Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

May 3, 2017

A victim of shoddy dental work in Croatia


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Dr. Hall,
I had $60,000 worth of dental work done in Croatia for $11,000. It was a great deal until the veneers are starting to fall off. That was in September 2015. I have a 10-yr warranty so I will be going back in September for hopefully permanent repairs.

I was eating a piece of chocolate cake in March when the veneer to the left of my front tooth popped off intact. A week later eating spaghetti the other one on the side of the front tooth fell off. Today after eating spaghetti one of the front teeth popped off. I had all on 6 done on the upper and an implant and replacement crowns on the bottom. I don’t think this should have happened.

I thought we got porcelain and I have not been eating with my front teeth, I cut everything up as instructed. My husband and I are baffled why it is not very strong. Will they have to re do my entire upper teeth or will they glue this back on? I can’t have anyone else touch it as it is under warranty so now I am gluing them on with Polident which lasts 3 hrs. I am so bummed out 4 months before I can get them fixed. Thanks for any insight.

– Cindy from US Virgin Islands

Cindy,
When they told you not to eat with your front teeth, that’s a big red flag. Properly bonded, you should be able to eat anything you want. Your dentist’s instructions remind me of what one patient told me – that her dentist told her that her porcelain veneers would come off every few months. A dentist who is placing these correctly wouldn’t put any of these restrictions on your activities.

I wouldn’t have any reason to believe that if they didn’t know the right way to bond on porcelain veneers in 2015, why they would know now and do it right. Why are you going back to these people?

Knowing that they didn’t know how to do porcelain veneers right, I would question all of the work they did for you–the dental implant and the crowns. I would recommend a second opinion on all of it.

What to do about your smile for now? If the veneers are truly porcelain and if they have fallen off intact, an expert cosmetic dentist should be able to clean them up and get them bonded correctly. But this is beyond the knowledge and abilities of probably 95% of family dentists. You need a dentist with strong expertise in cosmetic dentistry bonding techniques, who knows how to etch the porcelain and bond it correctly. The cost for re-bonding these veneers should be relatively small. I would recommend going to one of the cosmetic dentists we recommend and having them fix this for you.

– 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 29, 2015

Another case of a porcelain veneer falling off

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Dr. Hall,
I had 5 porcelain veneers put on my front teeth 4 months ago. The one canine fell off in one piece after chewing on a piece of bread a week after it was permanently bonded. The tooth was extremely sensitive to air & I couldn’t tolerate the pain. The dentist said it fell off because my bite was off so he needed to shorten the veneer & the bottom tooth that slightly touched it. His defense was he didn’t see the issue before placing the veneer. He also said I didn’t need to be numb & proceeded onto rebonding it. The chemicals applied hurt so much I felt like dying, so I asked to be numbed before he could continue (same pain was experienced for bonding all other veneers.)

Today it has been 4 months later & that same veneer fell off while chewing a pancake. I felt the same intolerable sensitivity again. I asked the dentist why this happened when he said it would last 10 years? He replied because your bite is off so now we need to make it a full porcelain crown. I really don’t want to ruin my healthy natural tooth. Is it normal for the underlying tooth to be extremely painful w/the veneer falls off & should I be concerned about proceeding to a crown? He claims to have 1 year training in a cosmetic dentistry course & has 5 years experience in general dentistry. Please help I’m so stressed & afraid to bite w/the other front teeth.
– Kelly from Texas

(Note – I asked Kelly to tell me the name of her dentist so I could do a little research on him, but I won’t mention the name here.)

Kelly,
I think you should find another dentist—an expert cosmetic dentist—to put this veneer on right.
Your dentist claims to have a one-year training course in cosmetic dentistry. I think what he must be referring to is his General Practice Residency. It’s a stretch to call that training in cosmetic dentistry. Yes, it’s advanced training, but it’s in general dentistry.

