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Is It Possible to Save Some Money on a Nice Smile Makeover?

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When I was younger I wore braces, but didn’t wear the retainer afterward like I was supposed to. Now my teeth are shifted and not centered. I also have chips and dings and some teeth are worn down from grinding. I know you have to go to an expert cosmetic dentist for this. My neighbor recently had a smile makeover and his dentist did a fantastic job, but the cost was $35,000. I can’t afford that. Is there a way to get an attractive smile makeover without it costing quite so much?

Aaron

Dear Aaron,

a porcelain veneer being placed on a tooth

A smile makeover is generally done with porcelain veneers, though because of your teeth grinding you may need some porcelain crowns as well. The most important aspect of any smile makeover is the skill and artistry of the dentist who does it. Each dentist’s prices vary depending on a great deal of factors including property and salary costs in their area.

There are two resources I can give you where you can safely price shop. Do NOT just call around to random cosmetic dentists looking for a cheap price. You will end up with a cosmetic dentistry horror story. Just use the dentists on these two lists I’m going to provide. The reason I say that is each of these cosmetic dentists have been screened for their training, technical knowledge and skill, as well as their artistry. Any one of them can provide you with a beautiful smile makeover. In these cases, you can go with the most affordable.

The first resource has a list of AACD accredited dentists. You will go to AACD.com and click on “find a cosmetic dentist”. Make certain you check the box for AACD accredited. Accreditation is completely different from membership, so that is vital. These are the top cosmetic dentists in the country.

The second resource is mynewsmile.com. The dentist that runs this website is a retired accredited dentist. He prescreens dentists who want to be listed. They can’t get on there without massive skills. While many are accredited on his list, some are still in the process of accreditation, which takes years, but have the skills necessary now.

I hope this helps!

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

Are All On 4 Dental Implants Okay?

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My husband is losing his teeth and we went to see our dentist about some options for him. He said we should get the all-on-4 dental implants. Are these as good as the regular ones?

Esther

Dear Esther,

Illustrations of all on 4 dental implants

All-on-4 Dental Implants

 

First, I want to check something. Was this the ONLY option he discussed with you? If so, I’d be wary. There are many options for tooth replacements. I’d be careful with any dentist who does not give you all of y our options. It means they are pushing a procedure on you. Where the all-on-four procedure is useful is when a patient has lost bone structure, but is not a good candidate for a bone grafting procedure. If he has plenty of bone structure, then this would be a stupid option for him. Instead, I would get him the traditional dental implant solution.

I am unclear from your question if he is losing all of his teeth or if he is just starting to lose some teeth. If he is only losing some teeth, then getting an individual dental implant for each of the lost teeth will be fine.

Implant overdentures

Implant overdentures

If he’s lost all of his teeth, then the more affordable option would be to get implant overdentures. This will use four or more dental implants and then, after the implants have had time to integrate with your bone, a denture will be anchored to them. These are very secure. Another way these are superior to all-on-4 implants is in failure. If one dental implant fails, you will replace that implant. With all-on-4, if one implant fails then the entire unit needs to be replaced.

What I would like you to do is get a second opinion from a dentist with good post-doctoral training in dental implants. To get an idea of the type of training you want, look at Dr. Weiss’s bio. This is important because dental implants are an advanced procedure and they are barely touched on during dental school. That additional training can make the difference between a successful case and a dental implant horror story.

There is an additional consideration. This is his smile. You want to make sure the dentist has some decent cosmetic skills. I would either go to an implant dentist who is AACD accredited and/or recommended on the mynewsmile.com website. They will be able to give them a smile he will be proud to share.

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

Brown Spots on Teeth

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My teeth are very healthy. I’ve never even had a cavity. However, I have these ugly brown spots on several teeth, including my very front teeth. My dentist and I have been trying all the over the counter teeth whitening brands, but they all seem to make it look worse. My dentist is wondering if she should grind the brown spots off, but admitted she doesn’t know if it would work or how far she’d have to grind. That sort of makes me nervous. Would professional teeth whitening work any better?

Mazie

Dear Mazie,

teeth whitening trays

 

I am very glad you wrote. It sounds like you have a dentist who cares about you, but she is in way over her head. Please don’t let her experiment on you any longer. She will end up doing inadvertent permanent damage to your teeth.  Cosmetic dentistry isn’t taught in dental school. In order for dentists to learn these procedures, they have to take post-doctoral classes. To do it well they need a lot of time invested in the training. Your dentist hasn’t done that yet. That’s okay. Some dentists just prefer to be a general dentist and help people have healthy teeth. Obviously, together the two of you have accomplished that.

