Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

February 3, 2018

My mouth seems to be collapsing


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Hi Dr. Hall,
I really hope you can help me.
I am not sure if my issue is related to my lips, teeth or jaw but I absolutely can’t stand my smile. It feels very forced to be able to show my upper teeth. When my mouth is in repose it is just empty space and you cannot see my teeth (especially my upper) and it makes me extremely self-conscious.
I also have jaw pain and wear a night guard and when I wear it my mouth feels more comfortable and I feel like it supports my lips better. It also gives an impression of upper tooth show that I would very much like. I also find I have difficult pronouncing certain words especially when it’s cold, almost as if my jaw tighten and I can’t open it properly to speak. P and T words are especially uncomfortable.

Are my only options veneers? Do I even have any options?

It’s very frustrating for me. I can attach pictures as well if need be.
– Laura from Toronto

Laura,
You’re going to need to be very careful how your proceed here, and if a dentist has told you that porcelain veneers will solve your problem, I would find another dentist. While that could help with your appearance, it could exacerbate your other problems—the jaw pain and trouble with pronunciation.

It sounds to me like you’ve worn your teeth down, making you overclosed. This could cause TMJ disorder, which would be characterized by jaw pain and possible tightness in your jaw. The fact that you feel better wearing a nightguard lends credence to that diagnosis, but you’ll need an examination by a dentist trained in TMJ therapy to confirm that.

The needed treatment, unfortunately, is likely to be extensive—probably a full-mouth reconstruction.

The problem is finding a dentist you can trust to do this. This is way beyond the capability of your average family dentist. I would look for a dentist with advanced training from one of three institutes:

  • The Pankey Institute in Florida
  • The Dawson Academy, also in Florida
  • The Las Vegas Institute for Advanced Dental Studies

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.

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.

November 4, 2015

My dentist said my new veneers may come off every couple of months

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Dear Dr. Hall,

I just got 8 top veneers placed on. As I was leaving the office, I was told they may come off every couple of months. I know I can’t eat apples or crunchy things with them but are they going to fall off that often??
Thank you for any info you can give me.
– Dorothy from Maine

Dorothy,
Really! They told you your new porcelain veneers may come off every couple of months? That’s a new one!

If they do come off, I will tell you what to do. Go back to their office and demand a refund or you will call a lawyer, because if they do, they weren’t done right. Take a copy of this email with you and show them – I’ll stand behind that statement 100%.

There is a principle in the dental profession called “the standard of care.” Now, unfortunately, since cosmetic dentistry isn’t a recognized specialty, the standard of care for cosmetic dentistry is pretty low. Your new veneers don’t have to be beautiful. They may even look dingy and still meet the standard of care. But they do have to stay on. That much is pretty basic. So if your veneers begin falling off within the first couple of years, that is a breach of the standard of care, and the dentist is legally liable for that. It’s hard to put a number on it, because they should never just fall off. But if I had to use a number, I would say they should last ten years, at least.

And about your dietary restrictions. I placed many veneers over a period of maybe 15 years, and I never told my patients not to eat apples or crunchy foods. I told them to eat whatever they wanted, except for pins and bottle caps and stuff like that.

In fact, I will go this far. I would encourage you to test the veneers by eating some apples. If these veneers aren’t going to stay on, it is better if you find out now rather than later. Put them through a stress test and see if they’re bonded properly. A properly bonded porcelain veneer will not come off. I had a couple of cases where I had to re-do some porcelain veneers, and you have to grind them off, just as if they were part of the enamel, they are bonded so tightly.

There are only a couple of legitimate restrictions to your activities after you have a set of porcelain veneers, and I list those on this website on a page dedicated to the postoperative care of porcelain veneers. That is to avoid biting metal objects, and to wear a mouth protector when playing contact sports. But even those activities would potentially cause the veneers to chip or crack, not to come off.

If someone tends to grind their teeth at night, I also would wear a nightguard over the teeth to protect the veneers from chipping or breaking.

But apples and crunchy foods? You should be fine with those. Go enjoy yourself, that’s what I would say.
– Dr. Hall

Do you have a comment? 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.

