This is an exchange with Lilly from California. Here is her original question and my reply. Then she replied, and I answered again, and that is below:
Dr. Hall,
I have a new implant bridge, with two implants, replacing four teeth on my bottom right. I notice now that when I bite down on the right side, the bottom teeth and the top teeth line up, but my teeth on the left don’t line up. Is this normal? What can be done?
Lilly from California
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Lilly,
This is not right. All your teeth should come together at the same time. Something isn’t right here. And if this isn’t fixed, it could lead to TMJ disorder.
This gets me to a recurring issue, and that is the quality and standards of implant dentistry in the country. This is one of the top areas for dental malpractice. One of the reasons is that the dental profession has not made it a recognized specialty, so anyone can claim to be an implant dentist with no extra training whatsoever.
My recommendation would be to have another dentist look at this. Look for a dentist with credentials from one of the two major dental implant organizations – the International Congress of Oral Implantologists, and the American Academy of Implant Dentistry. Fellowship or diplomate status in either of these organizations would indicate a dentist who understands and practices quality implant dentistry.
There are two possibilities for what went wrong. It’s possible the implants were restored incorrectly. I think more likely is that the surgery placed the implants in the wrong position.
Sometimes, if the surgery is done by one dentist and the implants are placed by another, there is a communication problem and they are placed in a position that makes it difficult or impossible to restore them correctly. What should be done is that the restorative dentist should make some type of surgical guide that fits in your mouth and that fixes the exact position and angle where the implant should be placed. But a lot of dentists don’t do that.
I wish you the best,
– Dr. Hall
This is a reply that Lilly sent
Dr. Hall,
Thank you for the comprehensive answer. I am suspecting the problem lies with the surgeon. He insisted he was in charge. I never saw the restorative dentist he referred me to until after he was done with the implants.
I have an appointment with both the surgeon (periodontist) and the restorative dentist in two weeks. I am hoping that these implants don’t have to be redone. In that case, is it fair for me to request a refund? I don’t want to return to this periodontist and dentist. You would think the restorative dentist would have known better than to just go ahead and make the bridge and charge me when he knew it was wrong.
-Lilly from California
Lilly,
Very interesting, to get that additional information from you. In my humble opinion, you are within your rights to ask for a refund, assuming that we have this sized up correctly. It is an established principle of implant dentistry that the implants need to be placed according to a restorative treatment plan, and that a surgeon should not place them until the restorative dentist has examined the case and made the determination of where they need to be. Sounds like the surgeon skipped that step.
Get your independent opinion from an implant dentist with a credential from the ICOI or AAID, as I mentioned in my earlier e-mail, and if it is determined that the problem was in the location of the implants and that they need to be replaced, then yes, I would complain. And actually, rather than a refund, ask that the surgeon pay whatever the cost would be to fix the problem, because it will likely cost more to get this fixed right than it cost to do it in the first place, plus you have to re-do the restorative part. I think there is some legal liability here to get this fixed right.
– Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
Trying to save money on Snap-on Smile – can I get it online?
I would like to be able to order the snap-on-smile online. I don’t want to spend time in dentists offices. I know that all I would have to do is have my teeth impressions taken. I want to do this at home. I also know of a site that claims to do it, but the company has a lot of bad reviews from people that paid their money up front and did’t get their orders. I ask some one at the conpany of the site and I was told that the complaints was from one dissatisfied customer. I’m still leary of them. But I would really like to order the snap-on smile online from someone reliable. Do you happen to know of any reliable online companies?
Thanks for your reply.
– Gibbs from Chicago
Dear Gibbs,
Interesting question.
There’s a reason the site you found that claims to deliver a Snap-on Smile online is a sleazy site that cheats its customers. The reason is that this doesn’t work, doing it online. It would be kind of like getting a haircut online. That was creative of them – to tell you that all the complaints were from one dissatisfied customer. Sounds like you didn’t believe them. I don’t.
