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A dentist is ethically obligated to give you all your options

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When I was a child I was hit in the mouth twice, once from falling out of a wooden school swing and the other time from throwing a croquet ball up in the air and catching it with my front tooth. Needless to say the older I’ve gotten the more yellow brown it has become. My dentist told me I would have to get an implant because there was no root but yet I still have the VERY UGLY BROWN TOOTH.

I also have several back teeth that need filings and at least 2 that need to be capped. I don’t have a lot of money to be putting into just one tooth when I have several others that need to be fixed, although the one that gives me an UGLY SMILE is the one everyone can see. PLEASE HELP ME.

Thank You so very much for your time.
Sincerely, THE GIRL WITH THE UGLY BROWN TOOTH
Danielle in Tennessee

Danielle,
I would switch dentists, and I will explain why.

One of these two traumatic incidents with your front tooth jarred it enough to sever the nerve and blood supply that go to the tooth. This would cause the tissue inside it to die, which would then cause it to become infected. It’s possible that if this tooth had received a root canal treatment at that time, it could have prevented the root of the tooth from being eaten away, but it’s also possible that would have happened anyway, as a side effect of the traumatic injury. The process is called root resorption, and it can happen because of an untreated infected tooth, or because of traumatic injury to the tooth.

But now that the tooth has no root left, you can’t save it.

There are three basic ways, however, to replace a missing tooth, and your dentist is negligent in only presenting one of them to you. He or she has an ethical obligation to give you all the options that would work. And while the implant option is probably the best choice for you, it is also the most expensive. Did you tell your dentist that this was too expensive for you? If you did, and you still didn’t get any options given to you, then it shows not only negligence but a lack of character on the part of your dentist.

A dental bridge is the traditional way to replace a single missing tooth. A bridge requires that the two adjacent teeth be covered with crowns (you may know them as caps), and then a false tooth is suspended between them. This is a little less expensive than an implant.

Another option is to use a removable partial denture that clips onto your other teeth and has a false tooth on it. While less comfortable than either a bridge or an implant, it is a fraction of the cost of a bridge. A flipper partial is the simplest way to do this, and it can cost as little as a couple of hundred dollars.

Find a dentist who is willing to give you all your options and who will work with you to keep the costs down. I don’t know everything that went on in your visit with your dentist, but just from the information that I have it doesn’t appear that you should trust this dentist.
– Dr. Hall

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About David A. Hall

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

Trying to save money on Snap-on Smile – can I get it online?

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I would like to be able to order the snap-on-smile online. I don’t want to spend time in dentists offices. I know that all I would have to do is have my teeth impressions taken. I want to do this at home. I also know of a site that claims to do it, but the company has a lot of bad reviews from people that paid their money up front and did’t get their orders. I ask some one at the conpany of the site and I was told that the complaints was from one dissatisfied customer. I’m still leary of them. But I would really like to order the snap-on smile online from someone reliable. Do you happen to know of any reliable online companies?

Thanks for your reply.
– Gibbs from Chicago

Dear Gibbs,
Interesting question.

There’s a reason the site you found that claims to deliver a Snap-on Smile online is a sleazy site that cheats its customers. The reason is that this doesn’t work, doing it online. It would be kind of like getting a haircut online. That was creative of them – to tell you that all the complaints were from one dissatisfied customer. Sounds like you didn’t believe them. I don’t.

You start with the impressions. You could maybe get that without a dentist, but I’m not sure how you’d go about getting that done. The impressions have to be a certain level of quality, without distortion. There’s a certain amount of training required to do that right. Some dental assistants can do a good job of it, but not even all dental assistants could do an adequate impression for these purposes. And then there’s the problem of getting the Snap-on Smile ordered. By law, Den-Mat is required to take orders only from licensed dentists. So you would have to have someone lie in order to get this made without a dentist. And then the question comes up, would YOU trust this person who is willing to lie and break the law. Well, maybe you would. But there are certain things you have to know to tell Den-Mat about HOW you want the Snap-on Smile made. What shade will you tell them to make it? Do you know that terminology? What will you tell them as far as how much facial bulk to allow? Will it fit your bite? How will you figure that out?

But wait, you’re not done. Once you get it back from the lab, the Snap-on Smile has to be fitted. When it is done in the lab according to the model that is sent in, it doesn’t just automatically fit. In most cases it will have to be adjusted. Do you have tools for doing that? Will you know what you are doing? Maybe you’ll trim it here or there and then, all of a sudden, it’s too loose and won’t stay in. What do you do then?

