The Cosmetic Dentistry Blog

January 30, 2009

A question about fees and dental insurance

Filed under: Cosmetic dentistry costs, Dental insurance — iowasmiles @ 5:15 am

Dr. Hall
I’m seeing a dentist covered by my dental insurance and need 3 crowns. I asked for a bill and see that I’m being charged the insurance rate $328 for each of the crowns but additionally I’m being charged $350 per crown for ‘Zirconia Upgrade’ and for tooth number 14 I’m being charged an additional $275 for ‘Upgrad Porc. on Molar’. What are these upgrades. Money is tight for me and I’m wondering if I need to pay $1325 additionally for upgrades. If it makes a significant difference I will take loans and do it, but I don’t want to unless it is necessary.
Thank you,
Ira in Maryland

Ira,
Whether these charges are “necessary” or not depends on you. You need to have a discussion with your dentist about this. Do you want porcelain on the dental crown for tooth #14, or will a metal crown do? And do you want zirconia crowns on the other teeth, or will the crown the insurance pays for be all right? That part I can’t answer, but I can help you know what is going on here. In the eyes of your dental insurance plan, these extras aren’t necessary, but keep in mind that they only have their bottom line in mind.

Your dental insurance plan is trying to save money to stay within a certain budget that your employer wants to pay for. And this dental insurance plan appears to me to be extra cheap. They have allotted a certain payment for a certain type of crown, and it appears to me that the dentist feels squeezed either in the costs allotted or in the types of crowns your insurance is willing to pay for, and is looking for a little leeway. (I have to admit that I’m going on sketchy information here, so I’m guessing at some things to fill in the blanks.)  I don’t fault the dentist for this. When I was dealing with a chintzy insurance company, I would give my patients the option of choosing the more expensive all porcelain crowns for front teeth because they looked so much better. But I gave them a handout that explained their options, the amount of the extra cost, and all the pros and cons of the different choices. It looks, from your confusion, like your dentist left out this step.

You are entitled to complete information from your dentist, including all of the options available and the pros and cons of each choice, to help you make an intelligent choice about these options. So ask for that.
- Dr. Hall

Related information: Read about the costs of porcelain crowns.

We thank our advertisers who help fund this site.

January 26, 2009

Should I go to a prosthodontist or a cosmetic dentist?

Filed under: Finding a cosmetic dentist — iowasmiles @ 9:17 pm

Dr. Hall, I’m planning to get veneers on my upper teeth. I’ve seen 3 different cosmetic dentists/prosthodontist/lumineer dentists. They are Dr. —-, Dr. —- and Dr. —-. They are all dentists in San Francisco, California. Can you please help me check if they are certified cosmetic dentist. Or should I still schedule a consultation with Dr. Jerry Bellen?

Thanx for your time.
Rich in San Francisco

Rich,
I want to say this kindly. I can’t find any of the three dentists you mentioned even on the membership roles of the American Academy of Cosmetic Dentistry, which is to me usually a bare bones minimum indication of a flicker of passion for cosmetic dentistry.

Cosmetic dentistry is a lucrative field and there are many pretenders. That is why I do this website – to help people like you sort this out.

In my opinion, a prosthodontist, as a general rule, is a VERY poor choice for a smile makeover. Prosthodontists have spent years studying function and the engineering principles of tooth restoration, and as a rule, at least by my experience, have very poor artistic sense. There are a very few exceptions, and I mean very, very few. I have turned down several prosthodontists who wanted to get listed on mynewsmile.com as recommended cosmetic dentists, because I looked at their work and yes, it was solid and functional but definitely not beautiful.

You are really doing yourself a disservice in San Francisco if you don’t go to Dr. Jerry Bellen for at least an opinion on your porcelain veneers case. He does absolutely beautiful work.

Dr. Hall

Click here to read about smile makeovers. Or you can read about what Dr. Hall thinks of Lumineers.
Click here to find a cosmetic dentist.

January 19, 2009

Are Lumineers reversible?

Filed under: Finding a cosmetic dentist, Lumineers — iowasmiles @ 3:10 pm

Hi Dr. Hall,

I am seriously thinking about getting Lumineers. I am thinking about using Dr. —- from Los Angeles. I understand that he is one of the premiere Lumineers dentists. I was wondering if you could do some research on him and provide me with any feedback on his training, cosmetic dentistry background, complaints, awards, etc.

Also, would Lumineers be a good option? Are there good reviews and feedback on Lumineers looking nice and also lasting a while? I’m afraid of having my teeth shaved down and wanted to go the route of Lumineers if they are worth it.

