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dentistry

Can’t Speak after Closing a Tooth Gap

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I had a tooth gap that my dentist closed and talked me into a smile makeover at the same time. I had porcelain crowns done from one canine tooth to the other. Ever since then I have had problems speaking, closing my mouth, my mouth is dry all the time, and my neck hurts constantly. Is there a way to put the gap back? Everything was fine with those things before. I just didn’t like the gap.

Carl

Dear Carl,

woman smiling with a gap between her two front teeth

The easiest way to close a tooth gap is with dental bonding

I want to start with the fact that crowning six teeth is a massive overtreatment for a tooth gap. It wouldn’t even be my solution for a smile makeover. Generally, tooth gaps are closed with dental bonding, which is much less evasive, doesn’t remove healthy tooth structure, and is much less expensive.

However, let’s say you really wanted a total smile makeover. As I said above, porcelain crowns still would not be the best choice. The go-to procedure for a smile makeover is porcelain veneers. The reason a dentist would suggest a porcelain crown if you don’t already have crowns there is because he or she doesn’t feel qualified to place porcelain veneers. That’s not a good reason. It would be better for them to refer you to a cosmetic dentist who would be able to give you a beautiful smile without having to grind down all your teeth. Unfortunately, once all that tooth structure is removed, you are stuck with crowns for the remainder of your life.

As to the issues you are facing, they are not from the gap being closed. Opening that back up won’t help. However, the issues are serious and are a result of the dental crowns not being placed properly.  Based on your description, it sounds like your dentist opened your bite too far. This means he’s either made the crowns too thick or too big for the shape of your mouth. It is imperative this is repaired–The sooner the better.

Here’s what is leading to the problems you’re facing. The neck pain is a result of your bite being thrown off and now you’re straining. Until that is restored, you will continue to be in pain.

Not being able to close your mouth properly is called lip incompetence. This is leading to the dry mouth you are experiencing. While I’m sure you know why the pain has to be dealt with, the lip incompetence is also a serious issue.  Our saliva is a major force in fighting decay in our mouth. Whenever you have dry mouth, you no longer have the minerals from your saliva to protect your teeth. It will lead to massive decay.

To get this properly fixed, I want you to get a second opinion from an experienced cosmetic dentist. Find an AACD accredited dentist in your area. These are the top cosmetic dentists in the country. They can help you get a refund from your dentist and then you can get this done properly so you have the proper function of your bite. Not only will you have a functioning bite, but it will also give you a stunning smile.

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

Full-Mouth Reconstruction to Whiten Teeth?

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I need to make some important choices soon. I have a dental crown that is about 20 years old and two porcelain veneers that are a bit older. I’ve been experiencing some dry mouth. I’ve chipped the veneers on the front teeth and now there is a gray line at the gumline by the crown. I went to my dentist to discuss replacing them. Because my smile is no longer very white, he is suggesting I get crowns on both my upper and lower arch to do a smile makeover of sorts. The more I think about it, the more concerned I am, especially with my dry mouth. It may be better for me to just replace the old work and wait to see what happens with the dry mouth first. What do you think?

Carolyn

Dear Carolyn,

teeth whitening trays

The first thing I am going to suggest is that you get a different dentist. If I understand you correctly, your dentist is suggesting crowning all of your teeth because your teeth need to be whitened? Really?

So, here’s the thing. Whitening your teeth will bring him in a few hundred dollars. Crowning all your teeth, known as a full mouth reconstruction, will bring him in $30,000+. Your dentist is being self-serving. The best dentists are doing their best to serve their patients without unnecessary expense for his or her benefit and while preserving as much tooth structure as possible. He’s doing neither.

My suggestion is you have your teeth whitened and then just replace the damaged dental work. However, I don’t think your dentist should be the one to do it and not just because he’s grabbing for the bucks. There is another warning sign that he isn’t what you need. When a dentist suggests dental crowns instead of porcelain veneers for a smile makeover, it is because they are not comfortable doing porcelain veneers. Doing crowns in a case where they are not needed is a waste of healthy tooth structure.

As you likely know from the crown you already have, in order to make room for the restoration, he’d have to grind your teeth down to nubs. This is irreversible. Once you have dental crowns you will always have to have dental crowns. It is much better to do porcelain veneers when it comes to a smile makeover.

Now, you do already have one crown. You mentioned a gray line at the gumline. This tells me the original dentist did a porcelain-fused to metal crown. On a front tooth, what you really want is an all-porcelain crown.

