All posts by iowasmiles

Dr. David Hall is a colleague of Dr. Malone's, an AACD accredited cosmetic dentist, the author of the consumer cosmetic dentistry information website mynewsmile.com, and the president of Infinity Dental Web in Mesa, Arizona.
Porcelain Veneers

Should I have crowns for my tetracycline stains?

I have severe tetracycline stains, and have had porcelain veneers for the past eighteen years. My teeth look gray with the porcelain veneers, but it is much better than the awful stains I had before.

I wanted to get new porcelain veneers, but my dentist says I should get crowns, so that the stain will be completely covered. What do you think?

– Ann from Louisiana

Ann,
I don’t think you need crowns.

Tetracycline stains are very difficult to treat, and you really need a lot of training and experience with cosmetic dentistry to do them right. The stain is very dark, and go to the core of the tooth. When general dentists try to fix them they end up at one extreme or another — either the veneers are too translucent so that the dark stain shows through, or they’re too opaque, so that they look chalky and fake. Or sometimes they get over-aggressive and grind the teeth down for crowns and then put an opaque crown over them. None of these approaches results in a truly beautiful smile.

But there are ways to make a beautiful smile with conservative porcelain veneers over tetracycline stained teeth. You may want to visit our smile gallery where we show Dawanna, who had brown tetracycline stains, that we treated with porcelain veneers.

So my advice is to stick with the porcelain veneers, but to go to an expert cosmetic dentist. We’d be happy to help you if you’d like to come here.

Related links:
Porcelain crowns

Uncategorized

Do I need crowns?

I have several old large silver fillings that are not bothering me but my dentist feels they all need crowned is this reasonable?
– Karen in Tennessee

Karen,
Yes, this sounds reasonable. Once a large silver amalgam filling has been in your mouth for a number of years, it begins to break down. It’s reasonable to take out the amalgam and do a crown before the tooth breaks.

And one of the disadvantages of the old-fashioned amalgam fillings is that it is very difficult to tell if they have decay under them until the decay has grown considerably. This is one of the reasons we like to do the white fillings in our office. The standard of care when you have large amalgam fillings would be to replace them with crowns when the margins of the filling begin to separate from the tooth or the margins develop defects.

If you wait until a tooth bothers you, that can be the most expensive way to do dentistry. Once they start bothering you, you will not only need crowns but may also need root canals.

Related links:
Read more about porcelain crowns

Invisalign, Porcelain Veneers

How to fix one tooth that is out of line

Dr. Malone,
What is the best procedure that can be done to a front tooth that is out of line with the other ones, besides using braces?
– Mark in New York

Mark,
There are two main ways that we would usually use to fix your smile if you have one tooth that is out of alignment, without using braces. And there is another possible way that could sometimes be used.

The fastest way, and this can be done in just a couple of main appointments, is to use porcelain veneers. Veneers are placed over your teeth. Usually the teeth are shaved just a little bit first, about the thickness of a fingernail, so that they don’t end up being too thick once the veneers are on. Even if your teeth are pretty badly out of line, they can be made to look perfectly straight. A good illustration is the patient, Bea, in our smile gallery. She had crooked teeth that were corrected with porcelain veneers.

The second major way is with Invisalign. While these are called “invisible braces,” they’re not really braces, in that metal brackets aren’t put on your teeth. And they’re twice as fast as metal braces. We use a series of clear plastic aligners that you snap in, and they push your teeth into the correct positions.

And if you have, say, just one tooth that is out of alignment, some people like us to use direct tooth bonding on just the one tooth that is out of line. This can look great when it’s done, but the bonding material isn’t nearly as durable as porcelain, and it tends to pick up stain over time.

 

Uncategorized

Problems with Lumineers

After a 2 month long ordeal with getting my lumineers and then having them redone due to pain and the color from one Lumineer to the next being greatly different, I was flossing as directed last Friday and the top of one lumineer cracked off. Then today, having my Mother’s Day lunch, Another Lumineer cracked into four pieces! There is a jagged piece still attached. I hate Lumineers and going back every 2 weeks to get them changed or fixed or redone. Also I can’t find any info on the better business bureau.
– Vanessa in Texas

Vanessa,
There are a lot of stories going around about problems with Lumineers. But the problem really isn’t usually with the material, but usually in the placing of the Lumineers. With their heavy promotion, where they talk about how easy they are to do, they are attracting a lot of dentists who aren’t thoroughly trained in cosmetic dentistry. They dentists have been to the two-day Lumineers course, but they need several years of going to extra courses to really be good at cosmetic dentistry.

Manipulating color is where most general dentists have the most trouble. You found that when you got your first set, because you said that at first the color was different from one tooth to another. To be lifelike, the porcelain needs to have some translucency, so the color of the underlying tooth strongly affects the final color. It takes considerable training and experience to know how to manipulate this color well.

Then when they began to crack and fall off, this is most likely due to a problem in the bonding technique. Lumineers and other brands of porcelain veneers get their strength from the strength of the bond to the tooth.

My advice is to keep with this dentist until he or she gets it right. It seems like the dentist got in over his or her head. They got the advertisements from the Lumineers people that made this all seem so easy, and they’re learning the hard way that it isn’t so easy.

One of the best ways to be sure that your cosmetic dentist knows what he or she is doing is to find one who is accredited by the American Academy of Cosmetic Dentistry, like Dr. Malone is. It’s a three-year process to become accredited, and the dentist has to pass a stringent series of examinations, including a review of the dentist’s actual work by a panel of examiners. You can’t get through that without a thorough understanding of cosmetic dentistry.

Related information:
Read about Dr. Mike Malone and his credentials