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All-on-4 Implants from ClearChoice leave her bite off

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I received All-on-4 implants in June 2023. They teeth are too big and don’t align. My bite is off. It’s hard to chew and swallow. ClearChoice said they are fine the front teeth set on top of each other. I feel like the back teeth are taller on the right then the left. I don’t know what to do.

– Kimberly from Visalia, CA


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Kimberly,
I’d start with a second opinion from another dentist with some expertise in dental implants. If ClearChoice did something wrong here, another dentist would be able to let you know that and put some pressure on ClearChoice to make this right for you.
– Dr. Hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

I like that my dentist is holistic, but she screwed up

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Dr. Hall,
Thanks so much for this wonderful site and your expertise, Dr. Hall. I feel like I can get an unbiased opinion from you since you are not going to be doing the dentistry work I need. I’ve been going to a holistic dentist whom I think has many good things going in her practice, and have wanted to stick with her despite noticing years ago some lack of care about my experience. I should have listened to my instincts and not returned, regardless of the fact that she is the only truly holistic dentist in my town.

I went to have a half metal crown replaced with all porcelain, as well as replace a mercury filling with ceramic, and fill another very small hole. She said my original crown was big but did not elaborate. She used the newfangled computer – CAD/CAM technology – to make a scan of my old crown and teeth and send it to a computer where it told her what size and shape of crown was needed for the replacement, which she made in her office on the spot. This “technology” gives you the new permanent crown in 30 minutes and there’s no need for a temporary one while another outside lab makes it. It all sooouuunds good and I trusted her. In hindsight, the first alarm bell was that she cemented the new crown in without even fitting it first to see if it felt right. After that, my bite felt off, so she did some sanding and sent me on my way.

It was obvious soon afterward that things were definitely not right but I didn’t know what. I went back the next week and she said the molar in front of the crown was hitting way too hard and proceeded to sand that tooth, which previously had no problems. My bite was so off that she also sanded 2 of my front teeth that were crooked and banging on each other now. I asked her what to do if my teeth still felt off. She said I needed to go to an orthodontist. This was very upsetting to me as I did not want to feel forced to immediately start a $6600 ortho treatment to make my teeth feel normal.
Another alarm bell went off that day when her assistant was doing half the work on my teeth, and I didn’t know her, or what her credentials were. She is not even listed on their website. She did not do the sanding on the pinhole filling correctly, either, and after 2 sandings that side still is off, as well.

I have had a second opinion already and it is obvious with the bite scan they did, that the crown is way too small/high and that that whole side of my teeth are not even meeting when I bite down. The front teeth are even getting sore from chewing. The second dentist said I would need to replace the crown with a bigger one, and add material to the front molar that they sanded unnecessarily, OR I could fix it and my other crooked teeth with Invisalign.

I have numerous questions about which is better, but have for sure decided not to go back to the first dentist and to also try and get my money back.

I also do NOT recommend getting the CAD/CAM technology crowns because it is up to the computer and dentist to “decide” what size of tooth you “should” have and is not based on reality. The old-fashioned way of using impressions to fashion a crown, which matches your original tooth pretty exactly seems to be the obviously smarter way to go. I would much rather put up with a temporary crown for a few weeks, then get it totally wrong and suffer until I can get Someone to fix it.
I would love your opinions on this.

Thank you so much,
Lisa from California

(See Dr. Hall’s answer below.)


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Lisa,
You’ve had quite the awful experience! Thanks for sharing this.

First, the question that you implied but didn’t ask directly—are you better off with a dentist who isn’t holistic but has more competence? I would say that you are. There aren’t many dentists who you could say are totally holistic in their thinking, but there are a number of them who are willing to accommodate patients with holistic concerns. That was how I was in my practice. While I did not personally subscribe completely to the holistic thinking, I had respect for those who did and was willing to accommodate them with their needs as they perceived them. I was mercury-free and nickel-free for starters. Then, they would bring me long lists of dental materials that would indicate that they were sensitive or not sensitive to those materials, and I accommodated all those requests. My holistic patients understood my philosophy and referred their friends to me, and they would come from a hundred miles away to see me. That to me is much better for your health that a dentist who may totally subscribe to holistic thinking but nearly ruins your mouth, as yours has done.