What you need is a skilled cosmetic dentist to take over. In your place, I’d look for an AACD accredited dentist. These dentists are in the top of the cosmetic field and have proven skill and artistry. You’ll have a smile you are proud of.

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

Do Dental Crowns Cause Dry Mouth?

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I’m having a really hard time with dry mouth ever since getting all my teeth crowned. I know it was a cosmetic procedure, and while the teeth look okay, I have to really focus on keeping my mouth closed. Never in my life did I think I’d be what my kids call a “Mouth Breather.” Is there a way to fix this or is it normal and I’m just not used to a wider smile?

Kathy

Dear Kathy,

A woman pointing at her smile

No this isn’t normal. Was there a particular reason your dentist did dental crowns instead of porcelain veneers. You mentioned it was cosmetic work. Generally, when someone is getting a smile makeover, porcelain veneers are the go-to. It removes less tooth structure.

Some inexperienced cosmetic dentists will do porcelain crowns for smile makeovers because that is what they’re familiar with, but it unnecessarily grinds down healthy tooth structure. It’s water under the bridge at this point as it is already done. I just wondered if there was a functional/mechanics reason for doing something so drastic. That leads me to my next question.
Why every tooth? Most smiles are about eight to ten teeth wide. Doing every tooth is excessive, not to mention expensive.

What your dentist did is known in dentistry as a full-mouth reconstruction. It’s an advanced procedure that isn’t typically taught in-depth, if at all, in dental school. Instead, dentists would seek out post-doctoral training.

Lip Incompetence is Dangerous

When you can’t close your lips naturally and are having to consciously force it, we call that lip incompetence. It is going to rain havoc on your teeth and oral health. While many people think brushing is our biggest defense against decay, the reality is our saliva has an even greater impact. It contains bacteria-fighting minerals that protect your teeth. Dry mouth deters saliva and allows that bacteria to multiply unhindered.

In creating this problem, y our dentist made a serious mistake. He (or she) needs to pay to get this fixed. Don’t just ask for a refund because the fix will likely be more expensive than the original procedure. If he complains about this, you may want to hint to him that another dentist told you that you have a valid case for malpractice damages. That should get his attention.

A Word about Smile Makeovers

You said the smile was “okay”. An okay smile would not be what you were stuck with when it came to a true cosmetic dentist. When you go to get this full mouth reconstruction done correctly, I want you to look for a dentist who is accredited with the American Academy of Cosmetic Dentistry.

AACD accredited dentists are in the top 1% in their field. Not only will you be able to close your mouth naturally and comfortably, but you’ll also have a stunning smile you will be thrilled to show off to the world.

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

What If You Don’t Like Your Smile Makeover?

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I wanted a smile makeover. I asked my dentist if he was a cosmetic dentist and he said no one is actually a cosmetic dentist they’re just dentists who did cosmetic work. He then asked what procedure I wanted. When I told him a smile makeover he told me that he could give me Lumineers. He showed me before and after pictures that looked good. When my porcelain veneers were first placed. I didn’t like them. I could tell that before they even put them on. They weren’t the right color. I told him that and he sent them back. When they came in the next time, I had a hard time seeing them on my teeth because they kept falling out. He assured me they could make adjustments after they were bonded on. It turned out that isn’t true. When I finally got a good look at them at home, I was super disappointed. First, they were whiter, but it had a chalky flat looking white, not a shiny one I was hoping for. Second, they are way bulkier than natural teeth. It was shortly after this that the quarantine started and his office closed. I called and left a message, but he hasn’t gotten back with me. I don’t know if that’s because his office is closed or he’s ignoring me. I’m hoping to get this fixed, but what if he’s actually just avoiding me?  The answering machine does say they’re checking messages and will get back with us, but he hasn’t.

Carol

Dear Carol,

A single porcelain veneer being placed on a tooth.

While technically your dentist is correct, there isn’t a recognized specialty in cosmetic dentistry, that doesn’t mean some cosmetic dentists aren’t more qualified than others. Doing smile makeovers aren’t taught in dental school. It is up to the dentist to invest the time and money into learning them well.  It doesn’t sound like your dentist has done that based on what you’ve described.

Problem One

The first thing that caught my attention was his recommendation of Lumineers. This is a brand of porcelain veneers that is highly marketed, especially to inexperienced cosmetic dentists as being easy to place. They say that because they are considered easy to place as they are an ultra-thin and don’t necessarily require any tooth preparation. However, they have two big problems working against them.

The initial problem is the inexperience of the dentist. Some smiles will look fine without tooth prep. Others will look bulky. A second big issue with Lumineers is their lab. Unlike other brands of porcelain veneers, the company that produces Lumineers require dentists to use their lab, which isn’t known for its high-quality work. In fact, many expert cosmetic dentists would consider it sub-par.

