Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

August 31, 2015

Dentist got the tooth bonding color wrong, doesn’t want to fix it

Dr. Hall,

I would like to send photos of what we consider is a bonding error. My granddaughter (25 years old) had a gap fixed between her two front teeth, and then had her lateral incisors bonded to make them a little larger. She immediately remarked on the color difference between her front teeth and her lateral incisors. But the dentist then told her, “The color difference was to match your eye teeth.” But then later he told me on the phone that he used the same material on all her teeth. So these are two different stories. The central incisors look fine and the color looks fine, but he told my granddaughter that he used a darker color on her lateral incisors to match the eye teeth, but he told me he used the same color.
He now wants further payment for a correction. He says to try whitening toothpaste too. I already paid $350 for whitening by tray and gel, and $900 for the bonding work. Her lateral incisors are a definitive blue/grey.
Where can I send pictures?
Thanks
John from Ontario

(Note – John then sent these photos of his granddaughter’s teeth after I told him how to send them)

before dental bonding errorBefore dental bonding[/caption]

dental bonding error - color mismatchAfter dental bonding error showing color mismarch.[/caption]

You can see in the after photo that the lateral incisors look substantially darker than the centrals.

Dear John,

Actually, truth be told, the lateral incisors should be slightly LIGHTER than the central incisors—just slightly, and then the canine teeth are darker, in a natural smile. I think this dentist knows that, which makes it seem like he is trying to make excuses. So my answer is, yes, this is a dental bonding error, a cosmetic dentistry mistake. The teeth look fake and her smile doesn’t look natural. And you didn’t ask about the shaping of these two lateral incisors, but that looks off, too. The tooth color error is particularly noticeable and makes the case unacceptable, in my opinion. Like you said, they’re kind of a gray putty color and are actually darker than even the canine teeth.
But then the next question is what do you do about this. You say that you’re okay with the work that was done on the central incisors. It looks like there was a chip in one of the centrals that he must have fixed and a gap between the two central incisors that he also closed. That much looks okay to me, thought the photo is a little fuzzy.
There are two directions to take in trying to get some satisfaction from this dentist. You can ask that he fix it himself, or you can ask that he pay to have someone else do it right. Generally it is better, when you’re talking about cosmetic dentistry, to forget about trying to turn the first dentist into an artist. That just doesn’t happen. So I usually recommend getting someone else who can do it right and getting some compensation from the first dentist to cover those costs. But in this case it looks like he maybe did okay on fixing the central incisors (though the photo isn’t as sharp as I would like). And while the shaping of the laterals isn’t great, you seem satisfied with that and are only concerned about the color.
You’re welcome to take this dentist my email here. I would recommend not being confrontational. Like I said, it appears that he did a nice job on the central incisors. See if you can get him to agree to re-do the bonding on the laterals. Bleaching isn’t going to work. Toothpaste isn’t going to work. I kind of think he knows that, too. The color is embedded in the bonding, and it needs to be removed and replaced with a lighter color. It needs to closely match the central incisors, maybe just a teeny tad lighter.
And then, of course, this needs to be at his expense. You paid to have a nice smile, and you haven’t gotten it yet. He should make good on the work.

Dr. Hall

Read more about fixing a discolored tooth from a root canal treatment.

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

August 14, 2015

My front teeth are darkening under my veneers

My Lumineers are 7-8 years old. Originally I had them on 16 teeth. At the time I had the money….there is no way I could afford this now. Soon after I had them put on by a dentist in Kona, Hawaii, I moved to Austin, Texas and they began to fall off. Two fell off and I paid to have them reinstalled. I told the dentist in Hawaii, and he ended up (after many letters and threats of legal action) sending me a very small refund so I could pay the dentist in Austin. The veneers had also begun to darken/no fit well at the gum line, making me self conscious more and more as time goes on. Since then no further veneers have fallen off, but over the past year I have noticed my front teeth darkening UNDER the veneers, one more than the other. I am afraid that I will need to have them removed and replaced and I definitely don’t have the money to do that. Interestingly, when I first chose the color of my new teeth I nearly chose a darker color to look more natural…as they seemed nearly too WHITE. But now they seem far darker…..I’m not flashing as white as my friends with natural teeth. Anyway….scared and disappointed I guess. Need advice on how to deal with the darkening teeth.
– Debbie from Texas

Debbie,
You’re right that the veneers will now need to be replaced. They are leaking, and the problem isn’t just the color, but when dental work leaks, the next step is that it begins to decay. When stain can leak in, bacteria also leak in.

