November « 2008 « The Cosmetic Dentistry Blog

November 26, 2008

Should my son have all his teeth extracted?

Filed under: Dental implants, Dentures — iowasmiles @ 4:52 am

Dr. Hall,
My 22 y/o son is a recovering drug addict whose teeth have been destroyed. His dentist recommends extracting 27 teeth at one time and replacing with dentures. Is this a lot to do in one visit? Aren’t dentures custom fitted? I know this is probably the best route to take for him and he is ok with this. Right now he only has his front teeth to chew with. Thank you.
- Rebecca in California

Dear Rebecca,
I am not in favor of this treatment plan. It’s easy for the dentist and a lifetime of difficulty for your son. Twenty-two is way too young to be getting all his teeth extracted.

Once the teeth are extracted, your son’s jawbone will start to shrink, and will continue to do so for the rest of his life. By the time he is 40 he will be a dental cripple, unable to comfortably retain any kind of a removable denture. His face will shrivel up and he will look much older than his years. He will be wanting expensive and complicated bone grafts to his jaw to try to get to some level of function where he can eat normal foods. By the time he is 60 it will be much worse.

Surely, out of those 27 teeth, there are some that can be saved. Any that are saved will help preserve that jawbone. Yes, it is more bother for the dentist and it will be more work for your son to maintain those teeth. But it is well worth it.

And, if there are none that can be saved, placing some dental implants will do the same thing as far as helping prevent the shrinkage of the jawbone. Even two implants per arch will help preserve his bone, though more would be better.

It’s easy to look down on your son and say, “Drug addict – not worth the trouble.” And he may well have similar feelings about himself. But I would hope for better things for him.

As far as the number of extractions, that is a little much for one sitting, in my opinion. The amount of novocain required to extract all the upper teeth in one sitting is pretty large, and that can be a significant risk factor, in addition to the amount of trauma from all those extractions. The lower jaw can be completely numbed with two main injections, but the upper jaw requires multiple injections.

If I were in your shoes, I’d go dentist shopping. Dentists have to pass minimum competency examinations, but there is no examination for caring. Find a dentist who gives you a feeling that he or she truly cares about your son and his long-term future, and that will greatly improve your chances of getting good care for him.
- Dr. Hall

Reply from Rebecca:

Dear Dr. Hall,
Thank you so much for your reply – I really appreciate it.

My son is the most important person in the world to me and if I was financially able I would have his teeth replaced with implants. I will accept your advice and get some other opinions. I am not an expert but I too thought this was an extreme treatment plan.

Again, thank you and have a great day!

Related links:
Immediate dentures are placed the same day as teeth are extracted. They require relining a few months after being placed.
Dentures that are made with special attention to their appearance are sometimes called cosmetic dentures.
Soft dentures are made with soft linings for a more comfortable fit and sometimes a more snug fit.

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November 21, 2008

Help in picking a dentist and wanting Lumineers

Filed under: Finding a cosmetic dentist, Lumineers — iowasmiles @ 5:32 pm

Dr. Hall,
My daughter wants to get the lumineers by cerinate – she has visited with a dentist in Lubbock, Texas, Dr. Jones (not the real name), who has quoted her a price of $900 per tooth.

She is needing to have six teeth done.

There is a 5 year warranty and they are estimated to last 20 years. Can you verify if this is a reputable dentist and any information you can provide on the Lumineers by cerinate. Thanks in advance for your reply.
- Betty in west Texas

Dear Betty,
Whether or not the dentist is reputable isn’t the right question. You want to know if the dentist is artistic, and if he or she is trained in cosmetic dentistry.

It is not illegal to advertise as a cosmetic dentist, even if you have absolutely no training in cosmetic dentistry, and that is because cosmetic dentistry isn’t a legally recognized specialty.

I checked my sources about the dentist you mentioned. He may be very reputable, but I don’t see him on any of my lists for cosmetic dentistry training. And from what I did see on the Internet about him, I strongly suspect he is not an artistically inclined dentist.

