Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

January 11, 2008

Bad breath problem

Filed under: Bad breath — mesasmiles @ 11:45 am

I have a bad smell in my my mouth. I brush daily but it still smells. Any suggestions?
– Garth in Indiana

Dear Garth,
There are several possible causes for having bad breath or a bad smell in your mouth, even though you brush.

The cause of bad breath is usually bacteria that are in your mouth. So brushing is a good first step. But I would also consider flossing daily, and if that still doesn’t do enough, then get a tongue cleaner.

There are also products you can buy that are very powerful in fighting bad breath. Check out BreathRx, which is available in many stores and from many dentists. They sell special rinses that are very effective, and they also make a bad breath toothpaste that you could use.

Some dentists take a special interest in treating mouth odor problems, and you can find them on the Internet.
– Dr. Hall

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September 2, 2008

A bad experience with Vivaneers

Filed under: Lumineers — mesasmiles @ 11:44 am

Hello Dr. Hall,
I had discolored teeth from smoking and a filling line that could be seen in my front tooth.  I had 6 top front Vivaneers (Porcelain) put in on the 29th of July ’08. They were TOO BIG and had skirts, but I thought I would get used to them.

I did complain to my dentist, who is also my friend, but didn’t want him to take the money loss. The “canines” were rounded out too. I did NOT like that. Then on 31st July ’08, I had the 6 front bottom ones put on, AND EVERY SINCE THEN I DO NOT HAVE ENOUGH SALIVA. I have “dry mouth.” No, not sores or cracks, just a dry mouth, and can’t speak as fast or as well as I used to. I have investigated everything on the net re: “dry mouth,” that it could be oral cancer/diabetes/hypothyroidism/dehydration etc. I do NOT believe it is any of these.

I bought the “snake oil” Dr. Hall and now regret it.

I spoke to my dentist at length about this; he is going to call the dental lab (Glidewell in Calif.) and speak with a Dr. Michael Ditolla to find out the WHY for the dry mouth. My vivaneers were “no prep.”

According to what I have read, the vivaneers could be lasered off. I don’t know what my options are after that…bonding or? I am gun shy; I don’t think I will ever get veneers again.

The tragedy is that I am a middle school teacher and speak all the time.

Additionally, ever since the veneers went in, my lip gloss and lipstick sit differently on my lips.
My lips get dry within 25 minutes after the lipsticks go on. This NEVER happened prior to the veneers.

Thank you Dr. Hall for any light you can shed on this.

Dear Janice,
Your basic problem is that your friend is not a cosmetic dental specialist. I sympathize with you, for all the problems you’re having with these Vivaneers. Let me help you understand them.

Realize that I can’t tell for certain why you are having dry mouth without doing a thorough examination, but I can guess. And I am pretty certain that, with the Vivaneers on your teeth, you can’t close your lips or your mouth properly, and this is why your mouth is getting dry. You are breathing through your mouth, and this dries it out.

Here’s my reasoning: There isn’t anything in the porcelain or in veneers that would react with anything in your mouth or would produce any kind of a reaction that would cause dry mouth. That rules out any chemical or physiological reason, so the reason must be mechanical — an inability to close properly. And when you do no-prep veneers on the lower front teeth, it is almost guaranteed that you will open the bite. This would also cause the difficulties you’re having with speaking and with your lips drying out.

I would be surprised if the dental lab figured that out. That isn’t their department. Your dentist is the one who is supposed to know. The fact that your dentist has to call the laboratory for help with this seems to show his lack of expertise in cosmetic dentistry.

I would have the Vivaneers removed. I rarely say that, but in your case, I believe that would be best. And your dentist doing only six veneers on the upper and six on the lower is also poor. Cosmetic dentists and all your friends know that when you smile you show at least eight teeth on the upper — sometimes ten or even twelve.

You’ve learned the hard way that you can’t go to a general or a family dentist for cosmetic dentistry. Dentists as a rule are technically oriented and aren’t artists. Don’t lose your faith in cosmetic dentistry, but if you decide you want to have this done right, go to one of the Connecticut cosmetic dentists on our list. Please, for your sake and the sake of your relationship with your dentist, don’t have him do any more appearance-related work. And don’t lose faith in him as a general dentist. Just understand that fixing broken teeth and creating beautiful smiles are two very different functions.