December 6, 2012

Dentist said everything was fine – but she grinds her teeth, so it’s not fine

Filed under: TMJ — Tags: , , , , , — mesasmiles @ 8:39 am

Hello Dr. Hall, I was hoping you could help and provide a little insight. I have been grinding my teeth for some time now while I sleep. My last dental cleaning and checkup was 8 months ago and everything was fine. I have recently been feeling pain from my lower back teeth. The dull pain lasts for 2 secs and then stops. It feels like someone is pulling at my back tooth and letting go. I feel this pain on both sides of the mouth (all back lower teeth). I have never had a cavity before so I don’t know what to expect. Does this seem like cavities? Or could it be something else? could it be from clenching teeth while asleep? What should I do to help my situation, I feel this pulling sensation and it’s very hard to describe. Hope you can help.
– Mona from New York

Mona,

Your two statements seem to contradict each other. You said that in your checkup everything was fine, but then you said you’ve been grinding your teeth in your sleep for some time now. If you have a grinding problem, then everything is not fine.

I’m not sure what is wrong with your teeth because I don’t have all the details – like what brings this pain on. And it would be helpful to see the x-rays and actually see your mouth and check things like tooth mobility. But I’m worried that your dental examination may not have been as thorough as it should have been, just from your comment that everything was fine in your checkup. Now I don’t know this for sure, not having been there, but I know this is a common problem in much dental care – a focus on cavities and fillings, and not paying much attention to other important dental problems like TMJ, gum disease, or occlusion. You get this in budget dental clinics and chain practices. I think you should get another opinion from a dentist who is possibly more thorough.

Having said that, your pain doesn’t sound like it comes from tooth decay. It sounds like the pain some people get when they have gum disease. Or it could be from the trauma of your grinding. I would find out, because either of these problems could be serious. If it’s gum disease, by the time you start having pain you could have significant bone loss. If it’s the grinding, you can literally grind your teeth away, and the solution could be as simple as wearing a nightguard.

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.

November 9, 2012

What to do about a cracked porcelain veneer

Filed under: Porcelain veneers — Tags: , , — mesasmiles @ 5:58 pm

I had 8 porcelain veneers put on my upper front teeth on September 2012. I have a grinding issue, so I wear a guard at night. I fell asleep without the guard and cracked a veneer ( it was in my mouth- I almost swallowed it!). Do I have the right to ask to have it replaced free of charge?
– Shannon from Illinois

Shannon,

If you knew you have a grinding problem and that you needed to wear the nightguard, then the dentist is not legally obligated to replace the porcelain veneer. Whether or not he or she feels an obligation will depend on your dentist.

If you were my patient, and the veneers are just two months old, I’d have mixed feelings about it. I’d probably go ahead and replace it, say, if you would just cover the laboratory charge, which would probably be about 1/3 the cost. But I would let you know that the next time it would be the full cost.

And this depends, too, on what your dentist told you. If you were given strict instructions to always wear that nightguard when you sleep, and then you didn’t do that, well, it’s not anything the dentist can do to prevent. However, if nothing was said, then the dentist should fix it for free.

One added item about cracked porcelain veneers. It is possible to repair them. If the veneer split cleanly into two pieces so that the pieces fit together perfectly, it can be bonded back onto the tooth and the crack will be virtually undetectable. I have seen it done.

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.

August 11, 2011

I brush and floss every day but still need root canals. What can I do?

Filed under: Root canals — Tags: , , , , , , — mesasmiles @ 7:40 pm

Dear Dr. Hall,
I am 27 years old in the middle of two root canals. The first one was a tooth whose white filling had begun to fail. The second was a crown placed a year and half ago that started to become sensitive to temperature and could not be used to chew with. I have become very worried about the health of my teeth. I have quite a few old (ten years or more) silver filings in the back of my mouth. These two root canals had fillings that were very close to the root of the tooth. I am also a stress grinder which has led to the cracking of at least two teeth. It seems like all my teeth hurt at this moment. Especially the canine on the side of my first root canal treatment. What can I do about the future of my teeth? I don’t want a bridge or implant so young. I brush and floss everyday, sometimes three times a day.
– Janie from New Hampshire

Janie,
I can relate to your experiences. In my late forties, I got my first toothache. It surprised me, because as a dentist, I have taken very good care of my teeth and have sought out the best care I could get from the best dentists. While I had a fair amount of decay in my young adult years, I hadn’t had dental problems for quite some time. The toothache came because I got little cracks in my teeth from the old fillings. Over the next ten years I ended up needing root canal treatments in most of my molars, and all of my molars now have crowns on them.

