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CEREC

CEREC Crown is Too Bulky

I had a dental crown break after three years. I needed to replace it but have been quite busy lately. Because of that, I went to a different dentist who advertised same day crowns using a CEREC machine. However, the tooth with the CEREC crown is way too bulky. It’s uncomfortable, doesn’t line up with my other teeth, and I find myself biting my tongue unintentionally because the crown is “in the way”. The dentist has tried filing it a couple of times, but it hasn’t really improved much. Where do I go from here?

Madeline

Dear Madeline,

porcelain block for CEREC crown
CEREC restoration

This must be so frustrating for you. Here you were trying to save time and it has ended up even more of a hassle. I have two concerns here, beginning with your original crown. It should not have broken after a few years. These are designed to protect the tooth underneath and keep them from breaking. As a result, they should last you many years. Your dentist should have recognized that and offered to replace it. Hopefully, it was a matter of flawed material, which can happen to the best of dentists, and not that he was incompetent in how he placed it.

As for the CEREC crown, it sounds to me like your dentist is new with this software. Usually, the dentist would take images of your tooth that needs to be crowned and the CEREC software would build-up an excellently fitted tooth from there. However, you didn’t have the original tooth because your need was to replace a damaged crown.

There are ways to build up a tooth from scratch that will fit perfectly using the software, but it seems to have been beyond the scope of your dentist’s knowledge.

This crown does need to be replaced. The issues you listed can lead to serous problems, including tumors on your gum where you keep biting it, gum disease from a crown iritating the area, and even TMJ Disorder from your bit getting thrown off.

Have your dentist replace this crown at his or her expense. However, I don’t think they are going to be able to get the results you want with her understanding of the software. I think you are going to have to go the “traditional” route and have this porcelain crown made in a dental laboratory.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

CEREC

CEREC Crown Disaster

I’d been hearing how wonderful CEREC crowns were. You could get them done in one appointment and they’d fit perfectly, designed to your tooth. I have experienced something quite different.

First, she said my tooth was in such bad shape that she had to take a generic image off the database. Then, it didn’t fit . She spent three hours grinding down on the sides and top of the crown so much that the top of the crown is flat and shorter than the rest of the teeth. Additionally, the gums are super sore where the crown is. It’s been over a week.

Is this normal?

Katelyn

Dear Katelyn,

porcelain block for CEREC crown

No , this is not normal. I’m a bit thrown off by her saying she had to get a generic image from the database because your tooth was in bad shape. Of course it was in bad shape. That’s why you needed a crown.

The CEREC Crown software is designed to build up a tooth. Your dentist starts by telling it which tooth needs to be crowned. In turn, it builds up what that tooth should look like. Then, your dentist adds the information for the remainder of your bite and the software designs the perfect dimensions.

It sounds to me that one of two things is going on: either your dentist didn’t know what she was doing with the software or there is information she didn’t pass on about your case, such your gums bleeding so much she wasn’t able to get a clear image.

Either way, her decisions after that give me some doubts about her skill with dental crowns as a whole. I’m going to suggest you get a second opinion from another dentist. If it is as bad I think, it will need replacing. In that case, don’t ask for a refund. Instead, have your current dentist pay for the repairs. It will likely cost more to get it re-done than you were originally charged.

Tips for Getting a Second Opinion

When you go to get your second opinion, don’t tell them who the original dentist is. The dental world is a small one. Often dentists are friends with one another. He or she may have a bit of difficulty saying something negative about a friend’s work.

Instead, just tell him you want his opinion, without any previous information, as to what he thinks about the CEREC crown.

Thinking Ahead

Normally, your dentist would have already relayed the information I’m about to give you, but I don’t have the highest confidence in your dentist at the moment.

You didn’t say where they CEREC crown was being placed. If it is in a place that is visible when you smile, you will want to make sure your teeth are the color you want in the long term.

While the CEREC crown can be made any color you want, the color will be permanent. If you’re not completely happy with the color of your teeth, you may want to get your teeth whitened before the crown is made. This way you will be sure to have the color you want for the long term.

