Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

August 17, 2016

Why you shouldn’t ask your family dentist to do porcelain veneers


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Dr. Hall,
2 days ago, I had a porcelain veneer placed on one of my upper 2 front teeth because it was chipped. I had bonding on this tooth before, but that fell off. This new dentist said bonding was out of the question because 1/5 of the tooth was chipped, and she recommended a crown. But I told her that I would like to do a veneer as it is less invasive than a crown.

Just before the veneer was placed, I had a chance to look at it on my tooth. It looked nice. It was lighter than my other tooth–I picked a few shades whiter anticipating bleaching my teeth afterwards. The shape looked perfect, so I signed the consent.

Once it was glued on, I had no chance to view it. The dentist and the assistant told me it looked great.

Once in the car, I looked in the mirror, and was in shock. The length of the tooth is a millimeter over to the next tooth and it looks like it is now placed a little forward. It looks like she put too much glue and that overall, the tooth looks protruded. On the back side of the tooth (closer to the tip of the tooth), I can feel a gap between the placed veneer and the back of my original tooth. When I bit in my sandwich I can feel the length difference of my teeth.

I called the dentist today and explained the issues. The assistant said the gap in the back of the tooth may be fixed but nothing could be done regarding the length. She even said it’s probably because the tooth moved. I told her I noticed right after the procedure when I got back to my car.

I have the feeling that I may need a second opinion. I made an appointment with the dentist, but I’m afraid to go.
I don’t know what to do, where to start. Any advice would be much appreciated.
Thank you so much in advance.
– Jennifer from Virginia

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Jennifer,
Unfortunately, I hear about this type of situation a lot.

Most dentists have an engineering mindset, and their appreciation of esthetics in a smile is very rudimentary. This is why they don’t take the time and trouble to learn proper techniques for doing esthetic procedures.

Let me tell you how I’m reading this situation. Admittedly, I’m making some assumptions, and I could be way off base as far as this individual dentist is concerned. But this will help you understand how many dentists think and also understand better how to get this done right.

First, the dentist says that bonding is out of the question. Why? And why so dogmatic about it? There’s no discussion of the pros and cons, just “out of the question.” It worked before, so it’s clearly not “out of the question.” With 1/5 of the tooth chipped, bonding would have been my first choice for repairing the tooth, and it would be the first choice of many cosmetic dentists. My guess is that she’s not that good at bonding. This is what dentists will do to deflect requests for procedures they don’t feel comfortable with.

So she recommends a crown. You perceived this as overkill (I would agree with you), so you asked her to do a porcelain veneer. Based on what happened to you as this procedure was completed, it seems to me that this dentist has limited or no experience with porcelain veneers. But your dentist, thinking that the artistic part is going to be done by the dental lab and not wanting to push you too hard, agrees to do the porcelain veneer, even though she doesn’t feel completely comfortable with that procedure either.

So the veneer is done and tried on. You said the shape, length, and thickness were fine when the veneer was tried on. You got a good look at it, which is appropriate. So far, so good. But then when the veneer was bonded on, this is where it gets odd. The instinct of the dentist would be to show you the final product. They had a mirror that they used before, why none now? That was always the last thing we did in my office whenever we did work on the front teeth–hand them a mirror so they can see the final product. Goodness, even my barber does that. But why didn’t your dentist? Because she’s embarrassed at how it turned out. They just told you it looked great. Ooooh, that part really annoys me, that they would try to tell you that.

This sounds like a case of getting the veneer positioned wrong when the bonding material was applied, and then when they got done curing it they saw that. This positioning of the restoration is something that is very different between veneers and crowns. It is very easy to seat a crown on a tooth–you just slip it on and it’s very easy to tell when it is fully seated and on correctly. With a veneer, the dentist doesn’t get that same feel for it being seated correctly and it is very easy to get the veneer seated in the wrong position.

