Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

September 21, 2018

Gap between my crown and my bridge


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I have a space between my 2 front teeth, however one of my front teeth is a crown and the other front tooth is part of a bridge. Can the gap between my front teeth be closed with Lumineers or any other procedure or would I have to get a new bridge and crown, possibly all in one structure to close the gap?
– Laura from Nevada

Laura,
Your question prompts me to ask a question of my own: Why did the dentist who made the crown and/or the bridge leave a gap between your front teeth? The easy way to fix this would have been to make them correctly in the first place.

At this point, yes, you pretty much need to have probably both of them re-made—depending on how big the gap is. Both front teeth need to be the same size—you don’t want to close the gap from just one side by making one side larger.

this microetcher has a long nozzle with a button on it, and at one end a small clear plastic bottle as a reservoir

A Micro-Etcher

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But there is a procedure you might want to try before doing that. There are ways to bond composite to porcelain, and you could start with trying that—treating this as a dental bonding case. If the dentist has what is called a micro-etcher, which is a small sand-blasting handpiece, he or she could micro-etch the porcelain surfaces next to the gap. This would be followed by etching with a hydrofluoric acid gel and then priming the surface with a silane coupling agent. A bonding resin would then be applied followed by composite bonding material to match the shade of the crown and the bridge. The composite would be shaped and polished. In theory, this should work. However, my experience with bonding to porcelain was that after a few months, we would see staining along the margin between the composite and the porcelain. But it could be worth a try to try to avoid the expense of a complete re-do of your front teeth.
I would think it goes without saying that you need an expert cosmetic dentist to do this, such as we recommend on this website.

The company that makes Lumineers, a few years ago, tried to promote the idea of bonding Lumineers over the top of porcelain crowns, but I strongly discourage that. You would get the same risk of staining at the margins, and would spend the same amount of money as you would spend just re-doing the case completely. Click the link to read more about the problems with that approach.

– 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.

June 11, 2018

Another family dentist trying to do cosmetic dentistry


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Dr. Hall,
Last year, I had a tooth with composite bonding chip. My dentist retired and the new dentist suggested veneers. After realizing my teeth had fillings, he said he could only do crowns. Unfortunately, I didn’t question him because I knew nothing about this procedure at all. Now, I have six porcelain crowns on my front teeth that I hate. My front two teeth look gray in pictures and do not blend with the other four crowns. What can I do?
– Anna from a small town in central Georgia

Anna,
So you have another cosmetic dentistry horror story. You have spent a lot of money and probably look worse than before you started.

There isn’t a whole lot you can do except have at least these front two crowns re-done. Hopefully your dentist cares enough about his work that he will take care of this for you without charging you.

In re-doing them, you should insist on a try-in before they are bonded, and you should make sure to get a good look at the crowns before they are bonded or cemented into place. And when they are tried in, that should be done with a clear try-in paste that will help transmit the color of the underlying teeth through the porcelain of the crowns. Since your dentist clearly doesn’t have much expertise in cosmetic dentistry and so is unlikely to have try-in pastes, he can just use clear glycerin or any other clear water-soluble gel which should work just as well. Otherwise, you can get a false reading of what the actual final color will be.

If your dentist won’t do that for you or balks at any part of these instructions, you will have to go somewhere else. If that is the case, I would strongly recommend taking the two-hour drive to Atlanta where you can go to a real cosmetic dentist who knows what he or she is doing. Check our list of recommended cosmetic dentists—any one of them could do a beautiful job of this for you.
– 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.

