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Another full mouth reconstruction gone bad. This case could be a mess.

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Dr. Hall,
I have recently gotten ALL of my teeth crowned. My old teeth were ground down to almost nothing, the front ones were paper thin and chipping daily and on the bottom left I was missing #21 and top right missing #3 and #4. I have also in the past had many unfortunate traumas to my jaw so it clicked loudly all the time when opening.

The dentist said I needed to have my bite opened in order to get my front teeth restored (all I actually wanted in the beginning was just top/bottom front teeth done) He said it would not be possible to do without doing my whole mouth. Fast forward to now, got bottom done all at once and was told that would be the hardest part for me to endure, it wasn’t it was a piece of cake compared to the pain I had for 3 weeks with the top ones. So anyway now i have had the new top ones in for 2 days and I will say they LOOK beautiful no complaints on the smile but the left side teeth touch whilst the right side has a space and my teeth do not touch at all 19-21 bridge not touching but bridge 2-5 hits fast and hard and my jaw is killing me.

He did cement them in with permanent cement and now my question to you is can he file this bridge down enough so my other side will hit and then can he polish it so my ground down rough teeth will not ruin my new crowns on bottom, or does the fixed bridge need to come out and be re-done. We have spent so much money on this and while we do have insurance it covered next to nothing and my husband is in the military and we cannot afford to have all this redone. I am really stressed out and any help you can give would be appreciated.
Thank you 🙂
– Erin from Alabama


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Erin,
You have had what is called a full mouth reconstruction. This is a highly complex procedure because it re-does your entire mouth and your bite. Dental school alone doesn’t train a dentist enough to be able to perform this kind of a procedure – it requires advanced training and/or considerable experience. And there are several well-known institutes that provide this advanced training. There is the Pankey Institute in Florida, and the Dawson Center for Advanced Dental Study, also in Florida. Another is the Las Vegas Institute for Advanced Dental Studies.

But even with that advanced training, these complex procedures should proceed cautiously, especially in situations like yours where the bite is being opened. It should first be opened with temporary crowns and then the bite adjusted with the temporary crowns until you are comfortable with the new vertical dimension. When that is settled, then the permanent crowns are made to replicate the new opening.

But that isn’t all. The crowns and bridgework should be seated temporarily and adjusted to a comfortable bite BEFORE being cemented permanently. And you are a perfect illustration of why this should be done. Here you are, already with TMJ problems (you mentioned loud clicking in your jaw) and apparently over-closed. And now crowns are cemented and your bite is off. Yes, the case needs to be re-done, and the dentist who did this is responsible for that. And if you have lost trust in him, then you need to have this done somewhere else and have this dentist pay for it.

Here’s the problem. Yes, the bridge that is throwing your bite off could theoretically be ground down in your mouth to where your bite is even. But from the sounds of your description (the other side isn’t meeting at all), it would take a tremendous amount of bite adjustment, and he would likely be grinding all the way through the porcelain in some places. Plus, the whole object of the treatment was to open your bite, and now he is going in and grinding it down, so your vertical dimension is going to be off. And this amount of change in the bite is much more difficult to do correctly in the mouth than in the laboratory. The crowns should have been carefully crafted in the laboratory to provide the proper bite relationship with all the cusps, grooves, and other anatomical features precisely mapped out so that your jaw functions correctly.

Having said this, it doesn’t take much for the bridge to throw your bite off enough to be painful. Maybe the discrepancy is only a fraction of a millimeter and it just feels to you like it is a lot. In that case maybe it could be adjusted to fit. And maybe he did try it in temporarily and it fit fine, but in the final cementation something went wrong and it didn’t fully seat. But if that did happen, at least the bridge should be re-done.

I would suggest a second opinion. You want a dentist who has been trained at one of the three institutes I mentioned to help give you assurance that they know what they are talking about, and I would suggest going out of town for the second opinion, to avoid any conflicts with dentists who may be buddies or competitors, which would interfere with getting an honest second opinion.

– Dr. Hall

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.

Did you really need that full mouth reconstruction? I’m suspicious.

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Dr Hall,
I have been going to a local female dentist here for the last 10 years and over the last few years she has put new crowns in the top front (6 or 8) teeth with the metal backed crowns and they leave a black stain across my gums (and chipping, breaking) all the time and she charges to repair these…. so she doesn’t back up her work.

