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My dentist said he can’t give me Hollywood white crowns

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Dr. Hall,
I had crowns put on 9 of my front top teeth 25 years ago. I hated the color of my teeth—they were yellow-gray. I just wanted white teeth. They talked me into a shade I hated. I am now having these crowns replaced hopefully to the white shade I originally wanted. My dentist recommended B1. He made my temporaries in the B1 shade so I could see how the color will look. I don’t feel like they are that much whiter than my previous crowns. My dentist said because I have post under a couple of my teeth anything whiter the post would show through. I would like a shade lighter than B1, but obviously don’t want the post to show through. Do you think I could go with M4 or BL4? I want white teeth without looking fake. Help, I’m having the permanent ones put on soon!
Deb

I searched for Hollywood white crowns.

(See Dr. Hall’s answer below.)


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Deb,
Based on your comments, I’m worried that your dentist is not an expert cosmetic dentist. And for getting your new smile you really need an expert cosmetic dentist.

Your dentist is confusing color with translucency. Making a crown more white will not make it more translucent. If the posts aren’t showing through with shade B1 crowns, they won’t show through with BL4 shade crowns, or for super-white crowns, say BL1.

For a smile makeover, the dentist should ask you what you want—what shape, what color, and anything else about the appearance. When a dentist tries to push a patient into something they don’t want, cosmetically, it’s often because the dentist has some feeling of discomfort with the procedure, usually from a lack of expertise and experience. So I’m wondering if your dentist has ever made a crown with one of these bleached shades. I would ask him that, and that will help you know about his level of expertise here. Ideally, your dentist should be able to show you photographs of a smile makeover case he did with one of these bleached shades. I can’t imagine an experienced cosmetic dentist not having a case like that in his or her photo album.

So here’s my advice about how to proceed. Note that I have not said that your dentist doesn’t have the expertise you need here—I’m only trying to guess what is going on. Let’s try to assume he can do this correctly. Tell him exactly what color you want and insist on that. Then be sure you have a good look at the new crowns in your mouth before they are cemented or bonded and make sure you’re happy with how they look. An expert cosmetic dentist will routinely have a try-in and will be making sure that you love the appearance before moving forward. If your dentist doesn’t do that, you can still insist on that. Have a good friend or family member with you if you want, to be a support for you and a second set of eyes. And then insist that you are perfectly happy with how they look before they are cemented or bonded. Don’t let him water down your expectations.

If your dentist won’t do what you want, or is unable to do it to your satisfaction, then you need to change dentists. This is a very do-able smile makeover. If you let me know where you are, I can maybe help you find an expert cosmetic dentist who will have no problem giving you what you want.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

I’m looking on Yelp to find the best cosmetic dentist

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Dr. Hall,

Help! Know this is short notice, as having work started on Wednesday, December 4, 2019. And thank you for the great website, that just discovered today.

Am approaching 70, medium fair skin tone, but not pale, blue gray eyes, medium neutral blonde hair. Have decided on bonding for economical reasons. Am a big time grinder, so will need a new nightguard when finished with dental work.

Have downloaded some color charts. Realize very white teeth would look un-natural with my age and coloring. Want bright, happy smile. Any suggestions on bonding color? Will have six teeth total, 2 central, 2 lateral, and 2 canines. There is bridge work on first premolars both sides; probably BL2 or BL3 color. Perhaps all six BL2, as bonding will darken a little with time? Tea drinker with half/half, white wine only, never red, and dental cleanings 4x a year (2 with Periodontist)

Thinking of having my dentist start with the canines. On yelp, he is ranked within top three dentists for smile makeovers in Pittsburgh. Thank you so much Dr. Hall. Appreciate your help.

– Mary from Pittsburgh


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Mary,
I’m going to break down your questions into three parts.

