Dr Hall,
I have tetracycline stained teeth, I have been referred to a dentist by my g. p. During my 4 visits I have had 4 different dentist.1st dentist says I need full crowns to cover the stains, 2nd says 2 sessions of laser teeth whitening will do this,3rd porcelain veneers. I then visited the Dentist that will do the procedure also advised porcelain veneers. He also admitted hes only done this twice. He had no photos, of his patients, nor anything to say he can specialise in this procedure. Now reading your blog, you say tetracycline is a delicate procedure and could easily be blotched up. So I have made an appointment for a consultation to a cosmetic dentistry been referred to by my brother.Is there anything else I should be asking for a cautious about, as I dont want to make a mistake as this is exspensive.
– Tania from Sydney, Australia
Tania,
Well, you’re on the right track, but I’m a little limited in what I can do to help you see an expert cosmetic dentist in Sydney, Australia. I do know of a great cosmetic dentist in Melbourne, but not Sydney. The level of expertise in cosmetic dentistry is low in Australia, and it could be difficult to find someone who can do this well. But you’re asking good questions, and you were able to weed out some dentists who would have been trouble for you. Let me try to help.
As you have discovered, a recommendation from another general dentist isn’t the way to go. This is because the basic problem is that the general dentist simply doesn’t have the appreciation for esthetics. His or her whole focus is on the technical aspects of the work and so the referral is likely to be to a dentist who is great at these technical aspects. Cosmetic dentistry tends to be pooh-poohed by the dentist community in general. Not always, but usually. So you usually need to get outside of that group to even get someone who appreciates good appearance-related dentistry.
The dentist wanting to do crowns, this is a red flag. Your teeth do not need to be ground down for crowns in order to cover tetracycline stains. Porcelain veneers is the treatment of choice, but some dentists are not comfortable with porcelain veneers, and this is one way to weed those dentists out, if they recommend that you do crowns.
And, as you have read on the website, laser bleaching would yield disappointing results. Tetracycline stains are simply too stubborn. It could lighten teeth a little, but not a lot.
I’m unclear about the dentist who was going to do the porcelain veneers who said he has only done this twice. Do you mean he has only done porcelain veneers twice? If so, that is a very bad sign. Or do you mean he has only treated tetracycline stains twice? That isn’t quite as bad. And asking for photographs is a minimum requirement. I would go a step further and ask to see photographs of the results of a tetracycline stain case. It would be best to have a dentist who has some experience doing porcelain veneers for a tetracycline stain case. Their first tetracycline case will always surprise them. When I did my first tetracycline case, I thought I knew how to treat it well. But a couple of years later, after I had learned more and developed more skills, I was embarrassed by how that first case looked, and I re-did it for the patient for free, even though she had never complained about how it looked. But when you begin to take pride in the beauty of your work, you don’t want any work out there that you have done that doesn’t look positively stunning.
In my years of fielding questions from patients over the Internet, I have learned that there is one hallmark of an excellent cosmetic dentist that is a pretty reliable indicator of the quality of their work, and that is their reaction to a patient who is trying on the new smile before it is permanently bonded. The excellent cosmetic dentist will be very concerned about your opinion of how the work looks, and the slightest sign of dissatisfaction will be addressed. Now this isn’t the only indicator that the dentist does quality cosmetic dentistry, but it is a minimum requirement for a dentist who is serious about appearance-related dentistry. They will try the case in your mouth temporarily and you will get a good look at it. If you’re lukewarm about how it looks, they will send it back to the laboratory to be fixed or even re-made. But the dentist who has little confidence in his or her abilities as a cosmetic dentist or simply doesn’t care that much if you are only partly satisfied will do this step very differently. Here are the different things they may do:
1. They may not really give you an adequate look at the work before permanently bonding the case.
2. If you’re not sure you like it, they will tell you how great it looks, trying to talk you into letting them bond it on permanently. Sometimes they get their staff involved, to come in and convince you it looks great.
3. They will make excuses for why it doesn’t look all that beautiful – saying it will look better after it is permanently bonded, or it will look better after it’s been in your mouth for a while or after you get used to it, or they will say that what you want is too difficult or even impossible to achieve.
An excellent cosmetic dentist will not only be very attentive to the slightest sign of a lack of enthusiasm by the patient, but will generally be fussier than the patient about how it looks.
So here’s what I would do in your situation, since I don’t have anyone to recommend in Sydney. I would make sure the dentist had done plenty of porcelain veneer cases and ask to be shown pictures. Then I would ask the dentist if he or she ever had a situation where they sent the case back to the laboratory to be re-made or revised before putting it on. Then I would ask further if they ever had a situation where the patient thought the work was okay but they said that it wasn’t good enough and they sent it back to the lab. And I would follow up this question with a request to speak to the patient involved, so you could quiz the patient on how this try-in went, to reassure you that if you aren’t too excited about the results, the dentist will have the case re-done by the laboratory until you do.
I don’t want to suggest that this method is fool-proof. It could land you with a dentist who is well-intentioned but lacking in skill. The best way is to have the dentist’s work evaluated by another expert cosmetic dentist. But this method will help you avoid most of the pretenders and is more reliable by far than a recommendation from another dentist.
I hope this is helpful,
Dr. Hall
| We thank our advertisers who help fund this site. |
|
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.