Otherwise, if you don’t and decide later to whiten, the crown will have to be replaced again in order to get it to match the new color.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Teeth Whitening

Stained Dental Bonding

I have some dental bonding that seems to be picking up some stains. Would whitening toothpaste brighten them up? If not, what about professional teeth whitening?

Richard

Dear Richard,

Almost all whitening toothpastes contain abrasives. While those abrasives can make your teeth look whiter, they do so at the cost of damaging the enamel. That in turn causes your teeth to pick up stains more easily practically making you dependent on using their whitening toothpaste.

I do have a solution for you, but before I go into that, let’s talk about your second option. Professional teeth whitening isn’t a good solution either, It does a marvelous job of whitening natural tooth structure. Unfortunately, it only whitens natural tooth structure. Any dental work, such as dental bonding or dental crowns, will remain the same color.

Getting Dental Bonding Whiter

Supersmile Toothpaste

In order to get this dental bonding the way you want it, you will first need to determine the reason behind the staining. If the polish is still on your bonding, then you have surface stains. If the polish isn’t there, you’ve got to have the bonding re-done. You didn’t say how long you had the bonding. They don’t last nearly as long as something like porcelain veneers.

If the polish is still there and you’re dealing with surface stains, there is an easy solution. If you remember, I told you almost all whitening toothpastes use abrasives. The exception to this is Supersmile Toothpaste. Its stain-removing ingredient is Calprox. This enzymatically dissolves the protein pellicle layer that covers your teeth. Stains attach themselves to that pellicle and are removed simultaneously.

This blog is brought to you by the Lafayette, LA Dentists of Camellia Dental.

Invisalign

Smile Direct Club

Is Smile Direct Club a viable option for me? I can’t get to my dentist with all the closures from Coronavirus. Plus, I just received a Groupon offer for them which makes it very affordable. Have you had any experience with them?

Destiny

Dear Destiny,

smile direct club image

I have done some research into this program because I’m always on the lookout for options that are both good and bad for my patients both as a means to keep abreast of what is available and to protect them from unscrupulous perveryors of medicine.

Smile Direct Club is one I’m not just concerned about but wonder how it is even legal. First, let start with the fact there is no pre-examination. Any reponsible dentist would do a complete exam before beginning any orthodontic treatment. There are good reasons for this. First, you could have some underlying gum disease. If you move forward with braces of any kind while you have gum disease, you could end up losing some teeth. Other issues this exam would look for is TMJ Disorder and / or decay.

Another concern I have about this program is the impression. The mold of your bite is one of the most important steps. Without a proper impression, your whole treatment plan will be off-kilter. Most dentists won’t even let their assistants do it. There can be no defects, including bubbles or tears in the material. Somehow, they are expecting you to do this with no training at all.

Finally, inaequate monitoring. Most people end up needing extra space in order to get their bite straight. There is too much crowding. Sometimes to make that space you will have a tooth extracted. Other times, it requires soms shaving at the sides of the teeth. You need a dentist invested in your treatment. That is not going to happen with mail order ortho. Many times, our teeth do not cooperate. Each person’s bite responds differently to their treatment. Sometimes the teeth do everything exactly as they are supposed to. Other times, teeth don’t turn the way they are supposed to and the dentist needs to intervene in the treatment.

Unfortunately, for patients using Smile Direct, there isn’t anyone there keeping an eye on whether or not your teeth are doing what they’re supposed to. You won’t know either, which means your smile could end up not correcting properly.

Why Invisalign Is a Better Option

Though it may mean waiting for a bit to get your teeth straightened, because of the pandemic, I would wait until you can get your treatment done properly with Invisalign.

You’ll get a complete and comprehensive exam to ensure your bite is ready to have shifting done without risk to your teeth. You’ll have an accurate impression. Then, every two weeks, your dentist will be checking to be certain the teeth are moving as they should and no more shaving needs to be done for there to be enough room.

