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Cosmetic and
restorative
dentistry

Smile Makeover on a Fractured Tooth

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Years ago, I had an accident which fractured some teeth. They received both root canals and dental crowns. As years past, my smile started to show it’s age. I decided to get a smile makeover after my last promotion. I went to see a highly recommended cosmetic dentist in my area. She did a combination of dental crowns and porcelain veneers. I love how it looks and am much more confident. My problem now is with tooth #9. It’s been sensitive ever since and there is a pimple on the tooth next to it. My cosmetic dentist thinks that the tooth needs to be extracted and to have a dental implant placed. I’m also getting a root canal treatment on the adjacent tooth. I’m attaching the x-ray to see if you think the tooth really needs to be extracted. I just had the restoration done and it seems like a waste of money to remove the tooth. I’ll also send a picture of the new smile in case you need it.

Aaron

Dear Aaron,

Aaron's Tooth X-rayI am in agreement with your cosmetic dentist. Looking at the circled tooth, in the middle of the root there is a horizontal radiolucent line. This is an old fracture that was either missed by your old dentist who worked on your teeth after the accident or he thought he could get out all the necrotic tissue and save the tooth.

Below the fracture looks healthy. However, above it the tooth looks moth-eaten. That tells me there is probably an infection there. Removing the tooth, will be the safest thing to do. A dental implant is a fantastic replacement so your dentist was right about that too.

Looking at the images you shared of your smile makeover, the dentist you choose was skilled. I’d stick with her for the dental implant as well.  However, she should have caught the fracture and infection.

Because she didn’t, it isn’t unreasonable to expect some flexibility in how this is paid for. Originally, had it been properly diagnosed at the beginning, you would have paid for an implant and a crown.  I’m going to suggest you ask to pay for the implant, but not the new dental crown to go on top of it because you just paid to have one placed. I don’t think she’ll have a problem with that.

From your x-ray, I have noticed one other issue. It looks like another tooth that had a root canal treatment, didn’t get done properly. You see the tooth on the left has filling material that stops a few millimeters short of the end of the root. I wouldn’t do anything about it unless it flares up. For now, the tooth itself looks healthy.

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

Collapsing Mouth

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I have an almost non-existent smile. Over the years, it seems my teeth have become less and less visible. It’s almost impossible to see my teeth, even when I smile. My jaw also aches all the time. I’ve noticed I feel the most comfortable at night when I’m wearing my night guard. When I talked to my dentist about my concerns, he suggested I get porcelain veneers. Before moving forward, I just wanted to get a second opinion.

Melanie

Dear Melanie,

Woman Holding her jaw in pain

I haven’t examined you so bear in mind I am only going based on your description. It sounds like you may be someone who struggles with either teeth grinding or clenching. This may be why your dentist has a night guard. The grinding can wear down your teeth to little nubs. It sounds like you’ve worn down your teeth to the point your mouth has become over closed.

Three things you mentioned lend credence to this. First, your teeth are less visible; second, your jaw aches; and third, you feel best when wearing the night guard.

What porcelain veneers will do is improve the appearance of your teeth. They will not solve the root issue of your mouth being over closed or the jaw pain.

My suggestion is for you to see a TMJ Dentist. This is a potentially serious issue that may need a totally different solution using dental crowns to build your bite back up.

One of the problems you will face is there isn’t a recognized TMJ Specialty, so any dentist can call themselves a TMJ Dentist. To make sure you are seeing a dentist who has the right training to help you, look for one who has done post-doctoral training at one of the following institutes:

  • The Pankey Institute
  • The Dawson Academy
  • The Las Vegas Institute for Advanced Dental Studies

A dentist with training from one of these reputable schools will be able to help.

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

$100k for a Smile Makeover?

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I’m so frustrated. I’m having trouble getting the right cosmetic dentist for my smile makeover. The first go-round I used my normal dentist. It turned out a complete disaster. He was gracious about it and completely refunded my money. Next, I went to someone who is supposed to be the top cosmetic dentist in our city. He said my bite is off and quoted me close to $100,000. There is no way in the world I can afford that. Is that the right amount for a top cosmetic dentist?

