Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

September 6, 2018

Matching the color on a crown for a front tooth


We thank our advertisers who help fund this site.

Hi Dr. Hall,
I had a root canal done on my front tooth over 10 years ago. In the past few years I had noticed a blue discoloration at the top of the tooth. After trying internal bleaching, my dentist ended up doing a crown.

The first crown that came back from the lab looked very white. He redid it. The next tooth, which is in my mouth now, looks better but doesn’t match the other front tooth. The dentist permanently cemented it in, but when I got home and took some selfies I was unhappy with how unnaturally white it looks.

The dentist will give it another try but my question is — should I let him try again or go to someone else who specializes in cosmetic dentistry? I now live in Princeton, NJ and my dentist is in Brooklyn. Cost is a factor.
Thanks,
Ronnie

Ronnie,
Doing a crown on a single front tooth is a tricky procedure. The slightest variation in color between the two front teeth is usually very noticeable. And it isn’t just the overall color—any tooth has multiple colors in it. Even expert cosmetic dentists will often have multiple try-ins before they get the crown to match perfectly. When I was in practice, I charged about 40% more for crowning a single front tooth because we would typically send it back to the lab three or four times until we got it perfect and I would charge the extra fee because of all the extra appointments. Dentists with poor cosmetic dentistry skills sometimes ask patients to crown both front teeth in order to get the color right.

That your dentist would think that the crown would look right after one or two trips to the lab shows either inexperience or a low level of commitment to excellent cosmetic dentistry. I’m not meaning to imply condemnation with that comment because that is typical of the overwhelming majority of dentists—maybe 98% of them. So yes, if you want this done so that your two front teeth match perfectly, you need to raise your sights and go to an excellent cosmetic dentist such as we recommend. There are several excellent ones within reasonable driving distance of Princeton, say 15-30 miles.

However, depending on how big a factor cost is for you, and if your dentist is willing to work with you to get this right for no extra charge, you may want to stick with this dentist to save the money of having another dentist start over with you. And, I would add, if you are willing to make several more trips back to Brooklyn. To help the process, you or the dentist should get hold of a good digital camera that is capable of taking a clear photograph of the new crown in place next to your natural tooth under outside light, such as right next to a window. That will go a long way toward helping the ceramist pin down the right color. And be sure that the crown is only temporarily cemented until you have seen it under various lighting conditions.

If you want perfection—a crown so natural that you can’t distinguish it from the real tooth next to it—you need the expert cosmetic dentist. But if you are willing to accept some compromise of that ideal in order to save money—try letting your dentist have some more tries to get this closer.
– Dr. Hall

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

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

July 3, 2018

Botched case by a very reputable dentist


We thank our advertisers who help fund this site.

Dear Dr. Hall
This started about five years ago when I wanted to get a single crown for my front tooth (#8). The crown ended up being bulky and the color was off. After that, I was referred to a very reputable dentist. The first crown he did was too gray. The second crown he did was closer, but didn’t fit into my mouth because of a protruding lower front tooth. At that point the dentist told me to get orthodontic work. When I did that, I ended up with a gap.

I’m now shopping around for a dentist I feel comfortable with, and I feel very uncertain about this. I am not 100% sure these dentists are going to follow through with getting it right. My last dentist has a really great reputation. He charged me enormous fees, paired me with a reputable ceramist, and it still didn’t work. Strangely, as I interview other dentists, when they hear his name, I am forced to defend myself. If they see the work, they back off, but everyone assumes the patient is at fault. As if I somehow caused the poor looking crown. Or am just being too picky?
– Melissa from Southern California

Melissa

Melissa,
Yes, I’m very familiar with stories like yours. But it’s interesting—you say the dentist and ceramist had “great reputations.” Oh, there is such a difference between a dentist with a great “reputation” and a great cosmetic dentist, and likewise for ceramists.

If you do a lot of reading on my blog, you’ll learn that institutional dentistry—most dental schools, the American Dental Association, and the “reputable” dentists look down their noses at cosmetic dentists. They mock them, calling them “cosmetologists” and unprofessional. I was taught in dental school that, on issues of how the dental work should look, we should not listen to the patient but should use our professional judgment. To these academics and dental leaders, true cosmetic dentists are pandering to the patient and unworthy. Read the Wikipedia article about cosmetic dentistry, written by someone with this academic mindset, and you’ll get a flavor of this condescending attitude.