You spoke about your daughter needing six Lumineers, as if there are teeth broken and they need to be fixed. I suspect that the situation is that she wants a beautiful smile. I would recommend against this dentist you mentioned, and I would recommend against Lumineers. Lumineers will likely make her teeth longer and bulkier, and especially if the dentist only does six, they will look funny. Lumineers work well for people with short teeth that are set back in the mouth a little. So if she wants a beautiful smile, that seems like an awful lot of money to throw at the problem and then not come away with a beautiful smile. That’s why you want an artist to do this.

Reputable dentists fix teeth so that they are functional, and they do work that lasts a long time. But unless your dentist is an artist, you may come away from the office hoping that it wears out or breaks quickly.

I would suggest a second opinion from a Texas cosmetic dentist on our referral list, before you spend all this money.

Good luck,
Dr. Hall

Click here to find a cosmetic dentist
Click here for information about porcelain veneers

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November 18, 2008

A DIAGNOdent question

Filed under: Tooth decay — iowasmiles @ 1:18 pm

Dr. Hall,
I just started at a new dentist. They used a laser to detect tooth decay. While they didn’t find any actual cavities, they found some four areas that could be cavities in the future. I am a little confused. They want to give me fillings where there are no actual cavities. Does this seem normal, and will it seal in decay? I feel a little bit like they were trying to sell me something that I don’t need? Thank you!
- Melanie in Indiana

Dear Melanie,
I don’t think your new dental office is trying to sell you something you don’t need, but I do think they need some help with their communication skills. I think it would be helpful for you to tell them how confusing their explanation was, so that they can explain this better to the next patient.

The new laser that is used to detect tooth decay is called DIAGNOdent. It detects actual decay, not areas that will in the future become decay. There may be someone in your dentist’s office who is confused about that, because the decay detected by DIAGNOdent doesn’t appear to be decay yet, since it is decay under the surface. But DIAGNOdent is very helpful because it enables the dentist to find and fill cavities when they are smaller and thus they can intercept problems before they become bigger and more expensive.

The way decay grows on a tooth makes it hard to detect when it is small. First, acids from decay-producing bacteria start to work on the enamel in a spot and they make it porous. This early change in the enamel often isn’t visible. Then the decay begins to grow just underneath the enamel in the dentin of your tooth. When the decay has grown enough, the enamel begins to cave in, and you have a full-fledged cavity that is visible to the dentist. What the DIAGNOdent does is it detects this decay under the surface before the enamel caves in. With the new bonding technology that is used with white fillings, the filling can be made quite small and unobtrusive.

And, besides being cheaper, smaller fillings tend to last much longer than large fillings, and they don’t weaken the tooth as much.

I’m assuming, in this answer, that your dentist is interpreting the results of the DIAGNOdent properly. If the results aren’t interpreted properly, you can get a false positive – an impression that there is decay when there is simply debris, say, clogging the pit of the chewing surface of a tooth. But when the clinician is properly trained, the results of this instrument are highly reliable and most helpful.
- Dr. Hall

Related links:
Laser tooth whitening
Ask Dr. Hall a question

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November 14, 2008

Can I have porcelain veneers if I’m pregnant?

Filed under: Porcelain veneers — iowasmiles @ 11:08 am

Hi I am having four veeners put on my upper front teeth by a cosmetic dentist after your website refered me to him. My question is I am 6 months pregnant and was wondering if the procedure was safe for my baby. The dentist said it would be because no anesthesia would be necessary but I just wanted to be sure.
- Chelsea

Dear Chelsea,
Congratulations on both accounts – on the baby you’re expecting, and on your new smile!

There is nothing to worry about being pregnant and having porcelain veneers.

Even if you did need novocain, novocain is one of the very few drugs that has been tested and is known to be safe for unborn babies – they even give that during childbirth in some cases. They do try to avoid novocain, however, during the first three months of pregnancy, because there are a lot of unknowns with babies that young. And it’s good to avoid any dental work when you are really close to delivery because that can be hard on the patient. But six months along – that’s good timing.
- Dr. Hall

Other links:
Ask Dr. Hall a question
What about teeth whitening while pregnant or nursing?

