The Cosmetic Dentistry Blog

May 30, 2008

Lumineers keep falling off

Filed under: Lumineers — iowasmiles @ 3:29 pm

Dr. Hall,
Our dentist placed Lumineers over my wife’s top 4 front teeth, that were already porcelain, at a cost of around $5,000.00 On three or four occasions at least one of the Lumineers has come off. The last time, while my wife is visiting her mother in another country, two came off. Is it a good idea to place porcelain Lumineers over existing porcelain? My wife is extremely disappointed and disgusted with the Lumineers.
- Kendall in Florida

Dear Kendall,
You can bond new porcelain to existing porcelain, but it’s tricky, and it sounds like this dentist almost knew how to do that. Generally what experienced cosmetic dentists will do when there are existing crowns is to simply replace the crowns. When you know what you’re doing, it’s about the same amount of work and about the same cost as porcelain veneers. And there’s much less risk of trouble.

A good cosmetic dentist can get new porcelain to bond to old porcelain, but it tends to stain on the margins after a few years. And, as I said, the technique is tricky. The old porcelain has to be etched and primed, and generally only dentists who do a lot of cosmetic dentistry have the proper equipment and materials to do that.

We’re getting a lot of stories of problems with Lumineers, and I think it’s because the company that makes them promotes them as being so easy, that general dentists who know little about cosmetic dentistry are doing them.

I’d insist that this dentist replace these Lumineers with new all-porcelain crowns, assuming he or she knows how to do that, or pay to have you go to someone who knows what he or she is doing and have them do that.

Dr. Hall

Related information:
cost of Lumineers
click here for referral to an expert cosmetic dentist
taking care of porcelain veneers after they’re placed
Vivaneers are a brand of veneers very similar to Lumineers

May 27, 2008

Will the dental hygienist damage my porcelain veneers?

Filed under: Post-op care for cosmetic dentistry — iowasmiles @ 3:45 pm

Dr. Hall,

I have a question would like you to help me. I have 8 veneers on the fronth teeth and I am wondering will the veneers loosen or break when a hygenist use dental tools to clean along the gumline during regular cleaning? Thank you and I look forward to hear from you.
Sincerely,
Vu from Ontario

Vu,
This is a good question. No, the hygienist won’t pull the porcelain veneers off or break them. They’re too strong for that. But yes, you do need to be concerned about possible damage that a dental hygienist can do to your porcelain veneers–she or he could chip them or dull the surface. It’s safest to have your cleaning done in the office of an expert cosmetic dentist, but if you have this checklist of “no-no’s” to give the hygienist, and you’re up front about what you want the hygienist to do and not do, you could have your veneers cleaned in any office:

  1. Power polishing equipment will ruin the surface. Some hygienists like to use Dentsply’s Prophy Jet. It’s a power polishing unit that sprays a mixture of sodium bicarbonate and water on your teeth and gets them really clean very quickly. Your porcelain veneers will look great at the end of the appointment, but the glaze will be completely gone and they will begin to stain as soon as you get home. This is the worst thing a hygienist can do to your porcelain veneers. There are other brands of power polishers that could also harm your veneers.
  2. An ultrasonic scaler can also damage the veneers right on the margins. It can cause little chips on the edges that will then become places where stain and plaque can accumulate and where decay will later start.
  3. Heavy duty manual scalers can also chip the margins, if they are used right on the margins of the veneers. Sometimes your hygienist needs to use these scalers, but she or he just needs to be careful not to be scraping hard right on the margins.
  4. And finally, coarse polishing pastes with coarse pumice can scratch the veneers a little, and can scratch the luting composite at the margins a lot. Hygienists should only use fine or ultra-fine polishing pastes, preferably with an aluminum oxide grit–no pumice.

I hope that’s helpful.

For more information, see:
Our page on taking care of porcelain veneers.
We recommend for people with porcelain veneers that they use Supersmile whitening toothpaste daily, because it is so effective at removing stains but yet it is gentle on cosmetic dental work.
Our page on general cosmetic dentistry maintenance, with tips on taking care of various cosmetic dental work.
Click here for a cosmetic dentist referral.

May 24, 2008

I have erosion of my teeth along the gumline.

Filed under: Porcelain veneers, TMJ — iowasmiles @ 12:26 pm

Dr. Hall,
I have considerable abrasions/erosion of my teeth along the gumline caused by brushing my teeth too roughly in the past.

If I get porcelain veneers, will the treated teeth be prone to staining and cavities along the edge of the gum because of the abrasions?
Does having porcelain veneers, since the protective enamel layer of the teeth is removed in the process, make your teeth especially vulnerable to cavity, decay, and staining, even if you are very conscientious and diligent in your oral hygiene regiment?
Is staining inevitable with veneers?
Upon first having them bonded, how long do they last before they become stained?
How much does it typically cost to have the margins professionally polished?
And how often must this be done?

Please consider my questions under the hypothetical condition that good, regular oral hygiene is maintained.
Also, is it necessary to severely restrict yourself from enjoying a lot of foods and drinks in order to increase the lifespan of the veneers and avoid/prevent staining?
- Lauren from Massachusetts

Dear Lauren,
Wow, you’ve got a lot of questions! I’m not going to have time to answer them all, but I’ll try to help you understand your situation.

Dentists for many years thought that the notches that occur on your teeth next to the gumline are from brushing too hard. While aggressive brushing can wear away your teeth, recent studies have shown that in most cases, these notches are from biting stress, otherwise known as bruxism. Clenching and grinding your teeth causes them to flex at the neck of the tooth, at the gumline, and this causes weakness at this spot and you end up with notches there. Click here for more information about grinding and other TMJ problems.

