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dentistry

Why Has My Smile Makeover Lost its Shine?

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I am planning on asking my cosmetic dentist the same question I am asking you, but want to go into the appointment with as much knowledge as possible. Just over six months ago I had a total smile makeover done on my upper teeth with porcelain veneers. For the bottom teeth, we just did teeth whitening. I chose my cosmetic dentist very carefully and he is one of the tops in the field. The smile makeover itself was stunning and I was thrilled with the results. It cost me quite a bit of money, but I have looked at it as an investment. I’ve been very diligent with my oral hygiene as I want this to last for many years to come. My routine consists of brushing twice a day with Crest 3D Glamorous White Toothpaste, flossing once a day, and then rinsing with Listerine Whitening 6 in one with Fluoride. Despite all this effort, my porcelain veneers have lost their shine. Now they look quite dull instead of having the lovely sheen they had when I first came home with them. I went online where someone suggested I use baking soda. I did, but did not see any improvement. Can you help me here?

Samantha

Dear Samantha,

Woman with a beautiful smile

I am delighted to hear that you were satisfied with your smile makeover and that you are striving to take such good care of it. Let’s start with what you are using to care for your smile. Both the toothpaste and the mouthwash you are using can cause some minor damage to your porcelain veneers. Nothing to the extent you are describing, but they will contribute. Typical whitening toothpaste at the stores rely on abrasives to remove the stains on your teeth. With porcelain veneers, these abrasives will scratch the veneer and eventually, leave it very susceptible to staining. Listerine, like most mouthwashes, contains alcohol. This will also damage the veneer, but it mostly damages the bonding materials.

As I mentioned before, this isn’t really enough to lead to the amount to anything significant this quickly, I can think of two things that would result in the damage you are describing. The first is if your dentist provided you with composite veneers instead of porcelain veneers. While porcelain is extraordinarily stain-resistant, even more so than your natural teeth.  Composite, however, picks up stains quite easily. You said you researched your dentist quite carefully, so I am not inclined to think this is the issue. It would take a very unethical dentist to place composite veneers but call them porcelain.

A second possibility is that your hygienist used something on your porcelain veneers that damaged the glazing. A couple of things you need to avoid during your cleaning/checkup appointments are the power prophy jet and the acidulated fluoride. If you go to a practice that does a lot of cosmetic work, the staff should be well trained enough to know this, but it is always possible you had someone new.

Your dentist can repair this. He should do so at his cost. Once they have that shine again, I want to make sure you have the right toothpaste to care for them. If you want a whitening toothpaste, the only one I recommend for people who have had any type of cosmetic work, especially a complete smile makeover, is to get SuperSmile Toothpaste. This is specially formulated to work with cosmetic procedures. There are no abrasives at all. Instead, it uses knowledge of chemical binding to remove the stains on your veneers. It is 100% safe. As for mouthwash, you can forgo it altogether or look for one that does not contain alchohol.

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

 

Dental Bonding Versus Porcelain Veneers

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My daughter has two lateral incisor peg teeth that we are ready to repair. Our dentist wants to do four porcelain veneers on her teeth to have them match. It was quite pricier than we expected, so he suggested he could do dental bonding for 1/5 of the price. This sounds like a great solution but I heard they don’t last as long. Should we do the cheaper one and just plan on re-doing it more often?

Millie

Dear Millie,

before and after dental bonding to repair a chipped tooth

I have some concerns here. First, the fact that he has to do four teeth instead of the two peg teeth tells me he is not comfortable with his skill level. He does not feel like he can match the lateral incisors to the front teeth so he wants to do all four which will make it easier for him. However, that doubles your cost and is totally unnecessary. A second thing that worries me is the cost he quoted you.

In reality dental bonding is best used for small repairs such as the one above for a chipped tooth. If a dentist tries to do it over the entire surface area of the tooth it would actually be more work than doing veneers. This is because composite bonding has to be done free hand. It would actually cost close to the same amount or possibly even more than the porcelain veneers.

