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Dental Work in Costa Rica

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I need twelve dental crowns done. After doing some calling around, I learned I can get this done for just $6000 in Costa Rica. I would have to stay two weeks, but that’s like a vacation and it is still cheaper than what I can do in the states. My sister is freaking out saying this is a huge mistake. She asked me to at least call my dentist and get his opinion on this plan, but of course he’s going to say don’t do it because then he gets my money. I came across your website. You are across the country from me and have no chance of getting my money, so what do you think of my plan?

Mason

Dear Mason,

map of costa rica

Should you get dental work done in Costa Rica?

 

I’m glad you wrote. I think I can save you a lot of grief. The dental industry is a real risk in Costa Rica. Because of the way their legal system is set up you have no recourse if something goes wrong. And let me tell you, a LOT can go wrong. Here are just a handful that come to mind:

  • A tooth can be broken off or lost
  • Overdrilling could take place causing nerve or root damage
  • You could end up needing a root canal treatment
  • Your bite can get thrown off leading to painful TMJ Disorder
  • Once you return home, the crowns can fall off
  • The crowns could look terrible, pasty, fake, and the wrong color
  • Poor placement of the crowns can impact your speech

Believe me, I am not exaggerating here. I recently read a case that you can read about in total here, but I will sum it up. A woman went to Costa Rica to save money on her dental care. The job was so badly done that she was in terrible pain. A dentist in the states called it criminal negligence and it would cost her around $35,000 to get the needed repairs done. Of course, she didn’t have that kind of money. She tried to get her money back from the Costa Rican dentist, even hiring a lawyer from the area, who was on her side. However, the law in that area is very corrupt and she ended up getting in trouble for complaining about a Costa Rican dentist publicly who had not been convicted of any crime and they put a warrant out for her arrest. She ended up having to flee the country.

You are at particular risk because of the number of dental crowns you need. There is a lot that could go wrong with that type of bite placement. My advice is to find a dentist here in the states with good qualifications and let him or her do the work. You may even be able to work out payment arrangements. Leave the Costa Rica trip for a true vacation, where you are not putting yourself at risk.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss, an AACD accredited dentist.

Dentist Wants to Crown My Tetracycline Stains

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I mentioned to my dentist how much I hate my smile because of my tetracycline stains. He said the best solution is to put crowns on all my visible teeth. While my teeth are ugly, they are also healthy. I hate the idea of grounding them all down. Will they look natural if I do? Would teeth whitening solve the problem instead?

Miranda

Dear Miranda,

Woman covering her mouth

 

It is difficult having a smile you are embarrassed by, especially when our smile is the first thing people notice about us. I agree with you that dental crowns is not the way to go for this. If you have healthy teeth, it is always best to keep them as intact as possible. While teeth whitening could help IF you were very persistent. Even then, they would never be completely gone. Because of that, it is not the best solution for tetracycline stains.

My recommendation is that you use porcelain veneers. These remove hardly any tooth structure. Unlike dental crowns, which have to fit around the entire tooth, porcelain veneers go on the front of the tooth. One important word of caution. I am going to recommend you do not go to your dentist for this.

Tetracycline stains are one of the most difficult to address. It takes advanced cosmetic dentistry training to do it properly. Training that is not available in dental school. The trick comes in getting the veneers opaque enough to cover the stains, but still translucent enough to look beautiful and natural.  A dentist has to invest in that instruction post-doctorally. The fact that your dentist is suggesting crowns instead of veneers tells me he does not have the right training for this. Many dentists think they can make up for that lack of training by using dental crowns, which are thicker. But that is not enough to make them look beautiful.

When dealing with tetracycline stains, I would only go to a dentist who is AACD accredited. You can find them on aacd.com. Accreditation is different than membership. Any dentist can join the American Academy of Cosmetic Dentistry. To become accredited, however, requires passing extensive examinations as well as proving your artistry to a board of examiners.

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

Best Solution for a Chipped Tooth

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I fell while my son was teaching me to skateboard and chipped one of my teeth. I wanted to just get bonding done to keep everything as minimally invasive as possible. My dentist said that dental bonding does not hold. Instead, she wants to give me a dental crown. I’m hesitant to do that because it is a healthy tooth. Plus, I have another crown and it really doesn’t look very natural. Thankfully, that one is toward the back, but this will be a front tooth. Is there an alternative to these procedures?

Patricia

Dear Patricia,

before and after dental bonding

Before I answer your questions, let me first say that you get the epic mom award. Now, onto why you really wrote. Unless you are an unusual case, dental bonding would be the correct fix for this. It can hold up well when done by an expert cosmetic dentist with the right materials. I think the bigger issue here is your dentist is not comfortable doing dental bonding and is, therefore, trying to steer you in another direction. You are right to be concerned about the dental crown.

