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dentistry

Should I Keep My Last Two Upper Teeth?

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After more problems with my teeth than I care to elaborate on, I am going to be left with most of my lower teeth and only my two front upper teeth. My main question is, would I be better off with removing those two teeth and getting dentures on my upper arch or keep those two teeth and work around them with partials? Those two teeth are healthy, but I cannot get a dentist to give me a good opinion one way or the other. I keep hearing, “Do whatever you want.” But, what I want is to know the best case scenario. I don’t really find the partial dentures very comfortable. I keep them out and mostly chew with those upper two teeth unless it is something that is too difficult for just those. But, if natural teeth are best I can keep doing it.

Ben

Dear Ben,

Illustration of dental implant overdentures

Implant Supported Dentures

You’re in quite a spot. In most circumstances, it is better to save your natural teeth. However, this situation is a bit different. Your upper teeth are going to hit those lower teeth when you’re chewing. Additionally, you are using those teeth more than usual and carrying the duty of the other teeth. I would not expect them to stay healthy at that rate. Dentures will be a little easier on those teeth, so that will work out well for you.

I did say in most circumstances it is better to keep your natural teeth, but that is more urgent if you are talking about lower teeth, not upper teeth. When your lower teeth are removed, it is more serious. This is because when your bottom teeth are removed, your body senses that and begins to resorb the minerals in your jawbone to use elsewhere in your body where you will get more use out of them. The big problem with that is that your jawbone slowly shrinks as a result. If you place dental implants in your lower jaw, it helps to preserve the bone. Without that, you will eventually not have enough jawbone left in on your lower jaw to keep your dentures in.

For upper dentures, that bone is not as essential because they are held in by suction. I would say, in your unique case, you would be better off removing those last two teeth. You’ll be much more comfortable and able to eat a bit better. Of course, getting implant-supported dentures is always better and will increase your quality of life, especially your chewing capacity. But, they are more expensive.

One thing to note. Whether or not you choose the removable dentures or the implant supported dentures, you will want them to be attractive. Make sure you see a dentist who creates beautiful smiles. One easy way to do that is to look on mynewsmile.com, They screen cosmetic dentists for their technical and artistic ability.

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

Smile Makeover Disaster with Tetracycline Stains

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I have tetracycline-stained teeth. I went to my dentist who is very reputable and has done a great job for me over the years. I was considering porcelain veneers, but my dentist talked me into porcelain crowns saying that they would help cover the stains better. This did not turn out to be the case. The gray is visible with each of the crowned teeth AND the crowns look fake, so it’s obvious I have fake teeth. But, not even pretty fake teeth. He said he can send them back to the lab. I’m so confused. I looked online and there is a woman from a different dentist who has beautiful teeth after getting her tetracycline teeth made over and she used porcelain veneers! What has gone wrong with my teeth? Will doing them again with crowns make a difference? I don’t think I can get porcelain veneers after I have crowns, right?

Leslie

Dear Leslie,

a porcelain veneer being placed on a tooth

You are correct that you will always have to have crowns now that you have them. This is because the teeth have been ground down to little nubs. That tooth structure is gone. In a way you have answered your other question already. You said, “…a woman from a different dentist.” The key to any smile makeover is the dentist who does it. One warning sign is when a dentist suggests porcelain crowns over porcelain veneers when the tooth is healthy and does not need a crown. These dentists are either not comfortable doing porcelain veneers to begin with or do not have enough skill in them and think that the added structure of dental crowns will make it easier to cover the stains.

Sending it back to the lab will only help if he can give them good directions. A lab is more like a pharmacy who fills the prescription of the doctor. It is the doctor that has to come up with the right diagnosis and the appropriate medicine for it. I am not convinced he can write the correct directions. However, there is no harm in allowing him to try. If you do that, do it on the condition that he uses a temporary try-in paste and if you don’t love them the second time then you get a refund. You should get to see them in several lights before making a decision.

If you end up needing a refund, you will want to look for an expert cosmetic dentist. The easiest way for you to do this is to look for a dentist who is accredited with the American Academy of Cosmetic Dentistry. AACD accredited dentists have proven skill and artistry. They can give you a beautiful smile whether using porcelain veneers or porcelain crowns.

