Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

December 27, 2017

A case of collapsed bite


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Hi Dr. Hall,
I really hope you can help me.

I am not sure if my issue is related to my lips, teeth, or jaw, but I absolutely can’t stand my smile. It feels very forced to be able to show my upper teeth. When my mouth is in repose it is just empty space and you cannot see my teeth (especially my upper) and it makes me extremely self-conscious.

I also have jaw pain and wear a night guard and when I wear it my mouth feels more comfortable and I feel like it supports my lips better. It also gives an impression of upper tooth show that I would very much like. I also find I have difficulty pronouncing certain words especially when it’s cold, almost as if my jaw tightens and I can’t open it properly to speak. P and T words are especially uncomfortable.

Are my only options veneers? Do I even have any options?

It’s very frustrating for me. I can attach pictures as well if need be.
– Laura from Ontario

Laura,
I’m glad you’re emailing me now, before going to a dentist to have this fixed. It’s painful to have to write back to people after a problem like yours and the dentist messed up their mouth.

This is a very difficult problem and you need to be very careful in picking a dentist to treat this for you. While I can’t tell for sure just with your description, it sounds like you may have a collapsed bite plus some other complicating TMJ issues (TMJ disorder). Veneers wouldn’t be the answer, at least not as a sole treatment. Opening your bite with crowns could solve your problem, but it would need to be done methodically by a dentist with experience in full-mouth reconstruction.

The proper way to open a bite is to do it reversibly first, with some type of provisional restoration. When that provisional is successful, then permanent restorations should be made that duplicate what was done provisionally. By successful I mean that you are out of pain, are happy with your appearance, show your upper teeth normally, and have no speech difficulties. That’s a tall order, but a dentist with adequate training should be able to do this.

It’s a small minority of dentists who have the training needed to address this type of situation. There are several training institutes in the United States that train dentists in this level of complex restorative dentistry. Those would be the L.D. Pankey Institute and the Dawson Academy in Florida, and the Las Vegas Institute for Advanced Dental Studies in Nevada. There are others, but these are the best known. I don’t believe there are any such institutes in Canada.

To help cement this idea of being careful in picking a dentist to do this, you may want to visit other blog posts I wrote for patients where the dentist opened their bite and caused more problems than they started with.

I will email you privately with a dentist recommendation for you. It will involve some travel, but you need to get this done right.

– 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.

August 8, 2016

Jaw pain after a long dental appointment

Filed under: TMJ — Tags: , — mesasmiles @ 5:25 pm

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Dear Dr. Hall,
Last Wednesday I had my upper arch prepared for 4 crowns and the rest of the teeth veneers, and am now in the temporaries. I like the way they look … very natural. But I am very concerned about the terrible jaw pain that I am now having. My dentist suggested that I take Advil. I have been and it does help a lot, but it has been 4 days now and the jaw pain is very bad without the Advil. The aching seems to get worse throughout the day until it feels like my cheeks are a little numb and my back crowns ache as well. I’ve been trying to take Advil as little as possible as I really try to stay away from most meds, but I usually break down and take it around 4 … and then again around 10pm.

If you have any advice, I would appreciate it a lot. Is this normal at 4 days out? I know that it was a lot of trauma to my mouth, but I didn’t experience this with the bottom arch.

My dentist is on vacation and I’m not sure if I should try to see another dentist before she returns in two weeks.
Thank you so much.
– Adrienne from New York

Adrienne,
I don’t find your pain to be anything unusual, given the extent of what you have been through, and I don’t think another dentist would be able to do anything for you besides tell you to do what your dentist has told you. I wouldn’t be surprised if the pain continued a week or two. It sounds like you have had the second half of a full-mouth reconstruction, which isn’t unlike having major surgery.

To prepare your entire upper arch for crowns and veneers would have required your mouth to be propped open for quite a while, and doing that can provoke the kind of pain you seem to be telling me that you have. There isn’t a lot you can do for that at this point other than taking Advil, maybe applying warm towels to your jaw, and just resting your jaw until it gets better.

If she is gone for two weeks, I imagine she has made arrangements with some other dentist to take care of any emergencies or follow-up care for her. I would wait until it has been a week, and if it isn’t any better, I would pay a visit to that dentist to see if there is anything else that can be done to make you more comfortable. That other dentist may have access to your records or have made some special arrangement with her for follow-up.
– 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 2, 2016

This full mouth reconstruction is going badly

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Here is a question from John from New York. It’s hard to follow. Don’t try to understand all of this—I summarize his problem in the first paragraph of my answer.

