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Why You Have to Carefully Pick Your Cosmetic Dentist

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

Pamela

Dear Pamela,

a porcelain veneer being placed on a tooth

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

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

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

Getting Beautiful Porcelain Veneers

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

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

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

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

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

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

Fixing the Appearance of Protruding Teeth

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I have teeth that are slightly protruded and stained. What are my options for getting an attractive smile that doesn’t include braces? Seriously…NO Braces!

Alicea

Dear Alicea,

You have a couple of good options to get a beautiful smile. The first option is to get orthodontics. Now, I can hear you saying, “No braces!” I promise I am not talking about traditional braces. There have been some wonderful advances in dentistry. One of those is an invisible braces option, such as Invisalign. Instead of metal wires and brackets, these use clear aligners that straighten your teeth. For the discoloration, some simple teeth whitening will do the trick.

a porcelain veneer being placed on a tooth

A second option is to have a complete smile makeover done using porcelain veneers. This is the go-to for celebrities that want that Hollywood smile. It can change the shape, size, and color of your teeth simultaneously.

The important thing with porcelain veneers, though, is to make certain you go to an expert cosmetic dentist. Doing smile makeovers is not taught in dental school. Nor is cosmetic dentistry a recognized specialty. If a dentist wants to develop skills in cosmetic procedures, it is up to them how much and how skilled they become. There is no baseline.

Your safest option is to find an AACD accredited dentist. Dentists who seek accreditation through the American Academy of Cosmetic Dentistry have to prove not just their technical knowledge and understanding about cosmetic work, but also have to demonstrate they have artistry by submitting a large number of visual evidence of procedures they’ve done.

With the right dentist, porcelain veneers will give you a smile that lights up a room.

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

Dentist Won’t Do Bonding

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I have black triangles that developed after some orthodontics.  I read online that this can be fixed with dental bonding but my dentist is insisting this is a bad idea. I don’t want to leave these holes so what can I say to convince him? I’ve tried showing him an article about it and he really still doesn’t think it is a good idea.

Brenda

Dear Brenda,

example of black triangles

While you are correct that dental bonding will be a good solution for this, I would not push him into this. When a dentist tries to steer a patient away from a procedure, it is usually because they are not qualified to do it but do not want their patient to lose confidence in them.

This is an advanced, tricky procedure to do. In your place, I am going to suggest you see a dentist with the training necessary to do it. The dentists with proven skills and training are AACD accredited. There are other excellent cosmetic dentists as well, but these have already been tested so you know what you are getting into. If I were in your position. That would be the dentist I’d use.

If you are interested in whitening your teeth. Make certain you do it before you have any bonding done. The color can’t be changed on the bonding after it is done, so you want any color matching to be done with the color you are going to keep.

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

 

Smile Makeover Gone Wrong

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I went to a dentist because I was finally in a position to fix my teeth. My four front teeth are overcrowded and misaligned. My dentist told me using smile makeover techniques with cosmetic dentistry I could fix my teeth without braces. In total, he did dental bonding, two porcelain veneers, and some tooth shaping. He also said he shaped some lower teeth, which we never actually discussed. I wish he hadn’t done that because it added to the price. I paid a total cost of $9.3K. When it was “finsihed”, there really wasn’t much of a difference. My teeth were still misaligned and I didn’t feel like it was prettier in any way. I asked how it was possible to get the teeth to look like he said they would. He told me I’d need to do four root canals and dental crowns, of course, there is a significant additional cost. I wasn’t too keen on that so I went to see another dentist to see what they thought. Their solution was to just whiten my teeth and then do four porcelain veneers. There cost for that was only $7K. I like that idea. Is there any way for me to recoup my original $9.3K?

Camille

Dear Camille

a porcelain veneer being placed on a tooth

 

I am sorry for what you have been through. We are going to file this in one of the many cosmetic dentistry horror stories people write to us seeking advice. One of the problems you are facing is that there isn’t a recognized specialty in cosmetic dentistry. On top of that, dentists are not taught much in dental school about doing smile makeovers.

The dentist who did your smile makeover obviously hasn’t invested much in his cosmetic dentistry training. Nor has he given you the smile he told you that he would provide. I think you have a good case for a refund. Before we get into that, I want to make sure the next dentist you see to repair this is qualified.

