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My Smile Makeover Is Turning Yellow

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I spent a good amount of money hoping to get my dream smile makeover. It’s been a disaster from the beginning. I selected a very white color because my natural teeth were very white. I just didn’t like their shape. My dentist gave me six porcelain crowns. However, when the came in they didn’t look as white as I expected. He assured me it is the color I asked for. Now, to make matters worse, the crowns seem to stain every time I even drink something. I am going in for a consultation with another dentist and I have no idea what to even ask him. Do you have any recommendations?

Dinah

Dear Dinah,

a porcelain veneer being placed on a tooth

Porcelain Veneers

I am sorry this happened to you. The first thing I’d like to ask is why dental crowns? Typically, a smile makeover is done with porcelain veneers. Was there some decay on the teeth that required crowns or were there already crowns there? Either way, it is water under the bridge. Those teeth will always need dental crowns from now on because the structure of the tooth has been ground down to fit the crowns over them.

One other thing that bothers me is why the crowns are picking up stains. If he truly gave you porcelain crowns, they would be very stain resistant. In fact, they’d be even more stain resistant than your natural teeth. I’m prone to wonder if he just said they were porcelain but used some other type of material. That is the first thing I’d have the dentist you are going to for a consultation look at.

However, let’s back up a bit. What makes you think this dentist you are going to get the consultation from is any better than the one who provided your disappointing results to begin with? I would make sure you are going to an expert cosmetic dentist. Look for someone who is AACD accredited. Then you’ll be certain to have an expert with both technical and artistic skill to work on your smile.

By the way, if it turns out your dentist gave you something other than porcelain crowns, you can get your money back because of misrepresentation.

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

Teeth Whitening Before a Dental Crown

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I am getting a dental crown on a white tooth and I want to do a touch-up on my teeth whitening before I get it. I asked my dentist how long I would have to whiten my teeth each day and for how many days to get them back to their original color when I first whitened them three years ago. He couldn’t tell me so I am wondering if there are some tips you have.

Bethany

Dear Bethany,

teeth whitening trays

 

I am going to help you with this, but before I do I want to let you know that I am concerned that your dentist was unable to answer these type of questions. Teeth whitening is a fairly straightforward procedure. If he can’t deal with that I would not trust him to place a dental crown on your front teeth. We’ll go over how to find a dentist who can in a moment.

The Basic Principles of Teeth Whitening

The main idea behind whitening your teeth is the longer you wear the whitening gel, the faster your teeth will whiten. You can wear them one hour a day, but they whiten faster than if you wear them several hours a day or overnight. Because each person’s teeth are different in the amount of staining and how white they want them, there is no way to quantify a number of days/hours. The one constant is you want to leave a week between when you stop your teeth whitening and when you begin the procedure for your dental crown. This is because the teeth will continue to whiten during that time period.

Getting a Crown on a Front Tooth

Crowns on back teeth are no big deal. The color doesn’t have to match exactly. However, matching a single crown to a front tooth is a completely different story. All the light hits your front teeth making all the differences much more visible. Even the best cosmetic dentists will do a couple of try-ins before settling on it being just so.

Ideally, you would want an expert cosmetic dentist to do this. Look for a dentist who is AACD accredited. Then you can be certain they will get it right. If your dentist cannot tell you about teeth whitening, I would not let him near this crown.

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

 

Smile Makeover Disaster with Tetracycline Stains

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I have tetracycline-stained teeth. I went to my dentist who is very reputable and has done a great job for me over the years. I was considering porcelain veneers, but my dentist talked me into porcelain crowns saying that they would help cover the stains better. This did not turn out to be the case. The gray is visible with each of the crowned teeth AND the crowns look fake, so it’s obvious I have fake teeth. But, not even pretty fake teeth. He said he can send them back to the lab. I’m so confused. I looked online and there is a woman from a different dentist who has beautiful teeth after getting her tetracycline teeth made over and she used porcelain veneers! What has gone wrong with my teeth? Will doing them again with crowns make a difference? I don’t think I can get porcelain veneers after I have crowns, right?