August 10, 2017

This cosmetic bonding went bad


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Dear Dr. Hall,

I recently had four of my front teeth bonded. My two very front teeth overlapped one another slightly and the dentist ground down both of them. The lateral teeth were set back in my mouth, and those are filled out to make it look more like a normal arc. My teeth are very uncomfortable and sharp feeling inside where he did the grinding down of the teeth. In other words, he “sacrificed” the one front tooth by grinding down the side of it in order to make the other front tooth look straighter. In addition, he also made the teeth a shade that is yellowish to “blend in”, no matter how much I protested. I have had such terrible regrets about doing this. I wish I could go back to the way my teeth were before the work because they were still intact and not damaged as they are now. I know there is no going back but would love your opinion on my options at this point. I have also had a problem at the gum line for a couple of years now, with there being a gap that has had to be bonded a couple of times before this work was done. I went with the bonding because I did not want to do anything drastic, but in fact that is what I had happen. I would like my teeth to be whiter and also not have that “damaged” feel to the back and sides of them. They were ground down quite a bit. I am very upset and this dentist is very difficult to deal with. I know this is rambling but if you have any advice for me, I would greatly appreciate it. Thank you for your time and assistance.

Sincerely,
Alani from Washington

Alani,
Your explanation of what happened is clear enough that I can help you with what to do from here.

This type of cosmetic bonding work is really beyond the ability of, I would estimate, 98% of general family dentists. It requires some artistic sensitivity, stocking a variety of dental bonding materials beyond the ordinary inventory that most dentists have on hand, and a fair amount of training and experience beyond dental school in shaping, coloring, and polishing the dental bonding materials, besides the shaping of the teeth.

I would need a photograph to see exactly what went wrong here, but I can tell enough to be able to say, with a fair level of confidence, that you aren’t going to get a pleasing result from this dentist. This is not to disparage him. I imagine he did the best he could and the work is probably up to the standard of care for general dentists. Your case was just over his head.

The good news is that there are a couple of excellent cosmetic dentists in Washington who are not too far from you. Go into our find a cosmetic dentist directory, type in your zip code, and it will pull up the recommended cosmetic dentists near you, either of which I’m confident could get you an attractive, comfortable result.
– 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.

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

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.

August 31, 2015

Dentist got the tooth bonding color wrong, doesn’t want to fix it

Dr. Hall,

I would like to send photos of what we consider is a bonding error. My granddaughter (25 years old) had a gap fixed between her two front teeth, and then had her lateral incisors bonded to make them a little larger. She immediately remarked on the color difference between her front teeth and her lateral incisors. But the dentist then told her, “The color difference was to match your eye teeth.” But then later he told me on the phone that he used the same material on all her teeth. So these are two different stories. The central incisors look fine and the color looks fine, but he told my granddaughter that he used a darker color on her lateral incisors to match the eye teeth, but he told me he used the same color.
He now wants further payment for a correction. He says to try whitening toothpaste too. I already paid $350 for whitening by tray and gel, and $900 for the bonding work. Her lateral incisors are a definitive blue/grey.
Where can I send pictures?
Thanks
John from Ontario

(Note – John then sent these photos of his granddaughter’s teeth after I told him how to send them)

before dental bonding errorBefore dental bonding[/caption]

dental bonding error - color mismatchAfter dental bonding error showing color mismarch.[/caption]

You can see in the after photo that the lateral incisors look substantially darker than the centrals.

Dear John,

Actually, truth be told, the lateral incisors should be slightly LIGHTER than the central incisors—just slightly, and then the canine teeth are darker, in a natural smile. I think this dentist knows that, which makes it seem like he is trying to make excuses. So my answer is, yes, this is a dental bonding error, a cosmetic dentistry mistake. The teeth look fake and her smile doesn’t look natural. And you didn’t ask about the shaping of these two lateral incisors, but that looks off, too. The tooth color error is particularly noticeable and makes the case unacceptable, in my opinion. Like you said, they’re kind of a gray putty color and are actually darker than even the canine teeth.
But then the next question is what do you do about this. You say that you’re okay with the work that was done on the central incisors. It looks like there was a chip in one of the centrals that he must have fixed and a gap between the two central incisors that he also closed. That much looks okay to me, thought the photo is a little fuzzy.
There are two directions to take in trying to get some satisfaction from this dentist. You can ask that he fix it himself, or you can ask that he pay to have someone else do it right. Generally it is better, when you’re talking about cosmetic dentistry, to forget about trying to turn the first dentist into an artist. That just doesn’t happen. So I usually recommend getting someone else who can do it right and getting some compensation from the first dentist to cover those costs. But in this case it looks like he maybe did okay on fixing the central incisors (though the photo isn’t as sharp as I would like). And while the shaping of the laterals isn’t great, you seem satisfied with that and are only concerned about the color.
You’re welcome to take this dentist my email here. I would recommend not being confrontational. Like I said, it appears that he did a nice job on the central incisors. See if you can get him to agree to re-do the bonding on the laterals. Bleaching isn’t going to work. Toothpaste isn’t going to work. I kind of think he knows that, too. The color is embedded in the bonding, and it needs to be removed and replaced with a lighter color. It needs to closely match the central incisors, maybe just a teeny tad lighter.
And then, of course, this needs to be at his expense. You paid to have a nice smile, and you haven’t gotten it yet. He should make good on the work.

