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Cosmetic and
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dentistry

New Lumineers Over Old Ones

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When I first got my Lumineers my dentist knew that I wanted them to be whiter than they were made, but his lab guy said that it wasn’t quite possible to do them that white. They could only do what he called “natural” looking styles.  These days I see people with very white teeth and figure they are now able to do them whiter. Is it possible for me to have new Lumineers placed over my old ones so I can have the smile I really wanted?

Kelly

Dear Kelly,

a porcelain veneer being placed on a tooth

Should you place new veneers over old ones?

While it is possible for you to place new Lumineers over old ones, I am not going to recommend it. First, it is just as much work for the dentist to do that than to just provide you with a totally new smile makeover. to begin with. Second, it will be less secure. Porcelain bonds much better to natural tooth structure than it does to porcelain. That puts you at a greater risk of bonding failure for your new Lumineers, not to mention that you have double the risk because at some point your old Lumineers bonding could give out. I am going to recommend something completely different.

The first thing you should be aware of is that Lumineers is simply one brand of porcelain veneers. That particular brand is heavily marketed to inexperienced cosmetic dentists and I believe your dentist falls into that category. One reason I think that is he just agreed with the lab when they said your Lumineers could not be as white as you wanted. That was not true. Even then, you could get veneers of any brand as white as you wanted. The lab was wrong about that. That brings me to a second issue with Lumineers, which is their lab. The DenMat company, which owns this brand, insists you use their lab. They are not known for their artistic, quality work.

What I would like you to do is look for an expert cosmetic dentist and have them just re-do your smile makeover altogether. Do not be surprised if they suggest a completely different brand of porcelain veneers than the one you currently have. There are many brands that are far superior and will give more artistic results. The best cosmetic dentists are AACD accredited dentists. You can find them listed on aacd.com. They have extensive training and have passed stringent exams as well as proven their artistry before a board of examiners on a large number of their cases.

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

 

Cavity on Tooth with Porcelain Veneer

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I have porcelain veneers and one of my teeth has a cavity. My dentist wants to remove the porcelain veneer, treat the cavity, and then replace the veneer with  a dental crown. I am not too keen on this idea and wondered if it was the standard operating procedure for someone in my situation? It is a front tooth, so it is important to me it looks good.

Malorie

Dear Malorie,

 

a porcelain veneer being placed on a tooth

 

If I were in your place, I would recommend you get a second opinion. A crown is a much more aggressive treatment than I think you need. Your cavity would have to be rather substantial in order to justify it. I would think you would need about 1/3 of the tooth to be overrun with decay in order to make it a valid treatment option. If it is just some small decay, why would he recommend a dental crown instead of a porcelain veneer?

Generally, when a dentist is suggesting a less than ideal treatment, it is because they are not comfortable doing the better option. Unfortunately, this does not directly translate to them being able to provide you with a beautiful dental crown that matches your porcelain veneers. In fact, I would estimate that only 1-2% of dentists are actually able to match a single crown to the adjacent teeth in a way that looks attractive and blends naturally.

Getting a Second Opinion

When you go to get that second opinion, you want make certain of two things. The first is that the dentist you go to for your second opinion is in that 1-2% category of dentists who can provide a beautiful result and have the skills to do things well. In order to find a qualified cosmetic dentist, I would look for someone who is accredited with the American Academy of Cosmetic Dentistry. AACD accredited dentists are the best cosmetic dentists in the world.

The second consideration is that it is a blind second opinion. Many dentists know each other. They are peers. You don’t want the dentist who is giving you the second opinion feel conflicted because telling you the truth would mean saying his friend is wrong.

Because of that complication, I always recommend you ask for their opinion without them knowing who it was that did the work to begin with or what their diagnosis was. Be open with them about wanting an unbiased opinion if they ask who your dentist is. They should not have a problem with that.

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

Can No-Prep Veneers Work for any Patient?

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I am considering getting a smile makeover and really like the idea of no-prep veneers, like Lumineers. I see that some people warn against them and say they end up bulky, but I saw on another blog a picture of a woman who had no-prep veneers and had gorgeous results. Can this happen with any patient or was that specific to her type of teeth, like maybe her teeth were smaller than other people’s? I also noticed he (the dentist) said that he used his own personal ceramist. Does that make a difference?

Kelly

Dear Kelly,

a porcelain veneer being placed on a tooth

 

What a great question. Let’s start with the ceramist issue. Having his own ceramist works well if the ceramist is skilled, but the dentist will also need to be skilled. You can have a great cook who follows the instructions to a terrible recipe and guess what? The dish will not taste good. In the same vein, you can have a great recipe but a cook who does not have the skill to follow through well. You will still end up with a yucky meal.

