Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

February 3, 2018

My mouth seems to be collapsing


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Hi Dr. Hall,
I really hope you can help me.
I am not sure if my issue is related to my lips, teeth or jaw but I absolutely can’t stand my smile. It feels very forced to be able to show my upper teeth. When my mouth is in repose it is just empty space and you cannot see my teeth (especially my upper) and it makes me extremely self-conscious.
I also have jaw pain and wear a night guard and when I wear it my mouth feels more comfortable and I feel like it supports my lips better. It also gives an impression of upper tooth show that I would very much like. I also find I have difficult pronouncing certain words especially when it’s cold, almost as if my jaw tighten and I can’t open it properly to speak. P and T words are especially uncomfortable.

Are my only options veneers? Do I even have any options?

It’s very frustrating for me. I can attach pictures as well if need be.
– Laura from Toronto

Laura,
You’re going to need to be very careful how your proceed here, and if a dentist has told you that porcelain veneers will solve your problem, I would find another dentist. While that could help with your appearance, it could exacerbate your other problems—the jaw pain and trouble with pronunciation.

It sounds to me like you’ve worn your teeth down, making you overclosed. This could cause TMJ disorder, which would be characterized by jaw pain and possible tightness in your jaw. The fact that you feel better wearing a nightguard lends credence to that diagnosis, but you’ll need an examination by a dentist trained in TMJ therapy to confirm that.

The needed treatment, unfortunately, is likely to be extensive—probably a full-mouth reconstruction.

The problem is finding a dentist you can trust to do this. This is way beyond the capability of your average family dentist. I would look for a dentist with advanced training from one of three institutes:

  • The Pankey Institute in Florida
  • The Dawson Academy, also in Florida
  • The Las Vegas Institute for Advanced Dental Studies

Good luck.
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.

December 27, 2017

A case of collapsed bite


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Hi Dr. Hall,
I really hope you can help me.

I am not sure if my issue is related to my lips, teeth, or jaw, but I absolutely can’t stand my smile. It feels very forced to be able to show my upper teeth. When my mouth is in repose it is just empty space and you cannot see my teeth (especially my upper) and it makes me extremely self-conscious.

I also have jaw pain and wear a night guard and when I wear it my mouth feels more comfortable and I feel like it supports my lips better. It also gives an impression of upper tooth show that I would very much like. I also find I have difficulty pronouncing certain words especially when it’s cold, almost as if my jaw tightens and I can’t open it properly to speak. P and T words are especially uncomfortable.

Are my only options veneers? Do I even have any options?

It’s very frustrating for me. I can attach pictures as well if need be.
– Laura from Ontario

Laura,
I’m glad you’re emailing me now, before going to a dentist to have this fixed. It’s painful to have to write back to people after a problem like yours and the dentist messed up their mouth.

This is a very difficult problem and you need to be very careful in picking a dentist to treat this for you. While I can’t tell for sure just with your description, it sounds like you may have a collapsed bite plus some other complicating TMJ issues (TMJ disorder). Veneers wouldn’t be the answer, at least not as a sole treatment. Opening your bite with crowns could solve your problem, but it would need to be done methodically by a dentist with experience in full-mouth reconstruction.

The proper way to open a bite is to do it reversibly first, with some type of provisional restoration. When that provisional is successful, then permanent restorations should be made that duplicate what was done provisionally. By successful I mean that you are out of pain, are happy with your appearance, show your upper teeth normally, and have no speech difficulties. That’s a tall order, but a dentist with adequate training should be able to do this.

It’s a small minority of dentists who have the training needed to address this type of situation. There are several training institutes in the United States that train dentists in this level of complex restorative dentistry. Those would be the L.D. Pankey Institute and the Dawson Academy in Florida, and the Las Vegas Institute for Advanced Dental Studies in Nevada. There are others, but these are the best known. I don’t believe there are any such institutes in Canada.

