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Cosmetic and
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dentistry

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.

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.

Collapsing Mouth

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I have an almost non-existent smile. Over the years, it seems my teeth have become less and less visible. It’s almost impossible to see my teeth, even when I smile. My jaw also aches all the time. I’ve noticed I feel the most comfortable at night when I’m wearing my night guard. When I talked to my dentist about my concerns, he suggested I get porcelain veneers. Before moving forward, I just wanted to get a second opinion.

Melanie

Dear Melanie,

Woman Holding her jaw in pain

I haven’t examined you so bear in mind I am only going based on your description. It sounds like you may be someone who struggles with either teeth grinding or clenching. This may be why your dentist has a night guard. The grinding can wear down your teeth to little nubs. It sounds like you’ve worn down your teeth to the point your mouth has become over closed.

Three things you mentioned lend credence to this. First, your teeth are less visible; second, your jaw aches; and third, you feel best when wearing the night guard.

What porcelain veneers will do is improve the appearance of your teeth. They will not solve the root issue of your mouth being over closed or the jaw pain.

My suggestion is for you to see a TMJ Dentist. This is a potentially serious issue that may need a totally different solution using dental crowns to build your bite back up.

One of the problems you will face is there isn’t a recognized TMJ Specialty, so any dentist can call themselves a TMJ Dentist. To make sure you are seeing a dentist who has the right training to help you, look for one who has done post-doctoral training at one of the following institutes:

  • The Pankey Institute
  • The Dawson Academy
  • The Las Vegas Institute for Advanced Dental Studies

A dentist with training from one of these reputable schools will be able to help.

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

$100k for a Smile Makeover?

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I’m so frustrated. I’m having trouble getting the right cosmetic dentist for my smile makeover. The first go-round I used my normal dentist. It turned out a complete disaster. He was gracious about it and completely refunded my money. Next, I went to someone who is supposed to be the top cosmetic dentist in our city. He said my bite is off and quoted me close to $100,000. There is no way in the world I can afford that. Is that the right amount for a top cosmetic dentist?

Jane

Dear Jane,

Woman with a beautiful smile

You are running into two problems when it comes to cosmetic dentistry. First, it isn’t a recognized specialty. This means any general dentist can call themselves a cosmetic dentist regardless of the amount of post-doctoral training they received. Unfortunately, creating smile makeovers isn’t taught in dental school. If a dentist wants to develop the skills needed to do it well, they need to invest in the training on their own. This is the issue you ran into with your family dentist. He obviously meant well and wanted to try to give you what you wanted. When he couldn’t, he had the integrity to return your money when he couldn’t.

The second dentist had a completely separate issue. The cost he quoted is quite high for porcelain veneers. He mentioned your bite was off. It’s possible what he was recommending was actually a full-mouth reconstruction, which is a completely different and much more involved procedure as well.

I would get a second opinion before moving forward. To be safe, I’d like to make certain you are seeing a qualified cosmetic dentist and not just someone trying to bring in a large fee. My suggestion is you look for an AACD accredited cosmetic dentist. These dentists have proven themselves by passing stringent exams as well as demonstrating the artistry to a committee.

If it turns out that you do need a full-mouth reconstruction, I think you should verify his qualifications. You need a TMJ Dentist with advanced training. Take a look at Dr. Weiss’ qualifications to get an idea of what type of dentist you would need for this type of procedure. Even then, I don’t think it would cost you $100K.

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

Cosmetic Solution for Fluorosis Stains

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I have fluorosis stains on my teeth and wondered if teeth whitening is a good cosmetic fix for someone in my position? I want to have a smile I am proud of.

Diego

Dear Diego,

I will say right off that teeth whitening will not be the solution. It whitens teeth evenly and is only more likely to make your fluorosis stains more obvious. For the benefit of those who are unfamiliar with what fluorosis stains are, it happens when someone ingests too much fluoride while the teeth are still forming. The fluoride in the water in the United States is optimized for the right consumption so we don’t see much of it here.

There is good news, though. Your teeth can be attractive again. Which solution depends on the amount of fluorosis you are dealing with. For either repair, you will need an expert cosmetic dentist. My suggestion would be to find an AACD accredited dentist.

If You Have Mild Fluorosis

 

mild fluorosis stains

The picture above is an example of mild fluorosis. If this is what you are facing, then dental bonding can be a sufficient repair. Your dentist will gently shave about 0.5 millimeters of your tooth enamel. Then, he or she will replace it with direct composite bonding. It doesn’t last as long as the next repair I will talk about, but it does cost less.

If You Have Darker Fluorosis

heavier fluorosis stains

In some cases, as in the picture directly above, the stains are more prominent. In this case, simple dental bonding will not be enough. Instead, I suggest you have porcelain veneers placed. This is actually the go-to procedure for a smile makeover. It is what gives people that “Hollywood Smile.”

This procedure can last for a lifetime. However, don’t try to cut corners by going to an inexperienced cosmetic dentist for this. It’s not an easy procedure to do under the best of circumstances. With severe stains like these, it will take someone highly skilled. This is why I recommended an AACD accredited dentist earlier, these are the best cosmetic dentists.

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

Can You Get Porcelain Veneers if You Have an Overbite?

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I have tetracycline stains that I have always wanted to be covered. I asked my dentist about porcelain veneers and he said I can’t get them because I have an overbite which makes my upper teeth cover my bottom teeth. Instead, he wants to do six porcelain crowns on the upper teeth. Because my lower teeth can’t really be seen, what do I do with those, whiten them?

Elisabeth

Dear Elisabeth,

Photo of a single porcelain veneers being held by the tip of dental forceps.

Please don’t let this dentist do your smile makeover. He’s making quite a few errors and he hasn’t even started. Him telling you that porcelain veneers don’t work for an overbite isn’t true. Instead, it is likely just an excuse because he doesn’t know how to do porcelain veneers. In fact, veneers make more sense in a case where there is an overbite involved because dental crowns must surround the whole tooth. This will cause it to hit up against your lower teeth.  Instead, porcelain veneers are thin wafers of porcelain that only cover the front and hug the sides a smidge. This is a much better fit for someone with an overbite.

A second concern I have is that dentists who recommend dental crowns for a smile makeover when it isn’t necessary are generally not experienced cosmetic dentists. They think they have done dental crowns for treatments before with decayed teeth. How hard could it be just to add a few more? Actually…quite hard. In your case, this is especially true. You are dealing with tetracycline stains which are among the most difficult and advanced cosmetic procedures there are to do well.

He’s also recommending just six dental crowns. Most smiles are at least 8 – 10 teeth wide. What does he intend to do to make those adjacent, visible teeth do to match? Teeth whitening, which could be an acceptable option on many cases, will not work in yours because of how deep and dark the stains are with tetracycline. This will make the six teeth that are crowned, look obviously fake and silly, like children playing dress-up in their parent’s shoes. They obviously don’t fit, but at least they’re trying.

Teeth whitening could help with your bottom arch. This arch won’t be so obvious when the color doesn’t match exactly. However, I’d recommend a strong whitening system such as KoR whitening. Plus, you will have to be persistent and stick with it much longer than the average patient.

Your Smile Makeover Requires an Expert Cosmetic Dentist

Especially because of the difficulty with your type of smile, you need a top of the line cosmetic dentist. My suggestion would be to find an AACD accredited dentist. This is different from being a member of the American Academy of Cosmetic Dentistry. To reach accreditation, the dentist has to pass stringent exams as well as provide visual evidence on a large number of specific cases they’ve done that are assessed by a panel of judges on their technical quality along with their artistry.

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

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.

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