Let me start by taking the easiest one to address. You’re not going to find the best smile makeover dentist by looking at the Yelp rankings. I love Yelp and am a Yelper myself, but sometimes the dentists they list as the best cosmetic dentists aren’t very good. They rank this with an algorithm, based in large part on their reviews, but it doesn’t appear to me that they make any distinction as far as what is in the reviews.

Let me show you that by the Yelp results in another market that I am very familiar with. This is in a suburb of a major United States city with a population of about 150,000 where I know a number of the dentists. Searching in Yelp for the best cosmetic dentist in this suburb gives as the #1 ranking a dentist with 33 reviews with an average rating of 4.5. However, none of the reviews say anything about smile makeovers. Only one mentioned anything with any appearance component, and that was just a single tooth where the dentist got the color right. The website of this dentist shows no significant cosmetic dentistry credentials and there is no smile gallery. The dentist I would rate as the best cosmetic dentist in this suburb ranked #13.

Getting more specific with your search term, I thought I’d try to search for “best smile makeover dentist” in this suburb. The #1 result was a group practice with six dentists, none of which had any credentials at all in cosmetic dentistry. The website has a smile gallery, but it displays stock photos they got from their dental website company, presumably because they don’t have any of their own to display. The #2 result is a dentist who has no website at all. None of the reviewers mentioned having a smile makeover. They mentioned things like doing a great job on a root canal, being gentle, reasonable fees, cleaning was great, the office was clean, etc. The #3 result was an oral surgeon who extracts teeth but doesn’t do any restoration.

This ties in with the reason I set up this referral service, because there aren’t really good ways for the public to tell who are the great cosmetic dentists. Lacking any other guidance, my advice would be to check the smile gallery yourself, make sure it tells you clearly that it is showing the dentist’s own work, and go from that. There are some technical issues you’re not going to be able to evaluate, so this method is imperfect, but it’s better than asking Yelp.

On Your Color Questions

All these questions you asked about the color—I really don’t know how to help you with that. There isn’t a formula for choosing the right color. The basic issue is how white you want to go. When you get into the darker natural shades of teeth there are yellow-whites, tan-whites, gray-whites, and brown-whites, but when you’re into bleached teeth colors, we don’t make those distinctions. If you’re going to do only six teeth, you’re going to be limited in that you have to match the color of the premolars. The color is best chosen in consultation with the dentist doing the case.

On Bonding vs Porcelain Veneers

And you didn’t ask this question but I’m going to address it. You’re looking for a budget smile makeover so you think you’re going to save money by doing it with composite bonding rather than porcelain veneers. I will tell you that it’s going to be really tough to get a beautiful smile makeover that way. There are great cosmetic dentists who won’t do a full smile makeover with composite bonding, and the reason is that it is so time-consuming to do that well, they would have to charge MORE for the composite than the porcelain. In all my years of practice, I only did two full smile makeovers with composite. One was on a young girl who had badly splotched teeth after she was done with her braces, and that was because she needed to be a little older before getting the porcelain. The other was on a patient I talked into letting me do that for a reduced fee so she could be one of my accreditation exam patients. I made her a deal to do that first and then the next year I did porcelain veneers over the bonding.

Another problem with composite bonding is that it stains or dulls so easily that often it only looks good for two or three years when it is done over that large an area. And then, since you grind your teeth, composite chips much more easily than porcelain. That would be another obstacle—protecting this bonding from breaking. I’m reading between the lines here that you have worn your teeth down and will need them made longer. If you came to me, I would decline to do your case in composite because I would feel it would be taking your money but doing you a disservice—it just wouldn’t hold up. Your risk is that you’ll get a dentist with poor ethics who will agree to do this for you. I think you’d be best getting porcelain and then protecting that with a nightguard.

So there’s my opinion for what it’s worth. I wish you the best. I’ll email you privately with my recommendation for a cosmetic dentist for you. I like to do that privately so I don’t offend the dentists I don’t recommend.

