Tag Archives: AACD Accredited 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.

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.

cerec crowns on front teeth

I was in a car accident and damaged both my front teeth. I need to get crowns on them. I am trying to decide between regular crowns and CEREC crowns. Is one better than the other?

Benjamin

Dear Benjamin,

porcelain block for CEREC crown

CEREC crowns are made out of single block of porcelain. This will give it a very uniform look. This works fine on most teeth. However, our front teeth are much more visible and exposed to light.

Natural teeth aren’t uniform. Look at this image of a tooth directly below. There are varying levels of translucency and opaqueness depending on where you are on the tooth.

image of a tooth

When a dentist does a traditional crown, it is built in layers with varying shades of porcelain. This can make a crown look more natural. However, even then, you’d need an expert cosmetic dentist because this takes a high level of skill.

If you really want a CEREC crown, then having an expert cosmetic dentist is even more important. They need to have a high level of skill in color theory so they can use various stains to give it that variated look while keeping that natural translucency.

Cosmetic Considerations with Dental Crowns

The dental crown can be made to match your teeth exactly. However, the color is permanent. If you are happy with the color of your teeth, then you do not need to take any further steps. However, if you want your teeth any whiter, the time to take care of that is before having the crowns designed.

In that case, your first step is to have your teeth whitened. You can do that in one appointment if you see a dentist who does Zoom Whitening.

Then, give it a couple of weeks for the color to calm down. That’s when your dentist can match the permanent color for you.

When you’re talking about front teeth, whether you get a traditional or CEREC crown, you will need a dentist capable of the skills required. I suggest you see an AACD accredited dentist.

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

Solution for huge tooth gap

I have a large tooth gap. It was last measured at 9mm. I thought about doing Snap-on Smile, but after all the tests and things, it turned out I wasn’t a candidate for that procedure. I’m too old for braces, so I’m thinking about Lumineers. I have scheduled an appointment with a Lumineers certified dentist in a couple of weeks but thought I’d check and see if you thought that was a waste of my time and money.

Kevin

Dear Kevin,

I am very glad you wrote before going through with this plan of Lumineers. While I am sure you could find a dentist willing to do it for you, it would end up a disaster!

The size of your gap is enough to fit another tooth. Unless the dentist is a top of the line, expert cosmetic dentist you are going to end up with something that looks ridiculous. And I will tell you right off the bat, dentists who advertise as placing Lumineers tend to be at the bottom of the barrel of cosmetic dentists.

The Lumineers company markets themselves to inexperienced cosmetic dentists as being easy to place because they don’t require any tooth preparation, the way other brands of porcelain veneers do. There are two problems with that.

One, that rarely turns out looking anything but bulky. Some people have described it as horse teeth. And, two, there is a whole lot more to creating a beautiful smile than just the tooth preparation.

An Invisible Alternative to Braces

side by side compairison of braces
Braces versus Invisalign

You mentioned you were too old for braces. Has your dentist discussed Invisalign with you yet? These are sometimes called invisible braces.

Both people in the image above are wearing orthodontics. The one on the left is wearing traditional braces. The one on the right is wearing Invisalign. No one will be able to tell you are wearing them even at a conversational distance.

With the size of the gap you are talking about Invisalign would be my number one recommendation for repair. It has an added benefit as well. Invisalign uses clear plastic aligners to straighten your teeth. Those aligners can double as teeth whitening trays. This will allow you to straighten and whiten your teeth all at once.

If you don’t like the idea of any orthodontics, then you will need to go with porcelain veneers. However, as I mentioned above, you will need an expert cosmetic dentist in your case. I would only see an AACD accredited dentist to do your porcelain veneers case, if that is what you decide on.

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

gums inflamed after porcelain veneers

I had porcelain veneers placed on four teeth almost a month and a half ago. Since they’ve been on, my gums have been inflamed. I went in to see the hygienist and she said it is probably that I’m babying the teeth and not brushing well enough. I can assure you that is not the case. Then, at my one-month follow up the dentist removed some excess cement. That helped a little but it has been a week and a half since then and they are still inflamed. My dentist doesn’t seem concerned but I’m worried, not to mention in pain. What do you recommend?

Kay L.

Dear Kay,

Our experience has been patients love their new smiles so much, after getting porcelain veneers, they tend to take better care of them, not worse. Isn’t it a tad annoying when medical professionals blame the patient when they can’t figure out what is wrong?

Cosmetic dentistry is both an art and a science. The health of the gums is one of many things the American Academy of Cosmetic Dentistry looks at in evaluating cases when dentists are working toward accreditation.

The lateral incisors, in this case, received porcelain veneers. Because of the gum inflammation on these teeth, this case would be rejected as unacceptable by AACD accreditation examiners.

In the case above, the gum inflammation on the lateral incisors would be an indication this dentist did something wrong, causing the case to be rejected by accreditation examiners as a means of demonstrating competency.

While there are several reasons your gums could be inflamed, I’m leaning heavily toward your dentist not removing all the excess cement. You said he removed some at your one-month follow-up appointment. When done properly, all the excess cement would have been removed immediately after they were bonded. There shouldn’t have been any to remove at the follow-up appointment.

