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dentistry

Root Canals Needed after Her Smile Makeover

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I had a complete smile makeover with veneer crowns. When I went in for my consultation I specifically asked about any risks involved. He told me there weren’t really any. I went forward with the procedure confident and excited. Since then, four of the teeth have needed root canal treatments. He suggested I see an endodontist. I did and was informed even more teeth are likely to need root canals soon enough. I thought there wasn’t much risk with these. What happened? Have you seen this before?

Ruth

Dear Ruth,

I think there is some confusion here. There are porcelain veneers and there are porcelain crowns, but there aren’t veneer crowns. So, I’m not sure which you received. However, based on the number of root canal treatments you received, my guess is it was porcelain crowns. I’m going to show you two photos below. The first image is what a tooth would look like with porcelain veneer preparation. The second with dental crown preparation.

Teeth prepped for porcelain veneers

Porcelain Veneer Preparation

Porcelain veneer preparation will take off maybe a 1/2 millimeter of tooth structure. It is rare for this procedure to end up needing even one root canal treatment, let alone the amount you are ending up needing.

preparation for porcelain crowns

Porcelain Crown Preparation

On the other hand, a porcelain crown preparation goes much deeper into the tooth structure, which puts you at a greater risk of exposing the pulp of your teeth. That in turn leads to a tooth infection.

What is a Smile Makeover

You said you were getting a smile makeover. Unless there are other issues such as extensive decay or TMJ Disorder, you would use porcelain veneers for this. Giving you the number of dental crowns he gave you is more of what would happen with a full-mouth reconstruction.

If you really only needed porcelain veneers than your dentist was much more aggressive than he should have been and should be liable for the damage he caused to your teeth. That means paying for the root canal treatments you need. This is especially true because he told you there weren’t really any risks. If he prepped for crowns, there are always risks.

Hopefully, you at least like how these teeth look.

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

Malpractice Smile Makeover

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I feel like I’ve ruined my mouth and my hard-working husband’s finances. I had some chipped teeth and some other minor issues with my smile. I asked my dentist about possible fixes and she suggested I get a smile makeover with porcelain veneers. She said it is what the celebrities use to get their gorgeous smiles. My husband and I discussed it as it was a big chunk of change and decided to go ahead with it. I’ve regretted this decision ever since. I’m about to move and running out of time to get this fixed. Here are my problems:

1. The teeth (eight of them) were ground down to nubs. Disgusting little yellow nubs. This wouldn’t be such a big deal if it weren’t for the second problem.
2. They don’t stay on. In the course of this year, they have fallen off eleven times. One of them over a major holiday when I couldn’t get in to get them fixed. The humiliation of having those tiny, yellow nubs was almost unbearable.
3. She says I’m being too rough on them, but one of them fell out while I was eating pasta. How is that too hard?

Please tell me a way to get this to work. I’m worried after we move no one will help because it is another dentist’s problem.

Katy

Dear Katy,

I have to express how sorry I am for what has been done to you as well as the anguish you’re going through. It shouldn’t have happened. The good news is you have a pretty solid case for malpractice. Additionally, this can be fixed. The bad news is she has misled you and done some things which will affect the repair as well as how your teeth function for the remainder of your life.

Porcelain Veneers verss Porcelain Crowns

Based on your description, your dentist gave you porcelain crowns, not the veneers she said she would. I know that based on your description of the teeth being ground down to nubs. Look at the two pictures below:

tooth preparation for porcelain veneers

This is what teeth look like when being prepped for porcelain veneers. There is minor removal of tooth enamel, around the width of a fingernail. This is not what you described.

tooth preparation for a porcelain crown

This is closer to what you described and is the preparation for a porcelain crown. Yours may even be more aggressive than this. Here’s where she has done some permanent damage. We don’t currently have the ability to regrow tooth enamel. Because of that, even when this is repaired properly, you will always have to have porcelain crowns instead of the porcelain veneers you were told you were getting.

Here’s where some “good” news kicks in. First, she lied. You were told you were getting porcelain veneers, which incidentally is the go-to procedure for Hollywood celebrities, but instead received dental crowns.

Second, she’s had gross incompetence in her handling of the dental crowns. While smile makeovers, including the procedure of porcelain veneers, isn’t taught in general dental school and therefore isn’t a required knowledge for dentists, dental crowns are a staple. They should NOT be coming off at all, let alone as much as you’ve had them come off.

