Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

May 29, 2018

I went directly to the dental lab to make my partial


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Dr. Hall,
I had an upper partial made by a dental lab. I did not go through a dentist.

The last partial I got, nine years ago, my dentist used this lab. They did such a good job that I decided to go directly to them this time. But this time it’s not working out so well. I have a front tooth missing that was supposed to be replaced using this partial, however, the tooth won’t stay fastened to the metal. There was so much plastic backing that all the pressure was on my one bottom front tooth. He ground down a lot to make my bite touch but now there is not way of holding this tooth in place. Also the plate is too short and is sitting in the cavity where my old tooth was and it creates a rocking motion when I chew.

I have been back at least nine times and the last time he told me to go away and stop bothering him. I asked for my money back but he refused. What can I do to get my money back?
– Bill

Bill,
A very interesting question, and there are some interesting points to make in answering you.

I must say that I’m not following you as far as understanding the problems you are having with the bite and the one tooth in this removable partial denture. The rocking I understand, and that is a fundamental problem that in most cases is due to a distorted framework—a problem that could have originated with a distorted impression. Fixing this would require starting over again. The impression is supposed to be taken by the dentist, who is trained and experienced in creating an accurate model of your teeth that will enable the technician to fabricate an accurate metal framework. Technicians aren’t trained to do this step, which is one of the reasons it is illegal for them to do that.

So the answer to how to get your money back is fairly simple—just threaten to report the technician to the authorities. This seems mean because, while it was illegal for him to make this removable partial without involving a dentist, you were the one who asked him to do it, so you should share in that responsibility. But he is the one who knows the law better and so bears the bulk of the responsibility. So just go to him and tell him that if he doesn’t refund your money you’ll tattle to the state dental board and agree to be a witness in his prosecution. My guess is that this will work magic. And hopefully that may save some other patient from making the same mistake you did.
– 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.

November 30, 2016

Allergic to her removable partial denture


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Dr. Hall,
I have been sick for over 2 years after having upper and lower partials put in. I’ve had sores in my mouth on my tongue. I complained to my dentist over and over. My dentist just referred me here there and everywhere. I finally went to Mass General Hospital and I am in fact allergic to several metals one being nickel. My questions is, can having these partials in my mouth for this long (I felt better at night when I took them out) however, never feeling quite right as I had to put them back in 7 or so hours later to go to work. Would this make you physically sick?
Thank you in advance for your advice.
Ginger from Massachusetts

Ginger,
I am continually surprised by these cases that come to me about metal allergies and people tell me that their dentist doesn’t have a clue. This is fundamental and important.

To answer your question, yes, you can definitely become physically sick from constant exposure to metals to which you are allergic. Of course I can’t diagnose from here, but it is entirely possible that your sickness from the date of having these removable partial dentures comes from your metal allergies.

I had one rare case in my practice of a woman who was allergic to mercury. While most of my patients didn’t want mercury-containing amalgam fillings in their mouths, for this woman it was imperative to get rid of them because she had a confirmed and very rare allergy to mercury. We had several appointments to take out all of her amalgam fillings and replace them with composites. After the first appointment, she developed a rash on her throat and chest and had some difficulty breathing because of the amalgam dust that we had created during this procedure. From then on we draped her to avoid any additional exposure and gave her a nose mask to breathe through during these appointments. I remember when she came in for her six-month checkup after all of this was completed and I asked her if there was any change in how she felt. She told me that she had been troubled with arthritis, but since the amalgam was removed the arthritis was gone. I am confident that her arthritis was related to her constant exposure to allergens.

Many metallic removable partial dentures are made with an alloy called Vitallium, which is composed of chromium and cobalt and has no nickel in it, but there are less expensive alloys that do have nickel in them. Or they could have other metals that provoke reactions.

About 10% of women and about 1% of men will test positive for nickel allergy. “Are you allergic or sensitive to any metals?” should be a standard question on every dentist’s medical history form, if they use any metals in their restorative materials other than precious metals. But sadly, it isn’t. Most women with these sensitivities will know that they have to wear hypo-allergenic earrings, and the dentist should get this information before treatment. Though there are a growing number of dentists now who only provide metal-free restorations–if that is the case then of course they don’t need to ask this.

Dr. Hall

Do you have a comment or a question or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

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.

January 11, 2016

Maryland bridges keep coming off. Is there another solution?

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Dr. Hall,
I have a question about my daughter’s teeth… The two lateral incisors did not come in. The dentist put on braces and left a place to use a Maryland bridge. The wings are both broke and she has had them cemented several times. She is 21 now and has no dental insurance. Her dentist said that she could have implants but she will have to have a bone graft.. Would it be better for her to go back and have braces applied again to the top teeth only to pull them all close together and file them down… Then again I’m wondering about the price?
– Alaina from West Virginia

Alaina,
So your daughter is missing her two lateral incisors.

