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dentistry

What If You Don’t Like Your Smile Makeover?

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I wanted a smile makeover. I asked my dentist if he was a cosmetic dentist and he said no one is actually a cosmetic dentist they’re just dentists who did cosmetic work. He then asked what procedure I wanted. When I told him a smile makeover he told me that he could give me Lumineers. He showed me before and after pictures that looked good. When my porcelain veneers were first placed. I didn’t like them. I could tell that before they even put them on. They weren’t the right color. I told him that and he sent them back. When they came in the next time, I had a hard time seeing them on my teeth because they kept falling out. He assured me they could make adjustments after they were bonded on. It turned out that isn’t true. When I finally got a good look at them at home, I was super disappointed. First, they were whiter, but it had a chalky flat looking white, not a shiny one I was hoping for. Second, they are way bulkier than natural teeth. It was shortly after this that the quarantine started and his office closed. I called and left a message, but he hasn’t gotten back with me. I don’t know if that’s because his office is closed or he’s ignoring me. I’m hoping to get this fixed, but what if he’s actually just avoiding me?  The answering machine does say they’re checking messages and will get back with us, but he hasn’t.

Carol

Dear Carol,

A single porcelain veneer being placed on a tooth.

While technically your dentist is correct, there isn’t a recognized specialty in cosmetic dentistry, that doesn’t mean some cosmetic dentists aren’t more qualified than others. Doing smile makeovers aren’t taught in dental school. It is up to the dentist to invest the time and money into learning them well.  It doesn’t sound like your dentist has done that based on what you’ve described.

Problem One

The first thing that caught my attention was his recommendation of Lumineers. This is a brand of porcelain veneers that is highly marketed, especially to inexperienced cosmetic dentists as being easy to place. They say that because they are considered easy to place as they are an ultra-thin and don’t necessarily require any tooth preparation. However, they have two big problems working against them.

The initial problem is the inexperience of the dentist. Some smiles will look fine without tooth prep. Others will look bulky. A second big issue with Lumineers is their lab. Unlike other brands of porcelain veneers, the company that produces Lumineers require dentists to use their lab, which isn’t known for its high-quality work. In fact, many expert cosmetic dentists would consider it sub-par.

I know your dentist showed you before and after pictures, but did he say they were HIS before and after pictures. They may have been stock photos.

Problem Two

A second big problem I noticed is that your dentist either doesn’t know or doesn’t care about temporary try-in paste. If he didn’t know, he has done practically zero training with cosmetic work. If it is, instead, that he doesn’t care, then he is definitely NOT a dentist you would want working on your smile. So you’ll be aware for next time, a temporary try-in paste allows you to get a good look at your porcelain veneers on your teeth for an extended period of time, without them having to be permanently bonded.

Problem Three

Finally, he told you he could make adjustments after they were bonded on. Cosmetic Dentistry 101 teaches you that is not possible. Again an indication he either doesn’t know he’s doing or he doesn’t care. The good news is this last issue works in your favor. He told you something that absolutely wasn’t true. I think this can help you get a refund.

So, once you’ve got that juicy refund in your hand, who should you go to in order to have a beautiful smile crafted for you? Ideally, you’d get an AACD accredited cosmetic dentist. They are at the top 1% of their field. If that isn’t possible, my next recommendation is you go to the website mynewsmile.com. They recommend expert cosmetic dentists in every area. A dentist cannot just pay to be listed. They have to provide their cosmetic dentistry training as well as visual evidence with before and after pictures of cases they’ve done themselves in order to prove their artistry. Any one of the dentists listed there can create a stunning smile for you. Many of them are on their way to accreditation, which is a process that can take many years.

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

Prosthodontist Versus Cosmetic Dentist

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I needed a lot of reconstructive work done on my teeth after a car accident. I went to a prosthodontist because they’re supposed to be the experts at this. I brought pictures of my old smile. I just wanted to have my beautiful smile back. I thought it would be fairly simple as they’d know exactly what I wanted ahead of time. When it came to the process of fitting, it looked like everything would be too dark. I mentioned that and they said it was because they weren’t the permanent ones. A common theme, whenever I brought up an issue, was the dentist saying, “He’s been doing this for twenty-five years and I should trust him.” Then, when I noticed the color didn’t match on the top and bottom he said, I didn’t understand how it worked and he was doing what was clinically correct.

