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dentistry

Victim of Dental Tourism for a Smile Makeover

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I went to Croatia and was able to receive $60,000 worth of cosmetic work for just over $10,000, including airfare. I thought I was getting the deal of the century. When I asked them how they could afford to do that, they told me health care was more affordable in their country because they don’t have as many laws and restrictions. I fell for it hook line and sinker. I’ve been home two weeks and have followed all their instructions including not to eat with my front teeth for a few months. But, since then four of them have already fallen out including one of the front teeth. I promise I haven’t been eating with it. What do you recommend?

Stacey

Dear Stacey,

A woman smiling with a beauttiful smile

The most important factor in a smile makeover is the skill of the cosmetic dentist.

Dental tourism is a booming industry, especially for advanced cases like smile makeovers. Unfortunately, as you are discovering, it rarely works out the way the tourist hopes. While it is true we have more regulations in our health care system, most of that is to protect the patient from unhealthy or incompetent practices.

If they truly gave you porcelain veneers, telling you to avoid eating with your front teeth sends off huge warning bells to me. With correctly bonded porcelain veneers, you should be able to eat anything you want. It sounds to me like these “dentists” may not truly understand how to bond them. Though, there is always the possibility they didn’t provide you with true porcelain veneers.

Getting this Smile Makeover Repaired

You are going to need the expertise of a top of the line cosmetic dentist. Look for one who is AACD accredited. They are in the top 1% of cosmetic dentists in the country.

The first thing you’ll want to find out is if they are truly porcelain veneers. That is your best-case scenario. If they are, an expert cosmetic dentist can bond them back on properly. This isn’t something any dentist can do. It requires techniques and skills most dentists don’t have. I’d recommend having the rest of them re-bonded as well if that is the case.

If they are not porcelain veneers, you can try to get your money back, but most of that will depend on the laws available to the consumer in Croatia. It’s not likely to be anywhere near as useful as what you have here.

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

Dental Insurance for Dental Implants

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I want to replace all of my teeth with dental implants. They are in pretty bad shape and I want a smile I can be proud of. Is there a dental insurance that will cover these?

Kevin C.

Dear Kevin,

When you say your teeth are in pretty bad shape, you didn’t specify whether you meant in appearance or in health. If it is just an appearance issue, getting dental implants would be an overtreatment. This is designed for patients who need to replace their teeth because they have to be removed as a result of decay and infections. If that’s not you, a great cosmetic dentist can create a stunning smile for you, while enabling you to keep your natural teeth using porcelain veneers.

If, however, the teeth are unhealthy and have to be removed, then dental implants will be the right way to go. If you already have dental insurance, they will cover part of the cost but probably not as much as you would hope. Dental insurance tends to only want to cover the least expensive option. For tooth replacements, that is dentures. Though I only recommend dentures as an absolute last resort for reasons I’ll go over in a moment.

If you don’t already have dental insurance, be aware that most policies have a waiting period for anything other than cleanings and checkups. That may defeat the purpose if your teeth need to come out right away.

Why Not Dentures?

Two profile photos of a woman who experienced jawbone shrinkage and facial collapse, which can be prevented with implant overdentures, available from Philadelphia cosmetic dentist Dr. Michael Weiss.

Jawbone shrinkage results in facial collapse

When your teeth are removed, your body begins to resorb the minerals in your jawbone to use elsewhere. This is in an effort to be efficient with its resources. Unfortunately, this also has the result of slowly shrinking your jawbone. Eventually, you won’t have enough jawbone left to retain your dentures. This is known as facial collapse.

Getting dental implants signals to your body your jawbone is still necessary and will leave the minerals in place, thereby protecting you from facial collapse.

Implant Overdentures

Implant overdentures

Implant overdentures are a combination of dental implants and dentures

You don’t have to get a dental implant for every tooth. Instead, you can get implant overdentures. This will use between four and six dental implants and will anchor a set of dentures to them. This has the benefit of being more affordable while still providing you with all the benefits of dental implants.

If You Want a Stunning Smile

Whether you get dental implants or porcelain veneers, you still need a dentist who is skilled in cosmetic dentistry to give you that gorgeous smile you want. The top cosmetic dentists are AACD accredited. When you’re looking for natural results that look great, then you need to see an accredited dentist.

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

Can Dental Bonding by Safely Removed?

