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Dens in dente

My dentist said I have a dens in dente. He wants to do a root canal on it. Is that the best option?

Karrie S.- Albany, NY

Karrie,

You didn’t say if your tooth with the dens in dente (a tooth within a tooth) is infected. If so, then a root canal treatment might be a good option. If not, then there is no point in doing the root canal.  The best treatment for this situation is to clean out the pit of the tooth really well, fill it, then cover it with a white composite material, like you’d get with white fillings. There is no reason to do anything else with this tooth unless there is a cavity or infection.

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

Porcelain Veneers

Really unhappy with Lumineers

We had some cosmetic issues we wanted to fix with my daughters teeth. They weren’t huge issues, but they really bothered her. I want her to have a good self image, so I talked to my dentist about it, who advertises as a cosmetic dentist.   He said Lumineers would be perfect for my daughter Naia. He also told us that we would get to see them on before they were bonded on permanently. He said she could see them in different types of lights and that she could show them to others. None of that was true. One of the things we were wanting to fix were some small gaps in her teeth. We thought about doing bonding, but he said this would be more permanent. When he put in the temporary  ones, we didn’t get to look at it any of the ways he said we would ahead of time. There were no different lights, no getting up to show them to others. Just sitting in the dental chair and looking in a hand mirror. Yet even with that limited way of looking at them we knew we didn’t like them. It did fix her gaps, but the Lumineers were so bulky she looked ridiculous. We asked if he could make them a little more reasonable in  size, but he insisted they were great. He said if we “lived with them” for a week or so we realize how nice they were. We agreed to try. She was teased unmercifully in school about them. She came home feeling worse about her smile than ever. It turns out my dentist wasn’t a cosmetic dentist, just a general dentist. Is there a way I can get a refund and then go to a real cosmetic dentist?

Azida A.- Tulsa, OK

Azida,

I think you can probably get at least some of your money back if this is handled correctly, but first I want to clear up a common misunderstanding.  There is no recognized specialty is cosmetic dentistry. So every cosmetic dentist is actually a general dentist. What sets apart a dentist as an expert cosmetic dentist is the amount of training they have and artistry they’ve developed. I would not consider your dentist an expert cosmetic dentist for several reasons.

First, cosmetic dentists know that Lumineers tend to appear bulkier than other brands of porcelain veneers, because they are advertised as a no-prep veneer. Most teeth will need some form of preparation to keep that from happening.  Secondly, a true cosmetic dentist won’t try to convince you that the porcelain veneers look great. If you don’t like them, they wouldn’t be satisfied either. Period.

Here is what I recommend. Don’t let him do any more work. You know you’re wanting to get a refund and go elsewhere so it is only fair you don’t use anymore of his time. Next, talk to him about how unhappy you are with how things have gone. Let him know that you weren’t given the procedure you were promised. Also be sure to let him know everything your daughter went through with school as a result of his work. Be upfront with him about your desire to get a refund and be done with this procedure.  That may work on its own.

If not, and you need to enlist some help, go to the mynewsmile.com website and find one of their recommended cosmetic dentists in Oklahoma. Don’t go to another one in Tulsa, but another nearby city. Dentists don’t like to go up against their peers because they have to deal with them on a regular basis. It will be easier to get one from another area. Have him look at the cosmetic dental work and give his opinion.

Generally the standard for refunds on poor dental work is that it is has to be non-functional. That makes it hard to get a refund on poorly done cosmetic work. Ugly doesn’t mean non-functional. However, in this case, your dentist didn’t keep his agreement. You were told your daughter would get to see it in several lights before you agreed on the final bonding and that didn’t happen. With another dentist backing up your claim that the work is poor, you have a chance.

Hopefully, others will learn from your experience to check the qualifications of cosmetic dentists ahead of time. Two of the best ways are seeing if they are accredited with the American Academy of Cosmetic Dentistry (AACD) and if they’re recommended on the mynewsmile.com website.

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

 

CEREC

Pain with CEREC crown

I had a CEREC crown put on and am having persistent pain. I’ve been back two times for my dentist to adjust and do a little shaving of it, but it is still hurting quite a bit. I’m afraid to eat food that I have to chew for fear of irritating the nerve. My dentist thinks it might be the way I chew. I don’t think so, becuase I didn’t have this problem beforehand.

Jackson R.- Los Angelos

Jackson,

Generally when there is persistent pain after a crown it is because of one of two reasons. Either the crown is too high or there is an infection. I don’t think it is the bite placement for two reasons. One, you’ve already been back and had it adjusted twice. And second, with CEREC crowns the bite placement is designed by the computer that mills the crown, which makes it easier to place. The next step is to check for an infection with an x-ray. These can sometimes be tricky to find.

If you’re a little suspect of your dentist’s diagnostic skills, you may get an endodontist to look at it. The intensity of your pain along with the amount of time that has passed makes me wonder if that is the real problem.

This blog is brought to you by Lafayette, Louisiana dentist Dr. Mike Malone.

Porcelain Veneers

Sonic toothbrush with porcelain veneers

I got porcelain veneers. I wanted  to get a sonic toothbrush, but just read on a website that sonic toothbrushes could damage the bond on porcelain veneers. Is that accurate?

Brooke K.- San Antonio, TX

Brooke,

I’m not sure what website you were reading, but I wouldn’t agree with it. Sonic toothbrushes are not only great for removing plague, but tests have shown that they are perfectly safe for use with porcelain veneers. If you’re interested, you can look up the 1998 survey from University of Missouri at Kansas City, where they tested sonic toothbrushes on porcelain veneers.

