Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

February 3, 2017

My dentist says I have too deep an overbite for porcelain veneers


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Dr. Hall,
My dentist told me that I am not a candidate for porcelain veneers because my top teeth almost completely cover my bottom teeth. Instead, he wants to put 6 porcelain crowns on my top front teeth. I want a beautiful set of teeth, and unfortunately mine are stained from tetracycline. I have 2 questions: 1) Have you heard of veneers being inappropriate for a particular bite such as mine? And 2) Since my bottom teeth will not be crowned, is it reasonable to expect that I can bleach them to match my new crowns on top?
– Susan from Louisiana

Susan,
Oh no, you don’t want to do crowns on all your front top teeth! To do that they’ll all have to be ground down to stubs. And you don’t need that. Having a deep overbite the way you do it actually makes more sense to do porcelain veneers, because nothing has to be done to the backs of the teeth—all the work is confined to the front.

This happens with cosmetic dentistry a lot. You want a cosmetic treatment. Your dentist doesn’t do a lot of cosmetic dentistry and doesn’t feel comfortable with the particular procedure you want, so he or she gives you some excuse why this isn’t appropriate for you. I’ll give your dentist credit for creativity at least—this is the first time I’ve heard of a particular bite being a reason for not doing porcelain veneers.

Furthermore, you have tetracycline stains. This is one of the most difficult smile makeover situations there is, and you don’t want to have your family dentist doing this. It requires a high level of expertise and a lot of experience with cosmetic dentistry.

And six teeth? People show eight to twelve upper teeth when they smile, depending on the width of your smile. Doing just six teeth when you have tetracycline stains would look really funny. This is another signal your dentist is giving that he is in over his head on this. Sorry to be so blunt about it, but I’m trying to look out for your best interests.

My recommendation: Go to one of our expert cosmetic dentists that we recommend. We have several in Louisiana who could do a great job for you and give you a beautiful smile. There is one close to you that I will email to you privately, so I don’t give any clues as to your exact location. If you otherwise like your dentist, explain what you are doing and that you’ll be back to him for your regular checkups, cleanings, and other work, but that you’ve been advised that this is a difficult cosmetic procedure for which you need a cosmetic specialist.

About bleaching your lower teeth—this is an option, depending on the type of bleaching and the severity of the tetracycline stains. This is another reason you want an expert who has experience with your type of case. The Kör deep bleaching system can give some pretty decent results with these stains.

– 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 30, 2015

What are the different types of teeth stains?

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Dr. Hall,
Can you please explain endogenous vs exogenous stains? Intrinsic vs extrinsic stains? What terms would a dental assistant hear more and which should they be familiar with? I appreciate your help.
– Jennifer from Oklahoma

Jennifer,
This sounds like something that must have come up in connection with a textbook or a classroom discussion (I see your email address is from a college). That’s not the primary function of this blog, but your question is interesting and I’d like to help you out.

The terms you are using are those that would be used by academics and not so much by practicing cosmetic dentists. But they are a useful way to categorize teeth stains. Of the terms you mentioned, extrinsic and intrinsic would probably be heard more often clinically among practicing dentists than endogenous and exogenous.

Extrinsic stains would be those that exist on the surface of the teeth. Tobacco creates extrinsic stains. Here’s a picture of some teeth with extrinsic stains. extrinsic teeth stains

These are child’s teeth, and children, as their teeth are developing, tend to pick up some of these stains as different naturally-occuring bacteria come to populate their mouths. Peridex mouthwash causes this type of stain. The milder stains of this type can be removed by brushing (e.g. whitening toothpastes). The more stubborn ones will need to be removed by a dental cleaning, or by Supersmile toothpaste.

Intrinsic stains would be those that are absorbed into the actual structure of the teeth. They take a long time to develop. Years of drinking coffee or tea, smoking, or even eating highly pigmented fruits such as raspberries, will cause the teeth to darken. These stains tend to be brownish or yellowish. They cannot be removed by any toothpaste, but they can easily be removed by bleaching. Here are before-and-after photographs of teeth that had these accumulated stains which were treated with the Kör deep bleaching system.
intrinsic teeth stains, removed by bleaching

Exogenous stains would be those that are caused by outside agents. All of the stains mentioned above would be exogenous. All can be removed by either a surface cleaning of the teeth or by bleaching.

