Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

April 25, 2018

A situation where Invisalign didn’t work


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Hello Dr. Hall,

The reason I want to speak with you is because I started with Invisalign October 25th 2016 with a Dentist. We agreed upon me paying $4,675.00.

My goal we spoke about for my smile was to fix my midline and also make room to put veneers on my lateral teeth.

His expert recommendation was Invisalign over a period of 9 months. I finished my first set of trays during the 9-month period (August 2017). Since my midline was not straight after the 9 months, my dentist ordered a new set of trays.

I was supposed to be done in March 2018. I’ve sacrificed double the time to work with him to correct the midline as we had initially discussed in Oct 2016.

So at this point, I’m at my wits’ end. I’m frustrated from sacrificing so much time and money. I took it upon myself to speak with doctors about my current situation. These are doctors who work with both Invisalign and traditional metal braces. Their professional recommendation was Invisalign would not give me the results I need and traditional braces is the only option.

How do I go about getting a refund to be able to fund my new braces?

Thank you for your advice.
– Kristen

Kristen,
I’m going to give you a two-part answer, and in the first part I’m going to address whether or not Invisalign would work in your situation. I’m guessing that these other dentists, who sound like orthodontists since you said they work with both Invisalign and traditional braces, are probably right that this wasn’t a case for Invisalign. Having said that, in my experience, many orthodontists, educated in traditional methods, don’t give Invisalign the credit it deserves. I’ll tell a story as an illustration. When I was practicing, there was an orthodontist who was an excellent orthodontist, and he had a patient come to him who wanted Invisalign. He told the patient that traditional braces were the best way to correct his crooked teeth, and he wouldn’t do it any other way. With those options, the patient chose no treatment at all because he was dead set against wearing metal braces. Then he came to me, and I told him that yes, the orthodontist was right that traditional braces were the “best,” most predictable way to move his teeth, but that Invisalign would also work and if he was willing to accept the limitations I would take the case. I did, and the results turned out fine and he was very happy. The point is that some dentists have this strict mindset. This includes some orthodontists who stubbornly refuse to give Invisalign the credit it deserves. Part of what is going on in the backs of their minds, I am sure, is that you don’t need to be an orthodontist specialist to use Invisalign, and they feel protective of their status as specialists. Their identity and status is tied up in diminishing Invisalign as much as they can.

Anyway, moving a midline and keeping it straight is a little tricky to accomplish, and I think is best handled by a specialist—an orthodontist, so I think you’re now in good hands.

So that brings us to my second point—getting your refund. Different dentists are going to respond very differently to a situation like this. Some will be fine with giving a refund for a treatment that didn’t work, while others will be nasty about it. So you start with a simple request, and then you ratchet up the pressure until you hopefully get your way. Here are the steps for ratcheting up the pressure:

  1. Start with a straightforward, polite request to the dentist
  2. Ask another dentist to call with the request for a refund. If another dentists feels that a refund is warranted, this adds a lot to the strength of your request.
  3. Complain to a local peer review committee, if one exists. This step may not be too effective, and most people could easily skip this.
  4. Threaten, and then follow through, with a complaint to the state dental board. No dentist wants a black mark on their record with the dental board.
  5. Get a lawyer.

And through all of this, you don’t want to be emotional or nasty. Be polite, with a calm voice, but firm.

I wish you the best.
– Dr. Hall

Do you have a comment 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.

July 3, 2015

A critique of SmileCareClub for straightening teeth

Filed under: Invisalign — mesasmiles @ 5:00 pm

The SmileCareClub company was founded in 2013, and provides what amounts to do-it-yourself Invisalign treatment.
The concept is the same as Invisalign. You wear a series of clear plastic aligners, changing them every three weeks (as opposed to two weeks for Invisalign). At the end of the treatment period (from 4 to 14 months), your teeth are straight.

Another company, Crystal Braces, offers a similar service.

Does it work? It appears to. Is it a good idea? I’m skeptical, but will try to be open-minded.

Yes, you do save quite a bit of money over Invisalign from a dentist. And it looks like, for the majority of patients, it could work out just fine. But there are things that can go wrong during Invisalign treatment, and this is where I think the system breaks down.