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

Can’t Floss My Porcelain Veneers

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I recently had porcelain veneers placed a week and a half ago. I have a couple of questions because they were a huge investment for me and I want to take good care of them. First, is Oral B Pro Expert Toothpaste good for them? Second, I’m having trouble flossing the porcelain veneers. Is there some special tool for them?

Carol

Dear Carol,

a porcelain veneer being placed on a tooth

Let’s start with the easy one. There is nothing unique or special about the Oral B toothpaste. However, there is nothing harmful in it either. One of the things I do warn against is most whitening toothpastes. This is because they use an abrasive to remove your tooth stains. The big problem with that is that it will scratch your porcelain veneers, which in turn will damage the surface and cause them to pick up stains.

There are exceptions. In fact, there is a toothpaste I specifically recommend to use with porcelain veneers because it is designed to be used with cosmetic dental work called Supersmile Toothpaste. While this is whitening toothpaste, it is not made with abrasives. Instead, it uses a chemical ingredient that causes your tooth stains to attach to a protein pellicle that the chemical breaks down.

The flossing is a more complicated issue. It is important that you should be able to floss your teeth with your porcelain veneers. The fact that you can’t means either the lab did something wrong in designing them or your dentist did by not cleaning off the excess cement. This could lead to you developing gum disease. Your dentist needs to look at this to repair it.

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

How Long Do Composite Veneers Last?

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I’ve been looking at options for smile makeovers. Most people suggest getting porcelain veneers, but I am just curious about composite veneers. Would they be less expensive? How long will they last?

Carol

Dear Carol,

before and after dental bonding

In most cases, composite bonding is better used for small repairs, like a tooth gap or chipped tooth. The procedure has to be done freehand, which would take much longer in the dental chair than porcelain veneers will. In fact, many dentists will not do a smile makeover with composite resin for that reason. It would end up costing you more because of the tedious nature of the smile development.  On top of that, the composite bonding will only keep their luster a few years before they begin to pick up stains. On the other hand, well-cared for porcelain veneers can last upwards of twenty years.

My suggestion would be to look for an excellent cosmetic dentist. This is not a skill taught in dental school, nor is it a recognized specialty. If a dentist wants to become skilled, they would need to invest in post-doctoral training. It would be easiest for you to just look for an AACD accredited dentist. These dentists have proven skill and artistry. It will keep you from having to investigate the training of each dentist you look at. Any one of them can give you an extraordinary smile makeover.

Let them look at your teeth and talk to them about the look you want. They will be able to determine what procedure can give you the best outcome.

I hope this helps.

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

Fixing a Gap Between a Crown and a Dental Bridge

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I have a gap between my front teeth I would really like to fix. Unfortunately, the tooth on the right is a dental crown and the left is a crown attached to a dental bridge. Is there a way for me to close this gap without having the fixtures replaced? Maybe by putting something like Lumineers on top of them?

Peggy

Dear Peggy,

Advertisement for Lumineers over dental crowns

Years ago, Lumineers would advertise something like you mentioned. They told patients that old crowns can be restored by placing Lumineers on them, but it ended up not working out as well as they hoped. First, porcelain does not bond to porcelain as well as it does to the natural tooth structure. Second, it takes as much work to place them over crowns as it would to just make a new crown. Finally, you have double the risk of failure because now there are two things bonded.

I am curious why your dentist didn’t place the crown and the bridge in a way where there was not a gap to begin with. That makes me wonder about his skills. In reality, because of that you will likely have to have these two procedures re-done. You don’t want to re-do just one of them because the porcelain would be “lopsided”.

There is a possibility you could have someone do a repair by bonding composite to porcelain, but they would need to have some experience with dental bonding and some special equipment. Your dentist would need to use a micro-etcher on the areas of porcelain near the gap. After that, they’d need to etch the area with a hydrofluoric acid gel. Then it would need to be primed with a silane coupling agent. Finally, a bonding resin and then a composite bonding applied to match the color of your crown and bridge. As you can see this would take some specialty skill. I’m not sure your dentist has it if he or she was not able to apply your procedures without a gap to begin with. If you want to try this repair method before resorting to replacing everything, I suggest you see an AACD accredited dentist.

