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dentistry

Should I Finish My Full Mouth Reconstruction?

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I am in the middle of a full-mouth reconstruction and I am not sure if I want to complete it. The lower teeth were done first. They look beautiful because I hired an AACD-accredited dentist. I know it sounds weird but that is what is bothering me. They look so perfect. I had a quirky smile and this just looks like your typical celebrity smile. I feel stupid but I miss the quirkiness of my smile. The reason for the reconstruction to begin with is that I had been grinding my teeth down. My dentist didn’t mention it until they were ground down and then he told me that I needed a full-mouth reconstruction. I was a little annoyed, which is how I started doing research about what it means and who should do it. That led me to getting an accredited dentist. Will I have to get the uppers done? Can I just whiten the uppers so they don’t look so perfect as the bottoms?

Callie

Dear Callie,

A woman pointing at her smile

First, I want to tell you that your original dentist could and should have told you about the grinding to begin with. That would have saved you this expense and hassle. All you would have needed was a simple mouthguard and your teeth would have been protected even with the grinding. I’m going to suggest you find a different dentist who is more interested in protecting your teeth. Though, that doesn’t help with your present predicament.

If you are worried about the smile looking too perfect, I would say take full advantage of the skill an AACD accredited dentist has. What I mean by that is they are tasked with making Hollywood smiles all day long. I think they would jump with glee at the chance to make a quirky smile. You could literally get whatever you wanted and make a dentist and ceramist’s day with your desire for it not to be perfect.

As for just not completing it and just whitening, I haven’t seen your case, so couldn’t tell you with definitely. While you can definitely whiten, what I can tell you is that if the damage isn’t too bad, you can just get a mouthguard to protect them for further grinding. This will be important because the crowns on your lower teeth will be a bit more abrasive on the uppers than your natural teeth are. If the damage is bad, you will want to complete the case. Having a collapsed bite can lead to pain and serious TMJ Disorder.

Just remember, you can get quirky.

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

Sinus Perforation with a Dental Implant

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I had a dental implant placed on one of the teeth adjacent to my front teeth. The dentist told me at the time that the sinus cavity was perforated by just a few millimeters, which he said is fairly common. He did not put me on an antibiotic at the time because he said it was unnecessary. Just six months after the implant was placed it had to be removed because he said the bone was not developing properly. After the removal, he again gave me no antibiotics because he said everything went fine.  My instructions were to wait a year for the bone to fill in and then we’d start again. He also said there was no need to repair the sinus perforation. A few weeks later, I started having problems. First, I was having crackling in my ears and congestion. I called and they said to use Flonase. I did but things seemed to get worse. I went in and they insisted everything looked fine. I disagreed because it felt like I was developing an infection. He reluctantly agreed to give me some antibiotics. Since then, everything started to clear up and I feel better. My question is should I have gotten an antibiotic from the beginning? Am I going to have any better luck the next time I go for the dental implant?

Cathey

Dear Cathey,

Diagram of a dental implant

 

You’ve been through a lot. I’m impressed you are willing to give it another go to get your dental implant. Good for you! It definitely is the best tooth replacement option. Before you do, I want to make sure some things are addressed by your dentist. However, let’s start with your question. It was not really needed to give you an antibiotic from the beginning, but when you started having problems, that would have been a good time. Believe it or not, that isn’t the real issue with your case.

Two Big Mistakes with Your Dental Implant Procedure

The first issue I would want an answer about is the depth of the perforation. While some oral surgeons say sinus perforations happen sometimes, all of them would say that a few millimeters is too much. In the dental field, that is a huge amount. Huge! I would want an answer for that.

The second big issue is diagnostics. My suspicion is that he did not do adequate diagnostics in preparation for your procedure. This may also explain why the bone did not integrate properly.

There should have been a number of x-rays done, including a 3-dimensional one such as a CT scan. The CT scan is especially important so that there isn’t a sinus perforation, such as what you experienced. Additionally, those diagnostics let the dentist know if there is enough bone structure to support the dental implant.

Can You Still Get a Dental Implant?

The short answer to the above question is yes…but. It is not as simple as your oral surgeon made out. First of all, the bone is not just going to fill out on its own. You will have to have a bone grafting procedure done. Once that is completed, you will need a time of healing before starting over.

