Archives for March 2020

My Dental Crown Doesn’t Feel Right

March 31, 2020 by writeradmin

I just had a dental crown placed on a severely damaged tooth. It hasn’t felt right since I got it a week ago. I think it’s too big and bumping into the opposing tooth when I bite down. My dentist said it is just because I’m not used to a crown and to give it time. If I’m not used to it by the time the quarantine is up he’ll take another look. Is this normal?

Selwyn

Dear Selwyn,

I would laugh at your dentist’s comment that it’s just because you haven’t had a crown before and you’ll get used to it, if it weren’t such a dangerous attitude. The way your teeth should come together is very specific and in dental circles is known as occlusion. The best dentists, who want to seriously treat TMJ Disorder or do things like a full-mouth reconstruction, will attend post-doctoral schools to learn the skills they need to properly treat their patients in every aspect. Unfortunately, some bread and butter dentists think they’re only going to do single crowns and therefore don’t bother to get the extra training.

In general, they get by. They will have the odd patient here and there, like you, who will complain about something feeling off. But, the dentist tells them they’ll adjust and either they do or they’re too embarrassed to keep complaining.

He said you’re not used to having a crown. The truth is you shouldn’t notice a difference. It should fit exactly like your natural tooth. The fact that you’re not used to it means he didn’t fit it properly.

To me, it doesn’t even sound like he took the very basic step of using bite registration paper. He should have asked you to bite down on this paper which would show were the bite is not coming together properly. Then the dentist can carefully adjust that area. He hasn’t even bothered doing that.

You can continue this dentist, but I think you can do better. Plus, if you don’t get this adjusted, you can end up with bone loss or TMJ Disorder. This requires attention, even during COVID-19.

My suggestion is you find a dentist who has studied at one of the following post-doctoral institutes:

Texas Center for Occlusal Studies
The Pankey Institute
The Las Vegas Institute for Advanced Dental Studies
The Dawson Academy

Have them fix the crown.

This blog is brought to you by Philadelphia Dentist Dr. Michael Weiss.

Prosthodontist Versus Cosmetic Dentist

March 28, 2020 by writeradmin

I needed a lot of reconstructive work done on my teeth after a car accident. I went to a prosthodontist because they’re supposed to be the experts at this. I brought pictures of my old smile. I just wanted to have my beautiful smile back. I thought it would be fairly simple as they’d know exactly what I wanted ahead of time. When it came to the process of fitting, it looked like everything would be too dark. I mentioned that and they said it was because they weren’t the permanent ones. A common theme, whenever I brought up an issue, was the dentist saying, “He’s been doing this for twenty-five years and I should trust him.” Then, when I noticed the color didn’t match on the top and bottom he said, I didn’t understand how it worked and he was doing what was clinically correct.

When it came time to put in the permanent ones on the try-in, I couldn’t see them because they would fall out. He was mostly checking for fit. I told him one of them felt weird. He snapped at me at that point and said, “Everything is clinically perfect and fits just as it should.” He also told me I’ve been overly demanding and if I don’t like it I can leave without the teeth. I was humiliated and couldn’t bear the thought of leaving without teeth. At that point, most of my teeth had been ground down to nubs for the teeth needing crowns. I just let them do the work and booked it out of there as quickly as possible.

Now that I’m home, the teeth don’t look anything the way I wanted. The top teeth are actually darker than the bottom teeth, which looks completely insane. One of the teeth still feels funny. The teeth are shorter than my old smile, which makes me look older. I hate this. Is there any way to get it fixed without spending a second fortune?

Mandy

Dear Mandy,

I hate it when I hear these cosmetic dentistry horror stories. All that time and money and the patient is left disappointed at best and in a horrible situation that destroys their bite and leaves them in pain in some of the worst cases. You haven’t been unreasonable and hard to please. When you talked about the difference in color from the upper and lower arch I cringed. While you can get away with the lower teeth being slightly darker than the upper teeth, the other way around just doesn’t work. You can get this fixed, but you’re going to have to be tough. If you think you can handle it, I’ll explain how you can get the smile you deserve.

