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dentistry

Can’t Speak after Closing a Tooth Gap

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I had a tooth gap that my dentist closed and talked me into a smile makeover at the same time. I had porcelain crowns done from one canine tooth to the other. Ever since then I have had problems speaking, closing my mouth, my mouth is dry all the time, and my neck hurts constantly. Is there a way to put the gap back? Everything was fine with those things before. I just didn’t like the gap.

Carl

Dear Carl,

woman smiling with a gap between her two front teeth

The easiest way to close a tooth gap is with dental bonding

I want to start with the fact that crowning six teeth is a massive overtreatment for a tooth gap. It wouldn’t even be my solution for a smile makeover. Generally, tooth gaps are closed with dental bonding, which is much less evasive, doesn’t remove healthy tooth structure, and is much less expensive.

However, let’s say you really wanted a total smile makeover. As I said above, porcelain crowns still would not be the best choice. The go-to procedure for a smile makeover is porcelain veneers. The reason a dentist would suggest a porcelain crown if you don’t already have crowns there is because he or she doesn’t feel qualified to place porcelain veneers. That’s not a good reason. It would be better for them to refer you to a cosmetic dentist who would be able to give you a beautiful smile without having to grind down all your teeth. Unfortunately, once all that tooth structure is removed, you are stuck with crowns for the remainder of your life.

As to the issues you are facing, they are not from the gap being closed. Opening that back up won’t help. However, the issues are serious and are a result of the dental crowns not being placed properly.  Based on your description, it sounds like your dentist opened your bite too far. This means he’s either made the crowns too thick or too big for the shape of your mouth. It is imperative this is repaired–The sooner the better.

Here’s what is leading to the problems you’re facing. The neck pain is a result of your bite being thrown off and now you’re straining. Until that is restored, you will continue to be in pain.

Not being able to close your mouth properly is called lip incompetence. This is leading to the dry mouth you are experiencing. While I’m sure you know why the pain has to be dealt with, the lip incompetence is also a serious issue.  Our saliva is a major force in fighting decay in our mouth. Whenever you have dry mouth, you no longer have the minerals from your saliva to protect your teeth. It will lead to massive decay.

To get this properly fixed, I want you to get a second opinion from an experienced cosmetic dentist. Find an AACD accredited dentist in your area. These are the top cosmetic dentists in the country. They can help you get a refund from your dentist and then you can get this done properly so you have the proper function of your bite. Not only will you have a functioning bite, but it will also give you a stunning smile.

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

Discolored Dental Bonding

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I’ve got dental bonding that is seeing the end of its lifespan. It is picking up stains and isn’t nearly as bright as it once used to be. I honestly don’t know if I should whiten them or replace them. If whitening would work then I’d like to do that. I’ve moved since then and don’t feel confident my new dentist can do the job. He said he’s willing to learn but I’d be his first case. Is there a specific type of teeth whitening that would work better with dental bonding?

Eliza

Dear Eliza,

before and after dental bonding to repair a chipped tooth

There isn’t a teeth whitening that will remove the stains from your dental bonding, unfortunately. In fact, because it only works on natural tooth structure, your teeth would whiten but not the dental bonding, making the disparity even worse. That being said, I am glad you are not just going to let your new dentist try his hand at dental bonding on you.

This requires some expertise because it is a procedure that is done freehand. A dentist needs training as well as artistry. However, you do need to have the bonding replaced. If you are happy with your dentist in every other aspect, you don’t have to switch practitioners. Cosmetic dentists are used to patients coming to them just for specific advanced procedures and then returning to their regular family dentist for the bread and butter type of care.

With that in mind, how do you go about finding a dentist to replace your worn out work? The easiest way would be to find an AACD accredited dentist in your area. These are dentists who have proven their technical knowledge and artistry to an examination board. They are more than qualified.

Should You Whiten Anyway?

Because the bonding color is permanent during its healthy lifespan, if you have any plans to whiten your teeth, the time to do that would be before you have the bonding re-done. This way when they replace the bonding, it can be done to the color you will want to keep for some time.

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

Ugly Porcelain Veneers

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My girlfriend has what I think is a pretty smile but she’s always been uncomfortable with it. I understand it’s not perfect, but I like it. However, she’s determined to get porcelain veneers. Here is my concern. My sister got these several years ago and I actually thought her smile looked worse after the procedure. While they were whiter, they were so bulky to me it looked like she had horse teeth. I mentioned this to my girlfriend and she just shrugged her shoulders and said my sister probably had a bad dentist and we’ll need to do some research. How do we find the dentist that can give her the beautiful smile she wants?

