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dentistry

Teeth Whitening Before a Dental Crown

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I am getting a dental crown on a white tooth and I want to do a touch-up on my teeth whitening before I get it. I asked my dentist how long I would have to whiten my teeth each day and for how many days to get them back to their original color when I first whitened them three years ago. He couldn’t tell me so I am wondering if there are some tips you have.

Bethany

Dear Bethany,

teeth whitening trays

 

I am going to help you with this, but before I do I want to let you know that I am concerned that your dentist was unable to answer these type of questions. Teeth whitening is a fairly straightforward procedure. If he can’t deal with that I would not trust him to place a dental crown on your front teeth. We’ll go over how to find a dentist who can in a moment.

The Basic Principles of Teeth Whitening

The main idea behind whitening your teeth is the longer you wear the whitening gel, the faster your teeth will whiten. You can wear them one hour a day, but they whiten faster than if you wear them several hours a day or overnight. Because each person’s teeth are different in the amount of staining and how white they want them, there is no way to quantify a number of days/hours. The one constant is you want to leave a week between when you stop your teeth whitening and when you begin the procedure for your dental crown. This is because the teeth will continue to whiten during that time period.

Getting a Crown on a Front Tooth

Crowns on back teeth are no big deal. The color doesn’t have to match exactly. However, matching a single crown to a front tooth is a completely different story. All the light hits your front teeth making all the differences much more visible. Even the best cosmetic dentists will do a couple of try-ins before settling on it being just so.

Ideally, you would want an expert cosmetic dentist to do this. Look for a dentist who is AACD accredited. Then you can be certain they will get it right. If your dentist cannot tell you about teeth whitening, I would not let him near this crown.

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

 

Fixing a Gummy Smile

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I have a gummy smile and wondered if there is something my dentist can do to change that and give me one of those smile makeovers I keep seeing online?

Penny

Dear Penny,

before and after a gummy smile makeover

It is possible to have a beautiful smile makeover done for someone with a gummy smile. However, one word of caution. this is very advanced and way beyond the capabilities of your typical dentist. You will need an expert cosmetic dentist for this. Beware of dentists who want to send you to an oral surgeon and cut your upper jaw. Not only is this invasive and expensive, but unnecessary and dangerous. It will likely lead you to TMJ Disorder.

Instead, you want a cosmetic dentist to do what is known as a gum lift. This removes a small amount of gum tissue, which will expose the bone beneath. Then, they can place porcelain veneers, which will cover the bone and completely make-over your smile.

Porcelain veneers can change anything you want about your smile, including the shape, size, and color. Please only go to an expert cosmetic dentist with this. I would look for someone who is AACD accredited. These are among the top 1% of cosmetic dentists in the country.

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

Smile Makeover Disaster with Tetracycline Stains

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I have tetracycline-stained teeth. I went to my dentist who is very reputable and has done a great job for me over the years. I was considering porcelain veneers, but my dentist talked me into porcelain crowns saying that they would help cover the stains better. This did not turn out to be the case. The gray is visible with each of the crowned teeth AND the crowns look fake, so it’s obvious I have fake teeth. But, not even pretty fake teeth. He said he can send them back to the lab. I’m so confused. I looked online and there is a woman from a different dentist who has beautiful teeth after getting her tetracycline teeth made over and she used porcelain veneers! What has gone wrong with my teeth? Will doing them again with crowns make a difference? I don’t think I can get porcelain veneers after I have crowns, right?

Leslie

Dear Leslie,

a porcelain veneer being placed on a tooth

You are correct that you will always have to have crowns now that you have them. This is because the teeth have been ground down to little nubs. That tooth structure is gone. In a way you have answered your other question already. You said, “…a woman from a different dentist.” The key to any smile makeover is the dentist who does it. One warning sign is when a dentist suggests porcelain crowns over porcelain veneers when the tooth is healthy and does not need a crown. These dentists are either not comfortable doing porcelain veneers to begin with or do not have enough skill in them and think that the added structure of dental crowns will make it easier to cover the stains.

