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She wants a natural, crooked-tooth smile

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Dr. Hall,
I have disoriented teeth. I haven’t gotten braces for alignment because I think it is better to let them stay as they naturally are. And also because the people around me advise me that it’s not necessary because it makes my smile cute. I need advice regarding any risks if I don’t align them. Also I have been getting my upper wisdom teeth. It doesn’t pain, but after searching about it a bit, I think that it might cause my teeth to disalign more, any might cause risk in later future. I’m in my early twenties now. Can you help me with some advice?
Thanks,
Tanaya from India

(See Dr. Hall’s answer below.)


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Tanaya,
This is an interesting question. My reaction is that I don’t believe crooked teeth are natural. Saying that they are feels to me like saying having cuts in your feet from walking barefoot over rocks or other hard surfaces is natural. To me, wearing some footwear to protect your feet would preserve their natural, heathy condition.

And, to extend your logic about a natural smile, isn’t it more natural not to brush and floss them? But where will that get you? They won’t last long if that’s your theory. If you don’t get lots of cavities, you will for certain end up with serious gum disease. Not to mention bad breath.

a portrait of a woman with long brown hair and a natural, beautiful smile.So what is a natural smile? Exploring this idea, I asked ChatGPT to create an image of a woman with a natural smile, and on the right is what it came up with. That’s pretty close to my idea of a natural smile.

To further answer your question—yes, there are health risks of crooked teeth. They tend to trap food and they are difficult to clean. They will be more susceptible not only to decay, but to gum disease. And crooked teeth may result in a unnatural bite that puts unnatural stresses on the teeth that they weren’t designed to take. So my advice would be to use orthodontics to put your teeth into their natural, divinely designed positions.

About your wisdom teeth. There are some people even in the dental profession who allege that wisdom teeth can push on the teeth further forward and make them out of alignment. But studies show that wisdom teeth do not have enough forward pressure to do that. Besides, those who allege that only allege that about the lower wisdom teeth, not the uppers.

One such study was at the University of Iowa by Dr. Tom Southard in which he placed sensors between teeth to measure the pressures between teeth. He found that whether or not wisdom teeth were present made no difference. Other studies have corroborated that.

So if you want a natural, healthy smile, you need the help of orthodontic treatment.
– Dr Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

My baby canine tooth hasn’t fallen out.

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Hi Dr. Hall,
I hope this finds you well. I’m 16 years old and still have one of my baby canine teeth. When I was 14, I lost one of my canines and the adult tooth grew back although it took quite a long time to erupt- maybe around 6 months. About a year ago I went to the dentist, he took an x ray and told me I had all my adult teeth but that I had a small mouth so it takes long for some of my teeth to erupt. He said that I would lose my other canine soon. Since then, nothing has changed as in my canine is not wobbly at all and I’m getting concerned that I’ll end up with a missing tooth at 17. I’m wondering if this is something I should be concerned about because my dentist acted like it was normal but I can’t find anything on the internet about it and I’m getting concerned. Also would there be a solution to covering my missing tooth while It grows back when or if I lose it. Thank you

– Missy

(See Dr. Hall’s answer below.)


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Dear Missy,
The permanent canine teeth normally erupt around age 10-12. If they haven’t erupted by the age of 14, there is cause for concern. Occasionally, the canine teeth will be impacted, meaning that they won’t erupt by themselves, and they will need some help. The earlier that help is provided, the better the chance of getting the tooth into normal position. It is possible, after a number of years, for the canine to become fused to the bone, at which point it will be impossible to get it to move and it can only be extracted. So I disagree with your dentist about waiting until now—I think this should have been addressed a couple of years ago, not only for clinical reasons but for social reasons as well. It’s easier to address this at age 14 than at age 16 or 17.

A panoramic x-ray of your jaw should show if the root of the unerupted canine is fully formed. If it isn’t, it should have some erupting force that will help it to come in normally and it can be assisted by extracting the baby tooth, which will clear a path for it. That could have been done at age 14 if the permanent canine was close enough to the surface, but it can still be done now. If your baby canine is loose, the crown of the permanent tooth is probably right under the surface and hopefully will be able to come in on its own. If it’s not loose, the x-ray will show how close the permanent tooth is. Based on what you have told me about your dentist, I’m not confident that he’s going to give you an accurate picture, so I would consult with an orthodontist. The final forming of the root of the tooth gives it erupting force, so a judgment needs to be made about whether your permanent canine needs help coming in or not. I wouldn’t cover the space with a replacement tooth because that could interfere with the canine coming in.

If it does need help coming in, it isn’t that complicated a procedure. The crown of the canine needs to be fully exposed surgically. Then a bracket needs to be placed on it, as shown here:

drawing of an impacted canine tooth with a bracket on it, which is attached by a rubber band to an orthodontic wire.

