Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

July 3, 2018

Botched case by a very reputable dentist


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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

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About David A. Hall

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

September 4, 2017

Wanting a cheap way to fix tetracycline stains


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I have terrible Tetracycline stains and thinking about Veneers, I am curious if the they cover just the front of the tooth?
Also, I am 60 years old and really want a nice smile before I pass on, not wealthy at all. Are there any dental schools that do work with interns?
Thanks
Tony from Louisiana

Tony,
Porcelain veneers cover the fronts of the teeth, but in the case of tetracycline-stained teeth, they need to wrap around the teeth somewhat in order to completely cover the very dark stain of tetracycline.

As far as the cost, you are in for potentially serious trouble if you are looking for cut-rate porcelain veneers. Covering tetracycline stains is a very demanding cosmetic dentistry procedure and I wouldn’t consider going to any dentist who would charge less than about $1000-1200 per tooth for this. I would absolutely not go to a dental school for this. Dental schools exist to teach the fundamental techniques of dentistry, not the artistry, and they are so ingrained with an engineering mentality that most dental school professors actually look down their noses at cosmetic dentists and procedures that patients want just to enhance their appearance. Also, not only would your “intern” be doing his or her first tetracycline case, but likely the instructor would also.

If you want to save money, the best way to do that is to do nothing. Otherwise, I would simply save up and have this done right. Make a selection from among the best cosmetic dentists in your area. Check out my recommendations in Lousiana–I list several excellent cosmetic dentists there. You want a dentist who has done several tetracycline cases and can show you beautiful before-and-after photographs of his or her results. Otherwise, your first attempt at having this done would probably end up being throwaway money, and then you would have to swallow hard and pay the full price to have your teeth re-done right. I have a huge stack of emails from patients who have made the mistake you’re contemplating making.

Another option for saving money without risking the need for expensive corrective work would be Kör whitening. I believe that Kör is the strongest whitening system available, and while it doesn’t whiten as much as some dentists claim, it could lighten your stains considerably for a fraction of the cost of porcelain veneers and without the risk of needing later expensive corrective work.

– 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 15, 2015

Where to go for discount dental care

 

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Dr. Hall,
Are there dentists, or dental schools that do work for less costs or to train students? And if so how do I apply?
Ronnie from Ohio

Ronnie,
Yes, all dental schools will provide low-cost dental care if you are willing to have the work done by students. It is very slow for a couple of reasons. The students, being new, are very slow. And then they have to wait for instructors to check their work. But you do get discounted care. You may pay half of what you would otherwise.

As an example of how slow dental schools are, in private practice, if I had a patient that needed, say, three fillings, I would do those in one appointment that might take 45 minutes. In dental school, I would have done one filling each appointment, and each appointment would be about an hour and a half.

And at a dental school you have an assurance that the care is going to meet a basic acceptable standard. You’re not going to get top-of-the-line work from students, but you’re not going to have shoddy work either, like you might get at a discount dentist.

I see on the map that you’re about an hour from Case Western Reserve University in Cleveland. Just Google their dental school and you should find a phone number on their website for patients to call to make appointments.

But don’t ever go to a dental school for cosmetic dentistry. They are in the business of training students in the technical skills needed to fix teeth and they tend to be totally dismissive of a patient’s appearance-related concerns. You are better off, in my opinion, doing nothing at all than having a student at a dental school do any appearance-related dental work on you.

Dr. Hall

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 28, 2011

Thinking of having my porcelain veneers done at a dental school

Filed under: Choosing a cosmetic dentist — Tags: , , — mesasmiles @ 2:13 pm

I have an appointment scheduled at the University of Iowa dental school at the end of November. I am seriously considering having veneers done through their dental school. A friend of mine is in their last year of school there, and is learning to do veneers through the supervision of a faculty member. I would like some recommendations as to whether this is a good decision, and how I can get the best possible results if I pursue this option.
– Teresa (Her e-mail is edited to remove the names of the dentists she shared with me).

Teresa,
I really don’t know what to say to answer this question. You’re already moving in this direction of having a student do your porcelain veneers, and if you think that this could possibly work out, I think we’re operating in two different worlds and nothing I could say would sway you.

Here’s how I would put it. Why would you want to go through all that trouble and getting something permanently bonded onto your teeth for the result of a mediocre smile? Why not just leave your teeth the way they are and not do anything? Do you really think that in dental school is where you find beautiful cosmetic dentistry? Do you really think that you could find any Hollywood star or New York model who had his or her smile done at a DENTAL SCHOOL? Dental schools are bastions of professional political correctness where they are uncomfortable with the art of designing smiles.

To see an illustration of the type of thinking that reigns in dental schools, read my recent post from earlier this month, answering a sweet patient from the San Diego area who had a horrible experience with her “cosmetic” dentist. And Iowa in particular is a stronghold of this type of thinking. The dental profession there is very conservative, and it has been hard for me to find good cosmetic dentists in the state to recommend. When I lived there, I drove clear to Chicago to have my own dental work done.

I’ll tell you a stroy about the University of Iowa that may help. This was back in the 90s, when white composite fillings for back teeth were just becoming very popular. The technical issues of their wear resistance and toughness had been resolved, and my patients had reached a point where that was all they wanted – to a person they were willing to pay the extra above and beyond what dental insurance plans would pay to have the composite fillings and I was only doing two or three amalgams a year. At the time I had a lovely girl come work for me as a dental assistant. She was studying to become a dental hygienist. She asked me to replace all her amalgams with composite, which I gladly did for her. Well, she was involved in a traffic accident and fractured her jaw, and went to the University of Iowa to have that repaired. While she was under the anesthetic, without her knowledge, the dentists at the dental school decided that this was so terrible that she had these white composite fillings on her back teeth that they broke the first rule of dental malpractice and removed them all, putting amalgam fillings back in her teeth. When she discovered this, she called me, crying, wondering what she could do. She could have sued them and won, but that wasn’t her nature. But this is the strength of the dental school culture – they know what is best, and they will decide what your teeth will look like. Now since then, composite fillings on back teeth are enjoying more professional acceptance, but the culture of dental schools has not changed.

I am somewhat familiar with the name of your dentist. He is highly respected. And so is the dental school professor you mentioned. But they are both highly trained engineers of dentistry and they are not artists. The type of dentists who become cosmetic dentists are those highly skilled practitioners who found dental school stifling and who, once they get out, want to break free and explore the art of dentistry. Back in dental school, paying too much attention to what the patient wanted was considered pandering to the patient and unprofessional. But as these budding cosmetic dentists interact with patients, they decide that is exactly what they want to do. It is a transformation process that takes several years to complete, because of the shift in attitudes and the extra training and experience required to blend beautiful art with highly developed technical skills.

I’m not sure if this will have any impact on you at all. You’re likely to go ahead and have your friend do this under the supervision of Dr. Vargas. I imagine you will get a smile that will be okay, with mediocre-looking teeth, and porcelain veneers that are bonded very well, that are very smooth and very technically correct and that sadly will last for years and years. Too many years. Then when you’re ready to replace them, come to me and I will help direct you to where you can get a truly gorgeous smile.

 

 

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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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