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30K Cosmetic Dentistry Disaster

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Can you help me find a different dentist. I just had a total smile makeover that included both dental crowns and porcelain veneers. This was done to fix both the damage done from my teeth grinding as well as cover my tetracycline stains. They look really opaque, which does give them a fake appearance. However, the thing I’m worried about is my jaw has been hurting. It didn’t hurt like this before the crowns and veneers were placed. I did have some low level aching because of the teeth grinding. However, now my jaw really hurts all the time. So much so that it is distracting. My dentist insists not only does everything look great but that he has passed all the check marks for proper placement. I’m at my wits end and have already spent $30,000 on this.

Laurie

Dear Laurie,

Woman Holding her jaw in pain

Under normal circumstances, it would be very hard for you to get this repaired without paying for the whole thing all over again. If the only problem is the appearance it is nearly impossible for you to get a refund. You’d think that wouldn’t be the case when you are talking about cosmetic work, but that is currently where it stands. However, you seem to be dealing with some functional issues. I don’t know how he thinks the markers for proper placement would not include your patient not being in pain.

It sounds like your bite may be thrown off a bit, which could be leading to complicating issues such as TMJ Disorder. This can work in your favor because it means that the case isn’t truly functional. We’ll go over how to get this diagnosed in a moment. First, I want to go over the difference between a general dentist and a true cosmetic dentist. Even though there is not a recognized specialty in cosmetic dentistry, there are some distinct differences.

One of those differences is the amount of training they get. Smile makeovers are not taught in dental school. In order for a dentist to truly learn the techniques and artistry required, they would need post doctoral training. Another important difference is how they treat the patient. A true cosmetic dentist would not be satisfied with the work if you weren’t. They would first do a temporary try in and allow you to look at it in several different lights and make sure you are completely thrilled with the results. Even a little hesitation would cause them to ask, “What do you wish was different?” and it would go back to the lab to make the changes.

The easiest way for you to find one of these dentists would be to go to the American Academy of Cosmetic Dentistry’s (AACD) website. They have a “find a cosmetic dentist” link. Make sure you check the box that says you want an Accredited Cosmetic Dentist. These are among the top 1% of cosmetic dentist’s in the country. Have one of them examine your case. It will be helpful if they also have TMJ training. They can tell you if your current dentist’s work threw off your bite. If that is the case, then they can help you secure a refund so you can get this done properly by a qualified dentist.

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

A Single Porcelain Veneer Turning Dark

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I have eight porcelain veneers on the top arch and six on the bottom. A few months after they were placed, I chipped one in a fall. The dentist buffed the tooth down so it would be even. Then he had to buffer down the partner tooth on the other side so they would be even. Fast forward a few months and now one of her teeth has turned bluish and has a darker spot underneath. I went back to the dentist and he said that he had no idea what I was talking about. He was pretty put out and said he was “excellent with color design.” His professional opinion is that I’m being too picky. However, I assure you that the color has changed. I don’t know what to do and I am worried that this veneer will fall off. Do you have any recommendations?

Carolyn

Dear Carolyn,

a porcelain veneer being placed on teeth

First, I am going to tell you that your dentist does not sound like a true cosmetic dentist. A dentist who has done a significant amount of post-doctoral training would never tell a patient they are being too picky. Their goal is to make sure the patient has the smile of their dreams.

Bear in mind that I haven’t examined you or even seen images. However, going solely on your description it sounds like you have a leaky veneer. This means that the bond between your tooth and your porcelain veneer is failing. The changing color is debris getting caught between your porcelain veneer and your tooth.

This needs to be fixed or you can end up with severe decay on that tooth. My suggestion is to go back to your dentist and have him fix this tooth. You may need to show him this blog post. If that doesn’t work, get a second opinion from an expert cosmetic dentist that examines you. One way to find an expert cosmetic dentist is to go to the American Academy of Cosmetic Dentistry Website (aacd.com). In their “Find a Dentist” link make sure you check that you want a dentist who is accredited. AACD accredited dentists are among the top 1% of cosmetic dentists in the country with proven skill and artistry.

When you get that second opinion, make sure it is a blind one. They should not know who your dentist is or what he said about the veneer that you are concerned about. If it turns out that it is a leaky veneer and needs to be replaced/rebonded, then he or she can give that recommendation to your dentist. Peer pressure is a thing, even in professional circles.

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

Am I Too Young for Porcelain Veneers?

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I am 21 years old and want to get a smile makeover. I had braces years ago, but some of the gaps are back. Plus, I was a bit of what my parents dubbed a tom-boy so I’ve chipped quite a few teeth. Now, I’m graduating from college soon and want to start thinking about a professional look. I want a nice smile. Am I too young to get porcelain veneers? If so, would bonding be a good substitute? As for the dentist, my general dentist doesn’t do porcelain veneers but said he’s willing to learn if it is important to me. I’m not sure I want to wait for him to learn so do I just look for one who already does them?

