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

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