It is the same with a ceramist. You need a skilled, artistic cosmetic dentist as well as a skilled, artistic ceramist in order to produce beautiful results. If the dentist whose blog you read used his own ceramist, then he did not use Lumineers. This is one of the drawbacks to that particular brand. They insist you use their lab. Unfortunately, their lab is notorious for creating bulky, and sometimes even chalky-looking results. The dentist you read about probably used a different brand of no-prep porcelain veneers.

Your Best Strategy for a Beautiful Smile Makeover

When it comes to smile makeovers, it is better to focus on choosing the right dentist and not the particular brand of porcelain veneers. Finding the right dentist means, he or she has the skill to create a beautiful recipe and he understands which ingredients (ie. the brand) will bring the flavor you want to your smile. In addition, he will know which ceramists are able to put his recipe together to perfection.

So where do you find such a celebrity chef? I would look for a dentist who has reached accreditation with the American Academy of Cosmetic Dentistry. AACD accredited dentists have proven technical skill and artistry. You will love the results they get.

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

 

Why You Have to Carefully Pick Your Cosmetic Dentist

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I had a chipped tooth which was repaired with dental bonding. That bonding fell off so I went to another dentist. This dentist said that bonding was not possible because 1/5 of the tooth was chipped and recommended getting a dental crown. That seemed too invasive to me so I asked for a porcelain veneer instead. She said she’d have to do two of them in order to get them to match. I agreed. Before it was bonded on I got to peek at them. They looked fine. They were whiter than my other teeth but we did that on purpose because I was going to whiten after getting the porcelain veneers. I did not see them after they were bonded on but they told me it looked fantastic. I left happy. When I got home, I noticed that one of the “teeth” is longer than the other. Not only that, the longer tooth has a bit of a ledge at the top so it appears they bonded it on too low. I called them, but they said that the tooth must have shifted and there is nothing they can do. How would my tooth shift away from a bonded veneer? Can this be fixed? If so, how do I go about getting it fixed?

Pamela

Dear Pamela,

a porcelain veneer being placed on a tooth

We hear these types of cosmetic dentistry horror stories way too often and it generally distresses me for two reasons. First, it is a burden on the patients. Second, because it was completely preventable. There is so much wrong here with what your dentist did.

We’ll start with her saying that dental bonding was out of the question. Really? Why? Obviously, you had dental bonding done there to begin with so it was not impossible. My guess is your dentist said that because she did not know how to do the dental bonding, so instead she steered you toward the procedure she did know, which is a porcelain crown.

You felt that was removing too much healthy tooth structure (rightly, I might add) and asked to have porcelain veneers instead. Based on what happened next, I would say she wasn’t very comfortable with that procedure either but was too embarrassed to say so. Or, maybe she thinks she’s good at them.

Getting Beautiful Porcelain Veneers

I suspect they knew something was wrong when they bonded your veneers because they didn’t let you look at them. That doesn’t give me much confidence in their professional integrity. So, where do you go from here?

The good news is they messed up big time. That will help you get a refund. If the only thing wrong with your porcelain veneers was they looked bad, it would be up to the dentist whether or not you received a refund.

In your case, they bonded them improperly leaving what you described as a ledge. In dental circles, we call this open margins. This is a functional issue because food and other bacteria will get trapped there putting your teeth at risk of decay and your gums at risk of developing gum disease. She owes you a refund so you can get this fixed.

Once you have secured your refund, I am going to suggest you find a dentist who has been accredited with the American Academy of Cosmetic Dentistry. AACD accredited dentists are the top cosmetic dentists in the country. You will have a beautiful smile when they do the work.

Oh, one other thing. The teeth whitening should have been done before you had the porcelain veneers placed. That allows the dentist to get an exact match. That was another error on your dentist’s part.

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

Mouthwash with Porcelain Veneers

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I have porcelain veneers that I really love and I want to take good care of them. I am doing a DIY mouthwash to be safe and want to make sure there are not any ingredients that can hurt my veneers. Here is my recipe:

4 oz. boiled wather

4 oz. hydrogen peroxide

1 T. sea salt

Will this be safe?

Ken

Dear Ken,

a porcelain veneer being placed on a tooth

I love to hear when patients are happy with their smile makeovers and how well they are caring for their teeth as a result. The ingredients you mentioned will not harm your veneers. However, I would be cautious with using it every day.

Peroxide is great about getting rid of bacteria. The only problem is it is non-discriminating as to which types of bacteria it kills. This means it will take away some of the good bacteria your mouth needs. That can lead to a candida infection for you.

Periodic use, about once a week, and you should be fine. Much more than that and you will risk that yeast growing in your mouth.

