Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

May 29, 2018

I went directly to the dental lab to make my partial


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Dr. Hall,
I had an upper partial made by a dental lab. I did not go through a dentist.

The last partial I got, nine years ago, my dentist used this lab. They did such a good job that I decided to go directly to them this time. But this time it’s not working out so well. I have a front tooth missing that was supposed to be replaced using this partial, however, the tooth won’t stay fastened to the metal. There was so much plastic backing that all the pressure was on my one bottom front tooth. He ground down a lot to make my bite touch but now there is not way of holding this tooth in place. Also the plate is too short and is sitting in the cavity where my old tooth was and it creates a rocking motion when I chew.

I have been back at least nine times and the last time he told me to go away and stop bothering him. I asked for my money back but he refused. What can I do to get my money back?
– Bill

Bill,
A very interesting question, and there are some interesting points to make in answering you.

I must say that I’m not following you as far as understanding the problems you are having with the bite and the one tooth in this removable partial denture. The rocking I understand, and that is a fundamental problem that in most cases is due to a distorted framework—a problem that could have originated with a distorted impression. Fixing this would require starting over again. The impression is supposed to be taken by the dentist, who is trained and experienced in creating an accurate model of your teeth that will enable the technician to fabricate an accurate metal framework. Technicians aren’t trained to do this step, which is one of the reasons it is illegal for them to do that.

So the answer to how to get your money back is fairly simple—just threaten to report the technician to the authorities. This seems mean because, while it was illegal for him to make this removable partial without involving a dentist, you were the one who asked him to do it, so you should share in that responsibility. But he is the one who knows the law better and so bears the bulk of the responsibility. So just go to him and tell him that if he doesn’t refund your money you’ll tattle to the state dental board and agree to be a witness in his prosecution. My guess is that this will work magic. And hopefully that may save some other patient from making the same mistake you did.
– 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 9, 2017

Saving your tooth looks like a no-brainer to me


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Dr. Hall
I have to have either a root canal or implant in the first molar on the left side, bottom. There is no molar behind it, and I am wondering if there is a “snap on” smile version that would be less expensive, invasive and will allow me to cover the empty space, should I decide to have the tooth pulled?
– Beth from Washington

Beth,
Having the tooth pulled and replaced with a Snap-On Smile would be the worst of several options for treating your infected tooth.

Let me go through your options and their pros and cons.

You’re telling me that there is no molar behind your first molar. So you’ve already lost your second molar. Losing your first molar would leave you with no molars on your left side. I guess if you’re planning on going on a soft or liquid diet you won’t need to chew, but you really need something there. A Snap-On Smile is a temporary tooth replacement solution designed to help you, say, get through a job interview or a social function and look like you have teeth. It isn’t a functional replacement for molars. It isn’t very durable and isn’t all that cheap, either. The least expensive functional tooth replacement would be a removable partial denture.

But any type of appliance you put in your mouth that is removable and designed to be a functional tooth replacement is going to be much more stable if you have teeth in the back to anchor it. Imagine having a table that has legs only in the middle and on one of the ends, as I have pictured below. This is called a cantilever and isn’t very stable.
An unstable table with legs in the middle and on one end
This is like the situation you are creating in your mouth when you lose these back teeth. When you try to attach a tooth appliance onto the front teeth and expect it to replace back teeth, it’s not very stable. In addition, it creates a twisting force on the teeth that are supporting it, which can lead to the early loss of those teeth. There are partial dentures that are designed to absorb the stress with the soft tissue on your ridge, but they would require clasping other teeth, too, probably going on to the other side of your mouth.

The root canal treatment makes the most sense because that saves your own natural tooth. Being a molar, the tooth would likely need a crown also. But there are people who argue that a dental implant is a very predictable solution also. The root canal and the crown would be less expensive, though. To me, it’s a no-brainer to save your tooth.

– 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.

October 27, 2016

Is the metal in a Maryland Bridge MRI safe?


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Dr. Hall,
Is the metal used in a Maryland bridge M.R.I.safe?
– Kevin from the U.K.

Kevin,
You’re referring to the use of metals with magnetic properties that should be avoided around magnetic resonance imaging machines. There is an excellent article that discusses this issue on a blog called the MRI Metal Detector Blog, and I would refer anyone with more questions about this to that blog. There is another piece from the National Institutes of Health about the interactions between MRI and dental materials, but they offer no definitive conclusions—they only bring up the problem.