Dr. Hall

Read more about fixing a discolored tooth from a root canal treatment.

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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.

January 23, 2013

What is this mysterious brown stain on my teeth?

Filed under: Tooth staining — Tags: , , , — mesasmiles @ 12:13 pm

Dr. Hall,
I appreciate your help. Last year I began getting mysterious brown staining on my teeth that my dentist cannot remove. He did not tell me it could be fluoride. A natural health practitioner told me it is from excess fluoride. I am 63 years old. I have not used fluoride toothpaste in years, but my township has fluoride added to the water. I have been drinking Poland Spring water which also has fluoride. I do not drink wine or coffee. Last year I started drinking a cup or two of green tea daily which I just found out has plenty of fluoride, so this must be what pushed me to fluoride overload and brown staining. I only drink plain water now. Do you know which bottled water brands do not contain fluoride? Which type of whole house water filtration system removes fluoride?

Which cosmetic dentists in New York City would you recommend for bonding? I have had some previous bonding in NJ and was not happy with the color matching.
– Linda in New Jersey

Linda,
Dental fluorosis is a mottling of the enamel caused by excessive intake of fluoride while teeth are forming. In its mild form it is manifest by white spots. When it is more severe the spotting or mottling can be brown.

Once your teeth are formed, they will not be stained by fluoride. So if this is a stain that is new, it has nothing to do with fluoride.

I’m a little puzzled by your statement that this is a stain that your dentist can’t remove. Once your teeth are fully formed, any stain that they pick up should be able to be removed. Let me explain the two different ways to do this, depending on the stain.

There are only two types of stain that you would be getting on your teeth at age 63. One type would be external staining – something that attaches itself to the surface of your teeth. Any stain of this character should be able to be polished off. Supersmile toothpaste also works very well for removing these types of stains. It enzymatically removes the protein pellicle on your teeth, and it is that pellicle to which the stains adhere.

The other type of stain would be internal staining. Your teeth can absorb pigments from food and drinks. Tea is an excellent source of this stain, and, from the clues you are giving me, that seems to be the top candidate for this stain. I would know better if I could see it myself. Internal stains get absorbed into the enamel of the teeth and can only be removed with bleaching. Internal staining would be manifested by a general darkening of the color of the teeth. External staining would probably concentrate around the gumline of the tooth and the spaces between the teeth and would be irregular in appearance. Internal staining would be evenly distributed throughout.

I would not recommend bonding for this type of staining, if that’s what you have. Bleaching works better, is much less expensive, and doesn’t require anything artificial to be attached to your teeth, so it will look nice perpetually. Bonding would also require an expert cosmetic dentist, which limits you to about 1-2% of dentists. Any of the expert cosmetic dentists we recommend on our site would do an excellent job with bonding. But you don’t need an expert cosmetic dentist for bleaching – many dentists can do that well.

If you do need bonding work, however, and you are in New Jersey, you shouldn’t need to go to New York. Dr. Allyson Hurley, in Bedminster, does a fine job with bonding. She is AACD accredited. Google her and you will find her website. Dr. Jeff Golub-Evans, in Manhattan, is internationally renowned for his bonding skills, and sees many fashion models and movie stars, if you need that level of care.

