Thanks,
Alicia from Madison

Dear Alicia,

Without seeing what your teeth were like before your makeover, it would be difficult to say why your dentist chose to go with porcelain crowns instead of veneers. Typically, a dentist will chose the most conservative treatment possible. Only a small amount of shaving of the front of the teeth is required for porcelain veneers, while substantial reduction of your natural teeth is required for porcelain crowns. For your own information, you should ask your dentist why he chose the more aggressive treatment option.

That being said, it is not at all unusual for a cosmetic dentist to use porcelain crowns in a makeover, especially across the front teeth. Your dentist might have chosen them to make a change to your bite, or to protect teeth that were weak or had fillings, or simply because they were the best choice to yield a beautiful smile.

In terms of cost, most dentists have identical or nearly identical fee structures for porcelain veneers and crowns, so you don’t really have to be concerned that your smile makeover cost more than it should have.

It is important, though, that you discover why your dentist went with porcelain crowns, so you have a full understanding of your dental procedure.

I went to see my dentist, and he diagnosed it in about three seconds! He blew some air on it a few times, asked if it hurt, then put a “desensitizing bonding agent” on it. That was it. He was in and out of the examination room in less than five minutes. He is always very abrupt, and never asks if I have any questions. I get the feeling like he is always in a hurry to be done and get on to whatever he is planning to do next.

I don’t feel like he really took the time to figure out what is going on with my tooth. Could he really diagnose my problem accurately that fast?

Peggy in Nashville

Dear Peggy,

To answer your question, yes, in some cases a very fast and accurate diagnosis can be made. The pain issue you described was very straight forward, from the sounds of it.

If you experience pain when air is blown on your tooth, that means that there is a sensitive, unprotected spot on your tooth. The amount of time you feel the pain is very important. If the tooth hurts for a moment and then is fine, that indicates that the nerve or pulp of the tooth is irritated, but has the potential to heal on its own. In that case, the treatment would be what you describe your dentist doing, which is to use a desensitizing bonding agent.

Conversely, if the pain lingers for more than a few seconds after the air is blown on it, the irritation of the nerve or pulp will require root canal treatment. It is irreversible, and will not heal on its own. So it sounds as if your dentist felt that your sensitive tooth has a good chance of healing on its own, which is good.

The underlying issue here, though, is your feeling of not being able to ask questions. This is not a situation that builds trust with your dentist, and without trust you simply cannot have good care. If you are not comfortable addressing this problem first with the dentist, try talking to the assistant the next time you are in, or speak to the receptionist on the phone. Let them know that if the dentist doesn’t have time for your questions, you’ll be finding a new dentist. Good luck!

Lynn in Marlboro

Dear Lynn,

I am a little confused about what you are asking, but I’ll try to help. First, bleaching does not harm porcelain veneers. It also will do nothing to change their color, either. Your Lumineers are the same color, all the way through, and no amount of bleaching is going to change that. I hope when you had them placed that you chose the shade you wanted, rather than matching it to your lower, unbleached teeth.

You absolutely can whiten your lower teethwithout worrying about any harm coming to your Lumineers, though.

You should find a new dentist, soon. After investing in Lumineers, you don’t want to lose your beautiful smile to neglect. You should look for a cosmetic dentist, one who has received accreditation from the American Academy of Cosmetic Dentistry. An accredited cosmetic dentist will have staff trained in the care of porcelain veneers, so you won’t have to worry about an uninformed hygienist destroying the finish.

Lisa from Williamsburg

Dear Lisa,

In our office, we really recommend that you get some kind of replacement tooth placed right away following an extraction. Even if it is just a temporary “flipper” (removable partial denture), it will stop the surrounding teeth from shifting, which can start in as little as a week.

With just a single missing tooth, you could elect to have a single dental implant, or a dental bridge. Your dentist will help you decide which option will be best for you.

The tooth you have lost is a significant one. It is one of your upper first molars, and the loss of it will cause your second molar to tip forward, and the tooth in front of it to tip back. The molar that corresponds to it in the lower jaw will grow upward trying to meet  a tooth that is no longer there. In short, a missing first molar can seriously disrupt your bite if not addressed right away. Gum disease or TMJ disorder can result, so do not delay in addressing this issue.

