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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.

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.

Dental Bonding Staining After Two Weeks

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

Carol

Dear Carol,

before and after dental bonding

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

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

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

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

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

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

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

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

Treating Enamel Hypoplasia

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

Caroline

Dear Caroline,

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

Mild and severe enamel hypoplasia

Treating Enamel Hypoplasia

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

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

Pick the Dentist Carefully

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

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

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

Cosmetic Dentistry Disappointment

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I am in my 50’s with 5 grown children. I’d always put their dental health and appearance before my own. Now that they’ve all left the nest, I felt it was finally my turn to get a pretty smile. I have tetracycline stains so smiling was always embarrassing for me. My dentist gave me 8 Lumineers. First, they are way too white and bulky. It looks more like I have chicklets in my mouth than teeth. I did tell him I wanted a white smile, so that may be my fault. However, the other problems I can’t figure out. My mouth hurts all the time in an achy way because my upper teeth feel too long so I can’t really relax my mouth. I have to hold the arches apart a bit. Is there any way to change this?

LeeAnne

Dear LeeAnne,

Woman covering her mouth

After all these years, you deserve to have the smile of your dreams. It sounds to me like you went to your normal family dentist for this smile makeover. Unfortunately, most family dentists do not have the skills necessary to do beautiful smile makeovers. This is especially true when the patient has tetracycline stains, which makes your case one of the more advanced ones.

The big problem you have is your dentist is in over his head. I cringed a little when I heard he gave you Lumineers because I felt I knew what was coming. This is a particular brand of porcelain veneers that is highly marketed to inexperienced cosmetic dentists as being easy to place. However, smile makeovers are not taught in dental school and take a great deal of training. Without that, the results will be disappointing, at best, as you’ve experienced. Lumineers especially are known for making teeth too bulky when done by a dentist without the right training. There are other, better brands.

Only about 2% of cosmetic dentists in the country are skilled enough to create stunning smiles when dealing with tetracycline stains. Those who aren’t, generally make one of two common mistakes. The first is that they make the teeth too opaque in an attempt to cover the stains. This can make them flat-looking, which is what is probably giving them that chicklet look. On the other end of the spectrum are dentists who don’t do enough to cover the stains and they show through the veneers.

My suggestion is you ask your dentist for a refund. Your teeth aren’t functional if you are in pain so your case will need to be redone. Once you secure your refund, I want to you find a dentist who is AACD accredited. This is different than just being a member of the American Academy of Cosmetic Dentistry. AACD accredited dentists have passed stringent exams and had their artistry closely judged by a board of examiners. They are the 2% of dentists I mentioned earlier. Find one and let them give you a smile you will be proud to share for the rest of your life.

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

Can No-Prep Veneers Work for any Patient?

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I am considering getting a smile makeover and really like the idea of no-prep veneers, like Lumineers. I see that some people warn against them and say they end up bulky, but I saw on another blog a picture of a woman who had no-prep veneers and had gorgeous results. Can this happen with any patient or was that specific to her type of teeth, like maybe her teeth were smaller than other people’s? I also noticed he (the dentist) said that he used his own personal ceramist. Does that make a difference?

Kelly

Dear Kelly,

a porcelain veneer being placed on a tooth

 

What a great question. Let’s start with the ceramist issue. Having his own ceramist works well if the ceramist is skilled, but the dentist will also need to be skilled. You can have a great cook who follows the instructions to a terrible recipe and guess what? The dish will not taste good. In the same vein, you can have a great recipe but a cook who does not have the skill to follow through well. You will still end up with a yucky meal.

It is the same with a ceramist. You need a skilled, artistic cosmetic dentist as well as a skilled, artistic ceramist in order to produce beautiful results. If the dentist whose blog you read used his own ceramist, then he did not use Lumineers. This is one of the drawbacks to that particular brand. They insist you use their lab. Unfortunately, their lab is notorious for creating bulky, and sometimes even chalky-looking results. The dentist you read about probably used a different brand of no-prep porcelain veneers.

Your Best Strategy for a Beautiful Smile Makeover

When it comes to smile makeovers, it is better to focus on choosing the right dentist and not the particular brand of porcelain veneers. Finding the right dentist means, he or she has the skill to create a beautiful recipe and he understands which ingredients (ie. the brand) will bring the flavor you want to your smile. In addition, he will know which ceramists are able to put his recipe together to perfection.

So where do you find such a celebrity chef? I would look for a dentist who has reached accreditation with the American Academy of Cosmetic Dentistry. AACD accredited dentists have proven technical skill and artistry. You will love the results they get.

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

 

Can I Get a Better Smile without Bonding?

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I have slightly discolored teeth, due to aging. A few years back, I also fell and chipped my front tooth. My dentist did composite bonding on that and I’ve never been happy with it. It doesn’t match the rest of my teeth and never has. Plus, there is a gap that wasn’t there before. I went to him about the discoloration for all my teeth to see what he’d recommend and he wants to do composite bonding on the top eight teeth. I am a little leary of this given how the gap turned out. Is there another way to handle this?

Kevin

Dear Kevin,

before and after dental bonding

You bet there are other ways to handle this. My first suggestion would be to simply have professional teeth whitening done. This will take care of the discoloration you are talking about.

The next step would be to replace the badly done dental bonding. The problem you faced with the bonding was not the procedure as much as it is the dentist who did the procedure. He could have matched your teeth perfectly and not had any gaps. The fact that he was not able to accomplish that tells me he is not a skilled cosmetic dentist.