To help cement this idea of being careful in picking a dentist to do this, you may want to visit other blog posts I wrote for patients where the dentist opened their bite and caused more problems than they started with.

I will email you privately with a dentist recommendation for you. It will involve some travel, but you need to get this done right.

– 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 23, 2016

Follow-up on trouble speaking with new veneers


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This is a follow-up to the previous post, where Susan emailed Dr. Hall telling about problems she was having speaking with her new porcelain veneers.

Susan commented at the bottom of the post:

Thank you for the reply. I think I am going thru a bad nightmare. After complaining about my speech and bite, the dentist took off the front four permanent veneers, to replace them. As he was taking them off he broke #9 [the upper left central incisor] after which I had to have the tooth pulled and an implant put in. I am currently 2 months with the implant temporary. I have to wait three months for it to heal. I asked him to make a matrix of the temporary veneers and the final veneers to see what is wrong. He said all the molars are each side were made too short and the lab made the mistake by using my original bite. Right now I have 9 temporaries in my mouth with the implant. He didn’t replace the 1st molars because he claims they are fine. My temporary veneers were 12.4 length for #9 and #10. Now they 11.8 and hitting my lip. Could it be those back 1st molars being too short? Or should I just run and find a new dentist?

And here is my answer:

Susan,

Again, I do have to qualify what I answer here by saying that not being able to see exactly what is going on, I may be missing something, but I CAN tell that something isn’t right here.

The molars being made too short—that would definitely explain your speech problems. But passing the mistake off onto the lab saying they used the wrong bite? No, that doesn’t work for me. It’s not the lab’s fault. The dentist gives instructions to the lab and the issue isn’t your bite, it’s the vertical dimension. And that has the potential to cause long-term problems. It is called bite collapse. You absolutely need to have your bite opened to its original position. What is starting out as just speech problems can easily progress to TMJ disorder with possible chronic headaches and jaw pain.

Cases like yours where the vertical dimension is altered need to be approached with great care, and a dentist needs more training than what they receive in dental school to pull this off. The dentist will replicate your bite on a machine called an articulator where he or she can carefully study all your bite movements. He or she will establish a vertical dimension by testing it in your mouth with temporary restorations, and then will send your case to the laboratory on the articulator with careful instructions on how to reconstruct your mouth.

And then I’m aghast at what happened to your front tooth. When you take off veneers, the way to do that is to grind them off. You can’t “pop them off” or remove them in any way like that if they’re bonded on properly. They become like a second enamel and the only way is to grind them off, which is a gentle process that is similar to preparing the teeth in the first place. I am again suspecting that he didn’t actually do porcelain veneers but did porcelain crowns and called them veneers. But even then, with front teeth, crowns should also be ground off, and there is no excuse for breaking a tooth.

I would not let this dentist touch your teeth any more—this is getting worse every time he sees you.
Actually, I do know an excellent cosmetic dentist in northern New Jersey. I will send you the name. I know her personally and have absolute confidence in her. She is AACD-accredited, which is no mean achievement, and a Master of the Academy of General Dentistry, and I believe she is one of the best cosmetic dentists in the entire state.

A couple of additional points:
1. You need to get tough with this dentist. As I said, not seeing your case personally I’m at a little bit of a disadvantage, but based on what you are telling me he has violated the standard of care and is very vulnerable legally. He seems to have got in way over his head and has done multiple things wrong. If I were you I would call him and say that you’re going to be nice and not take him to court where you could sue him out the wazoo, but to avoid that he needs to pay for everything that this new dentist needs to do to fix you up. Go to the new dentist first, confirm the details of what has been done wrong, and then confront him.
2. I can’t imagine that your bite and vertical dimension are the only problems with your case. You haven’t said anything about how your teeth look, but it is rare for functional incompetence in dentistry to be blended with artistic excellence. In my mind’s eye right now I can’t imagine that you have a beautiful smile. But based on what you have told me, your case needs to be completely re-done. That is your silver lining. The new dentist, in re-doing this, can give you a beautiful smile.