The space in my teeth is still there, and I can actually see the bonding material on my teeth. Is that normal? Because my teeth were chipped into a v-shaped gap, the bonding is at least an improvement, but this is NOT how I thought it would look! Please let me know if my expectations were too high.

Marie-Therese from Baton Rouge

Dear Marie-Therese,

You have every right to be disappointed, and you are correct that the work on your teeth was sub-standard. To answer your question first, yes, the dental bonding can be removed. Every dentist has special sand paper for this purpose, and the bonding can be removed and taken (gently!) right down to the original enamel.

When you’ve had the bonding removed, you need to find a different dentist. Direct bonding is done freehand, and only a really skilled cosmetic dentist has both the technical skill AND the artistic sensibility to do a really beautiful job. Most dentists are technically very competent, but lack artistry. Look for a dentist that has been accredited by the American Academy of Cosmetic Dentistry (AACD). Any dentist can SAY they do cosmetic dentistry, but only those that have passed many, many hours of post-graduate study and accreditation exams are actually qualified to do top quality work.

I am only 24, and really upset at the idea of losing teeth! My doctor is hard to talk to, and always in a hurry. What are dental implants, and what might that procedure be like for someone like me?
–Darcy in Atlanta

Dear Darcy,

It is unfortunate that you are having trouble talking to your doctor. Good communication is so important in medical and dental care. Maybe he has a partner you could talk to? Or consider setting up an appointment specifically to talk over your options in detail until you understand fully what your choices are.

That being said, I’ll try to answer your questions. Dental implants are used to replace missing teeth. A permanent root form is surgically implanted into the jaw bone, and then (after the site has healed) a dental crown is placed over the root form. Dental implants are considered the best solution to missing teeth, as they help maintain the health of the underlying bone, and do not require any modification of the surrounding teeth as a bridge would. If done by a skilled cosmetic dentist, a dental implant is indistinguishable from your natural teeth.

In your case, there may need to be some extra steps. Depending on the extent of the damage to the underlying jaw bone, you may first have to undergo a bone regenerationprocedure. This is necessary when the jaw bone at the site of the lost tooth is too fragile or deteriorated to support the implanted root form. This truly remarkable procedure has given people with severely damaged jaw bones a second chance at “permanent” teeth.

The good news is that there are procedures that can help you regain your oral health. If dental implants are necessary, it should comfort you to know that they will look, feel and function just like your natural teeth.

Best of luck to you.

My teeth have always been pretty good. I don’t have any cavities, and they are nice and straight, and just a little stained. They do seem a little looser than they have in the past, but I just figured that was part of getting older. I’ve also gotten a lot of complaints from my wife about my breath being bad. Is that a symptom?

Should I get a second opinion? I have a lot of trouble believing that things could really be that bad when my teeth look just fine!

Niko from San Antonio

Dear Niko,

Yes, you really should get a second opinion, if for no other reason than to find a dentist you can trust. It does not sound like you have a trusting relationship with your dentist, and that will stand in the way of keeping you healthy both now and in the future.

Loose teeth and bad breath are symptoms of gum disease, and you should take this very, very seriously. Your dentist is absolutely correct in saying that you can lose all your teeth if you allow gum disease to go untreated.

Of course, I would have to examine you before I could give you options for treatment, but I can tell you in general terms what treatments are available for gum disease.

Traditionally, you would undergo a deep cleaning, which involves a dental hygienist using instruments to remove the plaque and calculus from your teeth, both above and below the gumline. This is called “scaling and root planing”, and it can be a  lengthy and unpleasant procedure. Deep cleaning is usually performed under anesthetic, and can take four or more hours over several different visits.

The very latest in gum disease treatment is to use lasers and micro-ultrasonic equipment. A precisely calibrated laser is used to sterilize the pockets of infection, eliminating the source of the infection without damaging your teeth or healthy surrounding tissues.

This treatment is available in our LA office, and you should seek a dentist in your area who provides this sort of advanced technology in the treatment of your gum disease.