First, what he did is essentially malpractice, though I’m certain he won’t see it that way. He has a dental school mentality of “I’m the dentist, therefore I know best”. One of the standards of dentistry is informed consent. What he ended up doing, though, is coercing you into a smile you didn’t want. That’s not informed consent.

It’s obvious he didn’t care what you think to begin with. During the try-ins, you never got to see the crowns. He only cared about the fit, not whether or not you liked the appearance. If he did, there are temporary try-in pastes he could have used to let you get a good look and approve everything before moving forward.

Based on the arrogance you’ve described, I don’t think you’re going to get far with him on your own. Instead, you may need to involve a lawyer. His lawyer will immediately suggest he settle. I don’t want you to just ask for a refund. Instead, what you need to do is have him pay an expert cosmetic dentist to fix this.

While a prosthodontist studies reconstructive dentistry, not enough of them invest time developing the training necessary for the cosmetic side of things. You are more likely to find an expert cosmetic dentist with training in reconstructive dentistry than you are the other way around. I’d start by looking for an AACD accredited dentist. These are the top cosmetic dentists in the country and will certainly give you a stunning smile. Many of them also have reconstructive training as well.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Porcelain Veneers Over Fillings

March 24, 2020 by writeradmin

I have a couple of teeth which have fillings on the front of them. I’ve never been happy with their appearance and wanted to have a smile makeover with porcelain veneers. My dentist said that the veneers won’t work because of my dental fillings. He suggested crowns instead. Is this standard operating procedure for someone in my position or is there another option? The teeth are otherwise healthy.

Karen

Dear Karen,

I’m very glad you wrote. No, dental crowns are not standard operating procedure. My guess is your dentist isn’t comfortable doing porcelain veneers so he made up some lame excuse about the fillings. The truth is the bonding agent works very well on teeth with fillings. Why would you want to place dental crowns, which will require your dentist to grind down your healthy teeth? For argument’s sake, let us say you couldn’t get veneers and crowns were your only option. I still wouldn’t let this dentist do them.

If he hasn’t gotten trained in porcelain veneers, he hasn’t had significant training in cosmetic work period. Smile makeovers aren’t taught in dental school. A dentist has to invest the time post-doctorally to learn how to do beautiful, natural-looking smile makeovers. Doing dental crowns, especially on front teeth, still requires that training. I truly feel you’d be disappointed by the results.

Here’s what I’m going to recommend. See if you can find an AACD accredited dentist in your area. Not only have these dentists done extensive cosmetic dentistry training, but they’ve taken stringent exams to prove their knowledge, as well as provided visual evidence on a large number of cases they personally did in order to demonstrate their artistry. These cases were scrutinized by experts for both their beauty and technical accuracy. Any AACD accredited dentist will give you a stunning smile with porcelain veneers.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Horrible Solution for a Tooth Gap

March 1, 2020 by writeradmin

I have a tooth gap I want to fix. My dentist is suggesting Lumineers. I’ll do it if it is my only option but it is quite expensive. Can you give me a second opinion as to whether I have other options?

Susan

Dear Susan,

Please run away from your dentist as quickly as possible. This is a horrible suggestion to fix a tooth gap. Lumineers are a brand of porcelain veneers, which are used for complete smile makeovers. They’re also a bit pricey. You’re asking for a solution to a tooth gap.

The simple solution for that is dental bonding. It is much less expensive and will only affect the teeth you want to close the gap on. What your dentist is suggesting is a massive over treatment. So why would he do that?

My first guess is he doesn’t know how to do dental bonding. Truthfully, that wouldn’t surprise me at all based on the fact that for your porcelain veneers he is suggesting the Lumineers brand. These are highly marketed to inexperienced cosmetic dentists as being easy to place.

They tell dentists that because they are an ultra-thin brand of porcelain veneers, leading the dentists to believe there will be no need to prepare the teeth the way many other brands of porcelain veneers require. Unfortunately, this often ends up looking bulky. Some patients have even described the results as horse teeth.

Finding an Expert Cosmetic Dentist

If you were going to get a true smile makeover, then you would want a highly skilled cosmetic dentist, such as one who is AACD accredited. Let them pick the brand.

As for your tooth gap, again, you’ll want an expert cosmetic dentist. Dental bonding, the treatment I suggested, is done freehand and takes some serious expertise.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.