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Pain with Small White Fillings

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I had two small white fillings done. It’s my first experience with white ones. My dentist finally joined the twenty-first century. He’s pretty old school but he’s been my dentist since I was a kid so I don’t want to switch. I’m having this odd issue that is causing pain. If I bite down, clenching my teeth, there is no problem. However, whenever I am chewing on something hard, I get a sharp pain. My dentist can’t figure it out and I’m almost to the point of going back to the old amalgam fillings. I know those aren’t the healthiest, so I’m hoping you have heard of this problem.

Katie

Dear Katie,

before and after mercury-free fillings

I am aware of this issue and do have a solution. Don’t be too hard on your dentist. It’s a big deal for some older dentists to step out of their comfort zones and move away from procedures that have served them well for decades. It sounds like your dentist is trying to do just that. There is always a learning curve when someone is upping their skills.

While the procedure for amalgam fillings is completely different from the bonding for white fillings,. this issue is unique. For some reason, the issue you are experiencing only seems to be an issue with smaller composite fillings.

There are two possible solutions for this. Both of them will require replacing the composite filling. When you do, the first is utilizing the latest technology. When placing composite fillings, your dentist can use “self-etching primers.” These have been eliminating this type of sensitivity.

A second option is for your dentist to use a glass ionomer base under the filling. This will keep him from having to bond directly to the dentin of the tooth.

Either way should solve the problem you are having and give your dentist another tool in his toolbox.

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

Dealing with a Chipped Lower Incisor

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I have a lower incisor that is chipped. It is a bit irritating and I’m worried people can see the chip when I am talking. My dentist tried to repair it with dental bonding but that fell off after a few days. Is there a way to just regrow the broken part?

Olivia

Dear Olivia,

A porcelain veneer being held up with a dental tool

With a lower incisor there is always the problem with the upper teeth causing an issue with the dental bonding. This is because the incisal edges hit the insides of the upper incisors every time you close your mouth. Dental bonding is more susceptible to those type of stresses. You would need an expert dentist to who has studied occlusion to know how to avoid those type of stresses. Otherwise, the bonding will break.

Another option for fixing this is with a porcelain veneer. These are a bit stronger and last longer than dental bonding. While bonding will last a few years, veneers can last for decades if well cared for.

With either one of these procedures you will want a dentist with significant post-doctoral training and expertise in both occlusial studies as well as cosmetic dentistry.

In your position, I would look for a dentist who is AACD accredited. These are the top cosmetic dentists in the country and they will have the skills to give you not only a repair that will last, but that will also blend seamlessly with the rest of your smile.

If you can’t find a skilled cosmetic dentist in your area, then a last resort would be to have the dentist smooth out the chip. That would only be a last resort. You may have to travel to a nearby city, but I’m sure you can find a skilled cosmetic dentist.

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

An Absolute Dental Bonding Disaster

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I had dental bonding done a few years ago. They’ve picked up some stains and I went to my new dentist to have it replaced. The results were and absolute disaster. Here is just some of what is wrong with this “repair”:

  • The color doesn’t match the rest of the teeth.
  • The right tooth is longer than the left tooth
  • The left tooth is uneven and dips up in the middle
  • There is now a gap between my teeth that wasn’t there before

I asked her to fix these things. She didn’t argue about fixing things where the teeth weren’t even the same size, thankfully. However, with the color difference, she said that natural teeth have different colors and that the gap is almost impossible to not get when you do dental bonding. Next, she told me to give it a week and if I’m still unhappy we can talk about what I am still unsatisfied with. I went in to deal with discoloration and ended up with Frankenteeth. Do you think I should go through with this and give her another chance or should I just start over with someone else?

Mary

Dear Mary,

before and after dental bonding

I’m glad you wrote. While you are welcome to try and give this dentist another go at it, I would not hold your breath that this is going to turn out any better the second time. One of the problems you are facing here is that cosmetic dentistry is not a recognized specialty. As a result, any general dentist can “do” cosmetic dentistry. While dental schools will go over some basic technique, the aesthetics of the results are not judged or even required.

On top of that, dental bonding is one of the most difficult of the cosmetic procedures because it has to be done freehand. It also requires the dentist to keep on hand a variety of different texture, colors, and translucencies. This is expensive, especially if they do not do a lot of cosmetic work.