Porcelain veneers should cover up any of these notches. But the cosmetic dentist would be wise, before placing porcelain veneers, to find out if the patient has a bruxism problem, and to address that problem in order to maximize the lifespan of the veneers.

And porcelain veneers are very stain-resistant. They can pick up some stain, but they stain less than your natural teeth. My best advice for handling the stain is to use Supersmile toothpaste every day to help maintain the veneers.

And you shouldn’t really have to restrict your diet with porcelain veneers. If they are well made, they are very resistant to new tooth decay or other problems. You would be wise, however, to follow good oral hygiene habits – brushing and flossing daily – to help protect your investment. As far as eating, the best thing you could do would be to avoid frequent snacking. If you’re nibbling potato chips or other snacks frequently during the day, that could cause decay problems along the edges of the veneers.

I hope this is helpful.
Dr. Hall

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

May 20, 2008

My porcelain veneers didn’t stay white

Filed under: Porcelain veneers, Tooth staining — iowasmiles @ 8:23 pm

Dear Dr. Hall,
I had porcelain veneers placed on my teeth originally in 1987. I had them replaced with new veneers in February of 2008. The new veneers started off white in color, but ALL have now become gray and dingy. The dentist thinks too much enamel was removed in ‘87 and seepage of dentin is occuring underneath the new veneers discoloring them. She wants to replace them now with some sort of partial crown. Is this the only procedure left open to me to mask the dark color of my teeth from seeping through? I do not want more of my tooth taken away, and I am curious why in 2008 veneers cannot be made opaque enough to mask Tetracylcine staining and REMAIN white. What other option do I have besides partial crowns? I really just want to redo the veneers, but she is making me feel like every shade of veneer I try will yield the same result. Is this true?
- Amy from California

Amy,
I’m glad I caught this question to hopefully save you from trouble.

I am VERY suspicious of what this dentist is telling you. Something went wrong and she is trying to blame the first dentist. She says that seepage of dentin is occurring? I don’t know what she’s talking about. Because too much enamel was removed in 1987? This sounds crazy. These sound like made-up reasons to me. This problem is from something SHE did wrong, not the 1987 dentist.

You definitely need a second opinion from a true cosmetic dentist. I wouldn’t let this dentist do anything more on you. You DON’T need crowns.

Porcelain veneers can mask tetracycline stains. Absolutely. See the photos on our web site. That’s what you should expect. And the color of the veneers shouldn’t change AT ALL after they’re placed. But very, very few dentists know how to do this. And it sounds like your current dentist is one of those who don’t know how to treat tetracycline stains.

You’ve got some excellent cosmetic dentists in San Diego. See our page of Southern California cosmetic dentists and pick one of them and see what they can do.
Dr. Hall

Related links:
Ask Dr. Hall a question
Click here for referral to an expert cosmetic dentist.
Can you bleach teeth with tetracycline stain?

May 16, 2008

Am I too old to have my wisdom teeth out?

Filed under: Wisdom teeth — iowasmiles @ 7:39 pm

Dr. Hall,
I am a 31-year-old woman and my lower right wisdom tooth started to bother me a few days ago. I made an appointment with an oral surgeon for a consult. I was wondering what are the risk of extraction surgery for my age? Can my jaw bone get damaged or even break? I had my upper left wisdom tooth removed in emergency about 4 years ago but i was never told that the others needed to be removed. I hope I am not ” too old ” to get this done. And my last questions is can they remove all 3 remaining teeth at the same time? Thanks in advance for your help
Fran in Virginia

Fran,
No, I wouldn’t say you’re too old at all to have the rest of your wisdom teeth out. And, if the wisdom tooth is bothering you, that means it’s probably infected, and you don’t have much choice anyway. An infected wisdom tooth can become life-threatening if it isn’t taken care of, so I wouldn’t put off getting it taken care of.

Yes, it would have been better to have had them out at age 18-25, but the chances for complications still aren’t a lot. I didn’t start to get concerned until people were over 40. You’re very unlikely to have your jawbone get damaged or break. Now they will give you a scary consent form to sign with a list of absolutely every possible thing that could go wrong, but this is because they have to protect themselves in today’s legal climate. The chances of any of these bad things happening are pretty remote.

And yes, I would have the rest of them all out at the same time. It’s so much easier that way, and then you have them done. Don’t wait any longer–it doesn’t get any easier. The next time one of these bothers you, you may be over 40 and then the chances for complications will be that much worse.

Dr. Hall

Related links:
Wisdom teeth removal
Dry socket
Tooth infection

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May 8, 2008

Will dental insurance help pay to fix my tetracycline stains?

Filed under: Dental insurance, Tooth staining — iowasmiles @ 9:28 pm

Hello Dr. Hall,
I was wondering if you can tell me if medical insurance would cover the treatment of my teeth from tetracycline damage? My teeth are very weak and sensitive. I am afraid to bite into anything because I have chipped my front teeth before and I was hoping that because my teeth were damaged due to tetracycline to treat multiple infections due to asthma when I was a child. Please advise.
Thanks
- Jessica from Idaho

Dear Jessica,
It would sound reasonable that medical insurance would cover treating the side effects of a medical treatment like tetracycline teeth stains. But in reality, the medical policies usually list exclusions of any dental work. I have not heard of a case of medical insurance helping to pay for any treatment of tetracycline teeth stains.

But if you want to get a more authoritative answer as regards to your particular medical plan, I would call the insurance company and ask.
- Dr. Hall

Read more about dental insurance
Read about cosmetic dentistry and dental insurance

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