The Cosmetic Dentistry Blog

September 30, 2009

Infection after wisdom teeth removal

Filed under: Uncategorized — iowasmiles @ 9:17 am

Hi,
I am 48, had two wisdom teeth on left side removed. They said I had a small infection in around my teeth, otherwise my teeth are in decent shape.

About a week or two after the surgery this large lump in my lower jaw persisted and grew more painfull. They put me on a second round of antibiotics. That did not help. I went back, they opened up the area and cleaned it and put me on more antibiotics. I have one more day on antibiotics. The lump is smaller. It’s 10 days later and the pain is very little though that area is still a little tender. I don’t think opening it up again will help.

uggestion? Thankyou.
David in Tennessee

Dear David,
I wouldn’t think you’d need the area opened up again, but of course, I can’t see it for myself so I can’t give you a definitive answer. But it looks like everything else is working and you just need a little more antibiotics. But I would for sure let your dentist know that you haven’t completely healed from your infection yet and you need more antibiotics. Your symptoms should be gone for about three days or you should keep taking the antibiotics to avoid a relapse.

If you’ve killed off most, but not all, of your infection, you are at risk of the infection coming back. And when it comes the second time, it is harder to get rid of it because the bacteria have started to develop a resistance to the antibiotic.

And another comment about your situation. You’re one of many illustrations as to why you should get your wisdom teeth out when you’re young. Complications are rare when the patient is 25 or younger and has his or her wisdom teeth out, and they increase exponentially as you get into your 40s and beyond. Usually, when wisdom teeth get infected, it’s because there was never enough space for them to fully erupt, and this is something that is easily predicted when you are around 20.
- Dr. Hall

September 29, 2009

My dentist wants to do a metal crown.

Filed under: Dental crowns — iowasmiles @ 1:13 am

Hello Dr. Hall
I’m having a crown put on one of my rear molars. The dentist says it’s not possible to use porcelain due to the size. Something about how there is not enough space. So they’ve given me the option of metal or gold. Is this possible? I read that metal takes more space than porcelain. I don’t want metal, if at all possible.

Thank you,
- Rose from California

Rose,
When porcelain is used in a crown, it does have to be thicker than metal. And in some situations, on second molars, there is very little space to work with. I can understand why your dentist would want to use a metal crown if space is limited in your mouth.

There are various options for a metal crown. Gold is the most common metal because it is corrosion-resistant, and can be cast to a fine finish line so that it fits better than any other type of crown. If you have to have a metal crown, I would highly recommend gold. It might cost more, but you will get many more years of service out of your typical gold crown than any other metal.
- Dr. Hall

September 22, 2009

Questioning my treatment plan from Clear Choice

Filed under: Clear Choice Dental Implants Centers — iowasmiles @ 5:39 pm

Dr. Hall

I have had over $50K dental work the past 25 yrs. Porcelain Bridges, crowns, etc. I have gotten comments for years about my beautiful teeth and smile. I am replacing with full lower & upper implants. 4 implants holding top and 4 on the bottom. I have financed the upper at $25K and keep postponing the surgery for fear of implants looking fake and not working properly. I must obtain remainder of $$ to have bottom surgery at same time. Somehow, the Dr. I met did not sit well with me.

Is it reasonable to expect the implants to look real, even though they will not be porcelain? May I expect to keep my mouth clean after the permanent implants? I floss my bridges, etc a couple times a day and assume this will keep the implants clean as well?

They misled me in the beginning to believe the entire process would be 6 months. After the second visit, I realized I should assume 1 year for full recovery. When questioned, the Dr. insinuated I misunderstood. Now trust is an issue. Thanks for your help.
-Linda from Georgia

Linda,
Everything may be on the up-and-up with this dentist and the Clear Choice center, but I’m suspicious, and I would suggest getting a second opinion.

If you haven’t had the surgery yet, you’re entitled to get your money back. You have that right.

I have heard stories that the Clear Choice Dental Implants Centers tend to want to push this “All on Four” technique. Is that what is being proposed for you? Which would mean they are suggesting that you have all your natural teeth extracted. Is that something they have also told you?

A couple of days ago I got a threatening letter from lawyers representing Clear Choice, who basically are demanding that I not try to solicit comments like yours from people who have been to Clear Choice centers. This also makes me question their ethics. So trust is an issue with me with these people as well.  So maybe you need all your teeth extracted, maybe you don’t. My advice is to play it safe and get another opinion.

