October « 2008 « The Cosmetic Dentistry Blog

October 31, 2008

My lip is catching on my Lumineers

Filed under: Lumineers — iowasmiles @ 4:26 pm

Dr. Hall,
I recently got Lumineers and am very happy with the results. My only complaint is my upper lip seems to catch on the Lumineers, causing my lip to be very dry. Especially while talking. Is there a product I can use to help this?
- Joy in Nevada

Dear Joy,
I’m glad you’re happy with your Lumineers. While there are problems with Lumineers, they can be appropriate for some situations. But it’s too bad that you are having this problem with your lip. I think you’re being very nice about this issue because it seems to me that if your lip keeps getting stuck while you are speaking that this would be distracting and embarrassing. Other patients who aren’t as nice as you might be complaining loudly about this.

Lumineers are often done with a no-preparation technique, which means they are simply bonded over your existing teeth. The conventional porcelain veneer technique involves reducing the teeth about half a millimeter (approximately the thickness of a fingernail) to make space for the porcelain. This helps prevent the end result from being too thick.

Your teeth now, with the Lumineers, are a little thicker than what is natural. That’s why your lip is catching on them. And that will make your lip a little drier. I don’t believe there is any product that can help prevent that from happening. You could have the Lumineers shaved down a little and then polished well – but there would be a risk of shaving right through them to your tooth enamel, and that might look funny.

This will also lead to drying of your mouth, which can contribute to gum disease or an increased rate of tooth decay.

I don’t think there’s really anything you can do, short of re-doing the Lumineers. You’ll just need to try to adjust and get used to this.
- Dr. Hall

Other links:
Click here to find a cosmetic dentist
Click here to ask Dr. Hall a question
Do you want information on the cost of Lumineers?
GlamSmile is another short-cut option for porcelain veneers, like Lumineers

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October 28, 2008

A problem with an infected wisdom tooth

Filed under: Infected teeth, Wisdom teeth — iowasmiles @ 12:38 pm

I am a 25 year old female. I had a terrible toothache with slight swelling of the gums roughly 4 weeks ago. I went to the dentist who said I had an infection in my upper wisdom tooth and that it should be refered to a specialist and be removed. He gave me antibiotics and anti-imflamatory pain pills. The pain pills didnt work and I got stronger ones from the pharmacist. I went to the specialist just after the antibiotics had finished and the pain had gone away. He said to make an appoinment to have all my Wisdom teeth out. I have made the appointment but the earliest date I could get is the 10th of November. Over the last 3-4 days there has been a dull ache in that tooth and the tooth in front of it. It is not exactly painful just sensitive if I bite on that side.

My questions are these. Do you think it is another infection? Will the dentist refuse to operate if there is an infection? Must I see the dentist before my operation to remove the teeth to maybe get more antibiotics? I really cant afford this but I will not be able to afford more time off work if he refuses to operate because there is an infection? Please help I am hopelessly lost and confused as what to do.
- Jennifer from South Africa

Dear Jennifer,
It’s not essential, but it’s a good idea for the infection to be under control when the tooth is extracted. Some dentists will want the infection to be under control before the extraction. But more important is that this infection could get really nasty if it’s allowed to come back. Yes, your infection is coming back and you need to get back on the antibiotics and take them from now until you’re done with the extractions.

You should be able to call your dentist that gave you the prescription and tell him that you ran out and you need more, and that you need enough to get you to the time of your appointment and four or five days past. And he should be able to just phone that in without your needing another office visit. But if he won’t do that, you should go to the specialist and get that done. And I would do that as soon as you can.

