Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

June 18, 2012

Some expert tips on bleaching your teeth

Dr. Hall,
I have received various answers on retouching my bleached teeth with Opalescence PF used with trays. I want to do this before deciding on the color for crowns. I used 20%.

  1. How long should I touch-up (for example, 1 week, 2 weeks)?
  2. How many hours each day (1 hr., 2 hours, or 3 hours)?
  3. Is it necessary to stop whitening a certain length of time before appointment (not necessary, 1 week, 2 weeks)?

Cathy from Texas

There is no real fixed answer on how long you should touch up with Opalescence 20% PF or any other brand of bleaching gel, and I’m concerned if you’re having these crowns done by a dentist who can’t answer these questions for you. I would have to see your teeth, know a little of the history, and know how white you want them. Is this really the dentist you want giving you a new smile? Is this a dentist with an engineering mentality who has little passion for appearance-related dentistry and who will leave you with a well-fitting smile that looks very mediocre – kind of like the photo on our home page? Or is your dentist a true artist, one of the 1-2% minority of dentists who will actually give you a beautiful smile?

Here’s the deal on teeth whitening and how much to do it. No one has found a real limit on how much you can whiten your teeth. The longer you whiten, the whiter they get. The pace of whitening slows the more you do it, but the teeth keep getting whiter. So if you were my patient and had questions like this, I would ask questions like how satisfied you are with the current color, how much you bleached them before, have the teeth darkened much since you first had them whitened, and then how much work you are willing to go through to get them to what you would consider to be their ideal whiteness.

And the amount of time each day you should whiten depends on whether or not you are getting sensitivity from the bleaching gel. Do them as long as you can, is the bottom line, as long as you’re not having any sensitivity. Now if you are sleeping, your saliva flow goes way down and the bleaching gel will stay in the trays much longer. One application should last through the night. You don’t need a gel that is specifically designed for nighttime use – they all contain peroxide. During the day, depending on how tightly your trays fit, saliva will get into the trays and wash out the gel, and you’ll need to keep replenishing it. You do need a minimum period of 20-30 minutes for the gel to soak into the tooth. Beyond that, the more the better.

The one fixed answer that I can give you is how long to stop whitening before any color-matching is done on the new crowns. The whitening is accomplished by the peroxide gel releasing tiny bubbles of pure oxygen within your tooth, and the oxygen oxidizes the stains and darker colors. Once you’ve completed the bleaching, you need to give time for those little oxygen bubbles to disperse in order to get a true color for the teeth, and that takes a couple of weeks. Now if you are doing eight front teeth, the color of the back teeth and the lower teeth doesn’t need to really match – it just needs to be close – and a week would be enough time to wait. But if you need an exact color match of a front tooth with a crown matched to another front tooth with natural enamel, you need to wait the full two weeks.

So what I’ve answered goes beyond simple teeth whitening touch-up. Once your teeth are whitened to the degree you want, then there is a certain amount of teeth whitening relapse that you will have, as the teeth pick up stains from your food – coffee, tea, berries, fruit juices, etc. But whitening for two or three days maybe an hour a day and doing that once every year or two should take care of that and enable you to maintain that bright white bleached color.

But again, I’m quite worried about what kind of work is going to be done on you. An excellent cosmetic dentist would have brought up this subject with you when the case was treatment-planned and would have covered all these points. Do NOT rely on the claims of a dentist about being a cosmetic dentist, or advertising. The problem with the dentists who don’t do very good appearance-related dentistry is that they aren’t artistically inclined and they are blind to their own shortcomings in this area. Dentists with strong academic credentials, dentists who are prosthodontic specialists, and dentists with “high standing” among other dentists can be particularly problematic. They may do highly functional, long-lasting dentistry with absolutely no artistic taste. Be careful.

Dr. Hall

Link: Click here to read our page about the home teeth bleaching procedure.

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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 1, 2012

A cosmetic dentistry horror story – but there is a silver lining

Hi Dr. Hall.
I got 8 porcelain veneers and 2 crowns 2 weeks ago. I am 48 and have tetracycline stained teeth. I am very disappointed in a few ways and don’t know what to do. First thing is that they are too white. I look silly. I am Italian with dark skin and I look like I have Chiclets in my mouth. My dentist gave me an option on the color so I realize I am stuck with that problem. I will probably not smile very often now.