Trust is very important in health care, and if you have come to not trust this dentist, I think it’s time for you to look around for another.

About your other questions: Yes, it is reasonable for you to expect your implant-supported teeth to look perfectly natural. And as far as cleaning, that depends on how the dental implants are done. You should ask specific questions about how you keep them clean afterward. It’s important to keep them clean for them to last long.

Dr. Hall

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September 18, 2009

All porcelain crown vs. porcelain fused to metal

Filed under: Crowns for front teeth — iowasmiles @ 5:24 pm

Dear Dr. Hall,
I have an old crown in a front tooth. I visited a cosmetic dentist who works as an associate of a very famous cosmetic dentist in my area. He said he won’t know if he can do an all porcelain crown or a porcelain fused to metal crown until he removes my current crown. He also mentioned that even if he has to use a porcelain fused to metal crown, he will be able to add several layers of porcelain to make sure the metal won’t be shown or leave a shadow thorugh my gum.

Can I, as a patient, request that my crown be all porcelain or all ceramic? or should I let my cosmetic dentist pick the most appropriate for me?. I was initially going to have my general dentist have the crown done, but decided to go to a cosmetic dentist after exhaustively reading your website. Thank you for taking the time and effort to reply to our e-mails. Your website is so helpful! Margarita

Margarita,

First, no I think it’s a big mistake for you to try to push a dentist into any type of crown that he or she doesn’t recommend. Dentists that are comfortable doing all-porcelain crowns will by far prefer them on front teeth, provided they have a strong esthetic sense.

Please forgive me if am missing something, but I can’t imagine any reason this dentist would need to take your existing crown off before being able to tell you if he can do an all-porcelain crown on your front tooth. I haven’t met a front tooth that I couldn’t do an all-porcelain crown on. And no matter how much porcelain he layers over the metal, he can’t make the metal translucent – it’s still porcelain fused to metal. Is this guy trying to pull the wool over your eyes? What makes you think he is a cosmetic dentist? And being “famous” isn’t a credential for cosmetic dentistry.

I recommend you get a second opinion from someone better – someone who loves doing all porcelain crowns.  Is there anyone on our recommended list who is close enough to you that you could go see them for this crown?

Especially if it is ONE front tooth – you need a real artist to get it matched right, and it needs to be all porcelain.
- Dr. Hall

Read more about porcelain crowns for front teeth.
Click here to find a cosmetic dentist.

September 15, 2009

Thanks for your comments about Lumineers

Filed under: Lumineers, Thank yous — iowasmiles @ 8:07 pm

Dear Dr. Hall,

I just read your “Lumineers cost“article at  and also the “example” question and answer which pertains to this topic and I was so pleased to read it. I write dental websites, and because of my familiarity with the dental world I have long been aware that Lumineers are not the best option available. I prefer not to write about them in favorable terms, but it is sometimes required as part of my job. I was pleased to read this direct and honest representation of Lumineers. In writing for dental websites, I have seen innumerable before and after images of Lumineers and of truly custom porcelain veneers, and the difference is almost always highly noticeable. While I cannot write website articles that warn individuals against Lumineers in a professional sense, I was very pleased to see that someone else has. Your article came up 3rd when I Googled “Lumineers.”

Because of the nature of my work, I prefer not to make my name available and would appreciate your discretion regarding my email address. However, I wanted to thank you for representing Lumineers as an option, but one which may have more negative than positive aspects.

I am amused to read your “hate mail section” - to find that dentists who are not willing to undergo the training which will allow them to do really great dental work are disparaging toward your article and email, and see it only as confirmation of their lack of interest in their patients’ welfare. Sincerely, &tc.

“L”

Dear “L”,
Thanks for your kind comments.

September 11, 2009

da Vinci Porcelain Veneers

Filed under: Porcelain veneers — iowasmiles @ 4:11 pm

I had an interesting exchange with da Vinci Studios, a dental laboratory in West Hills, California. I have posted on my main website a page about da Vinci veneers where I was mildly critical in some respects. I had a time when I was practicing that they gave me beautiful results, but then the level of quality dropped off. It bothered them that I mentioned that they have some mediocre technicians, especially since my comments show up #3 in Bing when you search on “da Vinci veneers”. They offered me the opportunity to discuss any questions I may have about their business.

I felt like that type of response demonstrated class, and I wanted to give them kudos for responding in that way. I do believe that they are a very quality conscious dental laboratory and I think they may very well have ironed out the quality-control issues that I thought were fairly serious at the time I switched from them.