– Dr. Hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

Porcelain Veneers Gone Bad

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Dear Dr. Hall,
I recently went to a dentist to do a smile makeover, specifically because my four upper front teeth are misaligned and crowded. After he explained that cosmetic dentistry could correct the problem faster without the inconvenience of braces, I opted for that.

He said that a combination of bonding on #10 (left lateral incisor), a single veneer on #7 (right lateral incisor) and shaping would provide complete alignment, no crowding and an even smile. He also claimed he did shaping on the lower teeth – which I never discussed or mentioned about treating at a cost of 1.3k. He charged overall 9k for this work. When he declared it complete, the veneer was too small with a gap near the gum line, the teeth were still crowded and they remained uneven. When I asked him what would provide the outcome he originally described he said only 4 porcelain crowns on the upper teeth would, but at an additional cost of 7k, because he would need to do root canals in addition to placing crowns.

I went to another dentist for a second opinion and he advised me that his recommendation would have been to place 4 veneers to correct the original crowding and alignment problem. They also said that to correct the current problem I would still need the 4 veneers, no root canals necessary and no crowns necessary, just 4 veneers at a total cost of 4.5K.

My question is how do I successfully recover my 9K from the first dentist?
– Grant from New Jersey

Grant,
Well, I guess we’ll add your experience to our list of cosmetic dentistry horror stories.

Just from what you’re telling me it sounds like the first dentist took you for a ride, not delivering work that was promised and leaving you with a very poor smile makeover. In my opinion, you should be entitled to a refund of what you paid, if you go about it right. But before I get into that, I have a real concern about your second dentist. How do you know the second dentist will deliver the attractive smile you are wanting? Do you realize that smile makeovers are not taught in dental schools? You might want to check my blog post, Why you shouldn’t ask your family dentist to do porcelain veneers.

I strongly suggest getting a third opinion from a dentist you know can do smile makeovers. You’re there in the New York City metropolitan area where you have a varied selection of excellent cosmetic dentists. You can go to our list, or find an accredited cosmetic dentist.

Now back to your question of getting a refund from the first dentist.

Start, of course, by just asking for one, with some gentle pressure. I address some pointers about this in my blog post, How to ask for a refund. If that doesn’t work, you need to apply more leverage. There are a series of steps, each one applying a little more pressure.

The next step would be, after you find your expert cosmetic dentist who can do a beautiful job with this, is to see if that dentist will call on your behalf and say that a refund would be appropriate. Dentists tend to be sensitive about what other dentists say about their work.

Unfortunately, it seems to me from what you’ve told me about his conduct so far that your dentist is one who is going to require more pressure than that and you’ll need to play hardball. The next step in escalating pressure against the dentist is to complain to the dental board. The step after that is to contact an attorney. For each of these steps, it is very helpful to have the backing of another dentist to document the problems with the earlier work.

Good luck.

Dr. Hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

Expectations way too high here for the Snap-On Smile

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Dear Dr. Hall,

I’m thinking about purchasing a Snap-on Smile for esthetic reasons and to prevent, as much as possible, the loss of tooth tissue. But I had my doubts about it looking natural. So I googled “snap on smile looks fake” in order to find possible comments about this on the internet. I found this post and your helpful answer. It’s great that such a knowledgeable doctor gives (free) advice!

First of all I would order the Snap-on Smile in the same yellowish color of my own teeth, and demand that the irregularities of my existing teeth are duplicated in the Snap-on Smile. I believe it’s mostly the whiteness and the uniformity of fake teeth which make them look so unnatural (like horse teeth).