Over the Counter Products that Can Damage Porcelain Veneers

There are two main types of products to beware of that can do damage to your lovely porcelain veneers. The first is whitening toothpaste. These kinds of toothpaste typically contain an abrasive to scrub the stains off your teeth. The only problem is they will damage your teeth in the process by putting micro scratches on the surfaces of both your natural tooth structure and your porcelain veneers, this will cause them to pick up stains because they will lose some of their protective glaze.

If you really feel you need a whitening toothpaste, I recommend you get Supersmile Toothpaste. This is specifically designed for cosmetic work and will keep your veneers, as well as your natural teeth, shiny and damage free.

The second is over-the-counter mouthwash. Most of these contain alcohol. This is the one ingredient you want to avoid as it will eat away at the bonding that keeps the veneers on your teeth. I believe Colgate has an alcohol free mouthwash, but I would double-check to make sure the ingredients haven’t changed.

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

 

Fixing the Appearance of Protruding Teeth

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I have teeth that are slightly protruded and stained. What are my options for getting an attractive smile that doesn’t include braces? Seriously…NO Braces!

Alicea

Dear Alicea,

You have a couple of good options to get a beautiful smile. The first option is to get orthodontics. Now, I can hear you saying, “No braces!” I promise I am not talking about traditional braces. There have been some wonderful advances in dentistry. One of those is an invisible braces option, such as Invisalign. Instead of metal wires and brackets, these use clear aligners that straighten your teeth. For the discoloration, some simple teeth whitening will do the trick.

a porcelain veneer being placed on a tooth

A second option is to have a complete smile makeover done using porcelain veneers. This is the go-to for celebrities that want that Hollywood smile. It can change the shape, size, and color of your teeth simultaneously.

The important thing with porcelain veneers, though, is to make certain you go to an expert cosmetic dentist. Doing smile makeovers is not taught in dental school. Nor is cosmetic dentistry a recognized specialty. If a dentist wants to develop skills in cosmetic procedures, it is up to them how much and how skilled they become. There is no baseline.

Your safest option is to find an AACD accredited dentist. Dentists who seek accreditation through the American Academy of Cosmetic Dentistry have to prove not just their technical knowledge and understanding about cosmetic work, but also have to demonstrate they have artistry by submitting a large number of visual evidence of procedures they’ve done.

With the right dentist, porcelain veneers will give you a smile that lights up a room.

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

Covering Tetracycline Stains

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My twin sister and I both have tetracycline stains. Several years ago, she had porcelain veneers placed on her teeth, but they looked a bit fake. The dentist said the only way to adequately cover the stains was to make them opaque. I am hoping the technology has improved some since then and I can get a beautiful, natural-looking smile.  I really do hate my smile.

Avery

Dear Avery,

A single porcelain veneer being placed

I am not sure if you will want to tell your sister this or not, but the technology has been around for a long time to make porcelain veneers look beautiful on tetracycline stains. While your sister chose the right procedure, it sounds like she likely picked the wrong dentist.

Cosmetic dentistry is not a recognized specialty. That means any general dentist can call themselves a cosmetic dentist. To make matters even more challenging for the patient, smile makeovers aren’t taught in dental school. It is up to the dentist to invest in the post-doctoral training necessary to do the work properly.

While choosing your cosmetic dentist carefully is important for any smile makeover, tetracycline stains are among the most difficult type of cosmetic cases there are. You can tell by your sister’s case that it is a challenge to get the porcelain veneers opaque enough to cover the stains, but still translucent enough to look natural.

If I were in your position, I would only go to a dentist who is accredited with the American Academy of Cosmetic Dentistry. AACD accredited dentists are the top cosmetic dentists in the country. They’ve passed stringent exams as well as an examination board that has examined a large number of cases the dentist completed for both technical skill and artistry.

You find an AACD accredited dentist, you’ll find a dentist that can give you a stunning smile.

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

Smile Makeover Gone Wrong

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I went to a dentist because I was finally in a position to fix my teeth. My four front teeth are overcrowded and misaligned. My dentist told me using smile makeover techniques with cosmetic dentistry I could fix my teeth without braces. In total, he did dental bonding, two porcelain veneers, and some tooth shaping. He also said he shaped some lower teeth, which we never actually discussed. I wish he hadn’t done that because it added to the price. I paid a total cost of $9.3K. When it was “finsihed”, there really wasn’t much of a difference. My teeth were still misaligned and I didn’t feel like it was prettier in any way. I asked how it was possible to get the teeth to look like he said they would. He told me I’d need to do four root canals and dental crowns, of course, there is a significant additional cost. I wasn’t too keen on that so I went to see another dentist to see what they thought. Their solution was to just whiten my teeth and then do four porcelain veneers. There cost for that was only $7K. I like that idea. Is there any way for me to recoup my original $9.3K?