It also bothers me that when you called with this rather serious issue (your smile has to look at least a little funny with one front tooth longer than the other) that they had the dental assistant answer your questions. And the dental assistant is not right. Of course something can be done if the veneer is too long. If it were otherwise okay, it could be trimmed. In your situation that wouldn’t be good enough–the veneer needs to be re-done. But trimming it would certainly help. And it’s ridiculous to attribute the problem to your tooth moving. Your tooth isn’t going to move like that regardless of how much time had elapsed since the veneer was bonded.

As I said, they probably just got the veneer seated wrong. That’s not a fatal mistake. That actually happened a once to me. The bigger problem to me is their reaction to it. They should have said something to you immediately. The correction, after the veneer is bonded, has to be to completely re-do the veneer. So if this had happened in my office, I would have trimmed and polished the veneer so it looked like the adjacent tooth, I would have told you what happened after showing you the result, and then made an appointment to re-do it.

Oh, and another point. If you’re going to bleach, the dentist should have bleached your teeth FIRST, then waited a couple of weeks for the bleached color to stabilize, then done the veneer. Your front teeth need to match exactly, and you can’t bleach teeth to match a certain color. The only way to get the teeth to match is to do the bleaching first. An expert cosmetic dentist would have told you that.

So, what to do from here?

First you need to get with a genuine cosmetic dentist. Go to our website, put in your city, and see what your options are. We have several near you in northern Virginia.

And of course your dentist should refund your money. It seems to me that she is embarrassed about this, and I believe she won’t put up much resistance to your request for a refund. If she does give you any trouble over that, you could file an ethical complaint with the dental society or the dental board. But my guess is that she will want to make this right for you. Be sure you get good documentation about how this looks–have the expert cosmetic dentist take photographs of the front and back of the tooth, because it should be fairly easy to show that the veneer isn’t seated fully. This is a clear error that any dentist should recognize.

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.

December 10, 2015

The root of great cosmetic dentistry is empathy

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Dear Dr Hall
I am having 9 crowns replaced, I originally had a white bleach colour which I did love but wanted them replaced. The dentist I have now has put me in yellow temps which I hate and he cannot get the bite or shape correct and he wants me to move on to my finals, When I mention the shape he tells me he thinks they are perfect and raises his voice, I don’t know what to do, can you please advice me on any good cosmetic dentist in the UK.

Kind Regards
Yasmin from the UK

Yasmin,
I love your question because the way you have described your dentist gets at the foundation of the problem many dentists have in not being able to deliver good appearance-related dentistry. He is basically telling you with his response to your objections that he doesn’t care what you think about how it looks. You hate how it looks. He responds by raising his voice.

The root of great cosmetic dentistry is empathy. You want to look good and the dentist identifies with your desire and wants to help you feel good about your appearance. From that empathy springs the dentist’s desire to learn how to deliver beautiful dentistry and to hone his or her skills so that you can walk out of their office eager to show everyone your beautiful smile. Empathy also drives the willingness of the dentist to listen to you and to believe that your opinion of the appearance of the work is what really matters.

Some in the profession see cosmetic dentists as overly concerned with what the patient thinks, and they consider that pandering to the patient. They try to assert that because of their education dentists know what is best for the patient and to be too concerned with what the patient wants is a betrayal of the ideals of the profession. It’s a very different view of the doctor-patient relationship.

You can’t get around that fundamental problem with a dentist unless the the dentist has some type of “awakening” on the order of a spiritual conversion. That’s not to say that such a dentist can’t be an excellent dentist. It’s just that their priorities make them unsuited for appearance-related dentistry. So you have the right idea here–you need to find another dentist to get this to look right. You should have no problem switching in the middle of the procedure.

You’re up near Liverpool. I haven’t been able to find any really good cosmetic dentists in your part of the country, but there are several excellent ones in and around London. The one I think is the best and the one I recommend there is Dr. Tim Bradstock-Smith. He does beautiful work and is AACD-accredited. You’re going to have to live with this smile for a long time–I’d take the trouble to make the trip to get this done right.

I wish you well.
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.

September 3, 2015

Which costs less, DURAthin veneers or Lumineers?

