Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

May 16, 2018

Will my electric toothbrush loosen the post in my tooth or the crown?

Filed under: Uncategorized — Tags: , , , , — mesasmiles @ 11:06 am

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Hi Dr. Hall
On your page about how to remove a post in a tooth you mention that an ultrasonic tip can be used to help remove a post. I have a crown on a post and want to use an electric toothbrush. Is there any chance that an electric toothbrush can cause the crown falling off or post loosen up due to the vibrations?
– Anna

Anna,
Many of today’s electric toothbrushes use sonic vibrations through the bristles to help loosen plaque. I don’t believe these are strong enough to loosen anything that is cemented in your mouth.

The ultrasonic tip that a dentist would use to help remove a dental post cemented in a tooth would be the tip of an ultrasonic scaler—a powerful tool used by dental hygienists to help clean teeth. The tip is rigid and imparts the full strength of the ultrasonic vibrations to whatever it touches. When used to remove a post, it has to be pressed firmly on the post for an extended period of time.

By contrast, the vibrations of a sonic or ultrasonic toothbrush are transmitted through the soft bristles and thus are very gentle.

– 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 16, 2018

Porcelain Veneers Gone Bad


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Dear Dr. Hall,
I recently went to a dentist to do a smile makeover, specifically because my four upper front teeth are misaligned and crowded. After he explained that cosmetic dentistry could correct the problem faster without the inconvenience of braces, I opted for that.

He said that a combination of bonding on #10 (left lateral incisor), a single veneer on #7 (right lateral incisor) and shaping would provide complete alignment, no crowding and an even smile. He also claimed he did shaping on the lower teeth – which I never discussed or mentioned about treating at a cost of 1.3k. He charged overall 9k for this work. When he declared it complete, the veneer was too small with a gap near the gum line, the teeth were still crowded and they remained uneven. When I asked him what would provide the outcome he originally described he said only 4 porcelain crowns on the upper teeth would, but at an additional cost of 7k, because he would need to do root canals in addition to placing crowns.

I went to another dentist for a second opinion and he advised me that his recommendation would have been to place 4 veneers to correct the original crowding and alignment problem. They also said that to correct the current problem I would still need the 4 veneers, no root canals necessary and no crowns necessary, just 4 veneers at a total cost of 4.5K.

My question is how do I successfully recover my 9K from the first dentist?
– Grant from New Jersey

Grant,
Well, I guess we’ll add your experience to our list of cosmetic dentistry horror stories.

Just from what you’re telling me it sounds like the first dentist took you for a ride, not delivering work that was promised and leaving you with a very poor smile makeover. In my opinion, you should be entitled to a refund of what you paid, if you go about it right. But before I get into that, I have a real concern about your second dentist. How do you know the second dentist will deliver the attractive smile you are wanting? Do you realize that smile makeovers are not taught in dental schools? You might want to check my blog post, Why you shouldn’t ask your family dentist to do porcelain veneers.

I strongly suggest getting a third opinion from a dentist you know can do smile makeovers. You’re there in the New York City metropolitan area where you have a varied selection of excellent cosmetic dentists. You can go to our list, or find an accredited cosmetic dentist.

Now back to your question of getting a refund from the first dentist.

Start, of course, by just asking for one, with some gentle pressure. I address some pointers about this in my blog post, How to ask for a refund. If that doesn’t work, you need to apply more leverage. There are a series of steps, each one applying a little more pressure.

The next step would be, after you find your expert cosmetic dentist who can do a beautiful job with this, is to see if that dentist will call on your behalf and say that a refund would be appropriate. Dentists tend to be sensitive about what other dentists say about their work.

Unfortunately, it seems to me from what you’ve told me about his conduct so far that your dentist is one who is going to require more pressure than that and you’ll need to play hardball. The next step in escalating pressure against the dentist is to complain to the dental board. The step after that is to contact an attorney. For each of these steps, it is very helpful to have the backing of another dentist to document the problems with the earlier work.

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.

April 2, 2018

Questions about forensic dentistry

Filed under: Uncategorized — Tags: , , , — mesasmiles @ 4:27 pm

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Dr. Hall,
Hello! My name is Ashley, and I’m a college student who is currently working on a paper about certain kinds of forensic sciences and their credibility in court. In my paper, I am discussing the reliability of bite mark analysis when used as evidence to convict. While doing research, I came across your website and am now hopeful you could answer two questions for me:
1) Are teeth uniquely different? ( For example, if you had two patients whose teeth you have straightened, could you tell them apart from their x-rays or teeth impressions?)
2) How often/fast can teeth move? (For example, if a criminal purposely removed a tooth or their teeth were shifted in a confrontation, how long would it take before their teeth had shifted noticeably?)
I hope to hear back from you. Your knowledge on dentistry could really help me.
Good wishes and thanks,
~Ashley

Ashley,
Thanks for your questions.
On the first – bites are really quite distinct. While I was in practice, if I ran across, say, a stray model in my lab, I could pretty easily tell which patient it was. X-rays would be a little different story – I would have to study them carefully to determine which patient they were. But with comparison x-rays it would be much easier. I could match up and say these two sets of x-rays are from the same person. But to translate the x-ray view into the clinical view could be harder.