– 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.

March 5, 2016

Dentistry in Costa Rica

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I’ve written before warning about getting dental work done in Costa Rica. But I just became aware of an incident that truly highlights the risks. Because I am only able to partially confirm this patient’s claims, I am not publishing the name of the dentist, which she had provided, only her story because it illustrates the risks in dental tourism.

dental tourism in Costa Rica

Dr. Hall,
I went to Doctor [name withheld] at [name withheld] Dental Clinic just outside of San Jose Costa Rica for some dental work and to have porcelain veneers placed. The dentist broke one tooth and caused me to need three root canals. He left me with ten open margins, I had crowns pop off, and he screwed up my bite so badly that I now suffer from severe TMJ, constant pain, can’t eat or speak properly etc… I have an estimate of $35,000 to fix my bite (which I don’t have) which doesn’t include the root canals. He refuses to refund the small fortune that I paid him and refuses to pay to have my teeth fixed.

But the story gets worse.

After my follow-up with an American dentist who said that I was the victim of criminal negligence, I hired a Costa Rican attorney. We were able to get three Costa Rican dentists to concur with the American dentist. We met at the Dental Colegio. But all that mattered at the Colegio board meeting was the fact that I complained publicly about Doctor [name withheld]. It was explained to me that it is a felony to speak against the reputation of a Costa Rican citizen unless or until that person has first been found guilty of a crime in a Costa Rican court of law. It did not matter that I filed those complaints online about the dentist from my own home in America. I had to flee Costa Rica immediately to avoid being arrested.

As far as filing criminal charges or a lawsuit, my attorney told me that the dentist would just bribe an official and make the case go away. My only hope was with the Costa Rican dental Colegio and they cared nothing about justice. Their legal system in Costa Rica is very corrupt. There is no justice there for Americans.

I also learned that this dentist didn’t graduate from a dental school in Miami as it claims on his website. He only took a class there.

– Kimberly from Florida

I thought I would just pass on Kimberly’s experience here, as there isn’t much I can do to help other than to help publicize her plight. I did look up the dentist she mentioned, and the website looks very inviting and gives you the feeling that you’re going to get wonderful care. The credentials presented look legitimate. However, as a dentist, I noticed some red flags that I think would escape the normal patient. For example, this dentist claims to have had a minor in implant dentistry from Miami University, as Kimberly mentioned. But there is no such thing as a minor or major or any organized course of study in implant dentistry at any American school—it isn’t a recognized specialty. He also claims to have a minor in Orthodontics and Prosthodontics from the DaVinci Institute. Besides the fact that this makes no sense—there are no “minors” in any dental field in the United States, only majors. And the combination of those two specialty areas in dentistry is made up. If minors did exist, he would have two separate minors—one in Orthodontics and one in Prosthodontics. Besides this, the DaVinci Institute is a think tank in Colorado. It may sound dental because of the famous DaVinci Dental Studio in California (a renowned dental laboratory that makes porcelain veneers), but there is nothing dental about the DaVinci Institute. Then, googling the dentist’s name and the name of his clinic, I discovered that the name of the clinic had been recently changed, a tactic used to escape a bad reputation. Also, there are no Google reviews for this dentist or his clinic, under either of its names, which is very strange. These are all red flags. But they would escape the typical dental patient.

I also found another serious complaint filed against this dentist on the website ripoffreport.com.

Bottom line: Beware! Just don’t do it. Both implant dentistry and beautiful cosmetic dentistry are risky enough in the United States. Don’t compound it by going to a place where you have poor standards of care and absolutely no legal recourse in case something goes wrong.
– 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.