Then, about the care you received. I think your dentist violated the standard of care and is at risk of losing a lawsuit over this. So yes, I would press for a complete refund and if you don’t get cooperation, I’d talk to a lawyer. This could take quite a bit of work to repair your bite, and meanwhile there has been quite a bit of suffering.

While you have had problems with this crown made with the new CAD/CAM computer technology, many dentists are producing excellent work with it. The two principal companies making this technology are CEREC and E4D. The optically scanned impressions actually have a higher degree of accuracy than the physical impressions, since under certain conditions physical impressions can stretch or tear. The crowns made by this system are metal-free ceramic crowns and so are very biocompatible. You have been a victim of the old computer principle, “garbage in–garbage out.” To build a quality crown, this technology needs a skilled dentist directing it, and yes, the crown should have been tried in and adjusted to your bite before it was cemented. That’s pretty basic. Impressed with this technology, about 15 years ago I traveled to Tucson where I had a highly skilled colleague who had a CEREC machine and had him make me a CEREC crown for a lower molar. It fit perfectly and I have had no trouble at all with that crown since.

You need a highly skilled and honest dentist fixing the damage that you have suffered. I hope you are now in good hands. I’d be interested in hearing the follow-up on your case.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

After my new crowns my bite feels awkward

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After crowns my teeth feel dry.

When I was a child I chipped both my front teeth in an accident – and the dentist corrected it with filling material as well building up the two on either side (the lateral incisors) to correct some gaps. I had them redone once in my 20’s. At age 50 they were looking pretty worn out so I decided to finally bite the bullet and have crowns done.

In order to even everything out I needed 6 new crowns #6-11. I had them done in January 2018. It was a major change because all the spacing changed on my top teeth making them hit my lower teeth in awkward ways. Not only was the bite heavy in some areas, but I also felt the need to tap my teeth together constantly. Since the crowns I have been back maybe ten times for adjustments, but I continue to need to tap them and I think I have developed burning mouth syndrome. Usually when I wake up in the morning everything feels great but by mid-morning the back of my front teeth are burning and I feel the need to tap the teeth together. The ONE thing that relieves them is to chew gum, so I am now chewing a lot of gum! I don’t even really like gum. On one appointment I went back and the dentist husband (they are a husband/wife practice) told me NOTHING was wrong with my teeth and reluctantly referred me to a gum specialist. I instead went to another dentist who was recommended and he checked out my crowns. He did say they were very nice and seemed very well placed. Is there anything I can do to make this uncomfortable feeling stop and do I need to have more adjustments to stop the tapping together? I feel like they may have made my teeth a little bit longer and that is the root of the problem.
– Laura from Maine


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Laura,
You’re telling me several things about these crowns feeling funny, and I don’t have answers for everything you’re telling me, but I’ll share what I do know.

Let me start with the entire treatment plan, which was replacing some very successful composite bonding with six crowns. That seems to me to be very aggressive over-treatment. I think that an expert, ethical cosmetic dentist would have just replaced the bonding.

So right away I am suspicious of the ethics of your dentist. And from the experiences you had afterward it gives me the impression that she may have gotten in over her head here. Maybe not. I’m just being as honest as I can with my impressions here. So let’s go to your complaints.

You’re saying your teeth feel dry, there is a burning sensation, you want to tap your teeth together, you think your teeth are a little longer. I don’t have answers for all of that. But one comment you made particularly attracts my attention. You made the comment about your bite, apparently in reference to how the bite felt right after you got the new crowns: “making them hit my lower teeth in awkward ways.” That’s a red flag and is what gives me the idea that there is something wrong with the treatment, that your bite wasn’t right. When crowns are done right, the bite will feel completely natural and comfortable. But from the start you are saying that your bite felt awkward and now you are feeling that you want to tap your teeth together all the time.

