Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

October 13, 2007

A Lumineers story gone bad

Filed under: Gum disease,Lumineers — mesasmiles @ 6:00 pm

Dr Hall,
In July 2006 I got six lumineers to close the space between my two top front teeth. In September 2007 my dentist informed me that I have more than 50% bone loss in four of the teeth and that I will need to have them replaced with dental implants at a cost of $2,700 each. He is only willing to give me credit of $1,500 and that’s only if I let him do the procedure. The lumineers cost $720 each. My question is should my dentist have taken x-rays of my teeth prior to preforming this procedure to determine it this was appropriate as my last x-rays were done in 2003, and what recourse do I have If he was negligent. I faithfully, four times a year have periodontal maintenance, I don’t know how this was missed.

Thank you for you time.
– Lenore from Pennsylvania

Dear Lenore,
I’m known for being direct, so here goes. Yes, your dentist was definitely negligent. He missed the diagnosis because he neglected to perform a basic diagnostic procedure–taking xrays of the teeth on which he is doing major work. And he is admitting to you that he screwed up because he is telling you, a year later, that these teeth are in such bad shape that they are hopeless–they have to be extracted. And then to offer only $1500 credit toward an $11,000 follow-up procedure–he would still be making good money on the implants.

Here’s what I think you should do:
Demand a full refund for the Lumineers. Tell him that if he doesn’t cooperate, you will get a lawyer. Then go to another dentist for any further work. You will be being kind, because if you go directly to the lawyer, you will get more than a complete refund. You are in a very strong position on this.

And if he doesn’t cooperate, follow through with your threat and get a lawyer.

What you have told me causes me to question everything this dentist is telling you. I wouldn’t assume that the teeth have to be extracted. Maybe they do, maybe they don’t. But don’t have this dentist do the implants.

I believe that dentistry is one of the most ethical professions there is. Most dentists are in it for the love of helping people, and they bend over backwards for the patient. But I am not impressed with the ethics of this one. It is one thing to screw up. We have all screwed up. But to screw up and then to want to continue to make profits from your screw-up–that’s unacceptable. In my opinion, when he discovered he screwed up, he should have offered a complete refund and then go on to fix the problem.

– Dr. Hall

Read a post about another problem with Lumineers, only this dentist is fixing it for free, which is the decent thing to do.

Related pages in www.mynewsmile.com:
Read more about gum disease
What makes a cosmetic dentist different from a general dentist
Dental implants

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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.

October 1, 2007

Gums won’t quit bleeding

Filed under: Gum disease — mesasmiles @ 6:27 am

Dr Hall,
I had my impacted wisdom teeth removed almost 10 years back. The gums near the lower right wisdom tooth have become very sensitive since then. If I brush even lightly in that area, it starts to bleed. My dentist examined it and told me there is no pocket there. He did not find anything abnormal.

I don’t understand why the gums bleed, also sometimes there is a sticky kind of saliva coming out if I rub my finger over the gums. I also have an abnormal bite, for which I use a dental guard at night.

Please help, Thanks
– Nabil from Virginia

Navil,
The answer to your problem is that your gums are probably bleeding because you’re not brushing there. It sounds like you’re not brushing, because you say, “If I brush…” instead of , “When I brush…”

When you don’t brush, you leave plaque bacteria on the teeth next to the gums. The plaque bacteria produce toxins that cause your gums to become inflamed, which makes them bleed when you just touch them. So the answer to your problem is to brush that area, even if it makes your gums bleed. Be gentle, but you’ve got to keep the teeth clean.

I doubt that this has anything to do with your wisdom teeth. After being gone for ten years, you have been completely healed for many years and your body has totally re-shaped the bone and other tissues so that it’s like your wisdom teeth were never there.
– Dr. Hall

 Related information:
gum disease
gum infection
– the best toothbrush is soft
- what about an electric toothbrush

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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 18, 2007

Gum inflammation from crown work

Filed under: gum disease around crowns,Porcelain crowns — mesasmiles @ 9:46 pm

Dr Hall:
I had a crown put on my front right upper tooth and a veneer on the front top left. After this was done, my gums became inflamed, and they have not come back to normal after many months. I’ve seen a new dentist, a periodontist (who treated the gumline to try to fix), and most recently, a prosthodontist, because my new dentist and the periodontist were stumped about how to resolve this, as they think the Empress porcelain used on the crown is fine and that perio surgery might not resolve the gum inflammation and could risk cosmetic damage, so they said. The prosthodontist saw me yesterday, and she said it’s likely not a fixable problem. That the dentist that put in the crown went too deep and close to the bone, and that could be causing the gum inflammation. Furthermore, she stressed that if my gums aren’t treated it’s a health risk to me as inflammation there can lead to worse diseases, but I am not getting any solutions! She said perio surgery could possibly resolve this, but that cosmetic damage to the papilla(?) – the gum area between my two top front teeth – is quite possible as a result. I am so upset. I don’t want a health risk issue but don’t want to damage my smile via perio surgery (and there’s no guarantee the perio surgery will resolve the gum inflammation anyway!). Any ideas? THANK YOU.
– Mark from Maryland