While you can have the dental implant done, I do not recommend you use the same dentist/oral surgeon unless they can tell you what they are going to do to prevent this issue in the future. Another important point is that it should be the dentist who determines the placement of the implant, not the oral surgeon. Make sure you visit the dentist first.

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

 

Can I Get Porcelain Veneers with a Missing Front Tooth

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I have a removable partial denture on a front tooth, which looks absolutely awful. Even having my dentist redo the work a couple of times made no difference. My two front teeth look totally different. I’d like to get a pretty smile, but don’t know if it is even possible to get porcelain veneers when I am missing a tooth. Help!

Deanna

Dear Deanna,

Diagram of a dental implant

Dental Implant

 

There are some great options for you. I should tell you off the bat, you will probably have to go to a different dentist to have them done, though. Even your removable partial denture could have been made to look beautiful if your dentist and the lab he used had artistic ability. Most family dentists are of an engineering rather than aesthetic mindset. You need one with both.

If you are perfectly happy with your teeth, other than the replacement, your first and cheapest option is to just replace the partial using an expert cosmetic dentist. I’d suggest someone who is AACD accredited, which is different than just a membership with the American Academy of Cosmetic Dentistry. If, however, you want the best tooth replacement, you could upgrade to a dental implant (pictured above). This places a prosthetic root in your jaw and then a dental crown on top. It’s the most secure replacement you can get.

a porcelain veneer being placed on a tooth

Porcelain Veneers

As for a smile makeover, if you are not pleased with the remainder of your teeth, then yes, you can still get a smile makeover with porcelain veneers. A great cosmetic dentist will be able to seamlessly blend all the materials used to create a uniform, beautiful, and natural looking smile. Just make sure you go to the right dentist to do it. Otherwise, you are just spending more money for poor results.

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

 

My 11-Year-Old’s Dental Bonding Looks Terrible

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I need some advice. My eleven-year-old daughter fell in such a way that it knocked a giant portion of the middle of her two front teeth out. She has some on the sides and top and that is it. Our dentist said the best solution would be to fill in the empty space with dental bonding. We agreed, but in all honesty, it looks awful. Her two front teeth are now lumpy looking and the color doesn’t exactly match the remainder of her natural teeth. This is a very tricky age for kids and she has been in tears since we returned. I don’t know what to do. Can this be fixed? Did he need to do a different procedure?

Avalon

Dear Avalon,

before and after dental bonding

While your dentist was correct about the type of repair that would be the best solution, he doesn’t appear to have the cosmetic training necessary to do the actual work. Cosmetic dentistry is not a recognized specialty. As such, any general dentist can “do” cosmetic work, but very few of them have the actual training necessary to do it right.

Dental bonding is particularly difficult because it has to be done freehand. It also requires special materials in order to match the colors exactly to the remaining tooth structure. On top of that, your daughter’s type of repair is more difficult than most. It’s even on the list of cases dentists have to show proficiency and artistry in for them to pass the AACD Accreditation Exam, which is the one “guarantee”  for knowing that you have an expert cosmetic dentist.

My suggestion is you ask for a refund from your dentist. It doesn’t sound like he even came close to doing this in an acceptable fashion. Then, look for an AACD accredited dentist in your area. They will make certain your daughter has gorgeous front teeth as she returns to school.

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

Teeth Whitening Before a Dental Crown

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I am getting a dental crown on a white tooth and I want to do a touch-up on my teeth whitening before I get it. I asked my dentist how long I would have to whiten my teeth each day and for how many days to get them back to their original color when I first whitened them three years ago. He couldn’t tell me so I am wondering if there are some tips you have.

Bethany

Dear Bethany,

teeth whitening trays

 

I am going to help you with this, but before I do I want to let you know that I am concerned that your dentist was unable to answer these type of questions. Teeth whitening is a fairly straightforward procedure. If he can’t deal with that I would not trust him to place a dental crown on your front teeth. We’ll go over how to find a dentist who can in a moment.

The Basic Principles of Teeth Whitening

The main idea behind whitening your teeth is the longer you wear the whitening gel, the faster your teeth will whiten. You can wear them one hour a day, but they whiten faster than if you wear them several hours a day or overnight. Because each person’s teeth are different in the amount of staining and how white they want them, there is no way to quantify a number of days/hours. The one constant is you want to leave a week between when you stop your teeth whitening and when you begin the procedure for your dental crown. This is because the teeth will continue to whiten during that time period.