Invisalign also has a hidden benefit. The aligners can double as teeth whitening trays. Your dentist can provide you with professional strength teeth whitening gel to wear in your aligners during your treatment. By the time you are done with your treatment plan you will have a mini smile makeover, with a straight, beautifully white smile.

This blog is brought to you by Louisiana Cosmetic Dentists of Camellia Dental.

Teeth Whitening

How Long Should I Whiten?

I whitened my teeth a couple of years ago. Now I’m about to get a dental crown and want to touch the teeth up before having the crown made because they’ve picked up some stains since then. My dentist said he doesn’t know how to advise me so I’m turning to your blog in the hope you can. Here are my questions: 1. How long should I whiten per day and for how many days? 2. Is a waiting period necessary between whitening and getting a crown?

Brooke

Dear Brooke,

teeth whitening trays

I am going to answer your questions. However, first I am going to express concern that your dentist seems unable to do so. As your dentist, he (or she) is actually in a better position to give definitive answers because he knows your dental history.

The fact that he can’t, gives me concern about his ability to create a beautiful looking porcelain crown for you. Most dentists are engineering-minded. They can create a well-fitted, functioning crown but the appearance will be mediocre at best.

My guess is this is a tooth that is visible when you smile. This makes it all the more important to know if your dentist is a skilled, artistic cosmetic dentist.

Basic Teeth Whitening Guidelines

The duration of days will depend on how long it takes you to get to the level of whiteness you want. Teeth will get whiter the longer you use the gel. As for how much per day, it depends. The minimum you should wear your whitening trays, with the gel in them of course, is 20 to 30 minutes. That’s about the amount of time necessary for the ingredients to get into your teeth.

If you’re able, teeth whitening is more effective overnight. This is because our saliva production goes down at night. During the day, saliva gets into the trays and can dilute the gel. However, I would not whiten to the point of tooth sensitivity. You are the best gauge for that.

You will want to wait a week or two between the time you complete your teeth whitening and you have your porcelain crown made. If it is going on a front tooth, wait the two full weeks. If the crown will be more toward the back, one week is sufficient.

This blog is brought to you by the Lafayette Dentists of Camellia Dental.

Porcelain Veneers

Smile Makeover Disaster

I need some advise. I had porcelain veneers done. The first time they came back they were way too thick. Even my dentist knew that by looking. I asked him to send them back, which he did. When they came back again, they didn’t really let me see them. They did tell me they could make any adjustments necessary after they were bonded on. That turned out not to be true. They ended up very bulky looking and, though I did ask for a white smile, they ended up chalky and fake looking . I absolutely hate them, but my dentist isn’t returning my calls. Do you have a recomendation of how I can get this fixed?

Carla

Dear Carla,

A single porcelain veneer being placed on a tooth

I think you’re suffering from having a decent family who is trying to do cosmetic dentistry he’s not qualified to do. Believe it or not, smile makeovers aren’t taught in dental school. A dentist has to invest in a significant amount of post-doctoral training in order to develop the skills necessary to create beautiful smile makeovers. My guess is your dentist didn’t invest in that.

True cosmetic dentists also know that it is the patient’s perception of their smile that matters most. Because of that, they will use a temporary try-in paste so you can get a good look at your porcelain veneers in a variety of lightings before they are bonded on. You have a legal advantage. He misled you regarding the ability to make changes to your porcelain veneers after they were placed, bonding them on without your official permission.

Getting Your Porcelain Veneers Done Right!

Normally, I would say insist on a refund, however, you mentioned he’s not returning your calls. That may be because he is avoiding you or, if we want to be generous, maybe he’s not checking messages as much if his office is closed during the COVID-19 quarantine. Though, they should be open for emergency procedures.

Leave him another message letting him know if you don’t hear back from him this time, you’ll be contacting a lawyer. That will kick him into gear. If you do end up having to get a lawyer involved, you have a pretty solid case. I’m sure his insurance holders will advice him to settle quickly.