I found a cosmetic dentist in nearby (town’s name withheld), Dr. (doctor’s name withheld) and he inspected my mouth and told me that not only did those horrible teeth need to come out but that my bite wasn’t right and the top teeth were wearing down the bottom to the point of my bite collapsing. Well yesterday Dr. (name withheld) gave me 28 new temporary crowns – will get my permanent ones next week. They will be porcelain and the temps look great it’s just that I find it difficult to eat and maybe it will take some time. I guess I need to get used to it and learn to deal with it.

One more thing is when I order my new permanent crowns I want to make a couple of changes, such as slightly lengthening my eye teeth or maybe offset them slightly to give me a less perfect smile or should I say maybe they won’t look like false teeth. Do you have any input on this situation? It will be about a week or more before I have this done but I want to come out with the best “natural” looking and less fake smile. Is there any other tips! or tricks that I could do as well?

Thanks,
– David from Mississippi

 

David,
I’m glad you e-mailed me. You could be in for a lot of trouble, and you should take your next steps very carefully. I would not let this dentist put your permanent crowns on until you get two big issues solved. I am highly suspicious of this whole situation. I’m going to give you my phone number, and I want you to call me about this. But let me explain your situation first.

1. The number one issue is that you need to be sure that your bite is comfortable with the temporary crowns before proceeding with the permanent crowns. If I were you, I would call the dental office and ask that the laboratory order be put on hold until you have temporary crowns that are comfortable to your bite. Your dentist is opening your bite with a full mouth reconstruction. This is a risky procedure, and could leave you with serious TMJ disorder if it’s not done right. Clue number one for your impending trouble is that you find it difficult to eat. Clue number two is Dr. (name withheld)’s website, where, when I read his bio, I don’t see any clue that he has the advanced training that would be necessary to do work of this complexity. Ordinary dental school education isn’t enough – there are institutes such as the Pankey Institute in Florida or the Las Vegas Institute for Advanced Dental Education that train dentists to do this. And when dentists go through the trouble to obtain this advanced education, it is highly unusual that they would have a website that wouldn’t mention it.

2. You have some matters you want addressed in the appearance of the teeth. Those need to be settled BEFORE the dental laboratory starts making them.

Here is what you need to do, and I am emphatic about this. DO NOT let Dr. (name withheld) or anyone on his staff talk you out of this.
1. Get the laboratory work put on hold until you get the two issues above solved, and until you can get a second opinion about this work.
2. Go get a second opinion. You are spending well up into five figures on this, plus you are putting the rest of your life on the line. If this work isn’t done right and you end up with TMJ disorder, that can make you miserable for the rest of your life until you would get the work re-done. Don’t take this lightly.

I’m going to recommend you go see an excellent dentist in Lafayette, Louisiana, for an opinion on this. I have looked for excellent cosmetic dentists in your part of Mississippi, and haven’t been able to find any, so I think it would be worth it to you to make the trip to Lafayette. I looked up directions on Google Maps, and I see this is a drive of several hours for you. But that’s a small thing when you’re talking about something so major. It is Dr. Mike Malone. He is highly expert in both cosmetic dentistry and reconstructive dentistry. He’s a past president of the American Academy of Cosmetic Dentistry and has been trained in advanced reconstructive dentistry at the Pankey Institute. But more than that, I have known him personally for many years, and he is a decent, honest dentist who will tell you what you need to do. Additionally, if you get out of the Jackson area, you avoid complications that can occur when the dentist giving the second opinion knows the first dentist. They might be buddies, which isn’t good, or they might be fierce competitors, which could be worse. And be sure you see Dr. Malone personally. He has two associates who do the general dentistry, and he does the advanced restorative. When you call, tell him that I referred you. His website is www.mikemalonedds.com, and the contact information can be found there.

I can’t make any declarations for sure without seeing you myself, but as I said in the beginning, I am highly suspicious. There are dentists who recommend full-mouth reconstructions purely for the profit involved. I certainly hope this isn’t the case with you, but you need to find out before this work proceeds any further. If the dental laboratory doesn’t make the crowns, that makes this whole thing a lot easier financially. You could transfer to another dentist, for example, for no additional expense. On the other hand, if the crowns are installed, then fixing you would involve starting all over from the beginning, preparing the teeth, and making new crowns from scratch.

Please call me on my cell phone, and you can talk to me about this.
– Dr. Hall

Link: Click here for information on getting a referral to an excellent cosmetic dentist.

