Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

October 1, 2018

Better to do nothing than cheap cosmetic dentistry


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Dear Dr. Hall,
I reside in Henderson, NV. I have four porcelain fused to metal crowns on my front teeth since I was 24 yrs old. In 2015, I wanted to update dental work, I ‘Kör whitened‘ my teeth, which made those crowns look bad. I visited a cosmetic dentist, Dr. Featherstone who you have listed on your website. At that time, my paltry insurance would not co-operate, so I didn’t stay with Featherstone. His billing assistant actually had a credit application there to apply for a loan. Plus, she said, we had to pay in advance, and if there were money left over at the end, they’d refund it. My husband & I slunk out of there, glad to be free of that.

Next, I visited Dr. Michael Wilson, the only other one on your Nevada list. He would not do four, only eight, saying about four, “You won’t like it.” At first I agreed to do it, right then and there, he measured for a laboratory wax-up version, $800. I backed out the next morning, and a week later went and picked up the model. He was decent about it, and we left the door open.

Well, from there, I went to my general dentist, Dr. F. Those original crowns from when I was young were big and long and gave me a big smile, in every picture all my life. Now, Dr. F’s version are short, greenish (I picked the wrong shade). His words were, “I’ll make sure you get the teeth that you want.” But, he couldn’t please me, and ended up giving it to his assistant. I mean, it was excruciating, going over it again and again. You finally just settle. These teeth are too short, when I wake up in the morning with mouth agape, you can’t even see any teeth (thus, it makes you look like an old person). She remarked, “Oh, you probably are looking on the internet, and expect these perfect teeth.” Yes, exactly. I had your examples and pictures in hand.

Anyway, here I am, three years later, still not sure where to turn. Thank you for letting me vent. I live with this. My husband raises his voice at just the very mention of it.

Thank you very much.
– LaRae from Nevada

LaRae,
Quite the story you have.

I’m confident that either Dr. Featherstone or Dr. Wilson would have done a beautiful job for you. I’ve seen work from both of them and have interviewed them both. It’s too bad that they were too expensive for you. Your case illustrates a point I often make—if you can’t afford quality cosmetic dentistry, it’s better to do nothing and save up to have it done right than to go cheap. If the first dentist who did the Kör bleaching knew what he was doing and was honest with you, he would have told you that the crowns wouldn’t bleach and the results would commit you to re-doing the crowns. It would have been good to have had a complete plan from an expert cosmetic dentist from the start.

About Dr. Wilson wanting to do 8 crowns instead of 4—we see this where good cosmetic dentists will disagree on how to proceed with a case and in some cases will turn down a case unless they can do it the way they think will turn out the best. When I was practicing, I was more like Dr. Featherstone where I might compromise on a case because a patient didn’t want to spend more to get the “perfect” result.

– Dr. Hall

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

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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 29, 2016

Just a filling, but it’s getting really complicated now


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Dr. Hall
I am 34, never had a cavity, and had been with the same dentist for 10 years. Our insurance changed so I had to change dentists about 2.5 years ago.

At the first appointment with the new dentist she said I had a cavity needing filled. I was shocked, had had no symptoms, but due to childcare complications had her fill it right then. It hurt for weeks, she adjusted and it continued to hurt.

I waited out the year and switched insurance back to my old dentist, He said I had had that shadow on my x-rays for 10 years with no change and it was likely I didn’t need the filling. He adjusted it and within days the pain stopped! However, the filling kept tearing floss and pocketing food under my gums. He recommended I have it fixed so the pocketing food wouldn’t cause an issue.

He did the repair in January. As soon as the numbness wore off, I had pain where the numbing medication had been injected and my tooth was very sore. This remained and then progressed to heat and cold sensitivity over the next few hours. I called him a week later and he had me come in. He gave me options and we decided to try steroids orally for any inflammation. I have had bad reactions to steroids in the past, but thought I would be okay to try.

It really isn’t any better, and now I am scared to go back. He said worst case scenario is removing the tooth. I am devastated but also in almost continual pain for 6 months now, especially to anything not body temperature. My appointment is tomorrow to try to brave him fixing it again. I don’t know what to do or even if I can trust him anymore. HELP ME PLEASE.

– Erin from Texas

Erin,
Boy, there’s a lot to say about your saga with this tooth.

I’d love to be able to see your tooth and see exactly what happened here. Not seeing that, I have to make some assumptions. I will tell you that it doesn’t sound to me like either of these dentists is doing good for you, but there are more problems and more serious problems with your current dentist than with the one who originally did the filling.
Let me address several of the points you bring up:

1. One dentist seeing a cavity or feeling like a tooth needs to be filled and another dentist disagreeing with that–we see that kind of professional disagreement often and there is no ill intent with either dentist. My inclination is to be more partial to the dentist who called it a cavity. As an additional point, your dentist’s explanation seems suspect to me. A shadow on your x-rays for 10 years and he never even told you about it? That sounds to me like an excuse. A dentist doing one filling–because of the overhead involved there is little to no profit in that and it is more an annoyance to the dentist, so I don’t think there was any dishonesty in the dentist who filled it. It’s more likely there was sloppiness in the dentist who let it go for ten years.