Now, in the video ‘snap on smile part 2’ it shows the set of 6 small instruments with which “Snap-on Smile-dentists” can make subtle adjustments to the appliance. To make my snap-on look even more natural, I would be interested in getting the snap-on teeth flattened, including near the gums, and the “embrasures” and the vertical grooves between its teeth deepened. But, as you wrote, dentists “have an engineering mentality, and they simply aren’t artistic.” Therefore I would prefer to take my snap-on to a cosmetic dentist to get these adjustments made. Would a cosmetic dentist have the necessary instruments for a Snap-on-Smile? Or is the specific set of instruments needed which only Snap-on-Smile-dentists get? (Actually, I expect a cosmetic dentist to have even better instrumentaria! But I would like to be sure before I go ahead purchasing a Snap-on Smile, which, BTW, I hope my own “normal” dentist won’t mind me doing – I’ll ask him.)

Thank you in advance.
– Maylynn

Maylynn,
Your expectations with this Snap-On Smile are way too high, and you are headed for disaster with this plan of yours. I fear that you’re a budding cosmetic dentistry horror story. I’m glad you asked the question, though, because it gives me an opportunity to clarify this issue. Your question started as a comment on my earlier blog post where I answered Heather who said she was disappointed in her Snap-On Smile. I can see that while I told her she could get some improvement by getting a more artistic dentist to help her, I should have been more emphatic in my comments about the Snap-On Smile ending up looking bulky and not natural and her never getting to a beautiful smile.

We have had several dentists who are clients of our website design business who have tried marketing Snap-On Smiles. Some of them have quit doing it because patients are so disappointed in how they look. The ones who are successful in marketing them are better at tamping down patient expectations. We advise them to be sure to tell people they will NOT get an attractive smile, only an acceptable smile. The teeth will look bulky. They will not glisten like natural teeth. And while they may look natural from a distance, from up close it will be easy for someone to tell they’re not real.

And while you seem to be brimming with confidence that you can help your dentist get these looking just right, I would kindly remind you that you are not a professional, and some of your ideas are not correct. For just one item, whiteness is not the primary reason false teeth look fake. Monochromatic whiteness, with no variation in the color, yes, but I have made many sets of porcelain veneers that are nice and white and that even a skilled cosmetic dentist, from the front from twelve inches away, could not tell were not real. Also, your comments about how you are going to insist they be colored and shaped spell trouble for your relationship with this dentist who you think is going to make these under your supervision. And the dilemma you are in with your approach is that the more artistic the dentist you engage to do this for you, the more resistant they are going to be to your meddling in the process.

Snap-On Smile is for patients who have an ugly smile and want to upgrade to a smile somewhere between poor and mediocre—say from an “F” smile to a “C-.” DenMat’s marketing materials may lead you to higher expectations, but that’s their marketing. If that’s not where you are, you need to look into a different smile makeover technique.

– Dr. Hall

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Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

The hundred thousand dollar smile makeover

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Dear Dr. Hall,
I have had a terrible experience with my “smile-makeover.” It turned out horrible, so the dentist just refunded my money, and I am looking for a new dentist. I found your website while I was still his patient and was able to figure out that he had little to no knowledge of what you describe as a true cosmetic dentist.

So I made appointments with the first 3 cosmetic dentists on your list. I must say I was so disappointed with the 1st. While he rightly said my bite was off, I was there for a 2nd opinion of the 6 upper anterior crowns I had. He said I would first need to spend $300-400 with his hygienist, and then, to deal with my bite issues and everything the cost would range between $50,000 and $100,000. “About the price of a new car,” he said. I only wish I could replace my 6-yr-old car bought used, for 1/3 his idea of a new car. He never got to what type of smile I would end up with, as his idea was to build up my back teeth and have “an appliance” covering several teeth and add porcelain “where needed.”

My teeth and gums are pristine according to a general dentist I went to for opinion and a periodontist I also went to for opinion earlier. I don’t understand why I need all of this, and I can’t begin to afford this and want your opinion.
Thanks,
– Sally from Texas


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Sally,
There’s a great variation in what some expert cosmetic dentists charge, and the fees you’ve been quoted are definitely on the high side, even if you actually need all the work that has been quoted. I would keep going down the list and get another opinion. Meanwhile, let me give you a little insight into what I think is going on in your case.

