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Her dental bonding looks awful

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Dear Dr. Hall,

I chipped my two front teeth and had bonding done on them. Recently there was some discoloration of the bonding, so I asked my new dentist to fix the color. Things went downhill from there. There are multiple things wrong.

The color is wrong—the color is too white compared to the rest of my teeth. The bonding has a lot of texture, one tooth is longer than the other, and I now have a gap between the teeth. After she was done the dentist said that it’s not perfect but it’s better than before. But my only issue was a small discoloration. Now, when I looked in the mirror, I was like, “What the heck happened here?”

So I asked her to shave down the longer tooth to make it the same length as the other one. (I’m shocked that I even had to ask that!) The next thing was that the shorter tooth wasn’t straight across—it rose up in the middle, so I asked if she would just file it to make it straight. Then I asked her to fix the color a little bit a the top and she said that’s how normal teeth are with the different colors. Then I pointed out the large gap that wasn’t there before and she said yea with bonding it’s really hard to not have that. And then she said why don’t you see how you like it for a couple days then come back on Friday and I can go over whatever you don’t like. I have a good base to work with now. My question is should I let her try to fix it on Friday or just call her tomorrow and ask for refund. I feel bad because she is nice and all but this looks worse than it did when I went in. I’m very upset!

Michelle from Florida

I found your blog searching for bonding issues.

(See Dr. Hall’s answer below.)


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Michelle,
I wouldn’t hold out any hope that this dentist will get this right. The basic problem here is that dental schools don’t screen their applicants for artistic ability. They teach them the mechanics of how to fix teeth, but the schools aren’t designed to churn out dental artists. If this dentist can’t get this right, it’s time to make a separation and move on.

Dental bonding is the most artistic procedure that dentists do. They have a selection of materials of different colors, textures, and translucencies, and they have to put that all together to create a lifelike replica of tooth structure. A very small number of dentists are very good at this and can sculpt an entire tooth to look so real, no one can tell it’s dental bonding. A larger number of dentists can take on a small repair of a chipped front tooth and make it look pretty good. But it sounds like your dentist is on the far left of the bell curve and has trouble with very basic appearance-related dentistry.

There is also a difference in their approach to the patient between excellent cosmetic dentists and repair-oriented general dentists, and that is in their listening to the patient. An excellent cosmetic dentist will keep on a case until you, the patient, are happy with how it looks. Your dentist, however, is showing a tendency to be objecting to how you think this should look. When patients aren’t happy with the appearance, many of them will try to tell you that you just need some time to get used to it, rather than addressing your concerns. Listening to the patient is what drives the excellent cosmetic dentist to create beautiful work.

– 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.

I’m looking on Yelp to find the best cosmetic dentist

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Dr. Hall,

Help! Know this is short notice, as having work started on Wednesday, December 4, 2019. And thank you for the great website, that just discovered today.

Am approaching 70, medium fair skin tone, but not pale, blue gray eyes, medium neutral blonde hair. Have decided on bonding for economical reasons. Am a big time grinder, so will need a new nightguard when finished with dental work.

Have downloaded some color charts. Realize very white teeth would look un-natural with my age and coloring. Want bright, happy smile. Any suggestions on bonding color? Will have six teeth total, 2 central, 2 lateral, and 2 canines. There is bridge work on first premolars both sides; probably BL2 or BL3 color. Perhaps all six BL2, as bonding will darken a little with time? Tea drinker with half/half, white wine only, never red, and dental cleanings 4x a year (2 with Periodontist)

Thinking of having my dentist start with the canines. On yelp, he is ranked within top three dentists for smile makeovers in Pittsburgh. Thank you so much Dr. Hall. Appreciate your help.

– Mary from Pittsburgh


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Mary,
I’m going to break down your questions into three parts.

Let me start by taking the easiest one to address. You’re not going to find the best smile makeover dentist by looking at the Yelp rankings. I love Yelp and am a Yelper myself, but sometimes the dentists they list as the best cosmetic dentists aren’t very good. They rank this with an algorithm, based in large part on their reviews, but it doesn’t appear to me that they make any distinction as far as what is in the reviews.

Let me show you that by the Yelp results in another market that I am very familiar with. This is in a suburb of a major United States city with a population of about 150,000 where I know a number of the dentists. Searching in Yelp for the best cosmetic dentist in this suburb gives as the #1 ranking a dentist with 33 reviews with an average rating of 4.5. However, none of the reviews say anything about smile makeovers. Only one mentioned anything with any appearance component, and that was just a single tooth where the dentist got the color right. The website of this dentist shows no significant cosmetic dentistry credentials and there is no smile gallery. The dentist I would rate as the best cosmetic dentist in this suburb ranked #13.

Getting more specific with your search term, I thought I’d try to search for “best smile makeover dentist” in this suburb. The #1 result was a group practice with six dentists, none of which had any credentials at all in cosmetic dentistry. The website has a smile gallery, but it displays stock photos they got from their dental website company, presumably because they don’t have any of their own to display. The #2 result is a dentist who has no website at all. None of the reviewers mentioned having a smile makeover. They mentioned things like doing a great job on a root canal, being gentle, reasonable fees, cleaning was great, the office was clean, etc. The #3 result was an oral surgeon who extracts teeth but doesn’t do any restoration.

This ties in with the reason I set up this referral service, because there aren’t really good ways for the public to tell who are the great cosmetic dentists. Lacking any other guidance, my advice would be to check the smile gallery yourself, make sure it tells you clearly that it is showing the dentist’s own work, and go from that. There are some technical issues you’re not going to be able to evaluate, so this method is imperfect, but it’s better than asking Yelp.