2. The tooth becoming sensitive to hot and cold after repairing the filling–that’s bad. I would assume (because the problem was the filling catching floss and catching food and because of the post-operative sensitivity) that the “repair” involved replacing the filling. For it to become sensitive to hot and cold after a simple filling replacement something had to go wrong that he didn’t tell you about. Especially since the sensitivity wasn’t immediate. Temperature sensitivity after a new filling isn’t uncommon and doesn’t mean that anything went wrong. But this wasn’t a new filling. To simply take a filling out and replace it shouldn’t be that irritating to a tooth, and based on the problems you were having, he wouldn’t have even needed to replace the entire filling.

3. Steroids? Really? Wrong treatment! The hot and cold sensitivity in your tooth indicates a possible low-grade infection in the tooth. Steroids would make that worse. Steroids block your body’s response to inflammation, but also block its response to infection. Not good.

4. Removing the tooth? Bad again. I would be scared, too, if my dentist started talking to me about extraction at this point. Things are cascading out of control quickly here. There is quite a list of steps, every one of which has to go wrong, before he should be talking about extraction.

Bottom line–I think you should find a new dentist. Between the two you’ve seen, I think you would be better off in the hands of the dentist who did the filling. Though she didn’t do great for you, you just had the one mishap, not this series of problems. But the better thing would be to get a different dentist entirely.

I don’t know what the deal is with your insurance, but I wouldn’t let your insurance hold you hostage here and prevent you from getting adequate care. Losing this tooth over this simple cavity that was apparently just a slight shadow on your x-ray, that’s too much.

I’m wondering how you ended up with two dentists, neither of which has done very well for you. Maybe the problem is that you have really cheap insurance and no really good dentists want to participate in that plan. That occurs to me. If that is the case then maybe, to get this done right, you need to go outside your insurance company’s list of “preferred providers.” From the point of view of the patient, if your insurance company is using that term, “preferred provider,” I would translate that as “cheap dentist.” That’s what insurance companies mean by preferred.

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 20, 2015

My dentist says the cavity is too deep for a white filling

Filed under: White fillings — Tags: , , — mesasmiles @ 3:02 pm

Dr. Hall,

I recently went to a dentist who wanted to give me amalgam fillings on the back bottom teeth. I would not let him. He claimed that the cavities were too deep for white fillings, so I walked out. I need to find a dentist who will give me white fillings in my area. My insurance is Denti-Cal. do you know of anyone?
-Marion from Los Angeles

Marion,

A couple of points in answer to your question.
First, that is a lame excuse, saying that the cavity is too deep for a white filling. The truth is that the deeper the filling, the greater the reason for doing a white filling. Amalgam makes a tooth more sensitive to hot and cold, and the deeper the filling, the deeper the heat or cold is conducted into the tooth. Plus a deep filling is likely also to be wide, leaving the walls of the cavity thinner than usual. A bonded white filling will strengthen those walls where an amalgam filling will leave the tooth more susceptible to breaking.
But your insurance is a problem. Denti-Cal is the government dental insurance plan in California, and that is what is screwing you. Not only does Denti-Cal not provide any benefits for white fillings (because amalgam fillings are cheaper), they actually prohibit you from paying the difference yourself. So the only way you’re going to be able to get a white filling is to pay for the whole thing yourself.

– Dr. Hall

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

We thank our advertisers who help fund this site.
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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.

November 11, 2011

A dental horror story, and getting things fixed from here

In 2010 I changed going to the dentist I had gone to all my life as he was retiring. I am 62 now and I wanted to go to someone that was closer to my home. My insurance gave me a choice of dentists.

I went to my first appointment and my new dentist said I needed 4 crowns on my bottom back teeth replaced. He said they were over five years old, and they had decay. They had been on many years. Same with the four front teeth but he said he could put on whiter crowns but I would wait till the new year for more help from the insurance. I had the new crowns on my bottom teeth crowned in 2010 with CEREC porcelain and paid an extra $150.00 per tooth that they did not charge the insurance, just me. Now I find out that all porcelain crowns are usually put on just the front teeth.