You said that you know your bite is off, and it appears that you’re being quoted a fee for a full-mouth reconstruction to rebuild your bite. Do you actually need that? I don’t know that, but I can tell you that some dentists are very fussy perfectionists and they insist that every patient accept what they call “ideal treatment.” Other dentists are more pragmatic and will consider other options for patients who can’t afford the ideal. Fortunately, you’re in the Dallas-Fort Worth area where we have several recommended cosmetic dentists. Go ahead and shop around for second opinions.

I want to tell you a story about this cost issue and dentists’ fee levels. There is a city where we have two recommended cosmetic dentists—let’s call them Dr. Expensive and Dr. Budget. Dr. Expensive is famous and has patients flying in from far and wide to see him. He does absolutely exquisite work. Dr. Budget also does very beautiful work and has won awards for the beauty of his work. Dr. Expensive’s fees are about triple of what Dr. Budget charges. Is Dr. Budget an inferior dentist? I don’t think so. I’ve seen his work and it is world class. And guess what, Dr. Expensive goes to Dr. Budget for his dental work.

So get another opinion or two.

Dr. Hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

My dentist wants to give me CEREC veneers

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Dr. Hall
I’m about to have CEREC veneers done by a dentist I’ve used very little. He has told me that he does 1.5mm veneers, and that, after research, seems very thick.

I’m not sure of his abilities, and CEREC takes a magician to do correctly and natural.

Should I reconsider?
– Terry from Aurora, Colorado

(See Dr. Hall’s response below.)


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I wrote back to Terry and asked this:

Terry,
Who’s the dentist? That makes all the difference in the world!
Only about 1-2% of dentists are artistic enough to create a beautiful smile makeover.
So who’s the dentist? That’s the key question – not what material he’s using or how thick. Though you’re right—1.5 mm is about triple the thickness of the veneer most cosmetic dentists would place.
Dr. Hall

Whereupon he wrote back and gave me his name. Let’s not use the dentist’s real name—let’s call him Dr. Doe. So I responded with this:

Terry,
That’s very helpful.
It’s tough to find out any information about Dr. Doe—no website, no Yelp reviews. His Facebook page tells me nothing useful, no Angie’s List reviews.
I also checked databases that I have of institutions that train dentists in smile makeovers, and cannot find him listed anywhere.
Bottom line—highly risky. Especially given that he wants to make these veneers with a CEREC. There are some dentists who can do that, but this is harder than using a ceramist and requires an exceptional amount of skill. So not finding him among the alumni of these training institutions is troubling. He may be doing that to save money—he doesn’t want to pay a ceramist.

And you have to realize that if you get a smile makeover and end up hating how it looks, you have no legal recourse. As long as the veneers meet the standard of care—they stay on the teeth and function all right—the legal standard of care does not require you to like how they look.

Use one of our recommended cosmetic dentists. We have a couple in the Denver area, and either one could give you a beautiful smile makeover.

I have a bad feeling about Dr. Doe.

– Dr. Hall

And Terry responded:

Dr. Hall, thank you very much for doing the informative research. Even though not much was found, it was enough for me to reconsider my decision, and will give one of your recommended dentists a call, and mention your name.
I appreciate your time, of course your effort, thanks for everything.
– Terry

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

After my porcelain veneers, I need root canal treatments

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Dear Dr. Hall,
I had full mouth smile makeover done (veneer crowns) in January 2017, 12 upper teeth and 10 lower teeth. After they put permanent crowns on, I felt sharp pain on teeth #5 and #13 (upper second premolars). The dentist did crown height adjustment 3-5 times, finally the pain went away, but tooth abscesses formed on top of both #5 and #13 teeth within 4-6 weeks. The dentist x-rayed and said the teeth nerves had died, and I need root canals. I was upset and didn’t realize that nerve damage could be a risk involved in veneer crowns. I remembered I asked if there is any risk doing smile makeover during consultation, I was told there is no risk. The X-ray showed that my teeth nerve are fine before the procedure. I am confused and don’t understand what is going on.