Dr. Hall,
had full mouth reconstruction, all crowns, one bridge, removable upper partial. No wax up done. First set temps occluded well, still original partial and not great occlusion on left side, as was with original teeth. When lower perms delivered, lost all occlusion, only 5 and 28 touched, dentist did not address issue, when upper perms delivered, occlusion worse as the six lower teeth no longer fit inside the front uppers. I could not chew and side to side was unassisted by proper mechanics. I addressed this after completion and a number of attempts to remedy the occlusion were tried by grinding down the right side, then by modifying the partial. At each step of treatment my bite got progressively worse, and at the end, all attempts to alter the partial also gave progressively worse results. If I were to place implants in 12 and 4, which would allow me to lose the partial, I would have to have 13, 11 and 6 crowns redone as they do not occlude. l have offered to pay at least the lab fees to correct the non occluding crowns, but for some reason the dentist chose to keep trying to fix the issue by modifying the partial, which also got progressively worse and is now very uncomfortable, causes pain on some teeth when chew, and because of adding material to the saddle, has a squeezing rubbery effect when bite down. I have tried to get help from two other very well qualified dentists but neither of them said they saw anything wrong, other than one who did admit that the partial was doing nothing, but did not mention that 13, 11 crowns and 12 on the partial were not occluding and that 5 and 28 were the only teeth touching. I want to fix my bite but between not wanting to pay to have at least three crowns redone and make a new partial, and hope any of the other crowns won’t need to be redone as well, and because of how my confidence has been shaken by what appeared to be the two dentists being more concerned about protecting the dentist who did the work than they were about my health and welfare, I am stuck trying to figure out what my best course would be. I’d appreciate some guidance. Thank you.
John

John,
I am having a hard time following your story, so I am not sure of the details of what happened to you. Here is the gist of what I am getting from you:
You had what you are calling a full mouth reconstruction which implies that every tooth in your mouth was treated, using a combination of crowns, bridges, and a removable upper partial. You say the first set of temps (I assume you’re talking about a temporary partial, temporary crowns and bridges) fit well. But the permanent partial is not occluding well, as well as some of the other dental work. I am having trouble sorting out what occludes and what doesn’t occlude, but regardless, I couldn’t be of much specific help without personally examining you. However I think I can be of some help with this matter of your occlusion.

And then I understand that you are wondering if the other dentists helping you are more concerned about protecting their colleague than helping you. I also know quite a bit about that subject.

Occlusion is a complex subject

On the subject of occlusion—that is a very complicated subject. How the teeth interact with each other, with all their bumps, ridges, and pits, is complicated enough. But then you have this complicated joint, the TMJ, that allows a hinge motion, sliding back and forth and side to side—no other joint in the body does anything close to that—and dealing with it is beyond the capacity of a dentist who has merely graduated from dental school. There are high-powered institutes that are devoted to nothing more than the post-graduate training of dentists in the subject of occlusion and how it affects the TMJ and associated muscles. You need to find a dentist with a higher level of expertise to sort out your problems and fix them. As I said, I don’t know clearly what has happened in your case, but I am strongly suspicious that your dentist has gotten in over his head.

So how do you find a dentist who can sort out your occlusion? Look for a dentist trained at one of these occlusion institutes I mentioned. The two most prestigious are in South Florida. One is the L.D. Pankey Institute, the other is the Peter Dawson Academy. Both of these teach conventional occlusal theory. Another respected institute is the Las Vegas Institute. It teaches a different, functional theory of occlusion that also seems to work well in practice. There are others, such as the Texas Center for Occlusal Studies, but these three are the most popular. A dentist trained at any one of these institutes should be able to help you.

True professionalism

On the other issue, yes, it is very common for dentists to band together and defend each other against the interests of the patient. I get occasional flak from other dentists who tell me that my criticism of some dentists is unprofessional (see the “hate mail” category in this blog). That is their thinking. My thinking is the opposite—that the highest professionalism is serving the patient and calling out mistakes when I see them. That is why I counsel patients seeking second opinions to go outside their local area.