And then referring you to a gum specialist. Really? What does this have to do with your gums? The bite is off. Another dentist checked the crowns. That’s nice to know that the crowns look fine. But each crown can look like it is perfect, and the bite can still be off. When you do all six front teeth, there are certain occlusal principles that have to be followed. Not only do they have to all meet simultaneously in what we call centric occlusion, but they also need to provide anterior guidance. In addition, the canine teeth are very important and in most cases they provide what is called canine protection–when you slide your jaw side to side they will be the teeth that force all of the teeth apart. And then add to that the effect that the shapes of these teeth have on your speech and you have a very complicated situation. Something in all of that function has not been done right for you, and what you need is a second opinion from a dentist who knows a lot about occlusion. That training is not generally supplied to general dental students in dental school. Post-graduate training for dentists in all these complex occlusion issues is provided at the Pankey Institute, the Dawson Academy, Spear Education Center and the Las Vegas Institute. I would get a second opinion from a dentist who is a graduate of one of these institutions.

About the burning sensation and the dry feeling, yes, that could be burning mouth syndrome, which in my opinion is caused by stress. If you had your bite fixed, maybe that would go away.

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

My experience with “this new crown feels funny.”

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A recent question I had from a visitor to the website about a crown that felt funny caused me to reflect on my own experience with this sensation a couple of years ago.

I had a crown that came off and my dentist at the time, rather than try to re-cement it, wanted to make a new crown. I was uncertain that was the right thing to do, but didn’t say anything, and went ahead and got the new crown. After I got it, the bite never felt quite right. It wasn’t painful—just a very slight feeling on it. A crown, if it is done right, should not be noticeable or feel any different when you tap your teeth together or chew. Anyway, I switched to another dentist shortly after this and he made some fine tune adjustments to the bite, but there was still a vague slight discomfort when I chewed on it.

After some time passed and this feeling persisted, I showed up again at my new dentist for a scheduled cleaning and asked the hygienist to take a periapical x-ray of this tooth to see if we could see anything that didn’t look right. To my grave dismay, the x-ray showed that the tooth under my crown was maybe half eaten away with decay. The tooth had a root canal treatment, so there wouldn’t be any toothache to warn me of the deep decay. The only symptom was this vague feeling I kept having.

The fix for the problem was to have what was left of the tooth extracted, a dental implant placed, and a new crown on the implant. Everything feels fine now. The take-away lesson is to pay attention to a new crown that just feels funny. It should blend in with the other teeth and the bite should be completely comfortable. If it’s not, it needs to be adjusted or fixed or re-done to make it right.

– Dr. Hall


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Question and answer go here.
 
 
 
 
 
 

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

My new denture won’t stay in

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Hello Dr. Hall,
I had all upper teeth extracted several years ago and got a denture, and now I need a new denture. So I picked a dentist who said he could get me a good-fitting denture.

Anyway, he did the impression was done followed by a wax bite and then two wax try-ins. When I had the second wax try-in I informed the dentist that it wasn’t staying in. He said the wax try-in is just about the teeth. But then, when I got my new denture, there was no suction at all and it wouldn’t stay in. The dentist said I have to give my gums time to adjust to the new denture and come back in a week to be evaluated. I returned in a week with NO change. I told him I love it WHEN it stays in, which isn’t very often!

He thought that maybe the problem was that my bite was off, so he took my denture and ground on it, maybe four times, each time checking my bite again! Then he put Fixodent on it, put it in my mouth and said to use the Fixodent and come back in (another) week to give my gums time to adjust to the denture. Let me also add that he ground down 3 molars on each side of the inner side of the denture to practically nothing.

I overheard him say to an assistant about maybe doing a reline. ???????

My question is: Why would he think a reline will work when the original impression (done only a month earlier) didn’t work???? My suspicion is the original impression wasn’t right and he wants to just do a “reline” to save HIM money instead of re-doing my new $1225.00 denture AND owning that he, the lab or somebody in his office screwed up.
Am I on the right track here or am I missing something? My next appointment is next Wednesday after having to do the Fixodent for a week. This isn’t what I signed up for.

– Carol from California


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Carol,
While your dentist isn’t innocent of all dental transgressions here, a reline should be the appropriate remedy for your problem of the denture not staying in.

I going to try reading between the lines about the procedure your dentist went through in order to give you some insight into what is going on. If you have indeed told me everything that went on with your getting this denture made, your dentist skipped a couple of steps that he was taught in dental school. But this is a common practice. There is a lot of price competition in the denture market, and the way a dentist trims the cost of a denture is by skipping some steps. Most of the time the end product is a perfectly adequate denture. In your case, it sounds like the denture is okay except for the fit, and a reline should take care of that problem. Something didn’t turn out right in the impression process, and a reline basically re-does that impression.