Sending it back to the lab will only help if he can give them good directions. A lab is more like a pharmacy who fills the prescription of the doctor. It is the doctor that has to come up with the right diagnosis and the appropriate medicine for it. I am not convinced he can write the correct directions. However, there is no harm in allowing him to try. If you do that, do it on the condition that he uses a temporary try-in paste and if you don’t love them the second time then you get a refund. You should get to see them in several lights before making a decision.

If you end up needing a refund, you will want to look for an expert cosmetic dentist. The easiest way for you to do this is to look for a dentist who is accredited with the American Academy of Cosmetic Dentistry. AACD accredited dentists have proven skill and artistry. They can give you a beautiful smile whether using porcelain veneers or porcelain crowns.

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

Fixing a Gap Between a Crown and a Dental Bridge

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I have a gap between my front teeth I would really like to fix. Unfortunately, the tooth on the right is a dental crown and the left is a crown attached to a dental bridge. Is there a way for me to close this gap without having the fixtures replaced? Maybe by putting something like Lumineers on top of them?

Peggy

Dear Peggy,

Advertisement for Lumineers over dental crowns

Years ago, Lumineers would advertise something like you mentioned. They told patients that old crowns can be restored by placing Lumineers on them, but it ended up not working out as well as they hoped. First, porcelain does not bond to porcelain as well as it does to the natural tooth structure. Second, it takes as much work to place them over crowns as it would to just make a new crown. Finally, you have double the risk of failure because now there are two things bonded.

I am curious why your dentist didn’t place the crown and the bridge in a way where there was not a gap to begin with. That makes me wonder about his skills. In reality, because of that you will likely have to have these two procedures re-done. You don’t want to re-do just one of them because the porcelain would be “lopsided”.

There is a possibility you could have someone do a repair by bonding composite to porcelain, but they would need to have some experience with dental bonding and some special equipment. Your dentist would need to use a micro-etcher on the areas of porcelain near the gap. After that, they’d need to etch the area with a hydrofluoric acid gel. Then it would need to be primed with a silane coupling agent. Finally, a bonding resin and then a composite bonding applied to match the color of your crown and bridge. As you can see this would take some specialty skill. I’m not sure your dentist has it if he or she was not able to apply your procedures without a gap to begin with. If you want to try this repair method before resorting to replacing everything, I suggest you see an AACD accredited dentist.

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

Does the Dentist Matter If They Outsource Their Porcelain Work?

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I am getting a smile makeover, which will include porcelain veneers on the top arch and some dental bonding for some broken teeth on the bottom arch. I understand that they outsource their porcelain work, so I don’t have to worry about that as much, but the dental bonding is done by the dentist in the office. How do I know if they can do quality bonding work or not?

Billy

Dear Billy,

before and after dental bonding

 

You are correct that dental bonding is tricky and that the dentist really needs to know what he or she is doing. Not only is it done in the office, but it is done freehand. However, be careful about thinking the dentist won’t matter for the porcelain veneers. That is like saying it doesn’t matter what doctor you go to because it is the pharmacist who gives you the medicine. The reality is the pharmacist can only do what is precribed. If the doctor makes the wrong diagnosis and prescribes the wrong medicine, the result will be a disaster even if the pharmacist fills it perfectly.

With porcelain veneers, the cosmetic dentist prescribes the map for the ceramist to follow. He can do the work perfectly according to the dentist’s instructions, but unless the dentist is skilled and artistic the results will be disappointing. So, I would say you will need to find an expert cosmetic dentist for every part of the smile makeover.

How to Find an Expert Cosmetic Dentist

The hands down easiest way to guarantee you will have one of the best cosmetic dentists in the country is to look for a dentist who is AACD accredited. In order for a dentist to reach accreditation with the American Academy of Cosmetic Dentistry. They have to pass oral and written exams as well as have a large number of cases they’re required to do examined in front of a board to ensure they have artistry. You can be assured that they will give you both stunning porcelain veneers and dental bonding. It will be the complete package.

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

What Do You Think of GlamSmile?