October 21, 2015

My new crown doesn’t feel quite right

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Dr. Hall,
I just got a new crown on an upper molar, and it does not feel like it meshes with the tooth below it. I think it needs a deeper indentation to accomodate the tooth below. Is there a risk of damaging the tooth in drilling away more of the surface of the crown? My dentist says to give it time to get used to it. It’s been two weeks and still is uncomfortable.
– Criss from New York

Criss,
I smile thinking about your dentist’s response, “Give it time to get used to it.” That’s a classic “I don’t know what to do” response. Now this could be a particularly difficult situation, or this could reveal a lack of knowledge of your dentist.

A new crown or onlay should not be noticeable when you bite or chew. It should be so perfectly comfortable that you don’t even know it’s there. But the occlusion between your upper and lower teeth is very complicated with all the various motions that are involved in chewing, and many dentists are simply not experts in that. There are post-graduate institutes dentists can attend such as the Texas Center for Occlusal Studies, the Pankey Institute, the Las Vegas Institute for Advanced Dental Studies, the Dawson Academy, and others. These institutes train dentists in the science of occlusion–how the upper and lower teeth mesh and are supposed to function together. Many dentists attend these institutes, or will attend other solitary courses where the same principles are taught. But many don’t feel that they need this training, that their basic dental school education was enough, and they go through their careers with a fairly rudimentary understanding of occlusion. Without this training, they may not be qualified to do a full-mouth reconstruction, but they can do single crowns or onlays. They may have some patients who experience what you are experiencing–the teeth don’t feel quite right, but for the most part they get by. Yes, in time, over a period of months, you will probably get used to it, and it may cause no further complications. But an occlusal problem like this can in some cases lead to unnatural stresses on the teeth which can contribute to bone loss around the affected teeth. Or in some cases it can be a precipitating factor to TMJ disorder.

Many dentists will simply adjust a new crown or onlay so that it isn’t high. They will ask you to bite on what it called bite registration paper, and that paper will leave marks where the crown or onlay hits prematurely and then will grind down those places. I’m assuming that your dentist has done that basic step and that this onlay isn’t “high”–you can clench together without discomfort–and what is wrong with your bite is more subtle.

What should you do? The best thing would be to get the tooth adjusted so that it is comfortable. No, that shouldn’t damage your new onlay. Such adjustments are fairly common with new dental work, and there should be plenty of thickness in the new onlay to accommodate any necessary adjustments. But if your dentist doesn’t know what the problem is, then I wouldn’t ask him or her to do that, as they could do more harm than good. But then going to another dentist to have this adjusted could be awkward and would involve extra fees.

Here’s what I would recommend. If you’re generally pretty happy with this dentist, then I would let this go and wait a few months to see if this tooth begins to feel like it fits better into your bite. However, I would be leery about having this dentist do another crown or onlay on one of your back teeth.

If you have other points of dissatisfaction with your dentist, this could be a way to find a dentist whom you feel will better meet your needs. Look for a dentist who has publicized his or her training at one of the institutes I mentioned above, ask for a second opinion on this onlay, and if you’re happy with what they do for you, you’ve found a new regular dentist.

– 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.

March 14, 2013

Another full mouth reconstruction gone bad. This case could be a mess.

Dr. Hall,
I have recently gotten ALL of my teeth crowned. My old teeth were ground down to almost nothing, the front ones were paper thin and chipping daily and on the bottom left I was missing #21 and top right missing #3 and #4. I have also in the past had many unfortunate traumas to my jaw so it clicked loudly all the time when opening.

The dentist said I needed to have my bite opened in order to get my front teeth restored (all I actually wanted in the beginning was just top/bottom front teeth done) He said it would not be possible to do without doing my whole mouth. Fast forward to now, got bottom done all at once and was told that would be the hardest part for me to endure, it wasn’t it was a piece of cake compared to the pain I had for 3 weeks with the top ones. So anyway now i have had the new top ones in for 2 days and I will say they LOOK beautiful no complaints on the smile but the left side teeth touch whilst the right side has a space and my teeth do not touch at all 19-21 bridge not touching but bridge 2-5 hits fast and hard and my jaw is killing me.