My suggestion is that you want to get her teeth done you do it right. I would go to an expert cosmetic dentist and let him or her do just two porcelain veneers. Look for someone who are accredited by the American Academy of Cosmetic Dentistry. The accreditation process requires true technical expertise and artistry to pass. They are in the top 3% of dentists.

You didn’t mention how old your daughter is. If she is young, her teeth probably are not very stained. However, if she’s an adult, she will have developed some surface stains on her teeth which is a natural result of living. If that is the case, I would suggest you get her teeth whitened before you have the veneers done on her teeth.

Porcelain veneers can be made to any color, but once they are made the color is permanent. If she decides to whiten her teeth a few years later, her natural teeth will whiten but not her veneers. It is more financially responsible to whiten ahead of time. If you don’t the veneers will have to be replaced.

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

Thoughts on Premium Home Teeth Whitening

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I’ve been wanting to do a smile makeover for a while. Recently, I received an offer in the mail for Premium Home Whitening. Then, I received a Groupon offer for the same thing. It is less than what my dentist charges. I was wondering if it will really work or if I will be wasting my money.

Katherine

Dear Katherine,

teeth whitening trays

I looked into this. There are some good and bad things about this. First the good. The whitening ingredient they use is 35% carbamide peroxide. This is a valid whitening ingredient and will whiten your teeth. That is great. Now for the less than good news. The light they advertise seems bogus. This makes me uncomfortable with the company. If they are willing to lie to patients to draw them in, how do we know their ingredients are what they say they are? I don’t like deception.

A second thing to consider is the whitening tray. When you get teeth whitening done with your dentist, he or she will prepare custom fitted trays. This both protects your gums for being irritated by the whitening gel as well as keeps the gel concentrated on your teeth by not leaking or by letting saliva in to dilute it.

The tray you get with this will not be not be custom fit. Instead, it will sort of fit. However, your saliva will weaken the gel meaning you won’t get as much whitening out of each kit as you would with your dentist.

You mentioned the price was more than your dentist, but did not say how much more. One thing I would do is tell your dentist how much the kit is and ask him if he can come close to that so you will be able to do the procedure with him under a professional’s care. My guess is if he is not willing to, some dentist will be.

If you are thinking about improving your smile, teeth whitening will make you and your teeth look younger. If you are looking for a complete smile makeover, the way to do that is with porcelain veneers. However, while teeth whitening can be done with any dentist, porcelain veneers require an expert cosmetic dentist. If you decide to go that route, my suggestion is you only do that with a dentist who is AACD accredited.

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

Can I Get a Better Smile without Bonding?

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I have slightly discolored teeth, due to aging. A few years back, I also fell and chipped my front tooth. My dentist did composite bonding on that and I’ve never been happy with it. It doesn’t match the rest of my teeth and never has. Plus, there is a gap that wasn’t there before. I went to him about the discoloration for all my teeth to see what he’d recommend and he wants to do composite bonding on the top eight teeth. I am a little leary of this given how the gap turned out. Is there another way to handle this?

Kevin

Dear Kevin,

before and after dental bonding

You bet there are other ways to handle this. My first suggestion would be to simply have professional teeth whitening done. This will take care of the discoloration you are talking about.

The next step would be to replace the badly done dental bonding. The problem you faced with the bonding was not the procedure as much as it is the dentist who did the procedure. He could have matched your teeth perfectly and not had any gaps. The fact that he was not able to accomplish that tells me he is not a skilled cosmetic dentist.

If the only things you want to change about your smile are the color and this bonding, then I would simply find a better cosmetic dentist. Look for an AACD accredited dentist to do your work. These are the best cosmetic dentists in the country.

If, however, there are other things about your smile you are hoping to change, then I would look into getting porcelain veneers. These can give you a complete smile makeover. They’re able to change anything about your smile, including the color, shape, size, and character.

Like the dental bonding, it will require an expert cosmetic dentist, but when well cared for they will last for many years. Whatever you do, don’t go back to the same dentist who could not get your chip repaired properly.