The older a patient is, the more distinctive the bite is going to be. The teeth wear, get fillings or crowns, or other things that add to their distinctiveness as time goes on.

As far as how fast teeth move – in the context of bite marks – if a tooth were extracted yes, the teeth around it can move into that space. However, a bite mark would likely be mostly the front teeth, and front teeth will move much more slowly than back teeth. It could take months for you to see any significant lateral movement. Opposing teeth could also erupt further, and that movement would begin more quickly, maybe taking a couple of weeks to see significant movement. Back teeth can start to move in a couple of weeks because there are pressures on them from adjacent teeth, and teeth adjacent to a recently extracted back tooth will start to tip into that space in a couple of weeks.

I hope this is helpful. Good luck on your paper.

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 27, 2017

Hockey Players and Dental Implants


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Hi Dr Hall

My son in college is a hockey player who just lost his front tooth due to a direct hit from a hockey puck. He started the process for an implant, meaning they removed the tooth and added a plug. He was recently told by other teammates that an implant is not a good option until he finishes playing the sport because a second trauma is possible. Is an Encore Bridge or a Zirconia Maryland Bridge a good option? He wants it also for cosmetic reasons as he will be getting married later this year. He Lives in CA and would be willing to come to see you if needed.

Thanks
Geoff from California

Geoff,
Thanks for your question! I had never heard about this concern before – placing a dental implant in a hockey player, but your son’s teammates make sense. I went to the University of Minnesota Dental School. One of our oral surgery professors was official team dentist for I think it was the Minnesota North Stars hockey team at the time, and we heard a lot about hockey dental injuries. I would listen to those teammates. Getting a tooth knocked out is one thing. With that tooth anchored on a dental implant, the implant would be ripped out of the bone damaging who knows what else and requiring bone grafting on top of everything else.

There’s no harm in having the root fixture placed, but I would hold off on putting a crown on the tooth until after his hockey career is over. Meanwhile, no, a bridge is not a temporary restoration – whether it is an Encore bridge or a zirconia Maryland Bridge. A bridge requires tooth preparation on the adjacent teeth if it is placed properly. Besides, now you’re hooking three teeth together and that is going to magnify the risk to all those teeth should he have another accident.

What he needs is a removable flipper partial to tide him over. I would go to one of our recommended cosmetic dentists to get a great match of the false tooth to his other front tooth, which might require spending a little more money. Done well, no one will know it’s a false tooth.

– 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.

November 16, 2017

What to do when my dentist is getting really rude?

Filed under: Uncategorized — Tags: , , , — mesasmiles @ 6:16 pm

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Hello Dr. Hall,
I went in for a normal root canal. As my numbing started to wear off it felt as if someone had taken a bat to my face. The next morning I woke up in terrible pain and a very swollen face for about 3 days. This was on tooth # 10 [upper left lateral incisor].

I called the dentist and he put me on Flagyl. One week later still in pain he did an x-ray said root looks fine continue with Flagyl.

After weeks of visits with doctors I was told the injection had caused irritation with a nerve. One doctor told me I have trigeminal neuralgia. They told me to let the dentist know. I did so he called me in and started to be very rude telling me no dental procedure could affect a nerve from simple numbing procedure. I didn’t argue I don’t know. Just doing what the other doctor told me. He then pulled up my pharmacy history and started asking about all my medication not pertaining to any of this.

I scheduled my appointment for my crown and when the nurse calls me back she says I need a clearance letter to be treated any further and the doctor stands at the door and again is telling me no injection can cause pain to a nerve. He won’t even enter the room. At no point have I accused him of wrong doing or been angry I have just seemed treatment for pain and to get my tooth fixed. I call the office to yet again make another appointment with a clearance letter and the lady tells me I have to send the letter and once the doctor reads they will call me back to let me know if he will continue treatment or not. At this point I feel like I am being treated very poorly at no fault to myself so I am seeking the completion of my treatment elsewhere but I would like my money back since he did not follow through with completion of my procedure and billed my insurance for an office visit when he failed to even see me.
– Tonya D.

Tonya,
My goodness, what a reaction by your dentist!

There are several things that are odd about what he is doing, and you definitely need to sever the relationship and of course you should be entitled to a refund of any treatment that isn’t completed. Logically, it would seem that your dentist would welcome this and gladly hand you a check, but there seems to be a lot of emotion wrapped up in his actions, so I’m not sure what he will do.

