I recently had bonding done due to fluorosis staining. The doctor originally placed my bondings but they were uneven colored and we can still see the stains through them. A few hours after 3 of them fell off. I returned 2 days later he replaced them and I let him know I was unhappy with the color so he added a thicker layer however 3 days later they are falling off again. He said I have a bad bite and need a mouth guard which I got and wear but it didn’t help. I’m not eating anything hard to make them fall off. He says it’s not a permanent thing and they sometimes fall off. However he said it’ll be in like 5 years it’s only been a few days. At this point I’m frustrated and want my money back so I can go somewhere else.
– Chance from Maryland
(See Dr. Hall’s answer below.)
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For certain, you’re not in good hands and you need to go somewhere else. This is approaching a cosmetic dentistry horror story.
It can sometimes be a little tricky demanding a refund for cosmetic dentistry if the complaint is simply that you don’t like how it looks. But a basic standard for dentistry is that it needs to stay on, and the fact that your bonding fell off gives you great leverage. If your dentist resists refunding your money, you can always take your complaint to a peer review committee, to the dental board, or the insurance company (if there’s insurance involved), and they will likely stand behind you.
Let me say a couple of additional things about your case.
First of all, for the benefit of our readers, fluorosis is a condition where you consumed too much fluoride while your teeth were developing. Mild fluorosis results in white spots on the teeth that may be very slight spots, as pictured here.
Many patients suffering from very mild fluorosis may feel that no treatment is necessary. However, if the white spots become more extensive, they can cover the entire front surface of the teeth giving a mottled appearance to the teeth.
In severe fluorosis we see brown spots appearing. It can be quite ugly, as pictured below.
As far as your bonding, your dentist appears to be in over his head. You need an expert cosmetic dentist. One thing about placing dental bonding is that the dentist sees the results as he or she works. So the fact that after the first appointment you had to be the one to tell him that the bonding was the wrong color and you could see through it shows a gross insensitivity to aesthetic issues. And the answer to your problem is certainly not to plaster on a thicker layer but to start over with the correct materials and correct technique. If your dentist is an ordinary family dentist, he probably doesn’t even have the proper bonding materials to do your case correctly.
Fluorosis stains are generally pretty superficial and confined totally to the enamel. When they are treated with cosmetic dental bonding, the first step would be to grind out the discoloration and then to bond a composite that is designed to replicate the appearance of enamel. Depending on the case, it may be best to lay down a base layer of a composite that has some opacity to it, and then overlay it with a more translucent layer. If the fluorosis is mild, the bonding may be quite shallow and only a translucent composite will be needed. The surface composite should be of a type that will accept a high level of polish. Many family dentists stock only all-purpose composites which cannot be polished to a high sheen, so for the best result I would recommend an expert cosmetic dentist. The end result should be a tooth that looks so natural, no one can tell that any work has been done.
As far as the bonding staying on, this is pretty basic. Bonding to enamel requires a couple of steps. The first step is to etch the enamel, rinse, and dry it. It should show a frosty appearance if it has been etched properly. If there is severe fluorosis present, the etching time will need to be doubled. But it should be easy to tell if the etching is adequate because it will show that frosty appearance. After that a liquid bonding agent is applied and cured with a curing light. Then the composite is placed over the cured bonding agent. It should stay so firmly that it has to be ground off. You shouldn’t have to be careful about what you eat. Your dentist is doing something very wrong here, unfortunately.
And finally, unless I am missing something about your case, this bonding should only be on the front surface of your teeth and there should be no need of any diet restrictions or night guard.
We have several excellent dentists we recommend in Maryland. I would go to one of them. I would think it would be worth it to travel a little to get this done right.
Oh, and one more thing. If you were my patient, I would suggest bleaching your teeth before we started this bonding. The reason is that if you ever later wanted to whiten your teeth, you would have to re-do the bonding because it wouldn’t whiten any.
– Dr. Hall
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