Not only is it overly invasive, but it is extremely difficult to match a crown to a single front tooth. If she is not capable of doing dental bonding and your other crown looks fake, I would not let her anywhere near this chipped tooth.

My suggestion is you see an expert cosmetic dentist and let them do the repair. You are better off finding a dentist who has reached accreditation with the American Academy of Cosmetic Dentistry (aacd.com). AACD accredited dentists have to pass arduous examinations as well as have their cosmetic cases evaluated by a board of examiners. Those who reach accreditation are in the top 1-3% of cosmetic dentists in the world.

As a tip, I would recommend you get your teeth whitened before having your dental bonding done. While the bonding can be made to match any color exactly, once it is cured into place, the color cannot be changed. If you decide to whiten your teeth afterward, your natural teeth will whiten, but not your bonding. It will have to be completely re-done. If whitening is on the horizon, getting it done before saves you money.

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

Botched Implant Case

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A little over a year ago, I had four dental implants placed after a car accident left me with a lot of lost teeth. Since then, the crowns have broken or fallen off and the implants themselves are there but I don’t know how healthy or secure they are. I tried calling the office for quite a few weeks and they kept giving me the run around. Now I have discovered this dentist has left the country and no one can reach him. At first, I was worried about him, like maybe something happened to him on vacation, but it turns out he literally skipped the country. He’s emptied the practice account and they are closing the doors. What do I do now?

Andrew

Dear Andrew,

woman covering her mouth with her hand.

 

I am sorry this happened to you. First, the accident and then an unethical dentist. In all honesty, the only thing you can do now, is to have someone who is skilled with dental implants to look at your case and see how stable the implants are and what went wrong with the dental crowns. Hopefully, the implants themselves are fine and the dentist who did your case just did not bond them on properly.  Then, you will only have to replace the crowns. If it does turn out that your implants are poorly placed and at risk, you will have to replace them. Unfortunately, that will also mean getting one additional procedure, known as bone grafting, so that you will again have enough bone structure to retain your new dental implants.

There is an upside to these tragic circumstances. First, you can make any changes you want. If there was something you didn’t like about the earlier results, now is your chance to completely remake your smile. Make it gorgeous. Another opportunity is for you to whiten your teeth. If you decide to do that, do it before your new crowns are made. Whatever color they are fashioned with is permanent.

A second upside is that I am willing to bet that most dentists who hear the series of events that happened to you will be more willing to work with you on paying this out instead of having to pay up front, which is the typical requirement.

Again, I am sorry this happened to you. Hopefully, this next dentist will be just what you need!

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

 

Can You Get Porcelain Veneers if You Have an Overbite?

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I have tetracycline stains that I have always wanted to be covered. I asked my dentist about porcelain veneers and he said I can’t get them because I have an overbite which makes my upper teeth cover my bottom teeth. Instead, he wants to do six porcelain crowns on the upper teeth. Because my lower teeth can’t really be seen, what do I do with those, whiten them?

Elisabeth

Dear Elisabeth,

Photo of a single porcelain veneers being held by the tip of dental forceps.

Please don’t let this dentist do your smile makeover. He’s making quite a few errors and he hasn’t even started. Him telling you that porcelain veneers don’t work for an overbite isn’t true. Instead, it is likely just an excuse because he doesn’t know how to do porcelain veneers. In fact, veneers make more sense in a case where there is an overbite involved because dental crowns must surround the whole tooth. This will cause it to hit up against your lower teeth.  Instead, porcelain veneers are thin wafers of porcelain that only cover the front and hug the sides a smidge. This is a much better fit for someone with an overbite.

A second concern I have is that dentists who recommend dental crowns for a smile makeover when it isn’t necessary are generally not experienced cosmetic dentists. They think they have done dental crowns for treatments before with decayed teeth. How hard could it be just to add a few more? Actually…quite hard. In your case, this is especially true. You are dealing with tetracycline stains which are among the most difficult and advanced cosmetic procedures there are to do well.

He’s also recommending just six dental crowns. Most smiles are at least 8 – 10 teeth wide. What does he intend to do to make those adjacent, visible teeth do to match? Teeth whitening, which could be an acceptable option on many cases, will not work in yours because of how deep and dark the stains are with tetracycline. This will make the six teeth that are crowned, look obviously fake and silly, like children playing dress-up in their parent’s shoes. They obviously don’t fit, but at least they’re trying.

Teeth whitening could help with your bottom arch. This arch won’t be so obvious when the color doesn’t match exactly. However, I’d recommend a strong whitening system such as KoR whitening. Plus, you will have to be persistent and stick with it much longer than the average patient.