(Image courtesy of Manhattan Oral Surgery & Implant Center)

You’ll see that there is a chain which is attached to a spring. As the canine comes in further, the chain is shortened, link by link, until it is fully erupted. It should take about a year to pull the canine into position.

If you have any further questions, feel free to ask. You can use the comment form below or use the “ask doctor” link that you used to send me the original question.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

I’ve had braces three times

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Dr. Hall,
I am 67 and have had three sets of braces in my teens, twenties and thirties. I had orthognathic surgery 1989 for a short jawline. Great results. However my teeth have gradually crowded again, my two front teeth are prominent. I want to do veneers on my two upper side teeth to possibly make the two fronts look not so prominent. I’ve been told I have to do all six fronts. Too expensive and don’t feel like it’s necessary. This is cosmetic. I don’t feel like going through braces again I’m not sure how to send a photo.
– Deborah from Texas

(See Dr. Hall’s answer below.)


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Deborah,
I wouldn’t be able to tell whether two or six porcelain veneers would be appropriate for you without an exam, but I’ll try to be helpful.

There are two possibilities. One is that two porcelain veneers would do you just fine and your dentist is trying to get you to do more work than you really need. The other possibility is that your dentist is a highly ethical cosmetic dentist and doesn’t want to do a case that will reflect poorly on his or her reputation.

When I practiced, I was very firm in not wanting a cosmetic patient to walk out of my office with a smile that wasn’t beautiful. I believe that most ethical cosmetic dentists have similar feelings. They are passionate about the appearance of what they do, and the patient needs to love how it looks and the work needs to reflect their artistry.

I also have a comment about your teeth crowding. I had one patient, a woman in her 50s, who had a gap between her two front teeth, and I closed the gap by widening the teeth with dental bonding. Then, within a couple of years, the gap came back. I had to re-do the bonding, but this time I had an orthodontic retainer made for her and told her she needed to wear it every night because her teeth continued to move. Adult tooth movement happens, and the way to deal with that is to wear an orthodontic retainer after the treatment is completed. Most people need a retainer for a limited time, but there are some patients who need one long-term, and it sounds like you’re one of those. Had you worn a retainer consistently after your treatment in your teens, I’m guessing that you wouldn’t have needed to be re-treated.

The way to tell that you still need a retainer is to back off gradually. You wear it all the time for the time your orthodontist tells you. Then you start wearing it only at night. Then you wear it every other night, and you should be able to tell when you snap the retainer back in if your teeth have moved in the interim, because you’ll feel the pressure on your teeth. If it feels like they haven’t moved, go longer.

There are some orthodontists who will bond a retainer to the backs of the teeth and the patient wears that for the rest of their life. It sounds like that wouldn’t have been a bad idea for you.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

Cosmetic Contouring

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I’m pretty close to getting my braces off. My teeth look pretty straight, but the edges of my teeth look jagged. Is this something my orthodontist can fix?

– Maddy from New York
(See Dr. Hall’s answer below.)


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Maddy,
The procedure is called cosmetic contouring or enameloplasty, and it involves re-shaping the front teeth to a more aesthetic shape. The re-shaping should be confined just to the enamel, and after shaping, the enamel is polished.

While the skills involved aren’t highly demanding, the judgment involved is important. If the shaping needed is minor, many orthodontists will do this routinely to finish their case. If it is more involved, I would have it done elsewhere. I wouldn’t trust this procedure to a general family dentist, but would recommend you go to a dentist who has an impressive smile gallery of a variety of cosmetic procedures, or one who has a credential in cosmetic dentistry from the American Academy of Cosmetic Dentistry.

The procedure is more demanding than it may look at first glance, which is why I recommend a dentist who is experienced with cosmetic dentistry procedures. When the lengths of the front teeth are changed, it can change your bite which can cause those teeth to move. Experienced cosmetic dentists deal a lot with altering the lengths of the front teeth and should be able to avoid creating this problem.

Here are a couple of samples of cosmetic contouring.

Here is a before photo:
close-up photo of a smile showing front teeth with uneven incisal edges

After careful shaping of the maxillary front teeth, this is the attractive result:

A photo of this smile, after careful cosmetic contouring

In some cases, some composite bonding may be needed to finish the case. That is the situation with the patient pictured below, where the edges of the teeth have been shaped and some composite bonding has been skillfully added to the sides of some of the teeth:

two photographs of maxillary anterior teeth. The top shows teeth with jagged edges. The bottom shows them shaped to a more pleasing smile.

– Dr. David Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

Fixing a black triangle

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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 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.

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

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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

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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.

Gap in My Teeth Misrepresentation – A Confession!

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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!”

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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.

Should I continue to wear my retainer?

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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?

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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.

Can I use bleaching trays for a retainer?

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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.

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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.

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

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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 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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