The best, most accurate impression is done with a two-step impression. I actually used to use a three-step impression. I would take a preliminary impression with alginate, from which I would make a preliminary model of the jaw and my assistant would use that model to make a custom tray specific for the patient. Other dentists will use a special moldable stock tray which many dentists say are as good as a custom tray. But the important part of the impression is the next steps. A heavier impression material is used to register what will become the borders of the denture. The process is called border molding. It’s the border of the denture that is responsible for the suction of an upper denture. To create suction, you want the border to press into the tissue a little, which is why the dentist will use a heavy-body impression material. This will be followed by what is called a wash—a light-body material that fills up the interior of the impression that registers all the tiny details of the soft tissue. When this impression is shortened to one step, a medium-body material is used. As I said, the result will usually be an adequate denture, but the dentist will save chair time which saves on the cost, which is usually, but not always, passed on to the patient.

With your denture reline, your dentist will most likely use the denture he made for you as a custom tray and should get a more accurate impression than he got the first time. If he hasn’t done that impression yet, I would ask him to use a two-step impression, if he didn’t do that in the first place.

This that he told you that the gums needed to adjust to the new denture sounds to me like a stalling tactic. Gums don’t adjust to a new denture. As far as the fit of the wax try-in, he was correct that the base used for the wax try-in is made to be an approximate fit. If it is made to an exact fit it will abrade the model on which it is made and thus compromise the final fit of the denture. The wax try-in is done just to check the positions of the teeth and to make sure you like their appearance.

I hope this is helpful.

– Dr. Hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

My dentist wants to wait till the nerves settle down before replacing my crowns

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Dr. Hall,
My dentist convinced me to replace all my old amalgam fillings even though many were still stable. She was going to replace them with either composite or crowns depending on the size of the filling and how much tooth structure would be left. Anyway, we started on the project, and about six weeks ago she did three zirconia crowns for me. These crowns are so uncomfortable for me. They feel bulky to me, they press on my gums to the point that sometimes it hurts, and my bite feels off, making these teeth sore. It’s causing me a lot of stress, which especially concerns me because I have a new baby that I am nursing, and it’s like the stress is affecting her. She hasn’t been able to sleep lately and has been waking up crying all the time.
So I canceled the rest of her treatment plan. But of course she refuses to refund the money for the 3 crowns because she’s convinced they are fine and says if there is any problem, she will fix it. I don’t trust her to fix it though.
But now I have gone to a new dentist, and I want her to re-do these crowns. I realize that I will have to pay for this out-of-pocket, but I really want to get this done. But this new dentist says she does not want to touch my crowns until I give the nerves time to heal and lower the risk of needing root canals. But that can be months. I don’t know if I can wait that long.
 
– Gail from New Jersey
 


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Gail
I’m confused by the reluctance of your new dentist to replace these crowns, saying that the nerves need to heal. The problems you have with the crowns—pressing on the gums, bite is off, they feel bulky—have nothing to do with the nerves of the teeth. If those nerves were irritated, there would be heightened sensitivity to cold in those teeth. While it doesn’t sound like your first dentist has a strong level of expertise when it comes to crowns, it doesn’t sound like your new dentist has a firm understanding of dentistry either.
Yes, a crown preparation, where the dentist is cutting deeply into the tooth, can be irritating to the nerve of the tooth—in some cases highly irritating. But removing an existing crown is only mildly irritating, if any at all. If, indeed, the nerves had been highly irritated by the first crown preparations, which it doesn’t seem like has happened, six weeks would be enough time for them to settle down.
I wish you well and hope you get this problem solved. I see no reason for a delay in replacing these crowns, and I am very wary of the level of expertise of this new dentist of yours. She is displaying timidity in tackling this problem—not a good sign at all. I warn patients in several of my blog posts about how easy it is to push some dentists outside of their comfort zone, and she is giving you a red flag here that she isn’t comfortable re-doing these crowns. Maybe what is making her timid is the difficulty in grinding off zirconia crowns. They are very tough and very hard to grind off, especially if they are bonded on. The worst thing you could do would be to urge her to go against her instincts here.
If you’d like help finding a dentist who could do a good job on this for you, let me know and let me know exactly where in New Jersey you are. I know a number of excellent cosmetic dentists there.
Good luck,
Dr. Hall

 

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

The hundred thousand dollar smile makeover

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Dear Dr. Hall,
I have had a terrible experience with my “smile-makeover.” It turned out horrible, so the dentist just refunded my money, and I am looking for a new dentist. I found your website while I was still his patient and was able to figure out that he had little to no knowledge of what you describe as a true cosmetic dentist.