Your Smile Makeover Requires an Expert Cosmetic Dentist

Especially because of the difficulty with your type of smile, you need a top of the line cosmetic dentist. My suggestion would be to find an AACD accredited dentist. This is different from being a member of the American Academy of Cosmetic Dentistry. To reach accreditation, the dentist has to pass stringent exams as well as provide visual evidence on a large number of specific cases they’ve done that are assessed by a panel of judges on their technical quality along with their artistry.

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

Dentist Won’t Match Implant Crown

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I have had the dental crown placed on my implant three different times and none of them matched the adjacent teeth. My dentist said I’m being too picky and my tooth color is between A1 and A2 and I will never be satisfied. She’s refusing to do it again. I hinted I will try somewhere else and she said that puts my dental implant in danger of coming loose because she’s already removed the crown two other times. Now I’m worried. Am I stuck with mismatched teeth? I don’t want to risk the implant itself. Could I just whiten everything, crown included?

MaryAnne

Dear MaryAnne,

Using teeth whitening won’t help in this case. It will whiten your natural teeth, but the crown will stay the same shade, making the differences even more obvious. I’m very sorry that your dentist is treating you this way. She seems to be transferring her inability to match the crown for your dental implant to you. This isn’t your fault. Based on what you said, there are probably two problems going on with this. My first guess is this is a front tooth she’s trying to match. Those are trickier than others. Even top cosmetic dentists will do several try-ins before getting an exact match.

Notice I said try-in. There are temporary try-in pastes which allow you and the dentist to see what the dental crown will look like in place without using the permanent bonding materials that require her to grind your crown off every time you request a change. These are inexpensive. There are usually only two reasons a dentist doesn’t carry them. The first would be they don’t care what you think and will only look at it themselves. The second is they don’t know about it because they have not invested in cosmetic training, which has to be done in a post-doctoral setting. I believe your dentist falls into this latter category.

This leads me to her second problem. She’s just going by the standard Vita shade guides and expecting your tooth to be a perfect match. But, your teeth are between an A1 and A2. For back teeth, her method would work fine. However, a front tooth gets all the light when we smile, which shows the color and variations in striking clarity. The standard shade guide isn’t enough.

diagram of a dental color map This is an example of a color map a cosmetic dentist will send to the ceramist. Yes, it will have the basic shade, but there are also instructions for different tints to go in a variety of sections on the tooth, which changes the visual perception of the color. Our natural teeth aren’t one flat color. There are differences in opacity throughout the tooth. This is how you get a tooth to look natural and perfectly match its neighbor.

The truth is your dentist is in over her head. Ask for a partial refund and go elsewhere to get it done. See if you have an AACD accredited dentist in your state. They’re at the top of their field.

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

Prosthodontist Versus Cosmetic Dentist

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I needed a lot of reconstructive work done on my teeth after a car accident. I went to a prosthodontist because they’re supposed to be the experts at this. I brought pictures of my old smile. I just wanted to have my beautiful smile back. I thought it would be fairly simple as they’d know exactly what I wanted ahead of time. When it came to the process of fitting, it looked like everything would be too dark. I mentioned that and they said it was because they weren’t the permanent ones. A common theme, whenever I brought up an issue, was the dentist saying, “He’s been doing this for twenty-five years and I should trust him.” Then, when I noticed the color didn’t match on the top and bottom he said, I didn’t understand how it worked and he was doing what was clinically correct.

When it came time to put in the permanent ones on the try-in, I couldn’t see them because they would fall out. He was mostly checking for fit. I told him one of them felt weird. He snapped at me at that point and said, “Everything is clinically perfect and fits just as it should.” He also told me I’ve been overly demanding and if I don’t like it I can leave without the teeth. I was humiliated and couldn’t bear the thought of leaving without teeth. At that point, most of my teeth had been ground down to nubs for the teeth needing crowns. I just let them do the work and booked it out of there as quickly as possible.

Now that I’m home, the teeth don’t look anything the way I wanted. The top teeth are actually darker than the bottom teeth, which looks completely insane. One of the teeth still feels funny. The teeth are shorter than my old smile, which makes me look older. I hate this. Is there any way to get it fixed without spending a second fortune?

Mandy

Dear Mandy,

woman covering her mouth with her hand.

I hate it when I hear these cosmetic dentistry horror stories. All that time and money and the patient is left disappointed at best and in a horrible situation that destroys their bite and leaves them in pain in some of the worst cases. You haven’t been unreasonable and hard to please. When you talked about the difference in color from the upper and lower arch I cringed. While you can get away with the lower teeth being slightly darker than the upper teeth, the other way around just doesn’t work. You can get this fixed, but you’re going to have to be tough. If you think you can handle it, I’ll explain how you can get the smile you deserve.