Dr. Hall,

Dr. Hall, what is the price of Durathin verses Lumineers? I would like to know which one is less expensive. I like the picture of the Durathin much better.
– Sharon from Virginia

Dear Sharon,

I need to change how you think about porcelain veneers. They are not a commodity like a necklace that you would just go to a store and buy and it doesn’t matter what store you get it from. The actual cost of the porcelain I would guess is in the neighborhood of 1% of the cost that you pay as a patient. And I’m just guessing at that because even as a dentist ordering veneers from a lab, I never even thought of that. What you are paying for is the labor and the skill in taking that material and making it into a beautiful smile. Let’s take my guess of $10 as the value of the porcelain in a veneer. The laboratory technician (ceramist) will mark that up to maybe $100 to $300, depending on his level of skill, and that is what the dentist will pay. Then the dentist will mark that up again to $1000 to $2500 which will be the cost a patient will pay for a single veneer.
And how it looks depends much more on the skills of these people than on the material itself. The reason Lumineers don’t look very good is that, because of trademark restrictions, they have to be made in the Lumineers lab, and they’re not a good lab in my opinion. DURAthin and other brands can be made by a ceramist of the dentist’s own choice. With a highly artistic dentist and ceramist, you get a much more beautiful result.
Some dentists will charge very little for Lumineers–maybe around $500 to $700 apiece. I wouldn’t let any of those dentists anywhere near my front teeth. Some dentists will charge that same amount for other brands of porcelain veneers. Same story–stay away.
I would say that in Virginia, you should be able to get a quality smile makeover from one of our recommended cosmetic dentists for somewhere around $1000 to $1200 per tooth. And that would be with DURAthin veneers or some other brand of ultra-thin veneers, which seems to be what you want. Be very selective in who you go to. Remember than only 1-2% of dentists have the artistic skills and training necessary to create a beautiful smile makeover.

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.

August 22, 2015

Follow-up on crowns vs veneers for tetracycline stained teeth

Earlier this week I fielded a question from Michele from Florida. She wondered if she should get crowns or veneers for her severely tetracycline-stained teeth. I asked her some questions about the fees and the dentist she was talking about. Here is her reply, and my response to that reply:

Dr. Hall
Thanks for your input. The cosmetic dentist is Dr. A (name withheld to help preserve Michele’s identity). He wants to charge me $42,000 for a full mouth of veneers (two teeth require crowns due to damage). The other dentist wants $26,000 for crowns. My budget cannot go over $30,000. Also, I forgot to mention that I grind my teeth at night and wear an appliance. I’ve read that veneers don’t stand up to grinding as well as crowns.

My response:

I know the cosmetic dentist you went to, and he is really good. He would give you a stunning smile. I’m not surprised that his fees are high—he is worth it.
About your grinding (also called bruxism). If you wear your nightguard, you should have no problem with your veneers. If you grind your teeth, you are actually at higher risk with crowns because then you don’t just chip off the edge—you break off the entire tooth. I had several patients who had to deal with that and you end up with implants later in life. Once you break off a front tooth at the gumline, if you’re a grinder, there isn’t a whole lot you can do with it. You see, with a crown you grind off a full millimeter of the tooth, all the way around. So if you have an upper lateral incisor that is 5 or 6 millimeters in diameter (let’s say 5.5 mm) at the gumline, then you grind down 1 mm all the way around, you now have 3.5 mm diameter. So you used to have a cross-sectional area of 95 square mm – now you have 38 square mm. So you now have 40 % of the strength left, when you’re talking about resistance to breaking off at the gumline. People who grind break these teeth off when they’ve been prepared for crowns. The lower teeth are even worse. You actually cut the strength of lower incisors down to about 1/4th of their original strength.
Here are a couple of options I would suggest:
1. Do just the upper with Dr. A and do Kör Whitening on the lower. That way you get a stunning smile and cut the cost about in half. Kör, if you use it for long enough, will have a significant effect on the tetracycline stains and lighten them enough to be acceptable as lower teeth. Then at some later point, if you feel you need to improve the result even further, you could do the lower. I had a couple of cases of tetracycline stain that I treated where we did just the uppers and didn’t do anything to the lower. With most people, the lowers don’t show as much, especially if you are younger. And even when they do show, they are kind of in the shadows.
or
2. Check out Dr. B. He is in your city. I know him also, and he also does beautiful work and his fees might be within your budget. His work isn’t at the level of Dr. A, but it’s good. Call and find out what he charges per tooth for porcelain veneers. If that doesn’t work, you could find someone else that you could drive to see. I’m confident you could find someone who could do beautiful porcelain veneers and stay within your budget. Even if you needed to fly somewhere, if the fees were $15,000 less, it would be worth it.
The interesting thing about the costs of cosmetic dentistry is that really the fees are pretty comparable for a good general dentist and a good cosmetic dentist (with the exception of exceptional artists like Dr. A).