You start with the impressions. You could maybe get that without a dentist, but I’m not sure how you’d go about getting that done. The impressions have to be a certain level of quality, without distortion. There’s a certain amount of training required to do that right. Some dental assistants can do a good job of it, but not even all dental assistants could do an adequate impression for these purposes. And then there’s the problem of getting the Snap-on Smile ordered. By law, Den-Mat is required to take orders only from licensed dentists. So you would have to have someone lie in order to get this made without a dentist. And then the question comes up, would YOU trust this person who is willing to lie and break the law. Well, maybe you would. But there are certain things you have to know to tell Den-Mat about HOW you want the Snap-on Smile made. What shade will you tell them to make it? Do you know that terminology? What will you tell them as far as how much facial bulk to allow? Will it fit your bite? How will you figure that out?
But wait, you’re not done. Once you get it back from the lab, the Snap-on Smile has to be fitted. When it is done in the lab according to the model that is sent in, it doesn’t just automatically fit. In most cases it will have to be adjusted. Do you have tools for doing that? Will you know what you are doing? Maybe you’ll trim it here or there and then, all of a sudden, it’s too loose and won’t stay in. What do you do then?
I’m a “think outside the box” and “work outside the box” kind of guy, so I’d be all for creative ways for getting this done and simplifying it. But there are safeguards put in place and the reason they’re put in place is to keep businesses from scamming the public.
If it’s price you’re worried about, and you just want a basic Snap-on Smile that doesn’t need to look particularly great, you can call around and find out who will do it the cheapest, and you should be able to find someone who will do it for a couple of hundred over the lab cost. For front six teeth, the lab cost is $250. For all the upper teeth, the lab cost is $400. What a dentist charges over and above that will vary a lot from dentist to dentist. There will also be great variations in the quality of the result. But if you’re not fussy, you should be able to find someone who will do it cheap. Set a limit of, say $600, and I’ll bet you’ll find a taker if you call around and just ask, bluntly, if the dentist will do it for that, if you’re willing, say, to pay cash up front, so that there’s no risk for the dentist in not getting paid.
Dr. Hall
Links: Read more about the costs of cosmetic dentistry.
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
Supersmile for porcelain crowns
Hello: Although your website reassures that Supersmile is effective for veneers, I am unclear if the toothpaste also safely whitens porcelain crowns. Please clarify. Thank you very much.
– Thomas from California
Thomas,
Yes, Supersmile toothpaste is perfectly safe for any cosmetic dental work. It was specifically made to help in the maintenance of cosmetic dental work, which would include direct bonding, porcelain veneers, porcelain crowns, and bridges. It is formulated to keep all of it at its maximum brightness, and to be safe. I emphasize it for porcelain veneer maintenance because porcelain veneers are the most vulnerable. But I think it’s a worthwhile investment for the maintenance of any cosmetic dental work, especially expensive work.
Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
Does this tooth really have to be extracted?
I had a crown when I was younger that fell off and left half of my tooth there, my dentist tells me I now have a tooth infection under it. There is a little white bubble under my tooth – he didn’t say what the name of the infection is but I’m kinda worried about it. My dentist says he just has to take out my tooth but from what it says on your website he’d have to do a root canal right?
– Maggie from Rhode Island
Maggy,
I think it would be worth it to seek a second opinion about this extraction and see if the tooth can’t be saved. Some dentists, unfortunately, are all too eager to extract teeth when it isn’t necessary.
It could be that your dentist is right, that the tooth has to be extracted. But your dentist should have explained why the tooth can’t be saved and why a root canal treatment and a crown wouldn’t work. If he didn’t, ask another dentist.
It could be that the tooth has decayed so much and there is so little left that there is no way to restore it. It could also be that with the crown of the tooth being missing for so long, the teeth on either side have drifted together so that there isn’t space enough to restore the tooth. But if your dentist didn’t explain this to you, I would get a second opinion to ask another dentist if he or she thinks the tooth can be restored.