First, what he did is essentially malpractice, though I’m certain he won’t see it that way. He has a dental school mentality of “I’m the dentist, therefore I know best”. One of the standards of dentistry is informed consent. What he ended up doing, though, is coercing you into a smile you didn’t want. That’s not informed consent.

It’s obvious he didn’t care what you think to begin with. During the try-ins, you never got to see the crowns. He only cared about the fit, not whether or not you liked the appearance. If he did, there are temporary try-in pastes he could have used to let you get a good look and approve everything before moving forward.

Based on the arrogance you’ve described, I don’t think you’re going to get far with him on your own. Instead, you may need to involve a lawyer. His lawyer will immediately suggest he settle. I don’t want you to just ask for a refund. Instead, what you need to do is have him pay an expert cosmetic dentist to fix this.

While a prosthodontist studies reconstructive dentistry, not enough of them invest time developing the training necessary for the cosmetic side of things. You are more likely to find an expert cosmetic dentist with training in reconstructive dentistry than you are the other way around. I’d start by looking for an AACD accredited dentist. These are the top cosmetic dentists in the country and will certainly give you a stunning smile. Many of them also have reconstructive training as well.

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.

Protecting a Porcelain Veneer during a Root Canal Treatment

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I have porcelain veneers and my dentist recently told me I needed a root canal treatment in one of the teeth involved because of a periapical abscess. I’ve heard that root canals can turn the teeth dark. I’m afraid that will ruin the smile makeover. I’m also worried it will damage the veneer. Do you have any suggestions?

Carolyn

Dear Carolyn,

A tooth being prepared for a porcelain veneer I’m a little concerned you needed a root canal treatment to begin with. When teeth are properly prepared for a root canal treatment, there is very little tooth preparation done. The photo to the left shows the deep limiting diamond bur that is used to remove about a 1/2 millimeter of enamel. It adds the grooves and then a dentist will go back and remove the ridges with a traditional diamond.

Unfortunately, some dentists get aggressive and remove all the enamel and down into the dentin. Others actually do porcelain crowns, which requires massive tooth grinding, and just call them veneers. Both of these last two methods put you at greater risk of needing a root canal treatment. I’m wondering if this is what happened to you.

In your situation, however, it’s already done and you need to deal with what is happening now. You have to have the root canal. You don’t want to leave an infection in your bone. That can lead to serious complications. Fortunately, I have some advice to give your dentist to protect your porcelain veneers.

Protecting the Appearance of Porcelain Veneers after a Root Canal

You are correct that a root canal treatment can make a tooth look dark. Because your porcelain veneers are translucent, that will show through and make the color look off. This can be prevented. Make sure your dentist knows that most of the darkening of the tooth comes from the remnants of root canal filling materials left over in the crown of the tooth. Have him read this post so you can feel confident he knows the right technique for this situation. Here’s what he needs to do.

He needs to clean out any of those materials from the crown of the tooth. Then he’ll need to place a white fiberglass post down into the root and fill the rest of the space in the crown with a light-colored composite. While it won’t forestall the tooth turning dark forever, this method along with the fact that you have a porcelain veneer should keep the tooth white for many years.

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

She’s Going to Need a Better Dentist

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I need to replace six crowns. They were done by another dentist but I’ve since moved. I really loved them, but they’re old and need to be replaced. I want to replace them all at the same time. I don’t like the temps my new dentist has provided. They’re much more yellow than my old crowns and are shaped differently. I liked my other smile. When I told him I didn’t like the temporaries, he raised his voice and said he’s the dentist and they’re perfect. What do I do?

Kelly

Dear Kelly,

woman giving a thumbs up from the dental chair

Your bumping up against the difference in philosophy between a standard dentist and a dentist who really invests in cosmetic dentistry. In dental school, we’re taught the dentist knows what is best. But, cosmetic work is different. You are creating a smile which the patient wants. The best cosmetic dentists are more interested in how the patients feel about their smile.

Your current dentist doesn’t understand this. He’s not going to work with you. If I were in your place, I’d go to a different dentist to get this finished. Your current dentist is ethically obligated to pass on all your diagnostics, etc. to the new dentist.

Finding the Best Cosmetic Dentist

Cosmetic dentistry isn’t a recognized specialty. It is up to the dentist how much training they get after they graduate dental school. When you are talking about a smile makeover, you want the best cosmetic dentist possible. These are the dentists who take their craft seriously.

They’ve done significant post-graduate training and have an artistic eye. In your place, I’d look for an AACD accredited dentist. These are the top cosmetic dentists in the country. Through the American Academy of Cosmetic Dentistry, they’ve passed stringent exams which test their technical knowledge. They also have to provide visual evidence of a large number of cases they’ve done in order to gauge their artistry.

I hope this helps you. This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.