Hope Restorative & Cosmetic Dentistry

My Dentist Nicked My Maryland Bridge and Left a Silver Line Showing

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My Maryland bridge is 15 years old, but until recently, it was intact. I agreed with my dentist to replace two crowns on the top left side of my mouth. I grind my teeth, so the crowns were worn and looked rugged. I got new crowns three weeks ago, and when I got home, I noticed a silver line showing through the bridge tooth. My dentist covered the silver line with composite and said that I should probably get the bridge replaced. He did agree that he might have nicked the bridge tooth while adjusting my bite, but he also said that my teeth grinding more likely caused the streak. How could teeth grinding cause a line? Today, I see the silver line again on the bridge tooth. So, I probably will get it replaced. What’s the point of having two new crowns with another damaged tooth flashing a silver streak? I’m wondering if my dentist should pay for this, though. Should I ask? Thank you. Wesley from Andover, MD

 

Maryland Bridge replacing two lower teeth - info from Tulsa, OK dentist Jerome Cha, DDS

Dental Maryland Bridge

For our readers: A Maryland bridge is a type of tooth replacement. Replacement teeth are in the center, and wings, or extensions, on each end of the bridge attach to the back of adjacent teeth. See the photo on this page.

Wesley,

Thank you for choosing our office for your question.

Dr. Cha would need to examine your Maryland bridge to see its condition. But you realize that your bridge tooth did not have a silver line before your dentist replaced your crowns and adjusted your bite. So yes, you should ask your dentist to restore or replace the bridge tooth at no charge.

Asking Your Dentist to Pay for Your Damaged Crown

You can ask your dentist to pay for the bridge tooth directly, but you may want to prepare an explanation. We suggest finding an experienced cosmetic dentist to examine your Maryland bridge. The dentist who examines it can do the following:

  • Tell if teeth grinding caused the streak on the bridge tooth
  • Determine if a dental instrument scratched the surface
  • Give you documentation on the cause of damage to the surface

You can return to your dentist with the second opinion document and ask for a refund or if he will pay for getting your bridge restored or replaced.

Restoring a Crown without Replacing the Maryland Bridge

Perhaps a highly skilled cosmetic dentist can conceal the damage to the tooth of the bridge without replacing the entire bridge. One method includes these steps:

  • Grind some of the metal to make room for dental bonding cement
  • Etch the metal with a micro-etcher
  • Prime the metal with a thin layer of opaque cement that bonds to metal
  • Cure the cement
  • Place composite over the cement
  • Shape and polish the composite

Patient cases differ, so an advanced cosmetic dentist will need to examine your bridge and determine if they can save it.

Schedule an appointment with an accredited cosmetic dentist or one with extensive post-graduate training in cosmetic dentistry.

Dr. Jerome Cha, a Tulsa, OK accredited cosmetic dentist, sponsors this post.

 

Groupon for Teeth Whitening

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I received a Groupon for a teeth whitening kit called Premium Home Whitening. Is this okay to use? Will it work? Is it safe? I don’t know how to judge these types of products.

Margie

Dear Margie,

Teeth Whitening Trays

I’m glad you wrote. I looked at this kit. There are three aspects to this to consider. First, the whitening ingredient. They use carbamide peroxide, which is a good whitening agent. That part checks out. Second, the blue light. This light appears to be bogus. It seems to only be there as a psychological agent. This bothers me. Adding materials that don’t work to make your kit seem better is dishonest. Third, is the bleaching trays.

Above, I have an image of tooth bleaching trays. When you have your teeth whitened with a dentist, they will fashion custom-fitted trays for your whitening process. This has the advantage of insuring your teeth whitening will be as effective as possible. It does this by ensuring the gel does not leak out and your saliva does not seep in, thereby diluting the gel.

The trays you will get with this kit will not be form-fitted to your specific bite. That will mean you will not get the full effectiveness of the whitening gel. In addition, there is a safety issue. The gel leaking can irritate your gums. I know of one case where a person needed a root canal treatment as a result of an over-the-counter whitening kit.

Given the cost of this kit, my suggestion would be to talk to your dentist about professional teeth whitening. Let him know the cost you were offered from this kit and see if he’d be willing to come close to meething it. If he does, you can get more effective teeth whitening in a safer way.

This blog is brought to you by Tulsa Cosmetic Dentist Dr. Jerome Cha, an AACD accredited dentist.