Further information about Vivaneers:
Vivaneers are a brand of porcelain veneers that are very much like Lumineers. They can be made extra thin, and the advertising suggests that they can be without preparing the teeth. So they appeal to general dentists who know very little about cosmetic dentistry. Read our blog posts about Lumineers by clicking the category on the right. You may also want to go to our main web site Lumineers page for some excellent information and cautions. Everything said about Lumineers can be applied to Vivaneers.

– Dr. Hall

Related information:
Care of porcelain veneers

February 26, 2016

What mouthwash should I use for my porcelain veneers?

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Dear Dr. Hall,
I need to know what is the best mouthwash to use that won’t damage my veneers?
My veneers are one week old and were quite expensive but look beautiful & I want to
maintain them with good hygiene.
– Sarita in Connecticut

I never recommended mouthwash for any of my patients after receiving cosmetic dental work. I’m not sure why you feel you need mouthwash.

The basics for maintaining a set of porcelain veneers is keeping the teeth clean. You want to brush and floss, and have regular dental cleanings. And in doing so, I would avoid highly abrasive cleaning agents, like abrasive toothpastes and any abrasive cleaning techniques by your dental hygienist (pumice-containing polishing agents, or power polishing equipment).

Mouthwash doesn’t really contribute to this regimen.

Mouthwash Guidelines

Now mouthwash may not hurt anything. Check the ingredients. Most mouthwashes contain some type of alcohol. This will soften the bonding composite that was used to bond your veneers to your teeth. So that’s a big no-no. For example, you’ll see on the label that Listerine contains 21.6% alcohol.

Listerine mouthwash label shows alcohol content

Listerine mouthwash label shows alcohol content

That spells trouble for porcelain veneers. Crest Pro-Health, on the other hand, is alcohol-free, and is plainly labeled that way.

Crest Pro-Health label indicates it is alcohol-free

Crest Pro-Health label indicates it is alcohol-free

So that one won’t hurt anything and you could go ahead and use it.

Breath Rx mouthwash for bad breath is also plainly labeled as alcohol-free, and would be safe to use. Breath Rx was developed by a prominent Beverly Hills cosmetic dentist who is sensitive to this issue of not damaging cosmetic dental work.

– Dr. Hall

See my pages on tips for maintaining porcelain veneers and other cosmetic dental work.

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May 20, 2011

A good experience with Clear Choice Atlanta

Filed under: Clear Choice Dental Implants Centers — Tags: — mesasmiles @ 6:58 pm

Before I was introduced to Clear Choice I had spent $30,000 in the past 10 years trying to keep bridges, caps, root canals, etc. in an attempt to keep a clean and healthy mouth. During that time I don’t remember a year going by that I wasn’t having trouble. I do remember many visits to the dentist, bad breath, bridges moving around, and infections, not to mention the thousands of bucks spent. In about Feb 2009, two years now, I had total mouth, uppers and lowers done by Clear Choice in Atlanta. I have had no trouble at all since. It has changed my life all for the better. I have beautiful teeth, I can eat anything, my mouth is clean and I have had no dental problems, infections or bad breath since. I agree it would be great to have all your own teeth, but, if you are not one of the lucky ones, I can tell you that these teeth from Clear Choice are the best I have ever had. They take very serious procedures and impressions so that everything fits, looks natural and feels great.
– Rob from Georgia

Generally, we’re hearing that the dentists at Clear Choice are clinically knowledgeable, and I’m glad it worked out for you. Some people just don’t want to save any of their existing teeth, and for some of them, Clear Choice is a good fit.
Dr. Hall

April 7, 2010

A putrid smell in my mouth, after getting 28 crowns.

Sir i got all my 28 teeth replaced with crowns for the purpose of teeth lengthening. Upper & lower molars(8) of Porcelain fused to Metal. Premolars of Zirconia(8). Incisors & canine (12)of Empress. And now after 2 months from the procedure done am having very much bad breath that its very much difficult to live with and even to breathe, and it tastes like vomit. Still after using mouthwash and brushing twice a day its not helpful and the smell is as it is. even i got done scaling but still the smell and taste of the teeth remains. Please tell me some solution that can be done now to get rid of this as its too much difficult to live like this. i am really helpless. And also tell me is it was right for the teeth lengthening??
– Ogas in India

Dear Ogas,
There is something very wrong with your dental work. It my days of practice, I had several occasions to replace dental work done in other countries, and I frequently found poor dentistry with overhangs that would catch food or other basic defects.