The metal in a Maryland Bridge is generally a non-precious dental alloy. It has to either have some beryllium in it or be tin plated. Neither of those metals has magnetic properties. But often the metal will have cobalt and/or nickel also, possibly a lot of cobalt or nickel, and both these metals do have magnetic properties. If that is the case, would the pull of the MRI machine be enough to dislodge the bridge? I doubt it, but I confess that I don’t know enough about the MRI machines to say for certain. I would refer the question to an MRI technician. To function in the mouth, a Maryland Bridge has to be designed and bonded so as to resist chewing forces, which are very heavy forces. If chewing won’t dislodge it, I doubt that an MRI machine would be able to. But Maryland Bridges can sometimes be done without proper designing to resist dislodging forces, which is why patients have problems with them falling out from time to time.

There are other types of dental work that also use these alloys. Crowns and bridges, as well as removable partial denture frameworks, can be made out of non-precious alloys (also called base metal alloys). Crowns and bridges, again, should be cemented very securely so that they resist chewing forces, and I have a hard time believing that a conventional crown or bridge could have an issue with MRI forces. A removable partial denture, however, is not fastened very securely, and if there is any cobalt or iron in the framework, my recommendation would be to remove the prosthesis before having an MRI.

– 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.

August 4, 2016

A couple of teeth just fell out!


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Dr. Hall,
My mother is 85 years old. Just last week she had two teeth filled. She recently lost a tooth and has a partial for that area. Then a few days ago, another tooth fell out. Both missing teeth are from the lower jaw. Fortunately they are in different areas of the mouth. She is very self-consious. At her age, her remaining teeth and gums are probably not in the best of health. We are considering a bridge(s) but are not sure as we don’t know how healthy the rest of her teeth are. Do you have any affordable recommendations on what we can do for the area that is missing teeth?
– Diane from Colorado

Diane,
If I am understanding you correctly, these two teeth just fell out. If that is the case, your mother has advanced periodontal disease (gum disease). It doesn’t get more advanced than that, for teeth to be so loose that they just fall out.

Continuing on with that assumption, it is likely that she has no really solid teeth left, so bridges would be out of the question. A bridge anchors replacement teeth to the remaining teeth, but in doing so it puts additional stress on those remaining teeth. In your mother’s case, that would hasten their demise.

The ideal replacement for missing teeth is dental implants. However, you asked for something affordable. Your mother would likely need full-mouth restoration, and the price for doing that with dental implants could easily get to be $20,000 to $40,000.

Given the condition of advanced periodontitis, all of her teeth are likely loose and would be candidates for extraction. I would seriously look at complete removable dentures. The main disadvantage of removable dentures is that it begins a long-term process of bone resorption. But at the age of 85, that would not be likely to be a significant problem for her.

Cu-Sil partial denture

A Cu-Sil partial
(image courtesy of Dental Arts Laboratory, Peoria, IL)

Another solution would be a type of partial denture called a Cu-Sil partial that is built like a complete denture, but has holes in it to allow the existing teeth to poke through, and there is a silicone ring in each hole that snugly holds each tooth. This is a little more stable than a complete denture, and as additional teeth are lost, it is a simple matter to then close each hole and put in a new artificial tooth.

A conventional removable partial denture also puts extra stress on the remaining teeth. It’s not as much stress as a bridge, but it’s still enough to weaken the teeth, so I wouldn’t recommend that either.

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.

May 16, 2016

She says she’s too young for partial dentures


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Hi Dr. Hall,
I’ve had teeth problems my whole life. I have chipped missing and discolored teeth. It seems like no one wants to help me fix them. The only thing the dentist wants to do is partial dentures. I guess I could do that but I would really like something more permanent in the front. I’ve tried to talk to him about it and he doesn’t say anything. Finally he said the way your teeth are we can’t do anything else but take out the bad teeth and do partials. I thought with all the stuff dentists had they could fix anything. My question is if you have really bad teeth can they still get fixed? Plus why do dentists suggest partials instead of fixing your teeth? By the way I’m 35 feel like I’m to young for full partials.
– Theresa from New York

Theresa,
Dentists vary a lot in their interest in saving teeth. In my practice, I was passionate about that and rescued a number of teeth that other dentists said were hopeless teeth. Almost every tooth that has tooth decay or is broken can be fixed, but there are many dentists who don’t want to go to the trouble of saving them. And for missing teeth, if you’re willing to pay for dental implants, that is by far a better way to treat missing teeth than removable partials.