Mark,

The porcelain crown and porcelain veneer have violated the biologic width of your teeth–they are too deep under the gums. The porcelain in Empress crowns is very gentle on the gums, so that’s not the problem. It’s interesting that this stumped your dentists for so long. This isn’t a widely understood phenomenon, because it’s a relatively recently researched concept. But I’m disappointed that they’re being so timid with recommending a solution. Your case is an interesting study in the “dentist personality.” They’re saying you should have the gum surgery, but it’s like they don’t want to say it too directly for fear of being sued. The prosthodontist wants to call the change in appearance of the papilla between the teeth “cosmetic damage.” But the damage has been done already, and I think you should have the surgery. Yes, that won’t look perfect, but it doesn’t look good now, and your present condition certainly isn’t healthy. You have gum disease on these two teeth. I don’t think you should just let that go. And I don’t think your prosthodontist thinks you should just let it go, either. She just wants to be sure you feel thoroughly warned so she doesn’t get flak when you see the results.

It’s not right to say there isn’t a solution. It would be more accurate to say there isn’t a perfect solution.

I hate that when they say, “there’s no guarantee.” Of course there’s never a guarantee, but what’s the point of dwelling on that? Ask what results you’re likely to get, and then go on recommendations. No wise dentist is going to “guarantee” anything.

Meanwhile, I would think an antibacterial rinse such as Peridex would help reduce the inflammation some. But be careful. Peridex stains the teeth, and if you use it, you should also brush with Supersmile toothpaste, since that’s the only toothpaste known that keeps this stain from forming.
– Dr. Hall

Related links:
Click here to ask Dr. Hall a question.
Click here to find an expert cosmetic dentist.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

April 4, 2007

A bump

Filed under: Gum disease — mesasmiles @ 7:18 am

Question:
Yesterday I noticed that I could feel something under my tongue, behind my front teeth. I thought it was from the food I had been eating, but I’m pretty sure that it is actually part of my front tooth, poking up a little from the gum. This has happened from time to time in the past but never quite as prominently, just a little bump. It usually went back to normal after a day or so. This time it feels more pronounced and I am wondering if it’s something to be concerned about and what action, if any, I should take. Will it likely recede again with nothing to worry about. At my last dentist visit (6 months ago) nothing abnormal was found in that area.

Thank you.
– Carol from Boston

Dear Carol,
If I were examining you, the first thing I would check would be gum disease. In gum disease, you can sometimes get a flare-up of the infection that can cause a swelling – a small tooth abscess – near the gumline. So this is a possibility. And there are too many dentists and dental hygienists, unfortunately, who don’t screen regularly for gum disease, or don’t screen thoroughly enough. And many dental insurance companies have policies that pressure dentists not to deal with gum disease because it makes their costs go up.

If it does turn out to be a manifestation of gum disease, I would ask your dentist to refer you to a periodontist – a gum disease specialist. Gum disease is a particularly insidious disease because it progresses so slowly, generally without any symptoms at all, until one day, after it has become advanced gum disease, you notice that your teeth are getting loose. Have that checked carefully.
– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

March 28, 2007

Black deposits at the gumline

Filed under: Gum disease — mesasmiles @ 4:28 pm

Question:
I have black deposits on the side of the teeth at the gumline. When I scrape them with a steel scaler, they break down but brushing doesn’t do anything. It’s like a formation of plaques, but it’s not yellow, it’s black. What is it?
– Mr. Worried in New York City

Dear Mr. Worried,
Your black deposits sound like dental calculus, and you should worry. Over time, dental calculus like this can make your teeth get loose and eventually fall out. You need to get to a dentist, have him or her confirm what they are, and if it is this dental calculus, get into a gum disease treatment program.
Dr. Hall

We thank our advertisers who help fund this site. Our cosmetic dentist referral pages list cosmetic dentists we recommend.

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.

March 27, 2007

Receding gums

Filed under: Gum disease — mesasmiles @ 7:29 am

Question:

I was wondering what exactly is the cause of a receding gumline? Even when the gingiva appears healthy..is it malnutrition?? And it’s only really noticably serious on the person’s first premolars…

– Michelle in Texas

Dear Michelle,

There are several possible causes for a receding gumline. I’ll list them here:gum disease. If that’s the case, you need to visit a general dentist or a gum specialist (periodontist) for treatment. Plaque and other irritants build up under the gumline and will eventually cause your teeth to become loose.

2. The bone in the area of the recession could be thin or missing, causing the root to show through to some extent and the gum to gradually recede over your lifetime. The treatment for this is to be very gentle when you brush. It can sometimes be repaired with a gum graft, which is usually done by a periodontist, though some general dentists can do this.

3. You could have what’s called traumatic occlusion. If you clench or grind your teeth at night, it can cause notches to develop in your teeth at the gumline and your gums will recede from this area. Further gum recession can be prevented or slowed by wearing a nightguard.

4. You could be brushing too aggressively with a hard brush. (The best toothbrush is soft)

– Dr. Hall

We thank our advertisers who help fund this site. Our cosmetic dentist referral pages list cosmetic dentists we recommend.

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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