Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

January 24, 2019

My dentist wants to do crowns for my tetracycline stains


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Dr Hall,

I have severe tetracycline staining on all my teeth. As I’m getting older, it’s starting to bother me more and I really would like to improve my smile. I’m 48 and have very healthy teeth. I’ve only had 2 cavities so far. I’d like to explore porcelain veneers, but every dentist I go to wants to give me a full mouth of crowns. What can I do?

Your help is much appreciated!
– Gregory from Seattle

Gregory,
Severe tetracycline staining is definitely one of the most challenging aesthetic problems a dentist will face. It is caused by taking the antibiotic tetracycline before the age of 12 which is when the permanent teeth are forming. A gray-brown color becomes embedded deeply in the teeth and, when the staining is severe as it is in your case, that color is very dark.

There are a couple of problems with trying to cover this stain with porcelain veneers. One is that to make the porcelain look lifelike it needs to be somewhat translucent. A translucent porcelain veneer, however, will allow the dark underlying color to show through. Click the link for an example of a case that was brought to my attention. Or, the dentist and/or the laboratory technician, in an attempt to prevent that, will use too much opaquer, leaving the veneers looking chalky and fake. Another is that dentists who aren’t experienced in treating tetracycline stains will cover the fronts of the teeth only, leaving dark shadows showing through on the edges.

This is why you truly need an expert cosmetic dentist for this. With dentists who aren’t passionate about cosmetic dentistry, their weakest skill is often color manipulation. So I wouldn’t go to any dentist to treat your tetracycline stains unless they can show you before-and-after photographs of a successful tetracycline case that they have treated. Or, if the dentist is AACD accredited, you can be pretty confident that they have the skills needed to do this right and give you a beautiful smile. If you have any doubts about the dentist, insist that you get a clear view of the case with a try-in before the veneers are bonded. Make sure that you see with your own eyes that he or she has successfully given you a beautiful smile that you are proud to display before they are permanently affixed to your teeth. Don’t accept any excuses like, “Oh, once they are bonded on they will look better.” I also have confidence in all the dentists I list on this site.

There are properties of some porcelains where they scatter light in a way that creates a perception of translucency while they are blocking out underlying color. These opalescent porcelains are used by some of the more sophisticated dental laboratories teaming up with expert cosmetic dentists. But don’t expect 98% of dentists to know about this.

The way that your everyday family dentist may get around all these difficulties is to grind your front teeth down to stubs and put crowns on them. You clearly don’t want that, and I would never want to do that to a patient when there is a much more conservative solution. And, in some cases, even the crowns won’t fully block out the very dark underlying color.

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.

September 14, 2015

This “expert” cosmetic dentist got it wrong, too

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Hi Dr. Hall,
I had my veneers redone twice already within 3 months. The first time was done in May by an inexperienced dentist and the veneers were very thick and bulky. I didn’t like them and went to a very well known cosmetic dentist to have them redone; this was in August. After redoing the veneers twice and paying 18k the second time, I’m still not happy with the result. The veneers are dull, dark, very opaque and have no texture. I want to redo these veneers. My question is: Is it safe for my teeth if I redo my veneers for the third time? I hate my veneers but at the same time, I don’t want to end up having a root canal or not have any enamel left.
–Anna from California

I asked for more detail, and Anna sent photographs of the work, plus this narrative:

Dr. Hall,
Having gone through this process twice, (the first time with a general dentist) I can honestly say that this cosmetic dentist is very skillful, meticulous and really good at what he does. His mock up for the temporary was beautiful and I was very impressed. I think the problem here is the lab or lab technician. I loved the temporary and expected the final result to be like the temporary or even better, but it wasn’t.

veneers-temporary

Anna’s temporary veneers

When I tried on the veneers, right away I saw the dullness, the opacity and the lack of texture. The color was also a few shades darker than the color I picked for the temporaries. I told the dentist I didn’t like them. He said he had to make some adjustments to the veneers so the surface looks dull, but the dullness will go away when he polishes them at the very end. Opacity: he said he could send them back to the lab to make them more translucent but it won’t look nice. Lastly, he said if I wanted to know whether remaking the veneers will be nicer than this, the answer is, no. So he left me no option and I caved to have the veneers cemented that day.

veneers-porcelain

Anna’s permanent veneers

My veneers are shiny, but lack the gloss and texture so therefore they look dull. And in close examination, I see a lot of tiny scratch marks/abrasions. I called the dentist the following day to let him know I wasn’t happy. My follow up appointment is in two weeks to see what we could do.

