Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

September 21, 2018

Gap between my crown and my bridge


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I have a space between my 2 front teeth, however one of my front teeth is a crown and the other front tooth is part of a bridge. Can the gap between my front teeth be closed with Lumineers or any other procedure or would I have to get a new bridge and crown, possibly all in one structure to close the gap?
– Laura from Nevada

Laura,
Your question prompts me to ask a question of my own: Why did the dentist who made the crown and/or the bridge leave a gap between your front teeth? The easy way to fix this would have been to make them correctly in the first place.

At this point, yes, you pretty much need to have probably both of them re-made—depending on how big the gap is. Both front teeth need to be the same size—you don’t want to close the gap from just one side by making one side larger.

this microetcher has a long nozzle with a button on it, and at one end a small clear plastic bottle as a reservoir

A Micro-Etcher

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But there is a procedure you might want to try before doing that. There are ways to bond composite to porcelain, and you could start with trying that—treating this as a dental bonding case. If the dentist has what is called a micro-etcher, which is a small sand-blasting handpiece, he or she could micro-etch the porcelain surfaces next to the gap. This would be followed by etching with a hydrofluoric acid gel and then priming the surface with a silane coupling agent. A bonding resin would then be applied followed by composite bonding material to match the shade of the crown and the bridge. The composite would be shaped and polished. In theory, this should work. However, my experience with bonding to porcelain was that after a few months, we would see staining along the margin between the composite and the porcelain. But it could be worth a try to try to avoid the expense of a complete re-do of your front teeth.
I would think it goes without saying that you need an expert cosmetic dentist to do this, such as we recommend on this website.

The company that makes Lumineers, a few years ago, tried to promote the idea of bonding Lumineers over the top of porcelain crowns, but I strongly discourage that. You would get the same risk of staining at the margins, and would spend the same amount of money as you would spend just re-doing the case completely. Click the link to read more about the problems with that approach.

– Dr. Hall

Do you have a comment 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.

December 15, 2017

After my new crowns, my jaw and neck hurt all the time


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Dr Hall,
I recently had my six front teeth, from canine to canine, crowned. Doing this it closed a large gap between my two front teeth. Now I can’t speak clearly and because of the closure and the stress of trying to learn how to speak again my jaw and neck hurt all the time. Also, my mouth stays dry and my lips are numb what could this be caused by?? Also is it possible to get the space put back between the two new crowns on my front teeth?? Your advice would be appreciated.
– Paul from Georgia

Paul,
This sounds like a serious problem that needs to be addressed.
I am pretty confident your troubles have nothing to do with closing the gap between your two front teeth, but are because of other problems with the crowns. I closed many such gaps in my practice and never had any adverse feedback like you are giving me—no speech issues, pain, or dry mouth. It sounds to me that your dentist opened your bite too far.
It could be that your crowns are too thick and/or too long. This could cause a problem called lip incompetence which is the failure of the lips to close naturally, without effort when your teeth bite together. If your bite is correct, when you put your teeth together, your lips should naturally fall into place and be closed without your having to think about it. Your dry mouth and the numbness in your lips suggest to me that you may have this lip incompetence.
Also, if your crowns are too thick, they could throw off your bite leading to pain in your jaw and neck, besides causing speech problems.

Both the pain and the dry mouth are serious problems. The pain issue is obvious. The dry mouth less so but is just as important because it can lead to rampant tooth decay. The washing and buffering action of your saliva, plus the antibodies it contains are critical in fighting tooth decay. Don’t let this go on.

You really need a second opinion. I’m suspecting that your dentist got in over his or her head in doing this many crowns simultaneously on you. That’s my guess. I’d go to one of our recommended cosmetic dentists to evaluate the result and see what needs to be done to fix it.
– 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.