Multi-Colored Teeth After Porcelain Veneers

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I had four porcelain veneers placed and my teeth have ended up multi-colored. First, I have the color of my natural teeth that are next to the four veneers. Then, there is one that is the white color I wanted. The other two are varying shades of gray. One of the teeth was grayer to begin with. The dentist told me that wouldn’t be a problem because they could just make that porcelain veneer thicker. It is thicker, but the colors are still different. Plus, you can tell the one is thicker. What worries me the most are the gray ones because one of them started off white. Is there a way to make this look normal?

Cindy

Dear Cindy,

Porcelain veneer being placed on a tooth

Your dentist may have been well-intentioned, but he or she was in way over his head. Many patients do not realize that cosmetic dentistry is not a recognized specialty. Any general dentist can do cosmetic procedures. In addition, smile makeovers are not taught in dental school. Instead, it is dependent upon the dentist to decide if and how much training they pursue.

A second issue in regard to cosmetic dentistry is that doing a smile makeover is actually an art form. Like any art, some artists are more skilled than others. Two artists can have the same canvas, paints, and subject yet produce vastly different results.

Your dentist does not appear to have invested much in cosmetic training, neglecting even the most basic detail. For instance, you mentioned your natural tooth color doesn’t match your porcelain veneers. It would be rare if they did. Most people want a whiter smile than their current natural one. Because of that, when a smile is wider than the number of veneers a patient is getting, a dentist will have you whiten your teeth first. This is so your adjacent teeth will be in a similar shade to your makeover.

I would love to have an image of the tooth that started white but turned gray. However, I can give you some general ideas. If the discoloration is over the entire tooth, it could either be that the glazing has been damaged, which is causing the veneer to pick up stains or possibly it wasn’t porcelain at all.

On the other hand, if the discoloration is splotchy, it is more likely that you have microleakage going on. That happens when the bonding isn’t done properly. Food and other bacteria can get underneath the veneers. This will not only result in staining, but can seriously damage the tooth underneath causing decay.

Your only option in order to get them to look natural and beautiful, will be to have these re-done. I don’t think you will get any better results from your dentist the second time around. My suggestion is you simply ask for a refund and then have a skilled cosmetic dentist re-do your smile makeover properly. The best cosmetic dentists are AACD accredited. You’ll receive a stunning smile.

This blog is brought to you by Tulsa Cosmetic Dentist Dr. Jerome Cha.

My Two Front Crowns Don’t Match

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I have some metal allergies so I went to a dentist who offered zirconia crowns. I had damage to two front teeth that both needed crowns. The first time they came back, they looked really opaque and I asked him to re-do them. He didn’t seem thrilled but he agreed. When the permanent ones came back, I expected he would again let me see them first, but instead of putting them in with temporary paste, he just bonded them on. They are several shades darker than my natural teeth and are shorter than I would have expected. Normally, my front teeth are a little longer than my other teeth. He insists this is the color I told him I wanted. It isn’t. First, I didn’t pick a specific shade just that I wanted them as white has my natural teeth. I don’t know what to do. He said the only way he’ll change them out now is for the other ones I’d already rejected. I didn’t think I’d need a cosmetic dentist for two simple dental crowns. I thought that was something every dentist did.

Morgan

Dear Morgan,

Woman Covering her mouth

I am sorry you are going through this and will definitely file it in my cosmetic dentistry horror story file. Though, technically, you are correct that every dentist should be able to do a dental crown, that doesn’t mean they understand both function and form. Front teeth are tricky because they are so visible when you smile.

You have likely already figured this out, but this guy isn’t the best cosmetic dentist. He isn’t even the best dentist because he doesn’t seem to care how his patients feel about the quality of his work or their smile.

The one good thing you have going for you is that this dentist did not let you approve them before permanently bonding them on. Because he used a temporary try-in paste last time, you had a reasonable expectation that you would get to approve them this time. Therefore, bonding them on without your permission was wrong and unethical. Instead of having him re-do them..again, which I doubt will get you any better results, I suggest you just ask for a refund on the basis that you didn’t approve him bonding them on.

Once that is secured, you can find a great cosmetic dentist to do these. Those at the top of the cosmetic field are AACD accredited. They’ll give you two gorgeous crowns.

This blog is brought to you by Tulsa Cosmetic Dentist Dr. Jerome Cha.

