Hope Restorative & Cosmetic Dentistry

Solving a Collapsed Bite

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Most of my life has been spent with me uncomfortable about my smile. I have trouble speaking certain letters. My jaw hurts a lot, and you can’t even see my teeth most of the time. I wear a night guard and that does help with the jaw pain but obviously I’d love to be able to speak normally, not have pain, and for people to be able to see my teeth. Is there anything that can help me?

Danni

Dear Danni,

Woman covering her mouth with her hand

There is definitely hope for you, but you have to be extremely careful about who you let work on your bite. Bear in mind, I haven’t examined you, but based on your description it sounds like you have a collapsed bite with a sprinkle of TMJ Disorder thrown in for good measure.

What you need is a dentist who can open your bite. However, beware. This is one of the most advanced procedures out there and you need a dentist with the right training. Look at some of the credentials Dr. Cha has to get an idea of what type of dentist you are looking for.

Restorative dentistry is a wide field. You are looking at what amounts to a full mouth reconstruction. To do this properly, it has to first be developed in a way that isn’t permanent, so that necessary changes can be made without further damage to your bite.

This means a dentist will do temporary crowns, called provisionals, until you have a successful outcome. What does a successful outcome look like?

First, it means your jaw no longer hurts. You are completely comfortable. There are no longer any speech problems, you can see your teeth when your mouth is in repose, and you love the way your smile looks. That last part not only requires someone who understands restorative dentistry, but is also a skilled cosmetic dentist, such as you’d get with someone who is AACD accredited.

Please don’t let just anyone work on this. There are countless horror stories of patients who spent years in constant pain trying to fix what an inexperienced dentist did to them.

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

Crowns for Teeth Whitening? NO!

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I have two porcelain veneers on my front teeth. One of them chipped and needs replacing. My dentist says it is because I grind my teeth. The adjacent teeth are yellowing so my dentist wants to do dental crowns on eight of the upper teeth, which would pretty much be all of them when I smile. One of the things I’m wondering about is if I chipped my porcelain veneer would I also damage my dental crowns?

Marie

Dear Marie,

Woman covering her mouth with her hand

I’m appalled by what I’m hearing and am truly hoping there something else to this story. Putting dental crowns on all your upper teeth is a massive overtreatment unless there is something else going on. Based on what you’ve said he’s doing it because one of your porcelain veneers needs replacing and your natural teeth need to be whitened. That’s insane! When you need to whiten teeth, you do just that. You have teeth whitening done. I can see where it would benefit him to suggest otherwise. Teeth whitening will bring him in a few hundred dollars. What he’s suggesting, which is a full-mouth reconstruction, will bring in a minimum of $30,000. I hope that is not his motive.

Another concern I have is replacing your porcelain veneers with dental crowns. Whenever a dentist suggests that, it brings up massive warning bells. This tells me your dentist doesn’t know how to do porcelain veneers. Therefore, he’s telling you to do dental crowns. No dentist in his right mind would remove healthy tooth structure if he didn’t need to. Your dentist would rather do that than admit his lack of skill and send you to another cosmetic dentist with more expertise.

Now, there is a third thing that concerns me and gets to the heart of your question — your teeth grinding. I cannot believe your dentist would know you grind your teeth and not provide a way for you to protect them. A simple nightguard would have kept your porcelain veneer from chipping. As to whether you will damage your dental crowns, yes, if you don’t have the nightguard.

Bottom Line—You Need a Different Dentist

I don’t think you are being well served by your dentist. Here’s what I want you to do. Spend this time during the COVID-19 to research some dentists in your area. Ideally, you’ll want one who is AACD accredited. If you can’t find one, look on mynewsmile.com and go over the websites of their recommended dentists in your area. Check their reviews and pick one.

Once the quarantine is over, do the following. Get your teeth whitened. If you choose Zoom Whitening, give two weeks for the color to settle, then have that single chipped porcelain veneer replaced and have a nightguard made.

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

Touching up Your Teeth Whitening Before Dental Work

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I need to get a dental crown and wanted to touch up the whitening on my teeth first. My dentist provided me with Opalescence PF 20%. What I need to know is how long I need to use it and for how often before I schedule the crown. Can you give me any guidelines?

Yvonne

Dear Yvonne,

Teeth Whitening Trays

One thing which I want to bring up immediately is my concern that your dentist isn’t guiding you on this himelf. Is he unaware of how this works? It is a possibility. If that is the case, it would mean taking a big step back and deciding whether or not you want this dentist to be the one to do your crown. This is especially true if, as I suspect, it is a visible tooth.

If your dentist is mainly engineering-minded, you may end up with a functioning crown, that fits well, but you will be disappointed in the look of it.

As for the teeth whitening, there are a variety of factors involved. How white do you want them? There isn’t really a whiteness cap. The bottom line is the longer you wear the whitening trays, the whiter they get. How much you wear them each day, depends completely up to you. As long as you aren’t experiencing sensitivity you can wear them for as many hours a day as you can tolerate. You really need a minimum of 20 to 30 minutes for the gel to adequately seep into your teeth.

If it’s possible for you to wear them overnight, you will get faster results. Our saliva production slows down at night. That enables the whitening gel to stay on your teeth even longer. During the day, you can wear it as much as you’d like as well, but your saliva will slowly seep into your teeth whitening trays and wash away the gel, requiring you to reapply the gel several times a day.