When it came time to put in the permanent ones on the try-in, I couldn’t see them because they would fall out. He was mostly checking for fit. I told him one of them felt weird. He snapped at me at that point and said, “Everything is clinically perfect and fits just as it should.” He also told me I’ve been overly demanding and if I don’t like it I can leave without the teeth. I was humiliated and couldn’t bear the thought of leaving without teeth. At that point, most of my teeth had been ground down to nubs for the teeth needing crowns. I just let them do the work and booked it out of there as quickly as possible.

Now that I’m home, the teeth don’t look anything the way I wanted. The top teeth are actually darker than the bottom teeth, which looks completely insane. One of the teeth still feels funny. The teeth are shorter than my old smile, which makes me look older. I hate this. Is there any way to get it fixed without spending a second fortune?

Mandy

Dear Mandy,

woman covering her mouth with her hand.

I hate it when I hear these cosmetic dentistry horror stories. All that time and money and the patient is left disappointed at best and in a horrible situation that destroys their bite and leaves them in pain in some of the worst cases. You haven’t been unreasonable and hard to please. When you talked about the difference in color from the upper and lower arch I cringed. While you can get away with the lower teeth being slightly darker than the upper teeth, the other way around just doesn’t work. You can get this fixed, but you’re going to have to be tough. If you think you can handle it, I’ll explain how you can get the smile you deserve.

First, what he did is essentially malpractice, though I’m certain he won’t see it that way. He has a dental school mentality of “I’m the dentist, therefore I know best”. One of the standards of dentistry is informed consent. What he ended up doing, though, is coercing you into a smile you didn’t want. That’s not informed consent.

It’s obvious he didn’t care what you think to begin with. During the try-ins, you never got to see the crowns. He only cared about the fit, not whether or not you liked the appearance. If he did, there are temporary try-in pastes he could have used to let you get a good look and approve everything before moving forward.

Based on the arrogance you’ve described, I don’t think you’re going to get far with him on your own. Instead, you may need to involve a lawyer. His lawyer will immediately suggest he settle. I don’t want you to just ask for a refund. Instead, what you need to do is have him pay an expert cosmetic dentist to fix this.

While a prosthodontist studies reconstructive dentistry, not enough of them invest time developing the training necessary for the cosmetic side of things. You are more likely to find an expert cosmetic dentist with training in reconstructive dentistry than you are the other way around. I’d start by looking for an AACD accredited dentist. These are the top cosmetic dentists in the country and will certainly give you a stunning smile. Many of them also have reconstructive training as well.

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

Getting a Smile Makeover Through Yelp?

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I’m having trouble deciding on which cosmetic dentist to use for my smile makeover. I’m looking at the top three recommended in Yelp. I was thinking of doing composite bonding because it is cheaper, but I can’t tell which of them would be better for that over porcelain veneers. Any advice?

Hannah

Dear Hannah,

Brunette with a beautiful smile

AACD accredited dentists are in the top 1% in the country.

I’m glad you are writing. I think I can save you a lot of grief and wasted money. Let’s start with the way you’re going about finding the dentist you want to do your smile makeover. While Yelp is a great resource for many things, I don’t think its algorithms are going to be useful in this case.

They make their recommendations based on reviews. However, they don’t really make a distinction on what type of dental work is done. For instance, if you were to look at many of the reviews of those dentists, how many are based on their work doing smile makeovers? Most are likely just about how friendly the office is or some of the general dental work they’ve had done.

I’ll discuss how to get the best cosmetic dentist for your smile makeover in a moment. Before we do that I want to talk about the two procedures you were considering. You won’t find many great cosmetic dentists who will do a complete smile makeover with composite bonding. It actually takes significantly longer to do it with composite than porcelain and get it to look beautiful. Because of that, they’d actually end up having to charge you more. Plus, composite doesn’t last nearly as long as porcelain, so your investment isn’t as durable. Dental bonding is best done with small areas, such as repairing a chipped tooth or closing a tooth gap.

If you’re going to invest in a new smile and want it both beautiful and durable, then porcelain veneers would be the better investment for you.

Finding a Cosmetic Dentist for Your Smile Makeover

There isn’t a recognized specialty in cosmetic dentistry, nor is doing smile makeovers taught in dental school. That leaves patients in a bit of a quandary. Because of that, the American Academy of Cosmetic Dentistry began an accreditation program. Dentists who pursue accreditation have to pass exams demonstrating their technical knowledge. They also have to demonstrate their artistry by presenting visual evidence of a large number of cases they’ve done. Those are examined carefully to ensure they meet the highest standards. Only then will they be accredited.

If I were getting a smile makeover, I would look for an AACD accredited dentist.

