September « 2008 « The Cosmetic Dentistry Blog

September 25, 2008

Pain after a white filling

Filed under: Pain in teeth, White fillings — iowasmiles @ 4:36 pm

Dr. Hall,
Six months ago I had a front tooth filled with a white filling. Almost two months ago, I went back to complain how floss gets stuck in a notch between my teeth and to buff the surface of the tooth where leftover filling material was a nuisance. So my dentist smoothed it out. But then I got shocking pain when I took a bite into pizza. I gave it two weeks, went back in to have the tooth x-rayed. My dentist says the tooth is still sensitive to the filling procedure and take Advil and wait it out. But for the past two weeks the pain level is such that I can’t chew bread or drink room temperature liquids.

I am now constantly on pain medicine. My choices?? If I go back in, he will probably want to redo the filling. But can the dentist tell from the x-ray if the tooth really needs the root canal or do you think the porcelain did not get bonded or filled correctly? It is my front tooth so I don’t want to make a bad decision about whether to see an endodontist or let this dentist experiment around and redo the filling.

Any help or advice is greatly appreciated.
- Lisa in Colorado

Lisa,
If the pain is as intense as you seem to say, then you probably do need to see the endodontist. A dentist should be able to diagnose this by testing the tooth, and, if they’re good, they should be able to see it on the x-ray at this point. The endodontist should be able to tell.

This isn’t just irritation from being filled, because you are telling me that it’s been six months and the pain is getting worse. When a tooth is just irritated, it hurts, but then the pain will get better–sometimes very slowly, but always getting better. When the pain progresses, it’s a sign that there is some type of infection going on.

While it’s possible the dentist did something wrong, usually when this happens it’s just an indication that there was decay under the old filling or something like that. This would cause some bacteria to get into the pulp of the tooth. Then, with the added irritation of being worked on, it’s enough to push the tooth over the edge and start to show signs of infection.

And here’s an important tip for a root canal filling on a front tooth that a lot of dentists don’t know. Ask that they leave no gutta percha (root canal filling material) inside the crown, but to trim that filling material to below the tooth attachment. This will help keep the front tooth from discoloring. You may end up needing a crown on this tooth, in which case the discoloration won’t matter. But if there isn’t a large filling in the tooth, you may not need a crown and trimming the gutta percha will help keep the tooth from turning dark.
- Dr. Hall

Related links:
Read about dental implants
Tooth pain after filling
Tooth infection
Root canal

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September 19, 2008

Is it possible to re-do my veneers?

Filed under: Porcelain veneers — iowasmiles @ 8:23 pm

Dr. Hall,
I had 3 porcelain veneers and 1 porcelain crown put on today. The temporary ones I had in were too long, so I asked for the real ones to be a tiny bit shorter. Now, I feel like they are too small. I only got to look at them for a minute in the chair before they cemented them on. Also one of the insicors is smaller than the other. Is it possible to re-do veneers? Would it be a big pain for the dentist? Thanks so much.
- Katie in Nebraska

Katie,
Yes, it’s possible to re-do the veneers. That is the only way to make them longer. Yes, it would be a big pain for the dentist. But yes, I would ask that he or she do that for you.

I’m assuming that you did the porcelain veneers because you wanted a beautiful smile. So that is what you paid for, and I think you should insist that your dentist deliver that. I’m guessing that you’re paying several thousand dollars for this, and therefore you should like the end result. And the two corresponding lateral incisors should be similar in appearance. You don’t want them exactly the same, but they shouldn’t draw any attention and should be the same length.

I’m fairly confident that your dentist isn’t an expert cosmetic dentist, and the reason I say that is the comment you made, “I only got to look at them for a minute in the chair before they cemented them on.” That is so typical of general dentists. A genuine cosmetic dentist understands that the work needs to please the patient, and will generally make sure that you get a full opportunity to study them carefully BEFORE they are permanently bonded. If you can get this dentist to re-do them, then teach him or her that he or she needs to make sure you get a good look at them to make sure you like them. A good cosmetic dentist will allow plenty of time for you to do this.

But you also need to realize that you’re at the mercy of your dentist here. If the work is functional and looks halfway decent, even if you don’t like how it looks, your dentist has met the standard of care, according to the laws and the dental society. If he or she doesn’t want to re-do this, you have no leverage to force the issue. So be sweet and persuasive when you address this. And tell your friends to make sure, if they want a beautiful smile, to seek the services of expert cosmetic dentists like we recommend on this web site. Then they won’t ever find themselves in this situation.
- Dr. Hall

Related links:
Vivaneers are a brand of porcelain veneers made by Glidewell laboratories
Read about the proper care of porcelain veneers
Click here to find a cosmetic dentist

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September 6, 2008

Will porcelain veneers stick to my fillings?