Please don’t delay your treatment, Niko. Even if you feel your current dentist is overstating the problem, get a second opinion as soon as possible.

Dear Katherine,

I want to first caution you that teeth whitening systems do not work on all kinds of stains. You do not mention what kind of staining you have, and you should know that if you have tetracycline stains from antibiotic use as a child, the best treatment for you would probably be porcelain veneers. Most other stains can be addressed with laser whitening systems – a good, knowledgeable cosmetic dentist will let you know for sure.

If performed by a knowledgeable staff in a dental office, laser whitening systems such as Zoom Whitening can be wonderfully effective. An added bonus is that it is fast – most sessions only last a few hours, and most offices provide distractions such as DVDs or music to help the time pass quickly. After your first session, you can choose to maintain your bright new smile with additional visits, or with an at-home system that is quick and easy to use.

In the interest of being completely honest, though, I must tell you that yes, a few people DO experience some discomfort. Most commonly, a few people report sharp “zinging” pain in their teeth for a day or so following their appointment. This pain can be eased or avoided by taking ibuprofen immediately following your appointment. For most people, a brief period of increased sensitivity in your teeth and gums is very normal after a whitening session. If you have pain that is more intense, or lasts more than a day or two, make sure to contact your dentist right away so you do not have to suffer needlessly.

If your cosmetic dentist’s office is well-versed in Zoom whitening procedures, the staff will take great care to make sure none of the whitening gel comes into contact with any of the soft tissues in your mouth (gums, lips, inner cheeks). The whitening gel is irritating to soft tissue, so let a staff member know right away if you think some of the peroxide gel is coming into contact with your gums or cheeks.

An expert cosmetic dentist like Dr. Dustin Nelson can help you decide if Zoom whitening is right for you.

I want to have 4 Empress crowns for my front teeth. I have a cleft and had a surgery to remove the tooth beside my right front tooth. There is no bone to support for this tooth. So, 1 of the 4 Empress crowns would be a tooth that would be bonded to the teeth on either side. The 4 Empress crowns would be fused together.

My questions are,

1.I would like to seek your opinion on this, would 4 empress crowns that are fused together look natural and nice?
2. If one of the crowns cracks (by any means), do i have to change the whole for empress crowns?
3. What are the disadvantages for crowns that are fused together.

Doctor, I really appreciate your answer. Here in Malaysia, the number of cosmetic dentists are very limited and on top of that, not all of them have artistic touch. Thank you and have nice day ahead.
- Siti from Malaysia

Siti,
If you’re ending up with a missing tooth that needs to be replaced, then I don’t recommend doing Empress crowns. They don’t have the strength to reliably support a missing tooth.

And yes, if there is any problem with one of the crowns, the whole system would have to be replaced.

Would it look nice? Yes, until it broke it would look quite nice.

There is a newer material – zirconia – that is much stronger and can be made to be very beautiful.

Or, in Malaysia, you just may be best off letting a dentist use porcelain fused to metal.

And a word of warning – Don’t try to encourage a dentist to work out of his or her comfort zone. And if you go in suggesting a material, it becomes a temptation for the dentist to tell you what you seem to want to hear.

Read more about Los Angeles porcelain crowns.

Jo,
I’m a little puzzled by what your dentist is telling you. A couple of points.

First, tooth bleaching won’t do anything to these stains. It sounds like it should work, but a dentist with much experience with tooth bleaching knows that It only works on teeth, not on restorative materials. With tooth bleaching, the peroxide penetrates the inside of the tooth and oxidizes the darker colors. The stain on the edges of your porcelain veneers is completely different, and is because of a lack of smoothness in the bonding resin that holds your porcelain veneers to your teeth.

These stains can usually be polished away, but I don’t understand why he asked his dental hygienist to do this. Maybe she just used the regular tooth polish or pumice that she uses to clean teeth, and this wouldn’t work. The type of polishing you need is a composite polish, which is accomplished by abrasive disks of progressively finer grits. This should be easy for an expert cosmetic dentists. Hygienists aren’t usually trained to do this type of polishing.