Your question reminds me of a man who was president of the American Dental Association in the 1980s who was kind of a crusader for saving teeth, Dr. Burt Press. He often said that too many dentists are too eager to take teeth out. He had a funny way of putting it. When we were in dental school, we were given statistics about how many teeth are lost because of gum disease versus how many are lost because of tooth decay. He said he questioned those numbers. “You know why so many teeth are lost?” he asked. “Because dentists take them out.” But rescuing teeth is hard work, and sometimes you fail. Some dentists like to try to save them, because it’s a noble feeling to save a tooth. But some dentists don’t have that attitude and just take them out.
So my advice is to get a second opinion.
Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
This bridge has been done three times, and has never really looked good.
Hello Dr.Hall!
I love your website, it has so much information and I hope it’ll help me to make my decisions. The reason I am emailing you is this: I don’t have my upper left lateral incisor since I was 16 y.o ( I am now 39), it was pulled out when I was 16 because it was very crooked, so my mom took me to the dentist in my country(Russia) & he pulled it out and put a bridge (crown on canine tooth).
It was so ugly that I went to another dentist same week who did a little better job & that’s how I had this bridge for about 10 years, although I didn’t like it because it was whiter then my own teeth, its bigger & bulkier.
After 10 years living in US I thought I’ll try to get a better bridge, I thought in US they do it better, so I went to my general dentist about 3 years ago & he promised me he would make it much better & I’ll be happy. After he did it, it seemed like a better one. I don’t know what was wrong with me, why I did not see right away but after some time I noticed that it still bigger, still whiter & longer then my teeth on the other side but I never told him anything. In addition he was recementing them twice after 1 month and 2 months later, after which he said I have an overbite I need to fix it with braces or it may keep falling off.
I went to orthodontist, got braces, looks like he straightened my other teeth, probably fixed overbite, anyway to make a long story short when he took them off about a months ago he offered to shave of the fake tooth because its too long and catching peoples eyes, i agreed trusting him that he will stop when metal will start showing but he never stopped to ask if I think its enough or not, finally he gave me the mirror where I could see that on the bottom of that tooth metal is very well showing, he asked me why did I get upset when it looks better now. that is the last drop, I felt abused, I trusted him but all he said “lets stay friends”. I am very disappointed & upset. He was recommended by some people & he is very nice, I didn’t expect that he would handle it like this, but again he said this is a bad bridge & I should change it anyway. I think this is none of his business, he shouldn’t have touched my teeth & suggest to do things that cost a lot of $$$ when I didn’t ask for his suggestions, I think he should have offered to compensate somehow because I didn’t plan to do any cosmetic job for a few years but now I feel that I need to do something right now.
I went to my new general dentist who suggested that I need to get another bridge maybe on all four or six front teeth so they’ll look even,also because I have a few fillings on my front teeth. I asked her about getting a bridge on one side & veneers on the other side, I don’t know maybe its not a good question,but I feel that I don’t want my teeth to be shaved off so much for a bridge,she did not recommend veneers because of my fillings. an additional information about my teeth so you can imagine it: my teeth are far not white at all & because of fillings the color is not even.
So my questions:
1.should I let my orthodontist know that I am really unhappy with what he has done & ask him to compensate somehow;
2.if I decide to get a bridge on all six front teeth will they be bulky/bigger;
3. should I get a bridge or veneers?
I know its probably hard or impossible to answer my questions without seeing them, but at least tell me what you think. Another thing, after reading your website, I see you don’t suggest to go to a general dentist,so I looked up here a cosmetic dentist in my area (name withheld). I could go there also, it’s an hour drive, but I don’t mind if its a better doctor. I am so disappointed with all previous work that I had that its hard to believe for me that I ever get results that I want & also another big things that I have to pay so much $$$ & not even sure that I will be happy with that. I would greatly appreciate if you could answer me.
Thanks you so much.
– Lynda from Maryland
Lynda,
Thanks for your question and I really think I can help you.
