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Cavity on a Veneered Tooth

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I have a tooth that is covered with a porcelain veneer but now has a cavity on it. To treat the cavity, my dentist wants remove the porcelain veneer, treat the cavity, and then replace the veneer with a porcelain crown. I’m not too keen on this idea. Is this the standard operating procedure?

Jim

Dear Jim,

A single porcelain veneer being placed on a tooth

 

I wish I had more information about your situation. The first thing I would want to know is how large your cavity is. Truthfully, a cavity would have to be significantly large in order to make a dental crown necessary. Is this the dentist that did your porcelain veneers or a different dentist? It could be that this dentist doesn’t feel comfortable with porcelain veneers and is leaning on his knowledge of crowns.

It is extraordinarily hard to match a single crown to a porcelain veneer. Very few cosmetic dentists can do it well. Because of that, I am going to recommend you get a second opinion on this tooth. It would be best to get your second opinion from someone who does a LOT of cosmetic dental work. Don’t tell him or her what your dentist suggested. You want an unbiased opinion.

If it turns out you do need a dental crown, make sure whoever does the procedure tries in your crown with a temporary try-in paste and allows you to look at it in a variety of lighting. If it doesn’t match perfectly, they need to be willing to send it back until they get it right. If they do not agree to that, find a different dentist to do the procedure.

This blog is brought to you by Grosse Pointe Woods Cosmetic Dentist Dr. Patel.

 

Will We Actually Get Our Lumineers?

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My husband and I went to a local cosmetic dentist who was advertising smile makeovers using Lumineers. We were both excited about having a young and cleaner looking smile after years of teeth that show our age exactly. When we left, she told us that the Lumineers would arrive in two weeks. Well, two weeks came and we received a phone call saying that the lab called and we will need to re-do the impressions made.  We’ve already paid for everything up front and now I am a little worried we won’t actually ever see the Lumineers. Is this a common thing?

Keilly

Dear Kelly,

Lumineers Advertisement

While I do believe that you will receive the Lumineers you and your husband ordered, I am a little concerned that you are not going to like the results.  It does occasionally happen that an impression doesn’t go as it should have. That is not a big deal. You re-do the impressions and then your case gets completed. My concern is that your dentist doesn’t really know what she is doing. What makes me think that is the length of time we are dealing with here.

Knowing what goes on behind the scenes, here is my speculation, and bear in mind is speculation. Your dentist took the impressions, then sent them off to the lab. The lab then calls your dentist and says, “These impressions need to be re-done.” You guys are new patients so she is a little embarrassed about this and afraid you will lose confidence in her. So, instead of re-doing the impressions, she tells the lab to try and use them anyway. The fact that she had to call you back a couple of weeks later tells me the impressions were so bad that they were unusable to the lab. Now she had no choice but to call you.

Here is the thing. Lumineers are just one brand of porcelain veneers. They just happen to be a brand that is highly  marketed to inexperienced cosmetic dentists as being easy to place. Unfortunately, that is rarely the case.

Doing smile makeovers is not taught in dental school. That means for a dentist to develop the technical skill and artistry necessary to produce beautiful results, they have to invest a lot of time and money into post-doctoral training. It doesn’t sound to me as if she has the training necessary.

Here is my recommendation to you. Before you allow her to bond the Lumineers on, insist that she place them first with a temporary try-in paste. If she doesn’t have that on hand, which she may not if she doesn’t do many of these cases, then any water-soluble gel should work. Then, look at them carefully in a variety of lightings to ensure that you are pleased with the result and would be proud to show them off for a lifetime. If you are, great! Allow her to permanently bond them on. If you are not absolutely thrilled, ask for her to either send them back to the lab changing the things you are unhappy with or to refund your money. Do NOT allow her to bond them on until you are satisfied.

Doing this will protect you from becoming a statistic in the growing number of cosmetic dentistry horror stories. If you do end up having to get a refund, once you have secured your money, go to an AACD accredited dentist to have your smile makeover done. These are the top cosmetic dentists in the world.

This blog is brought to you by Grosse Pointe Cosmetic Dentist Dr. Theodore Hadgis.