Thanks a lot,
Ken from Pennsylvania

Dear Kenneth,
I can find no evidence of any cosmetic dentistry training that Dr. —- has. Sorry. He isn’t even a member of the American Academy of Cosmetic Dentistry, which to me shows a low level of commitment to cosmetic dentistry. And I can’t find his name among graduates of some of the popular cosmetic dentistry training courses that I have access to. And the other question I ask – is he an artist? I don’t know the answer to that. Most expert cosmetic dentists who are artists do post their work on the Internet, and I don’t find any of his posted. So I’m skeptical about that.

And the fact that you are telling me you are afraid of getting your teeth shaved DOWN concerns me. I think you’ve been overly influenced by the commercials. Before you go and possibly ruin your smile, I think you owe it to yourself to get some accurate information. And here are the inaccuracies I believe you have bought into:

1) For porcelain veneers, generally your teeth are shaved a little, but I don’t think it’s accurate to say they’re shaved DOWN. In many cases, from a conversational distance, you can’t even tell that the teeth are changed after they have been prepared for porcelain veneers and before the veneers are put on. That’s how small the reduction is, in many cases, if you get the beautiful porcelain veneers.

2) On the other side, I’m not so sure that Lumineers can be removed without damaging the teeth. Yes, THEORETICALLY, since the teeth aren’t shaved at all before placing the Lumineers. But it is very easy to have an ”accident” when the Lumineers are removed and to have a tooth or teeth gouged or nicked.

My advice is not to go only to a dentist who promotes himself too heavily as a “Lumineers dentist” before getting a new smile. You may not get an honest opinion about whether or not they’re good for you. Go to an expert cosmetic dentist first. Any expert cosmetic dentist listed on our website is able to do Lumineers. Just go for an opinion. Then compare what the two dentists say. Armed with more information, you are in a better position to make a good decision about whether or not to do Lumineers.

And I have not seen a really nice Lumineers smile. I’ve seen some bad ones and some okay ones. I’m sure there are some really nice ones out there, but I haven’t seen any. They make your teeth look rounded, a little bulky, and a little longer.

As far as long-lasting, Lumineers are excellent in that department. They’re durable—probably better than average in that department.
- Dr. Hall

Related information:
Click here to find a cosmetic dentist, screened for artistic ability and training in cosmetic dentistry.
Read more about smile design and smile makeover.

January 14, 2009

Should I get porcelain veneers or Invisalign?

Filed under: Invisalign, Porcelain veneers — iowasmiles @ 3:20 pm

Dr. Hall,
I always wanted to have better smile, that’s why I decide to do 10 porcelain veneers on my upper jaw. Although I don’t have any major problems with my teeth, I wanted them to be whiter and brighter, and I also have one crooked tooth, which is not that bad to my opinion to even consider braces.

However my dentist suggested that I would need to do Invisalign invisible braces treatment before I put my veneers. He stated that after this procedure the drilling would be minimum. He also didn’t recommend Lumineers for my teeth, he said that they might look bulky on my teeth. I am not excited about 9-12 months treatment and additional cost of course, please tell me what do you think about my doctors suggestions and if it make any sense.I would highly appreciate your answer.

Thanks,
Julie from Michigan

Dear Julie,
Please take my recommendations with a grain of salt, because I haven’t seen your case and don’t know why your dentist is suggesting doing Invisalign first and then porcelain veneers. It could be that you have a great deal of crowding or a serious bite problem or something else out of the ordinary. Because, ordinarily a cosmetic dentist would recommend either porcelain veneers or Invisalign for a smile makeover, not both.

I like what your dentist said about Lumineers for you. It is true that they make your teeth look bulky. But I’m suspicious about the other part of what he is saying, so I’d recommend a second opinion from one of our Michigan cosmetic dentists, and this would be a way of verifying what you’re being told. When you go for the second opinion, remember to not let the second dentist know what you were told by the first dentist. That way you can get a completely independent second opinion.

Porcelain veneers from an expert cosmetic dentist can mask crooked teeth so that they look straight. I would choose the porcelain veneers if you are especially impatient or if there are problems with the shapes of your individual teeth.

Invisalign invisible braces will make your teeth actually be straight. And they are much faster than conventional braces, with treatments typically taking six to twelve months. If you are also wanting whiter teeth, it is very easy to do tooth whitening treatments while you are wearing the Invisalign aligners. The aligners can actually be used as bleaching trays. This would be the option to choose if you aren’t in as big a hurry for results.