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 13, 2012

Fixing a black triangle

Filed under: Braces — Tags: , , — mesasmiles @ 8:00 am

I had a spring retainer made and then the orthodontist shaved 2mm off the side of my tooth and its created this black triangle because he didn’t make the spring retainer right. I still question whether the 2mm needed to be shaved because I had braces before and everything was fine before the tooth shifted. Anyway, is there a way to help the gum grow and cover this black triangle? .
– Jamie from California

Jamie,
About this black triangle – I feel like I would need to understand more about your case to say whether or not this is easily fixable. I would suspect that the orthodontist is planning on closing this space, but I don’t know. I general, these black triangles can be tricky. Preventing them or treating them is all in the shaping and positioning of the teeth on either side. It doesn’t really work to graft in gum tissue to cover these. The position and shape of the gums is a natural response to the positions and shapes of the teeth on either side, and if you surgically re-shaped the gums, within a few weeks they would go back to their natural contours.

We occasionally see complaints of people who have had braces and then have some associated gum recession and get black triangles between their teeth. If this does happen and the teeth are straight and touching each other, then the solution has to be some type of dental bonding to add to the sides of the affected teeth near the gumline.

To address this you need an expert cosmetic dentist. Please don’t make the mistake of going to your family dentist for a solution to this. This is way beyond the basic education dentists get in dental school.

Read a post with Jamie’s follow-up question, where Dr. Hall begins to question whether or not Jamie is becoming obsessive over a small defect: Sometimes you just have to trust your dentist.

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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 10, 2012

Do cosmetic dentists have to be artists if they outsource their porcelain work?

Dear Dr. Hall, How does one find a good cosmetic dentist that can do good bonding work? Most cosmetic dentist outsource their veneers and crowns to labs, but bonding is in the hand of a dentist. How do we filter the good and the bad? Does your list of referred dentist look at bonding work, in addition to veneers and crowns?
James from San Francisco

James,
Yes, the excellent cosmetic dentists that I recommend, for the most part, will also do beautiful direct dental bonding work. I say “for the most part,” because even some excellent cosmetic dentists don’t like doing direct bonding, but I would say that 90% of them do.

But I’d also like to address this question about “outsourcing” of their porcelain veneers and porcelain crowns to labs, because some people have the mistaken notion that if it’s a great esthetically inclined dental lab, it doesn’t really matter who the dentist is because it’s the lab that creates the porcelain work. I guess they think of it like buying artwork from a gallery – it doesn’t matter which gallery you bought it from, it only matters who the artist is.

But there are a couple of reasons that this isn’t true.

First of all, a great dental ceramist cannot really work around a poor dentist to produce a beautiful final result. The dentist starts by preparing the teeth and planning out the case. How the tooth is prepared and the quality of the tooth preparation as well as the quality of the impression that is sent to the laboratory is critical to the success of the case. Then the dentist is the one who writes the prescription, giving detailed instructions about the shade map of the final result, the surface texture, the degree of translucency, a mock-up of the final result desired, and a lot of other details. And then when the work comes back from the lab, it’s the dentist who approves the work and decides whether the case is ready to be bonded onto the patient or needs to be sent back to the technician. No, while a great laboratory technician is required for a great final result, there is too much that the dentist does for the case for an artistic laboratory technician to be able to produce a beautiful result in spite of the dentist.

Second, a dentist without a great artistic eye will not use the services of a great ceramist. Those services cost more, and it just doesn’t happen that you would get a “great ceramist – poor dentist” matchup. Oh, there are some dentists who are not very good cosmetic dentists who will use a name brand laboratory like DaVinci or Microdental in California to impress their patients, but those are large dental laboratories with large numbers of ceramists of varying levels of ability, and they will not assign their best ceramists to work with dentists whose work they perceive to be of lower quality. I’m sure it’s not something they talk about, but it doesn’t happen that way.

So pick the artistic cosmetic dentist, and that dentist will assume responsibility for the quality of the final result. That is the way for a patient to get beautiful cosmetic dentistry.