Also, when you have a mixture of missing teeth, chipped teeth, and discolored teeth, as you have explained, there are usually a number of different ways to fix them. But some of those ways require newer technologies such as dental implants or dental bonding and some dentists aren’t comfortable doing those.

You can be grateful, at least, that your dentist isn’t willing to go out of his comfort zone. Some dentists will do that, to please the patient or to avoid losing the patient, sometimes with disastrous results.

Just get a second opinion. Look for a dentist with a similar philosophy to yours. Again, don’t try to push any dentist out of his or her comfort zone. Listen to what they recommend, gently prod to see if they are giving you all the options, ask what they recommend, and then decide if that’s what you want to do. If you do want to save the teeth, you want a dentist who enjoys doing that, because they will have a passion and practice in doing that successfully. And for a dentist who is good at placing dental implants, that is the thing they will certainly prefer doing for you and will likely be the first thing they recommend.

Good luck,
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.

June 7, 2012

Why do these dentists just want to pull teeth?

Filed under: Fractured teeth — Tags: , , , — mesasmiles @ 5:38 pm

Dr. Hall,
I’ve been to two different dentists lately because one of my front teeth, that had previously been bonded, broke almost completely off. Both dentists wanted to pull most of my front teeth and get a PARTIAL! I am a single 35 year old woman and the thought of having removable teeth horrifies me! Please help! Money is not a concern. What can I say to get it through a dentists head that I DO NOT want my teeth pulled?? My teeth do not hurt in anyway, even the one that chipped off doesn’t hurt.
– Donna from Kentucky

Donna,
Don’t try to convince either of these dentists to save your teeth. That would be a mistake, even if you could convince them to try. Dentists vary greatly in their commitment to saving teeth. If a dentist doesn’t believe in saving teeth, there is a reason for it. Often it’s that he or she just doesn’t want to bother. It’s riskier to try to save teeth – you might not be successful. And pulling teeth and replacing them with a partial denture is much easier. Or it could be that the dentist doesn’t have very good skills for saving teeth, so I wouldn’t try to push them at all in this.

I wonder, when I get a question like yours, if the situation isn’t that the teeth are truly hopeless. But I’m inclined to believe, in your case, that is not the case, for two reasons. First, you seem very committed to saving your teeth, so I can’t believe that you’ve been neglectful. And you mention that money is not a concern. And then both dentists are recommending removable partial dentures, which is a really low-class way to fix your mouth, even if the teeth were hopeless. So that suggests to me that these dentists are both looking for easy solutions. Why no mention of dental implants, which is a far superior way to replace missing teeth?

Have you checked with Dr. —? [the mynewsmile.com recommended dentist closest to where Donna lives] That’s where I would recommend going. [He] believes in first class solutions. From what I know of [him], I think that [he] would try to do whatever [he] could to save them. To save yourself some money and some time, I would call the office and be very up front about what you want – you want a dentist who believes in saving teeth. And if they tell you over the phone that [this dentist] is strongly committed to saving teeth, tell them that Dr. David Hall recommended [him] and said he thought [he] would agree to a quick complimentary meeting where you could ask [him] about that, face-to-face. If you like what you hear, you could then schedule the exam.

Your case doesn’t sound simple. This front tooth, if it had been bonded, must have broken before. And now if it has broken almost completely off, that may mean that you have a very strong bite, which would require extra expertise to get your teeth fixed so that they will withstand those biting pressures. You really need to get away from dentists with this small-town-dentistry mentality and into a higher level of care. And by small-town-dentistry mentality, I don’t mean to imply that dentists from small towns aren’t good dentists. I have a great affection for small towns and some small-town dentists are among the best in the country. I refer to a mentality of doing patchwork dentistry, or low-tech dentistry, or avoiding difficult things.

– 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, 2011

Getting four front implant teeth to look right

Filed under: Dental implants — Tags: , , , — mesasmiles @ 7:37 pm

Dr. Hall:

I am missing my four front teeth. I have had a porcelain bridge and a removable partial denture, but I’ve just turned 50 and didn’t want to return to a partial. I wanted an esthetic and durable solution and something approaching the feel of natural teeth. I chose implants. Four separate implants for four separate crowns.