Disastrous Smile Makeover

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I went to my dentist in the hopes of having my top four front teeth fixed. They are overcrowded and misaligned. My dentist said if we did cosmetic dentistry, it could make the teeth appear aligned and not overcrowded and I wouldn’t have to deal with two years of braces. That sounded great to me, so I agreed. His assessment was to do dental bonding on the #10 tooth, a porcelain veneer on the #7 tooth, and shaping of the other visible upper teeth. He told me that would take care of all the appearance issues. By the time he finished, the teeth were still overcrowded and misaligned and he charged me a little over 9K, which included some shaping of the lower teeth, which I never signed on for. I asked him about the results he promised me and he said in order to achieve that I would need four dental crowns on the top teeth, including root canals. All of this additional work would cost me another 7K. I decided it was time for a second opinion. The next dentist said that all this smile makeover would have required would be some teeth whitening and four porcelain veneers on the upper teeth with no root canal treatments and no crowns. I am going to get this done with the second dentist. My question is, is there a way for me to get back the money I poured into this with my original dentist?

Matthew

Dear Matthew,

Porcelain veneer being placed on a tooth

We are gathering together a large number of cosmetic dentistry horror stories, such as yours, in order to warn patients about the importance of choosing the right dentist when it comes to cosmetic dental work. You have certainly been taken advantage of by this dentist. First, he promised results he did not deliver. Secondly, he charged you for work you didn’t agree to (which is illegal). Finally, he changed the treatment plan once you weren’t happy with the results. If that was the right course of action, why didn’t he suggest that to begin with?

I am glad you sought a second opinion, and porcelain veneers are definitely a better option for the type of smile you’ll like. The word of this second dentist should help you secure the refund I believe you are entitled to. However, before you do that, I want you to make sure this second dentist is any more qualified to give you a better result than the first dentist. Many patients don’t realize that not only are smile makeovers not taught in dental school, but there isn’t a recognized specialty in cosmetic dentistry. This means any dentist can do the work regardless of the training they invested in (or didn’t).

In your place, I would seek out an AACD accredited dentist. These are the top cosmetic dentists in the country with proven technical skills and artistry. Then, have that dentist help you secure your refund and do the follow-up work.

With regard to your refund, under most circumstances, most dentists would care enough about the opinion of their peers to give you that refund. However, it sounds to me like your dentist may be less interested in the opinions of his patients and peers than in his pocketbook. In that case, you may have to get tough and threaten to sue him. I am fairly certain his insurance company will tell him to settle.

This blog is brought to you by Tulsa Cosmetic Dentist Dr. Jeomre Cha.

I Hate My Porcelain Veneers

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I had a full set of porcelain veneers done (six in total). The whole thing feels like a disaster. I wish I’d have got my teeth whitened ahead of time because you can still see teeth that don’t have veneers on them when I smile and they are much more yellow than my new veneers. Even if I had though, this smile looks ridiculous. There are gaps on top between the veneers and the gum as well as between some of the teeth. They also aren’t as white as I asked for. When he first did the wax model, I mentioned all these issues and he told me it was because it was the wax. Once the real ones were made, none of that would be an issue. Then, when he did the try-in of the real ones, everything seemed exactly like the wax ones. I mentioned that and he said we should bond them on and we’d see what I thought then. I agreed, but I’m not sure why. He did appear frustrated with me so I felt a bit like I was being a “problem patient”. I didn’t like them after they were bonded on. He told me to give it some time and see if I’m just not used to the new look. I did, and still didn’t like them. Now he is saying I agreed to bond them on. Is there anything I can do?

Miriam

Dear Miriam,

Porcelain veneer being placed on a tooth

Thank you for writing. You have been through quite a bit with this dentist. You are facing one of the big problems with cosmetic dentistry these days. It isn’t a recognized specialty. That means any general dentist can do cosmetic dentistry. There are cosmetic dentists who have invested their time and money in training to do smile makeover, which is not taught in dental school. Then, there are general dentists who just call themselves cosmetic dentists.

It sounds like your dentist was going through some motions he’s heard about without understanding what they were for. Both the wax mock-up and the try-in are for YOU to decide what you think of them. If you don’t like them in either step, they should go back to the lab to be re-done until they are done to your satisfaction.

Under normal circumstances, because you had given approval for him to bond them on, you would have no recourse. You aren’t able to get a refund simply because you don’t like how they look. However, there is something you mentioned that could work in your favor. You said there are gaps between the top of your porcelain veneers and your gumline. This isn’t an issue of them being unattractive. It is a functional issue. Those gaps will trap food and other bacteria. This will cause you both gum disease and decay. So…yay you! Now you can get a refund.

My suggestion is that you have a dentist with real expertise look at your case. If they agree about that gap, they can help you secure your refund. Just make sure you don’t tell them who did your porcelain veneers until after they give their opinion. The dental world is a small one. It is better for you if they do not feel conflicted because it would mean saying something negative about a friend.

