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dentistry

Replacing a Front Tooth While on Fosamax

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I had to replace a tooth adjacent to my right front tooth. Right now I have a dental flipper and absolutely hate it. I wanted a dental implant but my dentist said that’s not possible because I take Fosamax. I suggested a dental bridge and he doesn’t want to do that either because it will crown the adjacent teeth which he says are fine. That’s true, but I want to get rid of this flipper. Would an Encore Bridge be an option?

Bruce

Dear Bruce,

Three stages of a dental implant

Can you get a dental implant while on Fosamax?

It is possible to get a dental implant while on Fosamax. Your dentist’s concern has to do with the increased risk of local bone problems when having oral surgery. While the risk is small, the complications are serious. Don’t minimize the risk. One possibility is to temporarily suspend taking Fosamax, under the cooperation of your physician who should oversee this.

If you decide against getting a dental implant, a dental bridge is fine, and a better permanent option for you than a dental flipper. That being said, let your dentist pick the type of bridge. You definitely don’t want to be the first patient he or she has done an Encore Bridge on. Some dentists are your basic bread and butter dentists who can only do the “standard” work. That brings up an important point about your dental implant.

Who Should Place Your Dental Implant?

The concern your dentist mentioned is legitimate, however you should be aware that sometimes a dentist will steer you away from a procedure because they aren’t comfortable or qualified to do it. They don’t want a patient to lose confidence in them so instead they come up with reasons to discourage that particular procedure.

You don’t want to push a dentist into a procedure they are not comfortable doing. This usually ends in disaster.

Dental implants are an advanced procedure. You’re in a high-risk group, so it makes it even more important you have an experienced, qualified dentist to do it for you. Look at Dr. Weiss’ qualifications to get an idea of what type of dentist you are looking for.

Another consideration is cosmetic. You’re talking about matching a single crown to your front teeth. You want someone with the cosmetic skill to make it blend both beautifully and naturally. The best cosmetic dentists are accredited by the American Academy of Cosmetic Dentistry.

In your place, I’d look for an AACD accredited dentist who has a high success rate in dental implants.

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

Cosmetic Dentistry Malpractice

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

Patricia

Dear Patricia,

A woman smiling with a beauttiful smile

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

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

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

Dealing with Shoddy Smile Makeovers

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

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

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

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

Crowns for Chipped Tooth

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I’m not sure what to do and need some advice. I tripped and ended up chipping one of my front teeth. It’s not a huge chip, but it bothers me. My sister told me that dentists can fix chipped teeth even if you don’t have the broken piece. I went in to see my dentist. While he did say he could fix it, he said the solution would be for him to crown my two front teeth. I’m not too keen on that, especially because the other tooth is fine. When I asked him why both teeth, he said so that they could match. While I get that they need to match, it feels stupid to grind down two healthy teeth. I’m worried I’m letting my vanity get in the way of sensibility. What do you think? Crown the teeth or live with a small chip?

Elaine

Dear Elaine,

While I am sure your dentist is trying to do his best for you, I’m going to recommend you see someone else to repair this chipped tooth. Many dentists need to do two crowns on front teeth to match them, however, there are great cosmetic dentists who can match a single crown. If a crown were the right course of action, then another dentist could do the treatment just on one tooth.

The easiest way to find a highly skilled cosmetic dentist is to look on the website of the American Academy of Cosmetic Dentistry (aacd.com). They have a link to help patients find a cosmetic dentist. However, you want one who has reached the accreditation level. AACD accredited dentists are the top cosmetic dentists in the country. Any one of them can match a single porcelain crown to a front tooth.

All that being said, you really don’t even need a crown on the one tooth let alone two. Yes, a crown will cover the chip, but there are much less aggressive ways to repair it.

Dental Bonding for Chipped Teeth

before and after dental bonding

Dental bonding is the standard treatment for a chipped tooth.

The standard treatment for this is to have dental bonding placed on the tooth. This uses a composite resin which a cosmetic dentist will sculpt freehand onto the tooth. I wouldn’t push your family dentist to do this. It is obviously not a procedure he is familiar with and it would take some technical skill along with artistry to do it right.

