Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

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

Jamie,
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.

October 12, 2011

My temporary crowns hurt

Hi Dr Hall,
I recently had two crowns replaced on the upper right side. The gap between the old crowns was too big and too much food getting trapped there. I had temp crowns for a total of three weeks, while I waited for my permanent ones to be ready. Unfortunately, the last week the temp crowns smelled, tasted horrible and I started to feel some pain. My dentist assured me that the pain would disappear once the new crowns where cemented in. The pain did not disappear and it only increased in the days after the permanent crowns where put in. I went back to the dentist and he explained the maybe the bite was off. He did a little drilling to fix the bite and now it hurts only in that one area but pain is still there. The pain comes and goes but it hurst to chew on that side or bite down on that side. Is this common? He assured me that I did not need a root canal. Thanks
– Larissa from New York

Larissa,
There are various types of pain that you can have when you are wearing temporary crowns, or when you have a new crown. Some are serious, and others aren’t.

Three weeks is a little long to be wearing temporary crowns. The last week you were wearing them and they smelled and then started to hurt, what was happening there is that they were beginning to leak, and microscopic particles were getting in between the temporary crowns and the teeth. Those trapped particles started to smell, and since they were in direct contact with the porous dentin of your teeth, they would also irritate the teeth.

I have had that kind of pain while wearing a temporary crown, and it was very uncomfortable. I do think your dentist should have explained better what would happen once the crowns were cemented. The cement is an additional irritant of the tooth, and the sensitivity could increase right after they are cemented, but then it would gradually subside and disappear. If it didn’t subside and go away, it would mean that the irritation was too much for the tooth, and it may end up needing root canal treatment.

The pain to biting is probably a separate issue. I would assume that the bite just needs to be adjusted until it is comfortable. There is a chance, however, that everything – all the irritation from being worked on, etc., has caused the pulp in one or both of the teeth to die, which would then begin to irritate the ligament that holds the tooth in. It would be prudent, at your next checkup, to ask that the roots of these teeth be x-rayed, just to make sure everything is okay. Especially if the sensitivity to biting or chewing never really completely goes away.

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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