The materials your dentist used sound first class. But if there are overhangs on all the crowns, that could produce the putrid smell that you’re experiencing. I can’t tell if that’s the case. There are other possibilities.

If this problem is allowed to remain, it will likely lead to gum disease and early loss of your teeth.

There are excellent dentists throughout the world. But I believe the consensus among the world’s dentists is that there is no place that has as high standards for dental care as the United States. So what I would look for would be a dentist in India with some credentials from an international organization based in the United States. A couple examples of that would be accreditation or some other credential from the American Academy of Cosmetic Dentistry (There are two accredited members of the AACD in Mumbai, India, and several accreditation candidates in the country), or fellowship or diplomate status with the International Congress of Oral Implantologists. There may be other credentials. I would track down a dentist with a credential like that and go there for an opinion on your case. Go to the website of the specific organization and they usually have a search tool for finding a credentialed member.
– Dr. Hall

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July 1, 2011

My teeth are crumbling, and what if I can’t afford any other treatment but dentures?

Filed under: Dentures — Tags: , , , — mesasmiles @ 6:19 pm

Dr. Hall,
I am considering getting full dentures. I was told I had little enamal left on my teeth about 13-14 yrs ago and since have had two pregnancies in which I vomited every day(sometimes multiple times a day) during my entire pregnancy. Since the birth of my last child 8 yrs ago my teeth have literally started crumbling like powder,cracking and I have a lot of visible cavities.

I had a tooth removed last week because it had already started falling apart and I cracked it in two blowing up a float for my child and I had flat out had enough. Five of my teeth are literally down to the gum line now and one crown and post have fallen out. My dental insurance only covers $1000 a yr and it doesn’t take much to use that up so if you are wondering why I have not had all this fixed as it happened when you run out of insurance in March it is hard to get anymore done with insane cost of cosmetic dentistry. It will only cost me $1400 out of my pocket to get upper dentures (I am still debating on lowers as they are not as bad as the uppers) but I was quoted about $4000-$5000 out of pocket to get root canals and crowns or bridges. I do not qualify for any loans or assistance to get this done so dentures appear to be the only option.

I have read just about everything you have on this site and am really irritaed at your comments about peoples care or lack of care for their teeth as you do not know ! what som e have gone through. I also had meningitis as a baby and was put on alot of meds( I have other health issues due to this but my teeth are the worst). I would love to have an awsome cosmetic dentist fix my teeth right but unless you or they intend to do it for free I think you need to stop being so condecending about what people should do and/or what caused their teeth to become bad in the first place. In case you are wondering I have brushed after every meal and snack since I was a kid and flossed at least once a day as well as rinsed with a mouthwash but it has done me no good except to ensure fresh breath.
– Wendi from Alabama

It sounds to me like you’ve almost completely decided what you want to do, so I don’t know that you need much help here, but I’ll offer some. I was also intrigued by your comments and wanted to respond to them.

I think you’re trying read things into my website that aren’t there if you come away from reading it thinking that I would condemn someone like you in your situation. I don’t know where you would get that. Yes, I’m going to tell people to take care of their teeth when they can. To do otherwise would be negligent. But I rarely criticize patients who write to me with their problems. And then there are always things that can happen that are difficult or even impossible to deal with, which sounds like what you have experienced.

If your finances are really limited, it may be that dentures are your only option. I saw a number of patients in your situation and did my best to help them as much as I could. But don’t expect me to sugar-coat your situation. There are troubles ahead when you get full dentures. They will reduce your chewing efficiency, and there is a great deal of dissatisfaction out there with people who have dentures. In addition, your jawbone will begin to shrink and within about twenty years or so, you will have to deal with facial collapse. But let me try to be helpful, and share some ideas that may be helpful for your situation, because you are in a difficult situation.

Losing your lower teeth is much more serious than losing your upper teeth, and an upper denture is much easier to adjust to and to use than a lower. An upper denture is held in place with suction, so it is considerably more stable than the lower denture, which rests and kind of floats on your lower jaw and is held in place by your tongue and cheeks. Additionally, if you have lower teeth chewing against an upper denture, it may help the lower teeth to last longer. So if you are looking for the most economical solution and you can keep your lower teeth, any amount of time you can keep them will delay facial collapse. And there is much more satisfaction with upper dentures than with lower ones.

