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She wants a bright teeth look. What shade crowns should she get?

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Dr. Hall,

I am so happy to find your website. You are really helpful to people like me.

I am an Asian Indian woman. I am getting my crowns done and really very excited to see my transformation. My complexion is fair but I am not white. I have broad smile where all my teeth shows. I want to go for a bright teeth look. I am leaning towards BL2 but I need your opinion if that will be too bright? I am open for BL3 and BL4 shades too as long as it does not look like a regular teeth which is maintained well. I want great looking teeth. Please help me. Thank you very kindly:)
– Dr. Mehta

(See Dr. Hall’s answer below.)


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Dear Dr. Mehta,
You can’t make this decision based on your complexion alone—it depends on your personality. If you want your teeth to look natural, I wouldn’t go any whiter than a BL4. But you say you want a bright teeth look, which leads me to think you may want to go even whiter. If you want to “light up the room,” you can go as white as BL1, the lightest of the bleached extension shades on the new shade guides.

An excellent cosmetic dentist, whenever they do a smile makeover, will do a provisional makeover in some type of resin to let you try out the color to see how you like it. If your dentist doesn’t do that regularly, that’s an indication that he or she probably doesn’t have the expertise in cosmetic dentistry that you need. Find a dentist who routinely does provisional crowns or veneers when they do a smile makeover, and then wear those provisionals for a while to see if you like the color.
– 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.

My dentist said he can’t give me Hollywood white crowns

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Dr. Hall,
I had crowns put on 9 of my front top teeth 25 years ago. I hated the color of my teeth—they were yellow-gray. I just wanted white teeth. They talked me into a shade I hated. I am now having these crowns replaced hopefully to the white shade I originally wanted. My dentist recommended B1. He made my temporaries in the B1 shade so I could see how the color will look. I don’t feel like they are that much whiter than my previous crowns. My dentist said because I have post under a couple of my teeth anything whiter the post would show through. I would like a shade lighter than B1, but obviously don’t want the post to show through. Do you think I could go with M4 or BL4? I want white teeth without looking fake. Help, I’m having the permanent ones put on soon!
Deb

I searched for Hollywood white crowns.

(See Dr. Hall’s answer below.)


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Deb,
Based on your comments, I’m worried that your dentist is not an expert cosmetic dentist. And for getting your new smile you really need an expert cosmetic dentist.

Your dentist is confusing color with translucency. Making a crown more white will not make it more translucent. If the posts aren’t showing through with shade B1 crowns, they won’t show through with BL4 shade crowns, or for super-white crowns, say BL1.

For a smile makeover, the dentist should ask you what you want—what shape, what color, and anything else about the appearance. When a dentist tries to push a patient into something they don’t want, cosmetically, it’s often because the dentist has some feeling of discomfort with the procedure, usually from a lack of expertise and experience. So I’m wondering if your dentist has ever made a crown with one of these bleached shades. I would ask him that, and that will help you know about his level of expertise here. Ideally, your dentist should be able to show you photographs of a smile makeover case he did with one of these bleached shades. I can’t imagine an experienced cosmetic dentist not having a case like that in his or her photo album.

So here’s my advice about how to proceed. Note that I have not said that your dentist doesn’t have the expertise you need here—I’m only trying to guess what is going on. Let’s try to assume he can do this correctly. Tell him exactly what color you want and insist on that. Then be sure you have a good look at the new crowns in your mouth before they are cemented or bonded and make sure you’re happy with how they look. An expert cosmetic dentist will routinely have a try-in and will be making sure that you love the appearance before moving forward. If your dentist doesn’t do that, you can still insist on that. Have a good friend or family member with you if you want, to be a support for you and a second set of eyes. And then insist that you are perfectly happy with how they look before they are cemented or bonded. Don’t let him water down your expectations.

If your dentist won’t do what you want, or is unable to do it to your satisfaction, then you need to change dentists. This is a very do-able smile makeover. If you let me know where you are, I can maybe help you find an expert cosmetic dentist who will have no problem giving you what you want.

– 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.

Is BL4 too light a shade, if I want a natural smile?

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Dr. Hall,
I’m getting ready to get my veneers would BL4 be too white or would it be natural looking? Thank you!
Wayfon from North Carolina

(See Dr. Hall’s answer below.)


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Wayfon,
For the benefit of our readers, the BL shades were developed by Ivoclar some years ago after tooth bleaching became popular, and they are whiter than teeth are found naturally. BL1 is the whitest, and BL4 is only slightly whiter than the whitest natural shade.

When I did a smile makeover for one of my patients, I had a little questionnaire I gave them where I asked them questions about how they wanted their new smile to look. One of those questions was about the color they wanted. I asked them to rate, on a scale of 1 to 10, whether they wanted a white color or a natural color. Marking a “1” indicated that they wanted bright white teeth. Marking a “10” indicated that they wanted a more subdued color that didn’t stand out and made it look like there was nothing artificial.