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

Getting Two Front Teeth to Match

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My daughter is about to graduate high school. Several years ago, she had an accident which damaged her two front teeth. One needed a root canal treatment and both of them received dental crowns. The one that had the root canal has turned gray over the years.  For her graduation, we were taking her to get these teeth cosmetically fixed. Our intention was for her to have a beautiful smile in time for her senior pictures. Our dentist said he could replace those old crowns with porcelain veneers. The problem we’ve had is they don’t match. The dentist said because one tooth is grayer they can never match. I wish he would have told us this before we spent several thousand dollars. Is there anything we can do to get these teeth closer together in appearance? Are we being too picky? I feel like we’re letting our daughter down.

Lorraine

Dear Lorraine,

You are not letting your daughter down. Your dentist is, though. There are a few issues going on here that need to be addressed. First, I don’t know what your dentist was thinking saying he was giving you porcelain veneers. If your daughter had porcelain crowns, the only thing he could replace the crowns with is more porcelain crowns. It was unethical of him to claim to be giving her veneers when he didn’t. We see this quite often. Patients come to us disappointed in the “veneers” their dentist provided only to find out they are actually crowns.

a porcelain veneer being placed on a tooth

To give you an idea. The image above shows a porcelain veneer being placed. As you can see, it is a thin wafer. A dental crown, on the other hand, is bulkier and completely surrounds a tooth that has to be ground down to a nub to make room for it.

A second issue I see is his inability to match two teeth. When one front tooth has to be replaced, it can be pretty tricky to match to the second one. It takes an expert cosmetic dentist. Because of that, less skilled cosmetic dentists will try to convince their patients they will have to crown both teeth, which is pretty simple to match. Unfortunately, your dentist can’t even do that.

Finally, a gray tooth can be made to look whiter. You are not going to get there with this dentist though. My suggestion is you ask for a refund. He misrepresented what you were being given and he never told you upfront he would not be able to match the teeth.

Once you have secured your refund, I want you to look for an AACD accredited dentist. Accreditation is different from being a member. They had to pass stringent exams and demonstrate a high level of artistry in their work.  These are the dentists that can give your daughter a beautiful smile.

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

Teeth Under My Porcelain Veneers are Turning Dark

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I paid a small fortune for a smile makeover. For some reason, the teeth underneath it are turning dark. My dentist doesn’t seem to believe me. I don’t think I am imagining this. I wonder if it has something to do with the tops of the veneers don’t quite go flush with the gumline. There is a bit of a ledge there.

Portia

Dear Portia,

 

a porcelain veneer being placed on a tooth

Bear in mind I haven’t actually seen your porcelain veneers, Based on what you’ve described, though. you have got a big problem here. It sounds to me that you have some open margins which is leading to leaking. This means your porcelain veneers need to be replaced. There is more at stake here than just the appearance. You are also putting your teeth at risk.

What is going on is your porcelain veneers were not bonded on properly. As a result, there is food and other bacteria getting trapped between your teeth and your porcelain veneers. That bacteria will sit on your teeth and turn into decay.

It doesn’t sound like your dentist is willing to own up to his error without some encouragement. Most dentists want to look good in front of their peers. My suggestion is you get another dentist on your side. In this case, you will want to see an expert cosmetic dentist. I recommend you see if there is an AACD accredited dentist in your area.

Have them look at your smile makeover and see what they say about it. Make sure it is a blind second opinion. By that, I mean don’t tell your dentist who did your smile makeover. If they ask, tell them you want their unbiased opinion.

If it turns out I am right and you do need to have these replaced, the dentist can help you get a refund. Then, I would make sure you have the expert cosmetic dentist do the new veneers. You’ll have much more beautiful results that will last a long time.

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

Dentist Says I Can’t Whiten My Teeth

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I have really ugly teeth and wanted to get them whitened. However, my dentist said my teeth are endogenous and because of that, I cannot get them whitened. Is that true? If so, is there anything I can do to make them look better? I am so embarrassed by my smile.