Filed under: Porcelain veneers — iowasmiles @ 7:41 am

Dr. Hall,
I am really considering getting veneers but am afraid they will not hold as I have fillings on my front two teeth. Also, can you recommend a good cosmetic dentist who specializes in veneers in Los Angeles county?

Your response is greatly appreciated.
- Anna in California

Dear Anna,
The bonding material used to bond porcelain veneers to your teeth is completely chemically compatible with the filling material in the fillings you have on those front two teeth. In other words, the fillings would chemically unite with the bonding material to form one solid piece. So you can get veneers over fillings without any worry.

As far as recommending someone who specializes in porcelain veneers, I carefully screen every dentist on our list, and they all do beautiful porcelain veneers. You have a number to choose from, if you just go to our Southern California cosmetic dentists page. They’re all terrific and I am absolutely confident any one of them will give you a gorgeous smile. That’s why they’re on our list.
- Dr. Hall

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September 2, 2008

A bad experience with Vivaneers

Filed under: Lumineers — iowasmiles @ 11:44 am

Hello Dr. Hall,
I had discolored teeth from smoking and a filling line that could be seen in my front tooth. I had 6 top front Vivaneers (Porcelain) put in on the 29th of July ‘08. They were TOO BIG and had skirts, but I thought I would get used to them.

I did complain to my dentist, who is also my friend, but didn’t want him to take the money loss. The “canines” were rounded out too. I did NOT like that. Then on 31st July ‘08, I had the 6 front bottom ones put on, AND EVERY SINCE THEN I DO NOT HAVE ENOUGH SALIVA. I have “dry mouth.” No, not sores or cracks, just a dry mouth, and can’t speak as fast or as well as I used to. I have investigated everything on the net re: “dry mouth,” that it could be oral cancer/diabetes/hypothyroidism/dehydration etc. I do NOT believe it is any of these.

I bought the “snake oil” Dr. Hall and now regret it.

I spoke to my dentist at length about this; he is going to call the dental lab (Glidewell in Calif.) and speak with a Dr. Michael Ditolla to find out the WHY for the dry mouth. My vivaneers were “no prep.”

According to what I have read, the vivaneers could be lasered off. I don’t know what my options are after that…bonding or? I am gun shy; I don’t think I will ever get veneers again.

The tragedy is that I am a middle school teacher and speak all the time.

Additionally, ever since the veneers went in, my lip gloss and lipstick sit differently on my lips.
My lips get dry within 25 minutes after the lipsticks go on. This NEVER happened prior to the veneers.

Thank you Dr. Hall for any light you can shed on this.

Dear Janice,
Your basic problem is that your friend is not a cosmetic dental specialist. I sympathize with you, for all the problems you’re having with these Vivaneers. Let me help you understand them.

Realize that I can’t tell for certain why you are having dry mouth without doing a thorough examination, but I can guess. And I am pretty certain that, with the Vivaneers on your teeth, you can’t close your lips or your mouth properly, and this is why your mouth is getting dry. You are breathing through your mouth, and this dries it out.

Here’s my reasoning: There isn’t anything in the porcelain or in veneers that would react with anything in your mouth or would produce any kind of a reaction that would cause dry mouth. That rules out any chemical or physiological reason, so the reason must be mechanical — an inability to close properly. And when you do no-prep veneers on the lower front teeth, it is almost guaranteed that you will open the bite. This would also cause the difficulties you’re having with speaking and with your lips drying out.

I would be surprised if the dental lab figured that out. That isn’t their department. Your dentist is the one who is supposed to know. The fact that your dentist has to call the laboratory for help with this seems to show his lack of expertise in cosmetic dentistry.

I would have the Vivaneers removed. I rarely say that, but in your case, I believe that would be best. And your dentist doing only six veneers on the upper and six on the lower is also poor. Cosmetic dentists and all your friends know that when you smile you show at least eight teeth on the upper – sometimes ten or even twelve.

You’ve learned the hard way that you can’t go to a general or a family dentist for cosmetic dentistry. Dentists as a rule are technically oriented and aren’t artists. Don’t lose your faith in cosmetic dentistry, but if you decide you want to have this done right, go to one of the Connecticut cosmetic dentists on our list. Please, for your sake and the sake of your relationship with your dentist, don’t have him do any more appearance-related work. And don’t lose faith in him as a general dentist. Just understand that fixing broken teeth and creating beautiful smiles are two very different functions.

Further information about Vivaneers:
Vivaneers are a brand of porcelain veneers that are very much like Lumineers. They can be made extra thin, and the advertising suggests that they can be without preparing the teeth. So they appeal to general dentists who know very little about cosmetic dentistry. Read our blog posts about Lumineers by clicking the category on the right. You may also want to go to our main web site Lumineers page for some excellent information and cautions. Everything said about Lumineers can be applied to Vivaneers.

- Dr. Hall

Related information:
Care of porcelain veneers

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