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dentistry

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.

Pain with Teeth Whitening

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For the last three weeks I have been using an over the counter teeth whitening kit. I had not had any problems until today. Out of the blue, I had this zing of pain that lasted half a minute. It was on a tooth that had some dental bonding done a few years ago. Could that be the problem? Will the teeth whitening damage the bonding or is it just a matter of the bonding nearing the time it needs to be replaced?

Avery

Dear Avery,

teeth whitening trays

Professional Teeth Whitening Trays

I do not believe that the teeth whitening is damaging the bond. If it did, the repair would just fall off. It would not cause pain the way you are experiencing. The pain tells me you have a sensitive part of the tooth. It may be that the dental bonding is not completely covering the area that it should be, either from age or from the beginning.

Hopefully, you are doing this under the supervision of a dentist. Either way, you need to be seen. Your dentist can put something over the sensitive area that will enable you to begin your whitening again without pain.

You should be aware that over the counter whitening will work, depending on which brand you purchased, but it will take significantly longer than professional teeth whitening done through your dentist. No matter which method you choose, however, the dental bonding itself will not whiten. Teeth whitening only bleaches natural tooth structure. If you are going significantly whiter than what your bonding is, you will want to replace it to match your teeth once you have reached the color you want.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.
Click here to learn about how to get a complete smile makeover.

Should Porcelain Veneers Have a Hump at the Gumline?

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I wanted to fix the appearance of my two front teeth. At first, my dentist covered them with dental bonding. This ended up looking terrible. When I told her how awful they looked, she agreed to switch to porcelain veneers. My question is should they have a hump at the top by the gumline? The rest of them look okay. They certainly look better than the bonding, but this hump makes them uncomfortable. Maybe it is just because I know it is there, but I swear I can feel it all the time. This is my first time having porcelain veneers, but some of the pictures I have seen seem smoother at the top. Should I ask her to re-do them? I am starting to feel like a difficult patient.

Haven

Dear Haven,

a porcelain veneer being placed on teeth

I am very glad you wrote, if only to tell you that you are not a difficult patient. You paid for a beautiful result and you should get one. In fact, I think you’ve been overly patient. Let’s start with the dental bonding. Why did you have to tell her they were terrible? She should have realized that. A true cosmetic dentist would not be satisfied with anything but a gorgeous result for a thrilled patient.

Then, she’s tried her hand at porcelain veneers and struggled to do those right as well. This hump is not correct and can actually lead to both decay and gum disease. So, yes, these porcelain veneers need to be redone. By the way, you shouldn’t settle for veneers that are just okay. You should find them stunning.

Here’s the problem you are facing. Cosmetic dentistry is not a recognized specialty. That means any general dentist can “try their hand” at it. Unfortunately, it takes a significant amount of post-doctoral training to have the technical skill and artistry necessary to produce a beautiful and correct result. I sincerely doubt that your dentist has this training.

The best thing for you to do for the health of your teeth and gums, as well as get a truly attractive smile, is to not ask this dentist to do something beyond her ability. Instead, ask for a refund, then have this redone by a dentist who has the training necessary to do it correctly.

The easiest way to find a dentist with the artistry and skill to do your smile makeover, is to go to the American Academy of Cosmetic Dentistry (AACD) Website— aacd.com. They have a “find a cosmetic dentist” link. Make sure you check that you are looking for an accredited dentist. AACD accredited dentists have passed stringent exams and demonstrated artistry on a large number of cases before an examination board. They are in the top 3% of cosmetic dentists in the country.

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

Am I Too Young for Porcelain Veneers?

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I am 21 years old and want to get a smile makeover. I had braces years ago, but some of the gaps are back. Plus, I was a bit of what my parents dubbed a tom-boy so I’ve chipped quite a few teeth. Now, I’m graduating from college soon and want to start thinking about a professional look. I want a nice smile. Am I too young to get porcelain veneers? If so, would bonding be a good substitute? As for the dentist, my general dentist doesn’t do porcelain veneers but said he’s willing to learn if it is important to me. I’m not sure I want to wait for him to learn so do I just look for one who already does them?

Phoebe

Dear Phoebe,

a porcelain veneer being placed on teeth

I am glad you wrote. You have some great questions. Let’s jump right in. First, you are not too young for porcelain veneers. The important factor is that all your teeth are fully developed. This generally happens around 18 years of age, so you should be fine. I don’t recommend dental bonding for full smile makeovers. They are not as useful over large surfaces. Instead, their sweet spots are small gaps or chips. You mentioned those, but if you have a lot of them and/or want to change other things about your smile, you are still better off with porcelain veneers. They are more durable, as well as beautiful.

You are wise not to go with your general dentist. It takes years of post-doctoral training, as well some natural artistry to be skilled with doing smile makeovers. It is not something taught in dental school, nor is it a recognized specialty. As a result, it is up to the patient to figure out the best dentist to do their smile makeover.

I am going to suggest that you use a dentist who has reached accreditation with the American Academy of Cosmetic Dentistry. AACD accredited dentists are proven in both their technical knowledge as well as their artistry. You will get a stunning smile.

