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Baking soda and porcelain veneers

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I’ve recently gotten 6 porcelain veneers and I’m very excited about my new smile. My dentist recommended supersmile toothpaste, but I’ve been doing some reading that you shouldn’t use baking soda on porcelain veneers. Supersmile has baking soda in it. What should I do?

Vinny- Bayonne, New Jersey

Vinny,

Glad to hear you are taking such good care of your veneers, and that you love the results. You are perfectly safe using Supersmile toothpaste on your veneers. In fact, it is excellent in removing stains on cosmetic dentistry work, yet gentle enough not to damage it. While it is true you shouldn’t use straight baking soda on your porcelain veneers, because of its abrasive quality, you can use certain toothpastes that contain baking soda. I wouldn’t use a strong toothpaste, just because it contains baking soda. you don’t want anything abrasive. What your dentist recommended is perfect.

This blog is brought to you by Grosse Pointe Woods Cosmetic dentist Dr. Ted Hadgis.

What to do after a traumatic mouth injury

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A few weeks ago I had a bad fall and hit my mouth on a bike rack. I didn’t go to a dentist or anything at the time because I don’t have any insurance or any money, but now all my front teeth both on the top and on the bottom are turning black. There is a weird lump up near my nose, almost like a root snapped off and is sticking out or something. Is that even accurate? I don’t know much about teeth.

Should I go to a dentist or a doctor? Is it too late to do anything? I am worried that I am going to lose my teeth.

I don’t even have any idea what they would do for this kind of thing. I can’t afford anything expensive. What is the cheapest way they might fix this?

Randy in Berrien Springs

Dear Randy,

If a tooth turns black after trauma to the tooth, it is a sign that the nerve tissue inside the tooth is dead. In that case, the tooth will need root canal treatment.

In your case, it sounds like you will need several. Root canal treatments in and of themselves are not expensive compared to other dental procedures, and also not as harrowing as they have popularly been portrayed.

In many cases, teeth that have had root canal treatments have dental crowns placed over them. If money is an option, there is  a method of bleaching teeth from the inside that many dentists don’t know about. For this reason, you would be best served going to a cosmetic dentist as opposed to a general dentist to get this work done. His fees may be a little higher, but the procedures would be less expensive.

Root canals on front teeth are usually a few hundred dollars for each tooth. If dental crowns or porcelain veneers are necessary, add about two thousand dollars per tooth to the total cost. As you can see, if a method of bleaching your teeth is available, it would certainly be less expensive.

This blog posted courtesy of the office of Grosse Pointe Woods cosmetic dentist Dr. Hadgis.

Dental care for a person in recovery from addiction

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Four months ago I started treatment for an addiction to opiates. I am on methadone maintenance, and it seems to be working well. The issue is that I need dental work, and a lot of it. I went to my old family dentist last week, and he refused to give me any pain medication when I was honest with him about the methadone. I didn’t last ten minutes in that chair before I had to call a halt. I tried to persuade him, but he would not even call the clinic, even after I gave him the number. He said I need at least five root canal treatments, maybe more, and treatment for gum disease.

So I need to find a new dentist. I know I have to tell them about the methadone because of the way it might react with the pain meds, but I don’t know how in the world to find someone who will work with me. The dentist I just saw has known me for more than 20 years, and he would not help. I guess that makes me feel like no one will.

Do you have any suggestions for finding someone?

Thanks,

Edward in Tampa Bay

Dear Edward,

Congratulations to you on your efforts to recover from addiction.

The first step in finding a dentist who might work with you is to look for a dentist who is a sedation dentist (sometimes called “sleep dentists” by lay people, though that term is inaccurate).  Sedation dentists tend to be more compassionate to pain issues than dentists who have not pursued the extra training in pain management.  Be very up front, and ask if he or she can help you.

A second avenue of information might be the doctor you work with at the clinic. They are very likely to have the names and contact information of dentists and doctors that are compassionate and educated in issues faced by people who are in addiction recovery.

The very best of luck to you in your endeavors.

Detroit cosmetic dentist Dr. Hadgis’s office sponsored this blog post.