Dental Bonding Problems

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I had some dental bonding done a couple of weeks ago. The intent was to have the some chips and wear on the teeth replaced. My dentist is the one who suggested it. I agreed because I have always wanted to have a pretty smile. The dental bonding made the teeth look way more bulky than they were. It almost look like I had halves of white chicklet gum stuck on them. They were obviously fake. They even made it hard for me to talk.  I asked my dentist to take them off. She did, but now the teeth are bumpy and the colors are uneven. When I mentioned that, she told me that my teeth were like that before I just did not recognize them because the bonding made them look even. I know what my teeth looked like. Even though they were ugly, they were THAT ugly. What do you recommend I do?

Elle

Dear Elle,

My guess is you have a family dentist who was trying to learn a new skill. Unfortunately, she did it at your expense. Dental bonding should not ever add to the bulk of the tooth. As you can tell, it can interfere with speech patterns. It can also put the tooth at greater risk for decay because food and other bacteria can get trapped in the nooks created when there is too much structure. All dental bonding should do is replace the lost structure so it looks perfectly natural. Directly below, I have an image of a chipped tooth repaired with dental bonding. There is no difference in the two front teeth. their color and shape are similar. Not carbon copies, which would also look fake. We want similar.

before and after dental bonding

Another mistake she made is the bonding removal. Maybe she told you this would be reversible if you didn’t like it as a selling point. However, as she is sanding or grinding off the composite bonding, how does she know where that ends and your natural tooth enamel begins? It is nearly impossible. I don’t know if she will be willing to give you a refund so you can get this done correctly, but if you have a clear image of what your teeth looked like before her work, that might give you some leverage.

You will want to see an expert cosmetic dentist to get this fixed. While you can go with dental bonding again if you want, my suggestion would be to get porcelain veneers instead. Bonding is good for small repairs. It sounds like your dentist did the entire tooth. If that is the case, porcelain veneers are more durable and will last you a few decades as opposed to the three to five years you’d get out of bonding.  Look for an AACD accredited dentist. They are the top cosmetic dentists in the country.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

Swindled with Lumineers

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I am in a mess and my poor daughter is the one paying for it. Our family has horribly positioned teeth. I grew up being unmercifully teased and did not want her to face the same experiences. We had her teeth worked on with braces, but there were still gaps. I looked up a cosmetic dentist and he said that it would be better if we did Lumineers. I wanted her to feel confident about her smile for the first time in her life so I agreed. We told him we’d like them more tapered than we saw in his picture and he said to leave that to him, he would make sure we loved them. He also told us we’d get to see them on her in different lighting before they were bonded on permanently. None of that happened. They held her mouth back with some big band and it was hard to see anything. I suspected they were too big based on what I could see and he said that was because they needed to be bonded on first to look the way they really would. I thought he’d know his field so agreed, but once they were bonded on they were just as big and bulky. They also looked square and not at all tapered the way we asked. He told us to give it a week and he was sure we’d love them. We tried, but when she went to school the students were so cruel. They told her she looked like she had horse teeth. Then, some of the boys started neighing every time she had to walk their direction.  To make matters worse, she’s having trouble pronouncing some letters now that have never been a problem in the past. My guess is it has to do with the size of them. I called the dentist and he said he’d thinks they’re gorgeous. What do I do?

Madeline

Dear Madeline,

Lumineers advertisement

First, I am going to say I am sorry for what is happening to your daughter. Kids, even older ones, can be so cruel. I was cringing as I read the account you have been through. As soon as I read the problem and then saw Lumineers mentioned as the solution, I knew we’d be having another cosmetic dentistry horror story. One thing you said was very telling. I looked up a cosmetic dentist. Most patients have no idea that cosmetic dentistry is not a recognized specialty. Any general dentist can do cosmetic dentistry. To make matters worse, it is up to them how much training they invest in to learn how to do things such as smile makeovers.

Generally, when there are small gaps between teeth, the solution is dental bonding. It is less expensive, however, it requires more expertise to pull it off and my guess is your “cosmetic” dentist does not know how to do it, nor does he have the materials necessary. Then factor in Lumineers. These are advertised to inexperienced cosmetic dentists as being easy to place. They’re not. Nor does bonding have anything to do with the ability to make them look beautiful.

Under normal circumstances, you would not be able to get a refund if the only issue is you do not like their appearance. However, your dentist broke some rules which will work in your favor. First, he told you that you would get to see them in several lights before making a decision and did not follow through. Then, when you expressed concern with how they looked, he pressured you into bonding them on telling you they would look different. Either he knew that was not true and lied or he’s incompetent and didn’t know that is not true. Neither one looks good for him.  A second thing that works in your favor is the fact that it has affected her speech. Together these things can help you get a refund.