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.

August 19, 2015

Should I get crowns to cover my tetracycline stains?

Dr. Hall,

I have severe tetracycline staining that I would like to get fixed. I’ve had consultations with a general dentist who wants to do a complete set of porcelain crowns and a cosmetic dentist who wants to do porcelain veneers (not Lumineers brand). I was quoted a price for veneers that is double the price of crowns. Can I achieve a great result with porcelain crowns or do I have to overspend my budget on the veneers in order to feel good about my smile? The general dentist has done one porcelain crown in my mouth already and I’m quite pleased with the result, although I know that a full set of these crowns will not look as real as the veneers which will have more variation in color to mimic real teeth. Please help me make the best decision regarding crowns vs. veneers. Thank you.

– Michele from Florida

Michele,

Thank you for your question.
You came to the right place! As I bring out in the website when I talk about tetracycline stains on teeth, this is a very difficult procedure and you absolutely need a talented and well-trained cosmetic dentist. There are so many things that could go wrong in your type of case.
But to get a good result, you need to shift your thinking from thinking about the techniques being used to the artist behind the technique. The reason I would tell you to beware of the porcelain crowns is because of what that says about the dentist. Let me explain.
Crowns are a very aggressive treatment, especially on front teeth. You have to grind away so much of the tooth that you weaken it and run a risk, when you are crowning all the front teeth, of snapping them off later in life. So why would a dentist suggest that when the more conservative porcelain veneers would do? Because he or she is uncomfortable doing porcelain veneers. The take-away here is that the dentist is not an artist. I think you already figured that out. I would absolutely not let him or her try to fix your tetracycline stains. Mediocre results would be the best you could hope for, and you run the risk of real trouble. And one problem you run into with the crowns is that if you need another dentist to come in later and re-do the case, you’re stuck with crowns. You can’t back-pedal to porcelain veneers.
And I’m not impressed with your telling me that you are quite pleased with the one crown this dentist did. There are a lot of dentists who can do a great single crown. A smile makeover, especially when you have severe tetracycline stains, is in a completely different league.
But this doesn’t mean I’m giving a green light to the other dentist. Is he or she a true cosmetic dentist or simply a dentist who claims to be a cosmetic dentist? This is the great peril the patient faces. Cosmetic dentistry is not a recognized specialty. All it takes to be a “cosmetic dentist” is a simple announcement–no extra training, no artistic talent. And you can’t judge them by the fees. Some poor ones charge high fees. Some terrific ones charge very reasonable fees.
You didn’t share any numbers for the fees we are talking about, or any names of dentists. You may have more than two choices here. If you’d like to follow up with any additional questions, feel free to email me back. Tell me the fee and give me the name of the “cosmetic dentist,” and I could tell you more. You have the potential here of getting a really stunning smile if you do the right thing.

– Dr. Hall

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Michele answers these last questions and I respond. Read the follow-up post: Crowns vs veneers for tetracycline-stained teeth.

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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.

August 17, 2015

What do I think of 3N Veneers?