The best cosmetic dentists are AACD accredited. This is different from membership. It means they have proven their cosmetic skill and are capable of creating beautiful smiles. This is who you should get to give your second opinion and to re-do your porcelain veneers.

As to the teeth whitening, go ahead and get that done. It won’t hurt your porcelain veneers and it will even up your smile somewhat.

This blog is brought to you by Tulsa Cosmetic Dentist Dr. Jerome Cha.

Gums Inflamed after Porcelain Veneers

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I had some porcelain veneers placed on my teeth. Since then, my gums around the porcelain veneers have been inflamed. The hygienist insists she’s never seen this before and is blaming me, essentially accusing me of not brushing my teeth well. Aside from how insulting this is, it is profoundly not true. At 42 years old, I know how to brush my teeth. When the dentist came in a little bit later, he removed some excess cement. Since then, it has been slightly better, but they are still red and inflamed. Now it hurts when I brush. I have never had problems with my gums before and don’t know how to handle the situation. My dentist sees no issues so I am not going to get any help there. Do you have any recommendations for me?

Laura

Dear Laura,

I am frustrated by the experience you are having. Whenever a patient has a smile makeover, it has been our experience that they take better care of their teeth. The fact that they are trying to pass whatever type of mistake they made on you is infuriating.
Gums inflamed from poorly done porcelain veneersIf you look at this image, you will see this patient is also suffering from inflamed gums. If a dentist were to submit this case to the American Academy of Cosmetic Dentistry, the board would reject them from accreditation.

AACD accredited dentists have to prove that they can not only produce beautiful results but that they do it in a technically proficient way so the patient suffers no problems as a result of the work. Your dentist didn’t do that.

Possible Problems with Your Porcelain Veneers

Left Behind Cement

Though your dentist did make this error, I think it is only part of your problem. However, it will cause issues with gums. This is a mistake often made by dentists who do not do a lot of porcelain veneers. Skilled cosmetic dentists have a system to prevent this from happening. The best way is to tack on the veneer by curing the cement in the middle of the tooth. Then, while the remainder of the cement is still soft, the excess is removed. Your dentist should have done this the day your porcelain veneers were seated. Doing it at your follow-up visit tells me he didn’t even realize his error until you complained.

Improperly Done Margins

You likely wouldn’t have a way of recognizing this and I doubt your dentist will either. Or maybe he will but does not want to own up to another mistake. My recommendation is for you to get a second opinion on these veneers by an expert cosmetic dentist. Look for one that is recommended on the mynewsmile.com website. All of them have artistic and technical expertise. Make sure it is a blind second opinion. That just means you don’t tell him who the dentist is that did your veneers. You don’t want him influenced by whether or not he’s friends with the dentist.

This is a huge mistake because it can not only cause gum disease but will also lead to decay because food and other bacteria will get trapped.

If it is just a matter of more cement being left, that will be an easy fix. If the margins are the problem, this dentist can help you get a refund from your dentist and can get them re-done by an expert cosmetic dentist.

This blog is brought to you by Tulsa Cosmetic Dentist Dr. Jerome Cha. An AACD Accredited Dentist.

Porcelain Veneers with an Overbite

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I wanted to get porcelain veneers to cover my tetracycline stains. My dentist said because I have an overbite, I will need to get porcelain crowns instead. Will this still give me a beautiful result?

Caitlyn

Dear Caitlyn,

porcelain veneer being placed on a tooth

I want you to run away from this dentist as fast as you can. He may be a great family dentist, but he is lacking in cosmetic dentistry skills. Rather than being honest with you, he is trying to steer you toward a procedure he feels comfortable with. If he does the work, the results will not be beautiful no matter which procedure he used.

This is because to do truly beautiful cosmetic dental work requires advanced post-doctoral training. Unfortunately for patients, cosmetic dentistry isn’t a recognized specialty this means any general dentist can call themselves a cosmetic dentist regardless of the amount of training they’ve acquired.

To get porcelain crowns on your teeth would require you to grind your teeth down to little stubs. That is not what you want. Why grind away healthy tooth structure? Nope. In your case, with an overbite, porcelain veneers actually make more sense. This is because they don’t require anything to be placed on the backs of your teeth the way crowns do.

Where Should You Go for Beautiful Cosmetic Work?

You want a dentist who is a true artist with great technical knowledge and skill. This is especially important for you because of your tetracycline cases. These are the most difficult cosmetic cases around. The veneers will need to be opaque enough to cover the dark stains but still have a natural light and translucency to them.

