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Full Mouth Reconstruction Going Badly

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I needed a full-mouth reconstruction because of how bad my smile looked. My dentist provided crowns on all my teeth, with the exception of one tooth which he extracted and placed a dental implant. When he did the temporaries for the crowns, everything seemed fine to me. However, now that the permanent ones are in things are off. Some of my teeth are not lining up properly. Because of this, it hurts when I eat. When I spoke to my dentist he said he met all the checkpoints and just to give it time. I went to get a second opinion and the other dentist said, “Oh, Dr. —- [name withdrawn] is a great dentist.” I got the feeling that he didn’t want to disagree with this dentist because they must know each other. In the meantime, I am stuck with this bite that is killing me. Is there any advice you can give me?

Laurie

Dear Laurie,

woman holding her her jaw in pain

I want to make sure I understand that your dentist gave you a full mouth reconstruction simply for cosmetic reasons. Is that right? If so, that is a massive overtreatment. A smile makeover is typically done with porcelain veneers and even then you would not put them on each and every tooth. You would only place them on the teeth that are visible when you smile. Generally, that is the eight to ten upper teeth, depending on the smile.

A full mouth reconstruction is for much more serious conditions and removes a LOT of your tooth structure. A couple of reasons for a reconstruction would be serious TMJ Disorder which does not respond to less invasive treatments; or to cover teeth that are worn down to nubs by bruxism (teeth grinding). Without a clinical reason for crowning all your teeth I would say this was unnecessary. Now, there may have been a good reason that just didn’t get mentioned because it was not relevant to your question. I just wanted to make sure.

Not that it is funny, but I chuckled a little at your dentist’s comment that he met all the checkpoints and you just need to get used to it. That is often dental speak for, “I want you to leave me alone. This is hard and I don’t know how to fix it.” Plus, I’m pretty sure any dentist should consider “My patient is not in pain” as a checkpoint. Just saying…

Occlusion, the term for how your teeth meet together, is an advanced subject. It takes post-doctoral training to understand this properly. It is very possible that your dentist does not have enough training in this area.

Getting a Real Second Opinion

I’m not surprised you didn’t have much luck with your second opinion. One of the cardinal rules in getting an unbiased second opinion is to not tell them who your dentist is. Just ask them about the way the crowns are meeting together and explain you’re in pain. If they ask before giving you their diagnosis, tell them you want an unbiased opinion so don’t want to tell them. They should understand that. When you get that second opinion, make sure you go to a dentist with the training you need. Unfortunately, there is not a recognized specialty in this type of work so you will just need to look for the right training. Two great post-doctoral institutes that instruct on TMJ and occlusion are the Dawson Academy and the Pankey Institute. Any dentist who has studied there, will be able to give you a truly educated diagnosis.

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

Should I Finish My Full Mouth Reconstruction?

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

Callie

Dear Callie,

A woman pointing at her smile

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

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

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

Just remember, you can get quirky.

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

$100k for a Smile Makeover?

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I’m so frustrated. I’m having trouble getting the right cosmetic dentist for my smile makeover. The first go-round I used my normal dentist. It turned out a complete disaster. He was gracious about it and completely refunded my money. Next, I went to someone who is supposed to be the top cosmetic dentist in our city. He said my bite is off and quoted me close to $100,000. There is no way in the world I can afford that. Is that the right amount for a top cosmetic dentist?

Jane

Dear Jane,

Woman with a beautiful smile

You are running into two problems when it comes to cosmetic dentistry. First, it isn’t a recognized specialty. This means any general dentist can call themselves a cosmetic dentist regardless of the amount of post-doctoral training they received. Unfortunately, creating smile makeovers isn’t taught in dental school. If a dentist wants to develop the skills needed to do it well, they need to invest in the training on their own. This is the issue you ran into with your family dentist. He obviously meant well and wanted to try to give you what you wanted. When he couldn’t, he had the integrity to return your money when he couldn’t.

The second dentist had a completely separate issue. The cost he quoted is quite high for porcelain veneers. He mentioned your bite was off. It’s possible what he was recommending was actually a full-mouth reconstruction, which is a completely different and much more involved procedure as well.