These infections in your back teeth can travel to your brain or down your neck, and can cause swelling that cuts off your breathing. I wouldn’t trifle with them. And antibiotics alone will only control them – they never eliminate an infection when it comes from a tooth - you have to eliminate the cause or you still have the infection, even if the symptoms aren’t active.
- Dr. Hall

Related links:
Read more about tooth infection
Read more about wisdom teeth removal
More information about dental implants

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October 24, 2008

Looking for inexpensive porcelain veneers

Filed under: Cosmetic dentistry costs, Finding a cosmetic dentist — iowasmiles @ 9:28 am

Dr. Hall
I had porcelain veneers put on my teeth over 10 years ago. They have shifted a bit and I would like to get them redone as well as adding some on my bottom teeth. However, as this is not covered by my insurance I was wondering if I could find a less expensive way to accomplish this by serving as a patient to a graduate student. Do you know if this is possible? I am willing to travel if the price difference is significant. Any information you could provide would be appreciated. Thank you.
- Jennifer in Pennsylvania

Jennifer,
The idea of traveling to find a lower fee for porcelain veneers is a possibility. When you get into smaller cities or different states you can get into lower fee areas and still have beautiful cosmetic dentistry. But be sure you go to an expert cosmetic dentist. Most of the dentists who advertise as cosmetic dentists aren’t really what I would call cosmetic dentists. They don’t have the artistic talent to be able to create a beautiful smile. But the idea of getting a new smile done for a lesser cost at a dental school is a very bad idea and won’t work, and I’ll explain why.

You need to understand that dentistry and cosmetic dentistry are two different things. Dentistry is a profession that fixes broken teeth. Cosmetic dentistry is a profession that creates beautiful smiles. They are two very different fields. Only one or two percent of dentists have the artistic inclinations to be cosmetic dentists. I would no sooner go to a dental school and ask them to create a beautiful set of porcelain veneers than I would pay my plumber to decorate the inside of my house. Even if he’s a really good plumber.

What’s the point of doing new porcelain veneers if they aren’t beautiful? If you don’t have the money, then I’d leave things alone. Your teeth probably work okay and this is something that can wait.
- Dr. Hall

Related links:
Read more about the cost of porcelain veneers, the cost of Lumineers, and the cost of cosmetic dentistry in general.
GlamSmile is offered as a low-cost option for porcelain veneers. But Dr. Hall has some grave reservations about the results.
Click here to ask Dr. Hall a question.
Click here to find a cosmetic dentist.

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October 21, 2008

Problems with kissing after wisdom teeth removal

Filed under: Wisdom teeth — iowasmiles @ 3:55 pm

Dr. Hall,
My name is Kim. About a year ago I had my wisdon teeth pulled on the right side.

I had it done by a military dentist who did a terrible job. Afterward, my entire mouth was in a large amount of pain for months. I thought the pain would never go away. It slowly did but now I have a constant irritating feeling on the lower right side of my lip and the right side of my chin. When I push down on it, it tingles and gives an irritating tender feeling. Everytime I kiss my husband I flinch and pull away because it does’nt feel good. That’s one of the reason it botters me so much. I want to be able to kiss my husband without issues.

After almost a year is this damage considered permanent? What is wrong with it? Will it ever go away? Is there something I can do to make it better? Please help me so that I can kiss my husband again.
- Kim in Virginia

Dear Kim,
When you had your wisdom teeth out, the nerve that goes by the roots of your lower right wisdom tooth was apparently damaged.

Because you are having strange sensations and your lip is not completely numb, it will probably fully recover in time. The strange sensations indicate that the nerve was damaged but not severed. Nerve tissue is very slow-growing and takes a number of months to fully recover. Usually it recovers in a year, but it can take longer.

There’s nothing we know of that you can really do to make it get better any faster.
- Dr. Hall

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October 18, 2008

Why are my children getting so many cavities?

Filed under: Tooth decay — iowasmiles @ 3:48 pm

First off Dr. Hall your site is amazing and has been extremely informative.