My advice

I see you are in a suburb of Rochester, New York. My advice to you would be to do a search on the term “TMJ dentist” in Rochester, look at the doctor bio of each dentist you find, and select a dentist who is either Pankey or Dawson trained and enjoys working with this complex field of TMJ treatment. And before you make an appointment with the dentist, ask if he or she would be comfortable going to bat for you in getting some type of refund from your family dentist to help defray the cost of fixing what he or she messed up.

And, as you have learned, it might be easiest to select a dentist across town who doesn’t know your dentist.

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.

October 21, 2015

My new crown doesn’t feel quite right

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Dr. Hall,
I just got a new crown on an upper molar, and it does not feel like it meshes with the tooth below it. I think it needs a deeper indentation to accomodate the tooth below. Is there a risk of damaging the tooth in drilling away more of the surface of the crown? My dentist says to give it time to get used to it. It’s been two weeks and still is uncomfortable.
– Criss from New York

Criss,
I smile thinking about your dentist’s response, “Give it time to get used to it.” That’s a classic “I don’t know what to do” response. Now this could be a particularly difficult situation, or this could reveal a lack of knowledge of your dentist.

A new crown or onlay should not be noticeable when you bite or chew. It should be so perfectly comfortable that you don’t even know it’s there. But the occlusion between your upper and lower teeth is very complicated with all the various motions that are involved in chewing, and many dentists are simply not experts in that. There are post-graduate institutes dentists can attend such as the Texas Center for Occlusal Studies, the Pankey Institute, the Las Vegas Institute for Advanced Dental Studies, the Dawson Academy, and others. These institutes train dentists in the science of occlusion–how the upper and lower teeth mesh and are supposed to function together. Many dentists attend these institutes, or will attend other solitary courses where the same principles are taught. But many don’t feel that they need this training, that their basic dental school education was enough, and they go through their careers with a fairly rudimentary understanding of occlusion. Without this training, they may not be qualified to do a full-mouth reconstruction, but they can do single crowns or onlays. They may have some patients who experience what you are experiencing–the teeth don’t feel quite right, but for the most part they get by. Yes, in time, over a period of months, you will probably get used to it, and it may cause no further complications. But an occlusal problem like this can in some cases lead to unnatural stresses on the teeth which can contribute to bone loss around the affected teeth. Or in some cases it can be a precipitating factor to TMJ disorder.

Many dentists will simply adjust a new crown or onlay so that it isn’t high. They will ask you to bite on what it called bite registration paper, and that paper will leave marks where the crown or onlay hits prematurely and then will grind down those places. I’m assuming that your dentist has done that basic step and that this onlay isn’t “high”–you can clench together without discomfort–and what is wrong with your bite is more subtle.

What should you do? The best thing would be to get the tooth adjusted so that it is comfortable. No, that shouldn’t damage your new onlay. Such adjustments are fairly common with new dental work, and there should be plenty of thickness in the new onlay to accommodate any necessary adjustments. But if your dentist doesn’t know what the problem is, then I wouldn’t ask him or her to do that, as they could do more harm than good. But then going to another dentist to have this adjusted could be awkward and would involve extra fees.

Here’s what I would recommend. If you’re generally pretty happy with this dentist, then I would let this go and wait a few months to see if this tooth begins to feel like it fits better into your bite. However, I would be leery about having this dentist do another crown or onlay on one of your back teeth.

If you have other points of dissatisfaction with your dentist, this could be a way to find a dentist whom you feel will better meet your needs. Look for a dentist who has publicized his or her training at one of the institutes I mentioned above, ask for a second opinion on this onlay, and if you’re happy with what they do for you, you’ve found a new regular dentist.

– 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.

December 6, 2012

Dentist said everything was fine – but she grinds her teeth, so it’s not fine

Filed under: TMJ — Tags: , , , , , — mesasmiles @ 8:39 am

Hello Dr. Hall, I was hoping you could help and provide a little insight. I have been grinding my teeth for some time now while I sleep. My last dental cleaning and checkup was 8 months ago and everything was fine. I have recently been feeling pain from my lower back teeth. The dull pain lasts for 2 secs and then stops. It feels like someone is pulling at my back tooth and letting go. I feel this pain on both sides of the mouth (all back lower teeth). I have never had a cavity before so I don’t know what to expect. Does this seem like cavities? Or could it be something else? could it be from clenching teeth while asleep? What should I do to help my situation, I feel this pulling sensation and it’s very hard to describe. Hope you can help.
– Mona from New York

Mona,

Your two statements seem to contradict each other. You said that in your checkup everything was fine, but then you said you’ve been grinding your teeth in your sleep for some time now. If you have a grinding problem, then everything is not fine.