Her blaming you is unacceptable. You could have been eating steak and apples every day and your dental crowns should have stayed in place.

Getting this Fixed

She needs to pay to have this done correctly. I don’t want you just getting a refund, because it is very likely going to cost more than your original price. You can let her know up front what you want, but don’t get them fixed until you move. I want you under the care of a long-term provider for you.

After you get to your new location. I want you to look on the website for the American Academy of Cosmetic Dentistry (aacd.com) for an AACD accredited dentist. This is different from just being a member, so make sure you check the accredited dentist option. Accredited dentists are in the top of the cosmetic field and will give you a stunning smile.

If your current dentist refuses to make this right and you have to go to court, make sure to ask for additional money because giving you crowns instead of veneers has damaged your teeth and changed your care for the remainder of your life. I think her malpractice insurance will tell her to pay up quick, because if it ends up in court, you will likely get a substantial amount.

Again, I’m sorry this has happened to you. I don’t like dentists who give our practice a bad name either through incompetence or lack of ethics.

Keep your chin up. You will soon have a smile you will be proud of.
This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Why Is there Too Much Shine on My Porcelain Veneers?

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I don’t know why, but my porcelain veneers have so much shine on them, they look fake. My dentist disagrees and thinks they are beautiful. He says it is because of the whiteness I wanted that they are so shiny. I did ask for very white porcelain veneers. But, I don’t understand the brightness. I have seen other white veneers and, while they shine, they still look natural. Mine look like shiny pieces of chicklet gum.

Tanya

Dear Tanya,

It simultaneously amuses and annoys me when a dentist puts the problem off on the patient, like it was their fault he didn’t produce a nice result. While I wish I had an image of your smile to be certain, I do have a sneaking suspicion of what is going on here.

It takes an expert cosmetic dentist to get porcelain veneers to look natural. Unfortunately, cosmetic dentistry isn’t recognized specialty so any general dentist can call themselves a cosmetic dentist. Even more unfortunate, smile makeovers aren’t taught in dental school. This means if a dentist wants to know how to create beautiful, natural looking smiles, they have to invest in post-doctoral training.

I want you to look at the picture below. Notice how the teeth have texture to them. If that texture isn’t added, the porcelain veneers will look flat, giving it an overly shiny appearance.

image of a smile after a smile makeover

The texture in the teeth needs to be varied as well. Plus, younger smiles have more texture because as we age, parts of that texture wears down. Believe it or not, one of the teeth in the image above is actually a dental crown. This is the kind of work a true cosmetic dentist does.

One thing I want to know is if your dentist bonded them on before or after you told him you didn’t like them. True cosmetic dentists will put your porcelain veneers in with a temporary try-in paste. They’ll have you look at them in various lights and make sure you absolutely love them. If you don’t, they’d go back to the lab.

If your dentist bonded them on and then you said you didn’t like them, you may not have much recourse. However, you could appeal to his ethics. You paid for a beautiful smile and should get one. If you got to try them on and told him you didn’t like them and he bonded them on anyway, then he didn’t have consent and you have the right to a refund. Ask for one.

Then, I would go to an AACD accredited dentist to get your smile makeover done. These dentists have proved their knowledge, skill, and artistry. In order to become accredited, a dentist has to pass stringent exams and turn in visual evidence on a large number of cases they’ve done.

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.

Porcelain Veneers Over Fillings

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I have a couple of teeth which have fillings on the front of them. I’ve never been happy with their appearance and wanted to have a smile makeover with porcelain veneers. My dentist said that the veneers won’t work because of my dental fillings. He suggested crowns instead. Is this standard operating procedure for someone in my position or is there another option? The teeth are otherwise healthy.

Karen

Dear Karen,

A woman pointing at her smile

I’m very glad you wrote. No, dental crowns are not standard operating procedure. My guess is your dentist isn’t comfortable doing porcelain veneers so he made up some lame excuse about the fillings. The truth is the bonding agent works very well on teeth with fillings. Why would you want to place dental crowns, which will require your dentist to grind down your healthy teeth? For argument’s sake, let us say you couldn’t get veneers and crowns were your only option. I still wouldn’t let this dentist do them.

If he hasn’t gotten trained in porcelain veneers, he hasn’t had significant training in cosmetic work period. Smile makeovers aren’t taught in dental school. A dentist has to invest the time post-doctorally to learn how to do beautiful, natural-looking smile makeovers. Doing dental crowns, especially on front teeth, still requires that training. I truly feel you’d be disappointed by the results.