This question is about my children. They are 6 and 4 and I brush their teeth morning & night, along with flossing nightly, and taking fluoride. Our 6 year old has had 4 cavities, while our 4 year old has had 11 Both children’s diets maintain very little sugar. Is the frequency of cavities a prelude to what is to come with their adult teeth? I am hoping not, I want so badly for my children to have beautiful healthy teeth. Is there any more that I could be doing to help them out?
- Kerri from California

Dear Kerri,
Sounds like you’re trying to be very diligent with caring for the teeth of your children.

Let me go over the risk factors for tooth decay. With the brushing, flossing, and the sugar consumption, you’re hitting a couple of the risk factors, but you’re missing the most important one.

1. The number one risk factor is frequency of eating carbohydrates. It’s not just sugar. Carbohydrates are changed into sugar by salivary enzymes, so any carbohydrate can cause decay. And it’s not the amount, it’s the frequency. If they’re snacking all day long, you’re going to get lots of decay, and brushing the living daylights out of your teeth won’t stop it.

2. Brushing and flossing help a lot, but they only help prevent smooth surface decay. They have practically no effect on pit and fissure decay, or decay in protected areas. So a prevention routine of brushing and flossing will reduce the number of cavities, but can’t eliminate decay.

3. A lack of fluoride makes teeth more susceptible to decay.

4. Watch the types of food consumed. Sticky foods that stay stuck to teeth after eating, such as raisins, potato chips, caramels, are particularly bad. Non-sticky foods such as fresh fruits, chocolate, soups, any drinks, are better. But if any food is consumed often enough, it’s just the same as if it were sticky. Sugar-containing soft drinks, when consumed just at mealtime, have practically no effect on tooth decay no matter how much you drink. Sipped constantly throughout the day, however, they can cause rampant decay.

I hope this is helpful.
- Dr. Hall

Related links:
Best toothbrush
Acid reflux and tooth decay
Tooth whitening and fillings

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October 11, 2008

My dentist tells ME that my porcelain veneers feel comfortable!

Filed under: Finding a cosmetic dentist, Porcelain veneers — iowasmiles @ 8:04 am

Dear Dr Hall,

I had 6 porcelain veneers fitted and am extremely disappointed with them. I am currently trying to negotiate a partial refund from the dentist, as they need to be re-done. The dentist maintains that the veneers were perfect, yet they were so bulky and uncomfortable. When I told her this, she disagreed, saying “yes they are comfortable.” I don’t know what gives her the right to make such a statement. She refused to make any adjustments, and I had to see another dentist to get the bulk trimmed down. However the veneers are not aesthetically pleasing, and the work needs to be re-done.

Can you please give me any advice or suggestions, as I feel it is not appropriate for her to make such statements that my veneers are comfortable or that I am too obsessed with them.

I would be grateful for any advice. Thank you
- Alice in London

Alice,
I laughed when I read about your experience. I know you’re exasperated, and to you I’m sure it’s not funny, but this is SO much the attitude of general dentists who try to do cosmetic dentistry. Let me help you understand this. I get many e-mails of patients who complain that their dentist says their new smile looks just fine, in spite of what the patient thinks of it. But this is the first where the dentist contradicts the patient and insists that they FEEL comfortable. That is SO funny!

Dentists are taught in dental school that THEY know best, and not to listen too much to the patient. This is what makes it so hard for them to do good cosmetic dentistry. A good cosmetic dentist, on the other hand, is very attuned to the preferences and feedback of his or her patients. It’s a different personality type.

Dentists decide to be dentists because they like to fix things. But cosmetic dentists need to be passionate about CREATING things. It’s very different. It’s only about one or two percent of dentists that are really good at creating a new smile.

If you want a new smile, you need an expert cosmetic dentist. We’re working on getting one in London. If you’d like us to let you know when we have someone to list, e-mail me back. But that’s what you need – a dentist with a true artistic temperament who really cares how they look and that you’re happy with them.