It doesn’t sound to me like either dentist, the one in Hawaii or the one in Austin, knew enough to do this right. They weren’t bonded right in the first place, as you now understand. But very few dentists know how to re-bond porcelain veneers. The old bonding material would first need to be completely cleaned off, with some type of sand-blasting equipment which few dentists have. Then the inside surface of the porcelain should have been etched with hydrofluoric acid, again something that few dentists would stock. The veneer could then be primed and bonded onto your tooth, where it should remain without leaking for many years.

If your veneers could be just popped off, they could probably be cleaned up and re-bonded properly, and you should be fine. But I’m guessing that the Austin dentist probably bonded them on pretty well, just not well enough to hold up over these years. So they would most likely break in trying to take them off.

Another issue will be getting the new veneers to match your old ones. Make sure you go to an expert cosmetic dentist for this. Don’t look for cheap here–you’ll end up paying more in the long run.

I hope this is helpful.

Dr. Hall

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

February 21, 2013

Sorting out LeAnn Rimes’ dental malpractice suit

I ran across a post on eonline.com that appears to be trying to poke fun at LeAnn Rimes for her dental malpractice lawsuit.

It posts this pair of photos, saying that the left one was taken before the disputed dental work, and the right one was taken after.LeAnn-Rimes

The implication is that her teeth appear to have problems “before” and look fine now. The comments get into a lot of ridicule of LeAnn, with some implying that she is just being litigious.

Here’s some added perspective, from a cosmetic dentistry expert. The “before” picture is NOT “before” any dental work was done. There is serious inflammation and swelling around her upper right central and lateral incisors revealing problems with the dental work on those teeth. The other teeth don’t have this inflammation around them, so I am confident that there is faulty dental work there.

Here is another pair of photographs. On the left is a very early photograph. The teeth seem to be smaller than in the “before” photograph above, which seems to bolster my point: LeAnn-Rimes

The “after” photograph, by the way, I believe was taken in 2010. The teeth look a little too large. And someone in my office remembers seeing her after the dental work was done and remarking to her son that the work didn’t look good and it appeared to affect her speech.

I get a lot of e-mails from patients who have been victimized by shoddy cosmetic dentistry. I can entirely believe that this happened to her.

When I am looking at photographs from dentists to possibly recommend on mynewsmile.com, I insist on photographs that show some gum tissue and that are enlarged enough to show whether or not the gums are inflamed. The presence of gum inflammation much less than what is displayed here will disqualify a dentist in my estimation and I will refuse to recommend them.

Click here to find a recommended cosmetic dentist and read some about how dentists qualify to be listed here.

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

June 1, 2012

A cosmetic dentistry horror story – but there is a silver lining

Hi Dr. Hall.
I got 8 porcelain veneers and 2 crowns 2 weeks ago. I am 48 and have tetracycline stained teeth. I am very disappointed in a few ways and don’t know what to do. First thing is that they are too white. I look silly. I am Italian with dark skin and I look like I have Chiclets in my mouth. My dentist gave me an option on the color so I realize I am stuck with that problem. I will probably not smile very often now.

But the worst things are that I feel like they are loose and may come off at any time. I can’t bite down hard as it hurts in my molars. And also I can’t relax my teeth as it feels like the upper teeth are too long and my entire face aches like I am clenching and grinding my teeth. Help me with some advice please. I have had 5 kids with dental issues I always took care of. They are grown and gone and I finally was able to do my own smile. I am so sad about it.

Thank you.
Jamie from Virginia

Jamie,
This is the sort of story have heard so much over the years, and is the reason I operate this website. 98 to 99% of dentists simply don’t know how to do beautiful cosmetic dentistry. They chose the field because they like to fix things, and they think like engineers, not like artists.

You’re kind to take the responsibility for the color of your porcelain veneers. But there are about three things a dentist who is truly passionate about doing beautiful cosmetic dentistry would have done differently in your case.

First of all, he or she would have been knowledgeable enough about the results you would get to predict how you would look when your case was done, and would have coached you to a more beautiful result. You’ve never had a smile makeover before – how are you supposed to know how a particular color will look once it is in your mouth? A truly artistic cosmetic dentist would be focused on creating a beautiful smile, and would steer you in that direction.

