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Cosmetic and
restorative
dentistry

Full-Mouth Reconstruction to Whiten Teeth?

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I need to make some important choices soon. I have a dental crown that is about 20 years old and two porcelain veneers that are a bit older. I’ve been experiencing some dry mouth. I’ve chipped the veneers on the front teeth and now there is a gray line at the gumline by the crown. I went to my dentist to discuss replacing them. Because my smile is no longer very white, he is suggesting I get crowns on both my upper and lower arch to do a smile makeover of sorts. The more I think about it, the more concerned I am, especially with my dry mouth. It may be better for me to just replace the old work and wait to see what happens with the dry mouth first. What do you think?

Carolyn

Dear Carolyn,

teeth whitening trays

The first thing I am going to suggest is that you get a different dentist. If I understand you correctly, your dentist is suggesting crowning all of your teeth because your teeth need to be whitened? Really?

So, here’s the thing. Whitening your teeth will bring him in a few hundred dollars. Crowning all your teeth, known as a full mouth reconstruction, will bring him in $30,000+. Your dentist is being self-serving. The best dentists are doing their best to serve their patients without unnecessary expense for his or her benefit and while preserving as much tooth structure as possible. He’s doing neither.

My suggestion is you have your teeth whitened and then just replace the damaged dental work. However, I don’t think your dentist should be the one to do it and not just because he’s grabbing for the bucks. There is another warning sign that he isn’t what you need. When a dentist suggests dental crowns instead of porcelain veneers for a smile makeover, it is because they are not comfortable doing porcelain veneers. Doing crowns in a case where they are not needed is a waste of healthy tooth structure.

As you likely know from the crown you already have, in order to make room for the restoration, he’d have to grind your teeth down to nubs. This is irreversible. Once you have dental crowns you will always have to have dental crowns. It is much better to do porcelain veneers when it comes to a smile makeover.

Now, you do already have one crown. You mentioned a gray line at the gumline. This tells me the original dentist did a porcelain-fused to metal crown. On a front tooth, what you really want is an all-porcelain crown.

What you need is a skilled cosmetic dentist to take over. In your place, I’d look for an AACD accredited dentist. These dentists are in the top of the cosmetic field and have proven skill and artistry. You’ll have a smile you are proud of.

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

Full Mouth Reconstruction Disaster

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I needed to replace some old veneers and two crowns. When I saw my dentist, he said that he’d need to open my bite a bit so my teeth would show more. I never considered that a problem, but figured there was a reason. The temporaries are very uncomfortable I asked him to redo them twice. Then when the permanents came in, he put them in so fast, I hardly had a chance to check them out before they were permanently bonded on.

I’ve had massive problems since and can’t even shut my mouth all the way. I have been drinking water and sloshing it around my mouth constantly. If I don’t, my lips stick to my teeth. I spoke to my dentist about it and he said he’s hit all the checkpoints and his work is perfect. What do I do? I don’t feel like I can continue like this.

Pam

Dear Pam,

Woman covering her mouth with hand.

This is unacceptable for you. When your dentist tried to open your bite, which I am not convinced was necessary, it sounds like he was in over his head as well. Additionally, it doesn’t sound like he cares. He ignored every concern you had during the temporaries. This is the stage that is imperative to help ensure the bite is perfect. He should never have moved forward until your bite was completely comfortable. He blew past that and placed the permanent ones in a rush.

Now that they’re on and not doing well, he’s ignoring you again. This time, putting your oral health at risk. What you are experiencing is lip incompetence because he opened your bite too much. He’s really messed up and doesn’t want to admit it.

The only way to fix this at this point is to completely have the case re-done. However, you don’t want to have this dentist do it. To be frank, he doesn’t know what he’s doing. You need another dentist to do this for you. I also think your dentist needs to be the one to pay for it. It is his mistake.

Who Should Re-Do This?

You need a dentist with both cosmetic and restorative training. When you do, make sure the temporaries are exactly the way you want them before the case goes any further. A good dentist will know this, but I don’t want you suffering the same way again, so I just want to make sure you don’t allow anyone to move forward without satisfactory temporaries.

What that means is, your lips will come naturally together, your bite “feels” normal to you, and you love how they look. Unfortunately, smile makeovers and advanced restorative procedures aren’t taught in dental school. A dentist has to study this in a post-doctoral setting, though it isn’t required for them to practice. If at all possible, you should get an AACD accredited dentist to do your case. They will be the most likely to have the training and the skills necessary to do this for you.

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

Do Dental Crowns Cause Dry Mouth?