He did cement them in with permanent cement and now my question to you is can he file this bridge down enough so my other side will hit and then can he polish it so my ground down rough teeth will not ruin my new crowns on bottom, or does the fixed bridge need to come out and be re-done. We have spent so much money on this and while we do have insurance it covered next to nothing and my husband is in the military and we cannot afford to have all this redone. I am really stressed out and any help you can give would be appreciated.
Thank you 🙂
– Erin from Alabama

Erin,
You have had what is called a full mouth reconstruction. This is a highly complex procedure because it re-does your entire mouth and your bite. Dental school alone doesn’t train a dentist enough to be able to perform this kind of a procedure – it requires advanced training and/or considerable experience. And there are several well-known institutes that provide this advanced training. There is the Pankey Institute in Florida, and the Dawson Center for Advanced Dental Study, also in Florida. Another is the Las Vegas Institute for Advanced Dental Studies.

But even with that advanced training, these complex procedures should proceed cautiously, especially in situations like yours where the bite is being opened. It should first be opened with temporary crowns and then the bite adjusted with the temporary crowns until you are comfortable with the new vertical dimension. When that is settled, then the permanent crowns are made to replicate the new opening.

But that isn’t all. The crowns and bridgework should be seated temporarily and adjusted to a comfortable bite BEFORE being cemented permanently. And you are a perfect illustration of why this should be done. Here you are, already with TMJ problems (you mentioned loud clicking in your jaw) and apparently over-closed. And now crowns are cemented and your bite is off. Yes, the case needs to be re-done, and the dentist who did this is responsible for that. And if you have lost trust in him, then you need to have this done somewhere else and have this dentist pay for it.

Here’s the problem. Yes, the bridge that is throwing your bite off could theoretically be ground down in your mouth to where your bite is even. But from the sounds of your description (the other side isn’t meeting at all), it would take a tremendous amount of bite adjustment, and he would likely be grinding all the way through the porcelain in some places. Plus, the whole object of the treatment was to open your bite, and now he is going in and grinding it down, so your vertical dimension is going to be off. And this amount of change in the bite is much more difficult to do correctly in the mouth than in the laboratory. The crowns should have been carefully crafted in the laboratory to provide the proper bite relationship with all the cusps, grooves, and other anatomical features precisely mapped out so that your jaw functions correctly.

Having said this, it doesn’t take much for the bridge to throw your bite off enough to be painful. Maybe the discrepancy is only a fraction of a millimeter and it just feels to you like it is a lot. In that case maybe it could be adjusted to fit. And maybe he did try it in temporarily and it fit fine, but in the final cementation something went wrong and it didn’t fully seat. But if that did happen, at least the bridge should be re-done.

I would suggest a second opinion. You want a dentist who has been trained at one of the three institutes I mentioned to help give you assurance that they know what they are talking about, and I would suggest going out of town for the second opinion, to avoid any conflicts with dentists who may be buddies or competitors, which would interfere with getting an honest 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.

March 5, 2013

Did you really need that full mouth reconstruction? I’m suspicious.

Dr Hall,
I have been going to a local female dentist here for the last 10 years and over the last few years she has put new crowns in the top front (6 or 8) teeth with the metal backed crowns and they leave a black stain across my gums (and chipping, breaking) all the time and she charges to repair these…. so she doesn’t back up her work.

I found a cosmetic dentist in nearby (town’s name withheld), Dr. (doctor’s name withheld) and he inspected my mouth and told me that not only did those horrible teeth need to come out but that my bite wasn’t right and the top teeth were wearing down the bottom to the point of my bite collapsing. Well yesterday Dr. (name withheld) gave me 28 new temporary crowns – will get my permanent ones next week. They will be porcelain and the temps look great it’s just that I find it difficult to eat and maybe it will take some time. I guess I need to get used to it and learn to deal with it.