The biggest issue, in my opinion, is gum disease. If a patient has gum disease and then gets these clear braces, that’s going to aggravate the gum disease. Can the dentist tell, just from the photos submitted, whether or not a patient has gum disease? Dr. Son Tran, the founder of Crystal Braces, when asked about this, said that he could tell, from the photographs submitted by the patient, if they had gum disease. I question that. It really takes a good set of x-rays as a starter, and probing of teeth to diagnose gum disease. And I’m skeptical that the photographs submitted by patients are really going to show the molars clearly. Yes, they employ dentists to review these pictures and the cases, but I think the pressure is on them to put the cases through. As a dentist, I would be able to tell certain cases of gum disease from the photographs, but not all of them, and if the evidence isn’t clear it would be easy to just approve it.

There are other problems that could arise during treatment. In some cases, teeth need to be shaved on the sides to make room for crowded teeth to straighten. They have you go to a dentist to have this done, but this is a dentist who then isn’t invested in the case, and I know from doing this myself that it can be a little tricky to get the right amount of enamel removed and maintain the proper shapes of the teeth.

And then there can be teeth that are supposed to rotate but don’t, or other things that could go wrong. So yes, in most cases it could work out just fine, but I’m not sure enough about this treatment to recommend it for anyone. I think there needs to be closer monitoring than just by phone and texted photos.

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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 20, 2011

I have a HUGE tooth gap. What are my options? Not Lumineers, please!

Dr. Hall,
i wanted to know what would be the best way for me to take care of my problem. i have a really large gap in the front of my teeth. i have already seen a local dentist in flint because i wanted to get the snap on smile. i paid for the x rays and everything and the dentist sent everything in to the snap on smile company. then i get a call saying the snap on smile would not work in my case. i dont want to do braces so what do you feel is the best way for me? from what i can remember the last dentist said the size of the space between my teeth is 8mm to 10mm something like that. i have an appt to talk to another dentist about the lumineers to see if i could go that route. thank you for your time and i really hope you can save me some time and money and let me know what you think.
thanks again.
-Phyllis, from Flint, MI

Phyllis,
I’m glad you wrote to me because you are headed for disaster. Stop with this plan of doing Lumineers. This could end up looking hideous, and that’s not even the worst part. The really bad part is, if the only problem with the work is that you don’t like how it looks, you won’t have any recourse. So you could end up stuck with an atrocious smile.

A gap of 8-10 millimeters is huge. That is enough space to fit one more whole tooth in there. This is no job for the dentist on the corner. Here are your options:

1. You said you don’t want to do braces. By that do you mean traditional braces? What about Invisalign invisible braces? Do you know anything about that, and is there are reason you wouldn’t want that? With a gap this large, that would be my number 1 recommendation. The invisible braces are clear plastic pieces that snap over your teeth – no metal brackets, and no one can tell that you’re wearing them because they are thin and clear. It would probably take a year to close your gap.

2. If for some reason you don’t want to do that, you truly need an expert cosmetic dentist. If you go to a dentist who advertises for Lumineers, as a general rule those dentists are not very good cosmetic dentists. The Lumineers material does not have the best coloring, and their lab tends to make the teeth kind of long and extra thick, so most good cosmetic dentists stay away from that brand of porcelain veneers. But there are other brands that work well. Don’t pick the brand of porcelain – the important thing is to get a truly artistic cosmetic dentist who has a lot of experience doing smile makeovers and let them use the material they feel the most comfortable with. Depending on how your teeth line up, it may be possible to fill in the gap and re-shape the other teeth so that it looks natural. But this is difficult to do, so you have to have a dentist with a lot more expertise than your family dentist on the corner or a dentist who simply advertises that they do cosmetic dentistry.

I just did a quick check of dentists who advertise as cosmetic dentists in Flint, MI, and you’ll have to be really careful here. I did not find one right off the bat that I would trust with a job like this. If that’s the route you want to go, let me know, and we can try to find one for you. But it’s possible, in a city like Flint, that there really aren’t any good cosmetic dentists. But we can look. Otherwise, you may be interested in driving to the Detroit area. There are several good cosmetic dentists there. Let me know.