I’m about to have the crowns done and have some concerns. One, I don’t want the crowns to appear to ‘sit’ on the gums as the bridge did. I have a very high smile that shows a lot of gum. I thought there would be some sort of surgical step to shape the gums. Secondly, I don’t want anything fused to metal because, as above, I have a high smile and I’d be really disappointed after so much time and expense to have an obvious crown in the front of my smile. Or in my case, 6 obvious crowns. The dentist plans to crown the two next adjoining teeth as well in order to work more with size and color. I said Alberta but I also spend time in the southern US during the winter so location is not a barrier to having good work done. I have read here that all-porcelain is best but also that ceramic is preferred. So I’m confused. Your input would be most appreciated. From reading your responses to others, I realize I need to reschedule my ‘impression’ appointment in order to consult with my dentist on type of crown he intends to use. One thing that is clear to me is that I also need to whiten my natural teeth before having any crowns made or placed. Correct? Thanks in advance for any help you can provide.
Kelli from Alberta

Kelli,
You bring up some good questions about replacing your front teeth.

There are a lot of different issues to deal with when you are using dental implants to replace your four front teeth. I don’t know that I can deal with them all in an e-mail or a blog posting. But I can be helpful.

There are several things that bother me about what you told me your dentist has done or plans to do. The first is that he or she plans to put crowns on the two adjacent front teeth, the teeth adjacent to the space where your teeth were missing. You say it is in order to “work more with size and color.” I don’t know what that means exactly, but it sounds like it’s an appearance issue. And if your dentist is doing crowns on your canine teeth for appearance reasons, that says to me that he or she doesn’t know how to do porcelain veneers well, because, for appearance’s sake, that would be the treatment of choice.

I am also bothered that your dentist didn’t suggest whitening your teeth beforehand, that no building up of the gum was done in preparation for the implants, and that your dentist didn’t mention any options about the choice of crown.

Don’t think you can make up for deficiencies in your dentist by researching answers on our website. It won’t work out. I have a file full of horror stories of people who thought they could do that.

You’re asking me these questions about the type of crown. Yes, all-porcelain or all-ceramic is the best crown for putting on a natural front tooth. But you’re talking about putting a crown over a dental implant, so you already have a metal implant as a foundation for the crown, and the choice between all-ceramic (or all-porcelain – they are virtually the same) or porcelain fused to metal becomes less important and what becomes important is having this work done by someone who knows how to manipulate the color to mimic translucency and how to permanently conceal the border line between the implant and the crown.

But you’re seeming to think that I can give you a choice that will make this go right when you already have made the single determining choice in the outcome of this case, and that is that you have selected the dentist who is doing this. And I fear, from what I said above, that you have selected your basic, mechanically-oriented non-artist dentist. And if that is the case, there is really nothing I can do for you. Just reconcile yourself to the idea that you’re going to get a mediocre result, appearance-wise. It may be structurally sound, but fake-looking.

Here’s the bottom line. If your dentist is artistically inclined, he or she will care about your lip line and the appearance of the gums, and will have sought out the training necessary to get this to look right. If your dentist isn’t artistically inclined, which would be the case with 98% of the dentists, this is not something I can coach your dentist through. He or she probably won’t listen to me, for starters, and even if he or she did, this is a skill that is learned over years.

Additionally, it is asking for disaster to go to your dentist and specify that you want such-and-such a type of crown and a certain technique. The reason your dentist didn’t choose the type of crown or technique that produces a beautiful result is usually because these techniques are harder and require specialized training to use. And your dentist is trained in dental school to never let you think that they are unfamiliar or uncomfortable with any procedure they do, as it makes the patient very nervous. So they will either come up with an excuse as to why they think their way works better, which leaves you as you started, or they will bluff their way through, which is worse.

Think about this. YOU took the trouble to look up this information and found it on the Internet. So you know it isn’t that hard to find. So why doesn’t your dentist know this stuff? I’ll tell you why – it’s because it is low on his or her priority list. That tells you all you need to know.

So here is my advice:
1. Do NOT approach your dentist about the type of crown being done with the idea of asking him or her to do some other type than what they were planning. If he or she hasn’t given you any choices, there is a REASON for that.
2. Reconsider your choice of dentist. WHO does this work is critical. If the appearance of this work is really as high on your priorities list as it seems, you need to have this done by an artist, and you will not change your dentist into an artist by trying to direct his or her choices of materials. If you want help from me with this, share with me the name of your dentist, and I will tell you what I think, and, if necessary, I can refer you to an excellent cosmetic dentist. And let me know where in the US South you go during the winter.

– 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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