One more thing is when I order my new permanent crowns I want to make a couple of changes, such as slightly lengthening my eye teeth or maybe offset them slightly to give me a less perfect smile or should I say maybe they won’t look like false teeth. Do you have any input on this situation? It will be about a week or more before I have this done but I want to come out with the best “natural” looking and less fake smile. Is there any other tips! or tricks that I could do as well?

Thanks,
– David from Mississippi

 

David,
I’m glad you e-mailed me. You could be in for a lot of trouble, and you should take your next steps very carefully. I would not let this dentist put your permanent crowns on until you get two big issues solved. I am highly suspicious of this whole situation. I’m going to give you my phone number, and I want you to call me about this. But let me explain your situation first.

1. The number one issue is that you need to be sure that your bite is comfortable with the temporary crowns before proceeding with the permanent crowns. If I were you, I would call the dental office and ask that the laboratory order be put on hold until you have temporary crowns that are comfortable to your bite. Your dentist is opening your bite with a full mouth reconstruction. This is a risky procedure, and could leave you with serious TMJ disorder if it’s not done right. Clue number one for your impending trouble is that you find it difficult to eat. Clue number two is Dr. (name withheld)’s website, where, when I read his bio, I don’t see any clue that he has the advanced training that would be necessary to do work of this complexity. Ordinary dental school education isn’t enough – there are institutes such as the Pankey Institute in Florida or the Las Vegas Institute for Advanced Dental Education that train dentists to do this. And when dentists go through the trouble to obtain this advanced education, it is highly unusual that they would have a website that wouldn’t mention it.

2. You have some matters you want addressed in the appearance of the teeth. Those need to be settled BEFORE the dental laboratory starts making them.

Here is what you need to do, and I am emphatic about this. DO NOT let Dr. (name withheld) or anyone on his staff talk you out of this.
1. Get the laboratory work put on hold until you get the two issues above solved, and until you can get a second opinion about this work.
2. Go get a second opinion. You are spending well up into five figures on this, plus you are putting the rest of your life on the line. If this work isn’t done right and you end up with TMJ disorder, that can make you miserable for the rest of your life until you would get the work re-done. Don’t take this lightly.

I’m going to recommend you go see an excellent dentist in Lafayette, Louisiana, for an opinion on this. I have looked for excellent cosmetic dentists in your part of Mississippi, and haven’t been able to find any, so I think it would be worth it to you to make the trip to Lafayette. I looked up directions on Google Maps, and I see this is a drive of several hours for you. But that’s a small thing when you’re talking about something so major. It is Dr. Mike Malone. He is highly expert in both cosmetic dentistry and reconstructive dentistry. He’s a past president of the American Academy of Cosmetic Dentistry and has been trained in advanced reconstructive dentistry at the Pankey Institute. But more than that, I have known him personally for many years, and he is a decent, honest dentist who will tell you what you need to do. Additionally, if you get out of the Jackson area, you avoid complications that can occur when the dentist giving the second opinion knows the first dentist. They might be buddies, which isn’t good, or they might be fierce competitors, which could be worse. And be sure you see Dr. Malone personally. He has two associates who do the general dentistry, and he does the advanced restorative. When you call, tell him that I referred you. His website is www.mikemalonedds.com, and the contact information can be found there.

I can’t make any declarations for sure without seeing you myself, but as I said in the beginning, I am highly suspicious. There are dentists who recommend full-mouth reconstructions purely for the profit involved. I certainly hope this isn’t the case with you, but you need to find out before this work proceeds any further. If the dental laboratory doesn’t make the crowns, that makes this whole thing a lot easier financially. You could transfer to another dentist, for example, for no additional expense. On the other hand, if the crowns are installed, then fixing you would involve starting all over from the beginning, preparing the teeth, and making new crowns from scratch.

Please call me on my cell phone, and you can talk to me about this.
– Dr. Hall

Link: Click here for information on getting a referral to an excellent cosmetic dentist.