September 25, 2012

This new tooth gap is really serious – her teeth may fall out

Filed under: Gum disease — Tags: , , , — mesasmiles @ 6:09 pm

What would you recommend for my smile? I had a huge overbite as a child from sucking my thumb, had braces and was very happy with the results. My problem is that I’ve been told I have periodontal disease and now have a HUGE gap between my lateral incisor and canine tooth and makes my smile look crooked.
– Karen from Washington

Karen,
Your periodontal disease sounds serious. Once your teeth start moving, they are already getting loose and may have lost half or more of their bone support. So your treatment plan is going to have to focus on that first. Exactly what options are available to you, that is going to depend on the severity of your periodontal disease. And your first step is going to be getting your periodontal disease under control, if that is even possible. Your dentist has hopefully made that clear to you.

And from there, you need to proceed cautiously. If saving your front teeth is a hopeless proposition, for example, you probably won’t want to invest thousands of dollars in porcelain veneers. Instead, you may want to be looking at getting dental implants, or a removable appliance to replace the hopeless teeth. On the other hand, if the periodontal disease can be brought under control and the destructive processes stabilized, the teeth may be able to be moved back into an esthetic position with braces and stabilized there with some type of splint that will prevent them from moving again.

You do want to be sure that your dentist is one of the small minority of dentists who is truly sensitive to appearance-related issues. 98% of dentists have a strong engineering mentality, focused on fixing things. While they are generally honest and skilled practitioners, they are not artistic and would not fully appreciate your concerns about your appearance or be able to give you back your beautiful smile. I would urge you to check our list of screened cosmetic dentists and choose one of those. That is why I operate this website.

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.

September 6, 2012

Sometimes you just have to trust your dentist

This is a follow-up to a question from Jamie from California about Fixing a Black Triangle.

So I went to a cosmetic dentist your site recommends about my black triangle between the 23 and 24. he said it was small and should not bond it because the gum in that area will be hard to keep clean and could become inflamed and not healthy in the long run. If he doesn’t want to do the bonding, should I go to another dentist? I’d really like to reduce the black triangle. He recommended getting veneers in twos for the space, but I’d really rather not ruin perfectly good healthy teeth for veneers at this point.

– Jamie from California

Jamie,
You’re saying that this black triangle is between teeth #s 23 & 24? Those are the lower right central and lateral incisors. I was thinking you were talking about UPPER teeth.

Does this actually show during conversation?

Now I need to be careful here, because maybe this space is really ugly, but I’m skeptical. I don’t have a photograph of your face, so I don’t know, and I’m going to need to make some assumptions in answering your question.

Having black triangles between lower teeth is not really abnormal, and I wouldn’t be inclined to treat them. Some people have them when they are young, and almost everyone has them as they age. I have them, and I have received numerous compliments about my smile. The lower teeth tend to be covered by your lower lip, and even when they aren’t completely covered, people’s attention is naturally focused on your upper teeth.

Have you had other people notice this black triangle? Or is this just something you’re looking at and you have an idea in your mind of how this is supposed to look and how it looks doesn’t measure up to that ideal?

I’d suggest getting a friend or two you can trust, and position them at a normal conversational distance, and have a little conversation with them. And ask them if they notice anything unattractive about your smile. Urge them to be honest with you, and hopefully you can trust them to be honest. And make a judgment from that about whether this black triangle needs treating.

A good cosmetic dentist addresses the cosmetic needs of the patient as the patient perceives them. But there are limits of reasonableness to this approach. I remember hearing Dr. Ronald Goldstein, who is considered by many to be the father of modern-day cosmetic dentistry, discuss the unreasonable obsession some patients have with the details of the appearance of their teeth. Patients, he said, should evaluate the appearance of their teeth at a conversational distance, and when they use a mirror to evaluate their teeth, should hold the mirror at arm’s length, so that they see themselves as others see them. Then he joked that when they would hold the mirror up close, he would adjust the fee to be inversely proportional to the distance between their face and the mirror. That brought a big laugh from the audience of cosmetic dentists, because they all are familiar with patients who have an inordinate obsession with tiny details in the appearance of their teeth that no one else notices.

And the dentist you went to mentioned functional problems with bonding – that you will create an area that will be difficult to clean. Essentially, from what he is saying, he would create a food trap. He is to be commended for his honesty and integrity. But I have a question for you. You said you don’t want to “ruin” perfectly healthy teeth by putting porcelain veneers on them. Why, then, would you want to ruin them by creating gum disease around them? A food trap is far more damaging to the health of your teeth than placing porcelain veneers, and could lead to the eventual loss of those teeth.