The dentist said he didn’t know why, it rarely happened, I am the unlucky one. He referred me to an endodontist to perform the root canal procedure, and the endodontist found more teeth showing no response to cold test, also my gum flared up, swollen and very painful. So far I have had root canals done on 4 teeth (#4, #5, #13, #14), and #12 needs a root canal too, just matter of time. The tooth #3 starts feel strange too. Dr. did agree to pay half of the cost of the 4 root canals, but I am worried it will be an ongoing nightmare. What if the crowned teeth one by one goes bad over the time? I am very frustrated and feel misled. It not only financially cost me, but also add lots of stress on me. Please tell me what i should do and I need some advice. Thanks!
Sincerely,
Jenny from Texas


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Jenny,
To answer your question, I first need to lay down some terminology so we’re clear in what we’re talking about. I’m a big fan of clarity in communication, which requires precisely defining what words mean.

two front teeth, prepared for porcelain veneers

Porcelain Veneer Preparation

You’re saying you had “veneer crowns.” But a porcelain veneer is one thing and a porcelain crown is something very different. A porcelain veneer requires very light shaving of the front surfaces of the teeth—sometimes no shaving at all is required. I found this photograph that illustrates a typical porcelain veneer preparation. Maybe half a millimeter of tooth structure has been shaved off, and the porcelain will be bonded over this.

two front teeth, prepared for porcelain crowns

Porcelain Crown Preparation

This second photograph shows a typical porcelain crown preparation for the same two front teeth. Much more tooth structure has been removed.

It appears from your description that what you had done were porcelain crowns, not porcelain veneers. It is very rare that a porcelain veneer preparation on a tooth will end up making it need a root canal treatment. But a crown preparation will go much deeper into the tooth, increasing the risk of a pulp exposure, resulting in an infection of the pulp and the need for a root canal treatment.

A smile makeover, by itself, does not require any aggressive grinding down of the teeth, which is what must have been done in your case. If your teeth had large fillings or decay before getting your makeover, then grinding them down was necessary. If that is the case, it wouldn’t be surprising if some of those teeth ended up needing root canal treatments. Anytime there is a lot of decay or large old fillings, there is a risk of teeth getting infected. But I would call that procedure a full-mouth reconstruction, not a smile makeover.

But if this that you’re calling a smile makeover was just for aesthetic reasons, then your dentist was much more aggressive than he needed to be, and I believe he should be responsible for the cost of the damages he caused. If you weren’t told of any of these risks up front, he is especially vulnerable.

A smile makeover should be done with porcelain veneers whenever possible, to avoid problems like you are having. There is even a trend in recent years for excellent cosmetic dentists to place what are called ultra-thin porcelain veneers, which require even less preparation than is shown in the photograph above. Some even try to do the makeover without preparing the teeth at all. But many dentists who aren’t expert in cosmetic dentistry simply don’t know how to do porcelain veneers very well, and so they resort to full coverage crowns. Porcelain veneers aren’t taught in dental schools—they’re a cosmetic procedure for which a dentist should get post-graduate education.

As far as what you should do now, I don’t know what to tell you. You don’t really have any option, if you want to save these teeth, besides having the root canal treatments done. And it’s curious that your dentist is offering to pay half the cost of the root canal treatments. This seems to indicate that he is feeling some guilt over this. If that’s the case, I would press him to pay the whole thing.

About what to expect long term, it’s hard for me to tell for sure from here. My guess would be that any teeth that end up having problems, you will find out within the first few months and then things will stabilize.

Dr. Hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

How do I get a digital smile makeover?