You’re a great illustration of the point I try to make on the website that 98% of dentists simply aren’t artistic. They have an engineering mentality. You’ve had three different bridges replacing this lateral incisor, and while each one has looked better than the one before, none of them have been really attractive. This is what you find with your average family dentist. They are nice, honest people but think like engineers and each dentist probably thought the work they did for you was fine, why are you complaining? And now this orthodontist says he can’t understand why it should bother you to show a little metal – he made the tooth shorter like you wanted.
Don’t let this happen any more. This is exactly the reason I run this website, to help people like you learn about cosmetic dentistry and get the work done right. The dentist you mentioned is an excellent cosmetic dentist and he would do a beautiful job for you, as would any dentist we recommend. Yes, it certainly would be worth it to take the hour drive and get this done right.
And besides that, this bridge shouldn’t have been coming loose all the time if it was made correctly. Your dentist is blaming it on your bite, but if it were made correctly with proper retention, it would stay on, in spite of your overbite.
Don’t let your dentist put a bridge across all your front teeth. That would be a terrible thing to do. All your front teeth would be ground down to pegs, and for the rest of your life, any time anything goes wrong with any one of those teeth you will need to get an entirely new bridge.
And yes, I would ask this orthodontist to compensate you for grinding down to the metal. Even an engineering-type dentist should recognize that this is a no-no, and I’ll bet he’s having some twinges of guilt over this. I think this is the type of thing that could be mentioned in a complaint to the dental board or to a peer review committee of dentists. But I would start by just asking nicely for some partial compensation for doing the new bridge. He has a point that the bridge needed to be re-done eventually, but you have a point, too, in that you were going to wait but now you have to do it right away. So maybe if he paid for half the bridge, that would be fair. There are ways to cover over the exposed metal with metal bonding techniques, but that is too sophisticated for your average dentist and requires equipment and materials that they don’t use, unless they are fairly expert cosmetic dentists.
And when you have this bridge re-done, an expert cosmetic dentist will recommend that it be done in all ceramic, not porcelain-fused-to-metal.
Dr. Hall
Click here to read about the cost of cosmetic dentistry.
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
Options for treating an infected tooth
Hi Dr Hall, I’ve had a partial filing on my teeth #31 and #32. Today, after 2 months of constant pain (I was taking Ibuprofen) I went to the dentist. After a x-ray, he said we should extract those teeth because I have an abscess and an infection. I want to know if that’s the only solution and what could be the consequences? What do you think I should do? Thanks.
– Mel in Maryland
Mel,
Yes, there are other options available, unless, say, you are on a government funded health care plan. When the government funds it, such as with Medicaid programs, they tell you what option you have to choose, and it’s almost always the cheapest one. In that case you would probably not have a choice and have to have these teeth extracted.
But otherwise, the dentist is under ethical and also legal obligation to inform you of all your options. If this dentist didn’t give you any other choice, I’d get a second opinion. Plus I’m suspicious that the fillings may not have been done right which led to the teeth being infected. That may be why he just wants to take the teeth out without giving you any other choices, if he feels that he screwed up somehow.
Tooth #31 is your lower second molar. #32 is your lower wisdom tooth. When a tooth is infected, generally the best option is to have a root canal treatment. And if the tooth has abscessed, the tissue inside the tooth is dead, so there is no feeling in the tooth, which makes a root canal treatment much more comfortable than, say, an extraction. However, with a wisdom tooth, the root anatomy is often very complex and the access to the tooth is very difficult, so I personally would not recommend that tooth for a root canal treatment. But a second molar, yes. I have two root canal treatments on my own lower second molars.
If the lower second molar is extracted, the upper second molar will probably drift down into that space until it hits the lower gums. If that happens, you will eventually lose that tooth also. So that is a consequence. Since there are no teeth behind that tooth, you won’t have the usual extra complication of teeth drifting forward and tipping into that space, which completely disrupts your bite on that side.
I hope this is helpful.
Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.