Kevin

Dear Kevin,

a porcelain veneer being placed on a tooth

It is so refreshing to see a young man caring about his girlfriend. What I love the most about this is you’ve tried to make her feel good about her natural smile and haven’t pressured her to “improve it”. You’ve also recognized that she has to feel as good about her smile as you do. This may mean some cosmetic dental work, but she’ll be happier with her smile, which in turn will make her more confident.

Let’s talk about your sister’s case first. Your girlfriend is correct that an ugly cosmetic case has more to do with the dentist than the procedure. However, I feel there is a combo effect going on with your sister’s case. You mentioned they looked bulky and described them as horse teeth. This is a fairly common complaint with a brand of porcelain veneers known as Lumineers. One of the reasons for this is they are typically marketed to inexperienced cosmetic dentists as being easy to place because they don’t need the tooth to be prepared, as they are thinner than some other brands.

However, as you saw with your sister’s smile makeover, this doesn’t always work out as advertised. Yet, the dentist doing the case doesn’t have enough training to know when or why the teeth need preparation.

Finding an Expert Cosmetic Dentist

Porcelain veneers can look stunning. Celebrities know that as it is their go-to procedures. However, one of the problems patients face is there isn’t a recognized specialty in cosmetic dentistry which allows patients to know who has had the training and who hasn’t. Any general dentist can call themselves a cosmetic dentist regardless of the amount or quality of the training they’ve received.

To makes things even harder, doing smile makeovers isn’t taught in general dentist school. That means to get really good at it, dentists have to invest time and money in post-doctoral training.

One thing I suggest to patients looking for a great smile makeover is to go to an AACD accredited dentist. These cosmetic dentists are proven for both their technical knowledge and their artistry. In fact, they make up the top 1% of cosmetic dentists in the country because the accreditation process is such a high achievement, requiring the dentists to pass rigorous oral and written exams as well as provide visual evidence for a large number of cosmetic cases they have done proving their technique and artistry.

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

Dental Bonding Doesn’t Match

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I chipped a tooth and did some research on repairs. The consensus was dental bonding was the best repair. I did get that, but the bonded part doesn’t even come close to matching the tooth part. It is so obvious there is a repair there. Is that normal? If not, who do I get this fixed? Will I have to pay for it?

Casey

Dear Casey,

before and after dental bonding

As you can see from the image above, dental bonding can and should look completely natural blending in seamlessly with the natural tooth structure around it. The problem you are facing is the dentist who did the procedure, not the procedure itself. It can be fixed and should be done at the dentist’s expense.

Doing bonding well is challenging because it has to be done freehand. This means the dentist either needs some natural artistic ability or invest significant time and money in the practice and training necessary to do it well. Not many dentists do that.

The first thing I recommend is you give your dentist another chance to get the dental bonding to look natural with your other teeth, with the understanding that if he can’t do it to your satisfaction, he’ll provide you with a refund so you can get it done properly. There is a reasonable expectation that the bonding matches the tooth.

If it turns out he can’t do it or just prefers to give you a refund, you’ll want to find an expert cosmetic dentist to do your dental bonding.  I suggest looking for an AACD accredited dentist or a dentist recommended on the mynewsmile.com website. These are the dentists that have the skill and artistry to give you a natural-looking result.

One other thing to be aware of in case your dentist didn’t tell you before your original bonding. Once the bonding is completed, the color is permanent. If you want to whiten your teeth later on, your natural tooth structure will whiten but not the dental bonding. Then, the only way to get them the same color again is to re-do the bonding. Because of that, I generally recommend to patients that they have any teeth whitening done before the bonding. However, you also have the option of waiting until it is time to replace the bonding. I just didn’t want you unaware of the limitations and then having to spend unnecessary money replacing your bonding early.

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Full-Mouth Reconstruction to Whiten Teeth?

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I need to make some important choices soon. I have a dental crown that is about 20 years old and two porcelain veneers that are a bit older. I’ve been experiencing some dry mouth. I’ve chipped the veneers on the front teeth and now there is a gray line at the gumline by the crown. I went to my dentist to discuss replacing them. Because my smile is no longer very white, he is suggesting I get crowns on both my upper and lower arch to do a smile makeover of sorts. The more I think about it, the more concerned I am, especially with my dry mouth. It may be better for me to just replace the old work and wait to see what happens with the dry mouth first. What do you think?