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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 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 1, 2012

A cosmetic dentistry horror story – but there is a silver lining

Hi Dr. Hall.
I got 8 porcelain veneers and 2 crowns 2 weeks ago. I am 48 and have tetracycline stained teeth. I am very disappointed in a few ways and don’t know what to do. First thing is that they are too white. I look silly. I am Italian with dark skin and I look like I have Chiclets in my mouth. My dentist gave me an option on the color so I realize I am stuck with that problem. I will probably not smile very often now.

But the worst things are that I feel like they are loose and may come off at any time. I can’t bite down hard as it hurts in my molars. And also I can’t relax my teeth as it feels like the upper teeth are too long and my entire face aches like I am clenching and grinding my teeth. Help me with some advice please. I have had 5 kids with dental issues I always took care of. They are grown and gone and I finally was able to do my own smile. I am so sad about it.

Thank you.
Jamie from Virginia

Jamie,
This is the sort of story have heard so much over the years, and is the reason I operate this website. 98 to 99% of dentists simply don’t know how to do beautiful cosmetic dentistry. They chose the field because they like to fix things, and they think like engineers, not like artists.

You’re kind to take the responsibility for the color of your porcelain veneers. But there are about three things a dentist who is truly passionate about doing beautiful cosmetic dentistry would have done differently in your case.

First of all, he or she would have been knowledgeable enough about the results you would get to predict how you would look when your case was done, and would have coached you to a more beautiful result. You’ve never had a smile makeover before – how are you supposed to know how a particular color will look once it is in your mouth? A truly artistic cosmetic dentist would be focused on creating a beautiful smile, and would steer you in that direction.

Second, every excellent cosmetic dentist I have ever asked, and I have interviewed a number of them on this subject, has some method for making sure that you will love your new smile before it is ever bonded permanently. They will often make a set of what they call provisional veneers in acrylic that will be temporarily cemented onto your teeth so you can “test drive” the final result, to make sure that you will be happy. In addition to this, they have a try-in with the actual veneers – they will use a try-in paste to insert the porcelain veneers to let you see exactly how they will look. You will get as much time to look at this as you want – will get to see it under different lights, have a friend or family member come in to give you feedback on how it looks – whatever it takes to make sure that this will make you proud to smile before these are bonded on permanently. Most recently, I interviewed a cosmetic dentist in the Boston area that we recommend on this site. In 30 years, he has never had a patient who has not been happy with their new smile. If he ever did, he would re-do the case.

And that brings me to the third thing an excellent cosmetic dentist would do. These dentists, as I said, are passionate about creating beautiful dental work. Most of them, if they heard you say what you just wrote to me – that you won’t be smiling much any more – would be so embarrassed that they would re-do the case for free. I had this happen to me. I was a young dentist and it was the first time I had done porcelain veneers on someone with tetracycline stains. When dentists are inexperienced with tetracycline stains, they will make one of two mistakes. These tetracycline-stained teeth are so dark on the inside that the color shows through most dental materials, and the dentist will have them made too translucent so that the gray-brown shows through. This is what I did. Or, they will make the teeth too opaque and white so that they look pasty and fake. This appears to be what your dentist did. Well, with the case that I did, after I gained more training and experience and knew better how to make this type of case look beautiful, I offered to the patient to re-do them for free, because I didn’t want work that I was responsible for not looking beautiful. The patient never complained, but I could tell she wasn’t excited about how they looked, and I wanted her to be excited. I’m not unique – that’s typical of artistic dentists who love to create beautiful smiles.

So what do you do at this point? There really isn’t much remedy other than doing the porcelain veneers over. And this time you need to be very careful about the dentist you pick to do them. Pick one from our list – that’s why I have this website. I personally check every dentist I list to make sure they can do beautiful smile makeovers.