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I have dental bonding I’m not too thrilled with. I’m moving and want to find a better cosmetic dentist. However, before I do anything I wanted to ask if it is possible to remove dental bonding without damaging the tooth. Have you had experience with that?

Mazie

Dear Mazie,

before and after dental bonding case

Yes, it is possible to safely remove dental bonding on two conditions: First, you must go to a dentist who understands the procedure and has the equipment. Second, the dental bonding has to be attached to the enamel of your tooth and not the soft dentist which is beneath the enamel.

Here are three ways to safely remove dental bonding:

Sandpaper disks

Dentists use these to polish composites. These are probably the easiest for a dentist to use for this particular job. They are flexible enough to form to the shape of the tooth and leave a nice smooth, polished tooth surface.

Carbide Drills

These have a high-speed. If the dentist is able to use them with light pressure, they will do the job faster than the sandpaper disks. Their big disadvantage is they tend to leave streaks of material on the tooth. If a dentist uses this, they’ll want to finish up with the sandpaper disks to get that nice smooth finish.

Air Abrasion

It will be hard to find dentists who have this equipment. It’s not as commonly used as the other options.

Getting Your Beautiful Smile

Whether you just have a dentist re-do your dental bonding or you get a full smile makeover with porcelain veneers, you want to make sure you have an expert cosmetic dentist do the work. In your place, I’d look for a dentist who is AACD Accredited. These are the top cosmetic dentists in the country.

Some, less experienced dentists, will try to tell you if you get Lumineers they will be reversible. This is absolutely not true. They say this because they are marketed as a no-prep veneer. However, the material in porcelain veneers, including the Lumineers brand is much harder than the composite material and the tooth will almost positively end up damaged in the removal process.

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

Her Gums Inflammed After Getting Porcelain Veneers

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I’m a little worried about my gums. I had porcelain veneers placed a couple of months ago. Since it happened. my gums have been inflamed and painful. I went back in and the hygienist said she’s never seen it happen before. The dentist came to look and both of them accused me of not brushing enough. I was quite annoyed. I’m a grown adult and know how to brush my teeth. Why in the world would I not brush after spending a fortune on these porcelain veneers? When I went back in for a routine one-month follow up he removed some excess cement. That has helped some but I’m still in pain. What do you recommend I do?

Avery

Dear Avery,

illustraing on lateral incisors inflammed by poorly done porcelain veneers

These lateral incisors are inflamed from poorly done porcelain veneers

When patients have a smile makeover they’re proud of, they tend to take better care of their teeth, not worse. I don’t like it when medical practitioners blame patients for things they don’t quite understand. Please bear in mind that I haven’t examined you so I can only give possibilities.

There are a few possibilities going on here. It can be one or a combination of them. With the first possibility, he could have left some cement in that is irritating the gums. This seems a very real possibility, especially because you said he removed some excess cement a month out from placement. The cement should have been removed right away, while it was still soft. The fact that your gums felt a little better after he finally did remove it. Now it is getting a chance to heal.

That doesn’t mean that is the only thing irritating your gums, though. I say that because It doesn’t sound like your dentist has invested a lot of time in understanding cosmetic dental work. Another option is there is some unevenness or temporary shelving in the margins between the porcelain veneers and the gumline. This is sometimes called bulky margins.

This will cause things to get trapped in between the gums and the porcelain veneers, leading to inflammation and, eventually, gum disease and tooth decay.

There are other possibilities too such as the extended wearing of temporaries, the veneers encroach on the gingival attachment, and, allergies to the materials used in bonding.

Dealing with a Disastrous Smile Makeover

The first thing I suggest you do is get a second opinion. When you do, make sure it is a blind second opinion. Don’t ask your dentist for a recommendation and don’t tell whomever you do see who your dentist was. Most of the time, they know one another. You want an unbiased opinion. What you don’t want is him feeling torn between an honest evaluation and betraying his friend. That’s why a blind second opinion is best.

If it is just a matter of the cement being trapped there, then when your dentist removed it at the last follow-up, that should help as it heals. The second opinion dentist can make sure there isn’t any more there. If, however, the problem is with the margins, the porcelain veneers will have to be completely re-done. Because it puts your oral health at risk, you are entitled to have them re-done free of charge. Though, my recommendation would be to get a refund and have a more experienced cosmetic dentist do this.

Look for someone who is recommended on the mynewsmile.com website. They are highly skilled and they will sort them by area of the country for you.