Leslie

Dear Leslie,

a porcelain veneer being placed on a tooth

You are correct that you will always have to have crowns now that you have them. This is because the teeth have been ground down to little nubs. That tooth structure is gone. In a way you have answered your other question already. You said, “…a woman from a different dentist.” The key to any smile makeover is the dentist who does it. One warning sign is when a dentist suggests porcelain crowns over porcelain veneers when the tooth is healthy and does not need a crown. These dentists are either not comfortable doing porcelain veneers to begin with or do not have enough skill in them and think that the added structure of dental crowns will make it easier to cover the stains.

Sending it back to the lab will only help if he can give them good directions. A lab is more like a pharmacy who fills the prescription of the doctor. It is the doctor that has to come up with the right diagnosis and the appropriate medicine for it. I am not convinced he can write the correct directions. However, there is no harm in allowing him to try. If you do that, do it on the condition that he uses a temporary try-in paste and if you don’t love them the second time then you get a refund. You should get to see them in several lights before making a decision.

If you end up needing a refund, you will want to look for an expert cosmetic dentist. The easiest way for you to do this is to look for a dentist who is accredited with the American Academy of Cosmetic Dentistry. AACD accredited dentists have proven skill and artistry. They can give you a beautiful smile whether using porcelain veneers or porcelain crowns.

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

Implant Teeth Don’t Match

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I had to get two dental implants on teeth that you can see when I smile. One is a front tooth and one is a canine. The implants themselves seem okay, but the teeth parts don’t match my other teeth. I’m guessing if they were beside one another they’d match each other, but they look weird and matte compared to the rest of my teeth. Is there anything that can fix this?

Ruth

Dear Ruth,

Diagram of a dental implant

There is always a way to get a dental crown to match your other teeth. However, your dentist may not have the cosmetic skills to do it. I would start by asking him to redo them. But, this second time, tell him you want them placed with a temporary try in paste, so you can make certain they match before they are permanently bonded on.

If he’s unwilling to re-do them, and the dental implants themselves are in good condition, you won’t have much recourse. You may have to bite the bullet and pay for new porcelain crowns by a dentist who has more cosmetic skills than your current dentist.

If it does come down to that, look for a dentist who is accredited with the American Academy of Cosmetic Dentistry or one recommended on the mynewsmile.com website. Dentists from either group will be able to create beautiful crowns that blend in perfectly with your natural teeth. Just make certain they have dental implant training as well so they understand how the crown will fit with the implant.

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

Crowns Versus Veneers for Tetracycline Stains

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I have tetracycline stains on my teeth and really want a pretty smile. I spoke to one dentist who has a good reputation in cosmetic dentistry, name Dr. —–[name withheld].  He wants to charge me $42, 000 for upper and lower full mouth veneers. Another dentist is suggesting porcelain crowns and is only $28,000. I really only have $30,000 to budget for this, so I should probably go with the crowns. However, I wanted to double check with someone not invested in getting my business as to crowns versus veneers for tetracycline stains. Is one better than the other for this? Plus, you should know I have a tooth grinding problem, which may impact your answer.

Carla

Dear Carla,

a porcelain veneer being placed on a tooth

 

The first dentist you mentioned, who is suggesting porcelain veneers is one of the top cosmetic dentists in the country. If you decide to go with him, he will provide you with a stunning smile. You didn’t give the name of the second dentist, but I am cautious about recommending him either way because he is suggesting dental crowns.

Tetracycline stains are some of the trickiest to deal with when it comes to a smile makeover. You have to get the teeth opaque enough to cover the stains, while still creating a natural looking translucency to the teeth. To compensate for the difficulty, some dentists will suggest dental crowns instead of porcelain veneers thinking the added thickness will make it easier for them. It doesn’t. I find porcelain veneers to be the superior treatment. As for your bruxism (teeth grinding), if you get a nightguard to wear while you sleep it will protect you from the grinding damage. So that will not be an issue.

If your budget is the main reason for going to the cheaper dentist, I am going to suggest a different approach. I know the quality you will get with the first dentist. Why don’t you have him just do your upper arch and use a strong teeth whitening, such as Kor Whitening to do on your lower teeth. It will take a bit to get the lower teeth to match, but if you are persistent they will. Then, you are only paying $21,000, which is below budget and will have a stunning smile.