Instead, I would find an excellent cosmetic dentist and have them do the procedure. You won’t have to completely switch dentists. You can still go to your family dentist for everything else,

There is a cosmetic consideration here (aside from the chipped tooth). Whatever color your dentist makes your bonding is permanent. If you are even considering having teeth whitening done on your teeth, it will save you money to do that before you have your bonding done.

Otherwise, your natural tooth structure will whiten but not your bonding. Then you’ll have to have the bonding re-done to match the newer color.

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

Best Dentist for a Recovered Bulimic

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I’m looking for a dentist for my daughter. She’s a recovered bulimic. I’m super proud of all the steps she’s taken to get a healthy mindset again. She’s been out of recovery for six months and has done spectacularly. I thought it was time to reward her new habits with a smile makeover. When she was purging it did tremendous damage to her teeth. I want her smile to reflect her beautiful spirit. I am just not sure how to find the right dentist for this type of situation. Any advice?

Kaylee,

Dear Kaylee,

A woman smiling with a beauttiful smile

It is great that your daughter has such wonderful support from you. That will help her go far for the remainder of her life. It’s also great you are doing some research ahead of time. I can’t tell you how many cosmetic dentistry horror stories there are of patients who went to an inexperienced cosmetic dentist. This would be the last thing your daughter needs.

Most cosmetic dentists have experience with bulimic patients. They are sensitive to how they’re affected by their smile and will not be judgmental, which is important. Equally important is their skill in creating beautiful smiles. Sometimes porcelain veneers are sufficient, but depending on the severity of the damage, she may need some dental crowns as well.

Because of that, you’ll want a dentist who understands not only how to create beauty but knows how her bite should come together if a lot of crowns are necessary.

Finding the Best Cosmetic Dentist

There isn’t a recognized specialty in cosmetic dentistry. This leaves patients in the quandary of figuring out who is skilled and artistic and who isn’t. The American Academy of Cosmetic Dentistry recognized that issue and started an accreditation program to serve both patients and dentists interested in cosmetic work.

Dentists can take classes to improve their skills. Plus, they can strive for accreditation. To get accredited, dentists have to pass stringent oral and written exams. In addition, they have to provide visual evidence of a large number of cases they’ve personally done in order to show their artistry in their work.

In your place, I would look for an AACD accredited dentist. They are the best cosmetic dentists in the country and will give your daughter a smile she’ll be proud to share with the world.

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

Should I Get a Second Opinion from a TMJ Specialist?

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I mentioned to my dentist that I wish my teeth were whiter. He mentioned because I have two crowns, I’d need to get those re-done first to match. He also looked closer at all my teeth and said my bite is off which means I have TMJ and need to get all the teeth crowned to fix it. This seems a bit excessive to me. Plus, it really surprised me to hear my bite was off. I had braces in my middle school years and didn’t feel like anything had changed since then. I’m thinking I should get a second opinion. What do you think?

Carla

Dear Carla,

Woman in pain with TMJ

I’m a little concerned with what I’m hearing. Let’s start with the teeth whitening. You don’t crown teeth to whiten them. Yes, you have a couple of crowns and they will have to be re-done to match but that will be AFTER your teeth are whitened. Not before. Otherwise, how will he know what shade of white to make them?

Now, about this crowning every tooth. This is called a full-mouth reconstruction and is usually reserved for more severe TMJ Cases. You haven’t mentioned any symptoms of TMJ Disorder. Without that, you should have serious doubts about this recommendation.

TMJ Symptoms

  • Jaw Pain
  • Popping in Your Jaw
  • Clicking in Your Jaw
  • Migraines, especially in the morning
  • Teeth Grinding or clenching

See a TMJ Dentist

I agree you need a second opinion. There isn’t a recognized specialty in TMJ Disorder. As such, there aren’t really any TMJ “Specialists”. However, there are dentists who have invested a great deal of time in studying TMJ Disorder and the different treatment options. Treatment is determined by first finding the underlying cause.