But in most cases it would be one treatment or the other, not both.
Dr. Hall

Click here to find a cosmetic dentist who has been screened for artistic ability and advanced training.
Click here to ask Dr. Hall a question.

January 10, 2009

An example of the esthetic sense of many dentists

Filed under: Finding a cosmetic dentist — iowasmiles @ 8:03 pm

I frequently read a popular implant dentistry forum. I thought I’d re-post this one question, asked by one of the participating dentists, to illustrate a point about many dentists’ esthetic sense:

“Dr. M. asks:
“I have a patient who is a beautiful woman with this huge diastema between her maxillary central incisors. I think if I placed an implant between them I could fit in a crown that would add harmony and balance to her smile line. Have any of you tried to solve this particular aesthetic problem with an implant solution like this?”

This dentist was proposing sticking an extra tooth in the middle of this beautiful woman’s smile, simply because she had a space large enough to accommodate one. There followed a serious discussion of the pros and cons of this question, whether or not there would be enough bone to support the implant, and how predictable various options would be. I saw eight replies to this question when I discovered it. Not one of the eight voiced what your average person would think of this suggestion: that it was absolutely ridiculous – maybe appropriate for a hillbilly, but absolutely atrocious for a beautiful woman.

The midline of your teeth should correspond to the midline of your face. And people expect a smile to show two central incisors in the middle, two smaller lateral incisors on the sides of those, and two slightly larger canines on the sides of those.

I repeat – don’t have a new smile from any dentist unless that dentist has strong artistic inclinations. These professionals, most of whom are very ethical and have the best interests of their patients at heart, simply do not understand esthetics. They went into dentistry because they are technical types who love to fix things that are broken. Go to a recognized artist for your smile makeover.

Read more about the difference between a general dentist and a cosmetic dentist.
Read about all the subtleties of smile design.
Read about dental bonding and porcelain veneers, two of the smile design tools of your cosmetic dentist.
And click here to find a cosmetic dentist with the artistic touch and training to create beautiful smiles.

January 6, 2009

Tetracycline stain, and no money for porcelain veneers

Filed under: Tooth staining, Tooth whitening — iowasmiles @ 6:39 pm

Dr. Hall,
I had bonding applied to my teeth and now they are chipping and dulling? Medicines I had when an infant caused my teeth to be discolored and gray.I do not have money for veneers. Is there a new whitener that will help?
- Tami in Wisconsin

Dear Tami,
You have tetracycline stains. Tetracycline, if you take it before the age of about 12 when your permanent teeth are forming, will deposit in the dentin of your teeth and will show up as a dark brown or gray stain, sometimes in bands.

It’s risky to have these treated by a general dentist or a dentist who does some cosmetic dentistry. You really need a lot of training and experience to mask out these stains with porcelain veneers.

But, if you can’t afford veneers, and if you have existing dental bonding on the teeth, you have two reasonable choices, in my opinion:

  1. If the bonding was placed over your intact enamel, then I would have your dentist remove this bonding with sandpaper disks. In many states, this could be done by a dental hygienist, at probably a lower fee. Then I would have your dentist set you up with a home tooth whitening tray and the strongest home bleaching gel that you can tolerate without your teeth getting sensitive. Then I would bleach every night for a couple of months. Your teeth will lighten and look much better. Not as good as porcelain veneers, but definitely better.
    Don’t try to do this with over-the-counter whitening products. They will be a waste of money because they are no where near strong enough for tetracycline stains. You need the strongest stuff money can buy.
    And don’t do the laser tooth whitening or zoom whitening. Yes, these are more powerful, so they would be faster. But if money is an issue, these power bleaching techniques that are done in the dentist’s office get to be really expensive, especially with the number of appointments you will need. With the home trays, you can do the extended treatments on your own time, at just the expense of the refills. If your dentist charges too much for the refills, you can find them cheaper on EBay.
  2. If the dentist who put the bonding on removed some enamel before putting it on, then I would bite the bullet and start saving for an expert cosmetic dentist to do eight or ten porcelain veneers. Meanwhile, I would have someone smooth out the bonding. Dental bonding, done well, is going to cost a lot of money, and will be several times more expensive over the long run than porcelain veneers because it begins to look crummy in one or two years, where porcelain veneers, which may cost anywhere from 10% more to twice as much initially, will last many years and look great for all that time.

Good luck,
Dr. Hall

Click here for more information about bleaching tetracycline stains.
Click here to find a cosmetic dentist, screened for artistic ability and training in cosmetic dentistry.
Click here to ask Dr. Hall a question of your own.

Powered by WordPress