The post-operative infection after the root canal treatment was unpleasant, to be sure, but not any certain indication of anything significantly wrong that your dentist did. There are sometimes these flare-ups and sometimes they happen in spite of the dentist doing everything right.

However, the use of Flagyl for your oral infection is a little odd. Flagyl is generally used for lower GI tract and vaginal infections—not for oral infections. It is an alternative antibiotic that is maybe a fifth or sixth choice for an oral infection when there is a reason not to use one of the others, and because of its limited spectrum it is usually combined with another antibiotic like amoxicillin in this type of setting.

But the oddest thing is your dentist’s extremely defensive reaction to the suggestion that you could have had irritation to a nerve from his local anesthetic injection. Now, just from what you’ve told me, it doesn’t add up to trigeminal neuralgia. Trigeminal neuralgia is characterized by extreme facial pain that is triggered by touching or stimulating an area of the face. It is something that recurs from this touching or stimulation, and so diagnosing that from a single instance and from an injection is a bit of a stretch. But my gosh, how about a simple “I disagree” and move on? Instead, he gets extremely defensive about it and feels this need to counter-attack the messenger. With that type of aggression being displayed by him, I can’t imagine you feeling safe under his hands.

So yes, go find another dentist to finish this, and insist on a refund, and, if you feel so inclined, report the “non-visit” to your dental insurance company. If I were you, though, I might ask for the refund and threaten to report the non-visit if this dentist gives you any flak over the refund. You could also report this to your state board of dentistry if he doesn’t cooperate.

Good luck,
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.

October 9, 2017

Saving your tooth looks like a no-brainer to me


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Dr. Hall
I have to have either a root canal or implant in the first molar on the left side, bottom. There is no molar behind it, and I am wondering if there is a “snap on” smile version that would be less expensive, invasive and will allow me to cover the empty space, should I decide to have the tooth pulled?
– Beth from Washington

Beth,
Having the tooth pulled and replaced with a Snap-On Smile would be the worst of several options for treating your infected tooth.

Let me go through your options and their pros and cons.

You’re telling me that there is no molar behind your first molar. So you’ve already lost your second molar. Losing your first molar would leave you with no molars on your left side. I guess if you’re planning on going on a soft or liquid diet you won’t need to chew, but you really need something there. A Snap-On Smile is a temporary tooth replacement solution designed to help you, say, get through a job interview or a social function and look like you have teeth. It isn’t a functional replacement for molars. It isn’t very durable and isn’t all that cheap, either. The least expensive functional tooth replacement would be a removable partial denture.

But any type of appliance you put in your mouth that is removable and designed to be a functional tooth replacement is going to be much more stable if you have teeth in the back to anchor it. Imagine having a table that has legs only in the middle and on one of the ends, as I have pictured below. This is called a cantilever and isn’t very stable.
An unstable table with legs in the middle and on one end
This is like the situation you are creating in your mouth when you lose these back teeth. When you try to attach a tooth appliance onto the front teeth and expect it to replace back teeth, it’s not very stable. In addition, it creates a twisting force on the teeth that are supporting it, which can lead to the early loss of those teeth. There are partial dentures that are designed to absorb the stress with the soft tissue on your ridge, but they would require clasping other teeth, too, probably going on to the other side of your mouth.

The root canal treatment makes the most sense because that saves your own natural tooth. Being a molar, the tooth would likely need a crown also. But there are people who argue that a dental implant is a very predictable solution also. The root canal and the crown would be less expensive, though. To me, it’s a no-brainer to save your tooth.

– 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.

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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 27, 2016

The oral surgeon accidentally cut my tongue

Filed under: Uncategorized — mesasmiles @ 10:48 am

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Dr. Hall,

I got a lower rear tooth extraction at the oral surgeon’s today, and it was a difficult one. Near the end, I experienced a sudden huge pain under my tongue. Then I noticed lots of stitches happening in an area not near my tooth, so I suspected something had occurred. However, the surgeon mentioned nothing after the surgery, and I was in such pain I let it go.

Later, I noticed I did in fact have a huge cut under my tongue, complete with 6 stitches and some had already fallen out. I called the office, and to make a long story short, apparently the surgeon DID tell me what happened before I left–but he explained it as “you had a soft tissue tear and I stitched it up.” On the phone, the dental assistant did allude to the fact that I got the tissue under my tongue drilled.

I am angry that this professional took zero responsibility for his mistake, which I know everyone has. I can forgive his mistake. I cannot forgive his arrogant and borderline dishonest explanation. I want this man to accept and admit his mistake and apologize for covering it up. Failing that, I will report him to the peer review board or dental board in my state. I would never dream of suing because someone made a mistake, but I feel strongly that he needs to own up to that mistake. Does this manner of recourse sound reasonable to you?

