born without a #7 incisor and my #10 is deformed and slightly recessed. After having braces (10 years ago) I was given a dental flipper to fill the #7 space. What sort of device would you recommend as a permanent solution for these teeth and also can you please recommend a cosmetic dentist in my area? Thank you.
- Jessica in Ohio

Jessica,
The teeth next to your missing tooth are probably completely healthy. I’m guessing here, but it seems that you’re young and you’re not giving me reason to think otherwise. In those situations, I strongly recommend dental implants. Otherwise you have to attach a dental bridge to the two adjacent teeth and to do that you have to prepare those teeth, which seems a shame when there’s nothing wrong with them.

For the deformed tooth, a porcelain veneer or an all-porcelain crown would be best, depending on the shape of the tooth.

The trick will be getting the implant and the porcelain veneer or crown to match, since they’re made very differently. A skilled artist/dentist can do this and do it well, but the overwhelming majority of dentists would have a lot of difficulty with this. I’m not sure you have anyone in your corner of Ohio who can do this. It may be worth your while to travel to Detroit to have this procedure done. Yes, it’s an hour and a half trip each way, but you’ll only have to do it a few times, and then you’ll have a lovely smile. After that you can go back to your family dentist.
- Dr. Hall

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March 1, 2008

Will Invisalign work if I have missing teeth?

Filed under: Invisalign — iowasmiles @ 9:07 pm

Hello Dr. Hall,
I never got braces as a kid. However, my bottom teeth are quite crooked. I have 2 second bicuspids that are baby teeth, one that has been pulled already because it was hurting. The other one I presume will have to come out. Also, my very back molar was taken out on my bottom left. I feel like a hillbilly!

My question is this: how good is Invisalign when working around missing teeth? I really don’t want to have regular braces at my age. And is it likely I’ll need to have dental implants to replace those missing teeth?

Also, I have a bit of an underbite and there isn’t enough space between my top and bottom teeth to straighten only my bottom teeth. We’ll have to move the top ones out to make room.

Thanks, Marlowe in North Dakota

Dear Marlowe,

Invisalign works with missing teeth. There are other factors governing whether you are a candidate for Invisalign. Your underbite may prove to be more of an obstacle to being an Invisalign candidate than your missing teeth. And there is a reluctance to use Invisalign in cases of severe crowding.

Different dentists have different degrees of bravery in tackling certain tooth crowding cases with Invisalign. Orthodontists tend to be more conservative–they have been trained to work with wire and brackets and they shy away from the new technology. But general dentists tend to be more willing to use the Invisalign. And the cases are always supervised by expert orthodontists that are on the Invisalign staff, that work at their headquarters, so any case they approve is pretty safe.

So I’d recommend visiting a two or three Invisalign general dentists in your area and see what they say about your case.

Invisalign could close the spaces in your lower jaw, so I doubt you’d need to replace the missing teeth. It could also move your upper teeth out–that can be done. But again, it depends on the severity of your case and the actual positions of everything.

Dr. Hall

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