Getting good dental care is a matter of being able to accurately judge whether you can trust your dentist. It appears to me that this dentist is trustworthy – as a recommended dentist on our list he has to be esthetically sensitive. And he is pouring cold water on your idea, saying that the damage that would be caused by the treatment you want would outweigh any esthetic benefit. You could just trust him, which is what I think you should do, or you could shop around until you find an untrustworthy dentist who will actually do what you want.

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.

August 10, 2012

Do cosmetic dentists have to be artists if they outsource their porcelain work?

Dear Dr. Hall, How does one find a good cosmetic dentist that can do good bonding work? Most cosmetic dentist outsource their veneers and crowns to labs, but bonding is in the hand of a dentist. How do we filter the good and the bad? Does your list of referred dentist look at bonding work, in addition to veneers and crowns?
James from San Francisco

James,
Yes, the excellent cosmetic dentists that I recommend, for the most part, will also do beautiful direct dental bonding work. I say “for the most part,” because even some excellent cosmetic dentists don’t like doing direct bonding, but I would say that 90% of them do.

But I’d also like to address this question about “outsourcing” of their porcelain veneers and porcelain crowns to labs, because some people have the mistaken notion that if it’s a great esthetically inclined dental lab, it doesn’t really matter who the dentist is because it’s the lab that creates the porcelain work. I guess they think of it like buying artwork from a gallery – it doesn’t matter which gallery you bought it from, it only matters who the artist is.

But there are a couple of reasons that this isn’t true.

First of all, a great dental ceramist cannot really work around a poor dentist to produce a beautiful final result. The dentist starts by preparing the teeth and planning out the case. How the tooth is prepared and the quality of the tooth preparation as well as the quality of the impression that is sent to the laboratory is critical to the success of the case. Then the dentist is the one who writes the prescription, giving detailed instructions about the shade map of the final result, the surface texture, the degree of translucency, a mock-up of the final result desired, and a lot of other details. And then when the work comes back from the lab, it’s the dentist who approves the work and decides whether the case is ready to be bonded onto the patient or needs to be sent back to the technician. No, while a great laboratory technician is required for a great final result, there is too much that the dentist does for the case for an artistic laboratory technician to be able to produce a beautiful result in spite of the dentist.

Second, a dentist without a great artistic eye will not use the services of a great ceramist. Those services cost more, and it just doesn’t happen that you would get a “great ceramist – poor dentist” matchup. Oh, there are some dentists who are not very good cosmetic dentists who will use a name brand laboratory like DaVinci or Microdental in California to impress their patients, but those are large dental laboratories with large numbers of ceramists of varying levels of ability, and they will not assign their best ceramists to work with dentists whose work they perceive to be of lower quality. I’m sure it’s not something they talk about, but it doesn’t happen that way.

So pick the artistic cosmetic dentist, and that dentist will assume responsibility for the quality of the final result. That is the way for a patient to get beautiful cosmetic dentistry.

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.

June 20, 2012

This complex appearance-related question won’t be solved by an unmotivated dentist

Dr. Hall,
I am a 67 year old woman who has had surgery for gum disease within the last six months. Also, because of the gum disease I have 6 missing upper teeth (3 on either side). I do have the front six and a back molar on each side. I suppose due to bone loss from the gum disease my front two upper teeth have a major gap between them. At the moment I contemplating either implants but due to the cost that may not happen. I have talked to my dentist about “partials”…currently I have a flipper. I have also been to an orthodontist to discuss braces to close the gap between the top 6 teeth, particularly the middle two. The problem with braces is that the flipper won’t fit and due to the amount of movement needed a partial would have to be remade multiple times. I am not sure if I just live with the gap and get the partial for the uppers and be done with it (even though I am 67, I still work, very active and I HATE that gap). My oral surgeon does do implants but he is talking well over $20,000 and that is a great deal of money. Any suggestions would be appreciated.
Janie in Texas

Janie,
If you’re going to get this aesthetic problem solved, you’re going to have to get out of this group of conventional-thinking dentists and find a dentist who is passionate about doing appearance-related dentistry.