Then the dental office said the front 4 were pre-authorized by the insurance. So I had all 8 front teeth prepared and got temp caps and waited for my crowns. They came back and he cemented them on. Then problems started. Besides finding out the work had not been pre authorized the back of one of my front teeth chipped off. I went in and he ground on it and sent me home. The next day half the tooth fell off. My husband left work and took me back and requested he redo both front teeth which he agreed to do. So I went back to the lab for color match again. The lab told me that they had not made any mistake on the first crowns and they were not very happy about it. So when the new crowns came in they were very thick on the backs and the dentist had to grind on them. After he ground for a while he stopped and said he could not grind anymore as it was getting too thin. So I went home and realized that everything I ate got stuck in between the two teeth. He said he would check with the lab but I would probably have to pay them to remake the crowns. I was shocked. A month went by and no word back. I finally called my insurance and they said to file a complaint. They did an investigation, sent me to a different dentist that said my bite was horribly off. The insurance finally said there was not enough evidence to show he did poor work on my front 2 teeth.

Then came a letter from my dentist that he would not see me anymore. I did not want to go back to him either but what about the problem and what about any guarantee on all the work previously done? I went on until it was time to go back for my checkup. I decided to go to a dentist that a friend went to and loved. He did his checkup and told me the blackish color on some of my new crowns was micro-leakage and bacteria under the crown had caused that. When putting on the crowns everything has to be as steralized as possible. So once again I filed a complaint with the insurance. In the meantime one of my front crowns broke off. I added to my complaint my tooth breaking off. So now I am waiting to hear back from the insurance again. This new dentist emailed his chart notes of his work. He did two root canals and crowns on my upper back teeth and he did not use all porcelain. He also included pictures of my teeth with the micro-leakage and the gap between my two front teeth and my bite being off with his recommendation. So I am waiting to hear back from the insurance and trying to decide whether or not to get an attorney involved as the insurance will only recover the money they paid if they agree with my complaint. In the meantime I have a temporary on my front tooth. This has been a nightmare. Will you please give me your thoughts on this?
– Corinne from Utah

Corinne,
If you go to a new dentist who says that all of a sudden you need a lot of work, something is wrong. Frequently, the old dentist was negligent in either not diagnosing correctly or in doing patchwork dentistry rather than comprehensive dentistry. But it could be that the new dentist is taking advantage of you. If that happens to anyone, I would recommend getting a second opinion from a dentist you know is up-to-date. Don’t rely on your insurance network – find another dentist on a private pay basis, a dentist who has a modern, clean office, that appears to be high quality, and get a second opinion and compare notes. Say as little as possible about your situation and nothing about what either dentist said. Don’t even identify the dentists, but make it clear that when you have the work done, you are going to use a dentist in your insurance network. You’re just looking for an honest opinion from a dentist you feel is up-to-date and who you know has no stake in the outcome. If you can take copies of your x-rays, do so, but remove any identification of the dentist. If you have to, just pay for additional x-rays. It’s worth it, to get to the truth.

Another problem people have is relying on dentists in their insurance network. These are not usually the best dentists. The dental insurance company usually picks them because they are the cheapest. (Read more about preferred providers here.) And while I am not in a position to say whether or not your crowns needed to be replaced, I am suspicious, from what this dentist said about the crowns being over five years old, that the dentist was merely taking advantage of a known insurance company standard that they will pay for replacement of a crown after five years, and maybe there really wasn’t any decay.

It appears that you were victimized by this dentist and all the crowns that you may not have needed and the poor workmanship. And if that is the case, I would seek some compensation from this dentist.

Here is what I would advise. Before going to an attorney, I would ask your husband to demand a refund of everything you paid and threaten, if the dentist doesn’t cooperate:
1. to go to an attorney and
2. file a complaint with the dental board.
I would also see if the dentist who examined the faulty dentistry would stand behind you on this dispute. That is key to getting any settlement from the dentist – having another dentist who can vouch for the faulty work.

If the dentist will settle with you, hopefully you can avoid going to court. But if the dentist resists, then I would talk to a lawyer.

About using porcelain crowns on back teeth, that isn’t an issue here. There are porcelains that work well on crowns on back teeth. I have a CEREC all-porcelain crown on one of my lower molars and it works fine. It depends on the strength of your bite, the position of the tooth, and the type of porcelain used.

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.

October 18, 2011

Beware of insurance plans that don’t include your dentist!

Filed under: Dental insurance — Tags: , , , — mesasmiles @ 8:56 am

I got this request from a website visitor regarding a dentist I know in Louisiana. I forwarded it to his office, but then also wrote an e-mail to the patient and thought I would share this with you. This dentist is an excellent general dentist, not in our cosmetic dentistry network, but a fine general dentist, and I felt the patient was making a mistake with the approach he was taking.

“I was Dr. X’s patient for years but unfortunately he’s not in my insurance network. I was trying to get his e-mail address to send him a list of available dental providers in Baton Rouge so he could recommend one. Thanks for your help.”
– J

Dear J,
This is Dr. David Hall. I’m a dentist who runs the company that services Dr. X’s website. I just happened to see your request, and it has been forwarded to Dr. X’s office. But I thought I’d offer a word of advice.

