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Cosmetic and
restorative
dentistry

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.

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.

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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

Help! I Look Like Jim Carrey!

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This quarantine has almost destroyed me. First, I tried to cut my own bangs which were almost down to the tip of my nose. Then, the other night I had WAY too much to drink and tripped, which resulted in chipping my front tooth. I seriously look like Jim Carrey in Dumb and Dumber. Help! My dentist still isn’t open but tell me there is a solution for this once he is. For now, I’m just going to hide indoors and ignore the doorbell. No one can see me like this.

Stephanie

Dear Stephanie,

Jim Carrey in Dumb and Dumber

Jim Carry in Dumb and Dumber

For the benefit of those who may not know Jim Carrey or the role he played in Dumb and Dumber, I’ve posted a picture above. Don’t feel too bad. This quarantine has been hard on us all. There are more than a few bad haircuts in the grocery stores these days. You’re also not the only one to hit the wine bottle either.

While a dentist can’t do anything about the cereal bowl haircut, you can certainly get that tooth repaired. The first thing the dentist will want to do is make sure there is no underlying damage to the pulp of the tooth from the trauma. If everything is okay there, the standard repair for a chipped tooth is dental bonding. This uses a composite resin that the dentist will sculpt on your tooth to make the tooth whole again. This is done freehand, so you don’t want your average dentist to do it. Dental bonding takes experience and artistry to make it look natural.

Finding an Expert Cosmetic Dentist

before and after dental bonding to repair a chipped tooth

Your family dentist may also be an expert dentist. Just make sure before having him work on your tooth. The top cosmetic dentists are AACD accredited. This means they have passed stringent exams on the technical knowledge and procedural process in cosmetic work. In addition to that, they also had to submit visual evidence of a substantial number of cases they’ve personally done to be examined by a board of experts for the quality and beauty of their work. Any dentist who reaches accreditation is in the top 1% of cosmetic dentists in the country.

What if Your Dentist Isn’t Accredited?

Just because your dentist isn’t accredited, doesn’t mean he can’t do beautiful work. This is a process which takes many years and there are some artistic dentists out there who are still in that process. I would first look to see if he is listed on the mynewsmile.com website. If not, then your next step would be to ask for before and after images of dental bonding cases he’s personally done. Don’t settle for stock photos. If you are not absolutely thrilled with the results, don’ t let him near your smile.

Expert cosmetic dentists are used to having patients come to them just for the one procedure and then staying with their family dentist when that is through. There is no shame in that. He’ll understand and your dentist should understand as well.

I hope this helps. Try to keep away from the booze for a while, you don’t want to end up needing dental implants. Hopefully, this whole Coronavirus mess will be over with soon. I know dentists are ready to get back to work!

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

Horrible Solution for a Tooth Gap

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

Susan

Dear Susan,

woman smiling with a gap between her two front teeth

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

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

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

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

Finding an Expert Cosmetic Dentist

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

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

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

Will Supersmile Whiten My Dental Bonding?

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I’ve had dental bonding on eight teeth for about ten years. They’re starting to pick up stains. I’ve heard Supersmile toothpaste is good at removing stains. Will that help with my situation or do I need to replace them?

Ellie

Dear Ellie,

Supersmile does a great job removing surface stains. It does it with an ingredient called Calprox, which dissolves the protein pellicles on your teeth. Stains attach to the pellicles and when they are dissolved the stains follow with it. One thing to be aware of is this works on surface stains only.

You mentioned your dental bonding is about ten years old. That is a long lifespan for bonding. My guess is they’ve been slowly picking up stains for a while. If those stains have become internal, there is nothing that will help. Even professional teeth whitening will only whiten natural tooth structure.

You can try the Supersmile toothpaste. I recommend it to anyone with any type of cosmetic work anyway because it does a wonderful job of keeping them bright without damaging the glazing. If that doesn’t work, then it means the stains are now internal and it is time to replace your bonding.

A More Permanent Solution for Your Smile Makeover

Dental Bonding is a great solution for small amounts of cosmetic work, such as chipped teeth or tooth gaps. It sounds like you were using them for a smile makeover. That’s fine, but you will get a significantly better, more permanent smile makeover with porcelain veneers.

There is one important factor in that. You will need an expert cosmetic dentist. Smile makeovers are an art form which are not taught in dental school. Because of that, you’ll want a dentist who invested a great deal of time or training in learning the art.

It is hard for patients to know which dentists have done this and which haven’t. There isn’t a recognized specialty in cosmetic dentistry. Because of that, the American Academy of Cosmetic Dentistry began an accreditation program. Dentists who obtain AACD accreditation are in the top 1% of artistic dentists in the country. They can give you a stunning smile.

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

Dental Bonding Color Doesn’t Match

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I need advice on how to help my sweet grandaughter. She’s not confrontational but paid over $1,000 to have teeth whitening and dental bonding done to improve the look of her smile. Her lateral incisors ended up gray, which is much darker than her natural teeth and even more so after the teeth whitening was done. She asked the dentist about it and he told her the lateral incisors are supposed to be darker. I just don’t buy that. She’s too nice to argue with her dentist but I know she is embarrassed by this and doesn’t smile as much. After paying that much money, she should be happy to smile. What can she do?

Andy

Dear Andy,

before and after dental bonding case

Your gut feeling is right. The lateral incisors should NOT be darker than her central incisors, as you can see from this case done by Dr. Weiss above. In fact, in many cases, they are actually slightly lighter. The dentist who did your grandaughter’s dental bonding either doesn’t know that, which means he doesn’t understand his own craft, or he isn’t honest and is making stuff up to shut her up. Neither of those options are good.