I’m not sure what is wrong with your teeth because I don’t have all the details – like what brings this pain on. And it would be helpful to see the x-rays and actually see your mouth and check things like tooth mobility. But I’m worried that your dental examination may not have been as thorough as it should have been, just from your comment that everything was fine in your checkup. Now I don’t know this for sure, not having been there, but I know this is a common problem in much dental care – a focus on cavities and fillings, and not paying much attention to other important dental problems like TMJ, gum disease, or occlusion. You get this in budget dental clinics and chain practices. I think you should get another opinion from a dentist who is possibly more thorough.

Having said that, your pain doesn’t sound like it comes from tooth decay. It sounds like the pain some people get when they have gum disease. Or it could be from the trauma of your grinding. I would find out, because either of these problems could be serious. If it’s gum disease, by the time you start having pain you could have significant bone loss. If it’s the grinding, you can literally grind your teeth away, and the solution could be as simple as wearing a nightguard.

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.

September 26, 2011

My bite is off, so my dentist wants to crown every tooth

Filed under: TMJ — Tags: , , , — mesasmiles @ 11:42 am

Dr. Hall,
I have had braces, and I thought my teeth were aligned. However, my dentist stated that my bite was “off”. He offered to correct my bite with full restoration. I do not want to cap every tooth in my mouth. Granted I do have fillings in many of the teeth the bands for braces were placed on. I’m a 40-year-old professional and want the best option for my appearance within financial reason. I’ve been researching my options.
– A veterinarian in New York

Dr. Hall’s answer:
I am very suspicious of your treatment plan. A full mouth restoration based on a statement by the dentist that your bite is “off”? Such a radical treatment would be called for if there were major functional problems, but the complaint would originate from the patient, not by a simple statement of the bite being “off.” Almost everyone’s bite is “off” to one degree or another. It’s not clear what problem this dentist is proposing to solve. My own bite is “off,” and I don’t need any treatment for it.

TMJ disorder is a serious disorder. It can cause debilitating headaches, and premature wearing down of all your teeth. In some cases, the best treatment for that disorder is a full mouth reconstruction, which means putting crowns on all your teeth. But that is a very complex treatment, and a dentist needs considerable post-graduate education in TMJ treatment to do that successfully. And even for those elite dentists who have been trained for that treatment at a prestigious institute such as the Pankey Institute, or the newer Las Vegas Institute, they would first try removable splint therapy and test a new bite alignment to see if it solved the problem before committing the patient to a permanent bite re-alignment.

I’d recommend a second opinion. I’d recommend Dr. ( — ). He’s not a super artistic dentist like some of those in Manhattan, but he’s an excellent restorative dentist who is tuned into esthetics, and I believe he is a solid and ethical practitioner. I’d see what he says about your options.
– 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.

July 14, 2011

How should my crowns come together?

Filed under: Dental crowns,TMJ — Tags: , , — mesasmiles @ 9:30 pm

Dr. Hall,
I am 59 years old, and have had 8 previous crowns. 2 weeks ago a new dentist fitted 2 new crowns (one porcelain and one gold) to my upper rear left adjacent molars.These are the permanent crowns, not temporaries. These new crowns are at least one mm or more distant from touching the opposing lower teeth (which are also crowned). I read that crowns should slightly touch opposing teeth. I also need another crown on the other side of my mouth, but need to know if my dentist made a mistake. Thank You very much!
– Mark from Colorado

Mark,
Yes, dental crowns should touch their opposing teeth. But, if they are made correctly, there are more rigorous demands than that. It matters where they touch. The study of how your teeth come together is called “occlusion,” and there are textbooks and entire courses that study occlusion.

How your upper teeth meet your lower teeth is important for proper jaw function. If your jaw is properly aligned, you should be able to clench together and all your teeth will meet at the same time. Then, when you slide your teeth from side to side, there are two acceptable patterns of occlusion. One is called canine-protected occlusion. In that type, when you grind your teeth to the side, only your canine teeth touch. These teeth have especially long and sturdy roots and are equipped to take this sideways stress.

The other acceptable pattern is called group function. In group function, all of the posterior teeth have the same slope and when you grind your teeth to the side, they all touch evenly.

