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dentistry

Why Is This Porcelain Veneer Popping Off?

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I had some porcelain veneers placed a few months ago. Shortly after, one of the veneers on a canine tooth popped off while I was eating toast. My tooth instantly became unbearably sensitive. I went back to the dentist and he said the problem is that my bite is off. He did some shortening of the porcelain veneer and the tooth. When I asked if I needed to be numbed first, he told me it wasn’t necessary. That was a mistake. The procedure was very painful. Now, that same tooth has fallen off again. I had to go back, again because of the sensitivity. He told me the issue was still my bite and that now he needs to switch it to a dental crown. I’m a bit confused here. I was told these were supposed to last me ten years. I don’t want to destroy a tooth that is healthy. I did ask this dentist about his qualifications before going forward with the procedure. He told me he had a year training in cosmetic dentistry. What do you recommend here?

Patricia

* Note to readers. I asked who the dentist was so I could check up on this training.

Dear Patricia,

a porcelain veneer being placed on teeth

After looking up some information on this dentist, I see no post-doctoral training in cosmetic dentistry. My guess is that he is considering his one-year residency his training. This would not be adequate cosmetic training for smile makeovers even with the most liberal of definitions.

I also do not think your bite is the problem here. I think he does not know how to bond it properly. If it were your bite, then the repair he did to the bite should have fixed the problem. Plus, if a porcelain veneer is properly bonded, then if something is wrong with the bite the porcelain veneer will chip instead of fall off.

Please do not allow this dentist to put a crown on your tooth. He does not know what he is doing. Plus, your porcelain veneer can be bonded back on properly so that it will stay on. Go to either mynewsmile.com or aacd.com. These are two safe ways to get a recommended cosmetic dentist. Anyone on the mynewsmile recommendation list can bond this on properly for you. If you use the aacd site, make sure that you check the box saying that you are looking for an accredited cosmetic dentist. These are the only ones with the right credentials.

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

Full Mouth Reconstruction Going Badly

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I needed a full-mouth reconstruction because of how bad my smile looked. My dentist provided crowns on all my teeth, with the exception of one tooth which he extracted and placed a dental implant. When he did the temporaries for the crowns, everything seemed fine to me. However, now that the permanent ones are in things are off. Some of my teeth are not lining up properly. Because of this, it hurts when I eat. When I spoke to my dentist he said he met all the checkpoints and just to give it time. I went to get a second opinion and the other dentist said, “Oh, Dr. —- [name withdrawn] is a great dentist.” I got the feeling that he didn’t want to disagree with this dentist because they must know each other. In the meantime, I am stuck with this bite that is killing me. Is there any advice you can give me?

Laurie

Dear Laurie,

woman holding her her jaw in pain

I want to make sure I understand that your dentist gave you a full mouth reconstruction simply for cosmetic reasons. Is that right? If so, that is a massive overtreatment. A smile makeover is typically done with porcelain veneers and even then you would not put them on each and every tooth. You would only place them on the teeth that are visible when you smile. Generally, that is the eight to ten upper teeth, depending on the smile.

A full mouth reconstruction is for much more serious conditions and removes a LOT of your tooth structure. A couple of reasons for a reconstruction would be serious TMJ Disorder which does not respond to less invasive treatments; or to cover teeth that are worn down to nubs by bruxism (teeth grinding). Without a clinical reason for crowning all your teeth I would say this was unnecessary. Now, there may have been a good reason that just didn’t get mentioned because it was not relevant to your question. I just wanted to make sure.

Not that it is funny, but I chuckled a little at your dentist’s comment that he met all the checkpoints and you just need to get used to it. That is often dental speak for, “I want you to leave me alone. This is hard and I don’t know how to fix it.” Plus, I’m pretty sure any dentist should consider “My patient is not in pain” as a checkpoint. Just saying…

Occlusion, the term for how your teeth meet together, is an advanced subject. It takes post-doctoral training to understand this properly. It is very possible that your dentist does not have enough training in this area.

Getting a Real Second Opinion

I’m not surprised you didn’t have much luck with your second opinion. One of the cardinal rules in getting an unbiased second opinion is to not tell them who your dentist is. Just ask them about the way the crowns are meeting together and explain you’re in pain. If they ask before giving you their diagnosis, tell them you want an unbiased opinion so don’t want to tell them. They should understand that. When you get that second opinion, make sure you go to a dentist with the training you need. Unfortunately, there is not a recognized specialty in this type of work so you will just need to look for the right training. Two great post-doctoral institutes that instruct on TMJ and occlusion are the Dawson Academy and the Pankey Institute. Any dentist who has studied there, will be able to give you a truly educated diagnosis.

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

Can I Bleach My Non-Veneered Teeth?

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I have four porcelain veneers placed on my teeth. I asked for them to be really white, which they are, but wasn’t thinking about how dark the teeth next to them would look. Is there a way for me to whiten them with something like Crest Whitestrips?

Evie

Dear Evie,

teeth whitening trays

Professional Teeth Whitening Trays

I have a solution for you but I want to address your smile makeover first. Most smiles are eight to ten teeth wide, so four porcelain veneers will make your non-veneered teeth quite obvious. Because of the difference in color, it can even make the veneered teeth look fake. Don’t beat yourself up about not knowing this. It was your dentist’s job to point this out. When a patient cannot get enough teeth to cover their smile, teeth whitening is recommended before the veneers are placed. That is too late for you now, but that doesn’t mean this can be worked around.

Though, Crest Whitestrips will whiten teeth, I do not recommend them in this situation. First, the gel that they use are much weaker because they are over-the-counter. Second, they are only designed to cover your front four to six teeth, depending on the size of your teeth. Those are the veneered teeth and not what you want to whiten. It won’t damage them, but it is pretty useless.