Getting a Crown on a Front Tooth

Crowns on back teeth are no big deal. The color doesn’t have to match exactly. However, matching a single crown to a front tooth is a completely different story. All the light hits your front teeth making all the differences much more visible. Even the best cosmetic dentists will do a couple of try-ins before settling on it being just so.

Ideally, you would want an expert cosmetic dentist to do this. Look for a dentist who is AACD accredited. Then you can be certain they will get it right. If your dentist cannot tell you about teeth whitening, I would not let him near this crown.

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

 

Do Whitening Strips Work?

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I went to my dentist to price teeth whitening. He uses this special light machine that whitens your teeth right there in the office. The cost was way above what I could do. I was wondering if those over-the-counter teeth whitening strips do any good. Ideally, I’d like something I can do at home.

Ben

Dear Ben,

teeth whitening trays being put on teeth

It sounds like your dentist offers Zoom Whitening. There are options that will allow you to whiten your teeth at home with professional strength gel, but before we go into that, let’s go over your question about over-the-counter whitening strips. The only one of these I would recommend is Crest Whitestrips, but before you run out to the store, I want you to understand its limitations.

Crest Whitestrips are Much Weaker

As a means of consumer protection, over-the-counter whitestrips you purchase will not be nearly as strong as what you would get through a dentist. For instance, Crest Whitestrips, which does work, only has a 6% concentration. What you’d get with your dentist has around 33%. This means you would have to purchase significantly more kits to get the same level of whitening.

Crest Whitestrips Only Covers Your Front Six Teeth

In addition to being weaker, the strips will only cover your front six teeth. Most smiles are eight to ten teeth wide. This means you will have to use more strips with each use, costing you even further.

Crest Whitestrips Tend to Whiten Unevenly

Unless you have just completed a cleaning with your dentist the results are going to be spotty. The cleaner areas are going to get more of the whitening gel than those which have some film over them. This film is often invisible to the human eye so you won’t be aware of it.

You Can Get Professional Whitening at Home

Your best option is to have take-home teeth whitening done by your dentist. If he doesn’t offer it there are plenty who do. They can make you custom-fitted trays that will allow you to whiten your teeth at your convenience. They’re discreet enough where you can wear them while running your errands or just overnight while you sleep if you prefer.

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

Did Listerine Turn My Porcelain Veneers Gray?

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I had ten porcelain veneers placed on my upper teeth about 7 months ago. I have tried to take very good care of them by brushing thoroughly with a hard toothbrush and using Listerine to keep the bacteria away. Now my porcelain veneers have turned gray over the entire surface. Could the Listerine have done this? They never really gave me any instructions on how to take care of them so now I wonder if I did something wrong without knowing it. If I damaged them, is there any way to fix it?

Mary Ellen

Dear Mary Ellen,

a porcelain veneer being placed on a tooth

 

I am sorry that your porcelain veneers have turned gray. I am disappointed that your dentist never gave you instructions on how to care for these. While Listerine can damage your porcelain veneers because of the alchohol content in it, the damage would be more to the margins, not the surface. There are a couple of things that could be the cause of them turning gray.

The first is that you do not actually have porcelain veneers. Some unethical dentists tell their patients they are getting porcelain veneers, when in reality they are only giving them composite bonding. This will deteriorate and stain much sooner than veneers.

A second possibility is that your dentist or hygienist did something to damage the surface of the porcelain veneers at your last cleaning. If they used something like a Power Prophy Jet or acidulated fluoride, it will destroy the glazing on your porcelain veneers.

Either way, it is your dentist’s fault that this happened. My recommendation is that you go to see an expert cosmetic dentist. Don’t tell them who did the work, just ask them if they are actually porcelain or composite and whether or not they can tell what is wrong with them. Look for someone who is AACD accredited. These are the top cosmetic dentists in the country and can give you some good feedback.

Caring For Your Porcelain Veneers

  1. Mouthwash is not really necessary, but if you feel you need it, make sure you look at the ingredients and only get some that is alchohol free.
  2. Use a soft-bristled toothbrush. These are actually better for your natural teeth too.
  3. Most over-the-counter toothpastes are fine, with the exception of whitening toothpastes. Whitening toothpastes tend to have abrasives in them, which you do not want. However, if you are looking for the best toothpaste for porcelain veneers, I would look into SuperSmile toothpaste. This brand is specifically designed for cosmetic dental work.