One way some dentists use to check the bite is to put a thin strip of plastic between your back teeth, about 0.05 mm thick and about the width of one tooth. No matter where you put it on the back teeth, you should be able to clench your teeth together and prevent the strip from being withdrawn.

When you have back teeth that don’t come together all the way, over time they may drift together and touch. But even though they may touch, there is a strong chance that they won’t touch correctly, and they could throw your bite out of alignment. A poorly aligned bite is one of the contributing factors in TMJ disorder.

I hope this is helpful.
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 26, 2011

Is this a case of gorilla bite?

Filed under: Dental crowns,Root canals,TMJ — Tags: , , , — mesasmiles @ 11:17 am

A little over three months ago I had a root canal and crown done. Tonight not only did the crown come out it broke off the post also. What do you reccomend doing to fix this? And since it didn’t even last four months should my dentist be responsible?
– Gerrard from California

Gerrard,
It sounds like a nasty situation, this tooth of yours. I suspect that the crown didn’t just come loose but broke off at the gumline. I’m guessing here somewhat, and answering based on what I’m visualizing of your situation, based on the few details you’ve given me. Not being able to see what has actually happened, I want to try to be helpful based on what is probably going on here. Anyway, if the post broke off, I’m guessing the tooth also broke off. It creates kind of a tough situation because there probably wasn’t a lot left of the tooth to start with. And if the post and crown have failed, it may be that the tooth really can’t be saved.

If not, then maybe the post was just weak and this can be re-done so that it works.

I want to be careful here, because I don’t want to make it sound like your dentist was anything other than well-intentioned and appears to have been trying to save a tooth that is proving pretty tough to save, which to me is admirable. And there could be extenuating circumstances. There are some patients that have what some dentists call a “gorilla bite” that generates a tremendous amount of force, and once they hit a certain age and their teeth start breaking down, they tend to break anything a dentist puts in their mouth. Having said that, if this post and crown only lasted three months, yes, if I were the dentist, I would eat some of the cost. What I would do when I tried what ended up being heroics to try to save a tooth, and I didn’t adequately warn the patient that this treatment might not work, I credited to the patient the cost of what I did do against the more aggressive treatment that I should have done in the first place. You are very likely going to need more aggressive treatment here – possibly a bridge or an implant to replace this tooth. So I think that credit would be fair. But whether the dentist is legally responsible to do that for you would depend on if he or she actually did something wrong, and it’s not clear that this is the case.

If you are one of these people with the “gorilla bite”, then your dentist may have to make you a night guard to help protect you against breaking off more teeth. You can tell the person with the “gorilla bite” by looking at the profile. If the bottom of the lower jaw is parallel to the upper jaw, that’s the “gorilla bite.” If that’s you, get a hard plastic night guard fitten to your upper teeth and wear it faithfully every night. I had three or four patients like that, and that was the only way to keep them from breaking off teeth. If you’re not, then count your blessings and just address this one tooth that may be unrestorable.

Dr. Hall

Links: Read about another patient who kept breaking teeth off, so had his whole mouth rebuilt with 28 crowns and has continued to break off teeth. This is likely a true case of gorilla bite.

 

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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 28, 2009

A Serious Case of TMJ Disorder

Filed under: TMJ — mesasmiles @ 6:31 pm

Dr. Hall,
I’m sure you’re quite busy, but if you have a moment, please read my email. I don’t know who to believe anymore and your site enlightened me. There ARE many pretenders out there.

I’m only 32. But due to a teeth grinding habit, I had crowns placed on all my teeth about ten years ago. They were not placed correctly and I have now worn them down and suffer pain and clicking. Now my jaw is crooked (slant on upper and lower), posterior crossbite, gums are in bad shape due to the crown placements – not to mention they’re just plain ugly, dark and “chiclet looking”.

Because of my jaw pain, out of desperation, I found myself in the hands of a “neuromuscular dentist”. I didn’t realize at the time that this was not a specialty. I now believe that I’ve been taken advantage of by charlatans. Now after 2 yrs in an orthotic that opened my bite too much and moved my lower jaw forward (of course it didnt’ work), I feel like my situation is even worse. Now, with this orthotic removed, I have an open bite and my crowns are further ground down and flat. Obviously I need some restorations, but I’m torn between a prosthodontist and a cosmetic dentist. Do I have to choose between function and appearance?