When you go to have these re-done, I want you to be certain you use a dentist with both training and artistry.. Ideally, you’d see an AACD accredited dentist (which is different from just being a member). Accredited dentists are in the top 1% of dentists in the country. If you can’t find one of them within a reasonable distance to you, contact me again and we’ll help you find someone.

This blog is brought to you by Lafayette, LA Cosmetic Dentist Dr. Mike Malone.

Invisalign

Smile direct Club Safety

I’ve been wanting to straighten my teeth for years, but wasn’t able to invest the amount of money into it required. I’d run across Smile Direct Club on Facebook. They are significantly cheaper than Invisalign.I did wonder in the back of my mind whether they were too good to be true. Is it okay to use this? I was especially interested because we can’t go in to see a dentist at the moment for routine care because of COVID-19. This seems like a quick, easy way to get my teeth straightened while still social distancing.

Mercy

Dear Mercy,

Invisalign aligner
Invisalign aligner

Smile Direct Club advertises as a more affordable way to invisibly straightening people’s teeth by comparing themselves to Invisalign. While there are some similarities, the differences are the most striking. First, how they’re similar:

  • They use clear aligners
  • You switch your aligners out as your treatment progresses.

That’s about it.

The Shortcomings of Smile Direct Club

It’s the ways in which Invisalign is different that create my biggest concerns.

The Pre-Exam

With orthodontics under the care of a dentist, you get a thorough pre-exam. This is important. You need a dentist to look for things like decay, failing fillings, gum disease, and signs of TMJ Disorder. Ignoring these can have serious consequences. For instance, if you do orthotdontics with untreated gum diease, you could end up with you teeth coming loose.

With Smile Direct, there is no real exam, putting you and your teeth at risk.

The Impression

An accurate impression of your bite is essential for a proper treatment plan. It’s so imperative it’s done right that many dentists won’t even let their hygienists do it.

What you’ll get with Smile Direct is a do it yourself kit. If that impression isn’t free of imperfections, it will throw off your treatment.

The Treatment

Though many cases go as planned, not all of them do. Sometimes teeth don’t turn the way they should or you need more space opened up than originally planned. In that case, a dentist will need to carefully shave some of the sides to your teeth.

I honestly think you are safer waiting for COVID-19 to calm down. This will be the safest way to straighten your teeth.

An Added Benefit with Invisalign

In addition to being able to safely straighten your teeth, the Invisalign aligners can double as teeth whitening trays enabling you to straighten and whiten your teeth simultaneously. It’s like getting a mini smile makeover.

This blog is brought to you by Lafayette, LA Dentist Dr. Mike Malone.

Emergency Dentist

what is essential treatment?

I know during this time of quarantine that we all have to do our part. I’ve been doing very well and not going anywhere. Unfortunately, I took a spill down our stairs and ended up chipping a tooth. Would this be considered an essential treatment? I feel silly. I know it is just a chip but it is bugging me.

Camille

Dear Camille,

a before and after picture of dental bonding for a chipped tooth.

The CDC hasn’t listed what procedures and treatments are considered essential and what isn’t. For the most part, they expect us to avoid routine procedures. If it were just a cosmetic issue alone, I would say you would need to wait until the quarantine is over.

However, based on what you said, there is more to this than just cosmetics. You took a fall which caused the damage. There could be underlying trauma to the tooth which needs immediate treatment. Sometimes the ligament can be stretched and if you don’t splint the tooth you can end up with a tooth that comes loose. Other times, the trauma is so severe, the pulp of the tooth dies and you need a root canal treatment.

Under normal circumstances, I’d suggest you call your dentist and ask him to squeeze you in for an emergency dental appointment. In this case, the only appointments are for situations like yours.

If you’re going to need an emergency appointment. This is the perfect time!

Getting the Chipped Fixed

If it turns out there is not damage from the trauma that requires immediate treatment, then your dentist can likely go ahead and fix the chipped tooth. I mean…you’re already there.