Jane

Dear Jane,

Woman with a beautiful smile

You are running into two problems when it comes to cosmetic dentistry. First, it isn’t a recognized specialty. This means any general dentist can call themselves a cosmetic dentist regardless of the amount of post-doctoral training they received. Unfortunately, creating smile makeovers isn’t taught in dental school. If a dentist wants to develop the skills needed to do it well, they need to invest in the training on their own. This is the issue you ran into with your family dentist. He obviously meant well and wanted to try to give you what you wanted. When he couldn’t, he had the integrity to return your money when he couldn’t.

The second dentist had a completely separate issue. The cost he quoted is quite high for porcelain veneers. He mentioned your bite was off. It’s possible what he was recommending was actually a full-mouth reconstruction, which is a completely different and much more involved procedure as well.

I would get a second opinion before moving forward. To be safe, I’d like to make certain you are seeing a qualified cosmetic dentist and not just someone trying to bring in a large fee. My suggestion is you look for an AACD accredited cosmetic dentist. These dentists have proven themselves by passing stringent exams as well as demonstrating the artistry to a committee.

If it turns out that you do need a full-mouth reconstruction, I think you should verify his qualifications. You need a TMJ Dentist with advanced training. Take a look at Dr. Weiss’ qualifications to get an idea of what type of dentist you would need for this type of procedure. Even then, I don’t think it would cost you $100K.

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

Root Canals Needed after Her Smile Makeover

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I had a complete smile makeover with veneer crowns. When I went in for my consultation I specifically asked about any risks involved. He told me there weren’t really any. I went forward with the procedure confident and excited. Since then, four of the teeth have needed root canal treatments. He suggested I see an endodontist. I did and was informed even more teeth are likely to need root canals soon enough. I thought there wasn’t much risk with these. What happened? Have you seen this before?

Ruth

Dear Ruth,

I think there is some confusion here. There are porcelain veneers and there are porcelain crowns, but there aren’t veneer crowns. So, I’m not sure which you received. However, based on the number of root canal treatments you received, my guess is it was porcelain crowns. I’m going to show you two photos below. The first image is what a tooth would look like with porcelain veneer preparation. The second with dental crown preparation.

Teeth prepped for porcelain veneers

Porcelain Veneer Preparation

Porcelain veneer preparation will take off maybe a 1/2 millimeter of tooth structure. It is rare for this procedure to end up needing even one root canal treatment, let alone the amount you are ending up needing.

preparation for porcelain crowns

Porcelain Crown Preparation

On the other hand, a porcelain crown preparation goes much deeper into the tooth structure, which puts you at a greater risk of exposing the pulp of your teeth. That in turn leads to a tooth infection.

What is a Smile Makeover

You said you were getting a smile makeover. Unless there are other issues such as extensive decay or TMJ Disorder, you would use porcelain veneers for this. Giving you the number of dental crowns he gave you is more of what would happen with a full-mouth reconstruction.

If you really only needed porcelain veneers than your dentist was much more aggressive than he should have been and should be liable for the damage he caused to your teeth. That means paying for the root canal treatments you need. This is especially true because he told you there weren’t really any risks. If he prepped for crowns, there are always risks.

Hopefully, you at least like how these teeth look.

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

Cosmetic Solution for Fluorosis Stains

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I have fluorosis stains on my teeth and wondered if teeth whitening is a good cosmetic fix for someone in my position? I want to have a smile I am proud of.

Diego

Dear Diego,

I will say right off that teeth whitening will not be the solution. It whitens teeth evenly and is only more likely to make your fluorosis stains more obvious. For the benefit of those who are unfamiliar with what fluorosis stains are, it happens when someone ingests too much fluoride while the teeth are still forming. The fluoride in the water in the United States is optimized for the right consumption so we don’t see much of it here.

There is good news, though. Your teeth can be attractive again. Which solution depends on the amount of fluorosis you are dealing with. For either repair, you will need an expert cosmetic dentist. My suggestion would be to find an AACD accredited dentist.

If You Have Mild Fluorosis

 

mild fluorosis stains

The picture above is an example of mild fluorosis. If this is what you are facing, then dental bonding can be a sufficient repair. Your dentist will gently shave about 0.5 millimeters of your tooth enamel. Then, he or she will replace it with direct composite bonding. It doesn’t last as long as the next repair I will talk about, but it does cost less.

If You Have Darker Fluorosis

heavier fluorosis stains

In some cases, as in the picture directly above, the stains are more prominent. In this case, simple dental bonding will not be enough. Instead, I suggest you have porcelain veneers placed. This is actually the go-to procedure for a smile makeover. It is what gives people that “Hollywood Smile.”