Phoebe

Dear Phoebe,

a porcelain veneer being placed on teeth

I am glad you wrote. You have some great questions. Let’s jump right in. First, you are not too young for porcelain veneers. The important factor is that all your teeth are fully developed. This generally happens around 18 years of age, so you should be fine. I don’t recommend dental bonding for full smile makeovers. They are not as useful over large surfaces. Instead, their sweet spots are small gaps or chips. You mentioned those, but if you have a lot of them and/or want to change other things about your smile, you are still better off with porcelain veneers. They are more durable, as well as beautiful.

You are wise not to go with your general dentist. It takes years of post-doctoral training, as well some natural artistry to be skilled with doing smile makeovers. It is not something taught in dental school, nor is it a recognized specialty. As a result, it is up to the patient to figure out the best dentist to do their smile makeover.

I am going to suggest that you use a dentist who has reached accreditation with the American Academy of Cosmetic Dentistry. AACD accredited dentists are proven in both their technical knowledge as well as their artistry. You will get a stunning smile.

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

Dental Bonding Staining After Two Weeks

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I had dental bonding placed just two weeks ago. It has already started staining, which surprised me. I did some research and realized it could be my coffee drinking. It was also suggested that I purchase Supersmile Toothpaste. Do you know if this will allow me to continue drinking coffee or if I will have to give it up? My dentist never told me to stay away from anything in particular.

Carol

Dear Carol,

before and after dental bonding

While it is true that dental bonding will pick up stains after a while, a few weeks is way too soon. I have a supicion your dentist is just a bread and butter general dentist and not one who does any significant amount of cosmetic work in his practice.

Dental bonding is made with a blend of composite and inorganic fillers. There are a variety of fillers and sizes. Some examples of this are silica, quartz, and glass. Hybrid composites are strong, but because their particles are larger they cannot be glossed to a high shine. Microfills, because they are very small, can be polished to a luster as shiny as natural tooth enamel but are not as strong. There is a newer nanofill composite which claims to have both strength and polishability. Because it is new, we have to see how that pans out.

Most general dentists, who don’t do a lot of cosmetic work, will just keep hybrid composites on hand because they are looking for durability. But, when you are talking about appearance, you need a combination. A skilled cosmetic dentist will use the hybrid on the inner part of the tooth and then use the microfills on the surface on the teeth which allows them to get the high shine you need to protect your teeth from staining.

My suggestion is that you return to your dentist and share what you’ve learned here. He should be willing to improve the shine. If he is incapable, then you will have to go to an expert cosmetic dentist.

Whenever we are talking about aethetic dentistry of any kind, I recommend you see an AACD accredited dentist. These are the top cosmetic dentists in the country and can give you stunning results.

I don’t know what your dental bonding was for, whether it was to repair a chip, close a tooth gap, or purely to give you a smile makeover. If you were doing a smile makeover, you will get longer lasting, more beautiful results with porcelain veneers.

As for Supersmile toothpaste, it does an excellent job removing surface stains from dental work. However, if yours has lost its shine, it won’t be helpful there. Save the toothpaste for when your bonding is repaired.

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

I Hate the Way My Implants Look

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Can you help me? I had dental implant overdentures done and when the bridges came in I was very disappointed in them. While they were very bright and white, they looked monochromatic, which in my opinion makes them look fake. They’re also bulkier than I would have expected and the surfaces of the teeth are very round and protruding. My dentist insists that they are up to the highest professional standards and I will get used to them. Is there anything I can do?

Andrea

Dear Andrea,

Woman covering her mouth

I am sorry this happened to you. It sounds like you went to a general dentist who does not understand the foundation of cosmetic work. Her saying it is up to the highest professional standards only refers to functionality. It has nothing to do with beauty of the results. When you are talking about your smile, beauty is an important factor.

The monochromatic look is very telling of your dentist’s cosmetic skill (or lack thereof). Our natural teeth are not uniform. The middle is more opaque than the remainder of the tooth. Plus there are grooves and other texture. All of this requires a high level of technical knowledge on the part of the dentist in order to properly convey instructions to the lab.

What you need is a true cosmetic dentist to re-do this dental bridge for your implant overdentures. At least the upper bridge. Look for someone who is AACD accredited. These are the top cosmetic dentists in the country. I don’t know that you will be able to get a refund from your current dentist on the upper bridge but you can certainly ask.

I hate it when a dentist says, “You just need to get used to it.” That’s dental speak for “I don’t know how to fix this so I’m just going to semi blame you for being too picky and whiny.”

It is unfortunate that your dentist did not care about how you felt about the smile she created you. Fortunately, a better cosmetic dentist can give you something stunning, that you will be proud to show for the remainder of your life.