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

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Broken front tooth

My daughter fell and broke off part of her front tooth. She is really embarrassed and I want to get if fixed right away, but my dentist said he can’t see her for six weeks. He told me the root of the tooth needs time to heal, so it is better to wait. Is there anything I can do to make her feel less conspicuous?

Jeanine- San Francisco

Jeanine,

There really isn’t any reason for you to wait to have her treated.  If you have the piece of the tooth the broke off then the dentist can re-attach it. If you don’t have the piece, they can fix it with dental bonding until she is old enough for a permanent porcelain crown.

Be careful not to price shop these procedures. I cannot stress enough how important it is to see an expert cosmetic dentist. You want your daughter to be comfortable with her appearance. Someone who is accredited by the American Academy of Cosmetic Dentistry (AACD) will be able to create a beautiful bonding for your daughter. Be aware that being a member of the AACD and being accredited by them are two very different things. Any dentist can join the AACD, but to become accredited you have to pass a stringent examination and demonstrate your artistic ability.

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

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Options for straightening teeth

I’ve had crooked teeth my whole life. My parents could not afford to get them fixed. I’m now starting my career and have some discretionary money to fix my teeth. Could you list out some ways to fix my teeth at varying expenses. Don’t tell me what is the cheapest or most expensive. I want to just think about what I feel the best option is.

Thanks,

Cynthia F.- Alabama

Cynthia,

Here are three good options for you:

1. Invisalign: Not everyone is a candidate, but any Invisalign dentist can tell you and many dentists do a complimentary consultation so you don’t waste money figuring out if you’re a candidate.  These are aligners that work like braces, except that they are essentially invisible. No one will know you are wearing them. They’ll take about six months to a year to straighten your teeth.  When you’re done, you’ll have a beautiful, straight smile. You might ask your dentist if he’ll allow you to use the aligners as whitening trays. That will allow you to knock out two birds with one stone.

2. Cosmetic Contouring: This is a reshaping of your teeth that takes about one to three office visits. You’ll need x-rays to make sure your teeth are healthy enough for this procedure.  Sometimes just a couple of millimeters of tooth reduction can make your smile completely different. A sanding drill or laser can reshape them. Abrasive strips can shape the sides of your teeth.

3. Porcelain Veneers: In just two appointments, you can change the shape, size, and color of your teeth.

Here is some important advice though, the last two methods need an expert cosmetic dentist.  Don’t settle for the average family dentist who knows some cosmetic procedures. He needs to have the expertise and artistry that only comes from extensive post-graduate training. Your safest avenue is to find someone who is AACD accredited.

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

Porcelain Veneers

Unhappy with porcelain veneers

My daughter had four porcelain veneers placed on her front teeth to help with some crookedness. We couldn’t do orthodontics because of some previous damage. He was afraid the teeth couldn’t take the movement. Unfortunately neither she nor I are happy with the results. They just don’t look as natural as we were led to believe, yet our dentist insists they look gorgeous. We didn’t even get to see them before he bonded them on. Can we get our money back? Why do people rave about porcelain veneers if they look so fake?

Desiree B. from Boston

Desiree,

Actually, porcelain veneers, when done artistically, look fantastic. I suspect your dentist is not a true cosmetic dentist. One of the problems with cosmetic dentistry is that any general dentist can call themselves a cosmetic just by learning a few procedure. Unfortunately, it takes significant post graduate training to become artistic enough to make porcelain veneers not only natural, but beautiful.

A true cosmetic dentist would try on the veneers with a temporary paste and let you look at them in several different lights. They would want to be sure you were absolutely thrilled with them before they bonded them on permanently. Another thing that makes me suspect your dentist isn’t a true cosmetic dentist is that he tried to convince you the veneers were beautiful. In dental school we are taught the dentist knows best. But, when it comes to cosmetic dentistry it is the patient who knows best. We are treating your self esteem. If you don’t love them, it’s not done.

As far as getting your money back, that might be tricky. If the only thing wrong with them is you don’t like their appearance, he has no legal obligation to give you your money back. You could try.  I would also go to a truly qualified cosmetic dentist and get a second opinion. If at all possible, go to a dentist outside of your area and don’t tell him who the dentist was. See if the second dentist thinks the work was done poorly. That may help your case.

 

Porcelain Veneers

Cleaning porcelain veneers

Are there special rules for cleaning porcelain veneers? I’m worried the dental hygenist can break them or pull them off when cleaning them.

Dorothy B- Nevada

Dorothy,

They won’t get pulled off or broken. However, they can be damaged or chipped. The hygienist of an expert cosmetic dentist will know what to avoid while cleaning them. If you are not able to go to an office that has an expert cosmetic dentist, here are some guidelines to give any hygienist and  you’ll be fine.

  • Don’t use any power polishing equipment, such as Prophy Jet. This is the worst thing that can be done to your veneers. Though they get teeth clean very quickly, it will take the glaze off of your veneers. Your hygienist won’t realize that she’s damaged them because they will look fine at the end of the appointment, but the moment you get home they will begin to stain and will never look good again.
  • Using an ultra-sonic or heavy duty manual scalers can chip the edges. I do realize sometimes they need to use scalers. Just make sure when they do, they know not to scrape hard on the margins.
  • Don’t use any coarse polishing pastes. Make sure they use an ultra-fine polishing paste with aluminum oxide grit, never pumice.
If you make sure of these things, your porcelain veneers should look like new for many years.
This blog is brought to you by Lafayette Cosmetic Dentist Dr. Mike Malone.