It’s disappointing that I paid a lot for these veneers but I feel like the quality is below average. This is the reason why I want them redone, but I don’t know if it’s worth it putting my teeth through the trauma for the third time. I’ve attached pictures of my temporary and my cemented veneers.

–Anna from California

Anna,
Thanks for that detail and the photos. That’s very helpful.

First, for the question you asked. No, there is no significant risk to your teeth for re-doing the porcelain veneers another time. In the first place, the preparation for porcelain veneers should be shallow, so there is little irritation to the teeth. When the teeth are prepared for veneers the first time, you do get some irritation to the teeth, but then they recover from that. And in the process of bonding the veneers, the bonding resin seals off the microscopic tubules in the teeth so that the second time, when the first set of veneers were ground off, there is less irritation. That irritation comes mostly from those tubules being opened up by the enamel being ground down, so sealing them off reduces that. The same thing for the third time. I am aware that some dentists will say that re-doing veneers is risky for the teeth, but they say that because they’re trying to talk the patient out of re-doing them–they want them to be quiet and just go away.

But then there is the question you didn’t ask, which is how are you going to make sure you get it right this time? Let me back up a little and explain what went wrong with your second set of porcelain veneers. To do that, I’m going to give you a little insight into how I screen the dentists I recommend on mynewsmile.com.

The first hurdle they need to cross to get recommended by me is that their work needs to pass inspection. I need to see good quality close-up photographs of their work. Knowing what to look for, I can judge whether they know what they are doing or not.

But it’s the second part where it gets interesting. If their work passes my inspection, then I need to interview them on the phone. The most important thing I ask them is about how they insure that a patient will love the new smile they create–your question. How do they avoid your situation, where they do a smile makeover and the patient isn’t happy? They will tell me some type of procedure they go through. Many of them have a procedure like you experienced–the dentist will talk to the patient, determine their smile design preferences, and from that create a wax model of their smile. From that wax model they will make a set of temporary veneers that the patient will wear to make sure they like the design and the color. Then they will have the laboratory technician make the permanent veneers to the same specifications. They can take an impression from which they make a model of the veneers to send to the lab, and they can also take a photograph to send.

But then comes the interesting part. I pose a hypothetical situation to them, and this is how I put it: “Say you go through all this, and then I assume you have some type of try-in of the veneers that come back from the laboratory. So you try them in, and you ask the patient how they like the veneers, and the patient says, ‘Oh, I guess they’re okay.'”

In order to qualify for me to recommend this cosmetic dentist, they need to pick up on this lukewarm response immediately and be highly disappointed that the patient isn’t more enthusiastic about how they look. And they have to be willing to send them back to the laboratory technician to be completely re-made, if necessary, and refuse to bond them on to the patient unless the patient is not just satisfied, but excited about how they look.

This clearly didn’t happen in your case. The dentist, rather than addressing your concern about the color and the luster of the veneers, he pushed you into having them bonded on and told you that the dullness would go away later. Wrong response. And the dullness didn’t go away, did it? He would have flunked my interview with a response like that. All the great cosmetic dentists I know would have stopped right there and sent them back to the lab to be remade so that they had more sparkle, more lifelike translucency, and a brighter color. All those things are do-able.

The other glaring error here is that the permanent veneers were not made to the color you and this cosmetic dentist had agreed upon with the temporary veneers. This is way off. I think you have grounds here for a legal complaint, because the end result was misrepresented. I agree with you that the final veneers look too dull and the color is off from what the temporaries were.

So what should you do?

In looking over this dentist’s work as displayed in photographs on his website, I believe he is capable of beautiful work. So I would recommend as a first step trying to assert your rights and telling him you need this re-done. This is not fixable by polishing or trimming–your case needs to be re-done. You may show him my email, if you think that will help.

If that doesn’t work, get back to me, and I’ll see if I can line you up with a cosmetic dentist who is not only a good artist, but actually listens to his or her patients. They may be able to help you put pressure on this dentist to give you a refund.

And about this being the lab’s fault–it’s the dentist who gives the instructions to the lab, and the dentist who has to take responsibility for the final result. It was your dentist who decided to not send these back to the lab and demand better work. So you can’t blame this on the lab.

I hope this is helpful.

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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