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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.

Root Canal on a Canine Tooth

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I have a canine tooth that recently had a root canal treatment. The appointment was awful and reinforced all the reasons I avoid the dentist to begin with. A friend told me I am going to need to go back and get a dental crown put on it or the tooth will fracture. I don’t think I can go back. Is this completely necessary?

Pamela

Dear Pamela,

woman smiling with a dentist behind her

I’m going to address the fear you are experiencing first and then we’ll go into the canine tooth with a root canal treatment. You are not alone in feeling uncomfortable at the dentist. Many people struggle with dental anxiety. So I understand your desire to stay away. However, doing so will make things harder for you. May I suggest something that could change your life and allow you to sit in the dental chair without anxiety?

I am going to suggest you see a dentist who offers sedation options. The option I’d like you to try is oral conscious sedation. it is administered with a simple pill. It is so strong that, if you want to, you can even sleep through your appointment. The only inconvenience is the sedation is so strong you will need someone to drive you to and from your appointment.  On the flip side of that, you can get much more work done in one sitting which will allow you to catch up on needed dental work much sooner.

Root Canals on Canine Teeth

If a back tooth has a root canal treatment, a dental crown is necessary to protect it from fracture because of the biting stress. Front teeth, however, have completely different biting stresses. Because of that, a dental crown will actually weaken the tooth. It can even cause it to break off at the gumline.

The only reason for a crown on a front tooth would be if a significant amount of the tooth was gone because of decay. In that case, a crown would be a necessity even if not ideal.

Another reason some people will put a crown on a front tooth that doesn’t need one is for aesthetic reasons. A tooth with a root canal will turn dark. However, you can avoid a crown if your dentist follows the following procedure.

First, they’ll need to clean out the inside of the entire crown of the tooth. They shouldn’t leave any root canal filling materials or cement. Believe it or not, that material is a large part of the darkening. Then, your dentist will need to place a white fiberglass post deep into the root of the tooth. This will help strengthen the tooth and add resistance against biting stresses. Finally, fill the remainder of the space with a white composite material.

This method prevents darkening for several years. When it does begin turning dark, I’d recommend a porcelain veneer done by a skilled cosmetic dentist.

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

Dentist Can’t Get Me Numb

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I am terrified of going back to the dentist but know I need to.  I had my first tooth infection. I went in to get the root canal treatment and was a bit nervous already. Then the dentist just couldn’t get me numb. He tried six times. By then, I was a mess of tears. He wrote me a prescription pain killer as well as an antibiotic and told me we’d try again in a week.  It’s almost time again and I’m not sure I can go through with this.  Have you seen this happen before? Is there anything that can help?

Marci

Dear Marci,

Woman asleep in dental chair from dental sedation

I am pretty sure I know what happened here. It is something not many dentists have been educated about so I am not surprised that your dentist wasn’t sure what to do, even though there has been at least one journal article on the topic.  It is interesting to me that you said you were a bit nervous to start.  When you have dental anxiety, it has the unfortunate effect of burning off your numbing medication. It’s a vicious circle because you end up in more afraid after that experience, which in turn makes it harder for you to get numb. Fortunately, there is a way to stop the cycle.

The Solution to Dental Anxiety

Depending on what your dentist has available, you may have to switch dentists for your root canal treatment. You need a dentist who offers dental sedation options. In your case, I am going to recommend oral conscious sedation. This will allow you to sleep through your appointment completely pain-free.  You won’t have to sleep if you do not want to, but you will have no anxiety and will feel no pain. It is quite strong so you will need someone to drive you to and from your appointment.

I am sorry you had this experience.  Using this additional tool will change this to a positive experience for you.

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

 

Scared to Get My Tooth Pulled

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I had a fall which broke my tooth a bit. It feels fine but looks funny with that chip. My sister told me I could get that repaired. Yet, when I went to see the dentist he wants to pull the tooth and give me a partial denture. I’m opposed to this for a few reasons. First, it’s a front tooth. Second, I’m too young for dentures. Third, and this is just being honest, the idea of getting a tooth pulled terrifies me. I’ve never been comfortable in the dental chair though I try to force myself to go at least once every couple of years. Is this my only option? Money isn’t an issue.

Craig

Dear Craig,

before and after dental bonding

I want you to bear in mind that I haven’t examined your tooth, but am inclined to think you need to see a different dentist. From what I’m getting, your tooth is chipped and that is all, right? If that is the case, the solution would be a dental bonding procedure (pictured above). This is a fairly difficult (for the dentist) cosmetic procedure. It may just boil down to your dentist doesn’t know how to do it. However, there is always the alternative of getting a porcelain crown.