I know your dentist showed you before and after pictures, but did he say they were HIS before and after pictures. They may have been stock photos.

Problem Two

A second big problem I noticed is that your dentist either doesn’t know or doesn’t care about temporary try-in paste. If he didn’t know, he has done practically zero training with cosmetic work. If it is, instead, that he doesn’t care, then he is definitely NOT a dentist you would want working on your smile. So you’ll be aware for next time, a temporary try-in paste allows you to get a good look at your porcelain veneers on your teeth for an extended period of time, without them having to be permanently bonded.

Problem Three

Finally, he told you he could make adjustments after they were bonded on. Cosmetic Dentistry 101 teaches you that is not possible. Again an indication he either doesn’t know he’s doing or he doesn’t care. The good news is this last issue works in your favor. He told you something that absolutely wasn’t true. I think this can help you get a refund.

So, once you’ve got that juicy refund in your hand, who should you go to in order to have a beautiful smile crafted for you? Ideally, you’d get an AACD accredited cosmetic dentist. They are at the top 1% of their field. If that isn’t possible, my next recommendation is you go to the website mynewsmile.com. They recommend expert cosmetic dentists in every area. A dentist cannot just pay to be listed. They have to provide their cosmetic dentistry training as well as visual evidence with before and after pictures of cases they’ve done themselves in order to prove their artistry. Any one of the dentists listed there can create a stunning smile for you. Many of them are on their way to accreditation, which is a process that can take many years.

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

Her Dentist told Her to Expect Her Porcelain Veneers to Fall Off!

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I just had six porcelain veneers placed on my teeth and, as I was leaving, the dentist told me to expect them to fall off every few months. I knew up front that I would no longer be able to eat crunchy foods, such as apples or nuts, but I really thought they’d stay on other than that. Do you know if I’m expected to pay for the rebonding every time?

Caitlin

Dear Caitlin,

a porcelain veneer being placed on a tooth

I’m astounded at what I’m hearing! First, let me start off by saying that one of the problems you are facing has to do with the fact that cosmetic dentistry isn’t a recognized specialty. This makes the standard of care a very low bar. It wouldn’t matter if they looked awful, as long as they were functional. That is actually the basis for a large number of cosmetic dentistry horror stories. They pay a fortune for a smile makeover and end up with a smile that looks worse.

The good news, though, is that your porcelain veneers falling off is NOT functional. It’s a basic standard of care. If your porcelain veneers fall off even once, go back and demand a refund. In fact, he should not have put eating restrictions on you at all. There are very few restrictions when it comes to porcelain veneers, such as not biting metal and wearing a nightguard if you are a teeth grinder. In your place, I’d go ahead and test the veneers by eating an apple the next time you feel like it. If they’re going to come off and need to be replaced (by a different dentist this time), it is better for you to know sooner rather than later. This way you can get a functional smile and not live in fear.

Finding an Expert Cosmetic Dentist

Without there being a recognized specialty in cosmetic dentistry, any general dentist can call themselves a cosmetic dentist. Unfortunately, creating beautiful smile makeovers isn’t taught in general dental school. Instead, a dentist has to invest in a significant amount of post-doctoral training as well as have an artistic eye.

It’s almost impossible for patients to know which dentists have done this and are truly qualified and which haven’t, essentially turning your trip to the cosmetic dentist into a gamble. The American Academy of Cosmetic Dentistry recognized this issue. As a result, they started an accreditation program. To become AACD accredited, dentists have to pass stringent exams that prove their technical knowledge of the procedures. Additionally, they’re required to submit a large number of specific cases they’ve personally done to show they can not only implement their technical knowledge but have the artistry required to create beautiful smiles.

If I were getting a smile makeover, I’d want an AACD accredited dentist to do it. When your porcelain veneers fail, and it sounds like your dentist is sadly confident they will, that is what you should look for in the dentist that will replace them.

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

I’m In Tears After My Smile Makeover

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I had a few teeth with composite bondings to repair some chips. They needed some repair. My dentist retired and said the man who took over his practice said they’d need to be replaced with porcelain crowns because you can’t just replace composite bonding. I didn’t realize at the time that wasn’t true and allowed him to do six dental crowns. The two front teeth look a darker grayish compared to the other teeth. Is there any way to fix this? My dentist insists they’re the exact same color as the others. It almost feels like I’m being gaslighted.

Elaine

Dear Elaine,

Woman covering her mouth with hand.