Kelly Anne

Dear Kelly Anne,

teeth whitening trays

There is always something you can do to make your teeth look better. I’m sorry your dentist was zero help to you. I am not crazy about it when dentists use clinical words with patients without explaining what it means. That doesn’t help you at all.

What he is trying to say is the stains on your teeth are endogenous, not your teeth themselves. Endogenous stains are simply stains that were acquired while your tooth was developing. There are two categories of this that dentists see most often.

The first is tetracycline stains. These are the result of taking the tetracycline medication during childhood while your teeth were still developing. Even professional teeth whitening does not make much headway with these type of stains. They are just too deep and dark.

The second is fluorosis stains. These are the result of consuming too much fluoride during your teeth’s development. While they are more superficial, teeth whitening is still not a good solution because the fluorosis stains usually result is splotched teeth. Because teeth whitening bleaches the teeth uniformly, the teeth will be whiter but still splotchy. That’s not an attractive look.

The Solution for Endogenous Teeth Stains

The best solution in both of these cases is to have porcelain veneers placed. These tiny wafers of porcelain that cover your teeth are the go-to procedure for celebrity smile makeovers. They can change anything you want about your smile, including the shape, size, and color.

The only real catch with these is it requires an advanced cosmetic dentist to give you beautiful results. Smile makeovers are not taught in dental school. It is up to the dentist how much training they invest in to do this type of work. Tetracycline stains, especially, are among the most difficult cases for a dentist to do. In your place, I would only go to an AACD accredited dentist.

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.

They Should Be Worried About Their Smile Makeover

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My husband and I went to a local dentist who advertised smile makeovers with Lumineers. We were both excited about getting our smile re-done. Our impressions were taken and we were told it would be two weeks. About the time they were supposed to be in, the dentist called and told us that the impressions were bad and we’d need to come in and have them re-done. It seems odd to me that they were still on the impression part when they were supposed to be done. Should I be concerned? Do you think we’ll actually get them? We’ve already paid upfront.

Miranda

Dear Miranda,

Lumineers Advertisement

I am not concerned that you will not get them. I feel certain you will get them. The thing I am concerned about though is whether you’ll be happy with them. There are some things here that concern me. The first is the impressions. It doesn’t bother me that the first impressions were not good and needed to be re-done. That can happen from time to time even at the best of cosmetic offices. What does worry me is how long it took them to tell you.

I obviously wasn’t with your dentist but I can tell you what it sounds like to me. The lab would have known fairly quickly that the impressions were not good, so why didn’t they call you then?  My guess is your dentist felt embarrassed that the impressions weren’t good.  Maybe he or she is insecure about their cosmetic skills and they don’t have a ton of experience. Maybe they didn’t realize everyone has bad impressions now and again. Either way, for it to go that long they would have had to try to tell the lab to try anyway. After some effort, the lab called back saying the impressions were unworkable. Now they have to call you to re-do them.

Lumineers are a particular brand of porcelain veneers that are often marketed to inexperienced cosmetic dentists as being easy to place. However, doing smile makeovers is not taught in dental school; nor is cosmetic dentistry a recognized specialty. A dentist has to invest in post-doctoral training in order to learn how to create beautiful smiles. Lumineers just requires them to do a single seminar and then the dentist is officially “Lumineers Certified”.

Unfortunately, that isn’t enough. Most patients who go to dentists with this type of training end up disappointed at best. Here is how you can prevent that. When the Lumineers come in, tell your dentist you want them to try them on with a temporary try-in paste. This is to give you time to look at them and decide if you love them. If you don’t, they should go back to the lab to make any changes you request. They shouldn’t get permanently bonded on until you are thrilled with them.

I suggest you call the dentist now and ask them to agree to this. If they don’t, ask for a refund. Then go to a great cosmetic dentist with extensive cosmetic training. The best cosmetic dentists are AACD accredited. Don’t be surprised if they suggest a different brand of porcelain veneers.

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.