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dentistry

Malpractice Smile Makeover

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

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

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

Katy

Dear Katy,

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

Porcelain Veneers verss Porcelain Crowns

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

tooth preparation for porcelain veneers

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

tooth preparation for a porcelain crown

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

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

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

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

Getting this Fixed

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

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

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

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

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

Why Is there Too Much Shine on My Porcelain Veneers?

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I don’t know why, but my porcelain veneers have so much shine on them, they look fake. My dentist disagrees and thinks they are beautiful. He says it is because of the whiteness I wanted that they are so shiny. I did ask for very white porcelain veneers. But, I don’t understand the brightness. I have seen other white veneers and, while they shine, they still look natural. Mine look like shiny pieces of chicklet gum.

Tanya

Dear Tanya,

It simultaneously amuses and annoys me when a dentist puts the problem off on the patient, like it was their fault he didn’t produce a nice result. While I wish I had an image of your smile to be certain, I do have a sneaking suspicion of what is going on here.

It takes an expert cosmetic dentist to get porcelain veneers to look natural. Unfortunately, cosmetic dentistry isn’t recognized specialty so any general dentist can call themselves a cosmetic dentist. Even more unfortunate, smile makeovers aren’t taught in dental school. This means if a dentist wants to know how to create beautiful, natural looking smiles, they have to invest in post-doctoral training.

I want you to look at the picture below. Notice how the teeth have texture to them. If that texture isn’t added, the porcelain veneers will look flat, giving it an overly shiny appearance.

image of a smile after a smile makeover

The texture in the teeth needs to be varied as well. Plus, younger smiles have more texture because as we age, parts of that texture wears down. Believe it or not, one of the teeth in the image above is actually a dental crown. This is the kind of work a true cosmetic dentist does.

One thing I want to know is if your dentist bonded them on before or after you told him you didn’t like them. True cosmetic dentists will put your porcelain veneers in with a temporary try-in paste. They’ll have you look at them in various lights and make sure you absolutely love them. If you don’t, they’d go back to the lab.

If your dentist bonded them on and then you said you didn’t like them, you may not have much recourse. However, you could appeal to his ethics. You paid for a beautiful smile and should get one. If you got to try them on and told him you didn’t like them and he bonded them on anyway, then he didn’t have consent and you have the right to a refund. Ask for one.

Then, I would go to an AACD accredited dentist to get your smile makeover done. These dentists have proved their knowledge, skill, and artistry. In order to become accredited, a dentist has to pass stringent exams and turn in visual evidence on a large number of cases they’ve done.

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

Porcelain Veneers Over Fillings

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I have a couple of teeth which have fillings on the front of them. I’ve never been happy with their appearance and wanted to have a smile makeover with porcelain veneers. My dentist said that the veneers won’t work because of my dental fillings. He suggested crowns instead. Is this standard operating procedure for someone in my position or is there another option? The teeth are otherwise healthy.

Karen

Dear Karen,

A woman pointing at her smile

I’m very glad you wrote. No, dental crowns are not standard operating procedure. My guess is your dentist isn’t comfortable doing porcelain veneers so he made up some lame excuse about the fillings. The truth is the bonding agent works very well on teeth with fillings. Why would you want to place dental crowns, which will require your dentist to grind down your healthy teeth? For argument’s sake, let us say you couldn’t get veneers and crowns were your only option. I still wouldn’t let this dentist do them.

If he hasn’t gotten trained in porcelain veneers, he hasn’t had significant training in cosmetic work period. Smile makeovers aren’t taught in dental school. A dentist has to invest the time post-doctorally to learn how to do beautiful, natural-looking smile makeovers. Doing dental crowns, especially on front teeth, still requires that training. I truly feel you’d be disappointed by the results.

Here’s what I’m going to recommend. See if you can find an AACD accredited dentist in your area. Not only have these dentists done extensive cosmetic dentistry training, but they’ve taken stringent exams to prove their knowledge, as well as provided visual evidence on a large number of cases they personally did in order to demonstrate their artistry. These cases were scrutinized by experts for both their beauty and technical accuracy. Any AACD accredited dentist will give you a stunning smile with porcelain veneers.

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

Can Porcelain Veneers be Re-done?