A couple of other possibilities would be uneven margins or the porcelain veneers going too far under the gumline. To truly know what is going on, though, you’re going to need to see an expert cosmetic dentist.

Getting a 2nd Opinion from an Expert Cosmetic Dentist

The first thing I want you to do is go to the website of the American Academy of Cosmetic Dentistry. (aacd.com). They have a link to find a cosmetic dentist. However, make sure you check the boxes for an accredited dentist. Membership is easy. AACD accreditation requires real skill.

Pick one which is reasonably close to you and schedule an appointment for a second opinion.

Finally, make sure when you go, you get a “blind” second opinion. This means you won’t tell them which dentist did the work or anything they said could be the problem. You want the accredited dentist to give his unbiased opinion without anything to sway him.

Best of luck.

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

can I fix the color of my cerec crowns?

I had a CEREC crown done on one of my canine teeth about three weeks ago. We never really discussed the shade while I was in the office, but as soon as I got home, I realized that it was a bit lighter than the rest of my teeth. Well, once I saw it, I couldn’t un-see it, and now every time I look at myself, all I see is that darn tooth. It looks fake.

I didn’t want to bother my dentist with this at first, so I started playing around with at-home whitening products to try to get the rest of my teeth to match, but I’m just not getting them as bright as that CEREC crown. This probably sounds crazy, but I’m starting to wonder if he can darken it just a bit, so it’s a better match. Is that even possible?

Thanks,

Stan

Dear Stan,

CEREC crown restorations and materials

There are a couple of things about your case that give away that your dentist isn’t really what I would call a cosmetic dentist. Every dentist who is serious about cosmetic dentistry, when they place a crown on a front tooth, will make sure you get a good look at it before it is permanently bonded on. He didn’t do that.

The other problem is that it is a CEREC crown. The CEREC material is a block of material that is a set shade. Unless the dentist is an advanced cosmetic dentist, he won’t know how to use color theory and stains to match a front tooth.

To match a front tooth, a true cosmetic dentist has the ability to customize the shade. Each tooth in your mouth has differences in color from the neck of the tooth to the tip, and it is quite a process to mix different materials to get a crown to match the surrounding teeth.

Tints and Stains Exist

There are tints and stains that can be applied to the CEREC to customize the shade. But on a ceramic, that has to be baked into the crown, so that has to be done before the crown is put in your mouth, obviously.

Sounds Like You Will Have to Have Your CEREC Crown Replaced

You deserve to be happy with your smile and he biffed the color. Hopefully, your dentist will agree to re-doing the crown. However, this time, make sure you get to look at it BEFORE they cement it. Check it out under various lighting conditions—seriously. Look at it in the chair. Get up and go into the bathroom and check it there. Venture to an outside window and view it in natural sunlight. If it isn’t right, don’t let them cement it.

Request a Lab-Made Restoration if All Else Fails

There are crowns that have a core that is made like a CEREC crown and then have porcelain baked over the top. If you want a natural-looking crown on a front tooth, this is the way to go. Although you’ll have to wait two weeks for the lab to make it, the lab technician will be able to tint the crown to match your existing teeth. But the dentist also needs to have a good eye for color and the ability to describe the color variations in your tooth, and your dentist doesn’t sound like he is that much into that. For the best results, you’d really want to switch to someone who specializes in cosmetic dentistry for these sorts of things, but you’ve already started with him, so as long as you’re keen to continue, give him the chance to fix his work too.

If he can’t, look for a dentist who has been accredited with the American Academy of Cosmetic Dentistry. AACD accredited dentists are the top cosmetic dentists in the country.

This blog is sponsored by Lafayette, LA Dentist Dr. Mike Malone.

covering tetracycline stains

I have pretty bad tetracycline stains, as did my sister. She had porcelain veneers put on them a number of years ago. While they look better than my teeth, they do not look natural. They told her they had to use an opaquer in order to get them to cover the stains. I was hoping in the last few years or so they’ve made some advancements so that if I had porcelain veneers done, they would look more natural. What are my chances?

Avery

Dear Avery,

A single porcelain veneer being placed on a tooth

When it comes to making natural-looking porcelain veneers, the need isn’t for better advancements; rather, it’s for better cosmetic dentists.

The technology has been around for years, but very few cosmetic dentists have the training and skill required to pull it off. To be fair, tetracycline stains are among the most challenging a dentist can face.

The porcelain veneers have to be opaque enough to cover the stains, yet translucent enough to reflect light and look normal. I would say only the top 1% of dentists in the country are capable of pulling this off.

Finding an Expert Cosmetic Dentist

If you want the best cosmetic dentist, and you will need that for tetracycline stains, you will want an AACD accredited dentist.

The American Academy of Cosmetic Dentistry realized, because cosmetic dentistry isn’t a recognized specialty, patients would have a hard time distinguishing who was actually skilled and who just dabbled.

To reach accreditation, dentist have to pass stringent oral and written exams as well as provide a large number of cases which demonstrate they have artistry in their work as well.

Those who reach this level are in the top 1-2% of dentists in the country. You can locate them at aacd.com. Just make sure you check you want an accredited dentist.