Teeth whitening, even professional strength, will not work on the type of stains you are dealing with. As you have discovered with the over-the-counter brands, it makes them look worse. This is because the whitening gel bleaches the teeth evenly. It doesn’t change the unevenness in the color.

Solution for Brown Spots

You have two good options available to you. The first is dental bonding. The second is porcelain veneers. If there are just a few brown spots and you are happy with every other aspect of your teeth, I’d recommend the dental bonding. It’s less expensive.

However, if the brown spots are extensive or if there are other things about your teeth you’d like to change then I’d recommend porcelain veneers. These are the go-to for total smile makeovers and can change the shape, size, and color of your teeth simultaneously. They are more expensive but do more and last years longer.

Finding a Qualified Cosmetic Dentist

Even though smile makeovers aren’t taught in dental school, there isn’t a recognized specialty for cosmetic dentistry either. That means it is up to the dentist how much, if any, cosmetic training they get before treating patients.  This makes it tricky for patients to know who can create beautiful smiles and who can’t.

I always suggest patients pick their dentist from the mynewsmile.com website. This site is run by a retired cosmetic dentist. He prescreens any dentist who wants to be listed to ensure they have not only the right technical knowledge but the artistry required to create a beautiful smile as well. Any dentists he lists will be able to give you the stunning smile you’ve always wanted.

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

Smile Makeover Gone Wrong

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

Camille

Dear Camille

a porcelain veneer being placed on a tooth

 

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

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

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

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

Tips for Getting a Dental Refund

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

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

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

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

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

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

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

Dentist Said there is no Color to Match my Teeth

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I don’t know what to do. I’ve never had a dental crown before and this one is on my very front tooth after a nasty fall. My dentist said that my teeth are so white that there is not a color to match a crown to it. He’s done the whitest shade available and it is still several shades darker than my teeth. He’s a new dentist for me because we just relocated. I just had to go to a dentist who saw new patients quickly for emergencies, so I don’t know much about him. I’m having my doubts about what he is saying, though. Is there no way to match white teeth?

Brianna

Dear Brianna,

I think what you are facing here is a dentist who may be a decent bread and butter type dentist but has no clue when it comes to dental aesthetics or cosmetic work. You are not going to have a beautiful, or even natural looking, dental crown done by him.

Standard Vita Shade GuideHere is where part of his confusion lies. Based on what you’ve said, he is still using the standard shade guide (pictured left). Before teeth whitening became both popular and affordable, this was the shade guide dentists turned to when they needed to match a dental crown to existing teeth.

A patient’s teeth would always fall somewhere close to one of these shades. Then, in the 1990s, teeth whitening skyrocketed. Dentists started seeing patients come in with teeth whiter than anything on their shade guides. This is because bleaching your teeth, doesn’t just whiten the stains. It can whiten your natural tooth structure as well. That means your teeth can actually become whiter than their natural white.

Eventually, a new shade guide addition came out that added some whiter shades to meet the demand for whiter teeth (pictured below).

updated Vita shade guide

Your dentist is facing an additional problem that he won’t know what to do with as well. Front teeth are harder to match. This is because the light hits them more directly revealing all the subtleties and variations in the shades and translucency. He will need to understand color theory and tinting in order to get a perfect match. That would have required extensive post-doctoral training in cosmetic dentistry, which I sincerely doubt he’s done.

In your place, I would either look for a dentist who has reached accreditation with the American Academy of Cosmetic Dentistry. AACD accredited dentists are the top 1% of cosmetic dentists in the world. If there isn’t one in a reasonable distance to you, then another good resource for finding excellent cosmetic dentists is the mynewsmile.com “Find a cosmetic dentist” link.  They prescreen all dentists who want to be listed there for their technical knowledge and training, as well as the artistry of their results.

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

Dental Bonding Doesn’t Match

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I chipped a tooth and did some research on repairs. The consensus was dental bonding was the best repair. I did get that, but the bonded part doesn’t even come close to matching the tooth part. It is so obvious there is a repair there. Is that normal? If not, who do I get this fixed? Will I have to pay for it?

Casey

Dear Casey,

before and after dental bonding

As you can see from the image above, dental bonding can and should look completely natural blending in seamlessly with the natural tooth structure around it. The problem you are facing is the dentist who did the procedure, not the procedure itself. It can be fixed and should be done at the dentist’s expense.

Doing bonding well is challenging because it has to be done freehand. This means the dentist either needs some natural artistic ability or invest significant time and money in the practice and training necessary to do it well. Not many dentists do that.