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November 11, 2008

My fillings at the gumline keep popping out.

Filed under: Tooth bonding — iowasmiles @ 2:18 am

Dear Dr.Hall,

I want to thank you for providing a wonderful informative site for FREE to the public. The patients you served during your career must have appreciated your care, talent, and quality of service.

I’m sure you can help direct me with my concerns. I have severe erosion at the gum line of my 3rd, 4th, and 5th teeth back from my center teeth at both top, bottom, left and right sides. I first had bondings done for the erosion areas only and they matched my teeth well and lasted 10-20 years. All my attempts to have them replaced with the same performance and quality have failed. Two years ago I had the majority of them replaced by a young dentist. They began falling out within a month so he replaced a couple and they also fell out quickly.

I’m very skeptical about returning though my family encourages me he will fix it without charge. Do you think it is too late to expect any refund so I can get appropriate help from a Cosmetic Dentist?

Should I attempt bondings again or porcelain veneers? I also have not mentioned that my teeth are discolored from Tetracycline when my adult teeth were developing.
Sincerely, Carolyn from Texas

Carolyn,
Thanks for your question and your kind comments.

The answer to how to restore your teeth is actually quite simple, but dentists who aren’t trained in advanced cosmetic dentistry techniques often don’t know this answer.

Recent research has revealed that these notch-shaped lesions at the gumlines of your teeth are actually caused by FLEXING of the teeth, which is aggravated by clenching of the teeth. They have been given the name “abfraction lesions.”

To get the restorations to stay in, the dentist needs to use a FLEXIBLE restorative material, which is counter-intuitive for most dentists. They think they need to use a very strong, hard restorative, but that type tends to pop out within a month or so.

If your dentist will use a microfill composite for these lesions, rather than a hybrid, that will go a long way toward helping them to stay in. Microfills are more flexible than hybrids. He should use something like Silux Plus, or Renamel. That will bend with the tooth and stay in usually for a number of years, provided that proper bonding techniques are used. Newer composites tend to be hybrids and microhybrids that don’t flex well, which may be why the older fillings stayed in for so long.

If your dentist is humble enough to take some direction, just sharing this information should be enough. If he isn’t, then you may need to seek out a refund and go to a more expert cosmetic dentist.

As far as your tetracycline stains, that is a more complicated issue. A set of beautiful porcelain veneers would totally transform your smile. But you definitely need a highly artistic, very competent cosmetic dentist for that, such as we recommend on our web site. Check our list of Texas cosmetic dentists. Don’t go to your family dentist for this – it is much too difficult, in spite of what they might tell you.

I hope this is helpful.
Dr. Hall.

November 4, 2008

Could I get dental implants and not dentures?

Filed under: Dental implants — iowasmiles @ 8:09 am

Dr. Hall,
This is the first time in nearly 30 years that I have had dental insurance. I have advanced peridontal disease, in which I have had teeth fall out. (eight in total) My gum line is very low. Would it be possible for me to get implants not dentures?
- Deena from Illinois

Dear Deena,
Dental implants are an excellent choice anytime you have to replace missing teeth. Especially if all your teeth are missing. Removable dentures will reduce your chewing efficiency by at least 50%, because they tend to slip and slide around. Not only do dental implants enable you to eat normally, but they will also help preserve your jawbone. When all your teeth are missing, if you don’t have implants, your body senses that the jawbone is no longer necessary and begins to dissolve it away in order to use those minerals elsewhere. This results in facial collapse. After about ten years, it becomes difficult to wear a denture because there is little bone left to rest it on. Your lower face also shrivels up and you begin to look much older.

Whether or not you are a candidate for dental implants, however, depends on a number of factors, including general health. Your history of advanced periodontal disease could make it more difficult for dental implants to work for you. And if you have had a lot of bone loss, you may need some bone grafts in order to provide enough bone to hold the implants. But I would go for it. Get a reputable dentist who has done a lot of dental implants and has been to a lot of dental implant continuing education.
- Dr. Hall

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