Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

August 13, 2012

Fixing a black triangle

Filed under: Braces — Tags: , , — mesasmiles @ 8:00 am

I had a spring retainer made and then the orthodontist shaved 2mm off the side of my tooth and its created this black triangle because he didn’t make the spring retainer right. I still question whether the 2mm needed to be shaved because I had braces before and everything was fine before the tooth shifted. Anyway, is there a way to help the gum grow and cover this black triangle? .
– Jamie from California

Jamie,
About this black triangle – I feel like I would need to understand more about your case to say whether or not this is easily fixable. I would suspect that the orthodontist is planning on closing this space, but I don’t know. I general, these black triangles can be tricky. Preventing them or treating them is all in the shaping and positioning of the teeth on either side. It doesn’t really work to graft in gum tissue to cover these. The position and shape of the gums is a natural response to the positions and shapes of the teeth on either side, and if you surgically re-shaped the gums, within a few weeks they would go back to their natural contours.

We occasionally see complaints of people who have had braces and then have some associated gum recession and get black triangles between their teeth. If this does happen and the teeth are straight and touching each other, then the solution has to be some type of dental bonding to add to the sides of the affected teeth near the gumline.

To address this you need an expert cosmetic dentist. Please don’t make the mistake of going to your family dentist for a solution to this. This is way beyond the basic education dentists get in dental school.

Read a post with Jamie’s follow-up question, where Dr. Hall begins to question whether or not Jamie is becoming obsessive over a small defect: Sometimes you just have to trust your dentist.

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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.

May 19, 2011

My dentist won’t do the crowns unless I do the braces

Hi, I went to dentist today to inquire about replacing the crown on my two front teeth. They were put on about fifteen years ago and are discolored and embarrassing. I was told I need full ortho braces before I can get the crowns replaced. I do not have the money for that and I don’t see why I can’t just get new crowns and do the other stuff later. My front teeth in question are a little crooked and bucked out but not that terrible. What should I do?
– PJ from Wisconsin

Dear PJ,
I don’t like it when dentists put these restrictions on their treatment – they will only do the perfect treatment or nothing. People have budgets and sometimes less than ideal is the only thing within their budget.

You certainly should be able to get these crowns replaced without doing the orthodontic treatment. You could forgo the braces entirely, or you could do it later. The dentist should still be able to do great crowns and get them looking great.

I would find another dentist who is a more sympathetic and understanding type who will work with you and your budget.

And I would be sure to do all-porcelain crowns on your front teeth. Otherwise they will tend to look fake and will end up showing a dark line at the gumline. Make sure your dentist feels comfortable with this type of crown. Don’t press your dentist to do a certain type of crown – but ask what type the dentist recommends, all-porcelain or porcelain fused to metal. And if he recommends porcelain fused to metal, you’re in the wrong office. Just quietly exit and find a dentist who loves doing the all-porcelain.
– Dr. Hall

We thank our advertisers who help fund this site.

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 18, 2010

Gap in My Teeth Misrepresentation – A Confession!

Filed under: Braces — Tags: , , — mesasmiles @ 11:03 am

I got an e-mail yesterday from the person who sells Teeth Perfect Teeth Gap Treatment bands on the www.gapinmyteeth.com website.

I had been saying that the before-and-after photographs on the home page were of different patients – that the “before” photograph was a different person than the “after” photograph. I was quite surprised when Rebecca told me that the pictures were of her, but that she had had other dental work in between the photographs. Either way, this is a misrepresentation. The work must be porcelain veneers or porcelain crowns, which would be one appropriate choice for fixing this tooth gap. The “after” photo does not represent the results of using these Teeth Perfect bands.

Here is the comment from her e-mail: “It is the same individual but they had additional work done to their teeth. How do I know? Because they are my teeth!”

We thank our advertisers who help fund this site.

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.

October 18, 2009

Should I continue to wear my retainer?