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

porcelain veneers during pregnancy

I’ve been saving up for a smile makeover. I just reached the amount I needed and I found out I was pregnant. Am I able to move forward wtih the porcelain veneers or do I need to wait until after the baby is born?

Melinda

Dear Melinda,

A single porcelain veneer being placed on a tooth

Congratulations on your new little one! While there are so many things you’ll have to protect your new child from, porcelain veneers won’t be one of them.

There are some cosmetic procedures which are not recommended during pregnancy, such as teeth whitening. This is because, especially during the first trimester, when the baby is most vulnerable you don’t want them ingesting any unsafe chemicals.

Fortunately, porcelain veneers do not have anything which could endanger your baby. The only chemical used would be lidocaine which has already been proven safe in pregnancy.

It is up to you at this point. Some women struggle with intense nausea during their first trimester. That may make having your mouth messed with a challenge. Because of that, you may want to wait and see how your body reacts to this new baby first. If you seem to be fine, you can move forward. If not, there is no harm in waiting.

Who Should Do Your Porcelain Veneers?

You don’t want just anyone doing your smile makeover, though. This is a once in a lifetime procedure and you’ll want it done right. Because there isn’t a recognized specialty in cosmetic dentistry, there is no real way to know if the dentist doing your procedure has had enough additional training to do the job well.

In your place, I’d look for a dentist who has attained accreditation with the American Academy of Cosmetic Dentistry. AACD accredited dentists are the top cosmetic dentists in the country.

They’ve passed stringent oral and written exams to prove their technical knowledge. Additionally, they had to provide visual evidence on a large number of cases they’ve done to show they are also artistic.

Any one of them can give you a stunning smile.

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

porcelain veneers & invisalign?

I’m hoping you can help me make a decision. I want to whiten my teeth and I have two crooked front teeth. I was thinking I could fix both getting porcelain veneers. I spoke to my dentist about it and he said that would be fine, but he’d like me to straighten the front teeth first. I was hoping not to have to do orthodontics because they’re so unattractive and take forever. Is it really necessary?

Kathryn

Dear Kathryn,

Invisalign aligner
You can now straighten your teeth invisibly

First, please understand that I haven’t seen your teeth and can only go by your description. Unless there is something your dentist hasn’t explained to you, I’m puzzled why you would need both as well.

Generally, a patient will either do porcelain veneers or orthodontics, not both. There could be an exception if you have either a serious bite problem or overly crowded teeth. In those unusual cases, it would be helpful to have orthodontics first. Other than that, you can just have porcelain veneers placed and it will make your front teeth appear to be straight.

If you are in that position, then I have some helpful news for you. You can completely straighten your teeth without anyone knowing. Invisalign uses clear aligners. You can see an image of one of the aligners above. When you are wearing them, they are completely invisible, even at a conversational distance.

The best part is they have the benefit of being able to whiten your teeth simultaneously. The aligners used to straighten your teeth can also double as teeth whitening trays.

Invisalign or Porcelain Veneers

If you have the choice and all you want to do is whiten and straighten your teeth, you would save a lot of money using Invisalign. However, if there are other things about your smile you want to change, such as the shape or length, then porcelain veneers are the way to go.

These are the go-to for a complete smile makeover. One word of caution. They require technical expertise as well as an artistic eye. Not every dentist can do a smile makeover with porcelain veneers. There are countless cosmetic dentistry horror stories to back this up.

If you decide to go that route, you will want a dentist who has been accredited with the American Academy of Cosmetic Dentistry. AACD accredited dentists are the top cosmetic dentists in the country.

If you go the Invisalign/teeth whitening route, just about any family dentist can do it.

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

dentist ruined this man’s bite

I’m worried I made a horrible mistake having a gap closed. I had a large gap between my two front teeth. To fix it, my dentist did six dental crowns. Ever since then, I’ve been in a lot of pain, I can’t speak properly, and my mouth is dry all the time. Can I put the gap back? Would that fix this?

Peter

Dear Peter,

CEREC Crown being placed on a tooth
Sometimes a dentist gets in over their head

Your problem isn’t because the gap was closed. These large gaps can be fixed without any negative repercussions. Instead, I think your porcelain crowns were not done properly. This case was probably too challenging for your dentist. As a result, he has inadvertently damaged your bite.

This is rather serious and needs to be addressed right away. My suspicion is your dentist made your dental crowns too thick, which opened your bite too much. This led to the pain you are experiencing as well as lip incompetence.

When your crowns are too thick, it leads to your mouth staying agape. That will cause the dry mouth you are struggling with. It is absolutely imperative your mouth closes naturally. Without that, you won’t have enough saliva in your mouth. Saliva is a key component in fighting decay because of its bacteria fighting minerals.

Pain is also a result of a bite being opened too far. This can lead to problems with TMJ Disorder. Though, pain is enough of a reason to have this fixed.

Your dentist appears to have been in over his head fixing this gap. I want you to see an AACD accredited cosmetic dentist. They’ll have the expertise you need to fix this. They can also help you secure a refund from your dentist.

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