On Your Color Questions

All these questions you asked about the color—I really don’t know how to help you with that. There isn’t a formula for choosing the right color. The basic issue is how white you want to go. When you get into the darker natural shades of teeth there are yellow-whites, tan-whites, gray-whites, and brown-whites, but when you’re into bleached teeth colors, we don’t make those distinctions. If you’re going to do only six teeth, you’re going to be limited in that you have to match the color of the premolars. The color is best chosen in consultation with the dentist doing the case.

On Bonding vs Porcelain Veneers

And you didn’t ask this question but I’m going to address it. You’re looking for a budget smile makeover so you think you’re going to save money by doing it with composite bonding rather than porcelain veneers. I will tell you that it’s going to be really tough to get a beautiful smile makeover that way. There are great cosmetic dentists who won’t do a full smile makeover with composite bonding, and the reason is that it is so time-consuming to do that well, they would have to charge MORE for the composite than the porcelain. In all my years of practice, I only did two full smile makeovers with composite. One was on a young girl who had badly splotched teeth after she was done with her braces, and that was because she needed to be a little older before getting the porcelain. The other was on a patient I talked into letting me do that for a reduced fee so she could be one of my accreditation exam patients. I made her a deal to do that first and then the next year I did porcelain veneers over the bonding.

Another problem with composite bonding is that it stains or dulls so easily that often it only looks good for two or three years when it is done over that large an area. And then, since you grind your teeth, composite chips much more easily than porcelain. That would be another obstacle—protecting this bonding from breaking. I’m reading between the lines here that you have worn your teeth down and will need them made longer. If you came to me, I would decline to do your case in composite because I would feel it would be taking your money but doing you a disservice—it just wouldn’t hold up. Your risk is that you’ll get a dentist with poor ethics who will agree to do this for you. I think you’d be best getting porcelain and then protecting that with a nightguard.

So there’s my opinion for what it’s worth. I wish you the best. I’ll email you privately with my recommendation for a cosmetic dentist for you. I like to do that privately so I don’t offend the dentists I don’t recommend.

– 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 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 composite bonding is turning yellow

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Hello Dr. Hall, 9 months ago I had dental bonding done on my four front teeth. There is quite a bit of composite on each tooth because I have been re-doing it every 3 or 4 years for 20 years. My question to you is, I see a bit of yellowing, is it possible to just polish them to try and whiten them again since they were done just 9 months ago? Thank you for your time!
– Linda from New Jersey


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Linda,
One of the big differences between composite bonding and porcelain veneers is that the porcelain is very hard and stain-resistant (it resists stains better than tooth enamel), and composite is much softer and much more susceptible to stains, so it has a much shorter lifespan.

The good news is that with the composite bonding, usually those stains can be polished out, depending on the type of stains.

Composite is susceptible to two types of staining. The first type, the type that can be polished away, is a surface discoloration. The surface of the composite will get tiny scratches in it and become roughened which causes it to attract stains of all kinds. A good polishing will get rid of the scratches and the accompanying stain and restore gloss to the surface. Below is an example of this type of staining. You can see that the surface of the two front teeth has a matte finish from all the tiny scratches, as contrasted with the gloss of the adjacent natural teeth:

dental bonding with yellow staining

Photo courtesy of Dr. Robert Soto, San Francisco, CA

But composite will also absorb stains into the actual substance of the material. Composite is composed of inorganic filler particles such as quartz or glass bound together in a plastic matrix. Certain colored liquids, such as coffee, tea, cola drinks, or highly pigmented fruit juices, will actually penetrate the plastic part of the material and become a part of it.

dental bonding stained yellow

Photo courtesy of Dr. Mark W. Langberg, Southfield, MI

This type of stain will not come out with polishing. But this staining also occurs more slowly and can take a couple of years to become noticeable. At the right is an example of this type of staining. You can see that the composite has retained its gloss. The discoloration is coming from deep within, as stains have been absorbed by the material.

Preventing This Staining

There are several preventive measures you can take to get the bonding to keep its nice appearance for longer.
1. First, choose an expert cosmetic dentist who stocks a full inventory of esthetic bonding materials. General dentists will typically stock general purpose composites that are actually impossible to polish to the high gloss needed to resist stain and look like enamel. The surface of the bonding should be a microfill composite that is polished to a high shine.
2. Second, don’t use an abrasive toothpaste. While Supersmile toothpaste is quite a bit more expensive than your typical Crest, Colgate, or other drugstore brand, those general brands have abrasives in them that will scratch the surface of your bonding. Some of the abrasives are worse than others. I always provided my bonding patients with a first free tube of Supersmile, because it has no abrasives but rather lifts stains off by chemically dissolving the protein pellicle on the teeth.
3. Third, make sure your dental hygienist is polishing your teeth with a very fine abrasive. Pumice tooth polish is a big no-no. She or he should be using a fine aluminum oxide polish. Ask for this. (See my web page giving tips for maintenance of dental bonding.)
3. Fourth, beware of staining beverages. If you need to drink them, swallow them quickly rather than letting them sit in your mouth. And remember that hot beverages have more staining power than cold ones because they cause a slight expansion of the plastic, opening up microscopic pores that can be penetrated with the stain.

Finally, I would seriously consider switching to porcelain veneers. I don’t know how much your dentist is charging for this bonding, but dentists who do it well will charge quite a bit. Which costs more–doing composite bonding six times over 20 years, or doing porcelain veneers once for those same 20 years? Porcelain veneers done by an expert cosmetic dentist can easily look beautiful for 20 years. Porcelain is harder than tooth enamel and more stain-resistant. But go to an expert cosmetic dentist for porcelain veneers–don’t ask your family dentist to do this.

– 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 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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