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Should I Finish My Full Mouth Reconstruction?

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I am in the middle of a full-mouth reconstruction and I am not sure if I want to complete it. The lower teeth were done first. They look beautiful because I hired an AACD-accredited dentist. I know it sounds weird but that is what is bothering me. They look so perfect. I had a quirky smile and this just looks like your typical celebrity smile. I feel stupid but I miss the quirkiness of my smile. The reason for the reconstruction to begin with is that I had been grinding my teeth down. My dentist didn’t mention it until they were ground down and then he told me that I needed a full-mouth reconstruction. I was a little annoyed, which is how I started doing research about what it means and who should do it. That led me to getting an accredited dentist. Will I have to get the uppers done? Can I just whiten the uppers so they don’t look so perfect as the bottoms?

Callie

Dear Callie,

A woman pointing at her smile

First, I want to tell you that your original dentist could and should have told you about the grinding to begin with. That would have saved you this expense and hassle. All you would have needed was a simple mouthguard and your teeth would have been protected even with the grinding. I’m going to suggest you find a different dentist who is more interested in protecting your teeth. Though, that doesn’t help with your present predicament.

If you are worried about the smile looking too perfect, I would say take full advantage of the skill an AACD accredited dentist has. What I mean by that is they are tasked with making Hollywood smiles all day long. I think they would jump with glee at the chance to make a quirky smile. You could literally get whatever you wanted and make a dentist and ceramist’s day with your desire for it not to be perfect.

As for just not completing it and just whitening, I haven’t seen your case, so couldn’t tell you with definitely. While you can definitely whiten, what I can tell you is that if the damage isn’t too bad, you can just get a mouthguard to protect them for further grinding. This will be important because the crowns on your lower teeth will be a bit more abrasive on the uppers than your natural teeth are. If the damage is bad, you will want to complete the case. Having a collapsed bite can lead to pain and serious TMJ Disorder.

Just remember, you can get quirky.

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

Crowns Versus Veneers for Tetracycline Stains

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I have tetracycline stains on my teeth and really want a pretty smile. I spoke to one dentist who has a good reputation in cosmetic dentistry, name Dr. —–[name withheld].  He wants to charge me $42, 000 for upper and lower full mouth veneers. Another dentist is suggesting porcelain crowns and is only $28,000. I really only have $30,000 to budget for this, so I should probably go with the crowns. However, I wanted to double check with someone not invested in getting my business as to crowns versus veneers for tetracycline stains. Is one better than the other for this? Plus, you should know I have a tooth grinding problem, which may impact your answer.

Carla

Dear Carla,

a porcelain veneer being placed on a tooth

 

The first dentist you mentioned, who is suggesting porcelain veneers is one of the top cosmetic dentists in the country. If you decide to go with him, he will provide you with a stunning smile. You didn’t give the name of the second dentist, but I am cautious about recommending him either way because he is suggesting dental crowns.

Tetracycline stains are some of the trickiest to deal with when it comes to a smile makeover. You have to get the teeth opaque enough to cover the stains, while still creating a natural looking translucency to the teeth. To compensate for the difficulty, some dentists will suggest dental crowns instead of porcelain veneers thinking the added thickness will make it easier for them. It doesn’t. I find porcelain veneers to be the superior treatment. As for your bruxism (teeth grinding), if you get a nightguard to wear while you sleep it will protect you from the grinding damage. So that will not be an issue.

If your budget is the main reason for going to the cheaper dentist, I am going to suggest a different approach. I know the quality you will get with the first dentist. Why don’t you have him just do your upper arch and use a strong teeth whitening, such as Kor Whitening to do on your lower teeth. It will take a bit to get the lower teeth to match, but if you are persistent they will. Then, you are only paying $21,000, which is below budget and will have a stunning smile.

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.

Bonding Color is Wrong

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I have these exposed places at the top of my teeth that are very sensitive. Other than that, my teeth were attractive. They showed me their plan and I knew immediately the color would need to be whiter. I pointed that out and they agreed. Then, they put in the new “whiter” color. It still doesn’t match my teeth. Plus, it looks opaque and is rougher looking than my natural tooth structure. I feel like what was an attractive smile has been made less attractive in order to prevent the sensitivity I was feeling. Is there a fix for this?