One definitive is the waiting period between the whitening and the crown development. I suggest waiting two weeks between the time you get the whitening to the color you want and the dentist making your crown.

Who Should Do Your Crown

As I mentioned earlier, it doesn’t appear that our dentist has a lot of cosmetic skills. A dental crown, especially one on a front tooth requires a lot of technical knowledge as well as artistry. This is something I would want you to get an expert to work on. Because cosmetic dentistry isn’t an actual recognized specialty, it is up to the dentist how much they invest in the training.

I’d start by looking for a dentist who is AACD accredited. While they are the top 1% of cosmetic dentists in the country, there aren’t very many of them. If you can’t find one in a reasonable distance to you, there is another list you can check. The mynewsmile.com website also lists expert cosmetic dentists by area. They’re not all AACD accredited, but they do all have expertise and artistry. Any of them can give you a beautiful crown which blends in perfectly with the rest of your teeth.

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

Pain During Teeth Whitening

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I went to see my dentist so I could get my teeth whitened. He knows I have bonding done on one of my teeth. He said I was a good candidate. Everything was going fine until today. I keep feeling this horrible zing on the tooth. It’s painful enough where it makes me jump a bit. It’s on the tooth with the bonding. I’m wondering if the bonding is being weakened by the whitening gel.

Casey

Dear Casey,

Woman covering her mouth with hand.

Can Teeth Whitening Cause Pain?

I’m glad you’re doing this under the supervision of a dentist. Too many people try to skirt the dentist to save money. Then, issues like this turn-up and they’ve got nowhere to turn for help.

The teeth whitening gel will not weaken your bonding. When bonding gets old and needs to be replaced a portion of it may just come off. If your bonding has been there for a while, it’s possible part of the coating has fallen off.

Tooth bonding is usually done on a chipped tooth, which means trauma and exposed parts of the tooth. This is a simple fix. Go see your dentist and let him know what’s going on. He can determine the exact source of the pain and put something there to coat the sensitive area so you can whiten your teeth without pain.

Just be certain not to whiten any further until you see your dentist. You don’t want to nail down what is going on.

Dental Work and Teeth Whitening

Whenever you have dental work, such as dental bonding, porcelain crowns, or even white fillings, the natural tooth will whiten. While the whitening gel will not damage your crowns and such, it won’t whiten it either.

The best course of action is to whiten your teeth, then when you’ve reached the level you want, re-do the bonding or white filling, to match your new color. Of course, this is only useful on work visible when you smile. If it’s on a back tooth, I wouldn’t bother with the expense, unless it will bother you.

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

Afraid the Dentist Will Kill Me

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I have to find a dentist. Normally, I get my teeth looked after by our local hygiene school. They’re thorough and do a good job. But, if an issue pops up you have to go to a dentist. I’ve never had an issue pop up so never really worried about it. But, that all changed at my last appointment. I need to get a tooth looked after and they said it could be saved with a crown, but I need to be prepared for the fact that it will likely need to be extracted. I’m quite afraid of the dentist. I realize that you probably consider that silly. But, I keep seeing stories like this one where people die from sedation. How can I be sure the dentist won’t kill me?

Stephanie – Boston

Stephanie,

It’s not silly to be afraid of the dentist. In fact, many patients are. Sedation dentistry has done a lot to help with that. But, when you have tragedies, such as the one suffered by that little boy, it can make frightened patients more frightened.

My understanding of that case is the dentist wasn’t certified, though for certain types of sedation that’s not required. However, he also gave a significantly excessive dose of sedative drugs to the child, well above the recommendation. I was appalled when I realized how much medicine he gave that preschooler.

So, how do you prevent such a tragedy from happening to yourself?

When you’re looking for the best dentist in this type of situation, the first thing I’d ask is whether or not the dentist is DOCS certified (The Dental Organization for Conscious Sedation). You’ll also want to be certain your vital signs are monitored at all times. There should be a separate person doing this, not the dentist. He or she will be too busy with the procedure to give your vitals adequate attention.

Additionally, it would be great if the dentist and their staff are ACLS certified (Advanced Cardiac Life Support). In any medical procedure there are risks, whether there’s sedation or not. Every medical professional should be prepared for the worst-case scenarios in order to give their patients the best care possible.

Hopefully, a crown will be available to you. An extraction should always be a last resort.

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

 

Problems with a dental crown

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I have gotten a new crown and it has been causing me a lot of pain and was crowding my other teeth. I’ve never experienced this with a crown before. Luckily, it is the temporary. My dentist has adjusted the temporary, but just a few hours later it is hurting again. If I push down on it for a while, it relieves the pain for a little while, but then starts hurting again. My dentist thinks that maybe there is decay with one of the adjacent teeth. I don’t agree. What do you think?

Alice S.- Michigan

Alice,

I think the problem with the dental crown is with your bite. If there was some kind of decay or infection in your other tooth, pressing down on it would not make it feel better. It could be that the adjacent teeth are the ones that need to be adjusted. Maybe when it was crowding your teeth they got knocked out.

It is important this gets dealt with and it may mean your dentist adjusting the other teeth. Pain aside, if you leave this you could end up with TMJ.

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

 

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