But the worst things are that I feel like they are loose and may come off at any time. I can’t bite down hard as it hurts in my molars. And also I can’t relax my teeth as it feels like the upper teeth are too long and my entire face aches like I am clenching and grinding my teeth. Help me with some advice please. I have had 5 kids with dental issues I always took care of. They are grown and gone and I finally was able to do my own smile. I am so sad about it.

Thank you.
Jamie from Virginia

This is the sort of story have heard so much over the years, and is the reason I operate this website. 98 to 99% of dentists simply don’t know how to do beautiful cosmetic dentistry. They chose the field because they like to fix things, and they think like engineers, not like artists.

You’re kind to take the responsibility for the color of your porcelain veneers. But there are about three things a dentist who is truly passionate about doing beautiful cosmetic dentistry would have done differently in your case.

First of all, he or she would have been knowledgeable enough about the results you would get to predict how you would look when your case was done, and would have coached you to a more beautiful result. You’ve never had a smile makeover before – how are you supposed to know how a particular color will look once it is in your mouth? A truly artistic cosmetic dentist would be focused on creating a beautiful smile, and would steer you in that direction.

Second, every excellent cosmetic dentist I have ever asked, and I have interviewed a number of them on this subject, has some method for making sure that you will love your new smile before it is ever bonded permanently. They will often make a set of what they call provisional veneers in acrylic that will be temporarily cemented onto your teeth so you can “test drive” the final result, to make sure that you will be happy. In addition to this, they have a try-in with the actual veneers – they will use a try-in paste to insert the porcelain veneers to let you see exactly how they will look. You will get as much time to look at this as you want – will get to see it under different lights, have a friend or family member come in to give you feedback on how it looks – whatever it takes to make sure that this will make you proud to smile before these are bonded on permanently. Most recently, I interviewed a cosmetic dentist in the Boston area that we recommend on this site. In 30 years, he has never had a patient who has not been happy with their new smile. If he ever did, he would re-do the case.

And that brings me to the third thing an excellent cosmetic dentist would do. These dentists, as I said, are passionate about creating beautiful dental work. Most of them, if they heard you say what you just wrote to me – that you won’t be smiling much any more – would be so embarrassed that they would re-do the case for free. I had this happen to me. I was a young dentist and it was the first time I had done porcelain veneers on someone with tetracycline stains. When dentists are inexperienced with tetracycline stains, they will make one of two mistakes. These tetracycline-stained teeth are so dark on the inside that the color shows through most dental materials, and the dentist will have them made too translucent so that the gray-brown shows through. This is what I did. Or, they will make the teeth too opaque and white so that they look pasty and fake. This appears to be what your dentist did. Well, with the case that I did, after I gained more training and experience and knew better how to make this type of case look beautiful, I offered to the patient to re-do them for free, because I didn’t want work that I was responsible for not looking beautiful. The patient never complained, but I could tell she wasn’t excited about how they looked, and I wanted her to be excited. I’m not unique – that’s typical of artistic dentists who love to create beautiful smiles.

So what do you do at this point? There really isn’t much remedy other than doing the porcelain veneers over. And this time you need to be very careful about the dentist you pick to do them. Pick one from our list – that’s why I have this website. I personally check every dentist I list to make sure they can do beautiful smile makeovers.

But I need to say a word about how your mouth feels now. The porcelain veneers cannot be loose – if they were loose they would immediately fall off. But what I am worried about is that your teeth are getting loose. You say that your entire face aches, like you are clenching and grinding now. And you think that the upper teeth are too long. I can’t tell this from a distance, but it certainly sounds like your bite has been thrown off. This could potentially be very serious and could lead to serious TMJ disorder or breaking of the dental work, or premature wearing down of your teeth, or periodontitis leading to early tooth loss, or even breaking of your teeth. This could actually be the silver lining of your cloud, because this could give you grounds for asking this dentist to compensate you so you can have this re-done correctly. Here’s what I would suggest. Go to a dentist on our list of recommended dentists. See what he or she thinks of what has been done – if the work has indeed thrown your bite off to where it is causing serious problems. And then see if he or she will help you get some satisfaction from this other dentist. You need someone more than just a skilled cosmetic dentist – you need someone who will be understanding and willing to stick their neck out a little to help you get what you deserve.