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

Dentist Gave Me a “Wallace & Grommit” Smile

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I have a disastrous smile makeover. The closest way I can describe it is he’s given me a Wallace & Grommit smile. My front teeth are way too big and make it hard to even close my mouth all the way! He also provided a few mini implants for missing teeth in the back of my mouth. What do I do? It is so bad that my friends ask me if they made my dentures too big. I don’t have dentures! That’s how ridiculous I look. My dentist thinks it is fine. What do you recommend?

Monica

Dear Monica,

Image of Wallace & Grommit

I’m sorry this has happened to you. I’ve put a photo of Wallace & Grommit here for the sake of those who may be unfamiliar with the reference. I’m afraid we hear about these smile makeover disasters way too often. Most of the problem stems from dentists who are inexperienced in cosmetic work. While cosmetic dentistry isn’t a recognized specialty, it does require specialized training. Smile makeovers aren’t taught in dental school, so they have to invest the time and training to study the skills in a post-doctoral setting. Not all dentists have invested in the necessary training or could just be he’s just started out. We have all had our first few cases.

Generally, if the problem with your case is simply it doesn’t look good, you don’t have much recourse. You could appeal to the dentist’s sense of integrity in his work or get another cosmetic dentist on your side to appeal to the dentist’s sense of peer respect. Another option is to threaten to write a bad review.

That being said, you are in a better position. Your mouth doesn’t close. This causes serious problems to your dental health and would not be considered a clinically sound case. When your mouth doesn’t close, it leads to dry mouth. This means you are not producing enough saliva. Our saliva is a key factor in preventing cavities. It contains minerals and other properties that help fight the bacteria in our mouths. People with dry mouth suffer from decay and gum disease and a much higher rate than normal.

Getting Your Smile Makeover Fixed

Frankly, your case needs to be redone. This is actually good news for you. I don’t want your current dentist doing the work. I’m concerned about what I”m hearing from you. You need a better cosmetic dentist. So, before you ask for your refund, I want you to see a better cosmetic dentist, preferably an AACD accredited dentist. While you are there, ask them to look at your implants too. I don’t like hearing he put mini implants in. While they are fine to help with securing a denture, they are not a good option for a single dental crown. For that, you would need a full-sized dental implant.

If your second opinion dentist thinks they are fine, then you can simply get a refund on the other work. If he thinks you’ve had the wrong tooth replacement then you will want to get a refund on both. Plus, have him pay the additional cost of the bone grafting which would be necessary to do the replacement.

You then have your second opinion dentist do the work or get another dentist.

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

Victim of Dental Tourism for a Smile Makeover

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I went to Croatia and was able to receive $60,000 worth of cosmetic work for just over $10,000, including airfare. I thought I was getting the deal of the century. When I asked them how they could afford to do that, they told me health care was more affordable in their country because they don’t have as many laws and restrictions. I fell for it hook line and sinker. I’ve been home two weeks and have followed all their instructions including not to eat with my front teeth for a few months. But, since then four of them have already fallen out including one of the front teeth. I promise I haven’t been eating with it. What do you recommend?

Stacey

Dear Stacey,

A woman smiling with a beauttiful smile

The most important factor in a smile makeover is the skill of the cosmetic dentist.

Dental tourism is a booming industry, especially for advanced cases like smile makeovers. Unfortunately, as you are discovering, it rarely works out the way the tourist hopes. While it is true we have more regulations in our health care system, most of that is to protect the patient from unhealthy or incompetent practices.

If they truly gave you porcelain veneers, telling you to avoid eating with your front teeth sends off huge warning bells to me. With correctly bonded porcelain veneers, you should be able to eat anything you want. It sounds to me like these “dentists” may not truly understand how to bond them. Though, there is always the possibility they didn’t provide you with true porcelain veneers.

Getting this Smile Makeover Repaired

You are going to need the expertise of a top of the line cosmetic dentist. Look for one who is AACD accredited. They are in the top 1% of cosmetic dentists in the country.

The first thing you’ll want to find out is if they are truly porcelain veneers. That is your best-case scenario. If they are, an expert cosmetic dentist can bond them back on properly. This isn’t something any dentist can do. It requires techniques and skills most dentists don’t have. I’d recommend having the rest of them re-bonded as well if that is the case.

If they are not porcelain veneers, you can try to get your money back, but most of that will depend on the laws available to the consumer in Croatia. It’s not likely to be anywhere near as useful as what you have here.