I would get a second opinion before moving forward. To be safe, I’d like to make certain you are seeing a qualified cosmetic dentist and not just someone trying to bring in a large fee. My suggestion is you look for an AACD accredited cosmetic dentist. These dentists have proven themselves by passing stringent exams as well as demonstrating the artistry to a committee.

If it turns out that you do need a full-mouth reconstruction, I think you should verify his qualifications. You need a TMJ Dentist with advanced training. Take a look at Dr. Weiss’ qualifications to get an idea of what type of dentist you would need for this type of procedure. Even then, I don’t think it would cost you $100K.

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

Full-Mouth Reconstruction to Whiten Teeth?

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I need to make some important choices soon. I have a dental crown that is about 20 years old and two porcelain veneers that are a bit older. I’ve been experiencing some dry mouth. I’ve chipped the veneers on the front teeth and now there is a gray line at the gumline by the crown. I went to my dentist to discuss replacing them. Because my smile is no longer very white, he is suggesting I get crowns on both my upper and lower arch to do a smile makeover of sorts. The more I think about it, the more concerned I am, especially with my dry mouth. It may be better for me to just replace the old work and wait to see what happens with the dry mouth first. What do you think?

Carolyn

Dear Carolyn,

teeth whitening trays

The first thing I am going to suggest is that you get a different dentist. If I understand you correctly, your dentist is suggesting crowning all of your teeth because your teeth need to be whitened? Really?

So, here’s the thing. Whitening your teeth will bring him in a few hundred dollars. Crowning all your teeth, known as a full mouth reconstruction, will bring him in $30,000+. Your dentist is being self-serving. The best dentists are doing their best to serve their patients without unnecessary expense for his or her benefit and while preserving as much tooth structure as possible. He’s doing neither.

My suggestion is you have your teeth whitened and then just replace the damaged dental work. However, I don’t think your dentist should be the one to do it and not just because he’s grabbing for the bucks. There is another warning sign that he isn’t what you need. When a dentist suggests dental crowns instead of porcelain veneers for a smile makeover, it is because they are not comfortable doing porcelain veneers. Doing crowns in a case where they are not needed is a waste of healthy tooth structure.

As you likely know from the crown you already have, in order to make room for the restoration, he’d have to grind your teeth down to nubs. This is irreversible. Once you have dental crowns you will always have to have dental crowns. It is much better to do porcelain veneers when it comes to a smile makeover.

Now, you do already have one crown. You mentioned a gray line at the gumline. This tells me the original dentist did a porcelain-fused to metal crown. On a front tooth, what you really want is an all-porcelain crown.

What you need is a skilled cosmetic dentist to take over. In your place, I’d look for an AACD accredited dentist. These dentists are in the top of the cosmetic field and have proven skill and artistry. You’ll have a smile you are proud of.

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

Full Mouth Reconstruction Disaster

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I needed to replace some old veneers and two crowns. When I saw my dentist, he said that he’d need to open my bite a bit so my teeth would show more. I never considered that a problem, but figured there was a reason. The temporaries are very uncomfortable I asked him to redo them twice. Then when the permanents came in, he put them in so fast, I hardly had a chance to check them out before they were permanently bonded on.

I’ve had massive problems since and can’t even shut my mouth all the way. I have been drinking water and sloshing it around my mouth constantly. If I don’t, my lips stick to my teeth. I spoke to my dentist about it and he said he’s hit all the checkpoints and his work is perfect. What do I do? I don’t feel like I can continue like this.

Pam

Dear Pam,

Woman covering her mouth with hand.

This is unacceptable for you. When your dentist tried to open your bite, which I am not convinced was necessary, it sounds like he was in over his head as well. Additionally, it doesn’t sound like he cares. He ignored every concern you had during the temporaries. This is the stage that is imperative to help ensure the bite is perfect. He should never have moved forward until your bite was completely comfortable. He blew past that and placed the permanent ones in a rush.

Now that they’re on and not doing well, he’s ignoring you again. This time, putting your oral health at risk. What you are experiencing is lip incompetence because he opened your bite too much. He’s really messed up and doesn’t want to admit it.

The only way to fix this at this point is to completely have the case re-done. However, you don’t want to have this dentist do it. To be frank, he doesn’t know what he’s doing. You need another dentist to do this for you. I also think your dentist needs to be the one to pay for it. It is his mistake.

