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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.

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.

I’m In Tears After My Smile Makeover

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I had a few teeth with composite bondings to repair some chips. They needed some repair. My dentist retired and said the man who took over his practice said they’d need to be replaced with porcelain crowns because you can’t just replace composite bonding. I didn’t realize at the time that wasn’t true and allowed him to do six dental crowns. The two front teeth look a darker grayish compared to the other teeth. Is there any way to fix this? My dentist insists they’re the exact same color as the others. It almost feels like I’m being gaslighted.

Elaine

Dear Elaine,

Woman covering her mouth with hand.

I’m very sorry you’re going through this. I can tell you the biggest obstacle you face is you have a bread and butter family dentist trying to do cosmetic dental work. One of the big problems in dentistry right now is the fact that cosmetic dentistry isn’t a recognized specialty. This means any general dentist can call themselves a cosmetic dentist regardless of the amount of training they’ve received.

This puts patients in a difficult position. They may not know that smile makeovers and other advanced cosmetic procedures are not taught in dental school. In order for a dentist to become skilled in those areas, it requires a significant amount of post-doctoral training. The best dentists invest in this type of training on a regular basis and are constantly improving their skills. My guess is your dentist didn’t receive that. This is what landed you in this position.

Getting Your Smile Disaster Fixed

A true cosmetic dentist would never tell a patient their smile looked fine when they were unhappy with it. Instead, they would re-do the work until the patient was thrilled. Because they want total patient satisfaction, they’ll use a temporary try-in paste. This allows the patient to get a good look at their smile before it is permanently bonded on.

It is unfortunate you now have dental crowns. You’re stuck with those the remainder of your life because it required your teeth to be ground down. The good news is he misrepresented to you the options available. It is not true that dental bonding could not be replaced. My guess is he said you had to have dental crowns done because that is all he knew how to do. In your place, I would ask for a refund and then go elsewhere to get them done properly.

If you’re happy with all the crowns except the two front ones that don’t match the adjacent teeth, you can just get those re-done. Either way you are going to need to find a top of the line cosmetic dentist. The best are AACD accredited cosmetic dentists. They’ve passed stringent exams as well as demonstrated their artistry on a large number of cases they’ve done.

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

Dentist Won’t Match Implant Crown

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I have had the dental crown placed on my implant three different times and none of them matched the adjacent teeth. My dentist said I’m being too picky and my tooth color is between A1 and A2 and I will never be satisfied. She’s refusing to do it again. I hinted I will try somewhere else and she said that puts my dental implant in danger of coming loose because she’s already removed the crown two other times. Now I’m worried. Am I stuck with mismatched teeth? I don’t want to risk the implant itself. Could I just whiten everything, crown included?

MaryAnne

Dear MaryAnne,

Using teeth whitening won’t help in this case. It will whiten your natural teeth, but the crown will stay the same shade, making the differences even more obvious. I’m very sorry that your dentist is treating you this way. She seems to be transferring her inability to match the crown for your dental implant to you. This isn’t your fault. Based on what you said, there are probably two problems going on with this. My first guess is this is a front tooth she’s trying to match. Those are trickier than others. Even top cosmetic dentists will do several try-ins before getting an exact match.

Notice I said try-in. There are temporary try-in pastes which allow you and the dentist to see what the dental crown will look like in place without using the permanent bonding materials that require her to grind your crown off every time you request a change. These are inexpensive. There are usually only two reasons a dentist doesn’t carry them. The first would be they don’t care what you think and will only look at it themselves. The second is they don’t know about it because they have not invested in cosmetic training, which has to be done in a post-doctoral setting. I believe your dentist falls into this latter category.

This leads me to her second problem. She’s just going by the standard Vita shade guides and expecting your tooth to be a perfect match. But, your teeth are between an A1 and A2. For back teeth, her method would work fine. However, a front tooth gets all the light when we smile, which shows the color and variations in striking clarity. The standard shade guide isn’t enough.

diagram of a dental color map This is an example of a color map a cosmetic dentist will send to the ceramist. Yes, it will have the basic shade, but there are also instructions for different tints to go in a variety of sections on the tooth, which changes the visual perception of the color. Our natural teeth aren’t one flat color. There are differences in opacity throughout the tooth. This is how you get a tooth to look natural and perfectly match its neighbor.

The truth is your dentist is in over her head. Ask for a partial refund and go elsewhere to get it done. See if you have an AACD accredited dentist in your state. They’re at the top of their field.

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.

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.

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.

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.

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.

Gross Dental Implant Incompetence

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I am not sure where to go from here and need some advice. I had a dental implant placed. It felt like the crown was loose so I went to see my dentist. He said the crown was loose and needed to be re-cemented. When he tried to take the crown off he had a bit of trouble. His next step was to use a special tool, but when he got the crown off the dental implant came with it. What do I do now?

Phylicia

Dear Phylicia,

Three stages of a dental implant

Can you get a dental implant while on Fosamax?

I hate to be the one to tell you this, but your dentist is completely incompetent. First, if a dental crown is loose, it is incredibly easy to remove them. Most often, they fall off of their own accord. What was actually loose was your dental implant. If your dentist wasn’t incompetent then he was incredibly dishonest. Neither scenario bodes well for you as his patient.

Some Reasons for Loose Dental Implants

If the implant came loose right after the dental crown was placed, then it means the crown was placed prematurely. Before you can place an implant crown there has to be sufficient osseointegration. Without that, the crown will pull the implant loose. Another option is there wasn’t enough bone support to begin with. Doing implants requires substantial diagnostics. A dentist should determine how healthy the bone structure is. Then, if there isn’t enough, suggest bone grafting to make sure you have the best chance of a successful outcome.

Some implants fail because of an infection. You didn’t mention either pain or a fever. In most cases of infection, one or both of those would be present.

Fixing a Failed Dental Implant

The first thing you need to do is demand the dentist who botched this so badly pay to get it fixed by a dentist you choose. That is important. Fixing this involves more than your original procedure, so just getting a refund will not be enough. You also want it to be a dentist you choose, so you can make sure they have the expertise to do this right.

It will require significant post-doctoral training. For instance, Dr. Weiss trained at the esteemed Dawson Academy. He’s also an instructor at the Academy of Osseointegration. This is what you want to look for. Not only that, he’san AACD accredited dentist which means he can create a beautiful crown.

I’m sorry this happened to you. Hopefully, this can be rectified soon.

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

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