The first thing I recommend is you give your dentist another chance to get the dental bonding to look natural with your other teeth, with the understanding that if he can’t do it to your satisfaction, he’ll provide you with a refund so you can get it done properly. There is a reasonable expectation that the bonding matches the tooth.

If it turns out he can’t do it or just prefers to give you a refund, you’ll want to find an expert cosmetic dentist to do your dental bonding.  I suggest looking for an AACD accredited dentist or a dentist recommended on the mynewsmile.com website. These are the dentists that have the skill and artistry to give you a natural-looking result.

One other thing to be aware of in case your dentist didn’t tell you before your original bonding. Once the bonding is completed, the color is permanent. If you want to whiten your teeth later on, your natural tooth structure will whiten but not the dental bonding. Then, the only way to get them the same color again is to re-do the bonding. Because of that, I generally recommend to patients that they have any teeth whitening done before the bonding. However, you also have the option of waiting until it is time to replace the bonding. I just didn’t want you unaware of the limitations and then having to spend unnecessary money replacing your bonding early.

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

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.

Will These CEREC Veneers Look Good?

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I am going to a new dentist because of a job relocation. Before moving, I’d been saving up for porcelain veneers and now have the sufficient funds. However, my new dentist wants to do CEREC veneers which are 1.5mm thick. I’m worried that is too thick and he doesn’t have any before and after pictures to show me of cases he’s done in the past. My last dentist had something called a smile gallery. Should I be worried?

Elaine

Dear Elaine,

A woman smiling with a beauttiful smile

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

The materials and thickness of any smile makeover are not nearly as important as having the right cosmetic dentist do the work. Of course, a great dentist will choose the best materials, but it is their skill and artistry which matters. Doing smile makeovers are not taught in dental school. Instead, a dentist interested in doing cosmetic work must invest in post-doctoral training.

I’m a little concerned about the fact this dentist does not have any visual evidence for you. Any dentist who wants to be taken seriously as a cosmetic dentist will have what is known as a smile gallery. This should show before and after pictures of various cosmetic procedures which they have done.

Can CEREC Veneers be Beautiful?

You can get a beautiful smile with CEREC veneers as opposed to porcelain veneers, however, it is more challenging. I would say only about 1-2% of cosmetic dentists could do it well. Some dentists try to do this to save on fees with a ceramist which isn’t a great reason.

So how would you know if your dentist can pull this off before investing all your hard-earned (and saved) money? There are two great resources to tell you about skilled cosmetic dentists. The first is aacd.com. This is the website for the American Academy of Cosmetic Dentistry. They offer an accreditation program. In order for dentists to get accredited, they have to pass stringent exams as well as provide visual evidence of their artistry with a large number of specific cases. AACD accredited dentists are in the top 1-2% of cosmetic dentists in the world. When you use their search feature, make sure you check the box for an accredited dentist.

Your second resource is mynewsmile.com. They don’t allow dentists to just pay to be listed. Instead, they check their educational qualifications for cosmetic work as well as require evidence of cases they’ve done to ensure they have an artistic eye. Many of their listed dentists are either accredited or on their way to accreditation. Any of them can create a beautiful smile for you.

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

Porcelain Veneers During Pregnancy

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I’ve been saving up for a smile makeover for years. Now, when I finally have the full amount I needed I find out I’m pregnant. Is it safe for me to go forward with this or do I need to wait until after delivery?

Madison

Dear Madison,

A single porcelain veneer being placed

While there are some procedures which are not recommended in the first trimester, such as teeth whitening, porcelain veneers should be quite safe. The concern is about introducing chemicals to the baby. With porcelain veneers, the only thing you have to worry about is the anesthetic used. Fortunately, lidocaine has been tested and proved safe for use during pregnancy and even delivery. You and your baby should be fine.

Who Should Do Your Porcelain Veneers?

There is another important consideration— who should do your smile makeover. This isn’t a skill taught in dental school, nor is there a recognized specialty where dentists become graduates in the field. Instead, dentists with an interest in cosmetic dentistry have to take the initiative to get the proper training post-doctorally.

This makes it a little challenging for patients. How can they separate the sheep from the goats, so to speak? The easiest way to handle this is to find an AACD accredited dentist in a reasonable distance to you. These dentists have been tested vigorously for both their technical knowledge and their artistic ability and are among the top 1% of cosmetic dentists in the country.

They will give you a stunning smile.

If you can’t find an accredited dentist without a significant amount of travel, which you’re probably not keen on while pregnant, you still have options.

The mynewsmile.com website also recommends excellent cosmetic dentists. Not all of them have reached accreditation, but they’ve all been carefully screened for their ability to do beautiful smile makeovers. Most are on their way to accreditation.

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