Dr. Hall
I have read many of your answers about the veneers available with interest. I have found them very useful.
I have a question about 3N veneers. Many practitioners in the Middle East refer to these as being better than Lumineers as they look more natural and less thick. I have checked on the net but I haven’t found 3N veneers in a dental clinic situated in UAE or Saudi ARabia. Could you please clarify this to me because they say they are used in Europe but I don’t know the name given to them here in Europe. Thank you in advance for your valuable tips.
– Asma from Brussels, Belgium

Dear Asma,
Thank you for your question about 3N Veneers and your information about their popularity in the Middle East. I had to look this up, as I hadn’t heard of them before. They have an attractive but very small website that doesn’t tell us a lot about them and all its information appears directed toward the prospective patient.

But how your 3N veneers, if you got them, would look would depend totally on the dentist doing them. Can 3N veneers look beautiful? It looks to me like they can, but they can also look ugly. Look at it this way: Do you think that there is anything about 3N Veneers that would prevent a dentist from making them too opaque and chalky-looking, too bulky, the wrong surface texture, or the wrong color? Of course not. As a patient, picking the porcelain would be like choosing the members of your country’s Olympic ski team based on the brand of skis they used. Or buying an oil painting based on the brand of brush the artist used. When you study art, do you categorize paintings based on the brand of brush or the brand of canvas? No, you categorize paintings based on the artist. Once you know the painting is a Picasso, or a Rembrandt, or some other artist, you know a lot about it and will have a rough idea of its value.

When actress Demi Moore got a smile makeover, I will guarantee you that she didn’t go and research brands of porcelain veneers. She asked around and found out who did beautiful cosmetic dentistry and went to that dentist and let the dentist pick the brand of porcelain.

And once you’ve found that dentist-artist you feel comfortable with, you don’t want to tell them what materials to use or what lab. They do their own research and will pick a lab and a porcelain that they are comfortable with. If you try to push them out of that comfort zone, you’re taking a chance.

Bottom line–I don’t see anything in what I can read about 3N Veneers that makes them special in any way. Yes, I don’t see the stark white and bulkiness that I see in Lumineers. But you don’t see that either in DURAthin veneers, or other brands of ultrathin veneers. And the problem in the appearance of Lumineers is mostly from the laboratory–only partly from the material.

– Dr. Hall

Read my page, Choose the cosmetic dentist, not the laboratory or the porcelain.

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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 11, 2013

Finding a cosmetic dentist in the Cayman Islands

Hi there Dr Hall,
Many thanks for such helpful information on your website. Your support is greatly appreciated! I currently reside in the Cayman Islands, my front right tooth slightly overlaps my front left tooth. Is there anyone you could recommend in Grand Cayman, so many cosmetic dentists I don’t know where to start. I have visited one, whom suggested getting all my teeth whitened, then 2 zirconia crowns on both front teeth as sister teeth. Are there any other options to compare, or does that sound wise. I am 34 with 2 young kids and finally want not to be too embarrassed to smile.

Many thanks
– Denise

Denise,
What you’re telling me about what this dentist wants to do makes me nervous. The idea that he or she wants to do zirconia crowns on these front teeth rather than bonded porcelain makes me think that he or she is not comfortable with bonded porcelain. Bonded porcelain would be preferable to zirconia. Zirconia is great for back teeth or bridgework, but I wouldn’t recommend it for an esthetically critical situation on your two front teeth. And I would think the ideal treatment would be porcelain veneers anyway, not crowns at all. Doing two or more crowns on front teeth can put you at risk of breaking them off from lateral stresses.

I don’t understand all these cosmetic dentists you are talking about. I just googled cosmetic dentists in the Cayman Islands and looked at several websites and couldn’t find anyone I would trust with even the simplest cosmetic procedures, much less something as involved as what you are telling me. Even in the United States, fewer than one dentist out of fifty could do a beautiful job on your case. I would be surprised if you could find a dentist in the entire Caribbean area who could do a nice job on this. Quite frankly, I would fly in to Miami and have someone there do this. Dr. Sam Sadati near West Palm Beach is one I know personally who would do beautiful work for you. You could have your teeth whitened there locally and then get the two veneers or whatever your case requires done in Florida.

