Treating Enamel Hypoplasia

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I have been dealing with enamel hypoplasia for years. Now I have finally saved enough to do something about it. Can you tell me my treatment options from a completely objective perspective? I live in a completely different part of the country from your practice, so I feel confident asking someone who cannot profit from the procedure chosen. I hope that doesn’t offend you. I just find I am likely to receive more accurate information by those who don’t gain any pecuniary gain from it.

Sylvia

Dear Sylvia,

I am not offended in the least by your question. It is always wise to get an unbiased opinion on something. In fact, I often recommend when patients get a second opinion from a dentist, that they do not tell the second dentist who their dentist is. This way there is no pressure to agree with a peer that they consider a friend.

As to your question about hypoplasia, the treatment you get will depend on the severity of the damage. For those who are unaware of this condition, enamel hypoplasia is when the enamel of the tooth does not fully form. This can happen from a medication taken during the development of your teeth or from a genetic defect.

Two examples of enamel hypoplasia

If you are dealing with the severe type of hypoplasia, then I recommend you have porcelain veneers placed. With this procedure, your dentist will place tiny wafers of porcelain over the teeth after some mild tooth preparation. This is also the standard procedure for patients who are looking for a complete smile makeover. It’s also the go-to for celebrities. So, if there was anything you wanted to change about your smile, including the shape, size, and color, this is the procedure to use.

If you are dealing with mild hypoplasia, then the solution would be to use either dental bonding or porcelain veneers. With dental bonding, the area with the damage is gently removed with microabrasion and then a composite bonding is placed on top of it and it will be polished to a high shine to match your teeth.

Both of these require someone with post-doctoral training in cosmetic dentistry. Don’t go to any dentist. Plus, make sure you check out their smile gallery to see that they have an artistic eye and can produce beautiful results with the procedure you choose.

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

Can Supersmile Remove Stains on Dental Bonding?

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Hi, I have dental bonding on a few teeth because of chips as well as between my two front teeth because of a small gap. They’re starting to stain and it looks weird next to my natural tooth color. Do you know if Supersmile toothpaste works on dental bonding? If so, how long does it take for it to remove the stains? I see they have an accelerator kit. I’m guessing that would be the one to use, right?

James

Dear James,

Supersmile tooth paste image

You have some great questions here. I’m actually going to start with your last question and work my way backward. I would not use the accelerator kit, but just the standard Supersmile Whitening Toothpaste. This is because the accelerator kit adds a whitening ingredient, such as you would get with teeth whitening kits, though not nearly as strong as what you’d get through a dentist. This will utilize a peroxide gel. While that will whiten your natural teeth some, it will do nothing for the bonding. The result will be them having a greater disparity than when you started.

Supersmile toothpaste, on the other hand, is great at removing stains, even from cosmetic dental work, with one exception we’ll get to in a moment. Your second question asked how long it will take the toothpaste to remove the stains. As long as it is a surface stain, it will begin to remove it immediately. This is because, unlike other whitening toothpaste, it removes the stain enzymatically. Its active ingredient is Calprox, which dissolves the protein pellicle layer. Stains attach themselves to the pellicle so when that is gone, the stain is gone.

As for your first question, that depends on the type of stains. As long as your dental bonding is still polished and the stains are on the surface of the polish, then, yes, Supersmile can totally remove those stains. However, if the polish is gone, then Supersmile cannot restore the polish and the bonding will just keep attracting stains. The only way to fix that is to have the polishing repaired or to replace the bonding.

This is one of the reasons I steer patients away from your typical whitening toothpaste. They use abrasives to “whiten” teeth, which damages both the dental bonding as well as the enamel on the surface of your natural teeth.

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

Will Supersmile Toothpaste Let Me Drink Coffee with My Dental Bonding?

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I had dental bonding done a few weeks ago to close a tooth gap. It started staining, which makes the gap repair look really ugly next to my natural color. I think it is because I drink coffee. However, my dentist did not tell me to stay away from any food or beverages. I read that Supersmile Toothpaste can take surface stains off of dental work, such as the bonding I have. What I am wanting to know is whether using this tooth paste will always remove the coffee stains or if I need to give up drinking it?

Dana

Dear Dana,

A side by side image of teeth before and after dental bonding

While it is true that dental bonding is more vulnerable to staining than your natural teeth or porcelain veneers, it should not be staining in just a few weeks. My guess is that you had this bonding done with your general family dentist rather than someone with more post-doctoral training in cosmetic dentistry. This is not a recognized specialty so it is up to the dentist how much, if any, post-doctoral training they invest in to gain some expertise.

Dental bonding is made from composite, which is a blend of plastic resin and inorganic fillers. There are differences in bonding and how vulnerable it is to staining based on the types of fillers used.

Hybrid composites are stronger but cannot be polished to the shine that you want because of the size of the particles. Microfills can be polished to a high luster but are not nearly as strong. Most general dentists just keep the general purpose hybrids, which serves them well for the type of procedures that they normally do.

If you were to go with an expert cosmetic dentist they would combine the two. They’d start with the hybrid on the interior for the strength and then add the microfills for the high luster. this gives you the best of both worlds.

I suggest you go back to your dentist and share what you’ve learned here. Hopefully, he’ll be willing to redo the dental bonding so that it will hold up better cosmetically for you. If your dentist can’t do that, then you can go to another dentist to get it done. If you have the funds, getting two porcelain veneers would last much longer than the bonding, which will have to be replaced every few years. Plus, they are even more stain resistant than your natural teeth.

I hope this helps.
This blog is brought to you by East Cobb Cosmetic Dentist Dr. Cristi Cheek.

Can Composite Bonding be Removed?

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I had composite bonding done on my front teeth to improve my smile, but now it actually looks worse. Is it possible to remove the bonding without damaging the underlying teeth?

Katie

Dear Katie,

Before and after dental bonding

There is a way to safely remove composite bonding from teeth. However, this only works if the composite is bonded to the teeth and not the soft dentin beneath the tooth enamel. Dentists often get requests for vampire teeth around Halloween. We use composite dental bonding because it is reversible.

Here are three ways to safely do it:

  • Sandpaper Disks: These are flexible and bend to the shape of the tooth, making them easier to use. They’re generally used to polish up the composite but can be time-consuming when talking about removing the enamel.
  • Carbide Drills: These are high speed and therefore faster than the sandpaper disks. It’s important light pressure is used so that too much material isn’t removed. However, they tend to leave streaks of material behind so your dentist will want to follow up with the sandpaper disks to remove all the remaining material and leave a nice polish.
  • Micro-etcher: This is also a slow method and best used as a finishing step.

Getting a Beautiful Smile

While a true cosmetic dentist can give you a beautiful smile with dental bonding, it is best used with something like a chipped tooth (as seen above) or for closing a tooth gap. This is because it is done freehand and more time consuming, so it is better on smaller areas. It also doesn’t last very long and will have to be redone every few years.

If you are looking for a gorgeous smile makeover, you would want to get porcelain veneers. These are the go-to for the top of the line smile makeovers and what gives celebrities that Hollywood smile. When well done and well cared for, they can last a lifetime.

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