Second, every excellent cosmetic dentist I have ever asked, and I have interviewed a number of them on this subject, has some method for making sure that you will love your new smile before it is ever bonded permanently. They will often make a set of what they call provisional veneers in acrylic that will be temporarily cemented onto your teeth so you can “test drive” the final result, to make sure that you will be happy. In addition to this, they have a try-in with the actual veneers – they will use a try-in paste to insert the porcelain veneers to let you see exactly how they will look. You will get as much time to look at this as you want – will get to see it under different lights, have a friend or family member come in to give you feedback on how it looks – whatever it takes to make sure that this will make you proud to smile before these are bonded on permanently. Most recently, I interviewed a cosmetic dentist in the Boston area that we recommend on this site. In 30 years, he has never had a patient who has not been happy with their new smile. If he ever did, he would re-do the case.

And that brings me to the third thing an excellent cosmetic dentist would do. These dentists, as I said, are passionate about creating beautiful dental work. Most of them, if they heard you say what you just wrote to me – that you won’t be smiling much any more – would be so embarrassed that they would re-do the case for free. I had this happen to me. I was a young dentist and it was the first time I had done porcelain veneers on someone with tetracycline stains. When dentists are inexperienced with tetracycline stains, they will make one of two mistakes. These tetracycline-stained teeth are so dark on the inside that the color shows through most dental materials, and the dentist will have them made too translucent so that the gray-brown shows through. This is what I did. Or, they will make the teeth too opaque and white so that they look pasty and fake. This appears to be what your dentist did. Well, with the case that I did, after I gained more training and experience and knew better how to make this type of case look beautiful, I offered to the patient to re-do them for free, because I didn’t want work that I was responsible for not looking beautiful. The patient never complained, but I could tell she wasn’t excited about how they looked, and I wanted her to be excited. I’m not unique – that’s typical of artistic dentists who love to create beautiful smiles.

So what do you do at this point? There really isn’t much remedy other than doing the porcelain veneers over. And this time you need to be very careful about the dentist you pick to do them. Pick one from our list – that’s why I have this website. I personally check every dentist I list to make sure they can do beautiful smile makeovers.

But I need to say a word about how your mouth feels now. The porcelain veneers cannot be loose – if they were loose they would immediately fall off. But what I am worried about is that your teeth are getting loose. You say that your entire face aches, like you are clenching and grinding now. And you think that the upper teeth are too long. I can’t tell this from a distance, but it certainly sounds like your bite has been thrown off. This could potentially be very serious and could lead to serious TMJ disorder or breaking of the dental work, or premature wearing down of your teeth, or periodontitis leading to early tooth loss, or even breaking of your teeth. This could actually be the silver lining of your cloud, because this could give you grounds for asking this dentist to compensate you so you can have this re-done correctly. Here’s what I would suggest. Go to a dentist on our list of recommended dentists. See what he or she thinks of what has been done – if the work has indeed thrown your bite off to where it is causing serious problems. And then see if he or she will help you get some satisfaction from this other dentist. You need someone more than just a skilled cosmetic dentist – you need someone who will be understanding and willing to stick their neck out a little to help you get what you deserve.

Good luck,
Dr. Hall

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

April 17, 2012

How long after cosmetic dental work should I feel pain?

One month ago, I went to Mexico for cosmetic dentistry. The dentist completed 12 lower crowns and 6 veneers on the front upper teeth. Since getting the work completed (2 1/2 weeks ago now), my lower jaw has been extremely painful. It’s not in the gums, but my jaw itself. One tooth hurts to chew anything (even something soft, like bread). I asked the dentist about it and she said to take ibuprofen for a few weeks because so much work was done in such a short amount of time; and that the crown on the tooth that’s sensitive to chewing may have high contact, or need a root canal. That tooth does not touch any of the top teeth when I clench. I’m concerned that I’m having to take so much ibuprofen, and that it’s not really helping the real issue. Should I still be experiencing pain at this point? I take 800mg of Ibuprofen every 4-6 hrs – that can’t be good!!
– Julie from Iowa

Julie,
This doesn’t sound good.

The dentist told you to take ibuprofen for a FEW WEEKS??? Are you serious? So much ibuprofen over that long a period of time can damage your liver or your kidneys. You are taking 3200 to 4000 milligrams a day. I think the maximum recommended dose is about 2400 mg per day over short periods.

No, this kind of pain after getting crowns or porcelain veneers is not normal. Something is wrong. Some tenderness or soreness for a couple of days maybe could be expected. And your teeth should all be touching evenly.