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

Will Medicaid Cover Porcelain Veneers?

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I’m a forty-seven year old cancer survivor. In the late 90s, I had porcelain veneers placed and really loved them. Unfortunately, the cancer treatments have done a number on my oral health and my gums have receded making my smile look ridiculous. I’m broke from medical expenses but am on Medicaid. Is there any chance because this is a medical issue that they would cover the expense of me getting my porcelain veneers replaced?

Carmen

Dear Carmen,

a porcelain veneer being placed on a tooth

I am sorry about what you went through with your cancer, but am glad you are a survivor! The problem you are up against is government based medical insurance. Let’s say that they agreed this was caused by a medical problem, which they probably won’t if they can get away with it. For instance, they can say you caused the receding gums and you’d have little way of proving otherwise, even though we know cancer treatments are horrible for teeth and gums, etc.

However, let’s say for argument’s sake that they agreed. National health care will only cover the least expensive treatment. In your case, that would mean extracting all of your teeth and giving you dentures. Something you most definitely do NOT want, especially at your young age.

I don’t know what type of dental insurance you have, if any, but I’d start by looking there. If that is no help, your best bet is to just begin to save up so you can get this done right. You don’t have to get all the porcelain veneers placed at once. You could do them one or two at a time as you have money.

Just remember, when it comes to cosmetic work, do not go to the cheapest dentist. This is an art and you want a smile that looks beautiful and a dentist who can match what you loved about your smile makeover, to begin with. There are countless cosmetic dentistry horror stories and you do not want to be one of them. If your original dentist who did your veneers isn’t available, look for someone who is AACD accredited.

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

Did I REALLY Get daVinci Crowns?

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I wanted to get a smile makeover, but have never been happy with the dental work that gets done in my area. I was very upfront with my dentist about this. He suggested that I get dental crowns and we have the work done by the da Vinci lab in California. He said they have a reputation for being the best of the dental labs. I thought this sounded okay and we went forward. When the crowns finally came in, my dentist called me for a try in, but when I got there he said they weren’t happy with the crowns and were going to have them readjusted to meet with what he asked for. I was a bit confused by this because he told me they were the best. Then, before I left, some man came to pick them up and work on them. I don’t think they noticed I saw that. Now, how would a guy from a California lab get all the way to Mississippi the same day? I mean, yes, he could fly, but would they really fly someone out for this or just have the dentist send them back? I’m worried I’m being taken.

Evie

Dear Evie,

a porcelain veneer being placed on teeth

I’m afraid you are being taken as well. My best guess is, if he sent them to daVinci to begin with, that he’s having a local guy make the changes. That is not what you agreed to so he is being dishonest there. I will say there are some other red flags here as well.

When someone wants a smile makeover, the standard for that is porcelain veneers, not porcelain crowns. Now it is possible that you already had dental crowns there and that is why your dentist suggested them. If you didn’t, then that is a sign your dentist is not a skilled cosmetic dentist. They will often suggest crowns because that is a basic procedure they were taught in dental school and porcelain veneers require post-doctoral learning.

What Matters Most – the Dentist or the Lab?

The truth is even though the daVinci lab has branded itself as one of the top ceramist labs in the country, they are a large lab. Not all of their ceramists are what is known as master ceramists. These are the ones who would create the most beautiful work. daVinci will save their master ceramists for some of the top cosmetic dentists in the country and then give the unskilled dentist’s work to one of their lower level ceramists. Why is this?

The reason behind that is no matter how good a ceramist is, it will not make up for the deficiencies of the dentist. When it comes to smile makeovers it is the skill of the dentist that makes all the difference. They design the smile. All the lab can do is follow directions. Granted some follow directions better than others, but even the best ceramist cannot make up for a poorly designed smile makeover.

I am going to suggest you not allow your dentist to bond on these porcelain crowns until you approve them. He should use a temporory try in paste and you should get to see them in several different lightings. If you don’t love them, have him send them back to the lab. If he tells you that you are being too picky, remind him that it is a smile makeover and you are supposed to be picky. If he can’t get it right then maybe he should refund you and let you see a dentist that can do it the way you want.

If it comes to that, you will want to see a dentist who is AACD accredited. These are the top cosmetic dentists in the country.

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

Can Dental Bonding Fix My Peg Laterals?

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I have peg laterals on my upper on either side of my two front incisors. I’ve had them since childhood and I really dislike how they appear. I’ve heard that I may be able to have them “fixed” using bonding–is this true? I’d love to smile without reservation at last.

Many thanks,
Moira

Dear Moira,

before and after dental bonding

This is a great question and one that is frequently asked by others as well.

What Are Peg Laterals?