Who Should Re-Do This?

You need a dentist with both cosmetic and restorative training. When you do, make sure the temporaries are exactly the way you want them before the case goes any further. A good dentist will know this, but I don’t want you suffering the same way again, so I just want to make sure you don’t allow anyone to move forward without satisfactory temporaries.

What that means is, your lips will come naturally together, your bite “feels” normal to you, and you love how they look. Unfortunately, smile makeovers and advanced restorative procedures aren’t taught in dental school. A dentist has to study this in a post-doctoral setting, though it isn’t required for them to practice. If at all possible, you should get an AACD accredited dentist to do your case. They will be the most likely to have the training and the skills necessary to do this for you.

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

Do Dental Crowns Cause Dry Mouth?

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I’m having a really hard time with dry mouth ever since getting all my teeth crowned. I know it was a cosmetic procedure, and while the teeth look okay, I have to really focus on keeping my mouth closed. Never in my life did I think I’d be what my kids call a “Mouth Breather.” Is there a way to fix this or is it normal and I’m just not used to a wider smile?

Kathy

Dear Kathy,

A woman pointing at her smile

No this isn’t normal. Was there a particular reason your dentist did dental crowns instead of porcelain veneers. You mentioned it was cosmetic work. Generally, when someone is getting a smile makeover, porcelain veneers are the go-to. It removes less tooth structure.

Some inexperienced cosmetic dentists will do porcelain crowns for smile makeovers because that is what they’re familiar with, but it unnecessarily grinds down healthy tooth structure. It’s water under the bridge at this point as it is already done. I just wondered if there was a functional/mechanics reason for doing something so drastic. That leads me to my next question.
Why every tooth? Most smiles are about eight to ten teeth wide. Doing every tooth is excessive, not to mention expensive.

What your dentist did is known in dentistry as a full-mouth reconstruction. It’s an advanced procedure that isn’t typically taught in-depth, if at all, in dental school. Instead, dentists would seek out post-doctoral training.

Lip Incompetence is Dangerous

When you can’t close your lips naturally and are having to consciously force it, we call that lip incompetence. It is going to rain havoc on your teeth and oral health. While many people think brushing is our biggest defense against decay, the reality is our saliva has an even greater impact. It contains bacteria-fighting minerals that protect your teeth. Dry mouth deters saliva and allows that bacteria to multiply unhindered.

In creating this problem, y our dentist made a serious mistake. He (or she) needs to pay to get this fixed. Don’t just ask for a refund because the fix will likely be more expensive than the original procedure. If he complains about this, you may want to hint to him that another dentist told you that you have a valid case for malpractice damages. That should get his attention.

A Word about Smile Makeovers

You said the smile was “okay”. An okay smile would not be what you were stuck with when it came to a true cosmetic dentist. When you go to get this full mouth reconstruction done correctly, I want you to look for a dentist who is accredited with the American Academy of Cosmetic Dentistry.

AACD accredited dentists are in the top 1% in their field. Not only will you be able to close your mouth naturally and comfortably, but you’ll also have a stunning smile you will be thrilled to show off to the world.

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.

Will Porcelain Veneers Solve My Problem?

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I have never liked my smile and I am finally in a position to do something about it. Here are the issues:

  • It’s extraordinarily difficult to show my upper teeth.
  • When my mouth is at rest you cannot see them at all.
  • I have pretty constant jaw pain, except for when I wear my nightguard at night for my teeth grinding.

What I’d like is to be able to see my teeth and maybe even improve my appearance. I’d also like my jaw to hurt less, like the way it does when I’m wearing my nightguard. Would porcelain veneers be my best solution?

Laurie

Dear Laurie,

woman holding her her jaw in pain

While porcelain veneers are the go-to procedure for a smile makeover, your situation is a little more complicated. It sounds like you are facing a collapsed bite along with TMJ Disorder. This requires a different approach. You will need to open your bite. This is typically done as full-mouth reconstruction with dental crowns. However, I want you to proceed with caution.

Only a small percentage of dentists are able to do this procedure correctly. When it isn’t properly done, it ends up making things much worse. Here is the way I’d recommend a dentist proceed.