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

Her Gums Inflammed After Getting Porcelain Veneers

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I’m a little worried about my gums. I had porcelain veneers placed a couple of months ago. Since it happened. my gums have been inflamed and painful. I went back in and the hygienist said she’s never seen it happen before. The dentist came to look and both of them accused me of not brushing enough. I was quite annoyed. I’m a grown adult and know how to brush my teeth. Why in the world would I not brush after spending a fortune on these porcelain veneers? When I went back in for a routine one-month follow up he removed some excess cement. That has helped some but I’m still in pain. What do you recommend I do?

Avery

Dear Avery,

illustraing on lateral incisors inflammed by poorly done porcelain veneers

These lateral incisors are inflamed from poorly done porcelain veneers

When patients have a smile makeover they’re proud of, they tend to take better care of their teeth, not worse. I don’t like it when medical practitioners blame patients for things they don’t quite understand. Please bear in mind that I haven’t examined you so I can only give possibilities.

There are a few possibilities going on here. It can be one or a combination of them. With the first possibility, he could have left some cement in that is irritating the gums. This seems a very real possibility, especially because you said he removed some excess cement a month out from placement. The cement should have been removed right away, while it was still soft. The fact that your gums felt a little better after he finally did remove it. Now it is getting a chance to heal.

That doesn’t mean that is the only thing irritating your gums, though. I say that because It doesn’t sound like your dentist has invested a lot of time in understanding cosmetic dental work. Another option is there is some unevenness or temporary shelving in the margins between the porcelain veneers and the gumline. This is sometimes called bulky margins.

This will cause things to get trapped in between the gums and the porcelain veneers, leading to inflammation and, eventually, gum disease and tooth decay.

There are other possibilities too such as the extended wearing of temporaries, the veneers encroach on the gingival attachment, and, allergies to the materials used in bonding.

Dealing with a Disastrous Smile Makeover

The first thing I suggest you do is get a second opinion. When you do, make sure it is a blind second opinion. Don’t ask your dentist for a recommendation and don’t tell whomever you do see who your dentist was. Most of the time, they know one another. You want an unbiased opinion. What you don’t want is him feeling torn between an honest evaluation and betraying his friend. That’s why a blind second opinion is best.

If it is just a matter of the cement being trapped there, then when your dentist removed it at the last follow-up, that should help as it heals. The second opinion dentist can make sure there isn’t any more there. If, however, the problem is with the margins, the porcelain veneers will have to be completely re-done. Because it puts your oral health at risk, you are entitled to have them re-done free of charge. Though, my recommendation would be to get a refund and have a more experienced cosmetic dentist do this.

Look for someone who is recommended on the mynewsmile.com website. They are highly skilled and they will sort them by area of the country for you.

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

Smile Makeover During Pregnancy

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I was planning on getting a smile makeover but just found out I’m pregnant. Can I go through with it or do I need to wait?

Avery

Dear Avery,

A woman smiling with a beauttiful smile

Congratulations on your upcoming blessing. Babies are the best. Whether or not you can go forward with treatment depends on a couple of things. The first is what procedures you were planning. The second is whether or not you’re in a high-risk category in your pregnancy.

Let’s start with the procedures.

Teeth Whitening

Getting your teeth whitened hasn’t been officially cleared for pregnant women. It’s not because there is evidence of it doing harm to the baby, it is because we’ve had no tests to say it doesn’t do harm. As you can imagine, there aren’t a lot of women lining up to have their unborn child be a test subject.

I’m sure you can find a dentist to do it for you. Just make sure you understand the risks. By that I mean we don’t yet know the risks.

Invisalign

These are clear aligners you wear over your teeth to straighten them. It’s perfectly safe to use during pregnancy. However, if you are prone to morning sickness and vomiting, you may find this an inconvenient time to straighten your teeth. The aligners have to be worn almost full-time, with the obvious time exceptions being during meals.

Vomiting will mean thoroughly cleaning out the aligners so you don’t get stuck with anything acidic in them. This will lead to massive decay.

Porcelain Veneers

Porcelain veneers are a safe procedure, even during pregnancy. The only chemical used would be the Lidocaine which is used for numbing during tooth preparation. Lidocaine is one of the medicines which has been FDA approved as safe to use during pregnancy. It’s even sometimes used during the delivery process.

The only cautionary tale I’d offer here is to make sure you see an expert cosmetic dentist or you will be disappointed with your smile makeover results.

All that being said, if you are in a high-risk pregnancy group, you’ll need to scrap everything I just said and talk to your obstetrician and get clearance on everything first. There will likely be special considerations.

Best of luck to you and your baby.