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Dr. Hall,
I saw on TV that I can upload a picture of myself and see what I’ll look like with better teeth. How can I do that?
I am seriously interested in doing something to fix my smile because I hate it.
– Amy from Kentucky

Amy,
Yes, for many years there has been software available to give you what is called a digital smile makeover–to take a photograph of you and have it altered so it shows you with a new smile. I got one of the early systems back in the late 1980s – it’s much simpler now to do these digital smile makeovers.
I don’t believe any of the companies that do this offer it directly to the patient. You need to visit a dentist who offers this service, and they will use it to show you what can be done with your smile. Without a dentist who has the capability of translating the image into reality, the digital smile makeover isn’t much more than a game. But if a dentist has this software and has the capability of creating a beautiful smile, often they will offer to provide this service for free.
We used to do that in my office for free, and most of the people who got the digital smile makeover went ahead and did the actual procedure. If you do this, realize that you will probably end up wanting the work done–it’s a pretty powerful way of convincing you to get it done.
Some cosmetic dentists who don’t offer digital smile makeovers will do what is called a provisional smile makeover, which is one step better than altering a photograph but it’s more work and may not be offered for free. They will create a new smile in plastic that you can actually snap over your teeth and try out the new smile to see if you like it.
Just remember not to expect your family dentist to be able to actually create the smile makeover. My estimate is that maybe 2% of dentists care enough about appearance-related dentistry to pursue the education they need to be able to create beautiful smiles.
I see that you’re in northern Kentucky, and the closest major city is Cincinnati. One of our mynewsmile.com recommended dentists is Dr. Tara Hardin in Cincinnati, and she offers this digital smile makeover service. I would check with her as she may well offer this for free.
– Dr. Hall

Question and answer go here.

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

I’m having trouble speaking after getting my porcelain veneers

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Dr. Hall,
I had 10 porcelain veneers placed and two crowns on each side 2nd to last tooth. The final temps looked and felt great. When the permanent teeth were put on I was having trouble speaking. Biggest problem is my tongue is very uncomfortable. It feels like it is too big for my arch and resting on the back of my bottom front teeth.
What is making my tongue sit low in my mouth. My dentist can’t figure it out. Could it be the back of front teeth are too thin? or maybe the two crowns that were put on premolars?

Thank you,
Susan from New Jersey

Susan,
It’s going to be hard for me, not seeing your case, to really tell what is wrong. But your question gives me a helpful starting point for saying something about smile makeovers and speech.

As far as your case, porcelain veneers, if that’s what they are, in most situations shouldn’t be affecting your tongue or your speech. They sit on the fronts of your teeth, so your tongue shouldn’t feel any difference. But some dentists actually do porcelain crowns for smile makeovers and call them porcelain veneers, so that’s a possibility for you. Crowns cover the entire tooth.

If you do get a smile makeover of porcelain crowns, that will have the potential to affect your speech. Expert cosmetic dentists are trained in the effect of the teeth on speech and will be careful about the contours of the crowns and how they affect your tongue. The thickness of the crowns on the lingual surfaces (the insides of the crowns) will affect the pronunciation of certain letters. The length of the front teeth and the positions of the incisal edges of those teeth will affect other letters. The height of back teeth will affect others. To assess all these effects, any new smile that changes any of these critical measurements in your mouth should be tested in provisional restorations first, and the provisionals should be adjusted to accommodate your speech to where they feel comfortable to you before the design is finalized in porcelain.

But you said that the temporary teeth looked and felt great and you only had trouble when the permanent teeth were put on. Something isn’t right there. What is usually done is that an impression is taken of the temporary smile makeover and that is sent to the dental laboratory so that the ceramist can duplicate that result in porcelain. That must not have happened exactly that way in your case. Either the dentist didn’t send those models to the ceramist (maybe only a photograph) or the ceramist didn’t follow the instructions.

Having said all that, ordinarily patients will adjust to new positions of the teeth and speaking will feel normal to you again after a while. If a couple of months go by and you still have problems, I would insist that it be fixed, even if it involves re-doing the case and/or referring to a different dentist.