Endogenous stains are those that were acquired during the development of a tooth. Tetracycline stains would be in this category. If the antibiotic tetracycline is taken during the development of permanent teeth (between birth and twelve years old) it binds to the dentin of the tooth and becomes a deeply embedded stain. Fluorosis stains are more superficial but they are also developmental—they are caused by the consumption of too much fluoride while teeth are forming. From the point of view of a cosmetic dentist, you could also call a dark natural pigmentation in the teeth to be an endogenous stain. Some people’s teeth are just naturally dark.

The treatment of these endogenous stains is different. Tetracycline stains respond somewhat to bleaching, but are best treated by porcelain veneers. Fluorosis stains should not be treated by bleaching because they occur in splotches. However, the natural pigmentation of teeth can be treated effectively by bleaching. With persistent bleaching treatments, people can get their teeth whiter than they were when they first erupted into their mouths.

I hope this is helpful. Good luck in your schooling.

– 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 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 27, 2012

A Review of the Tanda Pearl Ionic Teeth Whitening System

Hello Doctor Hall,
I have read and heard advertising recently regarding the Tanda Pearl Ionic Teeth Whitening System. It reportedly only requires 5 minute treatments twice a day to achieve professional results. First of all, is this system safe? Secondly, what do you think about the results it should yield? The customer satisfaction reviews are generally very positive, but these are few in number and do not address safety. I currently have professionally made trays for bleaching. Wearing them seems to aggravate my TMJ, so the 5 minute treatment suggested with the Tanda Pearl was of interest to me. Thank you for your help!
– Debbie from Kansas

Debbie,
I read all the information about this on the Tanda website and read the reviews by users that are posted on Amazon and I will tell you what I think.

First, this is the same basic tooth whitening concept that is used in professional teeth whitening products like Nite White and Opalescence. It’s a peroxide gel that is placed in a tray so that it has time to penetrate the tooth. I don’t see anything revolutionary here, other than this mysterious “ionic” system, which I will talk about later. The whitening with the Tanda Pearl system is accomplished by the release of tiny oxygen bubbles inside your teeth just like other systems. Here are the differences:

1. The tray. The Tanda Pearl tray is a homemade custom tray that is fabricated by biting into an impression material while it hardens. It is bulky and requires that you keep your mouth closed while using it, because it is a single tray that fits both your upper and lower teeth at the same time. You could not, for example, sleep with it and you would not want to be seen in public. The professional tray, by comparison, is made out of thin, clear plastic, and there are separate trays for your upper and lower teeth. You could be seen in public without anyone knowing that you are wearing teeth whitening trays. You can sleep wearing it.
2. The time frame. They recommend using it for 5-minute periods, where the professional trays have recommended use times varying from 15 minutes at a time to overnight. There is nothing magic about those times. You could wear the Tandy Pearl tray for 30 minutes, but it would get quite uncomfortable, as you would have to keep your mouth closed for the entire time. You could wear a professional tray for 5 minutes at a time. The less time you wear it, the less sensitivity. The more you wear it, the more profound the results. There is no secret formula with the Tandy Pearl that I can see that makes it faster. The time factor is what allows the gel to penetrate the tooth, and there is no evidence presented that the Tandy Pearl gel penetrates any faster than any other tooth whitening gel. If the five-minute time frame appeals to you, my recommendation would be to use your professional system for five minute periods, and I believe you would get equal or superior results to the Tandy Pearl results.
3. The patented “ionic” technology. I am suspicious about this and the veil of secrecy with which they have shrouded this. There is no information about what this is or what makes it unique anywhere on their company website. I don’t think there is any magic with their system. They tout low sensitivity with this product, and user reviews seem to confirm this. But I believe the low sensitivity comes from the five-minute use periods, not from any mysterious ionic technology. If this is such a breakthrough, they could make a lot of money producing a professional system for in-office use by dentists. Their apparent unwillingness to do this contributes to my suspicion – maybe they don’t want to become subject to professional scrutiny.
4. The cost. The Tandy Pearl is $195. Wow. If you’re willing to spend that much money on teeth whitening, why not go professional?