Callie

Dear Callie,

abfraction lesionWhen done well, dental bonding should blend seamlessly with the remainder of the tooth. I’m especially sorry for what you are going through because what your dentist is trying to do is even easier than when you have to repair a chip. If I understand your description correctly, you are dealing with what is known as an abfraction lesion (pictured left).

We used to think these were caused by brushing too hard. We now think it has more to do with clenching and grinding of your teeth. This flexes the tooth right at your gumline, adding stress. That repeated movement wears away the gumline. One thing you will want to do after this is repaired is to have a night guard made. This is a custom fit mouthpiece, similar to a sports mouthguard that you will wear while you are sleeping. Nighttime is when most grinding and clenching takes place. Usually, until their teeth are worn down, the patient has no idea it is taking place. Over time, this can lead to TMJ Disorder as well as wearing your teeth down to numbs.

Repairing Your Dental Bonding

before and after dental bonding to repair a chipped tooth

Pictured directly above, you will see a case of dental bonding done well. You can’t tell where the bonding ends and the natural tooth structure begins. Your teeth can look this way too. Unfortunately, the only way to fix this is to have it done over again.

Being blunt, I think this is beyond the scope of your dentist’s abilities. You will need to have a dentist with more cosmetic training step in and repair this. Ask your current dentist for a refund. Then, look for an AACD accredited dentist in your area. They can give you the results you are looking for.

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

Form and Function with TMJ Disorder

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I am a mess. I had been grinding my teeth for years. Apparently, my dentist knew this and never mentioned it until my teeth were down to nubs. He crowned the worn teeth, but now I am in constant pain. Plus, I’ve worn those down as well. I don’t know how to stop doing that because I didn’t realize I was doing it to begin with. I went to get specialist help but learned there isn’t a specialist in this. It has been suggested I see a prosthodontist, but I’m worried the teeth won’t look good. Do I have to choose between functioning pain-free teeth and a pretty smile?

Amelia

Dear Amelia,

woman holding her her jaw in pain

I’m sorry you’ve been put through this. Plus, I hope you don’t mind saying I think you need to find a better dentist. This one doesn’t seem to have your best interests at heart. He knew you were grinding your teeth and never provided you with the simple tool to protect your teeth to keep from wearing them down.

Then he let you do it again with your dental crowns. I’m sorry, but that is like standing there watching a blind person walk off a cliff, charge them for the hospital bill and repairs, then watching them do it again. How were you supposed to know you were grinding your teeth, let alone what would help? He’s the professional.

Yes, a prosthodontist will typically have more training in treating TMJ Disorders than your average dentist, but as you mentioned not many of them are artistic. They are passionate about the technical aspects and don’t really care about appearance-related issues.

What you need is a dentist who is passionate about form and function; one who has invested in both TMJ training as well as cosmetic training. I promise they exist. They’re not as much of a unicorn as it might seem at the moment.

Finding a Great TMJ Dentist Who Can Create Beautiful Smiles

You’ll need to begin with the TMJ training. It will not matter how beautiful your smile is if you are in too much pain to share it. Here are some institutions which have great TMJ training. You’ll want to find a dentist who has trained with one of them.

  • The Dawson Academy
  • The Kois Center
  • The Pankey Institute
  • The Las Vegas Institute of Advanced Dental Studies

From there, you’ll look to see if any of them have great cosmetic skills. The best are AACD accredited. These are hard to find. Dr. Weiss is one of six accredited dentists in the whole of Pennsylvania. If you can’t find one, that doesn’t mean it’s hopeless. Many great cosmetic dentists are on their way toward accreditation. I would look at their smile galleries to see what type of results they get. Just makes sure it is images of their actual work and not just stock photos.

One other thing. You need to get a nightguard. This is like a sport’s mouthguard, but is custom-fitted to your bite. It will protect your teeth from the grinding you are doing while you sleep.

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