You sound to me like, had you been my patient, you would have marked something between a “4” and a “6”—you want it as white as you can go with keeping it still looking natural. With you feeling that way, I would have recommended, as your cosmetic dentist, a shade B1 on the classic shade guide. With a “7” or “8,” I would have suggested an A1 shade. With a “9” or “10,” I may have gone to maybe halfway between an A1 and an A2. While my patients generally ended up very satisfied, over the long term, with the color we had helped them choose, I did have one smile makeover patient in the early days of my practice who chose the A2 shade and then later told me that she regretted not getting something whiter.

To help you see this, I have an image here photo of the Ivoclar shade guide extension for bleached teeth, showing shades BL1, BL2, BL3, and BL4 alongside the classic Vita shade guide with shades A1 and B1 of the Ivoclar bleach shade guide with shade tabs for A1 and B1 on the classic shade guide pasted next to it, for comparison. A1 is typically the whitest we would see in patients, but there would be some with very white teeth who would have shade B1 naturally. B1 is a common shade of baby teeth but not very common in adult teeth. While keeping in mind that the photographs of these shade guides may have been taken under different lighting conditions, it is still apparent that the BL4 is noticeably whiter than the B1. So if you truly want your smile to look bright but natural, I wouldn’t go whiter than B1. With BL4 you will have lovely white teeth, but they may look somewhat whiter than natural and it may look to people like you have had work done on your teeth to make them that white. Having said that, I had some patients who really wanted bright white teeth that would almost light up a room. We would give them BL1, which we nicknamed “ballistic white,” (some offices call that “Hollywood white”) and they were very happy with them. It all depends on your personality. You have to decide what kind of impression you want to make with people. If you want your bright smile to be noticeable, I would go with the whiter look. If you want them looking lovely but not advertise that you have had work done, I would stick with B1.

I hope that’s helpful.
– 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.

My new crowns are turning yellow

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Dear Dr. Hall
I was so thankful to find your website. I have been so upset for the last three weeks since these crowns have been in my mouth. I had 6 porcelain crowns on my upper front teeth. I selected color BL1, because I wanted really white teeth. My own teeth have always been very white.

But when I got the crowns, it didn’t seem to me that they were the color I selected. And now, on top of everything else, they are getting yellow. If I have a cup of coffee or something else, it seems like it stains the teeth a little. I have a consultation appointment this coming Monday about this, and I’m hoping you can give me some good advice. I haven’t been smiling because the crowns have yellow on them. I have been using Supersmile toothpaste, but it doesn’t seem to help.

My dream of beautiful white porcelain crowns is now a nightmare!

I have been looking at another dental office near me, [name redacted], and wondered if you would recommend this dentist.

Yours
Janyce in Miami, Florida

I found this blog searching for yellow crowns.

(See Dr. Hall’s answer below.)


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Dear Janyce,
I have a couple of things to say about your case.

If these are truly porcelain crowns with the glaze intact, they will not stain or pick up any yellow color. I have known a case where a patient was told she was getting porcelain veneers, which soon began to stain, and it turned out they were made from a cheaper resin substitute. I would be very surprised if that were done with crowns, but I guess it’s possible. It’s also possible that something has happened to break the glaze on your crowns. That can happen with power polishing equipment such as the Prophy Jet, or it can happen with a fluoride treatment at a dental office, if they use acidulated fluoride instead of neutral fluoride. Acids in general, such as the citric acid present in lemons and other citrus fruits, ascorbic acid in vitamin C, or the hydrochloric acid that would come up from your stomach in acid reflux, will not affect the porcelain at all. But the acid in acidulated fluoride is hydrofluoric acid which will etch the glaze away and leave your crowns with a satin, slightly rough and porous surface that will pick up stain. And, if that is happened, Supersmile toothpaste won’t take the stain away, because it has become embedded in the pores of the porcelain. Supersmile dissolves the protein pellicle on your teeth to which stains attach themselves, so it is very effective on teeth, but it also has low abrasivity, so it won’t remove stains on a rough surface.

You may want a second opinion from an expert cosmetic dentist to determine if something like this has happened.

But I also wanted to add a point about the color of your crowns. Admittedly, I don’t know the full details of your case, but I want to make some generalized comments here for the benefit of the readers who could be making some not helpful assumptions from reading the sketchy details we havephoto of the Ivoclar shade guide extension for bleached teeth, showing shades BL1, BL2, BL3, and BL4 about your case.

You said that the shade you picked was BL1. This shade is white beyond the whiteness of any natural teeth. On the right is a photo of the Ivoclar shade guide for bleached teeth. This shade guide was invented in the early 90s after bleaching began to become popular and the conventional shade guides that had been used for many years didn’t have samples matching these now super-white teeth that were whiter than any teeth that had been seen before. Your natural teeth could not have been this shade without having been bleached.