I would absolutely not bring the teeth together to close the space and then file down the canine teeth. I had a patient who had that done and later came to me as an adult to ask me to help make it look normal and there was no way to make the result of that look normal. The canines are thick, fat teeth that stick out in the front and that simply doesn’t work. Furthermore, the canines perform an important function in protecting the back teeth against sideways stresses and if you move them to the front, they can’t do that.

Here is a photo first showing the two missing laterals, which is probably the way your daughter looks now:
missing lateral incisors
And here is a photo showing what a smile looks like with the canines moved into the position of the lateral incisors:
missing lateral incisors after orthodonticsShaving the canines and even bonding to them or doing porcelain veneers would not look normal. Yes, it looks better than missing teeth, but as a cosmetic dentist, if a patient comes to me looking like this and wants the ideal solution, I would have them put in braces to move the canines back to their normal position and then use one of several methods to replace the lateral incisors.

The dental implants would be the best solution, no question. If there is money to do that, that’s what I would recommend.

However, the second best in my opinion would be a simple flipper partial. I had an office manager for my dental practice that used a flipper partial the entire time she worked for me. You would never know, meeting her, that her lateral incisors were not real. It’s a simple plastic plate with the twoflipper partial replacing lateral incisors teeth attached. It fits up on the palate and there are two wire clips, one on each side, that snap over the back teeth to hold it in. The cost should be pretty reasonable – maybe a couple hundred dollars, more or less. Here’s a photo of what that appliance would look like.

This isn’t the ideal solution. Some people have difficulty eating with these flipper partials and they have to remove them to eat. And over time, the jawbone shrinks where the missing teeth were. For a few hundred dollars more, you could get a more elaborate partial.

She could also get conventional porcelain bridges replacing these teeth, but that would require grinding down the healthy central incisors and canines. I would rather see her do the flipper and save up her money for implants later.

This monkeying with Maryland bridges, I would not do that. Not only do the wings of a Maryland bridge make the central incisors look darker, you can have problems with them staying in. I suspect that your daughter’s Maryland bridges were poorly designed, for all the trouble she has had with them. But even with a good design, they can be some trouble. I would prefer the flipper partial.

 

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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.

December 14, 2015

I’m missing a front tooth. Can I still get porcelain veneers?

Filed under: Partial dentures — Tags: , , — mesasmiles @ 6:31 pm

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Dr. Hall,
I have a partial consisting of 5 teeth. One of my front teeth is missing as well as 3 on one side and 2 on the other. I absolutely hate the dental work. It looks horrible. I had the dentist redo it 3 times. The front tooth looks nothing like the one next to it. My insurance paid for it and Im not sure if they will pay again. I would love to have porcelain veneers but I have teeth missing. What would you suggest I do to get my smile together?
– Doris from Detroit

Doris,
Even a removable partial denture can be made to look attractive and the missing tooth can be made to look like the one next to it, but it takes the right dentist using the right dental laboratory to get that done. For most family dentists, esthetics isn’t high on their priority list, and my guess is that your family dentist is working with a dental lab for whom esthetics is also a lower priority.

One disadvantage of a removable partial is that it has to have clasps that attach to your remaining teeth. With the old style partial, those clasps used to be metal and they could end up showing when you smile. There are newer plastic materials, however, that are transparent that give a much more attractive result. You could check out the Valplast partial as an option.

There are a lot of options on how to handle your case, and how it would be done depends on your budget and what you want to accomplish. If you’re happy with how the rest of your front teeth look, then it’s just a matter of replacing the missing front tooth and the other five back teeth. The economical way to do that would be with a removable partial denture. The nicest way to do that, which would be much more expensive, would be with dental implants.

You could also take the opportunity, since you already need major work, of combining the tooth replacement with a smile makeover. You mentioned porcelain veneers. A skilled cosmetic dentist will be able to seamlessly blend the different materials—implants and porcelain veneers—into one, beautiful, harmonious look.

About your insurance—on major dental work such as dentures, crowns, and bridges, they usually have a five-year rule—they’ll give you benefits for replacing the work if it is more than five years old.

You’re in Detroit. Check out our recommended cosmetic dentists in the Detroit area. Either of them could do a great job and give you a beautiful smile.

I hope this helps.

Dr. Hall

Do you have a comment? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

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 10, 2012

Are Nesbit partials illegal?

Filed under: Partial dentures — Tags: , — mesasmiles @ 12:06 pm

Dr. Hall
I had my #4 upper tooth (upper right second premolar) removed – the root had cracked. My dentist, very nice, states that a Nesbit partial is illegal to offer me in the State of Oregon due to a very few swallowing or inhaling the small dental fixture. I am currently wearing a temporary fixture. It has a large plastic palate piece with wire attachments at the back of my upper teeth on the right and left side of my mouth.