You need a second opinion from a reputable American dentist. You have two excellent cosmetic dentists near you. [Names not included in this post]. Have one of them look you over and see what is wrong before this gets out of control and so you can get off this ibuprofen immediately. It does sound like you may need a root canal treatment. Don’t have that done in Mexico, please.

Only about one out of every fifty dentists in the United States is capable of doing a beautiful smile makeover. However, most of our dentists are fairly competent in general dentistry. If you go to Mexico, your chances of getting in trouble with even basic general dentistry are high, and there are probably only a handful of good cosmetic dentists in the entire country. One for sure—there may be more.

Dr. Hall

Links: Read more about cosmetic dentistry costs.
Read more about the quality of dental care outside the US.

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

February 16, 2012

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 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 complete Internet marketing for dentists.

January 5, 2012

Opaque, bulky veneers from a dentist we recommended. Uh-oh!

I had an e-mail exchange from one of our visitors. Her name is Robin, and I’m not even going to say the part of the country she is from, because of the sensitive nature of what I did and what I told her. You can read her initial question and my initial response on my post: A $30,000 cosmetic dentistry blunder.

Here’s what she wrote back, which really surprised me:

Dr. Hall,
Thank you so much for responding to my question. I don’t do Facebook, but I would be happy to write a very positive review for you if you will tell me where to do it.

The dentist who did my dental work is actually on your recommended list, although I did not find your site until after the work was completed. I will happily check out your other recommendations. Thank you for taking the time to help me.
– Robin

After getting this I wrote back to her and asked her to identify the dentist that did her work, she responded to that with the following additional information:

Yes. I want to be fair, so I’ll tell you that I sought a second opinion from a periodontist because [Dr. Unnamed] stated that the brown margins are visible due to gum recession. This did not make sense to me because my gums are in most excellent condition by all accounts. I am told this at every check up. The hygienists tell me with amazement that I have no bleeding and that my home care is excellent. [Dr. Undisclosed], a periodontist, confirmed this as she said “Wow. These are really good numbers.” She also said the veneers fit very well. Yes, I guess they fit well, but they look bulky, opaque and lifeless. I was so disappointed from the moment I first saw them. I don’t want to suggest that [Dr. Unnamed] is an incompetent dentist. He is just not an artist.

I also saw [Dr. Anonymous – another cosmetic dentist we recommend in her state]. His opinion is that I should have them redone, as he thought they look lifeless.
– Robin

This was my response to that:
Generally, there are a lot of general criteria for whether or not I recommend a specific cosmetic dentist, and those criteria are lumped together, weighed, and I make a judgment call on the ability of the dentist. But there is one absolute, and that is that they have to listen and they can’t seat a case without the patient loving it. [Dr. Unnamed] has a lot of beautiful cases to show off. But an excellent cosmetic dentist will always try in a case and make sure it meets the patient’s expectations, and even if the patient doesn’t really object and the only clue to their dissatisfaction is the tone in their voice, I would expect the dentist to stop right there, find out why the patient is hesitating or not enthusiastic about the work, and send it back to the lab to fix whatever the issue is. If a dentist doesn’t do this, I don’t want to list them. Seating a case in the face of patient misgivings is a big “no-no.” I didn’t want to say this up front for fear you might be alarmed and out of niceness would then not tell me your complete, honest opinion. But I am going to pull his listing. I list these dentists with my personal recommendation, and it’s an embarrassment to me, a stain on my reputation, and a disservice to the patient to not have the dentist measure up to the expectations I create.

About the gum recession and gum disease – recession is one thing and pockets and bleeding are another. You can have very healthy gums with no bleeding and still have recession. There is a way to tell if the upper front teeth are vulnerable to recession, and placing a case where the bone and the gums are healthy but thin can provoke recession if the dentist isn’t extremely careful. So maybe this is what happened if the margins weren’t showing when the case was first placed but they are showing now.

[I’m embarrassed and a little nervous about taking the risk of being so open with our readers, but at the same time I wanted to let you know that I take seriously the responsibility of recommending the dentists I recommend. I made a mistake in listing this particular dentist and I feel bad about it. But this sort of thing hasn’t happened before, and hopefully it won’t happen again.]