My suggestion is that you go to your dentist and have him custom design teeth whitening trays to fit around your porcelain veneers. This will allow you to whiten your teeth much more quickly while protecting your gums and avoiding your veneers.

I hope this helps.
This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

30K Cosmetic Dentistry Disaster

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

Laurie

Dear Laurie,

Woman Holding her jaw in pain

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

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

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

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

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

Why Do I Need Root Canals after Porcealin Veneers?

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My dentist gave me a complete smile makeover with veneer crowns. When the permanent ones were placed in, two of them had sharp pains. The dentist adjusted them about 3 times and eventually the pain went away. However, not long after those same teeth developed abscesses on the top of them. He did some x-rays and said that the nerves died and those teeth need a root canal treatment. I was a bit shocked because he never mentioned nerve damage as a possibility. He said he didn’t know why it happened and I’m just unlucky when it comes to this. Since then, three more teeth have needed root canal treatments and two more teeth are starting to hurt. I feel like each of these teeth are going to “fail” at some time. I also feel like I’ve been taken advantage of. Is there anything I can do about this?

Miranda

Dear Miranda,

Comparison of tooth preparation between dental crowns and porcelain veneers

I am going to start by clarifying some terms because there is something that has me concerned you were misled. You mentioned you received a smile makeover with veneer crowns. That is not a thing. There are porcelain crowns and there are porcelain veneers. The two of these are very different procedures. You can see that even from the type of tooth preparation necessary.

Notice in the image above, on the left side there is a LOT of tooth preparation. This is what happens when your teeth are given dental crowns. On the right, is the preparation for porcelain veneers. I believe you were given crowns for a couple of reasons. First, it is pretty much unheard of for someone to need a root canal treatment as a result of porcelain veneers. Second, you said something about the permanent ones. It is dental crowns which start with temporaries and then go to permanent. However, there are times you’re given a mock up of your porcelain veneers and allowed to try them in to see if that is what you were wanting for your smile makeover.

A smile makeover does not require the aggressive grinding down of the teeth. That is why porcelain veneers are the standard. With dental crowns, if there is too aggressive a tooth preparation the dentist risks exposing the pulp. This is what I think your dentist did. Many dentists who did not invest in post-doctoral training will do porcelain crowns instead of veneers because it is what they are more familiar with. If your dentist lied to you and hinted you were getting veneers, then you need to demand a refund as well as for him to cover the cost of the root canal treatments. If he didn’t say you were getting porcelain veneers and you just assumed that, you can still ask him to cover the root canal treatments because he is the one who ground down your teeth too aggressively.

I’m sorry you are dealing with this. For those reading this considering a smile makeover, it is always better to have a smile makeover done by someone with the right training. I would recommend you use a dentist who is AACD accredited.

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

Treating Enamel Hypoplasia

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I am frustrated with my smile and tired of always hiding from pictures. We’re thinking about starting a family and I don’t want to avoid photos during my child’s entire life. What are my options for treating this?

Caroline

Dear Caroline,

Congrats on starting a family. I can completely understand why you want to feel comfortable and present for pictures. There are a couple of good options for you in giving you a smile you can feel proud to share with the world. For those who are unaware of what enamel hypoplasia is, it is a defect, which is caused either by genetics or an illness during the formation of the teeth, that causes to the enamel of the teeth to not fully form.

Mild and severe enamel hypoplasia

Treating Enamel Hypoplasia

With mild hypoplasia, you have two good options. The first is dental bonding. With this procedure, your dentist will drill or sand out the white spots and then fill the tooth with composite resin. This is done freehand and will be finished when you leave. It is the least expensive of the two options but does need to be replaced periodically.

Your second option is to have porcelain veneers placed over your teeth. If you are dealing with severe hypoplasia, as pictured above, this would be the only option I would recommend. With porcelain veneers, thin wafers of porcelain are bonded to your teeth. They are the go-to for those Hollywood smile makeovers and can not just cover the hypoplasia, but completely redesign your smile. Porcelain veneers can change the size, color, and even shape of your teeth.

Pick the Dentist Carefully

Both of these are cosmetic procedures. Unfortunately, cosmetic dentistry is not a recognized specialty yet. This means that any dentist can call themselves a cosmetic dentist. To make matters worse, smile makeovers are not adequately taught in dental school. If a dentist wants to develop skills in creating smile makeovers, then they will need to invest in post-doctoral training. Not many dentists do.

So how are you to know the real deal from the pretenders? Well, you could ask them where they got their post-doctoral training in cosmetic work and then ask to see their smile gallery to see what type of artistry they have. Another option is to look for a dentist who has been accredited by the American Academy of Cosmetic Dentistry. AACD accredited dentists have passed stringent exams on the technical procedures as well as demonstrated a high level of artistry in the work they do.

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

Did I REALLY Get daVinci Crowns?

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

Evie

Dear Evie,

a porcelain veneer being placed on teeth

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

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

What Matters Most – the Dentist or the Lab?

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

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

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

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

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

Can Dental Bonding Fix My Peg Laterals?

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

Many thanks,
Moira

Dear Moira,

before and after dental bonding

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

What Are Peg Laterals?

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

Will dental bonding help?

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

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

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

Getting Beautiful Dental Bonding

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

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

Picking the Color for my Smile Makeover

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

Teddy

Dear Teddy,

Comparison of color shades for smile makeovers

 

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

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

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

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

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

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

Are Lumineers My Only Option to Repair Old Dental Bonding?

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

Carmella

Dear Carmella,

before and after dental bonding

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

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

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

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

Your Most Important Decision

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

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