Why spend money to give you a mediocre cosmetic result and then possibly end up with damaged front teeth besides? Spend a little extra for a couple of trips to Florida and get it done right.
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 21, 2013

Sorting out LeAnn Rimes’ dental malpractice suit

I ran across a post on eonline.com that appears to be trying to poke fun at LeAnn Rimes for her dental malpractice lawsuit.

It posts this pair of photos, saying that the left one was taken before the disputed dental work, and the right one was taken after.LeAnn-Rimes

The implication is that her teeth appear to have problems “before” and look fine now. The comments get into a lot of ridicule of LeAnn, with some implying that she is just being litigious.

Here’s some added perspective, from a cosmetic dentistry expert. The “before” picture is NOT “before” any dental work was done. There is serious inflammation and swelling around her upper right central and lateral incisors revealing problems with the dental work on those teeth. The other teeth don’t have this inflammation around them, so I am confident that there is faulty dental work there.

Here is another pair of photographs. On the left is a very early photograph. The teeth seem to be smaller than in the “before” photograph above, which seems to bolster my point: LeAnn-Rimes

The “after” photograph, by the way, I believe was taken in 2010. The teeth look a little too large. And someone in my office remembers seeing her after the dental work was done and remarking to her son that the work didn’t look good and it appeared to affect her speech.

I get a lot of e-mails from patients who have been victimized by shoddy cosmetic dentistry. I can entirely believe that this happened to her.

When I am looking at photographs from dentists to possibly recommend on mynewsmile.com, I insist on photographs that show some gum tissue and that are enlarged enough to show whether or not the gums are inflamed. The presence of gum inflammation much less than what is displayed here will disqualify a dentist in my estimation and I will refuse to recommend them.

Click here to find a recommended cosmetic dentist and read some about how dentists qualify to be listed here.

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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.

June 20, 2012

This complex appearance-related question won’t be solved by an unmotivated dentist

Dr. Hall,
I am a 67 year old woman who has had surgery for gum disease within the last six months. Also, because of the gum disease I have 6 missing upper teeth (3 on either side). I do have the front six and a back molar on each side. I suppose due to bone loss from the gum disease my front two upper teeth have a major gap between them. At the moment I contemplating either implants but due to the cost that may not happen. I have talked to my dentist about “partials”…currently I have a flipper. I have also been to an orthodontist to discuss braces to close the gap between the top 6 teeth, particularly the middle two. The problem with braces is that the flipper won’t fit and due to the amount of movement needed a partial would have to be remade multiple times. I am not sure if I just live with the gap and get the partial for the uppers and be done with it (even though I am 67, I still work, very active and I HATE that gap). My oral surgeon does do implants but he is talking well over $20,000 and that is a great deal of money. Any suggestions would be appreciated.
Janie in Texas

Janie,
If you’re going to get this aesthetic problem solved, you’re going to have to get out of this group of conventional-thinking dentists and find a dentist who is passionate about doing appearance-related dentistry.

I can think of a couple of possible solutions to your problem that might work, but each one would depend a lot on assumptions about your condition that I really shouldn’t make via e-mail. A specific solution would require a complete examination to let me know the bone levels on the existing teeth, the sizes of your front teeth, the size of the gap, the prognosis of the remaining teeth, and how everything fits together.

Now maybe there are no good solutions other than what your oral surgeon is suggesting, given everything the way it is in your mouth, but I can tell you that the prevailing thinking in established dentistry would be that this isn’t that big of a problem and it’s not worth trying very hard and certainly not worth taking any risks. The way we were taught in dental school is that patient concerns like you are expressing over this gap are relatively trivial, and to give them too much weight is pandering and unprofessional. They would not want to APPEAR to be thinking that, but in their professional circles as they talk behind the scenes among themselves, this is the thought pattern that we see all too often.