Here’s what I’m going to recommend. See if you can find an AACD accredited dentist in your area. Not only have these dentists done extensive cosmetic dentistry training, but they’ve taken stringent exams to prove their knowledge, as well as provided visual evidence on a large number of cases they personally did in order to demonstrate their artistry. These cases were scrutinized by experts for both their beauty and technical accuracy. Any AACD accredited dentist will give you a stunning smile with porcelain veneers.

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.

Can Porcelain Veneers be Re-done?

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I had four porcelain veneers placed. When he did the temporary ones, they were too long. I asked them the make sure they were a little shorter. However, they ended up too short. I wish I had gotten to see them the second time before they bonded them on. Plus, the two lateral incisors are different shapes, which looks weird to me. Is it possible to re-do porcelain veneers? Is it hard to do?

Caitlyn

Dear Caitlyn,

a porcelain veneer being placed on a tooth

Yes, it is possible to have your porcelain veneers re-done. It’s hard on your dentist, but if you are paying for a beautiful smile makeover, that is what you should get. One word of warning, though. Technically, if the porcelain veneers are functional he doesn’t have to replace them, so be nice about it (not that I think you won’t).

It seems like your dentist is likely a decent family dentist but he doesn’t do a lot of cosmetic work. A true cosmetic dentist would never bond on y our porcelain veneers until you had a good look at them and approved. There is a temporary try-in paste he can use.

I agree that your lateral incisors shouldn’t be two different shapes. You don’t want them to be exactly the same, but you also don’t want them different enough to be distracting.

If he gives you trouble about re-doing them, one thing which may help is to see an expert cosmetic dentist for a second opinion. If he agrees they need to be replaced it will put some pressure on your dentist. He won’t want to look unskilled to a peer.

Finding an Expert Cosmetic Dentist

Because there isn’t a recognized specialty in cosmetic dentistry, it is hard for patients to know who has the skills to create beautiful smiles and who doesn’t. The American Academy of Cosmetic Dentistry recognized that and started an accreditation program.

In order for a dentist to get accredited, they have to pass exams that demonstrate their technical knowledge as well as demonstrate their artistry by providing visual evidence of a large number of specific cases they’ve done.

If there is an AACD accredited dentist near you, that is who I would get to help you if your dentist doesn’t want to fix the veneers.

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.

Trouble with Porcelain Veneers

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I have this set of porcelain veneers and I’ve had nothing but trouble with them. First, they kept coming off. Then, once they started staying on permanently, I noticed one of them has a horizontal divot which I hadn’t noticed before. I called my dentist and graciously agreed to buff it out, but now that tooth looks more matte than the surrounding teeth. What’s going on? I thought porcelain veneers were the top of the line for smile makeovers.

Pamela

Dear Pamela,

A single porcelain veneer being placed on a tooth.

You say that your porcelain veneers are the problem. On the contrary, I’m pretty sure it’s your dentist who is the issue here. First, you said they wouldn’t stay bonded. This shows a lack of basic technique. Then, you came to him with a divot in your veneer. While he may have buffed out the divot, he simultaneously took off the glazing on the veneer as well. This has ruined your porcelain veneer and it will begin to pick up stains rather soon.

You have three choices here.

  1. Have the veneer polished.
  2. Have your dentist replace your veneer.
  3. Have another dentist do the work.

First, you can have your dentist polish the damaged veneer. It’s not complicated, but it does require knowledge and equipment your dentist likely doesn’t have. You start by using diamond polishing instruments and polishing paste, then end with an ultra-fine diamond polishing paste. I recommend Brasseler’s Dialite Porcelain Polishing System.

If you aren’t confident your dentist can pull this off or he’s not interested in investing in the right equipment, then you can require him to replace the porcelain veneer. This would require he has improved his bonding technique.

Finally, if you don’t have confidence in him to be able to do either of the above correctly, then you simply ask him to pay for the repair from a more qualified dentist, whom YOU pick.

Who Should Do Your Porcelain Veneers?

You were correct in thinking that porcelain veneers are the top of the line smile makeover procedure. However, to get that gorgeous celebrity smile, it also requires having a top of the line cosmetic dentist. I always recommend you look for an AACD accredited dentist in your area.

These are the dentists who, not only invested in advanced cosmetic training, but also have an artistic eye with the ability to craft stunning smiles.

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

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