Here is what I recommend. First, don’t let him do any work on them if he suddenly develops a conscience and wants to make this right by trying again. Second, go see a true cosmetic dentist. One that has invested in the training necessary to do this right. I would look for an AACD accredited dentist. These are the best cosmetic dentists in the country. Have them look at your case. If they can document that the Lumineers caused the speech issues, it will be a real ace in your pocket. Then, go to your dentist and ask for a full refund armed with what the other dentist told you.

Once you have that refund, I would go back to the qualified dentist and have him re-do your daughter’s smile makeover. Don’t be surprised if he recommends a different brand of porcelain veneers for her. In fact, I would take that as a good sign.

This blog is brought to you by Grosse Pointe Woods Cosmetic Dentist Dr. Theodore Hadgis.

Over Shiny Fake Porcelain Veneers

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I recently had porcelain veneers done. I wanted them white. At first my dentist argued with me saying it would not look natural but I knew what I wanted and suggested. When they were put on, I realized they do look fake. They are overly shiny and bright. They almost look like pieces of chicklet gum. When I talked to my dentist about changing them, he said he told me this would happen and I’d have to pay again. I’m willing to, but I’m also confused because I have seen pictures of porcelain veneers that are really white that look perfectly natural. Why are mine so fake?

Penny

Dear Penny,

beautifully veneers teeth

I’ve got some good news for you, but I am going to tell you the bad news first. While it is your dentist’s fault that they do not look natural, it will be nearly impossible for you to get a refund. You can ask, but he said they wouldn’t look natural. You may luck out and get one, so it is always worth a try.

Let’s go over what went wrong. Look at the image above. Notice they have ridges as well as varying levels of opacity and translucency. It takes an expert cosmetic dentist to do this well. My guess is your porcelain veneers look flat. That adds to their over shiny nature. It’s also why they look fake. Believe it or not, one of the teeth in the images is fake. You can’t tell this because of the skill of the dentist who did the work.

Now for that good news that you are likely desperate for at this point. You can get the beautiful smile you want. You won’t be able to get it done with this dentist, though. Cosmetic dentistry is not a recognized specialty. It is up to the dentist whether and how much training they get. There are dentists who invest in a significant amount of training. The easiest way to find one of them is to get an AACD accredited dentist. These dentists are the top cosmetic dentists in the country.

This blog is brought to you by Grosse Pointe Woods Cosmetic Dentist Dr. Theodore Hadgis.

Gums Inflammed After Getting Porcelain Veneers

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I need some advice. I had four porcelain veneers placed not too long ago. Since having them bonded, my gums have been very inflamed. I’ve gone back to get some help from my dentist but they just accused me of babying my teeth and not brushing adequately. I have to admit, I found that insulting. I take care of my teeth and have never had problems with my gums my entire life. Why would I stop taking care of them after investing in improving their appearance? At my last follow-up appointment, the dentist did remove some excess cement that was caught there. My dentist said that is standard. I was hoping that was the cause of my inflammation. While it did help, it didn’t solve the issue. What do I go from here?

Madilyn

Dear Madilyn,

A single porcelain veneer being placed on a tooth

 

I do not blame you for feeling insulted by your dentist’s response to your concerns. Most cosmetic dentists find that patients take better care of their teeth after a smile makeover. They are proud of their new smile and want to keep it in top-notch shape. Like you, I doubt that you are the problem.

Possible Causes of Gum Inflammation

An example of inflammed gums from porcelain veneers.

Above is a picture of two lateral incisors with porcelain veneers that have inflammed gums. If this dentist were trying to become accredited from the American Academy of Cosmetic Dentistry, this case would have kept him from acheiving that goal.  A healthy result for the patient is a minimal expectation.

One of the leading causes of gum irritation and inflammation is not cleaning off all the excess cement. It is informative to me that you still had excess bonding cement at a follow-up appointment. Dentists who do a lot of porcelain veneers have a system to keep this from happening. They will tack on the veneer by curing the cement in the middle. Then they will clean off the excess cement while it is still soft.  Even though the dentist removed some excess cement at your follow up does not mean he was thorough and got all of it.

A second possible cause of inflammed gums is some unevenness where the veneers meet the teeth. This can cause bacteria to get trapped between the veneers and the gums leading to both inflammation and decay.