Is it safe? Pretty safe, in that it is as safe as the milder professional whitening systems, however you don’t have the professional supervision which introduces a risk factor. Their bold, upfront advertising proclaims zero sensitivity. But the fine print admits that you could have some sensitivity and warns you what to do if that occurs.

As far as the effect on your TMJ disorder, if the professional trays aggravate your TMJ a little, expect this Tandy Pearl tray to aggravate it a lot. If you really need a solution that is more TMJ-friendly, as I said, there is nothing sacrosanct about the time periods recommended with any of these systems – longer periods of time simply mean deeper penetration and faster results. So just wear your trays for shorter periods, and realize that you’ll have to increase the number of days you bleach, in order to compensate.

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.

June 18, 2012

Some expert tips on bleaching your teeth

Dr. Hall,
I have received various answers on retouching my bleached teeth with Opalescence PF used with trays. I want to do this before deciding on the color for crowns. I used 20%.

  1. How long should I touch-up (for example, 1 week, 2 weeks)?
  2. How many hours each day (1 hr., 2 hours, or 3 hours)?
  3. Is it necessary to stop whitening a certain length of time before appointment (not necessary, 1 week, 2 weeks)?

Cathy from Texas

Cathy,
There is no real fixed answer on how long you should touch up with Opalescence 20% PF or any other brand of bleaching gel, and I’m concerned if you’re having these crowns done by a dentist who can’t answer these questions for you. I would have to see your teeth, know a little of the history, and know how white you want them. Is this really the dentist you want giving you a new smile? Is this a dentist with an engineering mentality who has little passion for appearance-related dentistry and who will leave you with a well-fitting smile that looks very mediocre – kind of like the photo on our home page? Or is your dentist a true artist, one of the 1-2% minority of dentists who will actually give you a beautiful smile?

Here’s the deal on teeth whitening and how much to do it. No one has found a real limit on how much you can whiten your teeth. The longer you whiten, the whiter they get. The pace of whitening slows the more you do it, but the teeth keep getting whiter. So if you were my patient and had questions like this, I would ask questions like how satisfied you are with the current color, how much you bleached them before, have the teeth darkened much since you first had them whitened, and then how much work you are willing to go through to get them to what you would consider to be their ideal whiteness.

And the amount of time each day you should whiten depends on whether or not you are getting sensitivity from the bleaching gel. Do them as long as you can, is the bottom line, as long as you’re not having any sensitivity. Now if you are sleeping, your saliva flow goes way down and the bleaching gel will stay in the trays much longer. One application should last through the night. You don’t need a gel that is specifically designed for nighttime use – they all contain peroxide. During the day, depending on how tightly your trays fit, saliva will get into the trays and wash out the gel, and you’ll need to keep replenishing it. You do need a minimum period of 20-30 minutes for the gel to soak into the tooth. Beyond that, the more the better.

The one fixed answer that I can give you is how long to stop whitening before any color-matching is done on the new crowns. The whitening is accomplished by the peroxide gel releasing tiny bubbles of pure oxygen within your tooth, and the oxygen oxidizes the stains and darker colors. Once you’ve completed the bleaching, you need to give time for those little oxygen bubbles to disperse in order to get a true color for the teeth, and that takes a couple of weeks. Now if you are doing eight front teeth, the color of the back teeth and the lower teeth doesn’t need to really match – it just needs to be close – and a week would be enough time to wait. But if you need an exact color match of a front tooth with a crown matched to another front tooth with natural enamel, you need to wait the full two weeks.