I’m very sorry you’re going through this. I can tell you the biggest obstacle you face is you have a bread and butter family dentist trying to do cosmetic dental work. One of the big problems in dentistry right now is the fact that cosmetic dentistry isn’t a recognized specialty. This means any general dentist can call themselves a cosmetic dentist regardless of the amount of training they’ve received.

This puts patients in a difficult position. They may not know that smile makeovers and other advanced cosmetic procedures are not taught in dental school. In order for a dentist to become skilled in those areas, it requires a significant amount of post-doctoral training. The best dentists invest in this type of training on a regular basis and are constantly improving their skills. My guess is your dentist didn’t receive that. This is what landed you in this position.

Getting Your Smile Disaster Fixed

A true cosmetic dentist would never tell a patient their smile looked fine when they were unhappy with it. Instead, they would re-do the work until the patient was thrilled. Because they want total patient satisfaction, they’ll use a temporary try-in paste. This allows the patient to get a good look at their smile before it is permanently bonded on.

It is unfortunate you now have dental crowns. You’re stuck with those the remainder of your life because it required your teeth to be ground down. The good news is he misrepresented to you the options available. It is not true that dental bonding could not be replaced. My guess is he said you had to have dental crowns done because that is all he knew how to do. In your place, I would ask for a refund and then go elsewhere to get them done properly.

If you’re happy with all the crowns except the two front ones that don’t match the adjacent teeth, you can just get those re-done. Either way you are going to need to find a top of the line cosmetic dentist. The best are AACD accredited cosmetic dentists. They’ve passed stringent exams as well as demonstrated their artistry on a large number of cases they’ve done.

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

Horrible Solution for a Tooth Gap

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I have a tooth gap I want to fix. My dentist is suggesting Lumineers. I’ll do it if it is my only option but it is quite expensive. Can you give me a second opinion as to whether I have other options?

Susan

Dear Susan,

woman smiling with a gap between her two front teeth

Please run away from your dentist as quickly as possible. This is a horrible suggestion to fix a tooth gap. Lumineers are a brand of porcelain veneers, which are used for complete smile makeovers. They’re also a bit pricey. You’re asking for a solution to a tooth gap.

The simple solution for that is dental bonding. It is much less expensive and will only affect the teeth you want to close the gap on. What your dentist is suggesting is a massive over treatment. So why would he do that?

My first guess is he doesn’t know how to do dental bonding. Truthfully, that wouldn’t surprise me at all based on the fact that for your porcelain veneers he is suggesting the Lumineers brand. These are highly marketed to inexperienced cosmetic dentists as being easy to place.

They tell dentists that because they are an ultra-thin brand of porcelain veneers, leading the dentists to believe there will be no need to prepare the teeth the way many other brands of porcelain veneers require. Unfortunately, this often ends up looking bulky. Some patients have even described the results as horse teeth.

Finding an Expert Cosmetic Dentist

If you were going to get a true smile makeover, then you would want a highly skilled cosmetic dentist, such as one who is AACD accredited. Let them pick the brand.

As for your tooth gap, again, you’ll want an expert cosmetic dentist. Dental bonding, the treatment I suggested, is done freehand and takes some serious expertise.

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

Will Supersmile Whiten My Dental Bonding?

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I’ve had dental bonding on eight teeth for about ten years. They’re starting to pick up stains. I’ve heard Supersmile toothpaste is good at removing stains. Will that help with my situation or do I need to replace them?

Ellie

Dear Ellie,

Supersmile does a great job removing surface stains. It does it with an ingredient called Calprox, which dissolves the protein pellicles on your teeth. Stains attach to the pellicles and when they are dissolved the stains follow with it. One thing to be aware of is this works on surface stains only.

You mentioned your dental bonding is about ten years old. That is a long lifespan for bonding. My guess is they’ve been slowly picking up stains for a while. If those stains have become internal, there is nothing that will help. Even professional teeth whitening will only whiten natural tooth structure.

You can try the Supersmile toothpaste. I recommend it to anyone with any type of cosmetic work anyway because it does a wonderful job of keeping them bright without damaging the glazing. If that doesn’t work, then it means the stains are now internal and it is time to replace your bonding.

A More Permanent Solution for Your Smile Makeover

Dental Bonding is a great solution for small amounts of cosmetic work, such as chipped teeth or tooth gaps. It sounds like you were using them for a smile makeover. That’s fine, but you will get a significantly better, more permanent smile makeover with porcelain veneers.