Filed under: Braces — mesasmiles @ 6:22 pm

I had braces in my teens. I was told to wear a retainer for a month fulltime then only at night. I had a slight relapse in my upper front teeth. I talked with a new orthodontist who said new braces could fix the problem, or I could use my old retainer to move them as close to aligned as I could and a new retainer made to hold them in place. He said 6 months of fulltime wear and then night time wear should keep my teeth aligned. I’ve since worn my newly made retainer fulltime for almost three years. I notice after a few hours whenever I remove the retainer that the one tooth in particular seems to have shifted some, therefore I’ve not yet been brave enough to not go more than a few hours without it. Am I being paranoid about the movement of my teeth? If not, then will the movement stop or become less noticeable once I get the courage to wear it only at night? I mean if my teeth move slightly throughout the day and I have to force them back every night…is that normal? That can’t be good over time right?
– Ty in Indiana

Ty,
I don’t think you’re being paranoid about your tooth movement. If your teeth are starting to move within a few hours after you take your retainer out, then you need to continue to wear the retainer all the time.

If you don’t like the idea of wearing the retainer during the day, there are a couple of other options.

One is that you can get a teeth bleaching splint made. The clear bleaching trays help hold your teeth in position and aren’t as noticeable to others as a normal orthodontic retainer.
Another option is to have a permanent retainer bonded to the insides of your teeth, either upper or lower. This, however, does complicate cleaning your teeth – you have to use a floss threader to clean between them.

I don’t know why your teeth aren’t stable yet, but they aren’t. So get used to the retainer. It isn’t good for your teeth to be moved back and forth, so use the retainer to keep that from happening.
– Dr. Hall

Other links:
See our page on How long should I wear my retainer?

We thank our advertisers who help fund this site.

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 10, 2009

Can I use bleaching trays for a retainer?

Filed under: Braces — mesasmiles @ 2:13 pm

Dr. Hall,
I had braces on my teeth and I have had the old type retainer for years (pink w/wire) and have worn it out. Can I use my plastic bleaching trays for retainers? I do not use my trays anymore and my teeth have not shifted in any way. I just hate to spend $300+ if these would work just as well.
– Janice from Tennessee

Dear Janice,
Bleaching trays can be used as retainers in some cases, depending on how well they fit and the forces that are tending to get your teeth to move. But I give that advice cautiously. I think you’d be best off with an orthodontic retainer made for that purpose. I am surprised that they are asking $300 for the orthodontic retainer. Those aren’t hard to make. A dentist just has to get a good impression of your teeth, pour up a model, and send that to a dental laboratory. I would think you could find a dentist who would do it for a lot less and you wouldn’t notice any difference in the quality.

Here’s what I would suggest, and I’m assuming that you are wearing these teeth bleaching trays faithfully every night – use the bleaching trays. But, over time, if you can sense any difference developing in how your bleaching trays fit, then go get the retainer made.
– Dr. Hall

Other links:
Click here for referral to an expert cosmetic dentist.

We thank our advertisers who help fund this site.

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.

May 22, 2009

Will dental insurance help pay for bonding my daughter’s splotched teeth?

Filed under: Braces,Dental insurance,Tooth bonding — mesasmiles @ 4:49 pm

My 13-year-old daughter was born with a lack of tooth enamel. After braces her smile is straight but the two main teeth have two different colors on them – they’re splotchy looking. Will my dental insurance pay for this? It’s Anthem Blue Cross
– Pam in California

Pam,
When teeth are splotchy-looking right after getting braces off and they weren’t that way before, it’s probably because they weren’t really good about brushing their teeth while the braces were on. When you’re wearing braces, it’s a good idea to carry a toothbrush with you, because you need to get all that gunk off after each time you eat, or it will damage your enamel.

And since this is a situation that involves damaged tooth enamel, yes, your dental insurance is probably obligated to pay benefits. But there are a couple of cautions here.

First, your dental insurance is only obligated to pay for repairing the physical damage, and they will probably pay at a very minimal level. Don’t think of them as “covering” the repair, because that implies they will pay for the whole thing. Think of it as that they will “help” pay for the repair. You’ll want this done in a way that looks beautiful and natural. Your insurance is only committed to making the repair be functional.

Second, don’t let your family dentist do this. You want an expert cosmetic dentist. This may cost a little more, but the repair may involve free-hand tooth bonding or even porcelain veneers. You need a dentist-artist, and only 1 or 2 percent of dentists are artistic enough to produce a beautiful result with your front teeth.

– Dr. Hall

Click here to find an expert cosmetic dentist.
Teeth bleaching WILL NOT WORK for these splotches. Read our cosmetic dentistry horror story about how teeth bleaching made splotched teeth worse.

