Dr. Hall,
I had bonding done on my four front teeth almost 20 years ago to cover tetracycline stains. One chipped and I returned to my same general dentist to request veneers on the six front teeth as the solution. Instead, he talked me into six crowns, saying that they would last longer, serve as a better solution to the staining, and also help address my gummy smile. Foolishly, I listened without doing my homework, as I wanted the situation quickly corrected and he is a very reputable general dentist – not to mention a long-time family acquaintance. I trusted him. He is known as the best in the area.

Unfortunately, there is grey visible beneath a few of these luminescent crowns—and especially so in fluorescent light. I am horrified. He has said he will make it right and have the lab redo the problematic ones free of charge. However, I am now very concerned and thinking the better course of action might be to request a full refund and see a true cosmetic dentist. I think he is in over his head, despite trying to reassure me he does this work all the time.

I am now always going to be stuck with crowns versus my real teeth for the rest of my life and I am just sick about it. I think I would be justified in asking for a refund and entrust a re-do of the crowns to someone else. Your thoughts?
– Holly from Philadelphia

Holly,
This is tough, when you have a family acquaintance and supposedly reputable general dentist who seems to have little clue as to how difficult a procedure he has bitten off, probably with the best of intentions, but now you are suffering because of it.

Here is a list of his mistakes, all likely made with good intentions:
1. For lack of comfort with the porcelain veneers procedure, he recommended the highly aggressive porcelain crowns to fix your front teeth. And now that your teeth are ground down to stubs with crowns, there is no going back.
2. Based on the dental school mentality that there are six front teeth and the rest are back teeth, he tried to correct a very dark tetracycline-stained smile with fixing only six teeth. An excellent cosmetic dentist, in doing a smile makeover of dark teeth, will always include at least 8, maybe 10 or 12 teeth, depending on the width of the smile. Dental schools speak of anterior teeth and posterior teeth. Cosmetic dentists talk about the patient having 8 to 12 teeth in the “aesthetic zone.” Here’s a photograph of a patient with only six crowns on a background of dark teeth, but her smile is 10 teeth wide.

3. For lack of familiarity with the intense color issues involved in tetracycline stains, he didn’t adequately cover the teeth, and the dark color is showing through.

So should you let him go back and fix this now? Absolutely not. It’s likely that even his lab doesn’t know what they are doing. Tetracycline stains are one of the most difficult cosmetic dentistry procedures, and you need an experienced professional.

You’re in Philadelphia. We have several excellent cosmetic dentists in the area that I recommend, in downtown, the suburbs, and nearby. Being a trusted, reputable dentist, he would probably be willing to give you your refund, and I would ask for it. Done right, you could have a truly beautiful smile. And then you could go back to him for your general dentistry needs.

– Dr. Hall

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