There is also a difference in attitude between a true cosmetic dentist and what your dentist offered up. A cosmetic dentist would never be satisfied if you were not. Those dentists who say, “give it some time,” are actually hoping you’ll give up.

If you do let this dentist try again, make sure they understand that if it isn’t right this time, you will want a refund so you can get it done somewhere else. If it comes to that, my suggestion is for you to seek an AACD accredited dentist. These are the top cosmetic dentists in the country and will certainly be able to give you the results you want.

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

Dental Bonding Staining After Two Weeks

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I had dental bonding placed just two weeks ago. It has already started staining, which surprised me. I did some research and realized it could be my coffee drinking. It was also suggested that I purchase Supersmile Toothpaste. Do you know if this will allow me to continue drinking coffee or if I will have to give it up? My dentist never told me to stay away from anything in particular.

Carol

Dear Carol,

before and after dental bonding

While it is true that dental bonding will pick up stains after a while, a few weeks is way too soon. I have a supicion your dentist is just a bread and butter general dentist and not one who does any significant amount of cosmetic work in his practice.

Dental bonding is made with a blend of composite and inorganic fillers. There are a variety of fillers and sizes. Some examples of this are silica, quartz, and glass. Hybrid composites are strong, but because their particles are larger they cannot be glossed to a high shine. Microfills, because they are very small, can be polished to a luster as shiny as natural tooth enamel but are not as strong. There is a newer nanofill composite which claims to have both strength and polishability. Because it is new, we have to see how that pans out.

Most general dentists, who don’t do a lot of cosmetic work, will just keep hybrid composites on hand because they are looking for durability. But, when you are talking about appearance, you need a combination. A skilled cosmetic dentist will use the hybrid on the inner part of the tooth and then use the microfills on the surface on the teeth which allows them to get the high shine you need to protect your teeth from staining.

My suggestion is that you return to your dentist and share what you’ve learned here. He should be willing to improve the shine. If he is incapable, then you will have to go to an expert cosmetic dentist.

Whenever we are talking about aethetic dentistry of any kind, I recommend you see an AACD accredited dentist. These are the top cosmetic dentists in the country and can give you stunning results.

I don’t know what your dental bonding was for, whether it was to repair a chip, close a tooth gap, or purely to give you a smile makeover. If you were doing a smile makeover, you will get longer lasting, more beautiful results with porcelain veneers.

As for Supersmile toothpaste, it does an excellent job removing surface stains from dental work. However, if yours has lost its shine, it won’t be helpful there. Save the toothpaste for when your bonding is repaired.

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

Treating Enamel Hypoplasia

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I am frustrated with my smile and tired of always hiding from pictures. We’re thinking about starting a family and I don’t want to avoid photos during my child’s entire life. What are my options for treating this?

Caroline

Dear Caroline,

Congrats on starting a family. I can completely understand why you want to feel comfortable and present for pictures. There are a couple of good options for you in giving you a smile you can feel proud to share with the world. For those who are unaware of what enamel hypoplasia is, it is a defect, which is caused either by genetics or an illness during the formation of the teeth, that causes to the enamel of the teeth to not fully form.

Mild and severe enamel hypoplasia

Treating Enamel Hypoplasia

With mild hypoplasia, you have two good options. The first is dental bonding. With this procedure, your dentist will drill or sand out the white spots and then fill the tooth with composite resin. This is done freehand and will be finished when you leave. It is the least expensive of the two options but does need to be replaced periodically.

Your second option is to have porcelain veneers placed over your teeth. If you are dealing with severe hypoplasia, as pictured above, this would be the only option I would recommend. With porcelain veneers, thin wafers of porcelain are bonded to your teeth. They are the go-to for those Hollywood smile makeovers and can not just cover the hypoplasia, but completely redesign your smile. Porcelain veneers can change the size, color, and even shape of your teeth.

Pick the Dentist Carefully

Both of these are cosmetic procedures. Unfortunately, cosmetic dentistry is not a recognized specialty yet. This means that any dentist can call themselves a cosmetic dentist. To make matters worse, smile makeovers are not adequately taught in dental school. If a dentist wants to develop skills in creating smile makeovers, then they will need to invest in post-doctoral training. Not many dentists do.

So how are you to know the real deal from the pretenders? Well, you could ask them where they got their post-doctoral training in cosmetic work and then ask to see their smile gallery to see what type of artistry they have. Another option is to look for a dentist who has been accredited by the American Academy of Cosmetic Dentistry. AACD accredited dentists have passed stringent exams on the technical procedures as well as demonstrated a high level of artistry in the work they do.