Problems with Lumineers

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Two weeks ago I had Lumineers put on six of my teeth, and I’ve had nothing but trouble since. Four years ago, I had dental bonding done on the front two teeth, to cover some staining. I told my dentist this before we placed the Lumineers, because I was worried that it would make the Lumineers stick out too much, but she said that it would not be a problem, and that because the Lumineers are “no prep”, the lab people would be sure to accommodate for the extra material on my front teeth. That is SO not the case!

My teeth look AWFUL. They look like fake teeth, and don’t even seem to go with my face. I am so embarrassed I won’t even go out in public right now. I went back in yesterday and got into a big argument with my dentist. She says they “function fine” and that I will “get used to the new look” but there is no way I am going to get used to this. What are my options? As it stands right now, I told her I will be taking her to court. Things got so bad I am pretty sure I will need to find a different dentist to fix this problem, as there is no way I am letting that woman mess up my teeth anymore.

Help. What do I do?

Adrienne in Cheyenne, WY

Dear Adrienne,

We are always really sorry to hear stories like yours. You have been the victim of a general dentist who tried to do a smile makeover without adequate training, skills or aesthetic sense. The first indication of trouble should have been when your dentist said that the lab people would know how to accommodate for the bonding. Your dentist is the one directing the process – the lab people only know to do what she tells them to do!

In terms of your options, you may not have many. It is significant that she said your Lumineers are “functional”. If they are indeed functional, then you don’t have any legal recourse to sue her. Cosmetic dentistry is not a legally recognized specialty, so it is evaluated by the same standards as general dentistry, which is focused on function, not form.

Without legal alternative, your only choice is to ask her to refund your money. Like so many service professionals, your dentist relies on good word of mouth to keep her business healthy. One angry customer can do enormous damage to a professional reputation. We hope you find a solution.

Posted courtesy of Grosse Pointe Woods cosmetic dentist Dr. Hadgis.

For more information about Lumineers and other porcelain veneers, see our website.

First porcelain veneers, now porcelain crowns—what is going on?

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I have four crowns on my upper teeth that are badly stained, and need to be replaced. The dentist I am working with also wants to place six porcelain veneers, three on either side of the porcelain crowns. He could tell I wasn’t totally sold on the idea, and really poured it on, telling me how fabulous it would look, and how it would totally change my appearance. I had my doubts, but decided to go forward. I should have listened to my instincts!

I had the procedure done on a Monday, and by Wednesday I was starting to experience some pain. When I went back in for the recheck on Thursday, my dentist told me (after working on my mouth for forty-five minutes) that I was having pain because of “bruxism”. I had to ask what that meant, and he said “teeth grinding”, and made it sound like everyone should know that term. He said because of the grinding I would have to have all the veneers removed and replaced with porcelain crowns. WHAT? One of the veneers fell off yesterday when I was eating a sandwich. Clearly, if a soft sandwich caused a veneer to fall off, I need to do something, I just don’t know what.

Should I get a second opinion? I just can’t believe that I paid all that money for veneers, and now I have to pay to have them removed AND pay to have them replaced. This is not right!

Victoria in Tulsa, OK

Dear Victoria,

You are correct – something is wrong here. Many dentists claim to know something about cosmetic dentistry, and they simply don’t. If there is truly a problem with your bite, then your dentist should have noticed this before he did any work at all. If you already have a veneer falling off, it is even more evident that your dentist doesn’t really know what he is doing when he places porcelain veneers.

The best advice we can offer is to seek the services of an experienced, educated cosmetic dentist. Make sure you are being cared for properly, and then decide what to do about pursuing restitution from your current dentist.

This blog post courtesy of Grosse Pointe Woods cosmetic dentist Dr. Hadgis.

What causes erosion along the gumline?

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My teeth where they meet my gums are quite eroded and abraded. My old dentist always said this was from brushing my teeth too roughly, but he retired and I had to find a new dentist, and she says is probably caused by bruxism. I am not really comfortable with this new dentist and did not want to admit that I don’t know what that is.

I’d like to do something about my teeth, but I have a lot of questions first. If I get porcelain veneers, will they look ugly along the gumline, or be more prone to decay?

Do porcelain veneers stain, and if so, typically how long does that take, assuming excellent oral hygeine?

Finally, do you have to change what you eat and drink to try and avoid staining the veneers?