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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 30, 2012

I’m an adult with baby-sized teeth

Dr. Hall,
If you’re an adult with baby sized teeth. Can tooth bonding make them Adult size? If so, what is an estimate price for enlarging 4 teeth and closing a Gap?
Tiffany from California

Tiffany,
The best solution for making small teeth larger would be porcelain veneers. While dental bonding could be used, that’s not the best solution, and I’ll explain why.

The dental bonding material is relatively soft, compared to, say, tooth enamel, which is very hard. It will feel hard to the touch, but it is susceptible to scratching, and it can also absorb stains. So it won’t look that good for very long. Porcelain, however, is even harder than tooth enamel and less susceptible to staining. So what you would have with dental bonding would be a smile that would look really great for a year or two and then it would start to look dull and stained. But with porcelain veneers, with proper care they will stay shiny and bright for 10, 15, 20 years or more. Dental bonding can be less expensive – done well it may cost maybe 2/3 of what porcelain veneers would cost. But by the time you replace it or resurface it 4 or 5 times it ends up being considerably more expensive.

For a beautiful job, expect to pay $1000 to $2000 per tooth, maybe a little more on the higher end where you are in southern California.

And be very careful where you go for your porcelain veneers and absolutely do not try to look for bargains here. While many dentists claim to be able to place porcelain veneers, only about one in fifty is artistic enough to do a good job with them. If the procedure is too expensive for you, the best choice would be to do nothing. Your own natural, small teeth will look better than a poorly done set of porcelain veneers. But if you go ahead and get veneers and then don’t like how the final result looks, you will have no legal recourse. Look for our cosmetic dentistry horror stories section to read more, if you’re not convinced.

Dr. Hall

Links: Look for more blog posts about cosmetic dentistry horror stories.

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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.

January 16, 2012

Confused about the use of ultrasonic toothbrushes on bonding and porcelain veneers

I’m confused. Your site says not to use ultrasonic cleaning devices for bonded teeth, yet you’re selling an ultrasonic toothbrush. Please respond accurately with factual information – does ultrasonic toothbrushes cause any harm to dental restoration – not just abrasion, but do the vibration cause a loosening of the bond (over time or otherwise). Please explain.
– Helen from Florida

Helen,
Thanks for your question. I looked on the website to see where this confusion might be coming from, and I see where it is put in a fuzzy way and confusing. I have gone back to clarify a couple of the pages and hopefully that will help.

When I tell people not to let a dental hygienist use ultrasonic cleaning devices on their bonded teeth, I am referring to equipment like the Cavitron that has a metal tip that vibrates at ultrasonic speeds. This metal tip can nick the margins of bonding and also of porcelain veneers. In several places on the site I reference these as ultrasonic scalers, but in one place I call them ultrasonic cleaning devices. That’s too broad a term, and I’ve corrected that instance to make it clear I am talking about these ultrasonic scalers.

There are two differences in trying to apply this concept to toothbrushes. The first is that the bristles of these electric toothbrushes are soft and so are incapable of nicking anything solid like dental bonding or porcelain veneers. Rather, they clean and polish, which is a beneficial result. And the second is that the toothbrushes are almost always “sonic” toothbrushes, not “ultrasonic”, which means that they vibrate at slower sonic speeds, which also makes them more gentle.

And there is a dentist who has posted something on the Internet claiming that sonic toothbrushes loosen dental bonding. However, this is without any factual basis. He is the only one saying this, and, in fact, the University of Missouri at Kansas City did a study they published in 1998 which proves that this is a fallacy. They brushed teeth for two years with a sonic toothbrush and could not find any weakening of bond strength. This confirms my own observations.

And don’t misinterpret this to be a condemnation of ultrasonic scalers in the hands of a skilled dental hygienist. While they can be misused and can nick the root surfaces of teeth, when used properly they are a great aid and produce a superior result. My dental hygienist uses this every time I come in for a cleaning, and it leaves my tooth surfaces smooth and spotless.

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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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