There is one important factor in that. You will need an expert cosmetic dentist. Smile makeovers are an art form which are not taught in dental school. Because of that, you’ll want a dentist who invested a great deal of time or training in learning the art.

It is hard for patients to know which dentists have done this and which haven’t. There isn’t a recognized specialty in cosmetic dentistry. Because of that, the American Academy of Cosmetic Dentistry began an accreditation program. Dentists who obtain AACD accreditation are in the top 1% of artistic dentists in the country. They can give you a stunning smile.

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

Getting a Smile Makeover Through Yelp?

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I’m having trouble deciding on which cosmetic dentist to use for my smile makeover. I’m looking at the top three recommended in Yelp. I was thinking of doing composite bonding because it is cheaper, but I can’t tell which of them would be better for that over porcelain veneers. Any advice?

Hannah

Dear Hannah,

Brunette with a beautiful smile

AACD accredited dentists are in the top 1% in the country.

I’m glad you are writing. I think I can save you a lot of grief and wasted money. Let’s start with the way you’re going about finding the dentist you want to do your smile makeover. While Yelp is a great resource for many things, I don’t think its algorithms are going to be useful in this case.

They make their recommendations based on reviews. However, they don’t really make a distinction on what type of dental work is done. For instance, if you were to look at many of the reviews of those dentists, how many are based on their work doing smile makeovers? Most are likely just about how friendly the office is or some of the general dental work they’ve had done.

I’ll discuss how to get the best cosmetic dentist for your smile makeover in a moment. Before we do that I want to talk about the two procedures you were considering. You won’t find many great cosmetic dentists who will do a complete smile makeover with composite bonding. It actually takes significantly longer to do it with composite than porcelain and get it to look beautiful. Because of that, they’d actually end up having to charge you more. Plus, composite doesn’t last nearly as long as porcelain, so your investment isn’t as durable. Dental bonding is best done with small areas, such as repairing a chipped tooth or closing a tooth gap.

If you’re going to invest in a new smile and want it both beautiful and durable, then porcelain veneers would be the better investment for you.

Finding a Cosmetic Dentist for Your Smile Makeover

There isn’t a recognized specialty in cosmetic dentistry, nor is doing smile makeovers taught in dental school. That leaves patients in a bit of a quandary. Because of that, the American Academy of Cosmetic Dentistry began an accreditation program. Dentists who pursue accreditation have to pass exams demonstrating their technical knowledge. They also have to demonstrate their artistry by presenting visual evidence of a large number of cases they’ve done. Those are examined carefully to ensure they meet the highest standards. Only then will they be accredited.

If I were getting a smile makeover, I would look for an AACD accredited dentist.

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

Will Porcelain Veneers Solve My Problem?

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I have never liked my smile and I am finally in a position to do something about it. Here are the issues:

  • It’s extraordinarily difficult to show my upper teeth.
  • When my mouth is at rest you cannot see them at all.
  • I have pretty constant jaw pain, except for when I wear my nightguard at night for my teeth grinding.

What I’d like is to be able to see my teeth and maybe even improve my appearance. I’d also like my jaw to hurt less, like the way it does when I’m wearing my nightguard. Would porcelain veneers be my best solution?

Laurie

Dear Laurie,

woman holding her her jaw in pain

While porcelain veneers are the go-to procedure for a smile makeover, your situation is a little more complicated. It sounds like you are facing a collapsed bite along with TMJ Disorder. This requires a different approach. You will need to open your bite. This is typically done as full-mouth reconstruction with dental crowns. However, I want you to proceed with caution.

Only a small percentage of dentists are able to do this procedure correctly. When it isn’t properly done, it ends up making things much worse. Here is the way I’d recommend a dentist proceed.

You want whoever does your full-mouth reconstruction to start by using provisional crowns to open your bite. This way it is reversible. When you are completely out of pain and love the appearance of your smile, that is the time to move forward and the dentist can make the permanent crowns.

What Qualifications Do You Want in Your TMJ Dentist

It’s important whatever dentist you choose has extensive post-doctoral training in TMJ Disorder. For instance, Dr. Weiss did his TMJ training with the renowned Dawson Academy. Other reputable institutions would be the Kois Center and the Las Vegas Institute for Advanced Dental Studies.

You also want to ask them what experience they have in full-mouth reconstruction. You definitely don’t want to be their first case.

Cosmetic Considerations with Your New Bite

While you are opening your bite, you are also getting a smile makeover. Because of that, it is important you find a dentist who is a top of the line cosmetic dentist. Ideally, you’d want an AACD accredited dentist. The good news is finding such a dentist will likely take care of both sets of qualifications.

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

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