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I’m having a really hard time with dry mouth ever since getting all my teeth crowned. I know it was a cosmetic procedure, and while the teeth look okay, I have to really focus on keeping my mouth closed. Never in my life did I think I’d be what my kids call a “Mouth Breather.” Is there a way to fix this or is it normal and I’m just not used to a wider smile?

Kathy

Dear Kathy,

A woman pointing at her smile

No this isn’t normal. Was there a particular reason your dentist did dental crowns instead of porcelain veneers. You mentioned it was cosmetic work. Generally, when someone is getting a smile makeover, porcelain veneers are the go-to. It removes less tooth structure.

Some inexperienced cosmetic dentists will do porcelain crowns for smile makeovers because that is what they’re familiar with, but it unnecessarily grinds down healthy tooth structure. It’s water under the bridge at this point as it is already done. I just wondered if there was a functional/mechanics reason for doing something so drastic. That leads me to my next question.
Why every tooth? Most smiles are about eight to ten teeth wide. Doing every tooth is excessive, not to mention expensive.

What your dentist did is known in dentistry as a full-mouth reconstruction. It’s an advanced procedure that isn’t typically taught in-depth, if at all, in dental school. Instead, dentists would seek out post-doctoral training.

Lip Incompetence is Dangerous

When you can’t close your lips naturally and are having to consciously force it, we call that lip incompetence. It is going to rain havoc on your teeth and oral health. While many people think brushing is our biggest defense against decay, the reality is our saliva has an even greater impact. It contains bacteria-fighting minerals that protect your teeth. Dry mouth deters saliva and allows that bacteria to multiply unhindered.

In creating this problem, y our dentist made a serious mistake. He (or she) needs to pay to get this fixed. Don’t just ask for a refund because the fix will likely be more expensive than the original procedure. If he complains about this, you may want to hint to him that another dentist told you that you have a valid case for malpractice damages. That should get his attention.

A Word about Smile Makeovers

You said the smile was “okay”. An okay smile would not be what you were stuck with when it came to a true cosmetic dentist. When you go to get this full mouth reconstruction done correctly, I want you to look for a dentist who is accredited with the American Academy of Cosmetic Dentistry.

AACD accredited dentists are in the top 1% in their field. Not only will you be able to close your mouth naturally and comfortably, but you’ll also have a stunning smile you will be thrilled to show off to the world.

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.

Will Porcelain Veneers Solve My Problem?

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I have never liked my smile and I am finally in a position to do something about it. Here are the issues:

  • It’s extraordinarily difficult to show my upper teeth.
  • When my mouth is at rest you cannot see them at all.
  • I have pretty constant jaw pain, except for when I wear my nightguard at night for my teeth grinding.

What I’d like is to be able to see my teeth and maybe even improve my appearance. I’d also like my jaw to hurt less, like the way it does when I’m wearing my nightguard. Would porcelain veneers be my best solution?

Laurie

Dear Laurie,

woman holding her her jaw in pain

While porcelain veneers are the go-to procedure for a smile makeover, your situation is a little more complicated. It sounds like you are facing a collapsed bite along with TMJ Disorder. This requires a different approach. You will need to open your bite. This is typically done as full-mouth reconstruction with dental crowns. However, I want you to proceed with caution.

Only a small percentage of dentists are able to do this procedure correctly. When it isn’t properly done, it ends up making things much worse. Here is the way I’d recommend a dentist proceed.

You want whoever does your full-mouth reconstruction to start by using provisional crowns to open your bite. This way it is reversible. When you are completely out of pain and love the appearance of your smile, that is the time to move forward and the dentist can make the permanent crowns.

What Qualifications Do You Want in Your TMJ Dentist

It’s important whatever dentist you choose has extensive post-doctoral training in TMJ Disorder. For instance, Dr. Weiss did his TMJ training with the renowned Dawson Academy. Other reputable institutions would be the Kois Center and the Las Vegas Institute for Advanced Dental Studies.

You also want to ask them what experience they have in full-mouth reconstruction. You definitely don’t want to be their first case.

Cosmetic Considerations with Your New Bite

While you are opening your bite, you are also getting a smile makeover. Because of that, it is important you find a dentist who is a top of the line cosmetic dentist. Ideally, you’d want an AACD accredited dentist. The good news is finding such a dentist will likely take care of both sets of qualifications.

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

Her Dentist Seems Negligent

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I’ve never had a cavity so I don’t know what to expect. I do grind my teeth in my sleep, but I had a check-up just two months ago and everything was fine, so I don’t know what is causing this. Recently, I feel like someone is pulling on my back teeth for a second and then releasing. It’s happening on both sides of my back teeth. Is this a cavity or something else?