The ideal solution for this is to have dental bonding done. You can see an example of that in the image above. I will warn you. It does take an expert cosmetic dentist. If your dentist isn’t one, my suggestion is you see him for the trauma. Then, once the virus calms down, see an AACD accredited dentist to do the bonding to repair the chip to your tooth.

This blog is brought to you by Louisiana Cosmetic Dentist Dr. Mike Malone.

Porcelain Veneers

Caring for My Porcelain Veneers

I recently had porcelain veneers placed, before all this quarantine craziness. I do love the veneers but want to make sure I take good care of them. Is there a particular toothpaste or mouthwash I should be using. Normally, I make my own mouthwash, but don’t want to use it if the ingredients are bad for my veneers. Our governor closed all dental offices so I don’t think I can even reach my dentist.

Here’s my recipe:

  • 8 oz. of filtered water
  • 8 oz. of 3% hydrogen peroxide
  • 2 T. of sea salt

Karli

Dear Karli,

A single porcelain veneer being placed on a tooth

I’m glad to hear you love your porcelain veneers. Too many patients end up with a disappointing smile because they don’t go to a skilled and experienced cosmetic dentist.

Caring For Your Porcelain Veneers

Let’s start with the toothpaste. Generally, for any type of cosmetic dental work, I recommend Supersmile toothpaste. It was specifically designed to work with all types of porcelain as well as normal tooth structure. Unique in its ability to keep your teeth stain-free without damaging the glaze on your porcelain veneers or the enamel on your teeth.

Other whitening brands of toothpaste contain abrasives. While they can make your teeth look whiter and cleaner for a while, they are also putting micro etches into the tooth, which will cause it to pick up stains more quickly.

As for mouthwash, when you brush and floss regularly, you really would only need mouthwash occasionally, if at all. If you do want to use a mouthwash, the one thing you want to avoid is any mouthwash which contains alcohol. The alcohol will eat away at the bonding that keeps your veneers attached to your teeth.

The recipe you listed, while safe for your porcelain veneers, has one ingredient which requires caution. Hydrogen peroxide is great at killing bacteria. Unfortunately, it will also kill the helpful microbes allowing candida yeast to thrive.

If you use this recipe sparingly, like once a week, you should be fine. Much more than that and you’ll end up with thrush, which is an oral yeast infection.

I hope this was helpful. Enjoy the extra time with your family during this COVID-19 quarantine.

This blog is brought to you by Lafayette, LA Dentist, Dr. Mike Malone.

Teeth Whitening

How white can I get my teeth?

I am trying to figure out how white I can get my teeth. Ideally, I’d like them to match my eyeballs. Is that possible?

Miranda

Dear Miranda,

I love it when I get questions that surprise me. This is one I’ve never encountered. Whether or not your teeth can match your eyeballs really depends upon how white your eyeballs are. There are limits to what teeth whitening can do. Though, you certainly can get them very white.

In general, when a patient is striving to match a certain color, we suggest they have porcelain veneers done. These can be more specifically designed to match certain colors. In addition to color, they can change the shape and size of your teeth as well. It is the go-to procedure that celebrities use to get their Hollywood smiles.

Even when patients do get porcelain veneers we always have them whiten their teeth first, this way if they have a smile that is ten teeth wide but only get six porcelain veneers, the adjacent teeth will blend in with the veneered teeth and not look out of place.

Who Should Do Your Cosmetic Work?

Here’s what I recommend. Start with the teeth whitening. That may be all you need. If you get the level of whitening you want, job done. Any dentist can do teeth whitening, even your family dentist.

If it doesn’t get to the color you want, then you’ll have to decide if you want to get a total smile makeover with porcelain veneers. This does require some rather specific training.

Unfortunately, cosmetic dentistry isn’t a recognized specialty. That makes it hard for patients. Doing smile makeovers isn’t taught in dental school. The dentist has to seek post-doctoral training. The best cosmetic dentists are AACD accredited.

This blog is brought to you by Lafayette, LA Cosmetic Dentist Dr. Mike Malone.