Even if there were some more serious underlying issue, such as the tooth suffering enough trauma for the pulp to die, in that case you’d do a root canal treatment with a dental crown. I don’t understand this rush to extract the tooth. However, let’s say for the sake of argument that there is no way for the tooth to be saved. Why then do a removable partial denture when there are much better options available? Did he mention a dental implant or even a dental bridge? The fact that he is suggesting a cheap denture is a sign to me you are not getting top-quality care. You said money wasn’t an issue, so it is not a matter of him knowing you need the cheapest solution.

What I’d like you to do is get a second opinion from one of the dentists listed on the mynewsmile.com website. They can not only handle all your cosmetic dentistry needs, but additionally, they have the cosmetic skills necessary to give you a gorgeous repair that will blend right in with your tooth.

If the Tooth Needs to Be Extracted

Let’s say the worst-case scenario is true and the tooth needs to be extracted. Don’t be embarrassed for being uncomfortable with that. Many patients aren’t exactly counting down the days with joyous anticipation for their next dental appointment. One thing I suggest to patients in situations such as yous is to have the tooth extracted with a dentist who offers oral conscious sedation. This is sometimes dubbed sleep dentistry because you will be so relaxed you can just sleep through the procedure you want. The only downside is you will need someone to drive you to and from your appointment as well as stay with you until you are lucid and steady on your feet again.

Then, when it is time to get your permanent tooth replacement. I highly recommend you get a dental implant. This is the closest thing to a healthy, natural tooth. It’s also surgically implanted into your jawbone so you will not have to worry about anything removable.

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

My Tooth is Killing Me

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I’ve had a toothache since the quarantine started. Now it is almost unbearable. I’ve heard you can go to the dentist in situations like this, even during the quarantine, but I will be honest and tell you I am absolutely TERRIFIED of dentists. I feel like I’m going to have to go, but is there any way to do this at a hospital where they can knock me out for any procedures?

Todd G.

Dear Todd,

Man grabbing the side of his jaw in obvious pain and in need of a dentist

You are correct that in cases like yours, where you need urgent care, you are able to see a dentist. A hospital isn’t a good solution for you, though. They will not treat dental issues. At best, they’ll give you a $100 ibuprofen and tell you to see a dentist. However, I do have some good news for you.

First, you should know that you aren’t alone in your struggle with the dental chair. Many patients have a phobia of the dentist. Often, this springs from a traumatic experience as a child. Second, and this is the best bit, there are dentists who understand this, are compassionate, and have a solution.

I’m guessing, based on your question, that you don’t have a regular family dentist. I’d like you to do an internet search using the term sedation dentist. ‘for patients with high dental anxiety, such as yourself, I usually recommend looking for a dentist who offers oral conscious sedation. This is administered by swallowing a pill and will absolutely, completely relax you.

In fact, it is so strong you will need someone to drive you to and from your appointment as well as stay with you for a few hours after the appointment until you are lucid. Most people sleep through their appointments. It will give you a stress-free/pain-free appointment.

I say that now because I want you to understand that a tooth infection is serious and that you can get this treated in a way that you won’t have anxiety. When left untreated, they can spread to your heart, lungs, or even your brain. Those turn life-threatening quickly. It sounds crazy, especially given how treatable they are, but people still die from tooth infections in the 21st century.

Treating a Tooth Infection

Unlike other infections, an antibiotic alone won’t “heal” the infection. This is because the pulp in the tooth dies and the medication can no longer reach the root of the infection. A dentist will have to get in there and physically remove the infected tissue. This is typically done through a root canal treatment. If a tooth isn’t saveable, then you will need to have the tooth extracted. This is another good reason to get this dealt with sooner rather than later.

If you lose the tooth, you will want to replace it. Otherwise, aside from the aesthetic issues on your smile, the other teeth will shift or tip into the empty space. This will throw off your bite and could possibly lead to painful TMJ issues. The best tooth replacement is a dental implant. This will be like having a healthy, natural tooth again.

