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

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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.

February 3, 2017

My dentist says I have too deep an overbite for porcelain veneers


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Dr. Hall,
My dentist told me that I am not a candidate for porcelain veneers because my top teeth almost completely cover my bottom teeth. Instead, he wants to put 6 porcelain crowns on my top front teeth. I want a beautiful set of teeth, and unfortunately mine are stained from tetracycline. I have 2 questions: 1) Have you heard of veneers being inappropriate for a particular bite such as mine? And 2) Since my bottom teeth will not be crowned, is it reasonable to expect that I can bleach them to match my new crowns on top?
– Susan from Louisiana

Susan,
Oh no, you don’t want to do crowns on all your front top teeth! To do that they’ll all have to be ground down to stubs. And you don’t need that. Having a deep overbite the way you do it actually makes more sense to do porcelain veneers, because nothing has to be done to the backs of the teeth—all the work is confined to the front.

This happens with cosmetic dentistry a lot. You want a cosmetic treatment. Your dentist doesn’t do a lot of cosmetic dentistry and doesn’t feel comfortable with the particular procedure you want, so he or she gives you some excuse why this isn’t appropriate for you. I’ll give your dentist credit for creativity at least—this is the first time I’ve heard of a particular bite being a reason for not doing porcelain veneers.

Furthermore, you have tetracycline stains. This is one of the most difficult smile makeover situations there is, and you don’t want to have your family dentist doing this. It requires a high level of expertise and a lot of experience with cosmetic dentistry.

And six teeth? People show eight to twelve upper teeth when they smile, depending on the width of your smile. Doing just six teeth when you have tetracycline stains would look really funny. This is another signal your dentist is giving that he is in over his head on this. Sorry to be so blunt about it, but I’m trying to look out for your best interests.

My recommendation: Go to one of our expert cosmetic dentists that we recommend. We have several in Louisiana who could do a great job for you and give you a beautiful smile. There is one close to you that I will email to you privately, so I don’t give any clues as to your exact location. If you otherwise like your dentist, explain what you are doing and that you’ll be back to him for your regular checkups, cleanings, and other work, but that you’ve been advised that this is a difficult cosmetic procedure for which you need a cosmetic specialist.

About bleaching your lower teeth—this is an option, depending on the type of bleaching and the severity of the tetracycline stains. This is another reason you want an expert who has experience with your type of case. The Kör deep bleaching system can give some pretty decent results with these stains.

– 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.

July 12, 2016

She’s reluctant to do the second half of her full-mouth reconstruction


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Dear Dr. Hall,
I have taken great comfort in the information you provide and the honest, intelligent, accessible manner in which you provide it.

I am 37 years old and had my entire lower arch redone with crowns and veneers over a year ago. My dentist is a cosmetic dentist listed on your website. She recommended a full smile makeover for my worn teeth. After years of clenching and grinding (I didn’t wear a nightguard until recent years), I was having a lot of sensitivity on my molars and my dentist said that I had a collapsed bite.

I know that my dentist did a good job, but the whole process was very hard for me emotionally. I never wanted “perfect” teeth and I do miss some of the quirkiness of my originals. Even though I went for a “darker” shade (m2 instead of m1), I still feel they are a bit white for me. Also, I have had a bit of gum inflammation, which I never had before. My dentist is having me treat this with baking soda and peroxide and may eventually do some procedure she thinks will help.

My dilemma is now that I am torn about doing the top teeth. My dentist is pushing for it. And indeed my top teeth are very worn, darker in color and contrast with the bottoms. However, my gums are very healthy on top and I have no pain at all in the teeth. I know that I cannot whiten the tips because I did Zoom whitening years ago and now I think my teeth are too worn and it may cause sensitivity.

I am agonizing over this decision and would be very grateful for any advice you might have.

My dentist seems to feel that my teeth will be better off if she completes the whole mouth, but I am so hesitant to go through such a big procedure when I not in pain anymore. The esthetic discrepancy does bother me a little, but maybe not enough to get this major work done.

Thank you for any words you have for me!!

Best,
Anna from Connecticut

Anna,
It’s hard for me to give a definitive answer as to what you should do without seeing your case and knowing everything that is going on dentally. But I’ll see if I can be of some help with some guiding principles.

There are points to be made in favor of both options–doing something and not doing anything.

First, I am not in favor of half-mouth dental reconstructions. I don’t know what the crowns on your lower teeth are made of, but most ceramics are somewhat abrasive to natural teeth. Some of the newer ceramics are very kind to natural dentition, but most of them will wear natural dentition more than they would otherwise wear, which can lead to sensitivity and other problems. You may want to ask your dentist about this, if this is an issue in your case.

The original problem was excessive wear of the teeth. I’m sure that wasn’t confined to the lower teeth–they both must have worn equally. And now your upper teeth are continuing to wear down. So it appears to me that your original problem is now half solved, and you need to finish the treatment.

Having said that, crowning and veneering all the teeth is a very aggressive step, and if you aren’t completely sold on the benefits, my inclination would be to leave well enough alone.

On the issue of the “quirkiness” of your natural teeth, a masterful smile makeover will include some “quirkiness.” If you discussed that with your dentist, I’m sure she could take care of that so that it wouldn’t be an issue. Knowing that is your preference, I think that most ceramists would love the opportunity to put some quirky features into your smile. My ceramist wanted to do that, but the barrier to doing that is that there are some obsessive patients who fuss over anything that they perceive as an imperfection in the smile makeover. I would want the smile to look natural–they would want all the teeth to be “perfect.” I would try to persuade them to have some imperfections in the teeth, but in the end the patients would get what they wanted.

If the only problem you need to fix is the color, I would do whitening. You mentioned that you worry that you would have too much sensitivity, that you had Zoom whitening before and are reluctant to do that now. However, there are a number of other options for whitening the teeth besides Zoom. Zoom, because of the light, is more harsh than other options. Kör whitening is gentle yet very effective. There is also Nite White or Day White, Boost, Opalescence, and other systems, all of which are also more gentle than Zoom.

On the issue of gum inflammation around the lower teeth–I’m assuming that is around the crowns. That is a factor that should be taken into consideration. You could be having a sensitivity reaction to the ceramic in the crowns or it could be something else. I would try to pin that down before doing the uppers. One excellent option could be doing porcelain onlays on the upper teeth rather than full crowns. Onlays stop short of the gumline so that gum inflammation shouldn’t be an issue. If not porcelain onlays, then porcelain crowns that only go very slightly into the gingival sulcus or even stop at the gingival margin. There should be a way to avoid this on the upper.

And then, about the overall result. I had a number of patients who were hesitant about moving forward with smile makeovers and had some misgivings about the procedure before starting. But once it was done and they saw themselves in the mirror with their beautiful smile and felt that great sense of confidence to where they couldn’t stop smiling, I don’t believe anyone would have ever given a second’s consideration to going back to the way they were. It was always a positive, life-changing experience. You mention that the esthetics of your smile bothers you some now. I would fix that.

I hope this is helpful.

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.

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