About dealing with the dentist that did them, my advice is to be as pleasant as possible. You can also try to enlist the support of your new, expert cosmetic dentist. These dentists tend to be very dismissive of the patient, but they may listen better to another dentist.
- Dr. Hall

Related links:
Find a cosmetic dentist
Taking care of porcelain veneers
Cost of porcelain veneers
Read about GlamSmile low-cost veneers

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October 8, 2008

Filed under: Porcelain crowns — iowasmiles @ 2:54 pm

Dr. Hall,
About 1 1/2 years ago I had nine front teeth replaced by a “cosmetic” dentist. One front central tooth broke in April and now a second tooth has fallen off. I am awaiting replacement on Monday. The replacement tooth in April my dentist’s assistant ordered was incorrect in color and shape which the dentist tried to reshape.

I have no confidence in this Dentist or assistant. I know Dr. Smith uses a plastic/porcelain mixture as his advertisement states porcelain crowns prone to fracture. And Dr. Jones [not their real names] has good credentials.

I would appreciate your input please on both these dentists & is resin/porcelain effective?
Thank you,
Jeanne from Florida

Jeanne,
Unfortunately, the law allows this term “cosmetic dentist” to be tossed around pretty loosely. I can find no evidence, in my sources, of any significant credentials in cosmetic dentistry for either dentist you mention. But because cosmetic dentistry isn’t a legally separate specialty they can make claims to being cosmetic dentists. That’s why I maintain this web site – to help steer people around this confusion.

And I can only guess at what your dentist means by “plastic/porcelain mixture,” as this is unusual terminology. My guess is that he is referring to composite, and if this is the case, it is a poor substitute for porcelain. It is weaker, not nearly as long-lasting, and much more susceptible to staining. But it is easier to work with and less expensive to fabricate.

Porcelain or ceramic crowns, done right, are NOT prone to fracture and are the most beautiful restorations in dentistry today. Done right and maintained properly, they are practically impervious to staining and they don’t break.

Dr. Hall

Helpful links:
Porcelain crowns
Care of porcelain veneers
GlamSmile veneers are cheap, but are they good?
Click here to find a cosmetic dentist.
Click here to ask Dr. Hall a question.

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October 3, 2008

Should I wait the three weeks to get my tooth extracted?

Filed under: Extractions, Infected teeth — iowasmiles @ 11:25 am

Dr. Hall,
One specialist tells me I have a fractured root on a 3-year old root canal on my lower left molar (#19). There is an abscess/burst/bad taste/mild throbbing, sensitivity, and generally, I feel tired and foggy-brained since this started swelling 3 weeks ago. I’m scheduled for an extraction and implant later, but must wait over 3 more weeks for the extraction. It feels urgent to have this tooth out and to start feeling better. I’ve asked the specialist to get me in sooner, but it looks like I will have to wait. Should I find another specialist to remove the tooth? What are the consequences of waiting for the extraction/infection growing? Thanks for your advice on this.
- Jeanne in Arizona

Jeanne,
Unless they’ve given you some clinical reason that you should wait to have this tooth extraction done, I’d find someone who can get this done faster. You’re not saying what specialist you’re dealing with – I’ll assume it’s an oral surgeon as that would be the normal situation. You don’t necessarily need an oral surgeon to take out tooth #19. I doubt it would be that complicated. I’d tell your dentist who referred you to this specialist that this is unacceptable to you and you want him or her to refer you to someone who can get you in faster. Or you can go out and find someone on your own. You can call oral surgeons’ offices, or you can call general dentists. Unless there’s something unusual about this tooth #19 besides the fractured root, a good general dentist who does a lot of extractions would ordinarily be able to take it out.

In the meantime, before you get it out, this infection can grow, and it can become more entrenched. It PROBABLY won’t cause any serious complications to wait, but it could, and there’s apparently no reason to wait except that you have to deal with the schedule of the specialist. The biggest reason is that you’re uncomfortable. It also makes you more vulnerable to other ailments, while you’re battling this infection.

Good luck,
Dr. Hall

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