I want you to look for a dentist who has attained accreditation with the American Academy of Cosmetic Dentistry. AACD accredited dentists had to pass stringent exams as well as demonstrate their artistry to an examination board. They are the best cosmetic dentists in the country and will provide you with a stunning smile. In fact, most of them have a beautiful smile guarantee.

This blog is brought to you by Tulsa Cosmetic Dentist Dr. Jerome Cha.

Is It Possible to Have too Much Shine?

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I have a smile makeover with porcelain veneers. I know in most cases people like their porcelain veneers to shine, but is it possible for them to have too much shine on them? My veneers are so shiny, they look fake. Is there a way to take the shine off of them?

Belinda

Dear Belinda,

There is a way to get the shine off of your porcelain veneers, but I don’t think you will want to do that. The shine comes from the glaze put on them, which is what protects your porcelain veneers from picking up stains. If you take the glaze off, it won’t be long before they begin to stain. However, you still may be able to get the porcelain veneers to look the way you want. Here is what I think the problem stems from.

Close up image of teeth.

If you look at the image of these teeth you will notice that there is texture to them. Though they are shiny, the shine still looks natural because of that texture. In fact, I bet you can’t even guess which one of those is not a natural tooth. My guess is your dentist didn’t add the necessary texture. Without that, the teeth will be flat and have too much light reflecting which is what is making them look too bright.

My suggestion would be to simply talk to your dentist and ask him to re-do them. If he cares about the quality of his work, he shouldn’t have a problem with that. After all, you paid to get a beautiful smile and that is what you should get. An expert cosmetic dentist wouldn’t even bond on your porcelain veneers until you had an opportunity to see them with a temporary try-in paste and look at them in different lights. Only when you are absolutely satisfied would they be permanently bonded.

This blog is brought to you by Tulsa Cosmetic Dentist Dr. Jerome Cha.
AACD Accredited Dentist

Will I have an Ugly Smile with Dentures?

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I have had four pregnancies in a row where I vomited every day of the entire pregnancy. My teeth are a mess. They are literally crumbling. I can’t afford much dental work, as you can imagine with four children. They’re also the focus of any money I have for dental care. Because I am losing so many teeth I just want to get dentures. My dentist tells me my smile will be horrible with dentures. He wants me to get dental implants, but I’d have to sell my house to do that. There is absolutely no way I can do that. Am I condemned to an ugly smile for the rest of my life? Are there any in-between options?

Katarina

Dear Katarina,

Illustration of facial collapse

You are in a tough situation. I can tell you are a good mother because you are willing to sacrifice anything for them. I wish dentists understood not everyone has the ideal budget for things and I can tell you are doing your best. The dentures themselves can be beautiful if the dentist who makes them is a skilled cosmetic dentist, so hopefully, your dentist wasn’t meaning the dentures themselves would be unattractive. My suspicion is he’s worried about facial collapse.

The Danger of Facial Collapse with Dentures

I don’t know your age, but I am assuming you are pretty young. When you remove your teeth, your body will recognize that and will interpret that as you no longer needing your jawbone to retain your teeth. Our bodies are remarkably efficient. As a result, it resorbs the minerals in your jawbone to use elsewhere in your body where it perceives they will be more necessary. The unfortunate result of this is the shrinking of your jawbone. Eventually, you will lose so much of your jawbone that it becomes impossible to even keep in your dentures. This is known as facial collapse. I’ve placed a picture of this above so you can get an idea of what I mean.

The Compromise Solution

Having upper dentures isn’t as devastating as having lower dentures. I would recommend, in your case, getting dentures for your upper teeth and then, implant-supported dentures on the bottom teeth is a good solid middle ground. While ideally, you’d want between four and six dental implants to preserve as much of your jaw as possible, you can get as few as two and it will help.

The reason dental implants are so useful in this aspect is the implant serves as a prosthetic tooth root. This helps your brain to realize there will still be teeth there, albeit false teeth. Knowing that, your body leaves the jawbone intact.

Getting a Beautiful Smile Regardless of the Tooth Replacement

As mentioned earlier, you can have beautiful dentures made with the right dentist. I would look either for a dentist who is AACD accredited or one who is recommended on the mynewsmile.com website. These dentists have top cosmetic skills and will create a beautiful smile for you.

If you do decide to get some dental implants, be sure they have adequate post-doctoral training. Dr. Cha’s dental implant page will give you a good idea of what type of training they’d need to give you the best chance of a successful outcome.

This blog is brought to you by Tulsa Dentist Dr. Jerome Cha.

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