Thanks for your help,

Lupe in Oregon

Dear Lupe,

Before we address your questions about porcelain veneers, we’ll talk about what caused the erosion and abrasions in the first place. Bruxism is biting stress, and the wear/erosion pattern you describe is typically found when someone clenches and/or grinds their teeth. The constant stress on the teeth causes them to flex right where the tooth meets the gum (the “neck” of the tooth), and you wind up with eroded notches there, just as you describe.

So first, you need to seek a cosmetic dentist who also has experience in TMJ treatment. This more than anything will maximize the lifespan of porcelain veneers, which do not respond to grinding or clenching any better than natural teeth do.

When your dentist has addressed any bite issues, he or she can discuss placing porcelain veneers with you. If they are done properly, they will completely cover the notches at your gumline. There is no need to restrict your diet, as the veneers are actually more stain resistant than your natural teeth. It is still best, though to avoid frequent snacking, as that eating pattern often leads to decay.

This blog posted courtesy of Grosse Pointe Woods cosmetic dentist Dr. Hadgis.

One tooth is getting dark – what are my options?

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Many years ago, I fell and chipped a tooth. The dentist did a small filling to repair it, but over the ensuing years, it has darkened quite a bit.

I’ve talked to my regular dentist about this but she does not really seem to have any solutions to offer me. She is reluctant to do a porcelain crown because the canal has calcified as a result of the tooth being dead. I suggested Lumineers as a solution, but she said she was sure I would be unhappy with those, because there have been “problems” with them.

In the meantime, it seems like my tooth is getting darker every time I look at it, and I am getting kind of embarassed to smile, which frankly stinks. Do you have any suggestions? I am really not sure at all where to turn next.

Dulcie in Sante Fe

Dear Dulcie,

It really sounds as if your dentist is not comfortable with cosmetic dentistry procedures. If there is one hard and fast rule about dentistry, it is to never push your dentist to perform a procedure he is not comfortable with. The results are almost never good. The good news is that your dentist seems to be sending you the message loud and clear that she is not comfortable with doing either a porcelain crown or porcelain veneer (Lumineers are a brand name of porcelain veneers), so this opens the door for you to seek help from a truly gifted, trained cosmetic dentist.

If you choose the right dentist, they will help you choose the right treatment. If the only problem you have with your smile is that one tooth, then it may be possible that a skilled bit of dental bonding will take care of the problem. If there are other issues, then porcelain crowns or porcelain veneers may be in order. In any case, the most important task you have in front of you is to locate a dentist who has the artistic skills and experience to offer you all of these options.

This blog maintained by the office of Grosse Pointe Woods cosmetic dentist Dr. Hadgis as a courtesy.

Treatment options for a crooked front tooth

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I hope you can help me. It seems like every dentist I see has a different opinion about how to fix my teeth, and it really makes it confusing to know what to choose.

I have one, seemingly minor issue with my teeth. The tooth right next to my right front tooth is crooked, and way out of alignment with the other teeth. Other than that one tooth, the rest of my teeth are pretty straight and line up OK. But that one tooth IS pretty noticeable, and as I am about to change careers, I decided to get it fixed so I look my best in interview situations.

I’ve talked to three different dentists, and received three different treatment options. One is a well established orthodontist. He recommended traditional wire and bracket braces. The next dental professional I saw was a general dentist, but she said she also does Invisalign, and had all kinds of glowing information about “invisible braces”. It all sounded almost too good to be true. The third dentist suggested a porcelain veneer or crown to create the appearance of a normal tooth in that space. That one I am least sure about, largely because the dentist himself did not seem to sure that he could work with the tooth in the position it is in.

What do I do? Should I keep seeking opinions until I at least get a consensus? This is very confusing.

Libba in New Bedford, CT

Dear Libba,

What you have discovered is that dental issues often have many possible solutions, and a dentist’s particular comfort level with various forms of treatment will influence his or her recommendations for treatment.

The established orthodontist suggested the treatment he is most familiar and comfortable with, and traditional braces would very likely yield a very satisfactory result. The dentist who does Invisalign probably told you that Invisalign works faster than traditional braces, and that is generally true.

The dentist we suggest you avoid is the one who seemed unsure of his treatment recommendations. If your dentist is uncomfortable with the treatment plan, you should be, too. It is true that porcelain veneers can create the appearance of straight teeth without orthodontic treatment, but if, as you state, the tooth is extremely out of alignment, that might not be a viable option for you.