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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.

Sometimes you just have to trust your dentist

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This is a follow-up to a question from Jamie from California about Fixing a Black Triangle.

So I went to a cosmetic dentist your site recommends about my black triangle between the 23 and 24. he said it was small and should not bond it because the gum in that area will be hard to keep clean and could become inflamed and not healthy in the long run. If he doesn’t want to do the bonding, should I go to another dentist? I’d really like to reduce the black triangle. He recommended getting veneers in twos for the space, but I’d really rather not ruin perfectly good healthy teeth for veneers at this point.

– Jamie from California

Jamie,
You’re saying that this black triangle is between teeth #s 23 & 24? Those are the lower right central and lateral incisors. I was thinking you were talking about UPPER teeth.

Does this actually show during conversation?

Now I need to be careful here, because maybe this space is really ugly, but I’m skeptical. I don’t have a photograph of your face, so I don’t know, and I’m going to need to make some assumptions in answering your question.

Having black triangles between lower teeth is not really abnormal, and I wouldn’t be inclined to treat them. Some people have them when they are young, and almost everyone has them as they age. I have them, and I have received numerous compliments about my smile. The lower teeth tend to be covered by your lower lip, and even when they aren’t completely covered, people’s attention is naturally focused on your upper teeth.

Have you had other people notice this black triangle? Or is this just something you’re looking at and you have an idea in your mind of how this is supposed to look and how it looks doesn’t measure up to that ideal?

I’d suggest getting a friend or two you can trust, and position them at a normal conversational distance, and have a little conversation with them. And ask them if they notice anything unattractive about your smile. Urge them to be honest with you, and hopefully you can trust them to be honest. And make a judgment from that about whether this black triangle needs treating.

A good cosmetic dentist addresses the cosmetic needs of the patient as the patient perceives them. But there are limits of reasonableness to this approach. I remember hearing Dr. Ronald Goldstein, who is considered by many to be the father of modern-day cosmetic dentistry, discuss the unreasonable obsession some patients have with the details of the appearance of their teeth. Patients, he said, should evaluate the appearance of their teeth at a conversational distance, and when they use a mirror to evaluate their teeth, should hold the mirror at arm’s length, so that they see themselves as others see them. Then he joked that when they would hold the mirror up close, he would adjust the fee to be inversely proportional to the distance between their face and the mirror. That brought a big laugh from the audience of cosmetic dentists, because they all are familiar with patients who have an inordinate obsession with tiny details in the appearance of their teeth that no one else notices.

And the dentist you went to mentioned functional problems with bonding – that you will create an area that will be difficult to clean. Essentially, from what he is saying, he would create a food trap. He is to be commended for his honesty and integrity. But I have a question for you. You said you don’t want to “ruin” perfectly healthy teeth by putting porcelain veneers on them. Why, then, would you want to ruin them by creating gum disease around them? A food trap is far more damaging to the health of your teeth than placing porcelain veneers, and could lead to the eventual loss of those teeth.

Getting good dental care is a matter of being able to accurately judge whether you can trust your dentist. It appears to me that this dentist is trustworthy – as a recommended dentist on our list he has to be esthetically sensitive. And he is pouring cold water on your idea, saying that the damage that would be caused by the treatment you want would outweigh any esthetic benefit. You could just trust him, which is what I think you should do, or you could shop around until you find an untrustworthy dentist who will actually do what you want.

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.

Do cosmetic dentists have to be artists if they outsource their porcelain work?

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Dear Dr. Hall, How does one find a good cosmetic dentist that can do good bonding work? Most cosmetic dentist outsource their veneers and crowns to labs, but bonding is in the hand of a dentist. How do we filter the good and the bad? Does your list of referred dentist look at bonding work, in addition to veneers and crowns?
James from San Francisco

James,
Yes, the excellent cosmetic dentists that I recommend, for the most part, will also do beautiful direct dental bonding work. I say “for the most part,” because even some excellent cosmetic dentists don’t like doing direct bonding, but I would say that 90% of them do.

But I’d also like to address this question about “outsourcing” of their porcelain veneers and porcelain crowns to labs, because some people have the mistaken notion that if it’s a great esthetically inclined dental lab, it doesn’t really matter who the dentist is because it’s the lab that creates the porcelain work. I guess they think of it like buying artwork from a gallery – it doesn’t matter which gallery you bought it from, it only matters who the artist is.