This goes to the heart of why I founded this referral service and this blog—to be the politically incorrect advocate for beautiful dentistry.
Here, read two of my blog posts that deal with this issue. In the first one, the patient didn’t like the result because the teeth looked too white and phony, but the dentist insisted that they were fine, basically telling the patient that her professional opinion should out-weigh the patient’s opinion.

In the second post, I answer a patient named Glen from Massachusetts who kept having reservations as his smile makeover proceeded. As he voiced those reservations, his dentist kept telling him, “trust me.” After the work was completed and Glen was still unhappy with it to the point where he was embarrassed to smile, the dentist sent him a certified letter where he relates his professional opinion combined with that of several colleagues that the work looks great. This contrasts with the attitude of great cosmetic dentists that they are treating the self-perception of the patient and if the patient has reservations about the appearance of the final result, the case is a failure.

This is what I see over and over again when someone gets a recommendation from a dentist in this institutional mindset for appearance-related dentistry. They get a great mechanical dentist who has a “great reputation” among his or her peers but is really psychologically unfit for appearance-related dentistry. True cosmetic dentists are outliers in the dental community.

If you can come to fully understand that and realize that you were victimized by this institutional mentality and referred to a dentist who had a great reputation with the wrong crowd, and now you are moving into a different world that plays by a different set of rules where everything depends on whether or not the patient likes the final result, you may find it in yourself to trust again.

Dr. Hall

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

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

December 15, 2017

After my new crowns, my jaw and neck hurt all the time


We thank our advertisers who help fund this site.

Dr Hall,
I recently had my six front teeth, from canine to canine, crowned. Doing this it closed a large gap between my two front teeth. Now I can’t speak clearly and because of the closure and the stress of trying to learn how to speak again my jaw and neck hurt all the time. Also, my mouth stays dry and my lips are numb what could this be caused by?? Also is it possible to get the space put back between the two new crowns on my front teeth?? Your advice would be appreciated.
– Paul from Georgia

Paul,
This sounds like a serious problem that needs to be addressed.
I am pretty confident your troubles have nothing to do with closing the gap between your two front teeth, but are because of other problems with the crowns. I closed many such gaps in my practice and never had any adverse feedback like you are giving me—no speech issues, pain, or dry mouth. It sounds to me that your dentist opened your bite too far.
It could be that your crowns are too thick and/or too long. This could cause a problem called lip incompetence which is the failure of the lips to close naturally, without effort when your teeth bite together. If your bite is correct, when you put your teeth together, your lips should naturally fall into place and be closed without your having to think about it. Your dry mouth and the numbness in your lips suggest to me that you may have this lip incompetence.
Also, if your crowns are too thick, they could throw off your bite leading to pain in your jaw and neck, besides causing speech problems.

Both the pain and the dry mouth are serious problems. The pain issue is obvious. The dry mouth less so but is just as important because it can lead to rampant tooth decay. The washing and buffering action of your saliva, plus the antibodies it contains are critical in fighting tooth decay. Don’t let this go on.

You really need a second opinion. I’m suspecting that your dentist got in over his or her head in doing this many crowns simultaneously on you. That’s my guess. I’d go to one of our recommended cosmetic dentists to evaluate the result and see what needs to be done to fix it.
– Dr. Hall

Do you have a comment or a question or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

September 28, 2017

I want to avoid getting a crown on my front tooth, after a root canal


We thank our advertisers who help fund this site.

Hello Dr. Hall,
Back in May 21st I had my front upper tooth knocked out. It was put back in, bonded and set back into place. I had a root canal done on it as well. I’m noting that the color is slightly off (more yellow) than the rest of my teeth. My dentist said that I would probably have to get a crown after my last visit, but looking online I see that a crown for a front tooth may not be a good idea. How can I preserve the whiteness of this tooth without needing a crown? Thank you for your time.
– Joseph from Staten Island, NY

Joseph,
You’re right. A crown on a front tooth, while it strengthens it against chipping, actually weakens the tooth against lateral stresses. So if you have a heavy bite at all, it is at greater risk of breaking off.

After a root canal treatment, a tooth tends to discolor. But that discoloration can be greatly lessened by cleaning out the inside of the crown from any root canal filling materials such as gutta percha or cement. If it is starting to discolor already (four months after treatment), the dentist has left some of those materials inside the visible part of the tooth.

Here’s what I would do.