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

Dental Bonding Staining

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I have dental composite bonding on all my front teeth. I have them re-done every three or four years. This latest set is only six months old and is starting to look yellow. Can this be polished to look right again or do I have to re-do them early? What would cause this to happen so quickly?

Priscilla

Dear Priscilla

Whether or not these can be polished to get rid of the stains depends on the nature of the staining itself. Unlike porcelain, which is hard and very stain resistant, composite dental bonding is fairly soft and is susceptible to two different types of staining.

Dental Bonding Staining One

an image of dental bonding on teeth stained by scratches

This first type of staining is surface stains. It happens because of tiny scratches on the bonding which allow it to pick up stains that are trapped there. You can tell these front teeth have been scratched because they’ve lost their glossy finish, instead they look matte. If you look at the adjacent natural teeth, they still have a gloss to them.

The good news is this type of staining can be fixed. If your dentist thoroughly polishes them, it will remove the scratches and stains, all while bringing the gloss back.

Dental Bonding Staining Two

Teeth with the two front teeth having stained dental bonding

Composite bonding is made from a solution of inorganic filler particles such as quartz or glass bound together in a plastic matrix. Because of that, it will absorb stains into its actual material. For instance, if you drink a lot of staining beverages, such as coffee or tea, it will penetrate the plastic and become a part of the bonding structure.

The picture above is a good example of this. Notice the two front teeth are much more stained than the surrounding teeth. This is absorbed staining. You can tell that (as opposed to scratch staining) because the teeth still have their shiny gloss. Notice the adjacent teeth, though stained, aren’t as stained as the bonded teeth. This is because your natural teeth are less susceptible to staining than composite bonding.

Unfortunately, this has to be re-done. There is no way to polish this out. Teeth whitening won’t work either. It will only whiten natural tooth structure. If that is the case, I’m going to highly suggest you switch to porcelain veneers on your teeth. Yes, veneers are more expensive initially. However, you are re-doing these every few years. Great porcelain veneers can last upwards of twenty plus years. They’re much more stain-resistant than bonding. In fact, they’re even more stain-resistant than your natural teeth.

Keeping Dental Bonding Stain-Free

1. Start with the right materials. You want to go to a skilled cosmetic dentist. They are more likely to stock microfill composite. This is possible to get polished completely giving it a high gloss and helping it resist stains.

Most general dentists just keep a generic composite which will never completely polish up to the gloss you need.

2. Avoid abrasive materials. I recommend anyone who has cosmetic work use Supersmile toothpaste. It’s specifically designed to chemically remove stains, instead of doing it with abrasives the way most toothpaste works.

3. Avoid staining beverages. If you must drink them, try not to let it sit on your teeth. Swallow immediately.

4. Make sure your hygienist doesn’t use anything like a prophy jet or pumice on your bonded teeth. It will destroy the glazing.

I hope this helps. Seriously consider switching to porcelain veneers.

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

Will These CEREC Veneers Look Good?

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I am going to a new dentist because of a job relocation. Before moving, I’d been saving up for porcelain veneers and now have the sufficient funds. However, my new dentist wants to do CEREC veneers which are 1.5mm thick. I’m worried that is too thick and he doesn’t have any before and after pictures to show me of cases he’s done in the past. My last dentist had something called a smile gallery. Should I be worried?

Elaine

Dear Elaine,

A woman smiling with a beauttiful smile

The most important factor in a smile makeover is the skill of the cosmetic dentist.

The materials and thickness of any smile makeover are not nearly as important as having the right cosmetic dentist do the work. Of course, a great dentist will choose the best materials, but it is their skill and artistry which matters. Doing smile makeovers are not taught in dental school. Instead, a dentist interested in doing cosmetic work must invest in post-doctoral training.

I’m a little concerned about the fact this dentist does not have any visual evidence for you. Any dentist who wants to be taken seriously as a cosmetic dentist will have what is known as a smile gallery. This should show before and after pictures of various cosmetic procedures which they have done.

Can CEREC Veneers be Beautiful?

You can get a beautiful smile with CEREC veneers as opposed to porcelain veneers, however, it is more challenging. I would say only about 1-2% of cosmetic dentists could do it well. Some dentists try to do this to save on fees with a ceramist which isn’t a great reason.

