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Crowns or Veneers for Tetracycline Stains

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I have severe tetracycline stains that I am ready to get cosmetically treated. I’ve seen two dentists about this. The first suggested porcelain veneers, the second dentist suggested porcelain crowns. The price quoted to me for the veneers is almost double that for the crowns. Can I acheive the same beautiful result with either porcedure? I like the idea of saving money, but don’t want subpar results.

Avery

Dear Avery,

a porcelain veneer being placed on teeth

It is an exciting time when you are getting to plan your smile makeover. I am glad you wrote. The single biggest factor that detrmines the beauty of your case is not necessarily which procedure, but which dentist. Think of cosmetic dentistry as an art form. If I commissioned two painters to do the same portrait with the exact same materials, the portraits would not be exactly the same. This is because the skill and artistry varies from painter to painter. The same is true of cosmetic dentists.

Now factor in that you are dealing with severe tetracycline stains and the dentist becomes even more important. Tetracycline stains are one of the most advanced cases in cosmetic dentistry and quite difficult to do.

The standard treatment for this would be to have porcelain veneers placed. Usually, dentist who suggest porcealin crowns do so because they do not have the skill to cover the stains with the thin wafers of porcelain that make up veneers and think that using dental crowns will make that easier. This is not the case.

With dental crowns, you also want to consider that there is significantly more grinding of the teeth for preparation. This weakens the teeth and puts them at greater risk down the road. Plus, you can never backtrack from dental crowns. Once the tooth structure is gone, it’s gone. There is not a way to get it back.

Just because the first dentist suggested veneers instead of crowns, does not necessarily make him an expert cosmetic dentist. The easiest way for you to find an expert, artistic cosmetic dentist is to go to the AACD.com website. They have a find a cosmetic dentist link. However, it is important that you check that you want an accredited dentist. AACD accredited dentists are the top cosmetic dentists in the country. Any one of them can ensure you get a beautiful smile, even with severe tetracycline stains.

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.

Crowns Versus Veneers for Tetracycline Stains

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I have tetracycline stains on my teeth and really want a pretty smile. I spoke to one dentist who has a good reputation in cosmetic dentistry, name Dr. —–[name withheld].  He wants to charge me $42, 000 for upper and lower full mouth veneers. Another dentist is suggesting porcelain crowns and is only $28,000. I really only have $30,000 to budget for this, so I should probably go with the crowns. However, I wanted to double check with someone not invested in getting my business as to crowns versus veneers for tetracycline stains. Is one better than the other for this? Plus, you should know I have a tooth grinding problem, which may impact your answer.

Carla

Dear Carla,

a porcelain veneer being placed on a tooth

 

The first dentist you mentioned, who is suggesting porcelain veneers is one of the top cosmetic dentists in the country. If you decide to go with him, he will provide you with a stunning smile. You didn’t give the name of the second dentist, but I am cautious about recommending him either way because he is suggesting dental crowns.

Tetracycline stains are some of the trickiest to deal with when it comes to a smile makeover. You have to get the teeth opaque enough to cover the stains, while still creating a natural looking translucency to the teeth. To compensate for the difficulty, some dentists will suggest dental crowns instead of porcelain veneers thinking the added thickness will make it easier for them. It doesn’t. I find porcelain veneers to be the superior treatment. As for your bruxism (teeth grinding), if you get a nightguard to wear while you sleep it will protect you from the grinding damage. So that will not be an issue.

If your budget is the main reason for going to the cheaper dentist, I am going to suggest a different approach. I know the quality you will get with the first dentist. Why don’t you have him just do your upper arch and use a strong teeth whitening, such as Kor Whitening to do on your lower teeth. It will take a bit to get the lower teeth to match, but if you are persistent they will. Then, you are only paying $21,000, which is below budget and will have a stunning smile.

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.

Dentist Wants to Crown My Tetracycline Stains

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

Miranda

Dear Miranda,

Woman covering her mouth

 

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

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

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

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

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

Dentist Says I Can’t Whiten My Teeth

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I have really ugly teeth and wanted to get them whitened. However, my dentist said my teeth are endogenous and because of that, I cannot get them whitened. Is that true? If so, is there anything I can do to make them look better? I am so embarrassed by my smile.

Kelly Anne

Dear Kelly Anne,

teeth whitening trays

There is always something you can do to make your teeth look better. I’m sorry your dentist was zero help to you. I am not crazy about it when dentists use clinical words with patients without explaining what it means. That doesn’t help you at all.

What he is trying to say is the stains on your teeth are endogenous, not your teeth themselves. Endogenous stains are simply stains that were acquired while your tooth was developing. There are two categories of this that dentists see most often.

The first is tetracycline stains. These are the result of taking the tetracycline medication during childhood while your teeth were still developing. Even professional teeth whitening does not make much headway with these type of stains. They are just too deep and dark.

The second is fluorosis stains. These are the result of consuming too much fluoride during your teeth’s development. While they are more superficial, teeth whitening is still not a good solution because the fluorosis stains usually result is splotched teeth. Because teeth whitening bleaches the teeth uniformly, the teeth will be whiter but still splotchy. That’s not an attractive look.

The Solution for Endogenous Teeth Stains

The best solution in both of these cases is to have porcelain veneers placed. These tiny wafers of porcelain that cover your teeth are the go-to procedure for celebrity smile makeovers. They can change anything you want about your smile, including the shape, size, and color.

The only real catch with these is it requires an advanced cosmetic dentist to give you beautiful results. Smile makeovers are not taught in dental school. It is up to the dentist how much training they invest in to do this type of work. Tetracycline stains, especially, are among the most difficult cases for a dentist to do. In your place, I would only go to an AACD accredited dentist.

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

Covering Tetracycline Stains

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My twin sister and I both have tetracycline stains. Several years ago, she had porcelain veneers placed on her teeth, but they looked a bit fake. The dentist said the only way to adequately cover the stains was to make them opaque. I am hoping the technology has improved some since then and I can get a beautiful, natural-looking smile.  I really do hate my smile.

Avery

Dear Avery,

A single porcelain veneer being placed

I am not sure if you will want to tell your sister this or not, but the technology has been around for a long time to make porcelain veneers look beautiful on tetracycline stains. While your sister chose the right procedure, it sounds like she likely picked the wrong dentist.

Cosmetic dentistry is not a recognized specialty. That means any general dentist can call themselves a cosmetic dentist. To make matters even more challenging for the patient, smile makeovers aren’t taught in dental school. It is up to the dentist to invest in the post-doctoral training necessary to do the work properly.

While choosing your cosmetic dentist carefully is important for any smile makeover, tetracycline stains are among the most difficult type of cosmetic cases there are. You can tell by your sister’s case that it is a challenge to get the porcelain veneers opaque enough to cover the stains, but still translucent enough to look natural.

If I were in your position, I would only go to a dentist who is accredited with the American Academy of Cosmetic Dentistry. AACD accredited dentists are the top cosmetic dentists in the country. They’ve passed stringent exams as well as an examination board that has examined a large number of cases the dentist completed for both technical skill and artistry.

You find an AACD accredited dentist, you’ll find a dentist that can give you a stunning smile.

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

Can You Get Porcelain Veneers if You Have an Overbite?

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

Elisabeth

Dear Elisabeth,

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

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

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

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

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

Your Smile Makeover Requires an Expert Cosmetic Dentist

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

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