I’m a “think outside the box” and “work outside the box” kind of guy, so I’d be all for creative ways for getting this done and simplifying it. But there are safeguards put in place and the reason they’re put in place is to keep businesses from scamming the public.

If it’s price you’re worried about, and you just want a basic Snap-on Smile that doesn’t need to look particularly great, you can call around and find out who will do it the cheapest, and you should be able to find someone who will do it for a couple of hundred over the lab cost. For front six teeth, the lab cost is $250. For all the upper teeth, the lab cost is $400. What a dentist charges over and above that will vary a lot from dentist to dentist. There will also be great variations in the quality of the result. But if you’re not fussy, you should be able to find someone who will do it cheap. Set a limit of, say $600, and I’ll bet you’ll find a taker if you call around and just ask, bluntly, if the dentist will do it for that, if you’re willing, say, to pay cash up front, so that there’s no risk for the dentist in not getting paid.

Dr. Hall

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About David A. Hall

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

I don’t really think I had five cavities.

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Dr. Hall,
I recently went to a new dentist to get my teeth cleaned. I floss every day and I brush my teeth in the morning and most nights also, I dont drink alot of sodas either. I take really good care of my teeth. My old dentist told me I had great teeth. I found it weird that the dentist I went to the other day told me i have 5 cavities. All of them were in my back teeth. I went and had them filled, which he filled them with the white ones.

Since then I’ve had alot of problems with pain. I’ve had him adjust my bite but it still hurts. I really dont think I had cavities at all though. Should I get an xray from before and bring it to another dentist to see if I even needed the fillings? I looked at the xray after he took it, I didn’t see anything, but of course I’m not a dentist either. I just never had pain before and now I do, plus with the care I take with my teeth I dont see how I could have had 5 after just going to the dentist last year and had none. Just wanting another opinion.
– Alicia in Tennessee

Alicia,
It is possible that you had cavities that the first dentist missed. I had an experience after I got out of dental school where I had a large cavity in my own mouth that had been there for quite some time and the x-rays taken at dental school missed it because they were taken at the wrong angles. But I think you’re reasonable to be suspicious. Yes, if you have reason, like you do, to be suspicious, I would ask for a copy of the x-rays and get a second opinion. But tell the second opinion dentist as little as possible, and don’t let the second dentist know the name of the first. I would just present the x-rays and show up and say, “I’d like a second opinion on this dental work” without planting any ideas like that you thought the work was unnecessary. A dentist who is hungry for patients will sometimes try to agree with a patient in order to convince a patient to quit the other dentist and become a patient. And a dentist who is personally acquainted with another dentist will sometimes hold back and feel a strong obligation not to criticize. To get the very best second opinion, you could visit a dentist in a distant city while you’re on vacation or something.

The post-operative pain you’re feeling also makes me suspicious. It sounds like the white fillings may not have been done correctly – not bonded correctly. Do you have pain when you clench your teeth together? Or is it just pain when you’re actually chewing something? If it doesn’t hurt to clench, but it hurts to chew, that’s an indication that something went wrong in the bonding process. If that pain persists, it may be necessary to replace the fillings to alleviate it. If it hurts to clench, then it’s probably that the bite just needs to be adjusted.

– Dr. Hall

Links: read more about pain after new fillings.
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About David A. Hall

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

What treatment plan did Clear Choice give you?

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A comment I received this morning from a dentist in California prompts me to ask for information about treatment plans created by Clear Choice Dental Implant Centers.

Every treatment plan I have heard of to date from them has been the same: extraction of all remaining teeth, and the placement of all-on-four dental implants. In some cases, these patients have sought second opinions from other dentists who have told them they have teeth that can be saved and don’t need to be extracted. The dentist who e-mailed me this morning reported on a lecture by a Dr. Steve Parel at November’s annual meeting of the American College of Prosthodontics in San Diego. This lecture gave this dentist reason to believe that Clear Choice does the all-on-four technique even in cases where there is enough bone for conventionally placed implants.

So my question is this: Do Clear Choice Dental Implant Centers ever propose any other treatment plan? Or does everyone get full-mouth extractions and all-on-four dental implants? I would really like to know. Please contact me and let me know what your treatment plan was.

And then one patient relayed to me that they told him the extractions were free. It occurs to me that they may have this policy to soften their resistance to extracting all the remaining teeth. That policy doesn’t sit well with me.

Dr. Hall

We thank our advertisers who help fund this site.

About David A. Hall

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

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