Carolyn

Dear Carolyn,

teeth whitening trays

The first thing I am going to suggest is that you get a different dentist. If I understand you correctly, your dentist is suggesting crowning all of your teeth because your teeth need to be whitened? Really?

So, here’s the thing. Whitening your teeth will bring him in a few hundred dollars. Crowning all your teeth, known as a full mouth reconstruction, will bring him in $30,000+. Your dentist is being self-serving. The best dentists are doing their best to serve their patients without unnecessary expense for his or her benefit and while preserving as much tooth structure as possible. He’s doing neither.

My suggestion is you have your teeth whitened and then just replace the damaged dental work. However, I don’t think your dentist should be the one to do it and not just because he’s grabbing for the bucks. There is another warning sign that he isn’t what you need. When a dentist suggests dental crowns instead of porcelain veneers for a smile makeover, it is because they are not comfortable doing porcelain veneers. Doing crowns in a case where they are not needed is a waste of healthy tooth structure.

As you likely know from the crown you already have, in order to make room for the restoration, he’d have to grind your teeth down to nubs. This is irreversible. Once you have dental crowns you will always have to have dental crowns. It is much better to do porcelain veneers when it comes to a smile makeover.

Now, you do already have one crown. You mentioned a gray line at the gumline. This tells me the original dentist did a porcelain-fused to metal crown. On a front tooth, what you really want is an all-porcelain crown.

What you need is a skilled cosmetic dentist to take over. In your place, I’d look for an AACD accredited dentist. These dentists are in the top of the cosmetic field and have proven skill and artistry. You’ll have a smile you are proud of.

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

Can My Smile Be Pretty after Dentures?

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Around 30 years ago, I lost all my teeth. My dentist never mentioned dental implants so I don’t think that was an option. I have a friend who has them and her smile is so much prettier. Plus, she can eat anything she wants. I don’t know which I’m longing for more, but I think it is a pretty smile. If I got dental implants now, could they be as pretty as her smile?

Alice

Dear Alice,

Illustration of a dental implant next to a natural tooth
I’m so sorry you have been going through this for so long. It is not the dentures that are the reason your smile doesn’t look pretty to you. Both dentures and dental implants can be beautiful giving you a smile you are proud of. The problem lies in the artistic skills of the dentist. My guess is your dentist thirty years ago had good intentions but not the skill. I truly wish he would have mentioned dental implants to you. They were available then and it would have made the last 30 years significantly more pleasant for you. However, that is water under the bridge and all we can do now is go from here.

There’s one obstacle you will face when it comes to dental implants— the aftermath of facial collapse. When your teeth were first removed, your body decided without the roots of your teeth you no longer needed the minerals in the jawbone that are used to help retain your teeth. After all, they are already gone. Slowly, that leeches your jawbone away. After 30 years, I’m guessing you are having quite the time keeping those dentures in any more.

As you can see from the image above, like your teeth, dental implants need bone to keep them secured in your jaw. There is a solution to this, though. There is a bone grafting procedure that can build that missing bone structure back up for you. Once that is done, you will be right as rain for dental implant again.

How to Get that Beautiful Smile

As I mentioned earlier, it is the dentist who does your procedure that determines how beautiful your smile is. You need a dentist who is both qualified to give you dental implants along with the artistry to make the dentures that anchor to them beautiful. My suggestion is you start by looking for an AACD accredited dentist. These are proven artists when it comes to dental work. You will finally have that smile you have always wanted and you can share it while you eat some steak!

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

Bonding Color is Wrong

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I have these exposed places at the top of my teeth that are very sensitive. Other than that, my teeth were attractive. They showed me their plan and I knew immediately the color would need to be whiter. I pointed that out and they agreed. Then, they put in the new “whiter” color. It still doesn’t match my teeth. Plus, it looks opaque and is rougher looking than my natural tooth structure. I feel like what was an attractive smile has been made less attractive in order to prevent the sensitivity I was feeling. Is there a fix for this?

Callie

Dear Callie,

abfraction lesionWhen done well, dental bonding should blend seamlessly with the remainder of the tooth. I’m especially sorry for what you are going through because what your dentist is trying to do is even easier than when you have to repair a chip. If I understand your description correctly, you are dealing with what is known as an abfraction lesion (pictured left).

We used to think these were caused by brushing too hard. We now think it has more to do with clenching and grinding of your teeth. This flexes the tooth right at your gumline, adding stress. That repeated movement wears away the gumline. One thing you will want to do after this is repaired is to have a night guard made. This is a custom fit mouthpiece, similar to a sports mouthguard that you will wear while you are sleeping. Nighttime is when most grinding and clenching takes place. Usually, until their teeth are worn down, the patient has no idea it is taking place. Over time, this can lead to TMJ Disorder as well as wearing your teeth down to numbs.