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

Should I Get My Veneers Online?

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I have a discolored front tooth. Previously, it was damaged from a fall. My dentist did a composite repair on it. It was okay, but there was some color disparity and a small gap. I want to cover four teeth. I am not as worried about the color difference because the whole surface will be covered. The problem I’m having is the cost. It’s pretty steep. I just saw a company online that does snap-on veneers. I can get a full set for $700. Would that be a better option for me?

Kevin

Dear Kevin,

before and after dental bonding

 

Let’s talk about the composite bonding first. Don’t do it. First, you mentioned your dentist had trouble repairing a chipped tooth. There was a mismatch in color as well as a small gap. I’m not sure if you meant a gap between your two front teeth or a gap between the composite and natural tooth structure. Either way, your dentist has a serious lack of skill. If the gap was between the composite and your natural tooth structure, that can lead to serious decay issues. I would love for you to have a thorough check up before moving forward with this just to ensure there is not any build up of decay in the gap.

If your dentist could not handle a chipped tooth, which should blend completely like the case pictured above, then you certainly do not want him doing large surface areas of your teeth. Plus, composite does not last nearly as long as porcelain veneers. You would have to re-do the work every few years. So, even if you could afford what your dentist is suggesting, say no. If you’re going to get a smile makeover, do it with porcelain veneers. Even then, you will want an expert cosmetic dentist, such as an AACD accredited dentist.

As for the snap-on veneers, the best of these options is made by a company that produces Snap-on Smile. You have to understand its limitations before investing. It is not made of porcelain so will not be as beautiful or natural looking. They are made of acrylic. They are not really designed for smile makeovers and are mostly designed to help people with really bad teeth get through an important event such as a job interview or special evening. They will look okay, not stunning. Because they fit over your teeth, they have the tendency to look a bit bulky too.

If you were going to get Snap-on Smile, I say only do it as a temporary measure while you save up for a true smile makeover with porcelain veneers. Done and cared for well, veneers can last your lifetime.

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

Will Tooth Mousse Get Rid of My White Spots?

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I have some white spot lesions. My dentist provided me with some tooth mousse. When it is done, we’ll start teeth whitening. What type of results should I expect from this?

Casey

Dear Casey,

teeth whitening trays

Your dentist is way off here. Tooth Mousse can help some by remineralizing your teeth, but the company that made it has never suggested it be used on its own. There is normally some microabrasion that needs to be used with it.

His suggestion of teeth whitening is even worse. Any type of teeth whitening will whiten your teeth evenly. That means that you will still have the white spots. In fact, they will be even more noticeable.

Your best option to get rid of these spots is to have dental bonding done on the affected teeth. However, this will require an expert cosmetic dentist and I don’t feel your current dentist is up to the task. I am going to suggest that you look for an AACD accredited dentist to advise you on this. They will get a good look at your teeth and give you the best course of action.

The good news is, because they are in the top 3% of cosmetic dentists worldwide, you will get a beautiful result. My recommendation would be to go that route. Have your teeth thoroughly examined by the right dentist. Then let him or her suggest the best course of action for it. You will love the results.

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

 

Gap After Congenitally Missing Tooth

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My daughter is about to graduate high school. Since childhood, she has only one adult of the teeth next to the front one. I think it is called incisor. Our family dentist told us that once it fell out, her other teeth would shift into that space. It sort of did, but not as much as we were expecting. Now there is a gap there. She just doesn’t like to smile and isn’t even interested in getting senior pictures. I mentioned it to my dentist and he said we could just fill in the gap. I’m hesitant to do that because I’m worried it will make the teeth on one side look bigger than the others. Is there a better way to do this?

Petra

Dear Petra,

I am very glad you wrote. It appears this dentist has given you bad advice on two fronts. First, the original advice was not only bad esthetically but for the health of her bite in the long term. Let’s start with esthetics first. The tooth next to her lateral incisor is her canine tooth. It is thick and pointy. The Incisor is thin with a more rounded bottom. There is no way her smile will look balanced and normal trying to interchange those two. It also appears you have more of an artistic eye and common sense than your dentist for his latest suggestion, so I am with you. No, don’t just fill in the gap with dental bonding.

As for the damage to her bite, the canine tooth is also different in its root. It has a much longer, stronger root and handles all the sideways stresses of our teeth. If you move that out of its place, as he allowed, she will have long-term consequences.

Dealing with Congenitally Missing Teeth

Diagram of a dental implant

What should have happened in the beginning is he have you get an inexpensive dental flipper for her to hold that spot open once the tooth came out. Then when she is old enough, you can replace it with a dental implant. As it is now, you will have to use orthodontics to get the teeth back into their proper position. I am going to suggest Invisalign. This will work faster than traditional braces and no one will be able to tell she is straightening her teeth.

From there, get the dental flipper and then have a dental implant placed when her jaw is fully developed. It won’t be that much longer, given her age.