But there are a couple of reasons that this isn’t true.

First of all, a great dental ceramist cannot really work around a poor dentist to produce a beautiful final result. The dentist starts by preparing the teeth and planning out the case. How the tooth is prepared and the quality of the tooth preparation as well as the quality of the impression that is sent to the laboratory is critical to the success of the case. Then the dentist is the one who writes the prescription, giving detailed instructions about the shade map of the final result, the surface texture, the degree of translucency, a mock-up of the final result desired, and a lot of other details. And then when the work comes back from the lab, it’s the dentist who approves the work and decides whether the case is ready to be bonded onto the patient or needs to be sent back to the technician. No, while a great laboratory technician is required for a great final result, there is too much that the dentist does for the case for an artistic laboratory technician to be able to produce a beautiful result in spite of the dentist.

Second, a dentist without a great artistic eye will not use the services of a great ceramist. Those services cost more, and it just doesn’t happen that you would get a “great ceramist – poor dentist” matchup. Oh, there are some dentists who are not very good cosmetic dentists who will use a name brand laboratory like DaVinci or Microdental in California to impress their patients, but those are large dental laboratories with large numbers of ceramists of varying levels of ability, and they will not assign their best ceramists to work with dentists whose work they perceive to be of lower quality. I’m sure it’s not something they talk about, but it doesn’t happen that way.

So pick the artistic cosmetic dentist, and that dentist will assume responsibility for the quality of the final result. That is the way for a patient to get beautiful 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.

Why you have to be able to trust your dentist

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Dr. Hall,
I have a split tooth but the x-ray reveals a healthy root…my doc want to extract and I want him to save it! How do I convince a dentist to try something new like that described in your paper? Dentists seem to want to extract to solve all problems, use scare tactics and it’s hard to believe they are not doing it for the money since much more expense is involved in an extraction and insertion of a new tooth….I want to keep as much of me together as long as I can!!!

thanks
Mike from West Virginia

Mike,
This is one thing I worry about when I give patients these answers to their dental questions, that they will take this information and go back to their dentist and try to “convince” the dentist of one thing or another, or tell the dentist how to make their cosmetic dentistry more beautiful, or tell the dentist what type of filling or crown they want, different from what the dentist recommends. That will not work. The purpose of this website isn’t to help patients educate or change their dentist. What you need instead is to find a dentist with a philosophy that you are more comfortable with.

You aren’t going to convince your dentist to save this split tooth if he has told you that he wants to extract it. It would be misguided of us to even have me personally call your dentist and convince him to save it. I couldn’t do that because I haven’t examined you and for all I know maybe that is the only option here. But there are dentists who are strongly inclined toward saving teeth, and other dentists simply don’t want to do that. And this philosophy permeates their practice at many levels. If a dentist wants to save teeth at all costs, for example, he or she will need to spend focused study on the techniques for saving teeth, dealing with cracks in teeth, what to do for failed root canal treatments, advanced periodontal techniques, and a whole host of things. At the other end of the spectrum, if a dentist just wants to take out problem teeth then they won’t go through all that extra trouble. What point is there, then, trying to convince a dentist to save this tooth when he probably doesn’t even know how?

But it is not true that “dentists” in general just want to extract teeth. There is a wide variety of inclinations here. And I firmly believe, from my experience with the dental profession, that the vast majority of dentists are highly ethical people who honestly try to do the best for their patients. They have varying levels of skills and different philosophies. And if you have cause to believe that your dentist is just in this for the money, then you need to find a different dentist. There is no way to work around this trust issue. There is no way, as a patient, that you can check up on your dentist to make sure he is making the right decisions for your teeth. In this situation of yours, even I, as another dental professional, don’t know enough about your case to be able to say if your dentist is doing the right thing or not. You HAVE to be able to trust him. If you don’t, then find another dentist.

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.

How do dentists get to be listed on mynewsmile.com?

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We continue to get requests from visitors to find excellent cosmetic dentists for them, and I thought it would be helpful to explain the process we go through for this.