Also, any teeth that can be saved for any amount of time will delay the bone resorption. Sometimes the crowns of the teeth can be cut down and the roots of teeth can be retained and this will also delay the bone resorption.

I hope that you can find a sensitive and caring dentist who will take care of your needs and take the time to discuss your options.

Dr. Hall

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June 25, 2007

A root canal on a porcelain veneer tooth

Filed under: Porcelain veneers,Root canals — mesasmiles @ 1:17 pm

If porcelain veneers are put on and then later it is discovered that the person needs a root canal on one of the teeth that is covered by the porcelain, is it very difficult to get to the tooth under the porcelain to do the root canal?
– Kathy in Texas

It’s fairly easy to have a root canal treatment on a tooth that already has a porcelain veneer. For a front tooth, the opening to the canal is made through the back of the tooth and doesn’t affect the veneer at all.

But I want to caution you about this. Teeth with root canal treatments tend to turn dark afterwards, sometimes very dark, and this will show through most porcelain veneers. But there is a way to prevent that from happening, and what you want to do is find out if your dentist knows that technique. Pay attention carefully, and approach this issue exactly the way I explain. Ask your dentist if the tooth turning dark can be prevented and then ask how it is done. You are testing your dentist, so don’t give away the answer. If your dentist responds that he or she will just make sure any gutta percha and other root canal filling materials are cleaned out of the inside of the crown of the tooth, then you can breathe a sigh of relief because he or she understands. If your dentist doesn’t know that, don’t try to teach him or her. I don’t have time in this answer to fully explain why. But it is a very very bad idea to research stuff on the Internet and then try to teach your dentist. If your dentist has not cared enough about this issue to attend enough continuing education to learn it, then there are many other things that he or she doesn’t know that will give you trouble, and there are several other substantial reasons why I have seen so many patients who have tried to teach their dentists and who have met disaster.

Your dentist may insist on doing a dental crown in order to keep it from breaking, but if you don’t have an expert cosmetic dentist, the dentist will have a great deal of difficulty getting the crown to match your existing veneers. And a crown on a front tooth (an incisor or canine) will not help keep the tooth from breaking but will weaken the neck of the tooth. A dental post, on the other hand, will strengthen the tooth, and you may want to check out that link.
– Dr. Hall

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May 28, 2007

I’ve had an infected wisdom tooth socket for months

Filed under: Infected teeth,Wisdom teeth — mesasmiles @ 6:39 am

I had all 4 of my wisdom teeth removed last year with only one issue on my back left tooth # 17? I believe, where there was a little “pocket” where my bone should have been. this has led to a complication that my orthodontist pointed out as when she poked the gum where my wisdom tooth was, green puss started oozing out (small amount, but had a very foul smell) my breath has been mildly bad because of this bacteria or infection of some sort, and it almost seems as if the bacteria seems to want to move to other areas of my mouth as my plaque smells of this bacteria. Do you know what kind of bacteria it is and how i can get rid of it? I have tried squeezing the bacteria out of the pocket, however it keeps reproducing itself. i regularly use listerine. Also, my dentist blew some air with a tool over that area, and they could see i suppose a small green area. help!!!
– Crandall in California

You need to get rid of this bacteria that are causing your tooth infection. And what you’re doing isn’t working. And I can’t help but think this is awfully putrid smelling.
Your on a little bit of the right track with the air. These bacteria that nestle in sockets like this are “anerobia” bacteria – oxygen is poisonous to them. The Listerine clearly doesn’t seem to be getting the job done.
I’ve deal with these infections many times, and I would recommend, in your case, a heavy-duty two-pronged attack. One, you attack them right in the socket. But you need a gentle rinse of hydrogen peroxide, like the kind that is used to help whiten teeth. Get a bottle of 3% hydrogen peroxide from the drug store, and mix it with a mild salt solution, half and half. Then you need your dentist to give you an irrigating needle so you can poke directly into the socket and gently pump in this hydrogen peroxide. Do it after every time you eat, because that’s when this hole fills up with gunk.
Then I’d attack them through the bloodstream with a prescription of Clindamycin, 150 mg four times per day for a good ten days.
I’m pretty confident the smell and infection will be gone by then. Then back off and irrigate the socket just once a day as it fills up with tissue.

You can read more about hydrogen peroxide and oral yeast infections.
Dr. Hall

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