Here is the complete shade guide with the bleached shade extensions off to the left. The shade B1 is the color of very white natural teeth, and was the whitest shade we ever saw as dentists until the advent of teeth bleaching. The most common shade of adult teeth is probably A2.
a shade guide with the bleached tooth shade bl1 to bl4 on the left, and the rest showing the 15 natural shades A1 to D4
If you had not bleached your teeth, and you had come to me wanting 6 porcelain crowns on your upper front teeth, there is no way I would have given you crowns with a BL1 shade without addressing the color of the teeth further back. Otherwise, they would look fake because your darker premolars would be showing when you smiled, leaving you with a serious mismatch in colors. I would, of course, have told you that to give you the chance, if you were adamant about that request, to get that done by a different dentist. If you had wanted me to do it, there would be two ways we could get a match with the other teeth. For one, we could first bleach your teeth to see if we could get them that white. Or, we could do porcelain veneers on the remaining two or four upper teeth that show in your smile. You can get away with having the lower teeth be darker than your upper teeth, because lower teeth tend to be in the shadows anyway and it is natural for them to appear a little darker. But having a mismatch between the front six teeth and the premolars is not quality cosmetic dentistry.

About Getting a Second Opinion

It sounds like you’re already thinking about seeking a second opinion, which I think would be a good move. But I wouldn’t go to the dental office you suggested to me. I checked out their website, and there are two red flags. The first is that they have no smile gallery displayed. Any dentist in the Miami area who is serious about cosmetic dentistry is going to have photographs of successful cases, and is going to be eager to display those publicly. The office you suggested to me has no smile gallery. Also, while the information on the website about smile makeovers is fairly detailed, it shows to me a lack of artistic sensitivity and no depth of knowledge about the procedure. For example, it says that the color you want for the veneers will be picked after the teeth are prepared, an impression taken, and the case ready to send to the lab. But the final color is fundamental to the case and should be decided in the initial consultation, as well as the particular smile design you want, which isn’t mentioned. Finally, the doctor shows no cosmetic credentials—no post-graduate training in cosmetic dentistry or any accreditation. So I would definitely pick someone else. We have several recommended cosmetic dentists in the Miami area that you can check out.

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.

How white are bleached teeth?

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I’ve had this question come up in discussions with dental writers and with patients who have a misconception about teeth bleaching. They understand that teeth tend to accumulate stains over the years. They absorb the pigments from coffee, highly pigmented fruits, wine, and other sources. Bleaching, they think, is a way to remove all those stains.

They’re only partly right. Yes, bleaching will remove those stains, but it will whiten even the natural pigment in your teeth. Let me illustrate this with a couple of stories.

When I went to dental school, I learned about shade guides. The most popular one was the Vita shade guide. Here is a picture of it:
vita-shade-guide

It has a full spectrum of the range of shades a dentist is likely to encounter in natural teeth. When we needed a porcelain crown to match a patient’s other teeth, we could almost always find a shade in this guide that came pretty close to the patient’s natural tooth color.

In the 90’s, ivoclar-shade-guide-bleached-teeth when teeth bleaching became popular, we started to have a problem with this shade guide. We would have people who needed porcelain crowns, and when we tried to find a shade that matched them, they would be “off the chart.” Their teeth would be much whiter than the whitest natural shade on the shade guide. In response, shade guide manufacturers developed new whiter shades. Ivoclar was the first manufacturer that I remember doing this, and our office purchased this four-shade guide and used it to communicate with dental laboratories. You can see that shade guide at the right.

Vita also updated their shade guide, and here is a picture of the current version, with what they call the “bleached extension” shades on the left:
vita-shade-guide-bleached-extension

Serious cosmetic dentists will, of course, use this amplified shade guide because they are frequently dealing with patients who have bleached their teeth. Often, regular family dentists will only use the original A1-D4 shade guide. This led to a problem with one patient who e-mailed me around 2005. She had bleached her teeth, and was now getting porcelain veneers on four front teeth. Not knowing how specialized cosmetic dentistry is, she chose a regular family dentist to do these veneers. For the shade, this dentist selected the whitest shade on his chart. When the veneers came back from the lab, they were noticeably darker than her teeth. The dentist assured her that by using the whitest cement the veneers would match her teeth. She wrote to me, “Alas, this was not the result: there is at least an entire shade (if not more) of difference between my porcelain veneers and my other teeth.” I answered her that unfortunately, her dentist used the classical shade guide, and the whitest shade on that guide could be considerably darker than bleached teeth. For the full story, see the page under “Cosmetic Dentistry Horror Stories” where I discuss her question, can you bleach porcelain veneers?

When my own children got all of their permanent teeth in, I let them bleach their teeth if they wanted to. Even though they weren’t old enough to have any accumulated stains, they were able to whiten their teeth significantly.

So how white can you get your teeth? The results of studies seem to show that the longer you bleach, the whiter they will become, and no one, to my knowledge, has found the limit. The rate of whitening decreases the longer someone uses the bleaching gel, and everyone will hit a point where they don’t want to do it anymore. Some people get them so white that they seem to glow.

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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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