He says that the veneer came off because your bite was off on that tooth. Now I can’t tell you anything about your bite from here, but the explanation doesn’t fully cut it, especially since it came off a second time after he adjusted your bite.

A properly bonded porcelain veneer will chip or crack before it will pop off. So there had to be something not quite right with the bonding. And then re-bonding a porcelain veneer is advanced cosmetic dentistry and I’m skeptical, after researching his credentials, that your dentist has the training to do that.

If you have the veneer, it should be a fairly straightforward and quick procedure for a dentist who knows what he or she is doing to rebond it. I can recommend someone close to you who can do this for you. Don’t let him turn this into a porcelain crown—that is way more aggressive than you need.

On the sensitivity, that doesn’t surprise me. Your dentist may have prepared your tooth deeper than usual, which leaves you with exposed dentin when your porcelain veneer falls off, which would make it quite sensitive. But even a tooth with a shallow veneer preparation can in some patients be quite sensitive.

Good luck,
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.

November 4, 2015

My dentist said my new veneers may come off every couple of months

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Dear Dr. Hall,

I just got 8 top veneers placed on. As I was leaving the office, I was told they may come off every couple of months. I know I can’t eat apples or crunchy things with them but are they going to fall off that often??
Thank you for any info you can give me.
– Dorothy from Maine

Dorothy,
Really! They told you your new porcelain veneers may come off every couple of months? That’s a new one!

If they do come off, I will tell you what to do. Go back to their office and demand a refund or you will call a lawyer, because if they do, they weren’t done right. Take a copy of this email with you and show them – I’ll stand behind that statement 100%.

There is a principle in the dental profession called “the standard of care.” Now, unfortunately, since cosmetic dentistry isn’t a recognized specialty, the standard of care for cosmetic dentistry is pretty low. Your new veneers don’t have to be beautiful. They may even look dingy and still meet the standard of care. But they do have to stay on. That much is pretty basic. So if your veneers begin falling off within the first couple of years, that is a breach of the standard of care, and the dentist is legally liable for that. It’s hard to put a number on it, because they should never just fall off. But if I had to use a number, I would say they should last ten years, at least.

And about your dietary restrictions. I placed many veneers over a period of maybe 15 years, and I never told my patients not to eat apples or crunchy foods. I told them to eat whatever they wanted, except for pins and bottle caps and stuff like that.

In fact, I will go this far. I would encourage you to test the veneers by eating some apples. If these veneers aren’t going to stay on, it is better if you find out now rather than later. Put them through a stress test and see if they’re bonded properly. A properly bonded porcelain veneer will not come off. I had a couple of cases where I had to re-do some porcelain veneers, and you have to grind them off, just as if they were part of the enamel, they are bonded so tightly.

There are only a couple of legitimate restrictions to your activities after you have a set of porcelain veneers, and I list those on this website on a page dedicated to the postoperative care of porcelain veneers. That is to avoid biting metal objects, and to wear a mouth protector when playing contact sports. But even those activities would potentially cause the veneers to chip or crack, not to come off.

If someone tends to grind their teeth at night, I also would wear a nightguard over the teeth to protect the veneers from chipping or breaking.

But apples and crunchy foods? You should be fine with those. Go enjoy yourself, that’s what I would say.
– 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.

April 24, 2012

Tips for root canal treatment on a porcelain veneer tooth

Dr. Hall, For the past two months I have been experiencing slight pain, pressure, discomfort and even feeling as if my two front teeth are going to fall off. Hot or Cold do not bother my teeth. Approximately 9 years ago I chipped one and also had decay on my two front teeth. As a result, veneers were placed. Never had any problems until now. I went to a dentist that has been doing my cleanings and she did an x-ray and noticed inflammation on a nerve. Advised to take ibuprofen for 7 days for inflammation. I followed her instruction and it did work for 1-2 weeks until the same symptoms came back. I went back she took another x-ray, noticed the same inflammation. She stated if it continued then possible root canal would be the next step. However nerve had no damage, which it confused me as why she would do a root canal? I was advised from a friend that sometimes the nerve can be infected. I had some amoxicillin at home and took it for 5 days the pain once again was gone. Now 2 weeks later symptoms are back. My biggest fear is that veneers are going to fall off, is that possible? Even saliva feels weird around my front teeth only. Can you tell me if it may be possible for root canal?
– Sylvia from California