I’m worried that the complicated nature of my case – also, how does a dentist know where my natural bite in order to place the crowns? I did consult an orthodontist and he told me my case is complicated (clearly) and that I should see a prosthodontist. Any information you can share will be greatly appreciated. I am so incredibly skeptical of dentists after my experiences. I don’t know who to believe any more. Thank you so much.

Rachel from Pittsburgh, Pennsylvania

Dear Rachel,
You were on the right track looking for a “neuromuscular dentist.” The problem, as you have since found out, is that this isn’t a legally distinct specialty in dentistry, and your dentist doesn’t appear to have had the needed expertise for your problem. Grinding your teeth flat sounds like the work of someone who really doesn’t know what they are doing. Sorry to be so blunt, but it sounds like you have figured that out.

You do not have to choose between appearance and function. They aren’t exclusive goals – you don’t have to sacrifice appearance to have a balanced occlusion. You just have to find a dentist with the proper expertise who actually cares enough about the appearance, too. But the problem is that many dentists who immerse themselves in the technical aspects of dentistry have little or no interest in esthetic issues. This is why there is often a problem in going to a prosthodontist. While these specialist dentists have strong academic credentials, they tend to be indifferent to appearance-related issues, which is reinforced by their extra time in dental school. But many dentists who are passionate about excellence in function are also passionate about the appearance of their work.

And yes, it is tricky to find where your natural bite is supposed to be. But this is part of the training of dentists who have real expertise in treating TMJ disorders. That’s going to be your key – finding a dentist who first of all knows what they are doing but also cares how your end result is going to look.

I would recommend that you see Dr. Susan Petruska in Pittsburgh. She is a former professor of prosthodontics at the University of Pittsburgh School of Dental Medicine, but she is also accredited in cosmetic dentistry. There is also a dentist in her office who has been through the training in neuromuscular dentistry at the Las Vegas Institute for Advanced Dental Studies – a recognized leader in training dentists for treating TMJ disorder. We list her on our Pennsylvania Cosmetic Dentists page.

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.

May 24, 2008

I have erosion of my teeth along the gumline.

Filed under: Porcelain veneers,TMJ — mesasmiles @ 12:26 pm

Dr. Hall,
I have considerable abrasions/erosion of my teeth along the gumline caused by brushing my teeth too roughly in the past.

If I get porcelain veneers, will the treated teeth be prone to staining and cavities along the edge of the gum because of the abrasions?
Does having porcelain veneers, since the protective enamel layer of the teeth is removed in the process, make your teeth especially vulnerable to cavity, decay, and staining, even if you are very conscientious and diligent in your oral hygiene regiment?
Is staining inevitable with veneers?
Upon first having them bonded, how long do they last before they become stained?
How much does it typically cost to have the margins professionally polished?
And how often must this be done?

Please consider my questions under the hypothetical condition that good, regular oral hygiene is maintained.
Also, is it necessary to severely restrict yourself from enjoying a lot of foods and drinks in order to increase the lifespan of the veneers and avoid/prevent staining?
– Lauren from Massachusetts

Dear Lauren,
Wow, you’ve got a lot of questions! I’m not going to have time to answer them all, but I’ll try to help you understand your situation.

Dentists for many years thought that the notches that occur on your teeth next to the gumline are from brushing too hard. While aggressive brushing can wear away your teeth, recent studies have shown that in most cases, these notches are from biting stress, otherwise known as bruxism. Clenching and grinding your teeth causes them to flex at the neck of the tooth, at the gumline, and this causes weakness at this spot and you end up with notches there. Click here for more information about grinding and other TMJ problems.

Porcelain veneers should cover up any of these notches. But the cosmetic dentist would be wise, before placing porcelain veneers, to find out if the patient has a bruxism problem, and to address that problem in order to maximize the lifespan of the veneers.

And porcelain veneers are very stain-resistant. They can pick up some stain, but they stain less than your natural teeth. My best advice for handling the stain is to use Supersmile toothpaste every day to help maintain the veneers.

And you shouldn’t really have to restrict your diet with porcelain veneers. If they are well made, they are very resistant to new tooth decay or other problems. You would be wise, however, to follow good oral hygiene habits – brushing and flossing daily – to help protect your investment. As far as eating, the best thing you could do would be to avoid frequent snacking. If you’re nibbling potato chips or other snacks frequently during the day, that could cause decay problems along the edges of the veneers.

I hope this is helpful.
Dr. Hall

Click here for referral to an expert cosmetic dentist.
Click here to ask Dr. Hall a question.

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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