Good luck,
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.

February 28, 2011

Can I use a flipper to make my teeth look straight?

Filed under: Invisalign — Tags: , , — mesasmiles @ 5:56 pm

I have teeth that are not straight. I was wondering if I could get a flipper that could go over all my teeth and make my smile look straight. I don’t want to go and pay a lot to go and get braces when it takes a long time … and is more painful. thanks
– Taylor from New York

Taylor,
A dental flipper is used to replace one or more missing teeth, and it snaps onto your existing teeth with a small wire clasp.

What could work for you is a Snap-On Smile. This snaps over your teeth, and could work if you have crooked teeth – it will make them look straight.

But especially if you have teeth that stick out a little, the Snap-On Smile would have to be made even a little extra bulky. It might not look great for you. I’d recommend going to an excellent cosmetic dentist so you get an honest opinion about how this would look.

If it’s the pain of braces and the long time it would take, the best thing may be Invisalign invisible braces. It takes about half the time of conventional braces – most cases can be done within 9 months to a year. And there are no painful brackets or wires. I’d check that out.
– Dr. Hall

We thank our advertisers who help fund this site.

About David A. Hall

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

February 3, 2011

The best way to fix my nephew’s smile

Last June, as a high school graduation gift for my nephew, I said I’d pay for his dental work. I assumed he would choose ortho because that’s really what he needs. Unfortunately, he feels ortho takes too long and he wants to have Lumineers which his dentist is saying will cost $18,000 for eighteen teeth. My nephew knows that they only last twenty years, but he wants a new smile now so he can pursue an acting career. What do I tell him? Thanks!!!
– Jason from California

Jason,
Thanks for writing. I think I can really help you out here.

Since you’re paying for this, I assume you have to approve how this is done. Since you’re older and more mature, I hope you’ll exercise your right to be a guiding hand here, because I worry that your nephew is going to do something short-sighted, waste your money, and waste his opportunity. When you’re old enough to have been scammed a few times, hopefully you become more cautious and more wise.

Lumineers are just one brand of porcelain veneers, and in the opinion of many cosmetic dentists, including me, they are of lower quality – meaning of lower esthetic quality – than most other brands.

I’m going to guess that his main problem is crooked teeth, because you’re saying he needs ortho.

There are two excellent options, and which one you buy for your nephew depends on the situation in his mouth.

And here are the two options:
One would be Invisalign invisible braces. Your nephew, as a recent high school graduate, will have all his permanent teeth erupted already, meaning that he could be a candidate for Invisalign. And a nice thing about Invisalign is he could be bleaching his teeth with the Invisalign aligners at the same time. He would avoid the uncomfortable brackets of traditional braces, and would be done in 6 to 12 months, instead of the 2 years that regular braces require.

The other option would be porcelain veneers. Lumineers are a brand of porcelain veneers, but I get a lot of complaints of people with Lumineers who find they are too bulky, the teeth look chalky and not real, and they make the teeth longer. And when they are done on the lower teeth, I have had complaints of people saying they can’t close their teeth normally after they are done. I would find an excellent cosmetic dentist to do this, and I would stay away from a regular family dentist. Only about 2% of dentists are artistic enough to do a beautiful smile makeover.

Porcelain veneers will make the teeth look straight without making them actually straight. So that has to be weighed in this decision. But it’s not accurate to say they will last 20 years. There is no set lifespan on them, and how long they last depends absolutely on how well they are taken care of. If they aren’t well cared for, they could get cavities around the edges or start staining, and they may only last 5-7 years. If they are cared for carefully, they could last longer than 20 years. Either way, though, they are a maintenance burden, and having the teeth straightened with Invisalign will be trouble-free for the rest of his life.

But porcelain veneers give straight teeth in just two appointments. To a young man, I can understand how even 6 to 12 months can seem too long to wait for results.