I am not happy. I do not want to purchase the permanent fixture that is made of metal. The nesbit makes sense to me and I am prepared to go back to Montana and see my dentist of 20 years. I moved to Oregon 16 years ago. What states “outlaw” the nesbit? Vancouver, Washington is just 10 miles away. I will wear this one while healing and to keep the teeth on either side supported. Two months to heal and then I would like to get a Nesbit. Do you have any suggestions? Wish I had friends to visit in your state.
Kathy from Oregon

Kathy,
I am skeptical about the Nesbit partial being illegal to place in any state. Really? Maybe it is illegal in Oregon, but that would surprise me if it is. I would bet instead that your dentist is probably worried about being sued should you actually swallow or aspirate the appliance. Maybe that’s the equivalent of it being illegal.

But I, too, am leery of the Nesbit partial, for that very reason.

How do you like the temporary fixture that you are now wearing as a tooth replacement? The way you are describing it, it sounds like a flipper partial – a small plate of plastic held in by tiny wire clips. Why don’t you just keep wearing that? There’s no law that says you have to throw that away after two months. I’ve seen those flipper partials last for years and years. They’re not ideal, but they work.

If you really want a Nesbit, I would start by asking other dentists in your town. I’d be surprised if you have to go into a neighboring state.

Dr. Hall

Links: read more about removable partial dentures
Click here to ask the dentist a question.

Follow-up: Kathy wrote back and confirmed that I was right – Nesbits are not illegal in Oregon, and she found a dentist who will do one.

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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.

April 3, 2012

I love my Nesbit partial

Filed under: Partial dentures — Tags: , , , — mesasmiles @ 5:35 pm

Dr. Hall,
Not a question, but just a statement. I have had a Nesbit partial (left small incisor) since 2004 . I swear by it. Never came close to swallowing it or to losing it. One has to be aware of sink drains, however. I can see that the old ones, having metal parts, would be dangerous to swallow.
– Ed in Delaware

Ed,
Thanks for sharing that.

For those who aren’t familiar with the Nesbit partial, it is a small, clip-in replacement tooth replacing one tooth, or possibly two adjacent teeth. It clips onto the adjacent teeth. The clasps used to be made with metal, but now is almost always made with plastic clasps.
Dr. Hall

Link: Click here to read more about removable partial dentures in general.

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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.

August 6, 2010

Can a flipper be used to replace a lower tooth?

Filed under: Partial dentures — Tags: — mesasmiles @ 7:06 pm

Can you use a dental flipper for a bottom tooth?
– Debra from Colorado

Debra,
A flipper is a simple tooth replacement, usually for one or two missing teeth, that merely affixes a false tooth on a plastic plate that snaps into your mouth. It usually has a couple of simple wire clasps on it. It’s most often used for upper teeth, because they are the most visible and cause the most embarrassment if they’re missing. But yes, depending on the room the dentist has between your lower teeth and where your tongue attaches, a flipper can probably be made to replace a bottom tooth.

Just remember that a dental flipper is not very sturdy and is usually made to be temporary.
– 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.

April 5, 2008

Can I repair my partial myself?

Filed under: Partial dentures — mesasmiles @ 3:02 pm

Dr. Hall,
I have removable partial dentures and a small piece of the gumline portion of my upper partial broke off. I realize one should not use super glue to repair dentures but this is not a tooth and is above the gum line. Does this require professional work or can I fix it myself?
Thanks,
– David from Washington

David,
It’s tempting to go ahead and repair it yourself, since the piece is so small. The important thing in a repair like this is to get the pieces exactly in the same position they were in before they broke. Even a fraction of a millimeter deviation will cause sore spots. So that’s what needs to be done.

But superglue – superglue will deteriorate after a few days in the mouth, so the repair won’t likely hold. And there’s no common household product I’m aware of that will really hold a repair like this.

And, another problem with superglue is that, once the pieces come apart again, you will make the professional repair more difficult and likely more expensive. Maybe even quite a bit more expensive. The leftover superglue on the pieces makes it so the dental technician can’t fit the pieces back into the exact position they were in, meaning that a new impression could be required, which adds quite a bit to the expense.

So I’d get a dental office to repair this, even though it seems expensive. And the sooner you do it, the easier it is and likely the cheaper it will be.
– Dr. Hall

Related information:
Denture repair
Complete dentures
Cosmetic dentures

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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.

September 26, 2007

Dental bridge or removable partial

Filed under: Dental bridges,Partial dentures — mesasmiles @ 3:07 am

Dr. Hall
My dentist says I need a five unit bridge. I have a lot of bone loss from gum disease and he is afraid a partial will place too much pressure on my teeth since they are somewhat loose. The price he quoted is $5500 plus extraction costs. Is this a reasonable price or should I look elsewhere?
– Lela in Texas

Dear Lela,
The fee is in line for Texas. But I don’t understand why he’s suggesting a dental bridge instead of a removable partial denture. Maybe there’s something different about your situation. But a removable partial places less stress on the adjacent teeth and is much less risky. A bridge puts a lot of stress on the teeth it attaches to. And then, if you have a problem with one of those teeth it is resting on, you have to scrap the whole thing and start over, whereas with a partial you can later add a tooth to it without a lot of work or expense.

I’d encourage you to get a second opinion to see if the bridge is really the best treatment for you.
– 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.

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