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

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.

Do they Do Crowns for Smile Makeovers?

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I am a little confused about my smile makeover. I thought I was getting porcelain veneers, but when it was done, they seem to cover the whole tooth, not just the front. Is this normal for porcelain veneers? Should I be concerned?

Penny

Dear Penny,

a porcelain veneer being placed on a tooth

You are correct that porcelain veneers just cover the front of the tooth. If yours are going all the way around your tooth, then that means you were given porcelain crowns. Every once in a while, in the midst of preparing a smile makeover, a dentist may notice a tooth that has an issue and needs a crown instead of a veneer, but your dentist should have discussed this with you before going forward.

Preparing a tooth for a crown is much more aggressive than for veneers. It also weakens your teeth and puts them at a greater risk of breaking further on down the line. I would talk to your dentist and ask him the reasoning behind doing crowns? It was unethical to make the change or misrepresent what he provided you.

The thing to ask at this point is how your feel about the look of your smile makeover. Crowns or veneers, are you in love with the smile? If so, I wouldn’t ask for a refund. however, I will tell him you are concerned about the weakening of the teeth and ask him to take some responsibility if a tooth breaks as a result.

If, however, you are not pleased with the smile makeover, you are within your rights to ask for a refund. Then, I would like you to get this re-done by a skilled cosmetic dentist. In your place, I would look for an AACD accredited cosmetic dentist to redo your makeover.

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

Having Trouble Speaking After Porcelain Veneers

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I had a full smile makeover done with 10 porcelain veneers. The temporaries that he put on felt great and I didn’t seem to have any problems. However, since he’s put on the permanent ones, I have had trouble speaking properly and my tongue seems to feel out of place, like it doesn’t fit in my mouth anymore. Is this normal? If so, will I adjust to them and be able to speak normally?

Alicia

Dear Alicia,

a porcelain veneer being placed on a tooth

To answer your first question, no, this is not normal. It would be hard to tell you exactly what is going wrong without examining you, but I can give you some guidelines. One thing I am concerned about is whether your dentist actually gave you porcelain veneers or if he instead gave you porcelain crowns and called them porcelain veneers. Some unethical dentists do this. The reason I am concerned about this is that veneers just sit on the front of your teeth. Without them being done crazy wrong, they should not affect your speech. Dental crowns, however, go around your entire tooth. If they are not done correctly it will definitely affect your speech pattern.

Another thing that is odd here is your temporaries felt okay and you didn’t have any problems, but the permanent ones are an issue. That means your dentist didn’t send the model to the ceramist and maybe only sent images, or your dentist’s ceramist did not follow directions.

In some cases, people adjust to the position and are able to speak normally again. If you give it a month or so and your speech is still affected, I would insist on a refund so you can get this done right elsewhere. You could give your dentist a chance to do it right, but if he’s dishonest I’m not sure how skilled he is.

Smile makeovers are not taught in dental school. Dentists have to invest in post-doctoral training to know how to do them both properly and beautifully. If you decide to go to another dentist to get this repaired, I would look for an AACD accredited dentist. These dentists are the best cosmetic dentists in the country. To get accredited, they had to pass stringent exams as well as have a large number of their cosmetic cases evaluated for its technical correctness and artistry by a board of examiners. You can feel confident you will not only get a beautiful smile, but a functional one as well.

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

Horrible Color on My Front Teeth

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I had to have zirconia crowns placed on my front teeth. My dentist sent me to a prosthodontist. I have a bit of dental anxiety and so he suggested dental sedation. He assured me I’d be able to see the crowns before they were bonded on. Unfortunately, that didn’t happen. He said I saw them and approved them, but I have no recollection of that. I am sure that if I had seen them, I would not have approved them. They are completely gray compared to the rest of my teeth. The dentist is absolutely refusing to replace them, saying that I approved them and they are fine. What do I do? I absolutely do not smile anymore. My teeth look ridiculous to me.

Marion

Dear Marion,

Woman covering her mouth with hand.

You shouldn’t feel ashamed to smile after having dental work done.

