The Cosmetic Dentistry Blog

June 29, 2009

I don’t like my porcelain veneers

Filed under: Cosmetic dentistry mistakes — iowasmiles @ 3:36 pm

Dr. Hall,
I got 8 porcelain veneers about a month ago. I wasn’t impressed by the waxon models, but they promised that it would look better. Before they put veneers on, they let me look at them on my teeth without attaching them all the way. I didn’t like them at all. The shape is not what I expected them to have, color is almost stained, gaps are between every tooth along the gum line and some teeth just slightly touch and have gaps. The dentist said that we can put them on and see if I still don’t like them. Even now I am not happy with the result. Dentist told me that the lab person got kinda mad at him for listening to my complaints and it’s the best that can be done. But if I really-really wanted, I could start the whole process with the same cost. Is there anything I can do? And is it true that, if I don’t like the result, they are not required to fix it. Thank you very much for your time.
- Max from Colorado

Dear Max,
I’m not sure I’m hearing you right. It sounds like this dentist went to the trouble to make a wax simulation of what your porcelain veneers would look like, and you didn’t like it, but he went ahead and had them made anyway. And then, after the lab made them, they tried them on, and you still didn’t like them, but they bonded them on anyway. What was the point of the try-on? And what kind of dental laboratory technician would get mad at a dentist for listening to the complaints of a patient? The patient, after all, is ultimately paying the salary of both the dentist and the laboratory technician. The whole scenario you’re painting for me just seems weird.

One of the most prominent distinctions between a true cosmetic dentist and a general dentist who does cosmetic dentistry is that the true cosmetic dentist will always have procedures in place to make sure that you like the work before it is finally bonded on. It sounds like your dentist went through the motions of doing this, but without the intention of actually making you happy.

Unfortunately, you gave your implicit consent to the appearance of the porcelain veneers by allowing him to bond them on. And, with cosmetic dentistry, most of the dental profession doesn’t appreciate it at all, so the standard of care is that it needs to look only halfway decent and it needs to function okay. As long as your porcelain veneers function, I think you’re stuck.

Whatever you do, don’t have this guy re-do them. Either I am missing something fundamental in what you’re telling me or this guy doesn’t mean what he says. You have no assurance that the second time will be any better. In fact, you can pretty much count on it coming out the same.

There are some excellent cosmetic dentists in the Denver area. Check our list and go to one of those and see what they think.
Dr. Hall

Click here for referral to an expert cosmetic dentist near you

June 26, 2009

Crowns are wrong color

Filed under: Crowns for front teeth — iowasmiles @ 5:39 pm

Dr.Hall,
This might be a stupid question, but I’m going to ask it anyway. Two days ago I got porcelain crowns for my two front teeth. The color of them is noticeably more yellow than the rest of my teeth. I was in a lot of pain from sitting in the chair so I didn’t really get a long look at them before I left. But when I got out into the sun, I looked again and noticed a big difference. Now if I wanted whiter crowns, I would have to pay for them all over again right? (which I’m definitely not about to do, seeing as I already spent a fortune on them!) Or do you know if they can be whitened at all? I’m thinking that since I just got them done, that maybe he can do it over with a whiter shade….for free? Sorry if this is a stupid question, I just don’t know what to do….thanks for your time!
- Jennifer in Massachusetts

Jennifer,
This is one of the most consistent differences between the expert cosmetic dentists that we recommend on www.mynewsmile.com and others who just call themselves cosmetic dentists. There is that passion that true cosmetic dentists have that they want to make sure the work looks perfect to you before they cement it in or bond it. The other 98% of dentists really love to fix things and don’t have much appreciation for appearance-related issues. They really don’t see the importance of making sure you have a good look at the teeth before putting them in. Part of the reason may be that they think it looks “good enough” and they’re afraid you’ll be too fussy.

You’re kind of stuck with the color, unfortunately. Nothing you can do to porcelain will lighten the color. The only option is to re-do them. Maybe your dentist will do that for free. You can always ask.

Don’t let anyone talk you into putting porcelain veneers on top of the crowns. That has the potential for looking really bad, and if it’s done right, it will cost the same as re-doing the crowns. It doesn’t make any sense at all—don’t do it.
Dr. Hall

Related links:
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June 22, 2009

My tooth has a really sensitive spot at the gumline

Filed under: Teeth sensitivity — iowasmiles @ 10:18 pm

Dr. Hall,
Very recently for the past few weeks one of my teeth has grown rather sensitive. Not to cold or hot, but if I scrape it with my fingernail near the gum line it almost feels like touching a nerve. The funny thing is, eating, drinking, brushing and flossing are all painless; its only sensitive to pressure with something hard, like a toothpick or fingernail. I was wondering what this might be.

I see the dentist about 2-3 times a year, and they always tell me my teeth are extraordinarily clean. I’m just very paranoid about my teeth. I hate getting dental work, and I don’t want to find out it requires a painful procedure to get it fixed. Help!
- Brandon from Ontario

Brandon,
It’s important to pay attention whenever a tooth is sensitive for an extended period of time like yours is. Even if the cause isn’t serious, the constant irritation of your tooth isn’t good and can lead to nerve damage inside the tooth, requiring root canal treatment.

I’m encouraged to know that the tooth isn’t sensitive to heat or cold or anything other than touching it in this one spot. Teeth can have sensitive spots like this, and usually those spots can be sealed over with something to alleviate the sensitivity. It’s kind of like a tiny filling.