I would suggest getting a dentist who truly believes that appearance is important. Go to our list. There are actually several of our recommended dentist within 30-50 miles of you. They are all screened carefully by me personally to be highly sympathetic to appearance-related concerns like yours and to have excellent skills.

Dr. Hall

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.

June 18, 2012

Some expert tips on bleaching your teeth

Dr. Hall,
I have received various answers on retouching my bleached teeth with Opalescence PF used with trays. I want to do this before deciding on the color for crowns. I used 20%.

  1. How long should I touch-up (for example, 1 week, 2 weeks)?
  2. How many hours each day (1 hr., 2 hours, or 3 hours)?
  3. Is it necessary to stop whitening a certain length of time before appointment (not necessary, 1 week, 2 weeks)?

Cathy from Texas

Cathy,
There is no real fixed answer on how long you should touch up with Opalescence 20% PF or any other brand of bleaching gel, and I’m concerned if you’re having these crowns done by a dentist who can’t answer these questions for you. I would have to see your teeth, know a little of the history, and know how white you want them. Is this really the dentist you want giving you a new smile? Is this a dentist with an engineering mentality who has little passion for appearance-related dentistry and who will leave you with a well-fitting smile that looks very mediocre – kind of like the photo on our home page? Or is your dentist a true artist, one of the 1-2% minority of dentists who will actually give you a beautiful smile?

Here’s the deal on teeth whitening and how much to do it. No one has found a real limit on how much you can whiten your teeth. The longer you whiten, the whiter they get. The pace of whitening slows the more you do it, but the teeth keep getting whiter. So if you were my patient and had questions like this, I would ask questions like how satisfied you are with the current color, how much you bleached them before, have the teeth darkened much since you first had them whitened, and then how much work you are willing to go through to get them to what you would consider to be their ideal whiteness.

And the amount of time each day you should whiten depends on whether or not you are getting sensitivity from the bleaching gel. Do them as long as you can, is the bottom line, as long as you’re not having any sensitivity. Now if you are sleeping, your saliva flow goes way down and the bleaching gel will stay in the trays much longer. One application should last through the night. You don’t need a gel that is specifically designed for nighttime use – they all contain peroxide. During the day, depending on how tightly your trays fit, saliva will get into the trays and wash out the gel, and you’ll need to keep replenishing it. You do need a minimum period of 20-30 minutes for the gel to soak into the tooth. Beyond that, the more the better.

The one fixed answer that I can give you is how long to stop whitening before any color-matching is done on the new crowns. The whitening is accomplished by the peroxide gel releasing tiny bubbles of pure oxygen within your tooth, and the oxygen oxidizes the stains and darker colors. Once you’ve completed the bleaching, you need to give time for those little oxygen bubbles to disperse in order to get a true color for the teeth, and that takes a couple of weeks. Now if you are doing eight front teeth, the color of the back teeth and the lower teeth doesn’t need to really match – it just needs to be close – and a week would be enough time to wait. But if you need an exact color match of a front tooth with a crown matched to another front tooth with natural enamel, you need to wait the full two weeks.

So what I’ve answered goes beyond simple teeth whitening touch-up. Once your teeth are whitened to the degree you want, then there is a certain amount of teeth whitening relapse that you will have, as the teeth pick up stains from your food – coffee, tea, berries, fruit juices, etc. But whitening for two or three days maybe an hour a day and doing that once every year or two should take care of that and enable you to maintain that bright white bleached color.

But again, I’m quite worried about what kind of work is going to be done on you. An excellent cosmetic dentist would have brought up this subject with you when the case was treatment-planned and would have covered all these points. Do NOT rely on the claims of a dentist about being a cosmetic dentist, or advertising. The problem with the dentists who don’t do very good appearance-related dentistry is that they aren’t artistically inclined and they are blind to their own shortcomings in this area. Dentists with strong academic credentials, dentists who are prosthodontic specialists, and dentists with “high standing” among other dentists can be particularly problematic. They may do highly functional, long-lasting dentistry with absolutely no artistic taste. Be careful.

Dr. Hall

Link: Click here to read our page about the home teeth bleaching procedure.

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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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