So I made appointments with the first 3 cosmetic dentists on your list. I must say I was so disappointed with the 1st. While he rightly said my bite was off, I was there for a 2nd opinion of the 6 upper anterior crowns I had. He said I would first need to spend $300-400 with his hygienist, and then, to deal with my bite issues and everything the cost would range between $50,000 and $100,000. “About the price of a new car,” he said. I only wish I could replace my 6-yr-old car bought used, for 1/3 his idea of a new car. He never got to what type of smile I would end up with, as his idea was to build up my back teeth and have “an appliance” covering several teeth and add porcelain “where needed.”

My teeth and gums are pristine according to a general dentist I went to for opinion and a periodontist I also went to for opinion earlier. I don’t understand why I need all of this, and I can’t begin to afford this and want your opinion.
Thanks,
– Sally from Texas


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Sally,
There’s a great variation in what some expert cosmetic dentists charge, and the fees you’ve been quoted are definitely on the high side, even if you actually need all the work that has been quoted. I would keep going down the list and get another opinion. Meanwhile, let me give you a little insight into what I think is going on in your case.

You said that you know your bite is off, and it appears that you’re being quoted a fee for a full-mouth reconstruction to rebuild your bite. Do you actually need that? I don’t know that, but I can tell you that some dentists are very fussy perfectionists and they insist that every patient accept what they call “ideal treatment.” Other dentists are more pragmatic and will consider other options for patients who can’t afford the ideal. Fortunately, you’re in the Dallas-Fort Worth area where we have several recommended cosmetic dentists. Go ahead and shop around for second opinions.

I want to tell you a story about this cost issue and dentists’ fee levels. There is a city where we have two recommended cosmetic dentists—let’s call them Dr. Expensive and Dr. Budget. Dr. Expensive is famous and has patients flying in from far and wide to see him. He does absolutely exquisite work. Dr. Budget also does very beautiful work and has won awards for the beauty of his work. Dr. Expensive’s fees are about triple of what Dr. Budget charges. Is Dr. Budget an inferior dentist? I don’t think so. I’ve seen his work and it is world class. And guess what, Dr. Expensive goes to Dr. Budget for his dental work.

So get another opinion or two.

Dr. Hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

A cosmetic dentistry horror story – but there is a silver lining

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Hi Dr. Hall.
I got 8 porcelain veneers and 2 crowns 2 weeks ago. I am 48 and have tetracycline stained teeth. I am very disappointed in a few ways and don’t know what to do. First thing is that they are too white. I look silly. I am Italian with dark skin and I look like I have Chiclets in my mouth. My dentist gave me an option on the color so I realize I am stuck with that problem. I will probably not smile very often now.

But the worst things are that I feel like they are loose and may come off at any time. I can’t bite down hard as it hurts in my molars. And also I can’t relax my teeth as it feels like the upper teeth are too long and my entire face aches like I am clenching and grinding my teeth. Help me with some advice please. I have had 5 kids with dental issues I always took care of. They are grown and gone and I finally was able to do my own smile. I am so sad about it.

Thank you.
Jamie from Virginia

Jamie,
This is the sort of story have heard so much over the years, and is the reason I operate this website. 98 to 99% of dentists simply don’t know how to do beautiful cosmetic dentistry. They chose the field because they like to fix things, and they think like engineers, not like artists.

You’re kind to take the responsibility for the color of your porcelain veneers. But there are about three things a dentist who is truly passionate about doing beautiful cosmetic dentistry would have done differently in your case.

First of all, he or she would have been knowledgeable enough about the results you would get to predict how you would look when your case was done, and would have coached you to a more beautiful result. You’ve never had a smile makeover before – how are you supposed to know how a particular color will look once it is in your mouth? A truly artistic cosmetic dentist would be focused on creating a beautiful smile, and would steer you in that direction.