Here’s how we go about finding a cosmetic dentist. We start with lists of dentists with cosmetic dentistry education credentials. With those dentists who appear to have the necessary education credentials, we will then examine photographs of their work. Sometimes they will have photographs displayed on their website that have enough detail so that we can adequately evaluate them. If not, we will ask the dentist to send us photographs of their work. Someone asked me once whether that leaves us vulnerable to being deceived by a dentist who will re-touch the photo. In ten years of doing this, I have never had a case where I had reason to suspect that has been done. Furthermore, my experience is that the dentist who is not an artistic cosmetic dentist doesn’t even know how to alter the photograph to make it meet our standards. If they knew how to create beautiful cosmetic dentistry with Photo Shop, they would know how to demand that quality of work from their dental laboratory. Then the final step is I interview the dentist on the phone. If they pass all of this, I explain your needs to them, give them your name and contact information, and then I also send you an e-mail explaining why I recommend this particular dentist. After the referral is made, we will then ask the dentist to help support the website by becoming a sponsor. The sponsorship fees are modest, and most of the time they will agree to becoming a sponsor.

Most of the dentists recommended on mynewsmile.com are sponsors, but not all of them are. The criteria for being listed are the educational credentials and the quality of the work.

Occasionally we get requests from dentists who find out about us and they ask to be listed. I go through pretty much the same process with them. I will examine photographs of their work, looking for specific details that tell me that the work is of high esthetic quality. I also check educational credentials, and ask questions. Most of these requests are declined, but sometimes the dentist is approved to be listed.

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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.

You were right – and thanks!

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Last week, Kathy from Oregon wrote and said that she wanted a Nesbit partial, but her dentist said that they were illegal in Oregon. I told her that I was skeptical and gave her some advice about how to proceed.

Click here to read the original post, Are Nesbit Partials Illegal?

Kathy wrote back and confirmed my suspicions. Here is her thank you:

Dr. Hall,
Thank you….for the reply.

I hate my flipper partial. My speech is slurred and my mouth is dry since wearing it. I feel like I have a clump of peanut butter on the roof of my mouth all day long. I am wearing it to keep my teeth supported on either side of the extraction and also because the gap is very apparent when I talk or smile. I do have a consultation from a dentist I found using your site and his front desk did confirm that he did work with nesbit partials. Thank you for being honest which is more than I got from the dentist who took my tooth out.

Thanks….so much, Kathy from Oregon

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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.

A dentist is ethically obligated to give you all your options

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When I was a child I was hit in the mouth twice, once from falling out of a wooden school swing and the other time from throwing a croquet ball up in the air and catching it with my front tooth. Needless to say the older I’ve gotten the more yellow brown it has become. My dentist told me I would have to get an implant because there was no root but yet I still have the VERY UGLY BROWN TOOTH.

I also have several back teeth that need filings and at least 2 that need to be capped. I don’t have a lot of money to be putting into just one tooth when I have several others that need to be fixed, although the one that gives me an UGLY SMILE is the one everyone can see. PLEASE HELP ME.

Thank You so very much for your time.
Sincerely, THE GIRL WITH THE UGLY BROWN TOOTH
Danielle in Tennessee

Danielle,
I would switch dentists, and I will explain why.

One of these two traumatic incidents with your front tooth jarred it enough to sever the nerve and blood supply that go to the tooth. This would cause the tissue inside it to die, which would then cause it to become infected. It’s possible that if this tooth had received a root canal treatment at that time, it could have prevented the root of the tooth from being eaten away, but it’s also possible that would have happened anyway, as a side effect of the traumatic injury. The process is called root resorption, and it can happen because of an untreated infected tooth, or because of traumatic injury to the tooth.

But now that the tooth has no root left, you can’t save it.

There are three basic ways, however, to replace a missing tooth, and your dentist is negligent in only presenting one of them to you. He or she has an ethical obligation to give you all the options that would work. And while the implant option is probably the best choice for you, it is also the most expensive. Did you tell your dentist that this was too expensive for you? If you did, and you still didn’t get any options given to you, then it shows not only negligence but a lack of character on the part of your dentist.

A dental bridge is the traditional way to replace a single missing tooth. A bridge requires that the two adjacent teeth be covered with crowns (you may know them as caps), and then a false tooth is suspended between them. This is a little less expensive than an implant.

Another option is to use a removable partial denture that clips onto your other teeth and has a false tooth on it. While less comfortable than either a bridge or an implant, it is a fraction of the cost of a bridge. A flipper partial is the simplest way to do this, and it can cost as little as a couple of hundred dollars.

Find a dentist who is willing to give you all your options and who will work with you to keep the costs down. I don’t know everything that went on in your visit with your dentist, but just from the information that I have it doesn’t appear that you should trust this dentist.
– 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.