Repairing Your Dental Bonding

before and after dental bonding to repair a chipped tooth

Pictured directly above, you will see a case of dental bonding done well. You can’t tell where the bonding ends and the natural tooth structure begins. Your teeth can look this way too. Unfortunately, the only way to fix this is to have it done over again.

Being blunt, I think this is beyond the scope of your dentist’s abilities. You will need to have a dentist with more cosmetic training step in and repair this. Ask your current dentist for a refund. Then, look for an AACD accredited dentist in your area. They can give you the results you are looking for.

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

Full Mouth Reconstruction Disaster

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I needed to replace some old veneers and two crowns. When I saw my dentist, he said that he’d need to open my bite a bit so my teeth would show more. I never considered that a problem, but figured there was a reason. The temporaries are very uncomfortable I asked him to redo them twice. Then when the permanents came in, he put them in so fast, I hardly had a chance to check them out before they were permanently bonded on.

I’ve had massive problems since and can’t even shut my mouth all the way. I have been drinking water and sloshing it around my mouth constantly. If I don’t, my lips stick to my teeth. I spoke to my dentist about it and he said he’s hit all the checkpoints and his work is perfect. What do I do? I don’t feel like I can continue like this.

Pam

Dear Pam,

Woman covering her mouth with hand.

This is unacceptable for you. When your dentist tried to open your bite, which I am not convinced was necessary, it sounds like he was in over his head as well. Additionally, it doesn’t sound like he cares. He ignored every concern you had during the temporaries. This is the stage that is imperative to help ensure the bite is perfect. He should never have moved forward until your bite was completely comfortable. He blew past that and placed the permanent ones in a rush.

Now that they’re on and not doing well, he’s ignoring you again. This time, putting your oral health at risk. What you are experiencing is lip incompetence because he opened your bite too much. He’s really messed up and doesn’t want to admit it.

The only way to fix this at this point is to completely have the case re-done. However, you don’t want to have this dentist do it. To be frank, he doesn’t know what he’s doing. You need another dentist to do this for you. I also think your dentist needs to be the one to pay for it. It is his mistake.

Who Should Re-Do This?

You need a dentist with both cosmetic and restorative training. When you do, make sure the temporaries are exactly the way you want them before the case goes any further. A good dentist will know this, but I don’t want you suffering the same way again, so I just want to make sure you don’t allow anyone to move forward without satisfactory temporaries.

What that means is, your lips will come naturally together, your bite “feels” normal to you, and you love how they look. Unfortunately, smile makeovers and advanced restorative procedures aren’t taught in dental school. A dentist has to study this in a post-doctoral setting, though it isn’t required for them to practice. If at all possible, you should get an AACD accredited dentist to do your case. They will be the most likely to have the training and the skills necessary to do this for you.

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

Malpractice Smile Makeover

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I feel like I’ve ruined my mouth and my hard-working husband’s finances. I had some chipped teeth and some other minor issues with my smile. I asked my dentist about possible fixes and she suggested I get a smile makeover with porcelain veneers. She said it is what the celebrities use to get their gorgeous smiles. My husband and I discussed it as it was a big chunk of change and decided to go ahead with it. I’ve regretted this decision ever since. I’m about to move and running out of time to get this fixed. Here are my problems:

1. The teeth (eight of them) were ground down to nubs. Disgusting little yellow nubs. This wouldn’t be such a big deal if it weren’t for the second problem.
2. They don’t stay on. In the course of this year, they have fallen off eleven times. One of them over a major holiday when I couldn’t get in to get them fixed. The humiliation of having those tiny, yellow nubs was almost unbearable.
3. She says I’m being too rough on them, but one of them fell out while I was eating pasta. How is that too hard?

Please tell me a way to get this to work. I’m worried after we move no one will help because it is another dentist’s problem.

Katy

Dear Katy,

I have to express how sorry I am for what has been done to you as well as the anguish you’re going through. It shouldn’t have happened. The good news is you have a pretty solid case for malpractice. Additionally, this can be fixed. The bad news is she has misled you and done some things which will affect the repair as well as how your teeth function for the remainder of your life.