Second, every excellent cosmetic dentist I have ever asked, and I have interviewed a number of them on this subject, has some method for making sure that you will love your new smile before it is ever bonded permanently. They will often make a set of what they call provisional veneers in acrylic that will be temporarily cemented onto your teeth so you can “test drive” the final result, to make sure that you will be happy. In addition to this, they have a try-in with the actual veneers – they will use a try-in paste to insert the porcelain veneers to let you see exactly how they will look. You will get as much time to look at this as you want – will get to see it under different lights, have a friend or family member come in to give you feedback on how it looks – whatever it takes to make sure that this will make you proud to smile before these are bonded on permanently. Most recently, I interviewed a cosmetic dentist in the Boston area that we recommend on this site. In 30 years, he has never had a patient who has not been happy with their new smile. If he ever did, he would re-do the case.

And that brings me to the third thing an excellent cosmetic dentist would do. These dentists, as I said, are passionate about creating beautiful dental work. Most of them, if they heard you say what you just wrote to me – that you won’t be smiling much any more – would be so embarrassed that they would re-do the case for free. I had this happen to me. I was a young dentist and it was the first time I had done porcelain veneers on someone with tetracycline stains. When dentists are inexperienced with tetracycline stains, they will make one of two mistakes. These tetracycline-stained teeth are so dark on the inside that the color shows through most dental materials, and the dentist will have them made too translucent so that the gray-brown shows through. This is what I did. Or, they will make the teeth too opaque and white so that they look pasty and fake. This appears to be what your dentist did. Well, with the case that I did, after I gained more training and experience and knew better how to make this type of case look beautiful, I offered to the patient to re-do them for free, because I didn’t want work that I was responsible for not looking beautiful. The patient never complained, but I could tell she wasn’t excited about how they looked, and I wanted her to be excited. I’m not unique – that’s typical of artistic dentists who love to create beautiful smiles.

So what do you do at this point? There really isn’t much remedy other than doing the porcelain veneers over. And this time you need to be very careful about the dentist you pick to do them. Pick one from our list – that’s why I have this website. I personally check every dentist I list to make sure they can do beautiful smile makeovers.

But I need to say a word about how your mouth feels now. The porcelain veneers cannot be loose – if they were loose they would immediately fall off. But what I am worried about is that your teeth are getting loose. You say that your entire face aches, like you are clenching and grinding now. And you think that the upper teeth are too long. I can’t tell this from a distance, but it certainly sounds like your bite has been thrown off. This could potentially be very serious and could lead to serious TMJ disorder or breaking of the dental work, or premature wearing down of your teeth, or periodontitis leading to early tooth loss, or even breaking of your teeth. This could actually be the silver lining of your cloud, because this could give you grounds for asking this dentist to compensate you so you can have this re-done correctly. Here’s what I would suggest. Go to a dentist on our list of recommended dentists. See what he or she thinks of what has been done – if the work has indeed thrown your bite off to where it is causing serious problems. And then see if he or she will help you get some satisfaction from this other dentist. You need someone more than just a skilled cosmetic dentist – you need someone who will be understanding and willing to stick their neck out a little to help you get what you deserve.

Good luck,
Dr. Hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

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

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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 A. 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 advanced internet marketing for dentists.

Adjusting the bite after a crown

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Dr. Hall,

I recently had a dental crown put on my #18 tooth after having much tooth decay removed. This was about two weeks ago, and a few days after, I started noticing pain in the adjacent teeth in front of the one with the crown. It feels like those teeth have been moved slightly. They feel tight and misaligned so my bite is a little off, and it causes discomfort throughout the day. It feels a bit tingly or like something is stuck between my teeth. Is it possible that the crown has pushed these teeth, and if so, is there anything that can be done to fix this (inexpensively)?
– Patricia in Florida

Patricia,
Yes, it’s entirely possible that the crown pushed the other teeth forward a little which made your bite a little off.

I doubt the teeth could be moved back, once they’ve been pushed. But I would ask the dentist who placed the crown to adjust your bite. There should be no extra charge for that–adjusting the bite is part of the service in doing a crown.
– Dr. Hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

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