For those who may not be aware of what you are referring to, let me give a quick rundown. Peg laterals are when the teeth lateral to the upper incisors are malformed. Often they are small and occasionally even pointed. Considered a form of microdontia, peg laterals are congenital and can be hereditary. They are rarely seen in lower teeth.

Will dental bonding help?

The short answer is yes. In fact, dental bonding is often one of the best ways to treat peg laterals and gain an esthetically pleasing smile. You also have the option of porcelain veneers as a solution. Veneers last longer, but are more expensive so which you pick will depend on your budget.

During the bonding process, your natural peg lateral teeth are left in place, and a tooth-colored material is bonded to the surface to bring the size and shape of the teeth in alignment with the rest of the natural incisors. They will be expertly shade-matched, shaped, adjusted, smoothed and polished to match your other teeth and your occlusion, resulting in a pleasing smile.

These should last you several years. As I mentioned earlier, porcelain veneers will last longer and will be more stain resistant, so you will want to look at both options to decide which is best for you.

Getting Beautiful Dental Bonding

The real trick to this is who you have do the procedure, regardless of whether you choose bonding or veneers. Cosmetic dentistry is not taught in dental school so for a dentist to do it well, they need to have post-doctoral training. The top cosmetic dentists are AACD accredited. In your position, I would look for that type of dentist. This way, you will be pretty much guaranteed a gorgeous result.

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

Picking the Color for my Smile Makeover

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I am finally getting a smile makeover and I am trying to pick the color so I know what I want to get when I see the dentist. I am thinking about a BL4 because I want a white smile, but I don’t want it to look unnaturally white. Do you think this is the right choice for me?

Teddy

Dear Teddy,

Comparison of color shades for smile makeovers

 

How exciting that you are finally getting the smile makeover you have always wanted! If you want quite a white smile, but not unnaturally white, I would say either a BL4  or an A1. To be honest, though, the key to a beautiful smile makeover is not the color you choose, but the artistry of the dentist.

You should be aware going into this that cosmetic dentistry is not a recognized specialty. Any general dentist can call themselves a cosmetic dentist even though smile makeovers are not taught in dental school. If a dentist wanted to develop real skills in cosmetic dentistry, they would need to invest in post-doctoral training. It takes both technical skill and an artistic eye to create a beautiful smile.

A great cosmetic dentist will sit down with you and talk about what type of smile you want. They would go over the character (youthful, sporty, etc), color, and a few other things to have a real idea of the smile design you have in mind when you think about the smile of your dreams.

From there, the dentist will design the smile and make a mock up. Even after the lab finishes the porcelain veneers, your dentist should place them with a temporary try-in paste and make certain you get to look at them in a variety of lighting. You should be able to give your approval or suggest changes before anything is permanently bonded.

The safest way for you to find a true cosmetic dentist with real skill is to look for someone who is AACD accredited. These dentists have proven skill and artistry.

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

Are Lumineers My Only Option to Repair Old Dental Bonding?

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I had dental bonding done years ago to cover some tetracycline stains. Over time, the bonding has worn off and picked up stains. I wanted to replace the bonding, but I am in a new state with a new dentist. He is insisting that dental bonding cannot be replaced and I have to get Lumineers. That is a much more expensive procedure than I remember my dental bonding costing me. Are Lumineers the only option or is there something else I can look at, such as teeth whitening?

Carmella

Dear Carmella,

before and after dental bonding

It sounds to me like you are with a dentist that does not do much cosmetic dental work. For one thing, dental bonding can absolutely be replaced. I’m not sure how he does not know that. Secondly, he is recommending Lumineers. This particular brand of porcelain veneers is highly marketed to inexperienced cosmetic dentists as being easy to place.

You have three options for covering tetracycline stains. The first is porcelain veneers. This is the best option because the veneers will last longer than dental bonding. While bonding can give you a few years of stain resistance and heartiness, the porcelain veneers can last your lifetime when well taken care of. This means you won’t have to keep replacing them.

Your second option is to replace the dental bonding. Depending on the surface area, this may actually require more chair time for the dentist which could raise the price. They also have to be done free hand, so you will want to find a cosmetic dentist with a lot of experience covering tetracycline stains with dental bonding.

Finally, teeth whitening is sort of an option but you have to be very determined and patient in order to get it to work. It could take months and months of teeth whitening, which could lead to tooth sensitivity. I would only recommend professional strength take home whitening in this situation.

Your Most Important Decision

Your top priority should be to find a qualified cosmetic dentist to do this work. Tetracycline stains are some of the toughest to deal with. It will require a dentist with a significant about of post-doctoral training as well as an artistic eye. In your place, I would only allow a dentist who reached accreditation with the American Academy of Cosmetic Dentistry touch this. AACD accredited dentists are the top cosmetic dentists in the country. Listen to what his or her recommendation is before deciding on a procedure.

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