You do not mention whether or not anyone has suggested pulling the tooth. Unless there are extreme circumstances, I would not let anyone pull the tooth. A less than reputable dentist might suggest a dental implant to replace the extracted tooth, but this would be a very long and expensive process, and few good dentists will suggest pulling a perfectly healthy tooth that is merely out of alignment.

If another opinion would not cause even more confusion, it may benefit you to seek out a skilled, experienced cosmetic dentist who is also certified to do Invisalign. A professional with experience and talent both in porcelain veneers placement and in the use of Invisalign will be able to give you a sound, educated opinion on the benefits and drawbacks of both types of treatments.

This blog produced courtesy of Grosse Pointe Woods cosmetic dentistDr. Hadgis.

Does an oral surgeon have to do this kind of extraction for me?

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I’ve had problems with one of my molars for quite some time. It has had a filling in it since I was a kid, and a few years ago the filling fell out, and the tooth broke. I finally got it treated when it was just too painful to stand. The dentist did a root canal treatment, but I’m not sure it worked. I never did go back to get a cap put on the tooth, and now the temporary tooth has fallen out and the tooth is infected again.

It sounds like I don’t care about my dental health, but I do. I am just really, really scared of going to the dentist. Every time I go it hurts like crazy, and the pain meds they give me never seem to work for me the way they do for everyone else. No matter how much Novocaine they give me, I can always feel what they are doing! I mention this because my dentist has told me that this tooth needs to come out, and I don’t think I am going to be able to handle it.

My question is, should I get an oral surgeon to do the extraction, because can’t they knock me all the way out? I don’t want to be awake at all while this tooth is being pulled.

Carson in Omaha

Dear Carson,

Dental anxiety so often results in situations like yours, and that is a real shame.

You need to locate a dentist who does sedation dentistry. This is a dentist who is trained and licensed to administer different levels of sedation. Depending on the level of your anxiety, a dentist can treat with nitrous oxide (also called laughing gas) or what is called conscious sedation. When a patient is under conscious sedation, they are not unconscious, but so deeply relaxed that most patients do not remember anything at all about their treatment. The key for you is to locate a sedation dentist so they can help you figure out what level of sedation will be necessary for you to get this work done.

You would do best to locate a dentist that can do both sedation dentistry and dental implants. When the extraction is complete, the best solution to replace the missing tooth is probably a dental implant.

This blog brought to you courtesy of Grosse Pointe Woods cosmetic dentistDr. Hadgis.

Can I get all this work done in just one appointment?

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I’ve been putting off going to the dentist for many years, and just recently got dental coverage as part of my new job. Wow, am I going to pay a price for not keeping up on my dental care! I need six root canals, at least. I have three cavities that need to be drilled and filled, one tooth that needs to be ground down because it is messing up my bite, and all of my teeth need to be whitened, badly.

One of the reasons I put all this off for so long is that I hate going to the dentist. Is there any way all of this could be done in one appointment? I’d like to just get it over with! What is the limit for the number of hours treatment can take?

Stephanie in Baltimore, MD

Dear Stephanie,

You’ll really have to talk to your dentist about how much of the work they feel they can accomplish in one visit. The limiting factor will really be your tolerance for being in the chair that long, especially if you are an anxious dental patient. Most people who do not have dental anxiety can endure about four hours of treatment. If you are anxious at all, and I strongly advise you to be honest and up-front about that with your dentist right from the beginning, then your ability to tolerate treatment will be much less.

Something to consider is going to a sedation dentist, or asking your current dentist if he does sedation dentistry. You may have heard it referred to as “sleep dentistry“, which is a bit of a misleading term used by lay people. With sedation dentistry, you are not technically asleep, though you are in such a relaxed state that most patients report no memory of the treatment at all. If you are an anxious patient, this might be one way for you to get all that work done in a minimal number of visits.

Beyond your tolerance, the amount of time/number of appointments the treatments will take also depends on the locations of the teeth that need root canal treatment. If they are in the front of your mouth, they can likely be done in one appointment. If they are molars, you may want to consider going to an endodontist, which is a dentist who specializes in root canal treatments. For molars, it is important for you to get the treatments done in as few visits as possible, and with so many to do, you’ll need the speed and expertise of a specialist to get them all accomplished in a reasonable amount of time.

Best of luck to you. We’re glad you’re regaining your dental health!