Tina’s reply to our “Buccal nerve damage” post

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Last week I answered a question from Tina from California, who was told she has buccal nerve damage as a complication of the removal of her wisdom teeth. I suggested that she may have an entrenched infection that needs a long-term course of antibiotics. Here is her reply:

“Thank you so very much for your insight into my unusual case. I do feel that you could be exactly correct and this is combination of two things. Infection and nerve damage. I was prescribed a good strong dose of clindamycin. I will complete the duration and then reevaluate. Of course I will absolutely join you on Facebook. I really appreciate your reply!”
– Tina from California

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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.

Thinking of having my porcelain veneers done at a dental school

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I have an appointment scheduled at the University of Iowa dental school at the end of November. I am seriously considering having veneers done through their dental school. A friend of mine is in their last year of school there, and is learning to do veneers through the supervision of a faculty member. I would like some recommendations as to whether this is a good decision, and how I can get the best possible results if I pursue this option.
– Teresa (Her e-mail is edited to remove the names of the dentists she shared with me).

Teresa,
I really don’t know what to say to answer this question. You’re already moving in this direction of having a student do your porcelain veneers, and if you think that this could possibly work out, I think we’re operating in two different worlds and nothing I could say would sway you.

Here’s how I would put it. Why would you want to go through all that trouble and getting something permanently bonded onto your teeth for the result of a mediocre smile? Why not just leave your teeth the way they are and not do anything? Do you really think that in dental school is where you find beautiful cosmetic dentistry? Do you really think that you could find any Hollywood star or New York model who had his or her smile done at a DENTAL SCHOOL? Dental schools are bastions of professional political correctness where they are uncomfortable with the art of designing smiles.

To see an illustration of the type of thinking that reigns in dental schools, read my recent post from earlier this month, answering a sweet patient from the San Diego area who had a horrible experience with her “cosmetic” dentist. And Iowa in particular is a stronghold of this type of thinking. The dental profession there is very conservative, and it has been hard for me to find good cosmetic dentists in the state to recommend. When I lived there, I drove clear to Chicago to have my own dental work done.

I’ll tell you a story about the University of Iowa that may help. This was back in the 90s, when white composite fillings for back teeth were just becoming very popular. The technical issues of their wear resistance and toughness had been resolved, and my patients had reached a point where that was all they wanted – to a person they were willing to pay the extra above and beyond what dental insurance plans would pay to have the composite fillings and I was only doing two or three amalgams a year. At the time I had a lovely girl come work for me as a dental assistant. She was studying to become a dental hygienist. She asked me to replace all her amalgams with composite, which I gladly did for her. Well, she was involved in a traffic accident and fractured her jaw, and went to the University of Iowa to have that repaired. While she was under the anesthetic, without her knowledge, the dentists at the dental school decided that this was so terrible that she had these white composite fillings on her back teeth that they broke the first rule of dental malpractice and removed them all, putting amalgam fillings back in her teeth. When she discovered this, she called me, crying, wondering what she could do. She could have sued them and won, but that wasn’t her nature. But this is the strength of the dental school culture – they know what is best, and they will decide what your teeth will look like. Now since then, composite fillings on back teeth are enjoying more professional acceptance, but the culture of dental schools has not changed.

I am somewhat familiar with the name of your dentist. He is highly respected. And so is the dental school professor you mentioned. But they are both highly trained engineers of dentistry and they are not artists. The type of dentists who become cosmetic dentists are those highly skilled practitioners who found dental school stifling and who, once they get out, want to break free and explore the art of dentistry. Back in dental school, paying too much attention to what the patient wanted was considered pandering to the patient and unprofessional. But as these budding cosmetic dentists interact with patients, they decide that is exactly what they want to do. It is a transformation process that takes several years to complete, because of the shift in attitudes and the extra training and experience required to blend beautiful art with highly developed technical skills.

I’m not sure if this will have any impact on you at all. You’re likely to go ahead and have your friend do this under the supervision of the dentist you named. I imagine you will get a smile that will be okay, with mediocre-looking teeth, and porcelain veneers that are bonded very well, that are very smooth and very technically correct and that sadly will last for years and years. Too many years. Then when you’re ready to replace them, come to me and I will help direct you to where you can get a truly gorgeous smile.

 

 

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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.

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