So how would you know if your dentist can pull this off before investing all your hard-earned (and saved) money? There are two great resources to tell you about skilled cosmetic dentists. The first is aacd.com. This is the website for the American Academy of Cosmetic Dentistry. They offer an accreditation program. In order for dentists to get accredited, they have to pass stringent exams as well as provide visual evidence of their artistry with a large number of specific cases. AACD accredited dentists are in the top 1-2% of cosmetic dentists in the world. When you use their search feature, make sure you check the box for an accredited dentist.

Your second resource is mynewsmile.com. They don’t allow dentists to just pay to be listed. Instead, they check their educational qualifications for cosmetic work as well as require evidence of cases they’ve done to ensure they have an artistic eye. Many of their listed dentists are either accredited or on their way to accreditation. Any of them can create a beautiful smile for you.

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

Smile Makeover During Pregnancy

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I was planning on getting a smile makeover but just found out I’m pregnant. Can I go through with it or do I need to wait?

Avery

Dear Avery,

A woman smiling with a beauttiful smile

Congratulations on your upcoming blessing. Babies are the best. Whether or not you can go forward with treatment depends on a couple of things. The first is what procedures you were planning. The second is whether or not you’re in a high-risk category in your pregnancy.

Let’s start with the procedures.

Teeth Whitening

Getting your teeth whitened hasn’t been officially cleared for pregnant women. It’s not because there is evidence of it doing harm to the baby, it is because we’ve had no tests to say it doesn’t do harm. As you can imagine, there aren’t a lot of women lining up to have their unborn child be a test subject.

I’m sure you can find a dentist to do it for you. Just make sure you understand the risks. By that I mean we don’t yet know the risks.

Invisalign

These are clear aligners you wear over your teeth to straighten them. It’s perfectly safe to use during pregnancy. However, if you are prone to morning sickness and vomiting, you may find this an inconvenient time to straighten your teeth. The aligners have to be worn almost full-time, with the obvious time exceptions being during meals.

Vomiting will mean thoroughly cleaning out the aligners so you don’t get stuck with anything acidic in them. This will lead to massive decay.

Porcelain Veneers

Porcelain veneers are a safe procedure, even during pregnancy. The only chemical used would be the Lidocaine which is used for numbing during tooth preparation. Lidocaine is one of the medicines which has been FDA approved as safe to use during pregnancy. It’s even sometimes used during the delivery process.

The only cautionary tale I’d offer here is to make sure you see an expert cosmetic dentist or you will be disappointed with your smile makeover results.

All that being said, if you are in a high-risk pregnancy group, you’ll need to scrap everything I just said and talk to your obstetrician and get clearance on everything first. There will likely be special considerations.

Best of luck to you and your baby.

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

Do I Have to See an Accredited Cosmetic Dentist?

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I’m thinking of getting a smile makeover and research says it is important to go to an accredited cosmetic dentist. There doesn’t seem to be any in my area. To get a beautiful smile, do I have to see an accredited dentist?

Mercy

Dear Mercy,

Brunette with a beautiful smile

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

For a dentist to reach accreditation with the American Academy of Cosmetic Dentistry, they have to pass both technical and clinical exams. The technical exam is to ensure they have the requisite knowledge to do the job skillfully. The clinical exams show they also have the artistry to create stunning smiles.

AACD accredited dentists are in the top 1% of cosmetic dentists in the country. However, there is no regulation to compel a dentist to seek accreditation in order to provide cosmetic work. In fact, there are no regulations necessary for a dentist to call him (or her)self a cosmetic dentist.

Getting a Beautiful Smile Makeover

While you don’t have to see an AACD accredited dentist to get a beautiful smile makeover, you do have to make sure the dentist has the expertise to do the work properly and with artistry. If you don’t have an accredited dentist in your area, you still have an additional resource where you can trust the dentists to know what they’re doing.

The mynewsmile.com website also screens cosmetic dentists. They won’t list them unless they have done post-doctoral studies in smile makeovers at a reputable institution and provided visual evidence of their artistic abilities. Some of these dentists are accredited. Some are on their way to accreditation. Some aren’t interested in going through the process. All of them can give you a stunning smile.

You may already know that the top of the line procedure for a smile makeover is to get porcelain veneers. It is not recommended to place them over dental crowns, so if you have those on any teeth, you will still have to have a crown. A good cosmetic dentist is skilled enough to match your crowns to your veneers. If they’re on visible teeth, they will give you an all-porcelain crown. Those are more natural-looking.