My suggestion is that you look on the mynewsmile.com website. They prescreen cosmetic dentists who wish to be listed. They cannot purchase their way on. Instead, they have to demonstrate their technical skills, training, and artistry.  Anyone they list will give you a stunning smile.

The second dentist was on the right track. You do not need root canals or dental crowns. Please don’t let anyone do that to your teeth. Porcelain veneers are sufficient and will give you a beautiful result with an artistic dentist. The teeth whitening makes sense too if your smile is wider than the number of veneers you are getting. It also helps your bottom arch to blend.

Tips for Getting a Dental Refund

With some dentists, who care about patient satisfaction, you can simply ask for a refund when the work done wasn’t what was promised. However, some dentists are more stubborn than others. While I always recommend simply asking first in order to give them an opportunity to do the right thing, you do need some tips in case they don’t.

First, let them know you are doing them a favor. Often, a dentist will not know that written requests for a refund have to get reported to the National Practitioner Data Bank. It helps to educate them and give them an out by saying something like the following.

“I don’t want to make things difficult for you. This is why I am making an oral request, instead of a written one which would have to be reported to the National Practitioner Data Bank.”

If he still doesn’t comply, here are my recommendations:

  • Make a written request, explaining your reasons so it is on record.
  • Write a negative online review, which puts them in a position of needing to respond in order to save their reputation.
  • Complain to the dental board. With a legitimate complaint, the dental board can make life quite difficult for dentists. He’ll want to avoid this, so let him know it is your next step. That may spur him on.
  • Go to a lawyer. Often just the letter from the lawyer will be enough. With a legitimate complaint, the dentist’s malpractice insurance will encourage him to settle.

Best of luck. Make sure you get an expert cosmetic dentist to fix this.

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

Dental Bonding Turning Yellow in a Week

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I don’t know what is happening. I had dental bonding done on six of my front teeth. It’s been only a week and they’re turning yellow. I really loved them when I first got them and expected them to last a few years. What do I do? Can I whiten them?

Pauline

Dear Pauline,

before and after dental bonding

I am sorry this has happened to you. There are a couple of possibilities here. One is that your dentist used subpar materials. The second is that you did something to damage the polish on them. Either way, the fault will likely lie with your dentist because it is his responsibility to instruct you on your post-operative care.

Is it possible you brushed your dental bonding with something abrasive such as an over the counter whitening toothpaste or some baking soda? This will scratch the polish on the bonding allowing them to pick up stains much more quickly than they would otherwise. Many people aren’t aware that whitening toothpastes that you purchase at the store “whiten” your teeth by using abrasives. This creates a wicked cycle of making your teeth look whiter by scraping off stains, but it also creates micro-scratches on the surface of your teeth that causes them to pick up stains more quickly.

The only type of whitening toothpaste I would ever recommend is Supersmile Toothpaste, which uses a natural enzyme to whiten your teeth without any damage.

Unfortunately, teeth whitening won’t get them any brighter or whiter. It will only work on natural tooth structure. Because it has been such a short time since they provided your dental bonding for you, I am going to suggest you call and ask them to repolish them for you.

Caring For Your Dental Bonding

  • The best toothpaste for any type of cosmetic work is Supersmile Toothpaste. It’s specifically designed to remove stains without doing anything that will damage the work.
  • Like with anything related to your teeth, brushing and flossing is an important part of keeping the bonding healthy and shiny.
  • Make certain your dental hygienist knows how to care for your dental bonding. For instance, during your cleanings it is important she doesn’t use anything like a power prophy jet or acidulated fluoride, which will damage the polish on them.
  • If you use a mouthwash, make sure it is alcohol-free. Alcohol can loosen the bonding.

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

 

Cosmetic Solution for Fluorosis Stains

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I have fluorosis stains on my teeth and wondered if teeth whitening is a good cosmetic fix for someone in my position? I want to have a smile I am proud of.

Diego

Dear Diego,

I will say right off that teeth whitening will not be the solution. It whitens teeth evenly and is only more likely to make your fluorosis stains more obvious. For the benefit of those who are unfamiliar with what fluorosis stains are, it happens when someone ingests too much fluoride while the teeth are still forming. The fluoride in the water in the United States is optimized for the right consumption so we don’t see much of it here.

There is good news, though. Your teeth can be attractive again. Which solution depends on the amount of fluorosis you are dealing with. For either repair, you will need an expert cosmetic dentist. My suggestion would be to find an AACD accredited dentist.