I have run a dental blog for many years where I answer questions by patients, and I can tell you that I have seen many sob stories of dental care that started with this move that you’re about to make – you have a dental insurance plan that doesn’t include the dentist you have trusted for years, you switched to the dentist that accepted your insurance, and that is when all your troubles started.

What is going on behind the scenes, that you don’t see, is that the insurance company is trying to cut costs. They probably approached Dr. Collins and all the dentists in the area with their discount fee plan and Dr. Collins was one of those dentists who said, no, I can’t maintain the quality of services I wish to provide and cut the corners I need to in order to accommodate your fee schedule. So the insurance company has found a group of dentists who are willing to cut those corners, and now you’re about to trust your mouth to their care.

I would think twice about that.

With most of these plans, you can see a dentist of your choosing if you’re willing to pay a little more. I’d really suggest that you look into that option.

Dr. David Hall

Links: Read more about preferred provider plans.

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 1, 2011

My teeth are crumbling, and what if I can’t afford any other treatment but dentures?

Filed under: Dentures — Tags: , , , — mesasmiles @ 6:19 pm

Dr. Hall,
I am considering getting full dentures. I was told I had little enamal left on my teeth about 13-14 yrs ago and since have had two pregnancies in which I vomited every day(sometimes multiple times a day) during my entire pregnancy. Since the birth of my last child 8 yrs ago my teeth have literally started crumbling like powder,cracking and I have a lot of visible cavities.

I had a tooth removed last week because it had already started falling apart and I cracked it in two blowing up a float for my child and I had flat out had enough. Five of my teeth are literally down to the gum line now and one crown and post have fallen out. My dental insurance only covers $1000 a yr and it doesn’t take much to use that up so if you are wondering why I have not had all this fixed as it happened when you run out of insurance in March it is hard to get anymore done with insane cost of cosmetic dentistry. It will only cost me $1400 out of my pocket to get upper dentures (I am still debating on lowers as they are not as bad as the uppers) but I was quoted about $4000-$5000 out of pocket to get root canals and crowns or bridges. I do not qualify for any loans or assistance to get this done so dentures appear to be the only option.

I have read just about everything you have on this site and am really irritaed at your comments about peoples care or lack of care for their teeth as you do not know ! what som e have gone through. I also had meningitis as a baby and was put on alot of meds( I have other health issues due to this but my teeth are the worst). I would love to have an awsome cosmetic dentist fix my teeth right but unless you or they intend to do it for free I think you need to stop being so condecending about what people should do and/or what caused their teeth to become bad in the first place. In case you are wondering I have brushed after every meal and snack since I was a kid and flossed at least once a day as well as rinsed with a mouthwash but it has done me no good except to ensure fresh breath.
– Wendi from Alabama

Wendi,
It sounds to me like you’ve almost completely decided what you want to do, so I don’t know that you need much help here, but I’ll offer some. I was also intrigued by your comments and wanted to respond to them.

I think you’re trying read things into my website that aren’t there if you come away from reading it thinking that I would condemn someone like you in your situation. I don’t know where you would get that. Yes, I’m going to tell people to take care of their teeth when they can. To do otherwise would be negligent. But I rarely criticize patients who write to me with their problems. And then there are always things that can happen that are difficult or even impossible to deal with, which sounds like what you have experienced.

If your finances are really limited, it may be that dentures are your only option. I saw a number of patients in your situation and did my best to help them as much as I could. But don’t expect me to sugar-coat your situation. There are troubles ahead when you get full dentures. They will reduce your chewing efficiency, and there is a great deal of dissatisfaction out there with people who have dentures. In addition, your jawbone will begin to shrink and within about twenty years or so, you will have to deal with facial collapse. But let me try to be helpful, and share some ideas that may be helpful for your situation, because you are in a difficult situation.

Losing your lower teeth is much more serious than losing your upper teeth, and an upper denture is much easier to adjust to and to use than a lower. An upper denture is held in place with suction, so it is considerably more stable than the lower denture, which rests and kind of floats on your lower jaw and is held in place by your tongue and cheeks. Additionally, if you have lower teeth chewing against an upper denture, it may help the lower teeth to last longer. So if you are looking for the most economical solution and you can keep your lower teeth, any amount of time you can keep them will delay facial collapse. And there is much more satisfaction with upper dentures than with lower ones.

Also, any teeth that can be saved for any amount of time will delay the bone resorption. Sometimes the crowns of the teeth can be cut down and the roots of teeth can be retained and this will also delay the bone resorption.

I hope that you can find a sensitive and caring dentist who will take care of your needs and take the time to discuss your options.

Dr. Hall

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.

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