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I want to get a smile makeover and recently read about something called GlamSmile. It is supposed to be less expensive and the dentist can place them in just one hour. Have you looked into these? If so, what do you think of them?

Brooke

Dear Brooke,

a porcelain veneer being placed on a tooth

 

I’m glad you wrote. I think I can help you and save you a major disappointment. Here are some things to consider with GlamSmile:

First, similarly to Lumineers, they are marketed to inexperienced cosmetic dentists as being super easy to place. GlamSmile tells them that the lab does all the work so they don’t need extensive post-doctoral training to place these. There are countless examples of cosmetic dentistry horror stories of patients from both Lumineers and GlamSmile, and even other brands of traditional porcelain veneers. where patients were distraught because they spent a fortune on a smile makeover that actually made their smile look worse. This is because the brand does not matter nearly as much as the technical and artistic skill of the dentist doing the makeover.

Second, they have another marketing push that is telling dentists that they can make five times their normal means in the same amount of time they normally would spend with a patient in the chair. Whenever you push how much you’ll make to dentists, it stops becoming “which is best for the patient” and tempts dentists to push certain procedures which can increase their profit.

Finally, I am quite skeptical about their suggestion that this can be done in one hour. In fact, even they say the dentist may need to schedule a second appointment to finish up removing excess cement. Generally, to do this well, would take around three or more hours.

So, what should you do? Instead of looking for a specific brand, I am going to suggest you change your thought process to looking for the right dentist. You need someone with extensive post-doctoral training, as well as technical skill and artistry. The easiest way to find a dentist like this is to go to an AACD accredited dentist. These have proven skills.

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

Dentist Said I Cannot Have White Crowns

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I had eight dental crowns placed two decades ago. I wanted whiter crowns then they gave me but they insisted they wouldn’t look natural with the white color I wanted. Now, I want to replace them, this time getting the white color I’d always wanted. However, my new dentist said the whitest we should do is B1. The temporaries in that color are hardly whiter than what I have. His reasoning is that there are posts that would show through with a whiter color. I’m so disappointed. Before I have these permanently bonded on I want to see if there is a possibility I could get a BL4 without the posts showing. Just something a little brighter.

Sandy

Dear Sandy,

Woman with a beautiful smile

I don’t know who your dentist is, but I get the impression he isn’t really an expert cosmetic dentist. He is confusing color with translucency. If the posts are not seen through on a B1, they won’t be seen through the BL4 or if you want really white crowns, as it sounds you do, you could even get a BL1. I am not saying you have to switch dentists at this point, but I would insist your dentist give you the color you want for your porcelain crowns.

Additionally, you need to insist he do them with a temporary try-in paste and you get to see and approve them before they are permanently bonded on. If you don’t like them, they should go back to the lab until you do. Sometimes, it is helpful to have a friend with you during the try-in to give you courage and be a second set of eyes for you.

If he cannot or is unwilling to get them the way you want, then it will be time to switch dentists. If you do need to switch, the best cosmetic dentists are accredited with the American Academy of Cosmetic Dentistry. AACD accredited dentists have proven expertise and artistry. They will have not only the skill to give you the smile you wanted two decades ago, but the right mindset that it is about what kind of smile the patient wants that matters.

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

360 Wrap Veneer Scam

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Before the holidays, I went to my dentist to have a smile makeover done in time for Christmas with my family. When I went in for my consultation she told me that I was a good candidate for 360 Wrap Veneers. My big concern was that going all around the tooth they would need to take off more tooth structure than I was comfortable with. She assured me they wouldn’t need to take off much. So, I agreed. The temporaries seemed okay, but the permanent ones have had varies “teeth” fall out three different times. Once the wrap veneer came off, I noticed my tooth was just a little nub. This is not what I was expecting. I’ve followed all of their directions religiously. I don’t eat anything hard. I cut things up into tiny pieces and make sure things are further back when I chew. I even wear a nightguard when I sleep. They’re talking about getting a more powerful cement, but wouldn’t they have a good cement to begin with? I am beginning to feel taken for a ride and don’t know what to do. Any advice would be greatly appreciated.