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

Full-Mouth Reconstruction Problems

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I am having some problems with the procedure my dentist is doing. My teeth are down to tiny nubs. I’ve also had lots of pain in my jaw because of some trauma and it pops whenever I open it. My dentist said he’d need to open up my bite, which would require placing dental crowns on every tooth. At first, it went well. The temporaries fit fine and everything looks good. But, now that both the upper and lowers are placed, I am in tremendous pain. The right uppers don’t meet, but the left uppers meet too quickly and hurt like crazy. They’re permanently bonded on. Is there a way for him to shave down the ones that are hitting too soon?

Carrie

Dear Carrie,

Woman holding her jaw with TMJ pain

What your dentist is trying to do is called a full-mouth reconstruction. This is a very advanced procedure and takes a significant amount of training AFTER dental school to understand all the mechanics behind it. Three very good post-doctoral training centers for this are:

  • The Pankey Institute
  • The Dawson Academy
  • The Las Vegas Institute for Advanced Dental Studies

However, even with advanced training, this type of procedure has to be done carefully and methodically. It’s important to work from provisionals only until the case is successful at that point. By successful, I mean every occludes properly, your bite is so comfortable you don’t notice it, and you speak without any issues. Only when all that is accomplished are the permanent crowns even to be made.

From there, your dentist would seat the dental crowns, along with any bridgework, temporarily making sure they are completely comfortable and any bite adjustments necessary are made. Only after that would he permanently bond them on. It doesn’t sound like your dentist did this.

In cases such as yours, where there are already have symptoms of underlying TMJ Disorder issues, such as popping in your jaw, it’s even more important. You don’t want the procedure to throw off your bite even further, thereby exacerbating your TMJ problems.

While technically he could do some grinding on the crowns to get them to meet your teeth at the same time as the opposite side, based on what you said there would be too much grinding necessary for this to be a realistic functioning solution. At this point, my recommendation is you get a second opinion from a dentist who attended one of the schools I mentioned above. They can give you some guidance from there.

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

Novocain Doesn’t Work for Me

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I don’t know what to do. I have some kind of resistance to Novocain. Even after several shots I can feel everything. This has caused quite a few problems as you can imagine. I have a lot of work to catch up on and now I am wondering if the only way to get it handled is with hospitalization under anesthesia. I’ll do that if I have to but the expense will be astronomical. My dentist can’t figure it out. I’m just throwing a Hail Mary here and hoping you’ve encountered it and can give me another option.

Peter

Dear Peter,

Man grabbing the side of his jaw in obvious pain and in need of a dentist

Well, I have good news and great news for you. Yes, I have encountered this. I even have a solution for you. I’m not surprised your dentist didn’t know the solution. Though the cause is starting to become more well-known, there isn’t a ton of literature on it.

Much of the time it is caused by some form of dental anxiety. You may not even have been aware of it the first time. Then, when the medicine didn’t work, it would naturally grow higher. Even the bravest people can have some anxiety in the dental chair. Often that results from a difficult experience with the dentist as a child.

Physiologically, we’ve learned that when a patient is anxious, the metabolism kicks up. This burns off the Novocain the dentist is using to numb you. Hence, the pain during your appointments.

The Solution When You Can’t Get Numb

I want you to find a dentist who offers sedation options. For someone in your situation, I usually recommend oral conscious sedation. This is administered by a pill and completely relaxes you. It is so strong, you will need someone to drive you to and from your appointment as well as stay with you for a few hours when it is completed until you are lucid again.

This is different from anesthesia in a couple of ways. First, it costs significantly less. Second, you aren’t “out”. While most patients are so relaxed they sleep through the procedure, that is up to you. You are able to communicate if you want to. It’s up to you.

There is a side benefit to this type of sedation. It allows your dentist to get more work done in each sitting, enabling you to catch up with your dental work much faster.

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

Porcelain Veneer Problem

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I had a chipped tooth which had been repaired with dental bonding. The bonding was getting old and needed to be replaced, however, the dentist said because the chip was 1/5 of the tooth I needed to have a crown. I didn’t want to do that because the tooth itself was healthy. I suggested she do a porcelain veneer instead, which she agreed to. When they tried on the veneer, I saw it in a mirror and it looked fine. I expected it to be whiter than the other teeth because we planned on doing teeth whitening after I was done with the repair. I gave the okay and they bonded it on. I didn’t see it after that but they told me it was beautiful. When I got home. I noticed right away it was too long so it wasn’t matching up properly with the adjacent tooth. Plus, it doesn’t seem to be up against the tooth like it is supposed to be. It seems to stick out further and there is some space between the veneer and the tooth. I called them and they said that it was bonded fine and the tooth probably moved and there wasn’t anything they could do. Am I being overly picky? It just looks funny to me.