You have two choices in helping your granddaughter. The first is to ask the dentist to re-do the teeth which are too dark. Truthfully, I’m not sure you will get any better results the second time around. A true cosmetic dentist would not be satisfied with a case if their patient wasn’t thrilled. They certainly wouldn’t make up some excuse as to why his bad results are “good”.

Your second option is probably the best. That is where you ask him to cover the expense of having this done right with a different cosmetic dentist. She paid for a beautiful smile and didn’t get it. Additionally, he wasn’t honest. You can feel free to show him this post if it will help with her case.

Where to go to Get Her Dental Bonding Done Correctly

You need an expert cosmetic dentist to re-do her case. Smile makeovers aren’t taught in dental school and cosmetic dentistry isn’t a recognized specialty. If a dentist wants to excel at it, they have to invest in post-doctoral training themselves. Most just dabble. She needs an artist, especially with dental bonding which is done freehand.

I suggest, if at all possible to take your granddaughter to see a dentist who is accredited with the American Academy of Cosmetic Dentistry. AACD accredited dentists are the top in the country. They not only have to pass stringent exams to show they understand the technical process of their craft, but they also have to provide visual evidence of their artistry.

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

Can Dental Bonding by Safely Removed?

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I have dental bonding I’m not too thrilled with. I’m moving and want to find a better cosmetic dentist. However, before I do anything I wanted to ask if it is possible to remove dental bonding without damaging the tooth. Have you had experience with that?

Mazie

Dear Mazie,

before and after dental bonding case

Yes, it is possible to safely remove dental bonding on two conditions: First, you must go to a dentist who understands the procedure and has the equipment. Second, the dental bonding has to be attached to the enamel of your tooth and not the soft dentist which is beneath the enamel.

Here are three ways to safely remove dental bonding:

Sandpaper disks

Dentists use these to polish composites. These are probably the easiest for a dentist to use for this particular job. They are flexible enough to form to the shape of the tooth and leave a nice smooth, polished tooth surface.

Carbide Drills

These have a high-speed. If the dentist is able to use them with light pressure, they will do the job faster than the sandpaper disks. Their big disadvantage is they tend to leave streaks of material on the tooth. If a dentist uses this, they’ll want to finish up with the sandpaper disks to get that nice smooth finish.

Air Abrasion

It will be hard to find dentists who have this equipment. It’s not as commonly used as the other options.

Getting Your Beautiful Smile

Whether you just have a dentist re-do your dental bonding or you get a full smile makeover with porcelain veneers, you want to make sure you have an expert cosmetic dentist do the work. In your place, I’d look for a dentist who is AACD Accredited. These are the top cosmetic dentists in the country.

Some, less experienced dentists, will try to tell you if you get Lumineers they will be reversible. This is absolutely not true. They say this because they are marketed as a no-prep veneer. However, the material in porcelain veneers, including the Lumineers brand is much harder than the composite material and the tooth will almost positively end up damaged in the removal process.

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

Dental Bonding Staining

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I have dental composite bonding on all my front teeth. I have them re-done every three or four years. This latest set is only six months old and is starting to look yellow. Can this be polished to look right again or do I have to re-do them early? What would cause this to happen so quickly?

Priscilla

Dear Priscilla

Whether or not these can be polished to get rid of the stains depends on the nature of the staining itself. Unlike porcelain, which is hard and very stain resistant, composite dental bonding is fairly soft and is susceptible to two different types of staining.

Dental Bonding Staining One

an image of dental bonding on teeth stained by scratches

This first type of staining is surface stains. It happens because of tiny scratches on the bonding which allow it to pick up stains that are trapped there. You can tell these front teeth have been scratched because they’ve lost their glossy finish, instead they look matte. If you look at the adjacent natural teeth, they still have a gloss to them.

The good news is this type of staining can be fixed. If your dentist thoroughly polishes them, it will remove the scratches and stains, all while bringing the gloss back.

Dental Bonding Staining Two

Teeth with the two front teeth having stained dental bonding

Composite bonding is made from a solution of inorganic filler particles such as quartz or glass bound together in a plastic matrix. Because of that, it will absorb stains into its actual material. For instance, if you drink a lot of staining beverages, such as coffee or tea, it will penetrate the plastic and become a part of the bonding structure.

The picture above is a good example of this. Notice the two front teeth are much more stained than the surrounding teeth. This is absorbed staining. You can tell that (as opposed to scratch staining) because the teeth still have their shiny gloss. Notice the adjacent teeth, though stained, aren’t as stained as the bonded teeth. This is because your natural teeth are less susceptible to staining than composite bonding.

Unfortunately, this has to be re-done. There is no way to polish this out. Teeth whitening won’t work either. It will only whiten natural tooth structure. If that is the case, I’m going to highly suggest you switch to porcelain veneers on your teeth. Yes, veneers are more expensive initially. However, you are re-doing these every few years. Great porcelain veneers can last upwards of twenty plus years. They’re much more stain-resistant than bonding. In fact, they’re even more stain-resistant than your natural teeth.

Keeping Dental Bonding Stain-Free

1. Start with the right materials. You want to go to a skilled cosmetic dentist. They are more likely to stock microfill composite. This is possible to get polished completely giving it a high gloss and helping it resist stains.

Most general dentists just keep a generic composite which will never completely polish up to the gloss you need.

2. Avoid abrasive materials. I recommend anyone who has cosmetic work use Supersmile toothpaste. It’s specifically designed to chemically remove stains, instead of doing it with abrasives the way most toothpaste works.

3. Avoid staining beverages. If you must drink them, try not to let it sit on your teeth. Swallow immediately.

4. Make sure your hygienist doesn’t use anything like a prophy jet or pumice on your bonded teeth. It will destroy the glazing.

I hope this helps. Seriously consider switching to porcelain veneers.

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

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