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 23, 2009

Why should I have my upper wisdom teeth removed?

Filed under: Braces,Wisdom teeth — mesasmiles @ 6:56 am

Hi Dr. Hall,
First I would like to say, “Thank You” for putting up this site. I was looking for more advice online and came upon your site. I am hoping you can help me.

I am 22 years old and my cosmetic dentist says that I should get my upper wisdom teeth extracted, both at the same time, in order to put braces on me.

I need braces because I have a missing right incisor so my canine is taking up the space in the middle between my front teeth and the molar; an unerupted left canine, and a baby incisor also on the left.

I am apprehensive (about the extractions) because my wisdom teeth don’t bother me and they are not crooked or impacted. They have just erupted about a month or so ago though. I also have my bottom wisdom teeth, but my dentist says that they can stay in. How come my upper ones have to go and the bottom ones can stay? I need some advice in order to make my decision before signing the consent form. I am very apprehensive about the procedure.

Thank you again.
Have a good day,
Jasmine from Wisconsin

Dear Jasmine,
First, I’m not going to call your dentist a cosmetic dentist automatically, because only a fraction of the dentists who claim to be cosmetic dentists actually are, in my opinion. They have to be a true artist, not just a good dentist, for me to call them a cosmetic dentist.

About your case. I’m assuming from what you’ve told me that the dentist is wanting to use the braces to make space for the unerupted canine and your missing permanent incisors, though I don’t know this is the case. I hope he or she is not going to put your canine teeth right next to the central incisors and then try to make the canines look like lateral incisors. That is very, very difficult to pull off without looking funny, because the canines are simply too big.

But I would have the wisdom teeth removal done, if that is what your dentist recommends. If they are already erupted, these tooth extractions will be very simple, and it seems reasonable that something has to give in order to make some space for moving the other teeth.

Having said that, I’m leery about having a general dentist do braces for your case. It sounds a little tricky. Maybe your dentist is truly expert with braces, but maybe not. I would lean toward having this done by an orthodontist who has had all that extra schooling. If your dentist truly knows what he or she is doing, then I apologize for raising this question.

Dr. Hall

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.

December 30, 2008

Tooth Effects bands making her teeth become loose

Filed under: Braces — mesasmiles @ 2:20 pm

Dr. Hall,
I wore braces for most of my teenage life. I had a huge gap between my front teeth since I was a child. However, my orthodontist failed to tell me that I would need a surgical procedure done to remove the mass of tissue between my front teeth (the probable cause of the gap). After my braces were taken off, constant wear of the retainer caused it to break and my teeth shifted VERY quickly (within hours). Now I rely on the Teeth Effects bands (teeth-gap.com) your site wrote negatively about to keep my teeth together. Since my teeth shift very quickly, I wore the bands constantly. Lately, however, I’ve noticed my two front teeth are fairly loose and my gums are receding. However, if I do not wear the bands, my teeth shift so much that it causes discomfort to my other teeth. I wish I had read your article sooner – I really don’t want my teeth to fall out. 🙁 Any advice will do.
Thanks so much!
Katy from Pennsylvania

Dear Katy,
I hope that we are catching you in time, and that your front teeth aren’t so loose that they will fall out! This is a very real possibility, so I would recommend immediately discontinuing the use of the Teeth Effects bands. The damage to the support of your teeth will be much greater than it appears to be on the outside, and if your teeth are loose, you have probably already lost most of their bone support. As I explain in the web page I just linked here, the Teeth Effects bands are a high risk treatment and making your teeth become loose is an all-to-frequent side effect.

You have two options. One is to have another removable retainer made. It really isn’t very expensive, and almost any dentist should be able to do this for you. They just take an impression of your teeth and send it to the lab. It’s quick and easy.

But the preferred option would be to have a permanent retainer. Again, almost any dentist should be able to do this, or you could go to an orthodontist. And again, this shouldn’t be very expensive. The dentist would bond a short wire on the backs of your two front teeth to hold them together.

If money is a big issue for you, then tell the dental office that and ask them before you schedule the appointment how much either of these services would cost, and shop for a dentist who can do this for you at a fee you can afford.