Sylvia,
I’m at a little bit of a disadvantage not being able to see this myself, but at least from what you’re telling me it seems pretty clear that your tooth needs a root canal treatment. And I will tell you why I think that.

I am interpreting the “inflammation on a nerve” that you are telling me about as signs on the x-ray of pulpal inflammation. When the pulp of a tooth is inflamed, often the first sign is either a widening of the periodontal ligament space around the end of the root, or a breakdown in the bony lining of the socket of the tooth, also occurring at the end of the root. When anything shows up on the x-ray like this that indicates inflammation of the pulp of the tooth, it is pretty certain that you are going to sooner or later need to have that root canal treatment.

Taking some amoxicillin you had at home for a tooth infection isn’t a good idea. But the response of your tooth – the pain went away and then came back two weeks later – is another pretty certain indication that the tooth is infected, which means you need a root canal treatment. The problem with having taken the amoxicillin is that now you are that much more likely to have an amoxicillin-resistant infection in your tooth. You can never wipe out a tooth infection with antibiotics alone because the antibiotics have no way to get inside the tooth. So the infection will always come back, and the next time it’s always more likely to be an antibiotic-resistant infection.

Your porcelain veneer won’t fall off this tooth if you get a root canal treatment. But let me give you some helpful advice on how to have this done so that you preserve the esthetics of your smile. And this is something that many dentists don’t know, unless they are really expert in appearance-related dentistry. There is a strong potential for a tooth with a root canal treatment to turn dark. That dark color will show through the porcelain veneer and will require it to be done over again unless the dentist takes this simple precaution. After the root canal treatment, the dentist needs to clean out all root canal filling materials and cement from the insides of the visible part of the tooth – the part that shows above the gumline. Then she should cement a translucent fiberglass post inside the tooth to reinforce it and fill up the rest of the inside of the tooth with a light-colored composite material that will preserve the original color of the tooth. It is the root canal filling material and cement inside that cause most of the discoloration of the tooth. But by cleaning all that out and filling it as I have described, it won’t permanently prevent any discoloration of the tooth, but it may put it off for a good five to ten years. At that point you can get new porcelain veneers or go to a crown on the tooth.

Show this e-mail to your dentist, and she can contact me if she has any further questions.

Having this delayed response to the traumatic injury and decay you experienced 9 years ago isn’t unusual at all. Most dentists have seen this sort of thing before.

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 21, 2011

A cosmetic dentistry horror story – so many things turned out so wrong

Dear Dr. Hall,
Last year, I had gotten six veneers on top and two on bottom. After the dentist cemented them I realized that some of them had brush marks left from the lab. I told the dentist that I was unhappy. He tried shaving and polishing the veneers over several visits, and that only made them worse, as it destroyed the shine, made them fuzzy and irritated my mouth. After much arguing, he agreed to redo the four veneers that he had tried to polish, initially asking for a full price, but later agreeing to do it free of charge because I argued that it was his fault from initially not inspecting the veneers and later making the situation worse by trying to shave and polish them.

Second time around, when the veneers came back from the lab, some did not fit, all were a wrong shade and did not match the rest of my veneers. They had to be redone twice, to finally look decent. On the third attempt, the veneers fit, but were still a little off in color. The dentist told me “so what, the color is not that different.” There were also a small gap between two veneers, he also told me “so what, real teeth have gaps too.” Fed up with the unprofessionalism, I got the veneers cemented, since he told me that it was the best he could do. Two weeks later, the veneer that initially had a gap fell out. He put it back in. The next morning the veneer fell again. He just cemented it back on, telling me that this time around he etched the veneer better and it will not fall again. The gap got even bigger and I was very unhappy. I kept on insisting to get the veneer redone, he told me to “get out of his office” and that he is releasing me of his care.