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

Can Dental Bonding Fix My Peg Laterals?

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I have peg laterals on my upper on either side of my two front incisors. I’ve had them since childhood and I really dislike how they appear. I’ve heard that I may be able to have them “fixed” using bonding–is this true? I’d love to smile without reservation at last.

Many thanks,
Moira

Dear Moira,

before and after dental bonding

This is a great question and one that is frequently asked by others as well.

What Are Peg Laterals?

For those who may not be aware of what you are referring to, let me give a quick rundown. Peg laterals are when the teeth lateral to the upper incisors are malformed. Often they are small and occasionally even pointed. Considered a form of microdontia, peg laterals are congenital and can be hereditary. They are rarely seen in lower teeth.

Will dental bonding help?

The short answer is yes. In fact, dental bonding is often one of the best ways to treat peg laterals and gain an esthetically pleasing smile. You also have the option of porcelain veneers as a solution. Veneers last longer, but are more expensive so which you pick will depend on your budget.

During the bonding process, your natural peg lateral teeth are left in place, and a tooth-colored material is bonded to the surface to bring the size and shape of the teeth in alignment with the rest of the natural incisors. They will be expertly shade-matched, shaped, adjusted, smoothed and polished to match your other teeth and your occlusion, resulting in a pleasing smile.

These should last you several years. As I mentioned earlier, porcelain veneers will last longer and will be more stain resistant, so you will want to look at both options to decide which is best for you.

Getting Beautiful Dental Bonding

The real trick to this is who you have do the procedure, regardless of whether you choose bonding or veneers. Cosmetic dentistry is not taught in dental school so for a dentist to do it well, they need to have post-doctoral training. The top cosmetic dentists are AACD accredited. In your position, I would look for that type of dentist. This way, you will be pretty much guaranteed a gorgeous result.

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

Are Lumineers My Only Option to Repair Old Dental Bonding?

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I had dental bonding done years ago to cover some tetracycline stains. Over time, the bonding has worn off and picked up stains. I wanted to replace the bonding, but I am in a new state with a new dentist. He is insisting that dental bonding cannot be replaced and I have to get Lumineers. That is a much more expensive procedure than I remember my dental bonding costing me. Are Lumineers the only option or is there something else I can look at, such as teeth whitening?

Carmella

Dear Carmella,

before and after dental bonding

It sounds to me like you are with a dentist that does not do much cosmetic dental work. For one thing, dental bonding can absolutely be replaced. I’m not sure how he does not know that. Secondly, he is recommending Lumineers. This particular brand of porcelain veneers is highly marketed to inexperienced cosmetic dentists as being easy to place.

You have three options for covering tetracycline stains. The first is porcelain veneers. This is the best option because the veneers will last longer than dental bonding. While bonding can give you a few years of stain resistance and heartiness, the porcelain veneers can last your lifetime when well taken care of. This means you won’t have to keep replacing them.

Your second option is to replace the dental bonding. Depending on the surface area, this may actually require more chair time for the dentist which could raise the price. They also have to be done free hand, so you will want to find a cosmetic dentist with a lot of experience covering tetracycline stains with dental bonding.

Finally, teeth whitening is sort of an option but you have to be very determined and patient in order to get it to work. It could take months and months of teeth whitening, which could lead to tooth sensitivity. I would only recommend professional strength take home whitening in this situation.

Your Most Important Decision

Your top priority should be to find a qualified cosmetic dentist to do this work. Tetracycline stains are some of the toughest to deal with. It will require a dentist with a significant about of post-doctoral training as well as an artistic eye. In your place, I would only allow a dentist who reached accreditation with the American Academy of Cosmetic Dentistry touch this. AACD accredited dentists are the top cosmetic dentists in the country. Listen to what his or her recommendation is before deciding on a procedure.

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

My 11-Year-Old’s Dental Bonding Looks Terrible

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I need some advice. My eleven-year-old daughter fell in such a way that it knocked a giant portion of the middle of her two front teeth out. She has some on the sides and top and that is it. Our dentist said the best solution would be to fill in the empty space with dental bonding. We agreed, but in all honesty, it looks awful. Her two front teeth are now lumpy looking and the color doesn’t exactly match the remainder of her natural teeth. This is a very tricky age for kids and she has been in tears since we returned. I don’t know what to do. Can this be fixed? Did he need to do a different procedure?