Good luck,
Dr. Hall

Related links:
Read more about braces.
Read about the various options for treating a tooth gap.

We thank our advertisers who help fund this site.

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 18, 2008

How to fix my really crooked smile.

Filed under: Braces — mesasmiles @ 4:50 pm

Hi, Dr. Hall.
I’ve read just about everything I can find on your website and I have developed a serious respect for your opinion. You really know your stuff! So I wanted to ask you about my situation to see what you think.

I am 34 years old and have been living with a complicated situation on my upper left for close to 20 years. I have a decaying baby canine which never came out due to the adult canine growing in in the wrong place and never displacing the baby. The adult canine #11 grew in over the top of bicuspids #12 and #13 and, I’m told, is too far away from where it belongs and too complicated in the root structure to be moved with braces. Number 11 is partially obscuring the two bicuspids behind it and creating a triangular inner area which is difficult to keep clean, not to mention embarrassingly unattractive. (My general dentist isn’t even sure what kind of decay might be going on up in there, but so far it doesn’t hurt or have an odor so I’m keeping my fingers crossed.)

That whole area needs some serious work, but I’m not sure what the best option is. Do I extract the canines and get braces to widen the space where the baby was so a full-sized canine implant can be put in? Or do I extract the canines and get a bridge? Or can something else be done with a smaller implant plus veneers or something to create the illusion of normal teeth?
– Diana in Southern California

Diana,

Thank you for your kind comments.

#12 (your first bicuspid) can be made to look like a canine from the front, so if your canine can’t be moved, I’d consider that option, too, after having the permanent and baby canines extracted. Or one dental implant could work – replacing the baby canine with a permanent canine implant. I wouldn’t do the bridge to replace the canine because your bone will shrink in that position over time if you do that and it will be hard to keep it looking natural. But it’s really tough for me to say without seeing you, seeing the x-rays, and doing a clinical examination. You sound like you have a very interesting case–I’d love to have had you come in my door and be given the opportunity to solve it.

My recommendation – just find an excellent cosmetic dentist and trust his or her judgment. You have excellent choices in almost every direction. Just check our Southern California cosmetic dentists page. I am confident, because of the care I exercised in choosing each one, that any one of them could give you a beautiful smile with this situation. I wouldn’t ask your general dentist to do this.

– Dr. Hall

Related links:
Braces
Invisalign
Adult braces

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.

July 14, 2008

Front teeth too big. What can I do?

Filed under: Braces,Invisalign — mesasmiles @ 1:05 am

Dr. Hall,
I have a problem with my two front teeth. They are big. They are long. And they are set a bit more forward than the rest of my front teeth.

But, I don’t know what to do with them! I’ve done a bit of researching about different cosmetic dentistry options but nothing seems right. I don’t need anything added to them to make them bigger than they already are.

So, what is it that I need to do? Have them taken out and get dental implants? Is there a procedure for this? And do you have a referral for a dentist in NYC?

Thanks so much. I’ve been cringing at pictures for too long now.
– Claire in Brooklyn

Claire,
Don’t have your front teeth taken out! You don’t need to be that drastic.

I would recommend going to a really good cosmetic dentist and then trusting them to find the solution. I have looked for good cosmetic dentists in Brooklyn and can’t find one, but Dr. Robert Schwartz in Manhattan is excellent and he could fix this for you. You don’t have to figure it out for yourself.

I will tell you my impressions, from how you’re describing your problem. But my disclaimer is that I haven’t seen your teeth, so don’t take this as gospel. Depending on the results of your examination, an entirely different course could be advisable.

It is possible to make teeth smaller by carefully trimming them down with diamond burs and diamond strips. From the way you’re describing your teeth, I’m guessing they could be filed down on the sides, making them narrower, and then trimmed on the biting edges to make them shorter. Then a simple spring retainer could be used to push them back in alignment with your other upper front teeth.

Or, after they are trimmed, Invisalign invisible braces could be used to position them.

If they are really huge and require a lot of trimming, porcelain veneers could be needed to cover over the exposed dentin.

Anyway, several options. But all of these would be beyond the ability and training of the family dentist on the corner. You need an expert cosmetic dentist, or you could get yourself into a big mess that becomes very expensive to fix later.

Good luck,
Dr. Hall

Related links:
Read about braces.

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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