One week after he cemented the veneer back on for the second time, the veneer fell again for the third time. I have visited several dentist and they all told me that in general my dentist has done a bad job and that all my veneers need to be redone. Out of the top six veneers, two old ones have huge spaces between the veneer and my gum and the yellow cement is showing. The four that he had redone also have visible spaces between the veneer and the gum, the veneers are discolored, one keeps on falling and one is crooked. Two of my teeth on top have become extremely sensitive, not only to cold and hot water, but even to air. One dentist told me it could be due to bad bonding. The cement on two bottom veneers has turned brown, one veneer is placed higher than the other.

I have seen three different densitst and they are all telling me to get the veneers redone, but I am concerned about redoing the veneers for the third time since I am only 28 years old. What are the risks of redoing the veneers three time in two years? What is the best solution in my case?

I have also sent a letter to my previous dentist, expressing my dissatisfaction and asked for a refund, but he has not responded. Should I pursue a civil action against him or file a complaint with the dental board? I would at least like to get a refund and be able to redo the veneers. I want to also make sure that this dentist does not do this to anyone else. He is extremely unprofessional and rude. I also feel that he should not represent himself as a cosmetic dentist, since he obviously scewed up my veneers. What is the best course of action? Thank you in advance for your time.

All the best,
Liana from California

Liana,

It sounds like you’ve been around and around with this dentist. I’d like to try to help you, but I need something more from you first.

Anyway, in general I think your frustration comes from working with the wrong dentist. You need to understand that a dental degree and a dental license don’t make a dentist an artist. Cosmetic dentistry is art, and they don’t teach it in dental school in the regular curriculum. Dental schools are designed to teach dentists how to fix teeth that are broken, not how to create beautiful smiles. And because the profession will not declare cosmetic dentistry a specialty, any dentist, without any extra training, can claim to be a cosmetic dentist, and it’s all legal.

The bonding technique is only a small part of what you need to have this done right. Remember that when they were done the first time, they were apparently bonded correctly, because they stayed on your teeth, but they were ugly and then he made them fuzzy and you asked to have them removed. If you hadn’t done that, they would still be on your teeth today, it seems to me. Is that right? So now you want to go to a different dentist who will bond them correctly. But how will they look, and, if they stay on, what will you do when you don’t like how they look?

You’re asking about the risks of doing porcelain veneers a third time and you are only 23. There isn’t a single answer to that question. If you are just going to a “dentist” to get this done, then the risks are high. It all depends on how you are picking the professional who is going to do this for you. In the hands of the wrong dentist, this is very risky. In the hands of the right dentist, there is practically no risk.

If you’d like me to help you with this, why don’t you write back and tell me the name of the dentist you plan to go to to have this fixed, and I’ll try to tell you something of the risks I think you’ll encounter. I have resources where I can look up a dentist’s training and get other information about them that helps me evaluate these things.

Once you find the right dentist to re-do this for you, I can help you work with the previous dentist. But your problem here is that cosmetic dentistry is not a legally distinct specialty, so to pursue any action against this dentist you need more of a case than that you just don’t like how they look. That is why it is so important to pick the right dentist in the first place, because when it comes to cosmetic dentistry, often you have no recourse. Yes, he was promoting himself as a cosmetic dentist, but MOST of the dentists who promote themselves as cosmetic dentists aren’t very good at it. I would think you could get a refund, though, but it will depend on how you go about it, and you need another dentist to back you up, first. So let me know and I’ll see what I can do to help.

Dr. Hall

Links: read more cosmetic dentistry horror stories.
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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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