I’m very sorry for the experience you’ve had. We often see these type of cosmetic dentistry horror stories with people who get smile makeovers from an inexperienced cosmetic dentist. Most patients don’t realize that cosmetic dentistry isn’t a recognized specialty. If a dentist wants training in cosmetic work, they have to invest in post-doctoral training.

Unfortunately, this means every general dentist can call themselves a cosmetic dentist, regardless of the amount of training they’ve attained. This has resulted in some disastrous results. With a prosthodontist, it can actually be a worse scenario. This is because they think their extra training in restorations also makes them experts in cosmetics as well. Unfortunately, that is not the case.

This seems to be what you are facing. He fancies himself an expert and feels justified in not replacing his ugly work. Unfortunately, if the work is functioning it can be hard to get a refund, but I’ll give you some tips for that later. You do have one thing working in your favor.

He would be hard-pressed to say you were lucid enough to truly give approval. It’s never a good idea to use a strong sedation when there is cosmetic work involved, unless the patient is highly anxious. If that is what you are dealing with it is in both your and the dentist’s best interest to try you in provisionals for a while to ensure that you are satisfied with them, while you are in the best possible state of mind.

I’m also a tad curious about his choice of zirconia crowns for front teeth. These come in blocks and are milled into the shape needed for the tooth. Unfortunately, this has a very flat appearance. A wise cosmetic dentist would put a layer of porcelain on top of the zirconia. Porcelain can be done in varying levels of translucency which more mimics your natural tooth structure.

The best way to get a refund from one dentist is to get another one on your side. Often when a dentist won’t listen to a dentist they will listen to a peer. My first recommendation is for you to get a skilled cosmetic dentist, preferably an AACD accredited dentist, to look at them and share their opinion about the appearance. There are some more tips that you can find here.

I also think the dentist who referred you has some responsibility to make this right as well. If your teeth look bad, he or she could pressure the dentist into replacing them. After all, much of his patients will come from referrals. He should want to make sure your dentist is comfortable recommending him.

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

Smile Makeover on a Fractured Tooth

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Years ago, I had an accident which fractured some teeth. They received both root canals and dental crowns. As years past, my smile started to show it’s age. I decided to get a smile makeover after my last promotion. I went to see a highly recommended cosmetic dentist in my area. She did a combination of dental crowns and porcelain veneers. I love how it looks and am much more confident. My problem now is with tooth #9. It’s been sensitive ever since and there is a pimple on the tooth next to it. My cosmetic dentist thinks that the tooth needs to be extracted and to have a dental implant placed. I’m also getting a root canal treatment on the adjacent tooth. I’m attaching the x-ray to see if you think the tooth really needs to be extracted. I just had the restoration done and it seems like a waste of money to remove the tooth. I’ll also send a picture of the new smile in case you need it.

Aaron

Dear Aaron,

Aaron's Tooth X-rayI am in agreement with your cosmetic dentist. Looking at the circled tooth, in the middle of the root there is a horizontal radiolucent line. This is an old fracture that was either missed by your old dentist who worked on your teeth after the accident or he thought he could get out all the necrotic tissue and save the tooth.

Below the fracture looks healthy. However, above it the tooth looks moth-eaten. That tells me there is probably an infection there. Removing the tooth, will be the safest thing to do. A dental implant is a fantastic replacement so your dentist was right about that too.

Looking at the images you shared of your smile makeover, the dentist you choose was skilled. I’d stick with her for the dental implant as well.  However, she should have caught the fracture and infection.

Because she didn’t, it isn’t unreasonable to expect some flexibility in how this is paid for. Originally, had it been properly diagnosed at the beginning, you would have paid for an implant and a crown.  I’m going to suggest you ask to pay for the implant, but not the new dental crown to go on top of it because you just paid to have one placed. I don’t think she’ll have a problem with that.

From your x-ray, I have noticed one other issue. It looks like another tooth that had a root canal treatment, didn’t get done properly. You see the tooth on the left has filling material that stops a few millimeters short of the end of the root. I wouldn’t do anything about it unless it flares up. For now, the tooth itself looks healthy.

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