– Jana from Ohio

Dear Jana,

I think you’ve sized up the situation correctly. Yes, he was careless and cut the tissue under your tongue with his drill. It sounds like it was a really nasty one, too, if it required six sutures. Mistakes like that can happen even in the best of circumstances, and it sounds like he addressed it as he needed to. But his attitude makes you angry. The way he presented it to you reveals his attitude: “You had a soft tissue tear,” as if it’s an act of nature, rather than, “I accidentally cut your tongue.”

The tongue, in its resting position, sits partly over those lower molars, and it can be very easy to injure the tongue when working on those teeth. During surgery, the surgeon should have his or her assistant keep a metal retractor between the surgical field and the tongue, and this will prevent accidents like this. So I’m guessing he was careless in this. He should be embarrassed, and it’s a shame he doesn’t act like it.

You can report him to peer review or the dental board, but I doubt anything will come of it. I don’t remember ever hearing that a dentist was disciplined for rudeness. The peer review committee will likely view it as you have–a mistake that, while regretful, was properly addressed clinically. Though if this is a pattern with this dentist and a number of complaints like this go into his file, it could cause him some problems down the road.

I don’t believe suing would be an option. I don’t believe that an accident like this breaches the standard of care, as long as the accident is treated properly.

I’m sorry for what you had to suffer.

– 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.

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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.

January 8, 2016

An 8-letter word that relates to your teeth wiggling

Filed under: Uncategorized — Tags: — mesasmiles @ 1:11 pm

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.

Dr. Hall,
What is the word that starts with a f and has 8 letters. When your teeth naturally wiggle
– Jasmin from New York

Jasmin,
What is this, a crossword puzzle question? We get all kinds here, don’t we.
Just for fun, I’ll take a crack at it.
You want an 8-letter word that starts with “f”? The word “function” comes to mind. Teeth naturally wiggle in function.
– 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 20, 2015

How does a dentist fix a gummy smile?

Filed under: Uncategorized — mesasmiles @ 6:42 pm

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.

Dr. Hall,
I have a “gummy” smile, how would treatment go to make it not so “gummy”?
– Sherry from California

Sherry,
Fixing a gummy smile is way beyond the ability of your family dentist, so you need to be careful how you do this.

Some dentists might want to send you to an oral surgeon for this, for radical surgery to cut your entire maxilla (upper jaw) and shorten it. But this not only isn’t necessary but could cause complications with your bite that would adversely affect your TMJ (jaw joint). Expert cosmetic dentists are trained to do what is called a “gum lift.” A small amount of gum tissue and some of the supporting bone beneath it is removed, exposing some of the roots of the upper front teeth. Then porcelain veneers are placed over the front teeth to make them look natural. The teeth end up being a little longer, but in the hands of an artist/dentist, it will look completely natural.

Here’s an example of a case done by one of our mynewsmile dentists in Santa Rosa, California, Dr. James Klim, done with the technique I just explained:

gummy smile

Before


gummy smile after

After

It’s important in doing this that the dentist keep the incisal edges of the upper front teeth in the same place, and the bite the same. For example, if your front teeth are shortened, you might not be able to bite edge-to-edge any more. Further, in time the upper teeth could drift back down to where they meet the lower teeth, possibly bringing back your gummy smile, or causing some other complication. Notice in the photographs that the upper teeth have simply been made a little longer—not much, just a couple of millimeters.

The most important thing for you to do is to select the right dentist. To be honest with you, I’m not certain that every dentist I list on this site would be capable of doing this. My recommendation would be to call a dentist that I recommend and simply ask if they have ever performed a gum lift and if so, can they show you before-and-after photographs of the case.

Good luck,
Dr. Hall

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

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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 27, 2013

I chipped my front tooth but I really can’t afford Lumineers

Filed under: Uncategorized — mesasmiles @ 8:30 am

Dr. Hall,
If I chipped my front left tooth, the corner inner most closest to the front right tooth in a size approximately 1/8 of an inch is there a way a dentist can fix the chipped tooth without requiring Lumineers or costing me an arm or a leg in charges I’d have to pay for the repair. I fell on the ice & went face 1st. Can you please recommend a solution on what procedure may be best for a chipped front left tooth? Possibly one that doesn’t cost more than my budget can afford.
– Sara from Wisconsin

Sara,
A chip that size should be a simple direct bonding repair. You shouldn’t need Lumineers.

You do have to be careful where you go, though. There are some dentists who advertise themselves as cosmetic dentists who would either a) try to “upgrade” you to porcelain veneers for this simple case or b) wouldn’t have the necessary artistic skills to do direct bonding, which has to be done freehand by the 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.

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