Go to one of our recommended cosmetic dentists in Manhattan, Queens, or New Jersey, and have them clean out the inside of the crown. Since the tooth has begun to discolor already, it would be a good idea to have them do internal bleaching. Then you could have them fit the tooth with a fiberglass post inside and seal the opening, and you should be good for several years before it starts to discolor.

Then, when it discolors, I would just have them do a single porcelain veneer to correct that. This would require a fair amount of expertise in appearance-related dentistry to match the color of the adjacent tooth, but I’m confident that any dentist we list would be able to get that to look great for you.

Oh, one other thing. Since this is a replanted front tooth, you want to have it x-rayed again to make sure you don’t have any external resorption. It’s possible that your body could be eating away at the root. That happens sometimes with these replanted teeth. Be sure to find that out before you invest much money into this tooth.

And just a comment about your dentist. It looks like he or she did a nice job of saving your tooth—did all the right things, and is probably an excellent dentist. But these demanding aesthetic problems are over the head of the vast majority of general dentists.

I hope this is helpful.

Dr. Hall

Do you have a comment or a question or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

October 26, 2015

The cheapest, easiest, fastest way to fix a front tooth that broke off at the gumline

We thank our advertisers who help fund this site.
.

Dr. Hall,
I recently broke my front tooth off, right below the gumline. I am looking for the cheapest, easiest, fastest way to fix this. I am 100% against implants.
– Harley from Nebraska

Harley,
Are you really asking me this? I don’t think you really mean the question the way it came out.

For the cheapest, easiest, fastest way to fix your broken front tooth, go to Walmart, buy a tube of Superglue, and glue your tooth back in. Cheap, easy, fast.

Problem is, the repair will only last for a couple of days. But long-lasting wasn’t on your list of requirements.

Another solution, not as cheap but also easy and fast and, as a bonus, long-lasting, would be to have a dentist bond a glob of composite onto the broken part of the tooth, making a little mound. That would last a long time. It wouldn’t look very good, though, but looking good wasn’t on your list.

Let’s re-order your priorities and make it first, something that will look good, and second, something that will hold up long-term. To accomplish that, there are two options. And neither one is cheap, easy, or quick.

It could be possible to repair the tooth by placing a crown on the remaining root. But that would only work if there isn’t a lot of stress on this tooth. If you have a deep overbite or even just a strong bite, it would be hard to get the crown to stay on. But if you have a gentle bite, it could work. You would need to have a root canal treatment on the remnant of your tooth, then have a good, strong post that’s not completely rigid. Either a carbon fiber post or a fiberglass post would work. The stress on a front tooth is mostly lateral. If you have a rigid metal post going down into the root and then put stress on the crown of the tooth, that stress will transfer to the root through the post and tend to cause a root fracture. If the post has a little flexibility to it, however, it will not transfer stress to the root and thus not tend to fracture the root.

And better yet, I would place two posts side by side, to help resist rotational forces that would tend to weaken the bond to the tooth over time. All posts are perfectly round, so any twisting force on them will tend to dislodge them.

However, if there is any significant stress on this tooth, the only solution that will hold up over a long time would be replacing the tooth with a dental implant. This could cost twice as much as a root canal, posts, and crown, and would take substantially longer because of the healing time required. But it would look good and last much longer. Doing the crown first could have you ending up with the dental implant eventually because the crown would fail.

Bottom line—sometimes the cheapest dental solution is the most expensive, the quickest solution takes the longest, and the easiest solution is the most complicated. It’s generally best to just fix it right in the first place and then be done.

– Dr. Hall

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

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

March 18, 2013

Can I switch from having crowns on my front teeth to having porcelain veneers?

Dr. Hall,
If my top two front teeth were initially ground down for crowns and there is no crown on the teeth will veneers work on the teeth now?
– Tina from Kentucky

Tina,
Once a tooth has been prepared for a crown, a crown is the only restoration that will work for that tooth – it will always need a crown.

The difference between a crown and a porcelain veneer is that the veneer covers just the front of the tooth and not the back, whereas a crown covers the entire tooth. But the distinction is not cut and dried. Some veneers can also involve the sides of the tooth. And some dentists will talk about placing porcelain veneers and then prepare the teeth for crowns. I disagree with this practice, and most expert cosmetic dentists would feel the same way, but it happens. To make it more confusing, many dentists will charge the same fee for a veneer as for a crown. So if the dentist covers the entire front of the tooth, both sides, and half of the back of the tooth, is that a crown or a veneer? I would call it a crown, but some dentists would call it a veneer.