Another item I want to discuss is doing porcelain veneers on the lower teeth. Cosmetic dentists usually don’t do veneers on lower teeth. Usually, they can just be bleached, and the case will look beautiful, because lower teeth just don’t show much when you smile. So, since they’re spending your money, you may want to be in on that decision. That’s why it would help to go to a cosmetic dentist you know is respected and who will be honest with you.

If I were you, I would pick the dentist for your nephew and that way you know you’re spending your money wisely. I would have two suggestions. One would be Dr. Les Latner, a highly respected cosmetic dentist who also teaches at UCLA and has a practice right in Los Angeles. He will be more expensive per tooth than this other dentist, but I am worried that the other dentist is over-treating. So the final result may be considerably less. The other dentist would be Dr. Dell Goodrick in Santa Clarita. He has done beauty queens and is well known for his beautiful cosmetic dentistry. Both of these dentists are qualified in creating beautiful porcelain veneers, or in doing Invisalign, so they could give an excellent opinion to your nephew on the pros and cons of each choice as it relates to the condition of his mouth.

I hope this is helpful.
– Dr. Hall

Follow-up:
Jason wrote back, and I responded with an evaluation of the dentist his nephew was going to go to and comments on his nephew’s photograph. You’ll want to read this one. Check out my reply – warning about an impending Lumineers disaster.

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 13, 2010

What are my options with a crooked front tooth?

Filed under: Invisalign — mesasmiles @ 3:33 pm

Dr. Hall
You have a very interesting site and I really enjoy all the information that I’ve read.

Well, first of all, I have been struggling trying to find a good dentist who I can trust to straighten my teeth. I keep hearing different things about how to solve my problem and don’t know who to believe. Here’s my situation. The tooth next to my front tooth on the right is crooked and it is in the way back. It’s really bad. I was wondering are braces my only option, or will Invisalign work? If I want to pull my crooked tooth, what other treatments are offered?
– Ken from California

Ken,
Generally, if you’re an adult and your teeth are crooked, Invisalign will work just fine. Or porcelain veneers can also straighten your teeth.

I wouldn’t let anybody pull the one crooked tooth, but you may have dentists that want to do that. Your smile will never look right with an uneven number of front teeth. Each front tooth is a different shape, and you can get away with doing a lot of things to make them look straight, but one thing that’s important is to have both halves of your smile be symmetrical, and you can’t have that with five front teeth instead of six.

And if you need a local dentist, I have tried very hard to find excellent cosmetic dentists all over the country, and feel that you can trust the cosmetic dentists we list on this website. A dentist who is on our list and therefore is an excellent cosmetic dentist, if he or she is also certified to do Invisalign, they should be able to give you the best opinion about which way you should go.

– Dr. Hall

Other links:
Click here to find a cosmetic dentist.

We thank our advertisers who help fund this site.

About David A. Hall

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

January 14, 2009

Should I get porcelain veneers or Invisalign?

Filed under: Invisalign,Porcelain veneers — mesasmiles @ 3:20 pm

Dr. Hall,
I always wanted to have better smile, that’s why I decided to do 10 porcelain veneers on my upper jaw. Although I don’t have any major problems with my teeth, I wanted them to be whiter and brighter, and I also have one crooked tooth, which is not that bad to my opinion to even consider braces.

However my dentist suggested that I would need to do Invisalign invisible braces treatment before I put my veneers. He stated that after this procedure the drilling would be minimum. He also didn’t recommend Lumineers for my teeth, he said that they might look bulky on my teeth. I am not excited about 9-12 months treatment and additional cost of course, please tell me what do you think about my doctors suggestions and if it make any sense.I would highly appreciate your answer.

Thanks,
Julie from Michigan

Dear Julie,
Please take my recommendations with a grain of salt, because I haven’t seen your case and don’t know why your dentist is suggesting doing Invisalign first and then porcelain veneers. It could be that you have a great deal of crowding or a serious bite problem or something else out of the ordinary. Because, ordinarily a cosmetic dentist would recommend either porcelain veneers or Invisalign for a smile makeover, not both.

I like what your dentist said about Lumineers for you. It is true that they make your teeth look bulky. But I’m suspicious about the other part of what he is saying, so I’d recommend a second opinion from one of our Michigan cosmetic dentists, and this would be a way of verifying what you’re being told. When you go for the second opinion, remember to not let the second dentist know what you were told by the first dentist. That way you can get a completely independent second opinion.