Candy

Dear Candy,

woman holding her her jaw in pain

I’m concerned about what I’m hearing. You said everything was declared fine at your last appointment, but if you have been grinding your teeth than it most certainly isn’t alright. When you grind your teeth, it can lead to serious problems such as TMJ Disorder. Not to mention you can grind your teeth down to nubs. This will require you to need dental crowns on all your teeth. This type of full-mouth reconstruction is expensive.

Your dentist should have discussed this with you and warned you of the repercussions. This is especially true because the solution is to simply wear a nightguard.

It’s possible your dentist is just one of those bread and butter dentist who only looks at things like cavities and doesn’t check on other important issues such as bruxism and gum disease.

Your issue doesn’t seem like a cavity. However, bear in mind with anything I am telling you that I haven’t exactly examined you. Your situation sounds more like what would happen if you had gum disease. Though, for it to get to the point you have pain would be rather serious. You would be to the point of bone loss, which means you could start losing teeth.

Because you have just started feeling the pain, I tend to think it might be that you are experiencing pain because of your teeth grinding.

I’m going to recommend you see another dentist to get a thorough examination. At the very least you are going to need a nightguard. But, I’d like your gums checked as well.

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

Jaw Pain from Dental Appointment

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I had my teeth prepared for both crowns and porcelain veneers on my upper arch. I’m almost a week out and my jaw is still in massive pain. I ache constantly. My dentist suggested taking Ibuprofen, which I have been, but I feel like I’m living on the pills. Could my dentist have caused a TMJ problem? He’s going to be gone for a week. Do I need to see another dentist or can I wait until he gets back?

Missy

Dear Missy,

woman holding her her jaw in pain

This sounds pretty normal for what you’ve been through. Your mouth had to be propped open for quite a while. Soreness in your jaw is to be expected. It may even go on for another week or so. In addition to the pain medicine, you can do hot and cold compresses to help give you some relief.

If your dentist is gone for a week, he should have made arrangements with another dentist to care for his patients in the case of a dental emergency. I don’t think this is one, but if things get worse you can call your office and there should be a number on their answering machine for the dentist he’s made arrangements with.

Symptoms of TMJ Disorder

While jaw pain is a symptom of TMJ, that in isolation isn’t usually a sign. There are generally other things which accompany jaw pain. Some examples would be:

  • Popping or clicking of your jaw
  • Migraines, especially in the morning
  • A change in your bite
  • Neck pain

If any of these symptoms develop, that would be when you should talk to a dentist about TMJ disorder. There are tests a dentist can run to help determine if this is an issue for you.

Don’t go to any dentist about this, though. You want a dentist who has invested time in TMJ training after dental school. You’ve had what sounds like a full-mouth reconstruction. When this is done properly, it can actually treat TMJ disorder. But, if it is done improperly it can make things worse. That’s why you should keep an eye on those other symptoms.

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

TMJ and Dental Crowns

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I have TMJ. It’s been under control for a while, ever since I had a night guard made. However, recently, the pain has returned in force. I think it is because of how tall this crown is, but my dentist says it isn’t. This crown hits the upper teeth before all my other teeth. He’s adjusted it three times and told me that is as good as it gets. He said this happens to many first time crown wearers and I will get used to how it feels. Fine, but what about the TMJ pain? Should I get a second opinion?

Misty

Dear Misty,

Woman in pain with TMJ
Poorly place dental crowns can cause serious damage

On the contrary of needing a second opinion, I think you need a new dentist. This one is not serving you. In fact, he’s either ignorant or deceptive.

The way your teeth meet both adjacently and with their opposing teeth is extremely important. It’s obvious he hasn’t put much time in studying this, which will lead to disaster for his patients.

Normally, your biting force is spread out over all of your teeth. However, when a dental crown is seated to high, it takes on the full force of your bite. Not only does this cause pain on biting, but you also are causing problems to the rest of your bite.

If you have TMJ Disorder, this will exacerbate it. If you don’t have TMJ disorder, it can lead to it.

Finding a TMJ Dentist

As you look for your new dentist, and I strongly suggest you get one, I want you to look for one who specifically has TMJ training. For instance, Dr. Weiss studied at the renowned Dawson Academy known for its TMJ training.

Additionally, he’s been treating TMJ successfully since the 1990s and has a very high success rate. His advanced TMJ training combined with his cosmetic training and expertise in smile makeovers makes him uniquely qualified for the toughest TMJ treatment, reserved for the most advanced cases, a full-mouth reconstruction.

That’s the type of dentist you want to look for in your area so you can make sure you don’t face exacerbated TMJ problem again.

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

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