I still firmly believe, though, that a patient should not select a dentist merely because he or she uses da Vinci veneers. There are many excellent dental technicians who are very artistic and no one establishment has a monopoly on them. Besides, a dental laboratory cannot make up the difference for a dentist with no artistic ability who can’t communicate what he or she wants. A poor dentist plus a great dental lab equals a poor restoration. A great dentist with a poor dental lab also equals a poor restoration, but that great dentist will end up dumping the poor lab. As a dentist, I had a relationship with a local dental technician who was giving me excellent results, but then we took on a very challenging case that was beyond her ability, and she never could get it looking beautiful. So I cut my losses, and paid the extra lab fee to have it re-done. That is when I started using da Vinci. That is what excellent cosmetic dentists will do. They take responsibility for the final restoration and will stick with labs that give them beautiful results.

Something that Chester Garcia, CEO of da Vinci, said in his letter reinforces this point: “Part of our work is artistic in nature. For this reason, some dentists may feel that a particular restoration does not have the exact appearance they are looking for…. When this occurs, da Vinci works with the dentist to repair or remake the restoration until it has the perfect color, shape and feel that the dentist envisions.”

That is how it works. The dental lab works for the dentist. If the dentist can’t envision the beautiful result, the laboratory can’t make up for that difference.

September 8, 2009

Is Clear Choice attempting to silence complaints?

Filed under: Clear Choice Dental Implants Centers — iowasmiles @ 11:56 am

We have two reports now where Clear Choice Dental Implants Centers appear to be using intimidation to silence complaints. This information was received from Dr. Arthur Chal in Phoenix and Dr. William Cohen in Chicago in early September.

These dentists had received patient complaints about Clear Choice and had posted those on their websites, along with responses to those complaints. Subsequently, they received threatening letters from attorneys representing Clear Choice alleging trademark infringement.

I believe that Clear Choice and their attorneys know full well that such claims of trademark infringement are bogus. Trademark law specifically allows for the use of a competitor’s trademark in comparative advertising or for the purposes of news commentary or criticism. I also believe they know that many dentists will simply agree to their illegal demands to avoid a possible legal battle, and that this will silence criticism.

I am very disappointed in this action by Clear Choice Dental Implants Centers. When I first heard of their operation, my opinion was that they probably operated high quality treatment facilities backed by a strong marketing program. Reports I have been hearing recently, however, are giving me the impression that they have some questionable ethics. We have this legal bullying tactic, which I associate with enterprises that feel they can’t stand reasonable scrutiny. I have also heard a couple of unsettling reports of patients being pressured into tooth extraction or expensive dental implants treatment when there are other options that would be better for the patient.

Accordingly, I have posted a form for Clear Choice complaints. If you have had a bad experience at a Clear Choice Dental Implants Center, please let us hear from you.

I’ll post more on this later and on regular pages of our website in the dental implants section.

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September 3, 2009

Dental treatment for someone in addiction recovery

Filed under: Dental fear, Pain in teeth — iowasmiles @ 12:48 pm

I am currently on methadone maintenance for opiate addiction and I am in desperate need for extensive repair on my teeth. The last time I needed dental work the dentist refused to give me any pain medication after I had informed him that I was on Methadone. I even gave him the name and number of the clinic I attend and permission to speak to the clinic’s doctor and my counselor. I was in need of dental care and in quite a bit of pain and concerned about pain after the procedure. I already have anxiety issues about going to the dentist and my teeth are in great need of dental care. What would be the best way to go about talking to the dentist about my needs. I do not want to continue to suffer with the pain I have been nor do I want to suffer through pain after. If you could offer me any suggestions or know of a compassionate dentist in my area that would be willing to work with me, I would greatly appreciate it.
- Cheryl from California

Cheryl,
Dentists and medical doctors are afraid of the Drug Enforcement Administration, and many of them simply prefer not to deal with any issue that could raise questions from the DEA. Some dentists have gotten in trouble simply because they were trying to be compassionate, and as these stories circulate, it’s the patient that suffers.

You just need to find a dentist for whom the compassion will be a ruling factor and not fear of the DEA. I would start by looking for dentists who do sedation dentistry, and then ask them up front if they can help you with your treatment and post-operative pain control, given that you are in addiction recovery. My advice would be to just keep asking around until you find a dentist willing to help you. Dentists tend to be compassionate, but they also tend to be timid. But I’m confident you could find someone who would be a match for you.
- Dr. Hall

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