Dr. Hall

Follow-up – Turns out, this was just the beginning of Susan’s problems. Read what happened to her when the dentist tried to fix the problems and what Dr. Hall said in response. See the follow-up to problems speaking with new porcelain veneers.

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 A. 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 advanced internet marketing for dentists.

A smile makeover over a fractured tooth spells trouble for Aaron

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Dr. Hall,

I had a traumatic fall 12 years ago fracturing 2 front teeth and my smile was restored with root canals and Procera crowns by my family dentist. With age and time, I didn’t like the way my adjacent natural teeth looked with the Procera. Also, I had one left upper molar that had a pretty deep filling and was giving me trouble. I am 38 years old and that filling was almost 30 years old. I decided that it was time for a smile makeover. So I went to a cosmetic dentist here in Lexington who gave me a combination of porcelain crowns and porcelain veneers.

I love my new smile. After the restoration however, my #9 front fractured tooth began giving me trouble. It was tap and pressure sensitive, so I went back to my cosmetic dentist and she told me I need to get an implant and another restoration. I had a gum pimple at the time and was referred to a periodontist.

root fracture on tooth in a smile makeover

The x-ray of Aaron’s front tooth.

I went on a course of antibiotics immediately (Amoxicillin 500 mg). I saw a periodontist last week and he confirmed that extraction of my newly restored tooth was needed. I requested my x-ray, showed it to my family dentist, and he doesn’t necessarily agree that extraction is warranted. He is contacting the West Virginia University, University of Kentucky, and University of Louisville dental schools to see if this tooth can be saved by periodontics or endodontics. I really do not want to lose #9, especially after a $1500 crown was placed, and not to mention IT IS MY FRONT TOOTH. Wish me luck. Please feel free to comment. I have attached the x-ray.

– Aaron from Kentucky

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Aaron,

I actually have a couple of problems with your smile makeover. Not with its appearance. You also sent a photograph of your smile and it looks great! But it leaves me wondering if your dentist took x-rays before doing this smile makeover or, if she did, if she fully comprehended what she saw or gave it proper weight.

Root fracture on tooth #9

Your tooth #9 doesn’t look good at all. I have a fair amount of expertise in x-ray diagnosis and taught x-ray technique at the University of Minnesota, and I’ll tell you what I see. Right in the middle of the root there is a horizontal radiolucent line that looks like an old fracture. This must date from back to your original accident. The root canal filling crosses this fracture line, so the dentist who did the root canal either didn’t see the fracture or figured he or she could navigate through it, remove all the necrotic soft tissue, and hopefully get healing. And it looks like this happened to some extent, at least. The end of the root looks healthy. But just above the fracture line, the tooth looks moth-eaten. It appears that some of the root canal filling material is gone. If the pimple on your gum traces to that area, that spells trouble. And my guess is that it does. The moth-eaten appearance suggests that there is infection eating away at the root of your tooth. If this is the case, the tooth is unrestorable.

Does tooth#8 need root canal re-treatment?

If this weren’t enough, the other front tooth is suspicious. If I had done this case, I would have addressed the problem with #9 before starting, but I would have also recommended re-doing the root canal treatment on #8, because the root canal filling stops several millimeters short of the end of the tooth. Now that the crown is on that tooth, I wouldn’t do anything more than wait to see if it flares up. There aren’t any signs on the x-ray of any infection here, just evidence of a situation in which infection could develop.

So yes, I think you’re going to lose tooth #9. From everything I can tell, your dentist is an excellent cosmetic dentist, so I would have her stay with this case and finish it. But I think she missed the diagnosis here and should make concessions on the fee to get this fixed right. If I had made this mistake, I would ask you to pay for the extraction and the implant but then not charge you anything for the implant crown. That would make it so the total fee you pay would be equal to what you would have paid had the tooth been extracted in the first place and an implant placed, which is what should have been done.

– 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 A. 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 advanced internet marketing for dentists.

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