Good luck,
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.

April 7, 2011

Which looks better and is more durable, e-Max or Lava crowns?

Hi Dr. Hall,
I am about to go through a procedure that will hopefully change my smile. I currently have a metal crown in the front right tooth and it looks TERRIBLE. In addition to that the left front tooth has a very bad discoloring but also has deep fillings, and next to it, the tooth also has major fillings. My dentist initially recommended that I restore my smile with Lava Crowns, and then decided that he would use e-max crowns.

Is there a difference between these two products? I keep on searching the web to see which is better but I usually find sources that support both products. In addition to this I want the product to look as natural as possible. Is one better than the other? My dentist told me that the e-max crowns usually cost more, but that he would leave it as the same price as the Lava Crowns (which – according to him – cost less). Is this also true? And my last questions would be, what is the durability of each of these? Please help.
– Angie from California

The key questions in how these crowns are going to make your front teeth look are not going to be anything about which brand of ceramic crown your dentist uses. The key questions are going to be, “How artistic is your dentist?” And, “How artistic is the dental lab that your dentist has chosen?” Both questions center around your dentist, because an artistic dentist will make sure that the dental lab he or she uses produces highly esthetic work.

The Lava Crown and the e.max Crown are both fairly similar. Both have a high-strength core that is milled rather than cast. Lava crowns have a zirconia core and then have a layer of feldspathic porcelain baked over them. The e.max crowns come in two types. One has a lithium disilicate core and the other has a zirconia core. The e.max crown comes from Ivoclar, and it can be covered with either a baked feldspathic porcelain or a pressed ceramic. The consensus is that both of these are highly esthetic, but I don’t think either of them is the very most esthetic crown. On pure esthetics, I would lean toward a pure feldspathic porcelain that is bonded directly to the tooth without an inner milled core. Both e.max and Lava are high strength, and I couldn’t tell you which is stronger. Pure feldspathic porcelain isn’t as strong, but it will last as long in the mouths of most people as long as you don’t have an abusive bite. Some esthetic dentists think the pressed ceramic is the most beautiful, but more lean toward the feldspathic porcelains. Some esthetic dentists will choose one or the other depending on the demands of a particular case.

But again, the key ingredient is the dentist. Let me ask you this. If you were asked by your community to commission an oil painting for the foyer of a local concert hall, would you research the brand of paint, or would you focus on the selection of the artist and let the artist pick the paint he or she felt most comfortable using? I think you would pick the artist. But you’re approaching the creation of a life-like reproduction of your two front teeth as if it is some commodity to be purchased at a discount store, and all you have to worry about is the brand. Dentists vary greatly in their artistic abilities. 98% of dentists have very little artistic inclination – they chose a career in dentistry because they like to fix things. Some dentists rise to the top in artistic abilities, and they become renowned among celebrities who will fly across the country to see a particularly artistic dentist. On the mynewsmile website, I cater more to the general public and I search out from among the top 1% of artistic dentists and list them here for the benefit of my visitors. I have a lot of e-mails from disappointed patients who make the same mistake of thinking that the dentist on the corner, by virtue of having a dental license, is an artist. It doesn’t work that way.

As far as a choice between e.max and Lava, I think probably more cosmetic dentists use e.max. I have an e.max crown on one of my premolars. Done well, in the right hands, it can produce a nice result for front teeth. Depending on the amount of discoloration in your one front tooth, Lava or e.max can help block out some of the unwanted color. But I would still prefer straight feldspathic porcelain in that situation with a great lab technician who knows how to use opaquing porcelains. I think e.max may tend to cost a little more, but that’s going to depend mostly on the laboratory that’s doing it. Costs for both will vary greatly depending on the laboratory technician that is using it.

It does bother me some that your dentist switched recommendations. My guess is that he spoke with his laboratory technician about your case, and the technician recommended e.max, so the dentist is going along. An excellent cosmetic dentist would have a firm idea from the very beginning of how to best treat your case and wouldn’t be wavering about this.

Dr. Hall

We thank our advertisers who help fund this site.

About David A. Hall

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

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