Teeth tend to flex a little bit right where the crown meets the root. A lot of dentists aren’t familiar with this phenomenon, and it was only recently that it was discovered. But the tooth flexes at this spot, and causes tiny particles of tooth structure to break off, sometimes causing a sensitive spot, and sometimes continuing to progress until a significant groove develops. The trouble with treating them is that dentists have a hard time getting fillings to stick in this location – they tend to pop out. The way to get fillings to stick in this position is to use a flexible filling material, like a microfill composite.

So ask your dentist to seal over this sensitive spot, and if there is enough room for a filling, to place a small amount of microfill over the spot, and I believe the sensitivity will go away.
- Dr. Hall

Related links:
Read more about teeth that are sensitive to touch.
Read about a toothpaste for sensitive teeth.

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June 15, 2009

Feeling pushed into treatment

Filed under: Preventive Dentistry — iowasmiles @ 4:24 pm

I am a senior with limited income and recently had a vizilite solution performed by my new dentist’s employee. It cost $59.00 and they way it was pushed on me I feel their tactics indicate I wasted my money. Am I correct? Also for my next appointment they want to do a deep cleaning at a cost to me of $113.00. How can I determine it is necessary as dental insurance only covers a normal cleaning not deep. Thanks for a prompt reply.
- Joe from Florida

Joe,
Your concerns about being pushed into choices by your dental office sound justified. I know how you feel–you’re in a vulnerable position of needing to trust your dental office, and then you get pushed into add-on tests and services that you’re not sure you need.

The ViziLite is an excellent screening tool for oral cancer, but if I were on a tight budget, I think I’d skip it if it were going to cost me $59. The deep cleaning may be needed. But if they were pushy with me on the one issue, it makes me more skeptical.

If you are finding that you have a problem trusting your dental office, I would go shopping around for another dentist. There is no way for you to check up on them to make sure you need everything they say you need, so it all comes down to trust. In my opinion, dentists as a rule are very ethical, but there are some who are not trustworthy. And this pushiness is a red flag to me.

- Dr. Hall

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June 13, 2009

Shame on you, Dr. Hall

Filed under: Hate mail — iowasmiles @ 8:05 pm

Dear Dr. Hall,
I read your respose to Lesly [sic] (A Bad Experience with Lumineers) and was very shocked and disappointed that you without seeing the patient jumped to the conclusion that the treating dentist made an error and that his skills as a a cosmetic dentist are not up to the standards. As someone who claim that you try to educate and help the public you should be very objective and avoid judging your peers without knowing the whole truth…shame on you.

Dear Anonymous,
Shame on me? Before you talk to me about shame, I think you should have the decency to identify yourself. But your message came with no e-mail address, phone number, or first name. People who make comments behind a cloak of anonymity don’t have much credibility with me.

I am proud of what I write. So much so that I put my name on it, my address, my phone number, and all about the company I run. And I think Lesley is very glad that I didn’t pull any punches when I answered her question.

Lesley’s case was pretty clear cut – she had three crowns and three Lumineers placed on her front teeth and within a week, one of the crowns started turning dark. I think that any decent, self-respecting dentist would take responsibility for that. I certain would, if that happened with a case that I just inserted, and I don’t think it is out of line to expect that from her dentist. Do you think that is within the standard of care, to give a patient a dark crown on a front tooth?
Dr. David Hall
Phoenix, Arizona
Putting my name on everything I write.

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June 5, 2009

I have an infected tooth and no money

Filed under: Infected teeth — iowasmiles @ 4:15 pm

I am missing some teeth in the back part of my mouth. I now have an infection so bad and my cheek is swollen so much that I look like I have a golf ball in my mouth. I do not have medical or dental  insurance and I do not have a job so I wanted to know what I can do to treat the infection. Thank you for any help you can give.
- Rachel from Michigan

Rachel,
You’re in kind of a tough spot. But before I tell you what to do, let me tell you what NOT to do. Don’t take antibiotics to try to get rid of the infection unless you also have the tooth treated. And here is why. The infection you have is inside some tooth. Antibiotics cannot get to the inside of a tooth. So what happens if you try to get rid of the infection with antibiotics alone is that you attack the infection, but there is no way you can get rid of it, so you are helping the bacteria that survive develop resistance to the antibiotic. Then, when it comes back, you could be facing a situation where NOTHING will get rid of the infection–potentially a very serious situation.

Tooth infections are nothing to fool around with. They can spread to your brain and cause a brain infection, or they can spread to your throat and swell and choke you. So you need to get this fixed. A root canal would be good, but if you can’t afford that, at least have the tooth extracted. Depending on where the tooth is and its condition, you may need to take antibiotics for a few days before it is extracted. Be sure you follow through, because if you just take the antibiotics and leave it untreated, the infection always comes back and is always more resistant to antibiotics to some degree or another.

Many communities have clinics or programs where people who don’t have any money can get basic dental care in emergencies. Call your local dental society and ask about such a program or clinic. Or just start calling dentists. When I was in practice, I would always try to help someone in an emergency situation like yours, and I would take whatever payment they could afford. But they would need to call and let me know their situation.

And don’t delay. The infection can get much worse. It can also break through somewhere and drain and then start to feel better, but you can’t count on that.
- Dr. Hall

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