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I had four porcelain veneers placed. When he did the temporary ones, they were too long. I asked them the make sure they were a little shorter. However, they ended up too short. I wish I had gotten to see them the second time before they bonded them on. Plus, the two lateral incisors are different shapes, which looks weird to me. Is it possible to re-do porcelain veneers? Is it hard to do?

Caitlyn

Dear Caitlyn,

a porcelain veneer being placed on a tooth

Yes, it is possible to have your porcelain veneers re-done. It’s hard on your dentist, but if you are paying for a beautiful smile makeover, that is what you should get. One word of warning, though. Technically, if the porcelain veneers are functional he doesn’t have to replace them, so be nice about it (not that I think you won’t).

It seems like your dentist is likely a decent family dentist but he doesn’t do a lot of cosmetic work. A true cosmetic dentist would never bond on y our porcelain veneers until you had a good look at them and approved. There is a temporary try-in paste he can use.

I agree that your lateral incisors shouldn’t be two different shapes. You don’t want them to be exactly the same, but you also don’t want them different enough to be distracting.

If he gives you trouble about re-doing them, one thing which may help is to see an expert cosmetic dentist for a second opinion. If he agrees they need to be replaced it will put some pressure on your dentist. He won’t want to look unskilled to a peer.

Finding an Expert Cosmetic Dentist

Because there isn’t a recognized specialty in cosmetic dentistry, it is hard for patients to know who has the skills to create beautiful smiles and who doesn’t. The American Academy of Cosmetic Dentistry recognized that and started an accreditation program.

In order for a dentist to get accredited, they have to pass exams that demonstrate their technical knowledge as well as demonstrate their artistry by providing visual evidence of a large number of specific cases they’ve done.

If there is an AACD accredited dentist near you, that is who I would get to help you if your dentist doesn’t want to fix the veneers.

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

Trouble with Porcelain Veneers

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I have this set of porcelain veneers and I’ve had nothing but trouble with them. First, they kept coming off. Then, once they started staying on permanently, I noticed one of them has a horizontal divot which I hadn’t noticed before. I called my dentist and graciously agreed to buff it out, but now that tooth looks more matte than the surrounding teeth. What’s going on? I thought porcelain veneers were the top of the line for smile makeovers.

Pamela

Dear Pamela,

A single porcelain veneer being placed on a tooth.

You say that your porcelain veneers are the problem. On the contrary, I’m pretty sure it’s your dentist who is the issue here. First, you said they wouldn’t stay bonded. This shows a lack of basic technique. Then, you came to him with a divot in your veneer. While he may have buffed out the divot, he simultaneously took off the glazing on the veneer as well. This has ruined your porcelain veneer and it will begin to pick up stains rather soon.

You have three choices here.

  1. Have the veneer polished.
  2. Have your dentist replace your veneer.
  3. Have another dentist do the work.

First, you can have your dentist polish the damaged veneer. It’s not complicated, but it does require knowledge and equipment your dentist likely doesn’t have. You start by using diamond polishing instruments and polishing paste, then end with an ultra-fine diamond polishing paste. I recommend Brasseler’s Dialite Porcelain Polishing System.

If you aren’t confident your dentist can pull this off or he’s not interested in investing in the right equipment, then you can require him to replace the porcelain veneer. This would require he has improved his bonding technique.

Finally, if you don’t have confidence in him to be able to do either of the above correctly, then you simply ask him to pay for the repair from a more qualified dentist, whom YOU pick.

Who Should Do Your Porcelain Veneers?

You were correct in thinking that porcelain veneers are the top of the line smile makeover procedure. However, to get that gorgeous celebrity smile, it also requires having a top of the line cosmetic dentist. I always recommend you look for an AACD accredited dentist in your area.

These are the dentists who, not only invested in advanced cosmetic training, but also have an artistic eye with the ability to craft stunning smiles.

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

Three Different Colored Teeth After Getting Porcelain Veneers

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Help me! I had four porcelain veneers placed on my teeth. As a result, I have three different colored teeth. My natural teeth are yellowish. The four porcelain veneers I received were all the same color, but now have a grayish tint in a splotchy way all the way down. I’m so frustrated because I paid a lot for these. What do I do?