If the only things you want to change about your smile are the color and this bonding, then I would simply find a better cosmetic dentist. Look for an AACD accredited dentist to do your work. These are the best cosmetic dentists in the country.

If, however, there are other things about your smile you are hoping to change, then I would look into getting porcelain veneers. These can give you a complete smile makeover. They’re able to change anything about your smile, including the color, shape, size, and character.

Like the dental bonding, it will require an expert cosmetic dentist, but when well cared for they will last for many years. Whatever you do, don’t go back to the same dentist who could not get your chip repaired properly.

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

Mouthwash with Porcelain Veneers

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I have porcelain veneers that I really love and I want to take good care of them. I am doing a DIY mouthwash to be safe and want to make sure there are not any ingredients that can hurt my veneers. Here is my recipe:

4 oz. boiled wather

4 oz. hydrogen peroxide

1 T. sea salt

Will this be safe?

Ken

Dear Ken,

a porcelain veneer being placed on a tooth

I love to hear when patients are happy with their smile makeovers and how well they are caring for their teeth as a result. The ingredients you mentioned will not harm your veneers. However, I would be cautious with using it every day.

Peroxide is great about getting rid of bacteria. The only problem is it is non-discriminating as to which types of bacteria it kills. This means it will take away some of the good bacteria your mouth needs. That can lead to a candida infection for you.

Periodic use, about once a week, and you should be fine. Much more than that and you will risk that yeast growing in your mouth.

Over the Counter Products that Can Damage Porcelain Veneers

There are two main types of products to beware of that can do damage to your lovely porcelain veneers. The first is whitening toothpaste. These kinds of toothpaste typically contain an abrasive to scrub the stains off your teeth. The only problem is they will damage your teeth in the process by putting micro scratches on the surfaces of both your natural tooth structure and your porcelain veneers, this will cause them to pick up stains because they will lose some of their protective glaze.

If you really feel you need a whitening toothpaste, I recommend you get Supersmile Toothpaste. This is specifically designed for cosmetic work and will keep your veneers, as well as your natural teeth, shiny and damage free.

The second is over-the-counter mouthwash. Most of these contain alcohol. This is the one ingredient you want to avoid as it will eat away at the bonding that keeps the veneers on your teeth. I believe Colgate has an alcohol free mouthwash, but I would double-check to make sure the ingredients haven’t changed.

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

 

Sonic Toothbrushes and Dental Bonding

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I read that you cannot use ultrasonic toothbrushes if you’ve had dental bonding. Is there a particular type of toothbrush that should be used?

Addy

Dear Addy,

before and after dental bonding

 

I think there is some confusion of terms here. Toothbrushes can be sonic, but I don’t know of any ultrasonic toothbrushes at this point. Could it be you read something about ultrasonic scalers or cleaners?  These are used by dental hygienists. When not done skillfully, they can nick and damage the dental bonding. This is a danger to dental work.

However, if you are going to an office that does a LOT of cosmetic work, then the hygienist is probably trained and highly skilled and your dental work will be safe.

Sonic toothbrushes do not have the same risk. Sonic moves slower than ultrasonic. Plus, the bristles are soft, which also lessens the chance of damage.

You’re fine using pretty much any toothbrush you will use regularly.

That being said, one thing you will definitely want to avoid at your dentist’s office is that the hygienist doesn’t use the power prophy jet or acidulated fluoride. Both of those things will permanently damage your dental work.

Like the scalers, an office that does a lot of cosmetic work will know this, but your average family dentist may not.

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

Click here to learn about smile makeovers.

Can I Trust the Dental Tourism Adverstisement I received?

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I received this advertisement that describes the most delightful vacation I can take all while getting my dental care done at a fraction of the cost I would pay in the United States. I have my choice of Baja California or Cancun. I have to be honest, I am tempted. Is it safe?

Estelle

Dear Estelle,

Woman covering her mouth with hand.

I am very glad you wrote before taking part in this. Dental tourism is heavily marketed and when it works out, it can be okay. But, when it does not work out, and that is more often than people think, it can be a disaster.

I actually know about the dental group you are referring to here, but won’t give their name here, so as not to give them any more advertisement. Here are my concerns with this particular group, which believe it or not are better than most.

First, there are quite a few reports of them trying to upsell. That means they are proposing procedures that may not even be necessary. There are also reports of patients receiving the wrong treatment. In many of these dental tourism countries, when things go wrong there is not much recourse (if any at all) for the patients. The dentists themselves have zero risk.

Here is one review I saw on Yelp! where a patient experienced both of these issues at the same time. You should know they went to this dental clinic I believe you received this advertisement from.

“My mom and I went to Mexico recently for her to have dental work done. I’m sure mom needed some dental work done but not 10 crowns and a root canal. The 2nd molar that had the crown and root canal fell out 2 months later due to bone loss.”

Doing a root canal treatment and putting a dental crown on a tooth that had the type bone loss described here shows a serious lack of integrity on the part of the dentist. He did two useless procedures on this woman simply to take her money, all while not giving her the treatment she actually needed.

You can probably guess by now that my advice will be NOT to go.  If you want to go to Baja or Cancun, go to enjoy the sites, but get your dental work done here by dentists you can trust. You didn’t mention if you were going for general dental work or if you had cosmetic work in mind. If you are looking for cosmetic procedures, the best cosmetic dentists are AACD accredited. I would suggest that is the dentist you seek for your smile makeover.

If you are looking for a general dentist, be sure to check their Yelp! reviews. This will give you some idea of the experiences other patients have had with them.

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