Archives for January 2024

My Smile Is Disappearing

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I would love some advice. It is almost impossible to see my teeth, even when I smile. I don’t know what is causing this but I am so embarrassed by my smile. My dentist said that porcelain veneers might help. That is a pretty expensive procedure to get a might. Here is some more information and maybe you can tell me if that maybe leans more toward a yes or no. When my lips are in repose, you cannot see my teeth at all. When I force my smile as big as possible, you can see a bit of my teeth. I have jaw pain and wear my night guard. When the night guard is in, you can see my teeth a bit better. What do you think?

Caroline

Dear Caroline,

A chart showing the connection between muscles, jaw joints, and teeth

I am going to right off the bat tell you that porcelain veneers are NOT the solution for this. In fact, it is so much not the solution to this that I think when you get the actually procedures you need, it will be important to find another dentist to do it. While porcelain veneers might help your appearance, if he is a skilled cosmetic dentist, it could potentially make your pain significantly worse.

Based on your description, it sounds like you have ground your teeth down, which has caused them to be overclosed. That kind of positioning could lead to TMJ Disorder. The fact that you’ve been having jaw pain makes me think this is what is happening. I’m glad you have a nightguard because that could help prevent further damage. However, the damage already done needs to be dealt with. This will require a dentist who has training and understands TMJ Disorder and the different type of treatments.

I believe you are going to need a full mouth reconstruction which means crowning each of the ground down teeth. It needs someone with training far above what most general dentists have.

I would suggest doing an internet search for “TMJ Dentist.” Then, check that they have post-doctoral training in TMJ. It’s not a recognized specialty, but general dental school is not enough. Ideally, they would have gained additional training at one of these institutions:

  • The Dawson Academy
  • The Pankey Institute
  • The Las Vegas Institute for Advanced Dental Studies

Then, take the additional precaution of checking out their smile gallery to see if they have some artistic skill with cosmetic dentistry and can create beautiful smiles. You do not have to choose between form and function. Find a dentist who can do both.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Getting My Implant Crowns to Look

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I had two dental implants placed on front teeth. My dentist plans on doing the crowns soon, including two additional crowns on the adjacent teeth in order to get everything to match. I want it to look beautiful and have some things that are worrying me. I have a high smile that shows gums. Is there a way to address this? I haven’t heard the dentist mention anything about this. After looking some things up, I think I need to avoid porcelain fused to metal crowns and I would need to get my teeth whitened first, not after. Is that correct?

Misty

Dear Misty,

An image of both titanium and zirconia dental implants

I am glad you are writing before your dentist does this. I am not sure you are with the right dentist to give you the aesthetic result you are hoping for. I see four red flags right off the bat. First, that your dentist did no building up of the gums in preparation for this. Second, he hasn’t discussed with you the crown options. Third, that he is adding two unnecessary crowns in order to get everything to match. Finally, he didn’t address the teeth whitening with you.

I’m going to start with the third one first. Your dealing with front teeth that are particularly tricky to get to look beautiful and natural and it takes a great deal of artistry and experience. If he needs to add crowns in order to just get the color to match, he does not have those qualifications. Why would you want to remove structure from healthy teeth unnecessarily?

Looking at the type of crown you would use. Yes, you will want an all porcelain crown. However, depending on the type of dental implants you received, you may already have a metal base. My guess is your dentist did the traditional titanium implants, which are metal. There are zirconia ones that have a ceramic base, but if your implants are placed, you don’t want to switch them out. This does not mean that you cannot have a beautiful result. What you’ll need is a dentist who knows both how to conceal the border between the implant and your crown, as well as mimic the translucency of a natural tooth while making it opaque enough to cover the base. I’m concerned that your dentist is not the one to do this.

As for the teeth whitening, absolutely you need to do that before your dental crowns are made. The color of your crowns cannot be changed once the are completed.

You found all this information out on your own, without a dental degree. Why hasn’t your dentist? I am going to recommend getting a different dentist for this part of your procedure. Someone who is an expert cosmetic dentist. Don’t try to teach your dentist what to do. It won’t work.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Choosing a Cosmetic Dentist on Yelp?

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I am getting a smile makeover. I’ve narrowed the cosmetic dentist I’m going to use down to three of them, but have some questions before I settle on which one. All three are highly rated on Yelp. It sounds like dental bonding is less expensive than porcelain veneers but may not last as long. Do you have a recommendation on which to use? As I am in my 60s, would it look silly if I went with really white teeth?

Joyce

Dear Joyce,

porcelain veneer being placed on a tooth

Congratulations on getting a smile makeover. They can be life changing. I’m going to start with the bonding versus porcelain veneers question.

Dental bonding is typically for small repairs, such as a chipped tooth or a gap between two teeth. It will last a few years, but not much longer. While it is inexpensive with the small repairs, if you wanted to use it for a full smile makeover, you will find it will end up more expensive. It is done by hand and over such a large surface would be quite time consuming. You will definitely want porcelain veneers.

I don’t recommend that you choose your cosmetic dentists simply based on their Yelp rating. While I do use Yelp for certain recommendations, such as a plumber or electrician, it is not a great way to pick a dentist to do your cosmetic work. This is because they don’t distinguish the reason for the ratings. A dentist can have over one hundred 5-star ratings, but most of them could be just about how friendly he or she is and not their cosmetic skill.

As an example, I just did a search on Yelp for “Best Cosmetic Dentist” in a mid-sized city. Just looking at the top three dentists, only one of them even does cosmetic dentistry. On the one who did, when I looked on her website, there wasn’t even a smile gallery. That is a sure sign that they don’t do enough cosmetic dentistry to be serious about it.

A smile makoever is an advanced procedure. It takes more than technical knowledge. It also needs some artistry. I would look at whether or not they have any post-doctoral training in cosmetic work as well as the type of results they get with the cases they’ve done. This is where the smile gallery comes in handy because you get to see the before and after pictures.

As for the color, this is very subjective. If you want a white smile, you should get one. If you speak with the cosmetic dentist about the type of smile you hope to create, he or she will be able to advise you on the color.

This blog is brought to you by East Cobb Cosmetic Dentist Dr. Cristi Cheek.