 

 

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

January 3, 2012

A $30,000 cosmetic dentistry blunder

I had an interesting exchange with a visitor named Robin, and in this case, I am not even going to identify what part of the country she is from. But here is what she asked me:

Dr. Hall,
I recently endured an all-porcelain full mouth restoration with crowns and veneers due to bruxism and tetracycline stains. The dark margins of the tetracycline-stained teeth are becoming visible. Also, I am unhappy with the bulky, opaque appearance. Do you know of an artistic dentist in [name of state] who is very experienced with the complexities of masking these stains while retaining the translucency of the natural tooth?
– Robin

Robin,
That full mouth reconstruction with porcelain crowns and porcelain veneers
cost you well into five figures. What a shame that it was done by a poor cosmetic dentist. But that’s the state of the profession. Any dentist can claim to be a cosmetic dentist, because the profession doesn’t require any special training or certification, but 98% of dentists could not do a decent smile makeover.

Robin, one of the standards I have before I list any dentist on our website is that they would be able to do the type of work you want done and have it turn out beautiful. One of the basic differences between a dentist who takes appearance-related dentistry seriously and one who doesn’t, is what happens when the work is tried in and you finally get to see how this will look in real life. The vast majority of dentists will give you a quick look and say something like, “How’s it look? Good. Let’s hurry and put them in.” The excellent cosmetic dentist will actually want to know what you think of it, and if there is even a hesitation in your voice as you maybe say, “I guess it looks okay,” they will ask you what is wrong. “Why don’t you just love how it looks?” Every excellent cosmetic dentist will have that approach to their work. So you would be safe going to any dentist on our list.

[I then gave her the names of what I feel are the top cosmetic dentists in her state. But what surprised me was her answer and what I had learned about the dentist she visited. See the following post for that exchange.]

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

November 14, 2011

Another cosmetic dentistry horror story

Filed under: Cosmetic dentistry mistakes — mesasmiles @ 6:21 pm

Recent Bad Cosmetic Veneers: Help Please! I recently had veneers put on my teeth on August 11th and cannot be more dissatisfied with the work. I am having many problems with them and it is very hard to get in touch with the dentist that did them.

The quality of work that he did was far from expected. After getting the veneers on, they were popping off the next day and I had to rush back into his office. I swallowed one veneer accidently because it popped off while eating. He just ordered one veneer. The whole cosmetic work has a lot of issues and I contacted you in hopes of re-doing the whole process. I feel as if the dentist has no experience in doing cosmetic work and got me when I was feeling vulnerable. Now, after having the work done, I do not smile.  I would really like to re-do the veneers with an experienced cosmetic dentist and would be able to travel.

Here are the problems:

  • 2 veneers popped off, I swallowed one.
  • They feel and look too thick & Bulky.
  • One side is more prominent than the other.
  • Discoloration in the margins (open-margins) of the veneers where they meet the teeth, original teeth are showing. Subject to bacteria and significant decay (long-term issues).
  • Midline is slanted and poorly positioned.
  • Teeth are tilted.
  • Porcelain is monochromatic & poorly finished (no luster) •Bite is not right (one side hits before the other)
  • Improper length, over jet, and bite.
  • I have pain and sensitivity with my teeth.

I already paid for 5 veneers and a bridge and am very unhappy with the results. Now sure what to do, but need help and second opinions. Thanks for reading.
– Maria from Chicago

Here is the photo Maria provided of her cosmetic dental work:

maria-makeover

Maria,
I looked at the photos you posted of your work and see your concerns. I agree that the porcelain veneers look too bulky. In addition, the color is very drab. If you’re going to take the time, trouble, and money to get a new smile, I would think you would want one that sparkles.

I agree with you that this dentist does not seem to know what he is doing. Unfortunately, this is the state of cosmetic dentistry. It should be a specialty, but for political reasons the American Dental Association will never recognize it as such.

You shouldn’t have to travel that far to get this done right. There are several excellent cosmetic dentists in the Chicago area. You can check our list of Chicago cosmetic dentists.  The first step would be to visit him or her, let him see the condition of your mouth, and then see what help he could offer in working with your former dentist. If you feel you are entitled to some compensation from your former dentist, the new dentist would be able to help you know what you may be entitled to and could maybe help mediate that.
– Dr. Hall

 

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

November 11, 2011

A dental horror story, and getting things fixed from here

In 2010 I changed going to the dentist I had gone to all my life as he was retiring. I am 62 now and I wanted to go to someone that was closer to my home. My insurance gave me a choice of dentists.

I went to my first appointment and my new dentist said I needed 4 crowns on my bottom back teeth replaced. He said they were over five years old, and they had decay. They had been on many years. Same with the four front teeth but he said he could put on whiter crowns but I would wait till the new year for more help from the insurance. I had the new crowns on my bottom teeth crowned in 2010 with CEREC porcelain and paid an extra $150.00 per tooth that they did not charge the insurance, just me. Now I find out that all porcelain crowns are usually put on just the front teeth.