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

Implant Bridge Through Off My Bite

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I received two dental implants in order to replace four teeth with a dental bridge. This is on my lower right side. My teeth meet up on that side. However, on the left side they don’t touch at all. It feels uncomfortable when I chew. Is there anything that can be done about this or is it normal?

Casey

Dear Casey,

Woman Holding her jaw in pain

 

No, this isn’t normal. They way your teeth come together is called occlussion. Your teeth should all mesh at the same time. When it doesn’t, not only does it cause the pain you are experiencing when you are chewing, but it also can lead to debilitating TMJ Disorder. Your dentist needs to fix this.

While dental implants are not a recognized specialty, they are an advanced procedure that requires additional post-doctoral training. Yet, there are no regulations for getting that training or, if they do, how much.

There are two possibilities for what went wrong here. First, the implants could have been restored incorrectly. However, the most likely scenario is whoever placed them during the surgery did not do the right placement. If two different people are working on the procedure, such as a dentist and an oral surgeon, it is important you see the dentist first and that he or she determines the placement. Additonally, they need good communication throughout the procedure.

You need to have another dentist look at this to tell you what went wrong. Look for someone with the credentials that Dr. Weiss has on his bio to make sure you get someone who knows what they’re doing.

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

Fixing a Gummy Smile

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I have a gummy smile and wondered if there is something my dentist can do to change that and give me one of those smile makeovers I keep seeing online?

Penny

Dear Penny,

before and after a gummy smile makeover

It is possible to have a beautiful smile makeover done for someone with a gummy smile. However, one word of caution. this is very advanced and way beyond the capabilities of your typical dentist. You will need an expert cosmetic dentist for this. Beware of dentists who want to send you to an oral surgeon and cut your upper jaw. Not only is this invasive and expensive, but unnecessary and dangerous. It will likely lead you to TMJ Disorder.

Instead, you want a cosmetic dentist to do what is known as a gum lift. This removes a small amount of gum tissue, which will expose the bone beneath. Then, they can place porcelain veneers, which will cover the bone and completely make-over your smile.

Porcelain veneers can change anything you want about your smile, including the shape, size, and color. Please only go to an expert cosmetic dentist with this. I would look for someone who is AACD accredited. These are among the top 1% of cosmetic dentists in the country.

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

Discolored and Crooked Teeth

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I finally have money to do something about my hideous smile and wanted to find out what my options are. My teeth are both stained and crooked. What are some ways I can approach this?

Mindy

Dear Mindy,

You actually have a couple of good options. The first is porcelain veneers and the second is Invisalign combined with teeth whitening.

Option One: Porcelain Veneers

a porcelain veneer being placed on a tooth

 

A skilled cosmetic dentist can use porcelain veneers to do a total smile makeover. This can make your teeth look straight while making them any shape, size, and color you want. The key to this is the dentist who does the procedure. You need someone who has advanced training in cosmetic dentistry. This would need to be post-doctoral training because it is not adequately taught in dental school. Unfortunately, it is not a recognized specialty. This means any dentist can call themselves a cosmetic dentist regardless of the amount of training they have invested in. So, how is a patient supposed to know whether or not a dentist is truly qualified to give them a smile makeover?

The simplest way is to look for a dentist who is AACD accredited. This is different than just being a member of the American Academy of Cosmetic Dentistry. To receive accreditation, they not only have to pass difficult exams on the procedures and technique but also have to demonstrate their artistry in a demanding number of cases with visual evidence of their results. These are among the top 1% of cosmetic dentists in the country.

Option Two: Invisalign and Teeth Whitening

teeth whitening trays being put on teeth

 

Invisalign uses clear aligners to straighten your teeth. They are a huge improvement on braces. No one will even know you are straightening your teeth because they are even invisible at a conversational distance. Additionally, the aligners can double as teeth whitening trays, which means you can do them simultaneously instead of one at a time.

This is something I would recommend if you can’t afford (or don’t want) porcelain veneers. They don’t need someone with special cosmetic training. You simply have to find a dentist that offers Invisalign.

Enjoy your new beautiful smile whichever procedure you decide on.

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