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

Zoom Whitening and Uneven Teeth

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My daughter got her braces off not too long ago and there were a bunch of white spots around her teeth. The orthodontist said this was fairly common in teenagers and that our dentist could take care of it. When we went to see our dentist, she suggested we try Zoom Whitening. She had just gotten the equipment and would even give us a discount as her first patient using it. I liked the idea of getting a discount for the treatment that she would need anyway and agreed. When we were done, the teeth seemed worse, not better. Is it possible because this is a new thing for our dentist she did something wrong?

Sally

Dear Sally,

Patient under a zoom whitening light

 

I am very glad you wrote and believe I can be a great help to you and your daughter. Zoom Whitening is an effective teeth whitening procedure that can produce remarkable results in just one appointment.  The problem wasn’t with her not understanding how to do Zoom Whitening. The real problem was her not understanding the principles behind how teeth whitening works.

No matter what method of teeth whitening you do, it will always whiten the teeth evenly. That means the white spots will get whiter along with the remainder of her teeth. The good news is there is a solution.

The white spots your daughter is dealing with are actually decalcification spots. Decalcification is a precursor to decay. My guess is your daughter used traditional wire and bracket braces. Those can be very hard for patients, whether adults or teenagers, to really get in there and brush well around all the metal clutter. This leaves food and other bacteria trapped, which in turn leads to the decalcification which your daughter is dealing with now.

There are two possible ways to fix this. One only works sometimes but is less expensive, so I’ll make sure you know about it in case it works for her.

Repairing White Spots on Teeth

The first thing I would try is a product called Tooth Mousse. This is applied topically and can sometimes remineralize the teeth.  You can purchase it over the counter. It doesn’t always work so if you don’t start seeing results, I would move on to the next option before decay sets in.

The second solution is dental bonding. This needs to be done by an expert cosmetic dentist. I’ll tell you how to find one in a moment. With this repair, the dentist will gently remove the decalcified spots and then fill in the area with the composite bonding material. The dentist will use a variety of colors, textures, and translucencies to match her tooth structure and appearance perfectly.

As I mentioned, she will need an expert cosmetic dentist. This has to be done freehand and is one of the most difficult cosmetic procedures. I cannot stress enough that I do not think your current dentist is up to the task. In your place, I would look for an AACD accredited dentist or one who has been recommended on the mynewsmile.com website. Any of those dentists will be able to give your daughter a beautiful result.

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

Why You Have to Carefully Pick Your Cosmetic Dentist

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I had a chipped tooth which was repaired with dental bonding. That bonding fell off so I went to another dentist. This dentist said that bonding was not possible because 1/5 of the tooth was chipped and recommended getting a dental crown. That seemed too invasive to me so I asked for a porcelain veneer instead. She said she’d have to do two of them in order to get them to match. I agreed. Before it was bonded on I got to peek at them. They looked fine. They were whiter than my other teeth but we did that on purpose because I was going to whiten after getting the porcelain veneers. I did not see them after they were bonded on but they told me it looked fantastic. I left happy. When I got home, I noticed that one of the “teeth” is longer than the other. Not only that, the longer tooth has a bit of a ledge at the top so it appears they bonded it on too low. I called them, but they said that the tooth must have shifted and there is nothing they can do. How would my tooth shift away from a bonded veneer? Can this be fixed? If so, how do I go about getting it fixed?

Pamela

Dear Pamela,

a porcelain veneer being placed on a tooth

We hear these types of cosmetic dentistry horror stories way too often and it generally distresses me for two reasons. First, it is a burden on the patients. Second, because it was completely preventable. There is so much wrong here with what your dentist did.

We’ll start with her saying that dental bonding was out of the question. Really? Why? Obviously, you had dental bonding done there to begin with so it was not impossible. My guess is your dentist said that because she did not know how to do the dental bonding, so instead she steered you toward the procedure she did know, which is a porcelain crown.

You felt that was removing too much healthy tooth structure (rightly, I might add) and asked to have porcelain veneers instead. Based on what happened next, I would say she wasn’t very comfortable with that procedure either but was too embarrassed to say so. Or, maybe she thinks she’s good at them.

Getting Beautiful Porcelain Veneers

I suspect they knew something was wrong when they bonded your veneers because they didn’t let you look at them. That doesn’t give me much confidence in their professional integrity. So, where do you go from here?

The good news is they messed up big time. That will help you get a refund. If the only thing wrong with your porcelain veneers was they looked bad, it would be up to the dentist whether or not you received a refund.

In your case, they bonded them improperly leaving what you described as a ledge. In dental circles, we call this open margins. This is a functional issue because food and other bacteria will get trapped there putting your teeth at risk of decay and your gums at risk of developing gum disease. She owes you a refund so you can get this fixed.

Once you have secured your refund, I am going to suggest you find a dentist who has been accredited with the American Academy of Cosmetic Dentistry. AACD accredited dentists are the top cosmetic dentists in the country. You will have a beautiful smile when they do the work.

Oh, one other thing. The teeth whitening should have been done before you had the porcelain veneers placed. That allows the dentist to get an exact match. That was another error on your dentist’s part.

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

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.