Removing a lot of tooth structure is aggressive dentistry. However, I like the philosophy of minimally invasive dentistry, meaning that the dentist removes the least possible tooth structure to accomplish the desired outcome. This is the practice of the great majority of excellent cosmetic dentists – the type of dentists we recommend on this website. So if you need a new smile, we would shave about half a millimeter of enamel from the front of the tooth, which is about the thickness of a fingernail. There would still be enamel covering the tooth – it would just be a little thinner. That allows for half a millimeter of porcelain, which is adequate for changing the look of the tooth – the shape and the color. If a tooth is out of alignment – say it protrudes out in front of the others – then more would need to be removed to leave it in line with the others. Likewise, if it is turned inward, there may need to be little or no enamel removed at all to give an attractive result.

A crown will strengthen a back tooth against tooth fracture in almost every situation in which it is used. However, on front teeth, since they are subject more to horizontal stresses, a crown can weaken an otherwise healthy tooth, making it more susceptible to lateral shearing forces. That is why I like to be as conservative as possible in treatments to front teeth. A well-placed, conservative porcelain veneer will not weaken a tooth.
– Dr. Hall

We thank our advertisers who help fund this site.

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.

July 28, 2011

How to get a refund from the dentist who screwed up.

Dr. Hall,
In November 2009 I had a crown put on my number 8 front tooth. My tooth was slanted from sucking my thumb when I was little, and this was to fix that.

About 3 weeks after my crown was put on my tooth was really sensitive to hot and cold. I was told that was normal for the first few weeks. About 4 months later my tooth was hurting so bad that I had to go to the ER! The next day my face swelled up and I was out of work for 5 days. When I went to another dentist, they told me that my tooth was infected and that I would need a root canal and a new crown. I was like WHAT??? how could this happen? She told me that I had an open margin and it was from the crown not being placed properly.

I called the first dentist, who did the crown, and I told the secretary the situation. I told her that i deserved my money back because for his mistake i have to pay for another crown and a root canal!! she said that once the crown was in my mouth it was my responsibility!! I said even if it was a failed job???

Is he liable for this? Shouldnt he pay?? I have seen the xray and the open margin is huge! ! If he we re to have taken xrays at the end of the job he would have seen the open margin and knew it had to be redone.

At the time I was making payments on the crown and paid a little more than half. After I found out about his mistake i told the office i was not paying the balance . About three months later I got a notice saying he was suing me for the balance! I couldnt believe it ! I of course filled a countersuit and when I went to the small claims court his lawyer told me if i drop the counter claim then the dentist would “forgive my debit”. I said NO I want the money that I paid him and his lawyer said “Well he is not willing to do that.” The case now has to be handled by the superior court because civil court can’t deal with things like this.

My question is should this guy have fixed his mistake? Because of him I was in the most extreme pain I was ever in, I had to miss days of work, I had almost a dozen appointments ( emergency room, doctors and dentist visits), my face swelled up so bad that I could barely see and I had to get a new crown and a root canal . Please let me know what you think!

Thanks!
– Sarah from Massachusetts

Sarah,
You have quite the story!

I have to qualify this because I can’t judge this without seeing. But just going from what you’re telling me, yes, your former dentist is liable for violating the standard of care. The most important thing to check when a new crown is being seated on a tooth is to run the explorer around the margins and make sure there is a good fit to the crown. Usually a dentist won’t take an x-ray before seating a crown, but they always need to run that explorer completely around the margins of the crown and check for any open margins. But having the x-ray you have is good documentation showing his negligence.

The problem, though, in many cases like this is that the dollar amounts involved make it impractical to involve lawyers and to go to trial. But here are a couple of things you can do to increase the pressure on this dentist to refund your money:

1. Threaten to complain to the dental board. Not as serious as a malpractice suit, this is still something that the dentist is strongly motivated to avoid.
2. Have the new dentist help you. A call from one dentist to another, verifying that there was indeed a problem with the work, can be very persuasive. In a trial, you HAVE to have an expert opinion of a dentist to back up any claim of negligence. Your word isn’t good enough.
3. Have a lawyer write a threatening letter. Rather than pay for an entire malpractice case, just having a letter from an attorney can get the dentist to take your complaint more seriously.

Dr. Hall

Click here to read more about porcelain crowns on front teeth.
Click here to ask the dentist a question.

 

We thank our advertisers who help fund this site.

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.

Powered by WordPress

Follow this blog

Get every new post delivered right to your inbox.


Categories