Dania

Dear Dania,

A single porcelain veneer being placed on a tooth.

I’m sorry this has happened to you after investing in a beautiful smile. When you pay for a smile makeover, you expect it to be something you can be proud of. This isn’t what you received. My guess is your dentist is just your bread and butter general dentist, who hasn’t invested a lot of training in cosmetic work.

Unfortunately, this has its most negative impact on you. Most patients don’t realize that cosmetic dentistry isn’t a recognized specialty in the dental field. Any dentist can do it and it is up to them how much time they invest in training Think of it as an art form. If one person had a year of violin lessons and dabbled in practice and another person studied for years and practiced diligently, which one would you want to play at your wedding?

Getting Your Porcelain Veneers Done Right

There are some solutions to your situation. Let’s start with the visibility of your yellowed natural teeth. You received four porcelain veneers. Most smiles, including yours, are wider than four teeth. To keep that smile as uniform in appearance as possible, you have two options. One is to get enough porcelain veneers to cover all teeth which are visible when you smile. The second, if you can’t afford that many veneers, is to whiten your teeth. This is typically done before getting your veneers, so they can be made to match the color of your new white natural teeth as closely as possible. However, you can still get your teeth whitened now. The procedure will not damage your veneers.

As for your graying veneers. It sounds like the bonding isn’t well done on those teeth. Because it is splotchy, I believe there is food and bacteria getting caught between your teeth and the veneers. The only solution to this is to have them re-done. In fact, you need them to be replaced. Otherwise, your teeth will begin to decay under the porcelain veneers.

In some way, this is actually good news for you. It gives you a case for getting a refund from this dentist. Then, you can invest that money in a dentist who has done more training and has an artistic eye as well as the technical skill. My suggestion is you find an AACD accredited dentist. They’re the top cosmetic dentists in the country. They’ll give you a stunning smile.

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

Cracked Porcelain Veneer

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I received a huge bonus and decided to invest it on my smile. I had porcelain veneers done about three months ago. My teeth were quite small the excellent cosmetic dentist I went to made them longer. My smile is gorgeous. I can’t tell you how often I smile these days. This morning I noticed a horizontal crack about a 1/3 of the way down the tooth. Will it fall off? I spent all my bonus to get these veneers. I don’t think I can afford to get it replaced. I honestly don’t think I did anything to it. I’ve taken great care of the teeth. What do you recommend I do?

Portia

Dear Portia,

A single porcelain veneer being placed on a tooth.

I truly don’t think your dentist will blame you for what happened to your porcelain veneer. If a patient abused their porcelain veneers, it would show up as chips, not a horizontal crack. Plus, as you’ve said, patients generally love their new smile makeover so much they take great care of their porcelain veneers.

While often a cracked porcelain veneer is in no danger of falling off due to the bonding procedure, based on the fact that they needed to make your teeth longer, I’d be a little concerned it doesn’t have much to hold on to, especially given where you said the crack was located. I think this veneer will need to be replaced.

I know you’re worried about money, however, given the short amount of time you’ve had the veneer, I think it is very likely they will not charge you to replace it, especially if you explain the financial situation and what allowed you to get your smile makeover to begin with, he’ll be compassionate about the replacement.

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

Protecting a Porcelain Veneer during a Root Canal Treatment

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I have porcelain veneers and my dentist recently told me I needed a root canal treatment in one of the teeth involved because of a periapical abscess. I’ve heard that root canals can turn the teeth dark. I’m afraid that will ruin the smile makeover. I’m also worried it will damage the veneer. Do you have any suggestions?

Carolyn

Dear Carolyn,

A tooth being prepared for a porcelain veneer I’m a little concerned you needed a root canal treatment to begin with. When teeth are properly prepared for a root canal treatment, there is very little tooth preparation done. The photo to the left shows the deep limiting diamond bur that is used to remove about a 1/2 millimeter of enamel. It adds the grooves and then a dentist will go back and remove the ridges with a traditional diamond.

Unfortunately, some dentists get aggressive and remove all the enamel and down into the dentin. Others actually do porcelain crowns, which requires massive tooth grinding, and just call them veneers. Both of these last two methods put you at greater risk of needing a root canal treatment. I’m wondering if this is what happened to you.