If You Have Mild Fluorosis

 

mild fluorosis stains

The picture above is an example of mild fluorosis. If this is what you are facing, then dental bonding can be a sufficient repair. Your dentist will gently shave about 0.5 millimeters of your tooth enamel. Then, he or she will replace it with direct composite bonding. It doesn’t last as long as the next repair I will talk about, but it does cost less.

If You Have Darker Fluorosis

heavier fluorosis stains

In some cases, as in the picture directly above, the stains are more prominent. In this case, simple dental bonding will not be enough. Instead, I suggest you have porcelain veneers placed. This is actually the go-to procedure for a smile makeover. It is what gives people that “Hollywood Smile.”

This procedure can last for a lifetime. However, don’t try to cut corners by going to an inexperienced cosmetic dentist for this. It’s not an easy procedure to do under the best of circumstances. With severe stains like these, it will take someone highly skilled. This is why I recommended an AACD accredited dentist earlier, these are the best cosmetic dentists.

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

Discolored Dental Bonding

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I’ve got dental bonding that is seeing the end of its lifespan. It is picking up stains and isn’t nearly as bright as it once used to be. I honestly don’t know if I should whiten them or replace them. If whitening would work then I’d like to do that. I’ve moved since then and don’t feel confident my new dentist can do the job. He said he’s willing to learn but I’d be his first case. Is there a specific type of teeth whitening that would work better with dental bonding?

Eliza

Dear Eliza,

before and after dental bonding to repair a chipped tooth

There isn’t a teeth whitening that will remove the stains from your dental bonding, unfortunately. In fact, because it only works on natural tooth structure, your teeth would whiten but not the dental bonding, making the disparity even worse. That being said, I am glad you are not just going to let your new dentist try his hand at dental bonding on you.

This requires some expertise because it is a procedure that is done freehand. A dentist needs training as well as artistry. However, you do need to have the bonding replaced. If you are happy with your dentist in every other aspect, you don’t have to switch practitioners. Cosmetic dentists are used to patients coming to them just for specific advanced procedures and then returning to their regular family dentist for the bread and butter type of care.

With that in mind, how do you go about finding a dentist to replace your worn out work? The easiest way would be to find an AACD accredited dentist in your area. These are dentists who have proven their technical knowledge and artistry to an examination board. They are more than qualified.

Should You Whiten Anyway?

Because the bonding color is permanent during its healthy lifespan, if you have any plans to whiten your teeth, the time to do that would be before you have the bonding re-done. This way when they replace the bonding, it can be done to the color you will want to keep for some time.

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

Dental Bonding Doesn’t Match

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I chipped a tooth and did some research on repairs. The consensus was dental bonding was the best repair. I did get that, but the bonded part doesn’t even come close to matching the tooth part. It is so obvious there is a repair there. Is that normal? If not, who do I get this fixed? Will I have to pay for it?

Casey

Dear Casey,

before and after dental bonding

As you can see from the image above, dental bonding can and should look completely natural blending in seamlessly with the natural tooth structure around it. The problem you are facing is the dentist who did the procedure, not the procedure itself. It can be fixed and should be done at the dentist’s expense.

Doing bonding well is challenging because it has to be done freehand. This means the dentist either needs some natural artistic ability or invest significant time and money in the practice and training necessary to do it well. Not many dentists do that.

The first thing I recommend is you give your dentist another chance to get the dental bonding to look natural with your other teeth, with the understanding that if he can’t do it to your satisfaction, he’ll provide you with a refund so you can get it done properly. There is a reasonable expectation that the bonding matches the tooth.

If it turns out he can’t do it or just prefers to give you a refund, you’ll want to find an expert cosmetic dentist to do your dental bonding.  I suggest looking for an AACD accredited dentist or a dentist recommended on the mynewsmile.com website. These are the dentists that have the skill and artistry to give you a natural-looking result.

One other thing to be aware of in case your dentist didn’t tell you before your original bonding. Once the bonding is completed, the color is permanent. If you want to whiten your teeth later on, your natural tooth structure will whiten but not the dental bonding. Then, the only way to get them the same color again is to re-do the bonding. Because of that, I generally recommend to patients that they have any teeth whitening done before the bonding. However, you also have the option of waiting until it is time to replace the bonding. I just didn’t want you unaware of the limitations and then having to spend unnecessary money replacing your bonding early.

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.

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.