I am going to suggest you see an expert cosmetic dentist and have them look at your veneers and gums to make an evaluation as to what is going on. If it is necessary that they be replaced, he can help you secure a refund. Then, I suggest you go to that expert to have them redone properly.

So, how will you go about finding an expert cosmetic dentist? My suggestion is you go to aacd.com and use their “Find a Cosmetic Dentist” link. Make sure you put a checkmark indicating you are looking for an AACD accredited dentist. These are the best cosmetic dentists in the country.

This blog is brought to you by Grosse Pointe Woods Cosmetic Dentist Dr. Theodore Hadgis.

 

 

Dentist Wants to Do a Full-Mouth Reconstruction to Whiten Her Teeth

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I have two dental veneers and one dental crown. They’re all showing their age and my teeth are not very white, so my dentist suggested we do crowns on all the upper and lower teeth in order to get the whole smile to look the same instead of piecemeal. Is it okay to just do crowns on the teeth that need them or does everything have to be done in order for them all to look white and match?

Amanda

Dear Amanda,

woman with a beautiful smile

It takes a skilled cosmetic dentist to create a beautiful smile.

Please don’t let this dentist anywhere near your mouth. Crowning all your upper and lower teeth is called a full-mouth reconstruction. It is one of the most advanced cases any dentist can do. When not done properly, it can destroy your bite and lead to a lifetime of pain.

This type of procedure is usually done as a last resort for people who have worn down their teeth to nubs or have serious TMJ problems. Even if this was you, I would not suggest this dentist as the one to do it. You would need a dentist who has extensive post-doctoral training in restorative dentistry. I have serious doubts that he has this.

Also, if I understand you correctly, his justification for this is that your teeth need to be whiter and match? This can be done without taking such drastic measures that both grind down your healthy tooth structure and put you at great risk to the health and function of your bite.

How to Get the Smile You Want

I am going to tell you upfront that you are going to need to see a different dentist in order to get a beautiful natural-looking smile. If your dentist needs to cover all your teeth in order to make them match, then he is not a skilled cosmetic dentist. You will be much better served elsewhere.

My suggestion is you find a dentist who is AACD accredited. These are the best cosmetic dentists in the country with proven skill and artistry. Any one of them can give you a stunning smile. I can tell you what they will likely recommend.

First, you will want to whiten your teeth. This will improve the youthful look and color of the teeth that do not need work. Then, the two teeth that have the veneers can be replaced with porcelain veneers. There is no reason to crown those teeth and reduce their structure. The tooth that already has a dental crown will have to be replaced with a crown.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

A Disaster from an “Expert” with Lumineers

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I am in tears and have been hiding in my house because my smile looks so ridiculous at this point. I had 8 Lumineers placed on my teeth at quite an expense. These were supposed to last many years, yet in just four months two have fallen off and one is cracked. Plus, my gums are inflamed and hurt like mad. I don’t know how this happened. She assured me she was a certified expert in these. Is there any recourse here?

Meg

Dear Meg,

A single porcelain veneer being placed on a tooth

I’m glad you wrote. First, you should know being certified to place Lumineers by no means makes her an expert in either cosmetic dentistry or Lumineers. All the Lumineers certification means is that she completed a seminar. It does nothing to test her technical skill or her artistry. She obviously had neither.

In order to get a smile you are proud of, you are going to need to have another dentist do this case over.  This time an expert cosmetic dentist. While there is not a recognized specialty in cosmetic dentistry, there is a way to find someone with real expertise. My suggestion is to look for a dentist who is accredited with the American Academy of Cosmetic Dentistry. AACD accredited dentists have to pass stringent oral and written exams, in addition to demonstrating their artistry on a large number of cases to an examination board. Those who pass accreditation are among the top 1% of cosmetic dentists in the country.

Don’t be surprised if the new dentist suggests a different brand of porcelain veneers. This Lumineers brand is highly marketed to inexperienced cosmetic dentists. However, most expert dentists do not like to use that brand. This is because the manufacturers insist dentists use their lab, which is not known for their artistic work.

You should be able to get a refund on this work you have already have done. They’ve fallen off. They’ve cracked. They are even having a negative impact on your gums, which can lead to permanent damage. If the dentist is unwilling, you may have to get tough. Start by having the new dentist contact her. Sometimes dentists care more about what their peers think than patients. That may be enough pressure. If that doesn’t work, tell her you’ll go to the dental board. Her work doesn’t meet the minimum standard of care. She will not want the board involved.