Avalon

Dear Avalon,

before and after dental bonding

While your dentist was correct about the type of repair that would be the best solution, he doesn’t appear to have the cosmetic training necessary to do the actual work. Cosmetic dentistry is not a recognized specialty. As such, any general dentist can “do” cosmetic work, but very few of them have the actual training necessary to do it right.

Dental bonding is particularly difficult because it has to be done freehand. It also requires special materials in order to match the colors exactly to the remaining tooth structure. On top of that, your daughter’s type of repair is more difficult than most. It’s even on the list of cases dentists have to show proficiency and artistry in for them to pass the AACD Accreditation Exam, which is the one “guarantee”  for knowing that you have an expert cosmetic dentist.

My suggestion is you ask for a refund from your dentist. It doesn’t sound like he even came close to doing this in an acceptable fashion. Then, look for an AACD accredited dentist in your area. They will make certain your daughter has gorgeous front teeth as she returns to school.

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

Did Listerine Turn My Porcelain Veneers Gray?

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I had ten porcelain veneers placed on my upper teeth about 7 months ago. I have tried to take very good care of them by brushing thoroughly with a hard toothbrush and using Listerine to keep the bacteria away. Now my porcelain veneers have turned gray over the entire surface. Could the Listerine have done this? They never really gave me any instructions on how to take care of them so now I wonder if I did something wrong without knowing it. If I damaged them, is there any way to fix it?

Mary Ellen

Dear Mary Ellen,

a porcelain veneer being placed on a tooth

 

I am sorry that your porcelain veneers have turned gray. I am disappointed that your dentist never gave you instructions on how to care for these. While Listerine can damage your porcelain veneers because of the alchohol content in it, the damage would be more to the margins, not the surface. There are a couple of things that could be the cause of them turning gray.

The first is that you do not actually have porcelain veneers. Some unethical dentists tell their patients they are getting porcelain veneers, when in reality they are only giving them composite bonding. This will deteriorate and stain much sooner than veneers.

A second possibility is that your dentist or hygienist did something to damage the surface of the porcelain veneers at your last cleaning. If they used something like a Power Prophy Jet or acidulated fluoride, it will destroy the glazing on your porcelain veneers.

Either way, it is your dentist’s fault that this happened. My recommendation is that you go to see an expert cosmetic dentist. Don’t tell them who did the work, just ask them if they are actually porcelain or composite and whether or not they can tell what is wrong with them. Look for someone who is AACD accredited. These are the top cosmetic dentists in the country and can give you some good feedback.

Caring For Your Porcelain Veneers

  1. Mouthwash is not really necessary, but if you feel you need it, make sure you look at the ingredients and only get some that is alchohol free.
  2. Use a soft-bristled toothbrush. These are actually better for your natural teeth too.
  3. Most over-the-counter toothpastes are fine, with the exception of whitening toothpastes. Whitening toothpastes tend to have abrasives in them, which you do not want. However, if you are looking for the best toothpaste for porcelain veneers, I would look into SuperSmile toothpaste. This brand is specifically designed for cosmetic dental work.

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

Solution for Brown Stains on Teeth

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My son has brown fluorosis stains on his teeth. They’re not very big, however it does cause him some embarassment. We’ve been to our dentist and did teeth whitening. That didn’t work. Somehow it made them more noticeable. Now she is talking about doing veneers, but they are quite expensive. Is that the best solution?

Kelly

Dear Kelly,

before and after dental bonding

I am very glad you wrote. I don’t want you going to this dentist for the solution to your son’s fluorosis stains.  She may be a great general dentist but she has no idea what she is doing with cosmetic work. Teeth whitening is the simplest cosmetic procedure and she didn’t know the basics on that. The reason it didn’t help your son’s situation is that the bleaching gel will whiten the teeth evenly, which tends to make stains more noticeable instead of less.

Dental bonding would be a better solution in your son’s case. However, you would need to take him to an expert cosmetic dentist. Even if you have to travel to another city to find one, it will be worth it. This is a very advanced cosmetic procedure that has to be done freehand. In your position, I would look for an AACD accredited dentist. If there is not one in a reasonable distance, try someone recommended by the mynewsmile.com website.

Any of those dentists will do an excellent job for you son. They are the top cosmetic dentists in the country. He will finally have a smile he will not be embarassed by.

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