I can think of a couple of possible solutions to your problem that might work, but each one would depend a lot on assumptions about your condition that I really shouldn’t make via e-mail. A specific solution would require a complete examination to let me know the bone levels on the existing teeth, the sizes of your front teeth, the size of the gap, the prognosis of the remaining teeth, and how everything fits together.

Now maybe there are no good solutions other than what your oral surgeon is suggesting, given everything the way it is in your mouth, but I can tell you that the prevailing thinking in established dentistry would be that this isn’t that big of a problem and it’s not worth trying very hard and certainly not worth taking any risks. The way we were taught in dental school is that patient concerns like you are expressing over this gap are relatively trivial, and to give them too much weight is pandering and unprofessional. They would not want to APPEAR to be thinking that, but in their professional circles as they talk behind the scenes among themselves, this is the thought pattern that we see all too often.

I would suggest getting a dentist who truly believes that appearance is important. Go to our list. There are actually several of our recommended dentist within 30-50 miles of you. They are all screened carefully by me personally to be highly sympathetic to appearance-related concerns like yours and to have excellent skills.

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.

December 20, 2011

I have a HUGE tooth gap. What are my options? Not Lumineers, please!

Dr. Hall,
i wanted to know what would be the best way for me to take care of my problem. i have a really large gap in the front of my teeth. i have already seen a local dentist in flint because i wanted to get the snap on smile. i paid for the x rays and everything and the dentist sent everything in to the snap on smile company. then i get a call saying the snap on smile would not work in my case. i dont want to do braces so what do you feel is the best way for me? from what i can remember the last dentist said the size of the space between my teeth is 8mm to 10mm something like that. i have an appt to talk to another dentist about the lumineers to see if i could go that route. thank you for your time and i really hope you can save me some time and money and let me know what you think.
thanks again.
-Phyllis, from Flint, MI

Phyllis,
I’m glad you wrote to me because you are headed for disaster. Stop with this plan of doing Lumineers. This could end up looking hideous, and that’s not even the worst part. The really bad part is, if the only problem with the work is that you don’t like how it looks, you won’t have any recourse. So you could end up stuck with an atrocious smile.

A gap of 8-10 millimeters is huge. That is enough space to fit one more whole tooth in there. This is no job for the dentist on the corner. Here are your options:

1. You said you don’t want to do braces. By that do you mean traditional braces? What about Invisalign invisible braces? Do you know anything about that, and is there are reason you wouldn’t want that? With a gap this large, that would be my number 1 recommendation. The invisible braces are clear plastic pieces that snap over your teeth – no metal brackets, and no one can tell that you’re wearing them because they are thin and clear. It would probably take a year to close your gap.

2. If for some reason you don’t want to do that, you truly need an expert cosmetic dentist. If you go to a dentist who advertises for Lumineers, as a general rule those dentists are not very good cosmetic dentists. The Lumineers material does not have the best coloring, and their lab tends to make the teeth kind of long and extra thick, so most good cosmetic dentists stay away from that brand of porcelain veneers. But there are other brands that work well. Don’t pick the brand of porcelain – the important thing is to get a truly artistic cosmetic dentist who has a lot of experience doing smile makeovers and let them use the material they feel the most comfortable with. Depending on how your teeth line up, it may be possible to fill in the gap and re-shape the other teeth so that it looks natural. But this is difficult to do, so you have to have a dentist with a lot more expertise than your family dentist on the corner or a dentist who simply advertises that they do cosmetic dentistry.

I just did a quick check of dentists who advertise as cosmetic dentists in Flint, MI, and you’ll have to be really careful here. I did not find one right off the bat that I would trust with a job like this. If that’s the route you want to go, let me know, and we can try to find one for you. But it’s possible, in a city like Flint, that there really aren’t any good cosmetic dentists. But we can look. Otherwise, you may be interested in driving to the Detroit area. There are several good cosmetic dentists there. Let me know.

Good luck,
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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