Amanda

Dear Amanda,

before and after dental bonding

There are a few things your dentist got wrong here. I’m going to say right off I don’t think this is the best dentist to do your cosmetic work (of any kind). First, the teeth whitening. That should have been done before you had the veneer made. Then, you would wait two weeks for the color to settle down. You want your front teeth to be an EXACT match, which you can get if you do the whitening and then the veneers, but not if you do the porcelain veneers and then the whitening.

Next, the repair for the chipped tooth. The right repair for that would be to have dental bonding done. I know she said that your chip was too big. However, if that was the case, why would you be able to have bonding done to begin with and not this time? When she suggested the dental crown, it tells me she didn’t know how to do dental bonding and was using that as an excuse. A crown is a massive overtreatment for a chip. You recognized that yourself, which is why you suggested a veneer instead.

Now, the porcelain veneer itself. They let you see it before they bonded it on. That’s good and as it should be. However, it looks like when they bonded it on, things went screwy. It’s likely she didn’t notice it until after she cured it and was too embarrassed to tell you. That’s not okay. The fact that they didn’t offer to let you look at it hints to me that they knew. So, instead of admitting their mistake, they tell you it looks great. That isn’t ethical.

I know they said that nothing could be done about it, but that’s not true. They could re-do it. I would like you to ask for a refund. My guess is she knows what she did wrong and won’t give you too much trouble. If she does, get a second opinion from an expert cosmetic dentist. You can look on mynewsmile.com to find one in your area. Have them get good photographs of the case to show what went wrong, then tell your current dentist that you will be talking to the dental board. That will get her attention and should secure your refund. Then, you can have a more experienced cosmetic dentist work on your case.

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

Disastrous Sinus Perforation After Extraction

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I’ve had one disaster after another with a tooth extraction. First, they perforated the sinus but didn’t tell me about it until the following day. Then I developed a fever. They called in an antibiotic, but I only got worse. I insisted on coming in. At that appointment, they removed some bone from the area and prescribed me an even stronger antibiotic. I still got worse and went to see an ENT as a result, they said the hole has closed and I should feel fine. Of course I should feel fine. They just blew me off. How they can do that when I still have a fever and I can’t eat, I have no idea. I asked for a copy of my medical records because I’m going to have to go somewhere to get help. I don’t think I can do this much longer. I’m losing a lot of work and pay. Oh, one other thing. When I looked at my informed consent sheet it wasn’t signed. They just have a note that says I couldn’t sign it because I was sedated. Is that when they chose to tell me about the risks to this do you think? I never heard about the possibility of them perforating the sinus cavity.

Penny

Dear Penny,

Man grabbing the side of his jaw in obvious pain and in need of a dentist

I’m going to say first that I am appalled by the care you’ve gotten. First, you had a dentist who blew it on several levels and now you’re dealing with an ENT who seems to not care if you’re in pain. I want you to call your medical doctor. Your dentist has you on the wrong antibiotic. You should not still have a fever at this point. Plus, especially if the ENT is right and the hole is closed, you should be feeling much better. Make sure you tell him or her everything they have you on and how this came about.
I’m glad you are going to see another ENT. Ask your doctor to recommend one to you based on everything you’ve told him.

I’m also going to say you have a good case to get your dentist to pay for the remainder of your treatment as well as any money you’ve lost for work because of the perforation and ensuing poor treatment on his behalf.

Here is a start:

  • He didn’t get informed consent. Even if you’d had signed the document it wouldn’t count. You can’t give consent while you are under dental sedation. Because of that, good sedation dentists go over everything with you before the day of the actual procedure.
  • A bad extraction, resulting in a perforated sinus cavity.
  • Leaving bone fragments in the cavity.
  • Not informing you right away and letting you know what to avoid in the meantime.
  • Not beginning treatment of the perforated sinus until the next day when they finally told you about it.
  • Not giving you the correct antibiotic.

If he gives you a hard time, mention getting a lawyer. That should cause him to call his insurance. Given the circumstances, they’ll tell him to pay for your care. It will cost him a lot less than a lawsuit.

Once you’re healed, you’ll need to look into getting that tooth replaced. I’m going to suggest a dental implant. It is the best tooth replacement available. However, do your research on the dentist who does your procedure. It’s very advanced and requires a great deal of post-doctoral training.

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