So what I’ve answered goes beyond simple teeth whitening touch-up. Once your teeth are whitened to the degree you want, then there is a certain amount of teeth whitening relapse that you will have, as the teeth pick up stains from your food – coffee, tea, berries, fruit juices, etc. But whitening for two or three days maybe an hour a day and doing that once every year or two should take care of that and enable you to maintain that bright white bleached color.

But again, I’m quite worried about what kind of work is going to be done on you. An excellent cosmetic dentist would have brought up this subject with you when the case was treatment-planned and would have covered all these points. Do NOT rely on the claims of a dentist about being a cosmetic dentist, or advertising. The problem with the dentists who don’t do very good appearance-related dentistry is that they aren’t artistically inclined and they are blind to their own shortcomings in this area. Dentists with strong academic credentials, dentists who are prosthodontic specialists, and dentists with “high standing” among other dentists can be particularly problematic. They may do highly functional, long-lasting dentistry with absolutely no artistic taste. Be careful.

Dr. Hall

Link: Click here to read our page about the home teeth bleaching procedure.

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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 13, 2010

Bleach Your Teeth with Clorox?

Filed under: Tooth whitening — Tags: , , — mesasmiles @ 4:54 pm

I was checking out the dental questions on the Yahoo! Answers websites this morning, and found this interesting one from a guy. Here’s the question:

“Can I bleach my teeth with regular bleach?

“I want to bleach my teeth, and I have a whole like jug of bleach (like what you use on white clothes), how should I use it just gurgle it around in my mouth or what?”

He had thirteen answers from sensible people who responded with varying levels of horror.

I have a rather different take on this question, colored by my experience as a cosmetic dentist. It was maybe about 25 years ago, before teeth bleaching was widely practiced, that I had a patient who told me that she gargled with Clorox to help keep her teeth white. She was a young woman, and I have to admit that she had nice, white teeth. But I told her that I didn’t think that was smart.

Clorox isn’t an acid, it’s a base, kind of like lye. And it’s corrosive and can burn living tissue. Plus, contact with certain other chemicals can cause it to release chlorine, which is a toxic gas that will kill you.

But interestingly, it’s probably a majority of dentists who use Clorox or another brand of household bleach in doing root canal treatments. The active ingredient is sodium hypochlorite, which is an excellent cleanser to use inside a tooth root for dissolving away all the dead organic debris inside a cleaned-out root, and for disinfecting the tooth. They taught us this technique in dental school.

But don’t gargle with it.

There’s actually a question posted on the Clorox website in their FAQ section: Can I use Clorox® Regular-Bleach to gargle, brush my teeth or clean cuts and scrapes? Their answer: “No. Clorox® Regular-Bleach is not for personal usage.”

So there you go. That’s the official word. There is also a notice on the label: “It is a violation of federal law to use this product in a manner inconsistent with its labeling.” So beware. In addition to poisoning yourself, someone may sic the bleaching police on you. It would be a bad scene all around. Just don’t go there.

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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 8, 2010

Can I whiten my dental bonding?

Filed under: Tooth bonding,Tooth whitening — Tags: , , — mesasmiles @ 6:51 pm

Dr Hall,
I have bonding on my two front teeth. The bonding is about 14 years old and should be replaced but I dont have the money at the moment. I understand that bonding doesnt change color with bleaching. My questions is can I atleast bleach the bonding back to its orginal color? Will the white strips change the color at all?
– Robert from Philadelphia

Robert,

No teeth bleaching will get your dental bonding any whiter. It will only make it look worse because it will whiten your natural teeth and won’t affect the color of the bonding.

It’s possible that the bonding could be made to look better with a little polishing. If the discoloration of the bonding is from external stains and is not internal to the bonding material, it’s possible that the discoloration could be polished away by an expert cosmetic dentist.

Otherwise, it would have to be replaced.

If you’re short of money, it would be smart to wait. Don’t go looking for bargains in cosmetic dentistry, especially with dental bonding. It requires artistic talent to do that right, and most dentists don’t even have the materials on hand to do that right. We list several excellent cosmetic dentists in the Philadelphia area, and I would go to one of them if it matters to you how this looks.

Dr. Hall

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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