You want whoever does your full-mouth reconstruction to start by using provisional crowns to open your bite. This way it is reversible. When you are completely out of pain and love the appearance of your smile, that is the time to move forward and the dentist can make the permanent crowns.

What Qualifications Do You Want in Your TMJ Dentist

It’s important whatever dentist you choose has extensive post-doctoral training in TMJ Disorder. For instance, Dr. Weiss did his TMJ training with the renowned Dawson Academy. Other reputable institutions would be the Kois Center and the Las Vegas Institute for Advanced Dental Studies.

You also want to ask them what experience they have in full-mouth reconstruction. You definitely don’t want to be their first case.

Cosmetic Considerations with Your New Bite

While you are opening your bite, you are also getting a smile makeover. Because of that, it is important you find a dentist who is a top of the line cosmetic dentist. Ideally, you’d want an AACD accredited dentist. The good news is finding such a dentist will likely take care of both sets of qualifications.

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

Her Dentist Seems Negligent

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I’ve never had a cavity so I don’t know what to expect. I do grind my teeth in my sleep, but I had a check-up just two months ago and everything was fine, so I don’t know what is causing this. Recently, I feel like someone is pulling on my back teeth for a second and then releasing. It’s happening on both sides of my back teeth. Is this a cavity or something else?

Candy

Dear Candy,

woman holding her her jaw in pain

I’m concerned about what I’m hearing. You said everything was declared fine at your last appointment, but if you have been grinding your teeth than it most certainly isn’t alright. When you grind your teeth, it can lead to serious problems such as TMJ Disorder. Not to mention you can grind your teeth down to nubs. This will require you to need dental crowns on all your teeth. This type of full-mouth reconstruction is expensive.

Your dentist should have discussed this with you and warned you of the repercussions. This is especially true because the solution is to simply wear a nightguard.

It’s possible your dentist is just one of those bread and butter dentist who only looks at things like cavities and doesn’t check on other important issues such as bruxism and gum disease.

Your issue doesn’t seem like a cavity. However, bear in mind with anything I am telling you that I haven’t exactly examined you. Your situation sounds more like what would happen if you had gum disease. Though, for it to get to the point you have pain would be rather serious. You would be to the point of bone loss, which means you could start losing teeth.

Because you have just started feeling the pain, I tend to think it might be that you are experiencing pain because of your teeth grinding.

I’m going to recommend you see another dentist to get a thorough examination. At the very least you are going to need a nightguard. But, I’d like your gums checked as well.

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

Jaw Pain from Dental Appointment

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I had my teeth prepared for both crowns and porcelain veneers on my upper arch. I’m almost a week out and my jaw is still in massive pain. I ache constantly. My dentist suggested taking Ibuprofen, which I have been, but I feel like I’m living on the pills. Could my dentist have caused a TMJ problem? He’s going to be gone for a week. Do I need to see another dentist or can I wait until he gets back?

Missy

Dear Missy,

woman holding her her jaw in pain

This sounds pretty normal for what you’ve been through. Your mouth had to be propped open for quite a while. Soreness in your jaw is to be expected. It may even go on for another week or so. In addition to the pain medicine, you can do hot and cold compresses to help give you some relief.

If your dentist is gone for a week, he should have made arrangements with another dentist to care for his patients in the case of a dental emergency. I don’t think this is one, but if things get worse you can call your office and there should be a number on their answering machine for the dentist he’s made arrangements with.

Symptoms of TMJ Disorder

While jaw pain is a symptom of TMJ, that in isolation isn’t usually a sign. There are generally other things which accompany jaw pain. Some examples would be:

  • Popping or clicking of your jaw
  • Migraines, especially in the morning
  • A change in your bite
  • Neck pain

If any of these symptoms develop, that would be when you should talk to a dentist about TMJ disorder. There are tests a dentist can run to help determine if this is an issue for you.

Don’t go to any dentist about this, though. You want a dentist who has invested time in TMJ training after dental school. You’ve had what sounds like a full-mouth reconstruction. When this is done properly, it can actually treat TMJ disorder. But, if it is done improperly it can make things worse. That’s why you should keep an eye on those other symptoms.

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