But I need to say a word about how your mouth feels now. The porcelain veneers cannot be loose – if they were loose they would immediately fall off. But what I am worried about is that your teeth are getting loose. You say that your entire face aches, like you are clenching and grinding now. And you think that the upper teeth are too long. I can’t tell this from a distance, but it certainly sounds like your bite has been thrown off. This could potentially be very serious and could lead to serious TMJ disorder or breaking of the dental work, or premature wearing down of your teeth, or periodontitis leading to early tooth loss, or even breaking of your teeth. This could actually be the silver lining of your cloud, because this could give you grounds for asking this dentist to compensate you so you can have this re-done correctly. Here’s what I would suggest. Go to a dentist on our list of recommended dentists. See what he or she thinks of what has been done – if the work has indeed thrown your bite off to where it is causing serious problems. And then see if he or she will help you get some satisfaction from this other dentist. You need someone more than just a skilled cosmetic dentist – you need someone who will be understanding and willing to stick their neck out a little to help you get what you deserve.

Good luck,
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.

February 29, 2012

My new dental implant bridge doesn’t line up with my bite.

This is an exchange with Lilly from California. Here is her original question and my reply. Then she replied, and I answered again, and that is below:

Dr. Hall,
I have a new implant bridge, with two implants, replacing four teeth on my bottom right. I notice now that when I bite down on the right side, the bottom teeth and the top teeth line up, but my teeth on the left don’t line up. Is this normal? What can be done?
Lilly from California

Lilly,
This is not right. All your teeth should come together at the same time. Something isn’t right here. And if this isn’t fixed, it could lead to TMJ disorder.

This gets me to a recurring issue, and that is the quality and standards of implant dentistry in the country. This is one of the top areas for dental malpractice. One of the reasons is that the dental profession has not made it a recognized specialty, so anyone can claim to be an implant dentist with no extra training whatsoever.

My recommendation would be to have another dentist look at this. Look for a dentist with credentials from one of the two major dental implant organizations – the International Congress of Oral Implantologists, and the American Academy of Implant Dentistry. Fellowship or diplomate status in either of these organizations would indicate a dentist who understands and practices quality implant dentistry.

There are two possibilities for what went wrong. It’s possible the implants were restored incorrectly. I think more likely is that the surgery placed the implants in the wrong position.

Sometimes, if the surgery is done by one dentist and the implants are placed by another, there is a communication problem and they are placed in a position that makes it difficult or impossible to restore them correctly. What should be done is that the restorative dentist should make some type of surgical guide that fits in your mouth and that fixes the exact position and angle where the implant should be placed. But a lot of dentists don’t do that.

I wish you the best,
– Dr. Hall

This is a reply that Lilly sent

Dr. Hall,
Thank you for the comprehensive answer. I am suspecting the problem lies with the surgeon. He insisted he was in charge. I never saw the restorative dentist he referred me to until after he was done with the implants.

I have an appointment with both the surgeon (periodontist) and the restorative dentist in two weeks. I am hoping that these implants don’t have to be redone. In that case, is it fair for me to request a refund? I don’t want to return to this periodontist and dentist. You would think the restorative dentist would have known better than to just go ahead and make the bridge and charge me when he knew it was wrong.
-Lilly from California

Lilly,
Very interesting, to get that additional information from you. In my humble opinion, you are within your rights to ask for a refund, assuming that we have this sized up correctly. It is an established principle of implant dentistry that the implants need to be placed according to a restorative treatment plan, and that a surgeon should not place them until the restorative dentist has examined the case and made the determination of where they need to be. Sounds like the surgeon skipped that step.

Get your independent opinion from an implant dentist with a credential from the ICOI or AAID, as I mentioned in my earlier e-mail, and if it is determined that the problem was in the location of the implants and that they need to be replaced, then yes, I would complain. And actually, rather than a refund, ask that the surgeon pay whatever the cost would be to fix the problem, because it will likely cost more to get this fixed right than it cost to do it in the first place, plus you have to re-do the restorative part. I think there is some legal liability here to get this fixed right.
– 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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