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

Dental Work in Costa Rica

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I need twelve dental crowns done. After doing some calling around, I learned I can get this done for just $6000 in Costa Rica. I would have to stay two weeks, but that’s like a vacation and it is still cheaper than what I can do in the states. My sister is freaking out saying this is a huge mistake. She asked me to at least call my dentist and get his opinion on this plan, but of course he’s going to say don’t do it because then he gets my money. I came across your website. You are across the country from me and have no chance of getting my money, so what do you think of my plan?

Mason

Dear Mason,

map of costa rica

Should you get dental work done in Costa Rica?

 

I’m glad you wrote. I think I can save you a lot of grief. The dental industry is a real risk in Costa Rica. Because of the way their legal system is set up you have no recourse if something goes wrong. And let me tell you, a LOT can go wrong. Here are just a handful that come to mind:

  • A tooth can be broken off or lost
  • Overdrilling could take place causing nerve or root damage
  • You could end up needing a root canal treatment
  • Your bite can get thrown off leading to painful TMJ Disorder
  • Once you return home, the crowns can fall off
  • The crowns could look terrible, pasty, fake, and the wrong color
  • Poor placement of the crowns can impact your speech

Believe me, I am not exaggerating here. I recently read a case that you can read about in total here, but I will sum it up. A woman went to Costa Rica to save money on her dental care. The job was so badly done that she was in terrible pain. A dentist in the states called it criminal negligence and it would cost her around $35,000 to get the needed repairs done. Of course, she didn’t have that kind of money. She tried to get her money back from the Costa Rican dentist, even hiring a lawyer from the area, who was on her side. However, the law in that area is very corrupt and she ended up getting in trouble for complaining about a Costa Rican dentist publicly who had not been convicted of any crime and they put a warrant out for her arrest. She ended up having to flee the country.

You are at particular risk because of the number of dental crowns you need. There is a lot that could go wrong with that type of bite placement. My advice is to find a dentist here in the states with good qualifications and let him or her do the work. You may even be able to work out payment arrangements. Leave the Costa Rica trip for a true vacation, where you are not putting yourself at risk.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss, an AACD accredited dentist.

Should I Switch Implant Dentists?

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I am getting two dental implants. I’m paying a LOT of money for this and am concerned that my dentist may be in over his head for reasons I am about to explain. I have had the teeth extracted and some bone grafting done. Then, my dentist provided me with two different Maryland Bridges as temporary replacements. They’ve fallen off several times each. This has made me wonder if he understands esthetic dentistry. Should I switch dentists in the middle of my procedure to a dentist who has more experience?

Misty

Dear Misty,

Maryland Bridge Diagram

For those who do not know, a Maryland Bridge is a false tooth that is attached to the adjacent teeth with either metal or ceramic wings. I would not consider this a temporary tooth replacement because the adjacent teeth have to be etched and bonded on. If your dentist does not understand how to adequately place this, then I have concerns about two aspects of this. First, I have the same concern you do. If he doesn’t understand how a Maryland Bridge works you are not likely to get an attractive aesthetic result. A second concern is just the dental implant procedure itself. This is quite an advanced procedure. If he cannot do the Maryland Bridge, then I would have concerns about the implants.

You can switch dentists in the middle of a procedure. Your current dentist is ethically obligated to cooperate with your new dentist, including providing him with all the necessary diagnostics and notes that he has on your procedure. You will want to make certain that whichever dentist you go to has post-doctoral implant training. Some training to look for is someone who has been to the Dawson Academy, the Kois Center, or the Las Vegas Institute for Advanced Dental Studies. He will want to examine your implants and make sure they’re placed properly before moving forward. Don’t be surprised if the dentist suggests a different temporary tooth replacement. A dental bridge is the most common recommendation. The good news is that it is much less expensive than the Maryland Bridge.

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

 

Does the Dentist Matter If They Outsource Their Porcelain Work?

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I am getting a smile makeover, which will include porcelain veneers on the top arch and some dental bonding for some broken teeth on the bottom arch. I understand that they outsource their porcelain work, so I don’t have to worry about that as much, but the dental bonding is done by the dentist in the office. How do I know if they can do quality bonding work or not?