Porcelain Veneers verss Porcelain Crowns

Based on your description, your dentist gave you porcelain crowns, not the veneers she said she would. I know that based on your description of the teeth being ground down to nubs. Look at the two pictures below:

tooth preparation for porcelain veneers

This is what teeth look like when being prepped for porcelain veneers. There is minor removal of tooth enamel, around the width of a fingernail. This is not what you described.

tooth preparation for a porcelain crown

This is closer to what you described and is the preparation for a porcelain crown. Yours may even be more aggressive than this. Here’s where she has done some permanent damage. We don’t currently have the ability to regrow tooth enamel. Because of that, even when this is repaired properly, you will always have to have porcelain crowns instead of the porcelain veneers you were told you were getting.

Here’s where some “good” news kicks in. First, she lied. You were told you were getting porcelain veneers, which incidentally is the go-to procedure for Hollywood celebrities, but instead received dental crowns.

Second, she’s had gross incompetence in her handling of the dental crowns. While smile makeovers, including the procedure of porcelain veneers, isn’t taught in general dental school and therefore isn’t a required knowledge for dentists, dental crowns are a staple. They should NOT be coming off at all, let alone as much as you’ve had them come off.

Her blaming you is unacceptable. You could have been eating steak and apples every day and your dental crowns should have stayed in place.

Getting this Fixed

She needs to pay to have this done correctly. I don’t want you just getting a refund, because it is very likely going to cost more than your original price. You can let her know up front what you want, but don’t get them fixed until you move. I want you under the care of a long-term provider for you.

After you get to your new location. I want you to look on the website for the American Academy of Cosmetic Dentistry (aacd.com) for an AACD accredited dentist. This is different from just being a member, so make sure you check the accredited dentist option. Accredited dentists are in the top of the cosmetic field and will give you a stunning smile.

If your current dentist refuses to make this right and you have to go to court, make sure to ask for additional money because giving you crowns instead of veneers has damaged your teeth and changed your care for the remainder of your life. I think her malpractice insurance will tell her to pay up quick, because if it ends up in court, you will likely get a substantial amount.

Again, I’m sorry this has happened to you. I don’t like dentists who give our practice a bad name either through incompetence or lack of ethics.

Keep your chin up. You will soon have a smile you will be proud of.
This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Do Dental Crowns Cause Dry Mouth?

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I’m having a really hard time with dry mouth ever since getting all my teeth crowned. I know it was a cosmetic procedure, and while the teeth look okay, I have to really focus on keeping my mouth closed. Never in my life did I think I’d be what my kids call a “Mouth Breather.” Is there a way to fix this or is it normal and I’m just not used to a wider smile?

Kathy

Dear Kathy,

A woman pointing at her smile

No this isn’t normal. Was there a particular reason your dentist did dental crowns instead of porcelain veneers. You mentioned it was cosmetic work. Generally, when someone is getting a smile makeover, porcelain veneers are the go-to. It removes less tooth structure.

Some inexperienced cosmetic dentists will do porcelain crowns for smile makeovers because that is what they’re familiar with, but it unnecessarily grinds down healthy tooth structure. It’s water under the bridge at this point as it is already done. I just wondered if there was a functional/mechanics reason for doing something so drastic. That leads me to my next question.
Why every tooth? Most smiles are about eight to ten teeth wide. Doing every tooth is excessive, not to mention expensive.

What your dentist did is known in dentistry as a full-mouth reconstruction. It’s an advanced procedure that isn’t typically taught in-depth, if at all, in dental school. Instead, dentists would seek out post-doctoral training.

Lip Incompetence is Dangerous

When you can’t close your lips naturally and are having to consciously force it, we call that lip incompetence. It is going to rain havoc on your teeth and oral health. While many people think brushing is our biggest defense against decay, the reality is our saliva has an even greater impact. It contains bacteria-fighting minerals that protect your teeth. Dry mouth deters saliva and allows that bacteria to multiply unhindered.

In creating this problem, y our dentist made a serious mistake. He (or she) needs to pay to get this fixed. Don’t just ask for a refund because the fix will likely be more expensive than the original procedure. If he complains about this, you may want to hint to him that another dentist told you that you have a valid case for malpractice damages. That should get his attention.

A Word about Smile Makeovers

You said the smile was “okay”. An okay smile would not be what you were stuck with when it came to a true cosmetic dentist. When you go to get this full mouth reconstruction done correctly, I want you to look for a dentist who is accredited with the American Academy of Cosmetic Dentistry.

AACD accredited dentists are in the top 1% in their field. Not only will you be able to close your mouth naturally and comfortably, but you’ll also have a stunning smile you will be thrilled to show off to the world.

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

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