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

Cosmetic Dentistry Malpractice

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Can you advise me? I spent a small fortune to get my smile updated. I’d had some cosmetic bonding on my front teeth which was showing its age along with a dental bridge. I went to a dentist who advertises as specializing in cosmetic work. He replaced the metal bridge and then planned crowns on the remainder of the visible front teeth. When they put in the temporaries, they told me they wanted to be certain I’d like them. I’d brought them a very specific smile design I wanted so I was glad to hear them say that. Unfortunately, it proved not to be true. When the permanent ones came in they weren’t the same color. I mentioned that and they said they’ll look different in my mouth. They didn’t. I told them, they still looked dull. Then they said it was because I see them differently in this light. Which, by the way, was the same light I saw the temporaries. When we got in a different light I noticed, they didn’t match the metal bridge. Their response, was, “Of course they don’t. The bridge is metal.” Then they bonded them in even though I wasn’t happy with them and said I’d get used to them and love them. I don’t. I don’t know what to do. My teeth are not what I wanted and don’t match.

Patricia

Dear Patricia,

A woman smiling with a beauttiful smile

When you get a smile makeover, you should be thrilled to share your new smile.

You have a great case to have this re-done by a dentist who actually knows what they’re doing, but you are going to have to be tough. This dentist behaved quite unethically based on what you’ve said and I don’t think he cares whether you like your smile or not.

Aside from shoddy cosmetic work, they violated a very important principle of dental practice, which is informed consent. You did not consent to them bonding in your new smile. In fact, they badgered you into it by trying to make you feel unreasonable. This was after they promised you that you’d get to approve the smile and love it first.

Dealing with Shoddy Smile Makeovers

Because they didn’t have your consent, you have the right to have this done again. However, I wouldn’t trust this dentist to do it. Instead, have them pay for an excellent cosmetic dentist to re-do your work properly. You may have to involve a lawyer, but you’re on solid ground.

It’s unfortunate he ground all those teeth down for dental crowns. Porcelain veneers would have been a better option for you and is much more conservative on your tooth structure. Seeing as you had crowns done (through no fault of your own) you will have to have crowns done again.

This time, get them done by someone who’s invested time and training in cosmetic dentistry (which by the way isn’t a recognized specialty). In your place, I’d go to mynewsmile.com and see which dentists they recommend in your area. Anyone on their list will give you a stunning smile makeover you’ll be proud to show off.

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

Best Dentist for a Recovered Bulimic

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I’m looking for a dentist for my daughter. She’s a recovered bulimic. I’m super proud of all the steps she’s taken to get a healthy mindset again. She’s been out of recovery for six months and has done spectacularly. I thought it was time to reward her new habits with a smile makeover. When she was purging it did tremendous damage to her teeth. I want her smile to reflect her beautiful spirit. I am just not sure how to find the right dentist for this type of situation. Any advice?

Kaylee,

Dear Kaylee,

A woman smiling with a beauttiful smile

It is great that your daughter has such wonderful support from you. That will help her go far for the remainder of her life. It’s also great you are doing some research ahead of time. I can’t tell you how many cosmetic dentistry horror stories there are of patients who went to an inexperienced cosmetic dentist. This would be the last thing your daughter needs.

Most cosmetic dentists have experience with bulimic patients. They are sensitive to how they’re affected by their smile and will not be judgmental, which is important. Equally important is their skill in creating beautiful smiles. Sometimes porcelain veneers are sufficient, but depending on the severity of the damage, she may need some dental crowns as well.

Because of that, you’ll want a dentist who understands not only how to create beauty but knows how her bite should come together if a lot of crowns are necessary.

Finding the Best Cosmetic Dentist

There isn’t a recognized specialty in cosmetic dentistry. This leaves patients in the quandary of figuring out who is skilled and artistic and who isn’t. The American Academy of Cosmetic Dentistry recognized that issue and started an accreditation program to serve both patients and dentists interested in cosmetic work.

Dentists can take classes to improve their skills. Plus, they can strive for accreditation. To get accredited, dentists have to pass stringent oral and written exams. In addition, they have to provide visual evidence of a large number of cases they’ve personally done in order to show their artistry in their work.

In your place, I would look for an AACD accredited dentist. They are the best cosmetic dentists in the country and will give your daughter a smile she’ll be proud to share with the world.

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