This procedure can last for a lifetime. However, don’t try to cut corners by going to an inexperienced cosmetic dentist for this. It’s not an easy procedure to do under the best of circumstances. With severe stains like these, it will take someone highly skilled. This is why I recommended an AACD accredited dentist earlier, these are the best cosmetic dentists.

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

Can You Get Porcelain Veneers if You Have an Overbite?

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I have tetracycline stains that I have always wanted to be covered. I asked my dentist about porcelain veneers and he said I can’t get them because I have an overbite which makes my upper teeth cover my bottom teeth. Instead, he wants to do six porcelain crowns on the upper teeth. Because my lower teeth can’t really be seen, what do I do with those, whiten them?

Elisabeth

Dear Elisabeth,

Photo of a single porcelain veneers being held by the tip of dental forceps.

Please don’t let this dentist do your smile makeover. He’s making quite a few errors and he hasn’t even started. Him telling you that porcelain veneers don’t work for an overbite isn’t true. Instead, it is likely just an excuse because he doesn’t know how to do porcelain veneers. In fact, veneers make more sense in a case where there is an overbite involved because dental crowns must surround the whole tooth. This will cause it to hit up against your lower teeth.  Instead, porcelain veneers are thin wafers of porcelain that only cover the front and hug the sides a smidge. This is a much better fit for someone with an overbite.

A second concern I have is that dentists who recommend dental crowns for a smile makeover when it isn’t necessary are generally not experienced cosmetic dentists. They think they have done dental crowns for treatments before with decayed teeth. How hard could it be just to add a few more? Actually…quite hard. In your case, this is especially true. You are dealing with tetracycline stains which are among the most difficult and advanced cosmetic procedures there are to do well.

He’s also recommending just six dental crowns. Most smiles are at least 8 – 10 teeth wide. What does he intend to do to make those adjacent, visible teeth do to match? Teeth whitening, which could be an acceptable option on many cases, will not work in yours because of how deep and dark the stains are with tetracycline. This will make the six teeth that are crowned, look obviously fake and silly, like children playing dress-up in their parent’s shoes. They obviously don’t fit, but at least they’re trying.

Teeth whitening could help with your bottom arch. This arch won’t be so obvious when the color doesn’t match exactly. However, I’d recommend a strong whitening system such as KoR whitening. Plus, you will have to be persistent and stick with it much longer than the average patient.

Your Smile Makeover Requires an Expert Cosmetic Dentist

Especially because of the difficulty with your type of smile, you need a top of the line cosmetic dentist. My suggestion would be to find an AACD accredited dentist. This is different from being a member of the American Academy of Cosmetic Dentistry. To reach accreditation, the dentist has to pass stringent exams as well as provide visual evidence on a large number of specific cases they’ve done that are assessed by a panel of judges on their technical quality along with their artistry.

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

Will Dental Implants Help if I Still Have Baby Canine Teeth

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Both my upper and lower canine teeth are still baby teeth. I recently removed the bottom ones, but now there is a space because the adult teeth came up behind them.  I know I need to take the upper baby teeth out too, but I’m worried about there being a space there too. I’m a senior this year and will be taking my senior pictures. I don’t want to look ridiculous in my pictures. Could I just take them out and replace them with dental implants so I have teeth?

Penny

Dear Penny,

Illustration of a dental implant next to a natural tooth

I am very surprised your dentist hasn’t taken care of this. We are taught in dental school exactly what to do in these situations. I’m concerned that you may need a new dentist.

Your canine teeth are very important both to the form and function of your smile. It is important this is fixed. How it is handled will depend on whether you have adult canine teeth and, if so, the position they are in.

The first thing you need are x-rays to determine what is going on with the canine teeth. Often when they haven’t erupted, it means they are impacted. In this case, you will need some brackets and braces to help the tooth come up in the right position. Because your baby teeth are smaller, there may not be enough room for the adult teeth. Your canine teeth are very important as I mentioned earlier, so you will need to open up room for them. It is often advisable in this case to remove a first premolar to make room for them, but this is best addressed by an orthodontist.

A dental implant will only work if there are no adult teeth at all. When this happens, it is called congenitally missing teeth. If you have any adult teeth there, it is best to get those into proper position.

I’m sorry you are going through this. It would have been much easier for you if your dentist would have addressed this early on.

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

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.

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