Billy

Dear Billy,

before and after dental bonding

 

You are correct that dental bonding is tricky and that the dentist really needs to know what he or she is doing. Not only is it done in the office, but it is done freehand. However, be careful about thinking the dentist won’t matter for the porcelain veneers. That is like saying it doesn’t matter what doctor you go to because it is the pharmacist who gives you the medicine. The reality is the pharmacist can only do what is precribed. If the doctor makes the wrong diagnosis and prescribes the wrong medicine, the result will be a disaster even if the pharmacist fills it perfectly.

With porcelain veneers, the cosmetic dentist prescribes the map for the ceramist to follow. He can do the work perfectly according to the dentist’s instructions, but unless the dentist is skilled and artistic the results will be disappointing. So, I would say you will need to find an expert cosmetic dentist for every part of the smile makeover.

How to Find an Expert Cosmetic Dentist

The hands down easiest way to guarantee you will have one of the best cosmetic dentists in the country is to look for a dentist who is AACD accredited. In order for a dentist to reach accreditation with the American Academy of Cosmetic Dentistry. They have to pass oral and written exams as well as have a large number of cases they’re required to do examined in front of a board to ensure they have artistry. You can be assured that they will give you both stunning porcelain veneers and dental bonding. It will be the complete package.

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

What Do You Think of GlamSmile?

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I want to get a smile makeover and recently read about something called GlamSmile. It is supposed to be less expensive and the dentist can place them in just one hour. Have you looked into these? If so, what do you think of them?

Brooke

Dear Brooke,

a porcelain veneer being placed on a tooth

 

I’m glad you wrote. I think I can help you and save you a major disappointment. Here are some things to consider with GlamSmile:

First, similarly to Lumineers, they are marketed to inexperienced cosmetic dentists as being super easy to place. GlamSmile tells them that the lab does all the work so they don’t need extensive post-doctoral training to place these. There are countless examples of cosmetic dentistry horror stories of patients from both Lumineers and GlamSmile, and even other brands of traditional porcelain veneers. where patients were distraught because they spent a fortune on a smile makeover that actually made their smile look worse. This is because the brand does not matter nearly as much as the technical and artistic skill of the dentist doing the makeover.

Second, they have another marketing push that is telling dentists that they can make five times their normal means in the same amount of time they normally would spend with a patient in the chair. Whenever you push how much you’ll make to dentists, it stops becoming “which is best for the patient” and tempts dentists to push certain procedures which can increase their profit.

Finally, I am quite skeptical about their suggestion that this can be done in one hour. In fact, even they say the dentist may need to schedule a second appointment to finish up removing excess cement. Generally, to do this well, would take around three or more hours.

So, what should you do? Instead of looking for a specific brand, I am going to suggest you change your thought process to looking for the right dentist. You need someone with extensive post-doctoral training, as well as technical skill and artistry. The easiest way to find a dentist like this is to go to an AACD accredited dentist. These have proven skills.

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

Dentist Said I Cannot Have White Crowns

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I had eight dental crowns placed two decades ago. I wanted whiter crowns then they gave me but they insisted they wouldn’t look natural with the white color I wanted. Now, I want to replace them, this time getting the white color I’d always wanted. However, my new dentist said the whitest we should do is B1. The temporaries in that color are hardly whiter than what I have. His reasoning is that there are posts that would show through with a whiter color. I’m so disappointed. Before I have these permanently bonded on I want to see if there is a possibility I could get a BL4 without the posts showing. Just something a little brighter.

Sandy

Dear Sandy,

Woman with a beautiful smile

I don’t know who your dentist is, but I get the impression he isn’t really an expert cosmetic dentist. He is confusing color with translucency. If the posts are not seen through on a B1, they won’t be seen through the BL4 or if you want really white crowns, as it sounds you do, you could even get a BL1. I am not saying you have to switch dentists at this point, but I would insist your dentist give you the color you want for your porcelain crowns.

Additionally, you need to insist he do them with a temporary try-in paste and you get to see and approve them before they are permanently bonded on. If you don’t like them, they should go back to the lab until you do. Sometimes, it is helpful to have a friend with you during the try-in to give you courage and be a second set of eyes for you.

If he cannot or is unwilling to get them the way you want, then it will be time to switch dentists. If you do need to switch, the best cosmetic dentists are accredited with the American Academy of Cosmetic Dentistry. AACD accredited dentists have proven expertise and artistry. They will have not only the skill to give you the smile you wanted two decades ago, but the right mindset that it is about what kind of smile the patient wants that matters.

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