Porcelain veneers from an expert cosmetic dentist can mask crooked teeth so that they look straight. I would choose the porcelain veneers if you are especially impatient or if there are problems with the shapes of your individual teeth.

Invisalign invisible braces will make your teeth actually be straight. And they are much faster than conventional braces, with treatments typically taking six to twelve months. If you are also wanting whiter teeth, it is very easy to do tooth whitening treatments while you are wearing the Invisalign aligners. The aligners can actually be used as bleaching trays. This would be the option to choose if you aren’t in as big a hurry for results.

But in most cases it would be one treatment or the other, not both.
Dr. Hall

Click here to find a cosmetic dentist who has been screened for artistic ability and advanced training.
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.

August 11, 2008

Can I switch dentists after Invisalign treatment?

Filed under: Invisalign — mesasmiles @ 11:19 am

I have finished my Invisalign treatment and am currently receiving retainers every 4 months. However, I am not happy with my dentist and am changing. Will I be able to continue with my retainers? I don’t really want to have to choose a dentist because of an affiliation with Invisalign. By the way, I am extremely happy with my results!
– Linda in Texas

Linda,

Your current dentist, that you are leaving, has an ethical obligation to do everything necessary to facilitate a smooth transition to another dentist. So yes, you should be able to continue with your retainers with another dentist. You could switch even if you were in the middle of treatment.

And even if your dentist doesn’t live up to that ethical code required by the dental association, it isn’t difficult or expensive to have a new retainer made without any of the previous information. The dentist has his or her assistant take a simple impression of your teeth, pour up a model, and send it to almost any dental lab.

And the new dentist does not need to be Invisalign certified. (Though it could be helpful.)

And glad to hear you are so happy with your Invisalign treatment. In surveys of patient satisfaction with cosmetic dental and cosmetic surgery procedures, Invisalign ranks near the top.

Dr. Hall

Related links:
Read about braces in general.

About David A. Hall

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

July 14, 2008

Front teeth too big. What can I do?

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

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

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

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

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

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

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

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

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

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

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

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

Good luck,
Dr. Hall

Related links:
Read about braces.

About David A. Hall

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

March 1, 2008

Will Invisalign work if I have missing teeth?

Filed under: Invisalign — mesasmiles @ 9:07 pm

Hello Dr. Hall,
I never got braces as a kid. However, my bottom teeth are quite crooked. I have 2 second bicuspids that are baby teeth, one that has been pulled already because it was hurting. The other one I presume will have to come out. Also, my very back molar was taken out on my bottom left. I feel like a hillbilly!

My question is this: how good is Invisalign when working around missing teeth? I really don’t want to have regular braces at my age. And is it likely I’ll need to have dental implants to replace those missing teeth?

Also, I have a bit of an underbite and there isn’t enough space between my top and bottom teeth to straighten only my bottom teeth. We’ll have to move the top ones out to make room.

Thanks, Marlowe in North Dakota

Dear Marlowe,

Invisalign works with missing teeth. There are other factors governing whether you are a candidate for Invisalign. Your underbite may prove to be more of an obstacle to being an Invisalign candidate than your missing teeth. And there is a reluctance to use Invisalign in cases of severe crowding.

Different dentists have different degrees of bravery in tackling certain tooth crowding cases with Invisalign. Orthodontists tend to be more conservative–they have been trained to work with wire and brackets and they shy away from the new technology. But general dentists tend to be more willing to use the Invisalign. And the cases are always supervised by expert orthodontists that are on the Invisalign staff, that work at their headquarters, so any case they approve is pretty safe.

So I’d recommend visiting a two or three Invisalign general dentists in your area and see what they say about your case.

Invisalign could close the spaces in your lower jaw, so I doubt you’d need to replace the missing teeth. It could also move your upper teeth out–that can be done. But again, it depends on the severity of your case and the actual positions of everything.

Dr. Hall

We thank our advertisers who help fund this site.

About David A. Hall

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

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