You want a dentist who has studied TMJ and occlusion at one of the reputable post-doctoral schools, such as The Dawson Academy, the Las Vegas Institute of Advanced Dental Studies, and The Kois Center.

Dentists who’ve studied at one of these schools are qualified to help diagnose your problem and come up with a good treatment. Most dentists prefer to start with the most conservative treatments first to see if that solves it before delving into something as invasive (and expensive) as a full-mouth reconstruction.

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

Implant Overdentures with Diabetes

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I’ve had dentures for a few years and really hate them. Now I learned that they’re the worst replacement I could have gotten because they will contribute to my jawbone shrinking. I’d like to get implant overdentures to replace them, but I have Type 1 Diabetes. My dentist said that is a contra-indication for dental implants. If so, what can I do?

Martin

Dear Martin,

Implant overdentures

 

I feel like you haven’t been getting the best dental advice available. Your dentist should have forewarned you about facial collapse when he suggested dentures. He also hasn’t been completely forthright in regard to your question about diabetes. It is not a contra-indication. However, it does put you at a greater risk of implant failure than other patients.

What you’ll need is careful diagnostics previous to your procedure and close monitoring throughout. Make sure they are willing to take more care with you. I want you to see a dentist with significant post-graduate training in the dental implant procedure. Look for someone who’s trained at the Dawson Academy or the Las Vegas Institute of Advanced Dental Studies.

I think it’s also important you go to a dentist who is skilled in both the placement and the restorative (cosmetic) aspect of your case. If they can’t be the same person, they’ll need to work in close communication so there is complete coordination between them to ensure everything goes smoothly.

Benefits of Implant Overdentures

You’ve already mentioned the biggest benefit to implant overdentures. You will no longer have to worry about losing the minerals in your jawbone. Instead, having implants will signal to your brain that those minerals are needed. You will not suffer from facial collapse the way you will if you continue with dentures.

There are other quality of life improvements as well. You won’t ever have to worry about your overdentures slipping or sliding. They will be completely secure. You can eat what you want. You can brush and floss normally. It’s like having a healthy set of teeth again.

Who Should Do the Cosmetic Work?

When it comes to the appearance of your new teeth, you’ll want them to look natural. However, this is also an opportunity to improve the look of your smile at no extra cost. As I said earlier, your dentist should also be skilled in cosmetic work along with the implants. The best cosmetic dentists are accredited by the American Academy of Cosmetic Dentistry. He or she can help you design the smile of your dreams.

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

My Porcelain Veneers Look Fake

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I’ve cried since getting home from the dentist. I spent years worth of savings to get a beautiful smile, but it looks totally fake. They’re bulky and chalky white. Honestly, to me, it looks like my dentist bonded pieces of white chicklet gum to my teeth. I told him what I thought and he said I am overreacting and am just not used to what they look like. He said in a week I’d be thanking him. Maybe he’s right but all I can do right now is cry. Am I overreacting?

Patricia

Dear Patricia,

A single porcelain veneer being placed

I can’t tell you how much it breaks my heart every time I hear a story like this. It sounds like you went to a family dentist who dabbles in cosmetic dentistry but hasn’t invested time in serious training to develop his knowledge, skill, or artistry. Based on the description of the results (and I’m taking a guess here) he likely placed Lumineers.

Lumineers are a brand of porcelain veneers which are highly marketed to inexperienced cosmetic dentists as being easy to place because they are considered “no-prep”. The problem with no-prep veneers is they often look bulky when they’re finished. Their lab also isn’t known for its beautiful work. Most expert cosmetic dentists prefer other brands of porcelain veneers.

If they are permanently bonded on, the only way to fix it is to have them replaced. The first thing I would do is tell your dentist this isn’t the smile you paid for. If he cares about the quality of his work and satisfaction of his patients, he’ll be willing to re-do it. If he does, make sure he lets you see them on your teeth with a temporary try-in paste. This way you can approve them before he bonds them on again.