This blog is brought to you by Grosse Pointe Cosmetic Dentist Dr. Theodore Hadgis.

Finding a Cosmetic Dentist on Yelp!

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I’ve been in the market to get a smile makeover. I understand that porcelain veneers are more preferred than Lumineers. What I am trying to figure out is which dentist to do it. I’ve narrowed it down to three different dentists that have the highest ratings on Yelp! for cosmetic dentistry. Are there any tips for picking between the three of them?

Margaret

Dear Margaret,

woman smiling with a dentist behind her

 

We’ll get to choosing your cosmetic dentist in just a moment. There was something else you mentioned that I want to clear up a bit because it is a common confusion. Lumineers aren’t a different procedure than porcelain veneers. They are simply a brand of porcelain veneers. One that is highly marketed.

You were probably under the impression they were different because most highly skilled cosmetic dentists aren’t crazy about the Lumineers brand. They prefer other brands. This has more to do with their lab than anything else. Most cosmetic dentists prefer to choose their own lab and ceramists. The DenMat company, which owns the Lumineers brand insists dentists use their labs. This particular lab is not known for its artistic results.

Choosing the Best Cosmetic Dentist

When it comes to choosing the best cosmetic dentist, Yelp! isn’t your best option. It is a great service for many things, but this isn’t one of them. That has to do with their algorithm. They factor in patient’s reviews, but don’t seem to distinguish between what type of procedures are done with those reviews.

As an example, I did an experiment. I searched for a cosmetic dentist in a large city. Of the top five they listed, only one has the qualifications to do skilled cosmetic work. Three of them don’t even do cosmetic work. The final dentist does some, but the before and after photos he shows in his smile gallery are strictly stock photos. This tells me he doesn’t have any quality work of his own to show.

If you truly want a proven artistic cosmetic dentist, the easiest way to get that is to go to the website for the American Academy of Cosmetic Dentistry (aacd.com). They have an accreditation program which is designed to help patients in this very situation. In order to reach accreditation, dentists have to pass stringent exams as well as provide visual evidence of their artistry. These dentists are the best cosmetic dentists in the country.

This blog is brought to you by Grosse Pointe Woods Cosmetic Dentist Dr. Theodore Hadgis.

Placing New Lumineers over Old Ones

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I had Lumineers done about eight years ago. They’ve always been a bit dingy so I want to re-do them. I did want a whiter smile at the time of their original placement but my dentist said the technology didn’t accommodate that at the time. I think it does now because I see other people with Lumineers that have very white smiles. I don’t think they can be whitened with teeth whitening, so I am wondering if I can put new Lumineers with the more advanced colors over my old ones. Is that a possibility?

Margie

Dear Margie,

A porcelain veneers being placed on a tooth

First, I want to address the technology. When you originally had your Lumineers placed, your dentist would have been able to make them as white as you wanted. My guess is he isn’t an experienced cosmetic dentist so he didn’t quite understand the color theory necessary to create the smile you wanted.

This doesn’t surprise me. Lumineers are just one brand of porcelain veneers. However, this brand has been highly marketed to inexperienced cosmetic dentists as being easy to place.

As to whether you can place new Lumineers over old, yes, you can. However, I am going to recommend against it. In reality, it takes just as much effort on the part of the dentist to just re-do the case completely than it would for him or her to place new ones over old ones. Because of that, it makes more sense to just do them over for a couple of reasons.

The Risk isn’t Worth It

The first issue is the bonding process. It is much easier to bond to natural tooth structure than it is to bond porcelain to porcelain. This means you have a greater risk of the bond failing on the porcelain than you would if you removed the original veneers and bonded the new ones directly to your teeth.

Then, you want to think about the bond on the original Lumineers. What if that bond fails for some reason. All you have accomplished is to double your chances of failure.

Get this Done Right

Your original dentist was out of his depth, so if you are going to invest in a second smile makeover, you’ll want to do it with a dentist who knows exactly what he’s doing. I would look for an expert cosmetic dentist. Those who are at the top of this field are AACD accredited. They can give you a stunning smile.

This blog is brought to you by Grosse Pointe Woods Cosmetic Dentist Dr. Theodore Hadgis.