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

Cosmetic Dentistry Malpractice

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Can you advise me? I spent a small fortune to get my smile updated. I’d had some cosmetic bonding on my front teeth which was showing its age along with a dental bridge. I went to a dentist who advertises as specializing in cosmetic work. He replaced the metal bridge and then planned crowns on the remainder of the visible front teeth. When they put in the temporaries, they told me they wanted to be certain I’d like them. I’d brought them a very specific smile design I wanted so I was glad to hear them say that. Unfortunately, it proved not to be true. When the permanent ones came in they weren’t the same color. I mentioned that and they said they’ll look different in my mouth. They didn’t. I told them, they still looked dull. Then they said it was because I see them differently in this light. Which, by the way, was the same light I saw the temporaries. When we got in a different light I noticed, they didn’t match the metal bridge. Their response, was, “Of course they don’t. The bridge is metal.” Then they bonded them in even though I wasn’t happy with them and said I’d get used to them and love them. I don’t. I don’t know what to do. My teeth are not what I wanted and don’t match.

Patricia

Dear Patricia,

A woman smiling with a beauttiful smile

When you get a smile makeover, you should be thrilled to share your new smile.

You have a great case to have this re-done by a dentist who actually knows what they’re doing, but you are going to have to be tough. This dentist behaved quite unethically based on what you’ve said and I don’t think he cares whether you like your smile or not.

Aside from shoddy cosmetic work, they violated a very important principle of dental practice, which is informed consent. You did not consent to them bonding in your new smile. In fact, they badgered you into it by trying to make you feel unreasonable. This was after they promised you that you’d get to approve the smile and love it first.

Dealing with Shoddy Smile Makeovers

Because they didn’t have your consent, you have the right to have this done again. However, I wouldn’t trust this dentist to do it. Instead, have them pay for an excellent cosmetic dentist to re-do your work properly. You may have to involve a lawyer, but you’re on solid ground.

It’s unfortunate he ground all those teeth down for dental crowns. Porcelain veneers would have been a better option for you and is much more conservative on your tooth structure. Seeing as you had crowns done (through no fault of your own) you will have to have crowns done again.

This time, get them done by someone who’s invested time and training in cosmetic dentistry (which by the way isn’t a recognized specialty). In your place, I’d go to mynewsmile.com and see which dentists they recommend in your area. Anyone on their list will give you a stunning smile makeover you’ll be proud to show off.

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

Why Can’t Lumineers Make My Teeth Longer?

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I’m so frustrated right now and need some advice. I’m looking at the Lumineers advertisement holding it in my hands. They show before and after pictures of teeth being made longer. When I went to see my dentist, he said it could happen. All I wanted was whiter, longer teeth. Yet, when the lab sent them back, they weren’t any longer. My dentist called and they said that’s as long as they can get. I don’t get it? Do they falsely advertise?

Mischa

Dear Mischa,

Lumineers Advertisement

So, your biggest problem here is your dentist. Think about this. If the Lumineers lab is right (which they are not) shouldn’t he have known this? Also, He’s the doctor. The lab workers are technicians. They follow the doctor’s instructions, not the other way around. So, what is going on here?

Smile Makeovers Aren’t Taught in Dental School

Many people don’t realize that dental schools are for general dentistry. If a dentist is interested in learning how to do smile makeovers, they have to invest in the time and training for that post-doctorally.

Some dentists do it. Some don’t. Some invest more time and effort into it than others. As a result, some smile makeovers end up beautiful and some end up a disaster.

The Lumineers brand, in particular, is highly marketed to inexperienced cosmetic dentists in being easy to place. However, the brand forces dentists to use their lab, which isn’t known for its beautiful work. That means you have two things working against you– the inexperience of your dentist and the low-quality results of the lab.

How to Get a Guaranteed Beautiful Smile Makeover

Your dentist hasn’t provided the smile he promised. You specifically asked for longer teeth and he didn’t provide that even though porcelain veneers can accomplish that very request. In your place, I’d ask for a refund and start over with a true cosmetic dentist.

Then, go to aacd.com. This is the website of the American Academy of Cosmetic Dentistry. They have an accreditation program where dentists who truly want to excel in cosmetic dentistry can receive training and be tested for their skill and artistry.

They have to pass both oral and written exams as well as show visual evidence of a large number of specific cases they’ve personally done to demonstrate their artistry. Only then can they be accredited. Their website has a link where you can search for AACD accredited dentists in your area.

That would be the dentist I would go to in order to get a stunning smile makeover.

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

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