Then the dental office said the front 4 were pre-authorized by the insurance. So I had all 8 front teeth prepared and got temp caps and waited for my crowns. They came back and he cemented them on. Then problems started. Besides finding out the work had not been pre authorized the back of one of my front teeth chipped off. I went in and he ground on it and sent me home. The next day half the tooth fell off. My husband left work and took me back and requested he redo both front teeth which he agreed to do. So I went back to the lab for color match again. The lab told me that they had not made any mistake on the first crowns and they were not very happy about it. So when the new crowns came in they were very thick on the backs and the dentist had to grind on them. After he ground for a while he stopped and said he could not grind anymore as it was getting too thin. So I went home and realized that everything I ate got stuck in between the two teeth. He said he would check with the lab but I would probably have to pay them to remake the crowns. I was shocked. A month went by and no word back. I finally called my insurance and they said to file a complaint. They did an investigation, sent me to a different dentist that said my bite was horribly off. The insurance finally said there was not enough evidence to show he did poor work on my front 2 teeth.

Then came a letter from my dentist that he would not see me anymore. I did not want to go back to him either but what about the problem and what about any guarantee on all the work previously done? I went on until it was time to go back for my checkup. I decided to go to a dentist that a friend went to and loved. He did his checkup and told me the blackish color on some of my new crowns was micro-leakage and bacteria under the crown had caused that. When putting on the crowns everything has to be as steralized as possible. So once again I filed a complaint with the insurance. In the meantime one of my front crowns broke off. I added to my complaint my tooth breaking off. So now I am waiting to hear back from the insurance again. This new dentist emailed his chart notes of his work. He did two root canals and crowns on my upper back teeth and he did not use all porcelain. He also included pictures of my teeth with the micro-leakage and the gap between my two front teeth and my bite being off with his recommendation. So I am waiting to hear back from the insurance and trying to decide whether or not to get an attorney involved as the insurance will only recover the money they paid if they agree with my complaint. In the meantime I have a temporary on my front tooth. This has been a nightmare. Will you please give me your thoughts on this?
– Corinne from Utah

Corinne,
If you go to a new dentist who says that all of a sudden you need a lot of work, something is wrong. Frequently, the old dentist was negligent in either not diagnosing correctly or in doing patchwork dentistry rather than comprehensive dentistry. But it could be that the new dentist is taking advantage of you. If that happens to anyone, I would recommend getting a second opinion from a dentist you know is up-to-date. Don’t rely on your insurance network – find another dentist on a private pay basis, a dentist who has a modern, clean office, that appears to be high quality, and get a second opinion and compare notes. Say as little as possible about your situation and nothing about what either dentist said. Don’t even identify the dentists, but make it clear that when you have the work done, you are going to use a dentist in your insurance network. You’re just looking for an honest opinion from a dentist you feel is up-to-date and who you know has no stake in the outcome. If you can take copies of your x-rays, do so, but remove any identification of the dentist. If you have to, just pay for additional x-rays. It’s worth it, to get to the truth.

Another problem people have is relying on dentists in their insurance network. These are not usually the best dentists. The dental insurance company usually picks them because they are the cheapest. (Read more about preferred providers here.) And while I am not in a position to say whether or not your crowns needed to be replaced, I am suspicious, from what this dentist said about the crowns being over five years old, that the dentist was merely taking advantage of a known insurance company standard that they will pay for replacement of a crown after five years, and maybe there really wasn’t any decay.

It appears that you were victimized by this dentist and all the crowns that you may not have needed and the poor workmanship. And if that is the case, I would seek some compensation from this dentist.

Here is what I would advise. Before going to an attorney, I would ask your husband to demand a refund of everything you paid and threaten, if the dentist doesn’t cooperate:
1. to go to an attorney and
2. file a complaint with the dental board.
I would also see if the dentist who examined the faulty dentistry would stand behind you on this dispute. That is key to getting any settlement from the dentist – having another dentist who can vouch for the faulty work.

If the dentist will settle with you, hopefully you can avoid going to court. But if the dentist resists, then I would talk to a lawyer.

About using porcelain crowns on back teeth, that isn’t an issue here. There are porcelains that work well on crowns on back teeth. I have a CEREC all-porcelain crown on one of my lower molars and it works fine. It depends on the strength of your bite, the position of the tooth, and the type of porcelain used.

Dr. Hall

 

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

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