If he’s unwilling, one thing I’m going to suggest you do is see an expert cosmetic dentist. Look for one in your area who is AACD accredited. They are the best cosmetic dentists in the country. They may be able to help you secure at least a partial refund. Then, you can let the skilled dentist do your smile makeover.

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

Safety of Dental Implants from a Dental Student

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I wanted to get a dental implant and spoke with my dentist about it. He said I was a good candidate, but the price he quoted me is beyond what I have. Someone from church mentioned I might be able to get it cheaper at a dental school. I’m all for more affordable, but wanted to double check this was a wise option. Would this be a safe way to get dental implants?

Lizzie,

Dear Lizzie,

Three stages of a dental implant

Going to a dental school will cost less. They do that both to draw patients in for their students to practice on and because you are getting a less experienced caretaker.

It is up to you to weigh the risk versus reward and decide which you think is the most important factor to you.

Dental Implants at Dental Schools

Dental schools are very careful. They are there to teach their students best practices. There is always an instructor there to check the student’s work. All that being said, this is an advanced procedure and even uncomplicated cases, such as yours, still require surgery.

It will be the dental student which implants the prosthetic tooth root. Even expert implant dentists who’ve been doing the work for years will sometimes have a procedure fail.

There are things which can go wrong and although there is an instructor there, it is a matter of whether or not this dentist is skilled at recognizing issues quickly enough to intervene.

Paying for a Skilled Implant Dentist

If you decide you’d rather see an implant dentist with more experience, then you can see if they have in-house payment plans. They may not. But, even when they don’t, dental implants are generally paid for in two phases. First, you would pay for the implant surgery. Then, after a period of healing, you would pay for the dental crown.

If that is still out of reach, there is a medical credit company that could pay the fee to the dentist and allow you to pay it out to them. You can apply for Care Credit online. They have low and even no interest plans. If you have basically good credit, you shouldn’t have a problem.

If it turns out you absolutely cannot have a dental implant, getting a dental bridge, which is simply a false tooth suspended between two dental crowns) is a perfectly acceptable tooth replacement option.

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

Why Can’t Lumineers Make My Teeth Longer?

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

Mischa

Dear Mischa,

Lumineers Advertisement

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

Smile Makeovers Aren’t Taught in Dental School

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

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

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

How to Get a Guaranteed Beautiful Smile Makeover

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

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

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

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

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

Blotchy Teeth After Bonding

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I had Dental Bonding done because of some chips and some wear of my enamel. The bonding itself was so bulky I couldn’t speak properly. My dentist said she’d remove it but when she did my teeth ended up looking splotchy. My dentist insists this is how my teeth looked before but I know it isn’t. What do I do?

Catherine

Dear Catherine,

before and after dental bonding

It sounds to me like your dentist, who may be a decent general dentist, doesn’t understand cosmetic work at all. If she’d done it right to begin with, your teeth wouldn’t have been bulky. This is especially true because you were only getting chipped and worn teeth fixed.

Look at the before and after picture above. This is a case Dr. Weiss did for a patient. Her teeth look natural and there is no added bulk. When dental bonding is done properly, the results are beautiful and natural.

I haven’t seen your case, but based on what you’ve described, I think I can guess what happened in her removal process. She likely went past the bonding and ended up taking off some of your natural tooth enamel. The structure underneath is a different color and will end up making your teeth look splotchy.

When Dental Bonding Goes Wrong

You can ask her for a refund. If she cares about her results, she should give you one. However, without a “before” picture to show what your teeth looked like before the bonding, you won’t have any proof that they didn’t look splotchy beforehand. There’s no way to hold her to a refund without proof.

Again, this is also evidence she’s not a true cosmetic dentist. They always take before and after pictures.

The only way to fix this is to have your case completely re-done. Please don’t use the same dentist. You need a great cosmetic dentist this time around.

In your place, I’d look for an AACD accredited dentist. These are the top cosmetic dentists in the country. They will give you a stunning smile.

Before you move forward with the procedure though, you may want to look into porcelain veneers instead. These are much more durable than dental bonding and will last for many more years.

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