In your situation, however, it’s already done and you need to deal with what is happening now. You have to have the root canal. You don’t want to leave an infection in your bone. That can lead to serious complications. Fortunately, I have some advice to give your dentist to protect your porcelain veneers.

Protecting the Appearance of Porcelain Veneers after a Root Canal

You are correct that a root canal treatment can make a tooth look dark. Because your porcelain veneers are translucent, that will show through and make the color look off. This can be prevented. Make sure your dentist knows that most of the darkening of the tooth comes from the remnants of root canal filling materials left over in the crown of the tooth. Have him read this post so you can feel confident he knows the right technique for this situation. Here’s what he needs to do.

He needs to clean out any of those materials from the crown of the tooth. Then he’ll need to place a white fiberglass post down into the root and fill the rest of the space in the crown with a light-colored composite. While it won’t forestall the tooth turning dark forever, this method along with the fact that you have a porcelain veneer should keep the tooth white for many years.

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

Porcelain Veneers During Pregnancy

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I’ve been saving up for a smile makeover for years. Now, when I finally have the full amount I needed I find out I’m pregnant. Is it safe for me to go forward with this or do I need to wait until after delivery?

Madison

Dear Madison,

A single porcelain veneer being placed

While there are some procedures which are not recommended in the first trimester, such as teeth whitening, porcelain veneers should be quite safe. The concern is about introducing chemicals to the baby. With porcelain veneers, the only thing you have to worry about is the anesthetic used. Fortunately, lidocaine has been tested and proved safe for use during pregnancy and even delivery. You and your baby should be fine.

Who Should Do Your Porcelain Veneers?

There is another important consideration— who should do your smile makeover. This isn’t a skill taught in dental school, nor is there a recognized specialty where dentists become graduates in the field. Instead, dentists with an interest in cosmetic dentistry have to take the initiative to get the proper training post-doctorally.

This makes it a little challenging for patients. How can they separate the sheep from the goats, so to speak? The easiest way to handle this is to find an AACD accredited dentist in a reasonable distance to you. These dentists have been tested vigorously for both their technical knowledge and their artistic ability and are among the top 1% of cosmetic dentists in the country.

They will give you a stunning smile.

If you can’t find an accredited dentist without a significant amount of travel, which you’re probably not keen on while pregnant, you still have options.

The mynewsmile.com website also recommends excellent cosmetic dentists. Not all of them have reached accreditation, but they’ve all been carefully screened for their ability to do beautiful smile makeovers. Most are on their way to accreditation.

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

My Porcelain Veneers Look Fake

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I’ve cried since getting home from the dentist. I spent years worth of savings to get a beautiful smile, but it looks totally fake. They’re bulky and chalky white. Honestly, to me, it looks like my dentist bonded pieces of white chicklet gum to my teeth. I told him what I thought and he said I am overreacting and am just not used to what they look like. He said in a week I’d be thanking him. Maybe he’s right but all I can do right now is cry. Am I overreacting?

Patricia

Dear Patricia,

A single porcelain veneer being placed

I can’t tell you how much it breaks my heart every time I hear a story like this. It sounds like you went to a family dentist who dabbles in cosmetic dentistry but hasn’t invested time in serious training to develop his knowledge, skill, or artistry. Based on the description of the results (and I’m taking a guess here) he likely placed Lumineers.

Lumineers are a brand of porcelain veneers which are highly marketed to inexperienced cosmetic dentists as being easy to place because they are considered “no-prep”. The problem with no-prep veneers is they often look bulky when they’re finished. Their lab also isn’t known for its beautiful work. Most expert cosmetic dentists prefer other brands of porcelain veneers.

If they are permanently bonded on, the only way to fix it is to have them replaced. The first thing I would do is tell your dentist this isn’t the smile you paid for. If he cares about the quality of his work and satisfaction of his patients, he’ll be willing to re-do it. If he does, make sure he lets you see them on your teeth with a temporary try-in paste. This way you can approve them before he bonds them on again.

If he’s unwilling, one thing I’m going to suggest you do is see an expert cosmetic dentist. Look for one in your area who is AACD accredited. They are the best cosmetic dentists in the country. They may be able to help you secure at least a partial refund. Then, you can let the skilled dentist do your smile makeover.

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

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