Still, I don’t have any serious worries about losing my teeth or needing bridgework or implants. Root canal treatments, once they are successful, last for a lifetime. And if crowns are done well and are well cared for, they will last 20, 30, maybe 40 years.

Your problems are not the usual but are not uncommon either. After a tooth has been worked on several times, it is easy for it to develop sensitivity. And grinding your teeth puts a lot of stress on them.

My advice is to be sure you get good dental care. Don’t look for cheap care. Cheap care ends up being very expensive in the long run. Look for a quality dentist who is trustworthy and stays abreast of the latest techniques. Then, if you trust this dentist, stay regular with your checkups and do what the dentist recommends. Follow through with your home care. And to keep tooth decay down, avoid frequent snacking. Most people, and even some dentists, don’t realize how much damage frequent snacking during the day does to your teeth.

For your grinding (dentists call it bruxism), a nightguard can do wonders to provide considerable protection to your teeth.

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.

March 26, 2011

Is this a case of gorilla bite?

Filed under: Dental crowns,Root canals,TMJ — Tags: , , , — mesasmiles @ 11:17 am

A little over three months ago I had a root canal and crown done. Tonight not only did the crown come out it broke off the post also. What do you reccomend doing to fix this? And since it didn’t even last four months should my dentist be responsible?
– Gerrard from California

Gerrard,
It sounds like a nasty situation, this tooth of yours. I suspect that the crown didn’t just come loose but broke off at the gumline. I’m guessing here somewhat, and answering based on what I’m visualizing of your situation, based on the few details you’ve given me. Not being able to see what has actually happened, I want to try to be helpful based on what is probably going on here. Anyway, if the post broke off, I’m guessing the tooth also broke off. It creates kind of a tough situation because there probably wasn’t a lot left of the tooth to start with. And if the post and crown have failed, it may be that the tooth really can’t be saved.

If not, then maybe the post was just weak and this can be re-done so that it works.

I want to be careful here, because I don’t want to make it sound like your dentist was anything other than well-intentioned and appears to have been trying to save a tooth that is proving pretty tough to save, which to me is admirable. And there could be extenuating circumstances. There are some patients that have what some dentists call a “gorilla bite” that generates a tremendous amount of force, and once they hit a certain age and their teeth start breaking down, they tend to break anything a dentist puts in their mouth. Having said that, if this post and crown only lasted three months, yes, if I were the dentist, I would eat some of the cost. What I would do when I tried what ended up being heroics to try to save a tooth, and I didn’t adequately warn the patient that this treatment might not work, I credited to the patient the cost of what I did do against the more aggressive treatment that I should have done in the first place. You are very likely going to need more aggressive treatment here – possibly a bridge or an implant to replace this tooth. So I think that credit would be fair. But whether the dentist is legally responsible to do that for you would depend on if he or she actually did something wrong, and it’s not clear that this is the case.

If you are one of these people with the “gorilla bite”, then your dentist may have to make you a night guard to help protect you against breaking off more teeth. You can tell the person with the “gorilla bite” by looking at the profile. If the bottom of the lower jaw is parallel to the upper jaw, that’s the “gorilla bite.” If that’s you, get a hard plastic night guard fitten to your upper teeth and wear it faithfully every night. I had three or four patients like that, and that was the only way to keep them from breaking off teeth. If you’re not, then count your blessings and just address this one tooth that may be unrestorable.

Dr. Hall

Links: Read about another patient who kept breaking teeth off, so had his whole mouth rebuilt with 28 crowns and has continued to break off teeth. This is likely a true case of gorilla bite.

 

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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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