Regina

Dear Regina,

I hate to say this, but you have been taken for a ride. Porcelain veneers are thin wafers of porcelain that go on the front of your tooth. The tooth preparation is minimal, similar to what you see in the image below.

Teeth prepped for porcelain veneers

Porcelain Veneer Preparation

This is not at all what you’ve described. I believe there term 360 Wrap veneers is a deceptive way of saying dental crowns. Crowns go around your entire tooth and would require more tooth structure to be removed in order to make room for the entire restoration. The fact that they can’t keep them in is another issue as well. While creating and bonding porcelain veneers is not taught in dental school, placing dental crowns is the bread and butter of dentistry and no dentist graduates (or at least should not graduate) without knowing how to bond them on properly.  You should not need to take any of the precautions they prescribed for you either. When dental crowns are done correctly, you can eat anything you want. A stronger cement is not likely to fix this. My guess is it has more to do with how they shaped your crowns to begin with.

Instead of just asking for a refund, I want you to tell them you want them to pay for a dentist of your choosing to fix this. Their practice was deceitful in how they handled this so if they give you a hard time about your request, let them know you will be going to the dental board about their ethics violations. That should sober them up.

Who Should Fix This Smile Makeover

You will want an expert cosmetic dentist to create a truly beautiful smile for you. While it is unfortunate that you will be stuck with dental crowns from now on because that tooth structure is gone permanently, you can still have a gorgeous smile. My recommendation is that you look for a dentist who is accredited with the American Academy of Cosmetic Dentistry. AACD accredited dentists are the top cosmetic dentists in the world.

I am sorry this has happened to you.

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

Adult with Baby Sized Teeth

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I need to figure out if there is anything I can do to improve the appearance of my teeth. I am a 33-year-old adult with baby-sized teeth. It is very embarrassing to smile. One of the things I am considering is dental bonding to make the babyish teeth look better.  Is that a good solution? Is there a better one?

Lindsey

Dear Lindsey,

before and after dental bonding

While you could use dental bonding for this, there are drawbacks. First, dental bonding does better on tiny repairs, such as a chipped tooth. For larger repairs, such as what you are facing, you will be much better off with porcelain veneers. Compared to your natural enamel, dental bonding is quite soft. It will scratch and stain easily, making it only a short term solution.

Porcelain veneers, on the other hand, are stronger than your enamel when they are bonded to your teeth. They are also much more stain resistant. When well cared for, you can expect them to last a lifetime in many cases.

Who Should Do Your Porcelain Veneers?

It is important you find an expert cosmetic dentist to do this. Cosmetic dentistry is not a recognized specialty so any general dentist can “do” cosmetic dentistry. On top of that, smile makeovers do not get taught in dental school. If they want to learn how to do beautiful cosmetic work, dentists have to invest in post-doctoral training on their own.

So, how will you know which dentists have this training and which do not? The easiest way is to use an AACD accredited dentist. These dentists have passed stringent exams on both their technical skill and their artistry. They are the top cosmetic dentists in the country and any one of them can create a stunning smile for you.

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

Fixing Black Triangles

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My orthodontist did some shaving of my teeth to fit me for a retainer and it has resulted in black triangles. Is there a gum grafting procedure I can do to fix these? My smile looked great before he did the shaving.

Andrew

Dear Andrew,

example of black triangles

Black Triangles

 

I haven’t examined you so cannot tell you if the shaving was necessary or not. It is very likely that your orthodontist is planning on dealing with the black triangles when your procedure is over. If he doesn’t, there is a solution. I would not consider gum grafting. Our gums respond to the position of our teeth. If your teeth are straight, the gums will move back to the open position even after the grafting.

The solution to this when your treatment is done and your teeth are perfectly straight would be to have dental bonding placed in the open spaces on either side of the teeth. Be careful though. I would not expect your average family dentist to be able to do this procedure. Dental bonding is quite tricky and has to be done freehand. You will need an expert cosmetic dentist for this procedure. I would look for someone who is AACD accredited. These are the top cosmetic dentists in the country and will give you a natural looking result that blends perfectly with the rest of your teeth.

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