Camille

Dear Camille

a porcelain veneer being placed on a tooth

 

I am sorry for what you have been through. We are going to file this in one of the many cosmetic dentistry horror stories people write to us seeking advice. One of the problems you are facing is that there isn’t a recognized specialty in cosmetic dentistry. On top of that, dentists are not taught much in dental school about doing smile makeovers.

The dentist who did your smile makeover obviously hasn’t invested much in his cosmetic dentistry training. Nor has he given you the smile he told you that he would provide. I think you have a good case for a refund. Before we get into that, I want to make sure the next dentist you see to repair this is qualified.

My suggestion is that you look on the mynewsmile.com website. They prescreen cosmetic dentists who wish to be listed. They cannot purchase their way on. Instead, they have to demonstrate their technical skills, training, and artistry.  Anyone they list will give you a stunning smile.

The second dentist was on the right track. You do not need root canals or dental crowns. Please don’t let anyone do that to your teeth. Porcelain veneers are sufficient and will give you a beautiful result with an artistic dentist. The teeth whitening makes sense too if your smile is wider than the number of veneers you are getting. It also helps your bottom arch to blend.

Tips for Getting a Dental Refund

With some dentists, who care about patient satisfaction, you can simply ask for a refund when the work done wasn’t what was promised. However, some dentists are more stubborn than others. While I always recommend simply asking first in order to give them an opportunity to do the right thing, you do need some tips in case they don’t.

First, let them know you are doing them a favor. Often, a dentist will not know that written requests for a refund have to get reported to the National Practitioner Data Bank. It helps to educate them and give them an out by saying something like the following.

“I don’t want to make things difficult for you. This is why I am making an oral request, instead of a written one which would have to be reported to the National Practitioner Data Bank.”

If he still doesn’t comply, here are my recommendations:

  • Make a written request, explaining your reasons so it is on record.
  • Write a negative online review, which puts them in a position of needing to respond in order to save their reputation.
  • Complain to the dental board. With a legitimate complaint, the dental board can make life quite difficult for dentists. He’ll want to avoid this, so let him know it is your next step. That may spur him on.
  • Go to a lawyer. Often just the letter from the lawyer will be enough. With a legitimate complaint, the dentist’s malpractice insurance will encourage him to settle.

Best of luck. Make sure you get an expert cosmetic dentist to fix this.

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

3 Reasons Porcelain Veneers Might Turn Dark and What You Can Do About It

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In January, I received six porcelain veneers. Two of them are turning dark. I am originally from Indiana, and I’ve been with my dentist for a little more than a year now. I asked him about the veneers, and his response was, “Hmm. I am not sure what’s going on.”  This is making me nervous. Why would my veneers be turning dark in just a few months? – Vivian

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

Porcelain veneers can rejuvenate your smile

Vivian – Dr. Weiss would need to examine your porcelain veneers for us to identify the exact problem. We can tell you that porcelain is stain resistant and very hard—much more so than natural teeth. So why might they turn dark?

Reasons Porcelain Veneers Might Turn Dark

  1. A gap between the veneer and your tooth – If your dentist left a small gap between the two porcelain veneers and your teeth, bacteria can leak in and attract stain. Correcting the issue can be tricky, and only a highly skilled cosmetic dentist should attempt it.
  2. Excess composite – If your dentist didn’t polish away any excess dental composite when bonding on your porcelain veneers, it could cause them to look dark. Excess composite can easily be polished away by a cosmetic dentist who regularly creates beautiful smile makeovers.
  3. Power-polishing equipment – If a dentist or dental hygienist uses power-polishing equipment on your porcelain veneers, the glaze on them can be quickly destroyed. It only takes a few weeks for the damaged glaze to attract stains and make your teeth look darker. Trained cosmetic dentists and hygienists understand which tools to use on porcelain veneers and which tools to avoid. Ultra-fine polishing strips and ultra-fine aluminum oxide polishing paste help in several ways:
  • Keeps the area smooth
  • Helps it resist stain
  • Helps prevent plaque accumulation
  • Helps prolong the life of your porcelain veneers

Although your dentist or hygienist might have been negligent in the placement or maintenance of your porcelain veneers, we recommend that you only let a skilled cosmetic dentist correct the issue.  An expert cosmetic dentist has the tools needed to correct the problem. He or she also knows the techniques required to polish your veneers properly. Find an experienced cosmetic dentist to examine your veneers and recommend the options for lightening them.

Philadelphia, PA accredited cosmetic dentist Michael Weiss, DDS sponsors this blog post.

Root Canals Needed after Her Smile Makeover

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

Ruth

Dear Ruth,

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

Teeth prepped for porcelain veneers

Porcelain Veneer Preparation

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

preparation for porcelain crowns

Porcelain Crown Preparation

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

What is a Smile Makeover

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

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

Hopefully, you at least like how these teeth look.

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