Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

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

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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.

November 30, 2012

How to treat a cracked tooth

Filed under: Fractured teeth — Tags: , , , , — mesasmiles @ 6:15 pm

I have cracked a tooth. It is on the bottom next to the back. An endodontist looked at it and suggested a crown. but was asked by my regular dentist to take out the filling to see how deep the crack was.This was not done.So my dentist tried to mend the crack.I cannot stand pressure on one side of tooth and it did not work. Since one side of tooth feels strong we are now considering an onlay. Do you feel a cracked tooth can be mended like this? Or should I go with the crown. I hated drilling away so much of my tooth that was not damaged.
– Pamela from Kentucky

Pamela,

I’m not going to be able to give you a certain answer to your particular situation. There are many degrees of cracks in teeth, from a superficial crack that is just in the enamel, to a deep crack that goes all the way into the dentin and could even involve the pulp of the tooth. And there are different places a tooth could be cracked. The crack could be horizontal, involving a cusp or a corner of the tooth, or it could be vertical, down the middle.

And to be clear, here, we’re talking about cracks and not fractures. If the pieces of a tooth move independently, then the tooth is fractured. The idea of treating a cracked tooth is to keep it from fracturing.

And there are different kinds of onlays. Some would work well for any type of crack and some would have restrictions.

An onlay covers all or most of the chewing surface of a tooth. It is a very nice restoration. It is hard to do, so a lot of dentists don’t do them. Since it doesn’t go down below the gumline except between the teeth, it is very gentle to the gums and helps promote good gum health. They can be made out of gold, porcelain, or hardened composite.

A gold onlay covering the entire chewing surface of a tooth would completely protect any type of cracked tooth. I would feel very comfortable with that. If the onlay is made of porcelain, I would only use it to protect the tooth in the case of a minor crack – either a superficial crack or a horizontal crack involving just a cusp or a corner of the tooth. The porcelain is not strong enough to hold a tooth together that has a serious vertical crack. Some supposed experts teach that the bonding strength of porcelain to the tooth is strong enough for this situation, and I believed that at one time, until I used an all-porcelain crown on a tooth that had a serious vertical crack. The porcelain crown and the tooth both ended up cracking all the way through, and I ended up repairing the situation at my own expense.

And hardened composite is considerably weaker than porcelain. I would not recommend that for any type of crack in a tooth.

This idea of repairing the crack with some other technique than a crown – no, that wouldn’t work. It might hold for a short period, but it’s not a long-term solution. Now if you were putting pressure on your dentist to find a more economical solution, then I understand. But if this was the dentist’s first choice of treatment, it makes me a little skeptical. I’m not sure what you’re meaning when you say that this treatment didn’t work, and I’m not following you when you talk about the pressure on one side of the tooth. I can’t visualize what you’re saying. And I don’t understand what that means, that a side of the tooth feels strong. So maybe your dentist is right. But I have this skepticism and would suggest a second opinion.

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.

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