Am I Too Young for Porcelain Veneers

Posted on by .

I am twenty-two years old and have had my braces off for several years. Despite that, there is still a slight gap between my front teeth. I would like to get some porcelain veneers because I also have some chips and have always thought my teeth were too short. My dentist hinted I may be too young for porcelain veneers and to wait until I was 25. If I am too young, should I try to get Invisalign to close the little gaps? Or maybe dental crowns because my dentist said that could make the teeth longer?

Melanie

Dear Melanie,

A porcelain veneer held up against a tooth

I fear that your dentist is steering your toward dental crowns because he knows how to do those. Doing dental crowns is taught to every dentist. However, advanced cosmetic work, such as porcelain veneers, has to be learned after dental school in post-doctoral training. If the teeth are healthy, grinding them down for dental crowns makes no sense.

There is a second factor here. Just because he can do dental crowns, doesn’t mean they will look beautiful or natural. Most dentists will just use a standard shade guide. With back teeth, that is fine. But, with front teeth, there is a lot more that goes into making it look natural and matching the other teeth perfectly.

Invisalign, while a great option for straightening teeth, is not great a closing those tiny spaces left after braces. That is because those tend to open back up fairly quickly after you stop orthodontics. You could have some direct dental bonding placed there to close the gap, but they tend to pick up stains quickly and will have to be replaced more than you’d like.

Your best option to deal with all the issues you described including the lengthening of your teeth is to get porcelain veneers. Plus, they are even more stain resistant than your natural teeth and should last for many years.

So, what about the age issue? The fact is, that once your teeth are fully erupted, which generally happens around the age of 18, you are old enough for porcelain veneers. The caveat will be to find a dentist who can provide you with a beautiful result. You do not want to end up as one of those cosmetic dentistry horror stories.

Look at their smile gallery, which contains before and after pictures of cosmetic work they’ve done. Look specifically at their porcelain veneers cases. If they’re not stunning, find someone else to do them. If a dentist does not have a smile gallery on their website, then they don’t do enough cosmetic work to be good at it.

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

A Full-Mouth Reconstruction Causing Problems

Posted on by .

I am in the middle of a full-mouth reconstruction, and things are not going well. It’s a bit of a mixed bag with two dental implants and the rest are crowns and bridges. I am a bit worried, because the first round went well and I thought I would be good to go. Unfortunately, that has not been the case. Once the permanent ones were bonded on things went really wonka-donk. The teeth are not meeting together the way I had always considered normal. I thought at first maybe it felt different because I was used to it the wrong way. But, now I’m having trouble chewing both because of the way the teeth are meeting (some of them don’t even touch) and the fact that my jaw isn’t moving properly. I don’t think this is because it is unfamiliar to me. Do you have any advice? I’m in quite a bit of pain.

Sandy

Dear Sandy,

An image of a woman holding her jaw while in pain.

Bear in mind that I have not examined you. However, if I am getting an accurate understanding of your description, there is a real problem here. First, for those who are not aware of what a full-mouth reconstruction is, it is when a dentist uses crowns, in some form, on every tooth. In this case, there is a mixture of dental implants, along with crowns and bridges.

Doing a full-mouth reconstruction is a very advanced procedure which very few dentists are actually qualified to do. It takes significant post-doctoral training. Based on your description, the way this was done is a serious problem and it sounds like it has completely thrown off your bite and you are now dealing with both poor occlusion of your teeth as well as TMJ Disorder. If that is the case it needs to be fixed as soon as possible.

One thing that puzzles me is the fact that you said the temporary placements were fine. Your permanent crowns and bridges should have been modeled after your temporaries. Also, your dentist should have used a temporary try-in paste and made sure everything still lined up properly. It does not sound like he did that.

I want you to get a second opinion by a dentist with significant TMJ training. Look for someone who has post-doctoral training in TMJ Disorder. Look for training at one of the following institutions, which are known for their great TMJ instruction:

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

One word of advice. When you do get your second opinion, make sure it is a blind appointment. That means that you do not tell your dentist who did your full-mouth reconstruction. If they ask, just tell them you want an unbiased opinion and would prefer he or she gave their thoughts without knowing who the dentist is.

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

Don’t Be Fooled By 360-Veneers

Posted on by .

I’m so heartbroken. I went to my dentist to get porcelain veneers to finally get a pretty smile. He told me I would be a better candidate for 360-degree wrap veneers. I asked if that would take off too much structure and his response was “hardly any.” I trusted him and put myself in his hands. I think I made a huge mistake. The temporaries they gave me kept falling off but he told me that was because they don’t use strong cement. Now, I have the permanents and though the look is a little better than my natural smile, it is not the gorgeous smile I was hoping for. The worst part is the permanent ones keep popping off too. Three times now. Plus, my teeth when they come off look like little nubs. That is not the “hardly any” he told me. I’m afraid to go anywhere because they keep falling off. The dentist asked if I’d been following his instructions and I have. I don’t eat anything hard. I cut up my food very tiny. It doesn’t matter, they are still coming off. They’re talking about a new cement, but I’ve lost confidence in them. What do I do?

Carol Anne

Dear Carol Anne,

I am very sorry this happened to you. Being generous, I am going to say your dentist is ethically challenged. You should know there is no such thing as 360 wrap veneers. That is a “synonym” for dental crowns. Below is a picture of porcelain veneer tooth preparation.

toot preparation for a porcelain veneer

Tooth preparation with porcelain veneers

As you can see from the picture above, only a few millimeters of structure is taken off the front of your teeth. This is because veneers do not wrap around. That is what crowns do. You mentioned your teeth look like little nubs. My guess is they look a bit like the picture below.

tooth prep for dental crowns

Tooth preparation for dental crowns

Why Give Me Crowns Instead of Veneers?

One of the first things dentists learn how to do in dental school is a dental crown. So, they graduate knowing how to do that. Though, your dentist seems to struggle with even that basic skill. Porcelain veneers, on the other hand, are a cosmetic proceedure. Cosmetic dentistry is not taught in dental school. Instead, dentists have to voluntarily take post-doctoral classes in the procedures.

Because of that, dentists who do not invest in that training will steer their patients toward dental crowns instead of saying, “I don’t know how to do those.” It’s one thing to steer your client in another direction. It’s totally a different thing to lie to them about what they are getting, which is what happened in your case.

In addition to that, your dentist can’t even make crowns that stay in. He deceived you and the work is not functional. My suggestion is for you to ask for a refund and then find a cosmetic dentist that can actually fix this for you. Unfortunately, you are stuck with crowns now that your teeth are ground down, but that doesn’t mean you can’t have beautiful crowns that give you the smile you wanted AND will stay put. By the way, you should be able to eat whatever you want without them falling out. He’s trying to blame you for his incompetence.

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

TMJ Dentist Disasters

Posted on by .

I’ve been to two different TMJ Dentists and both times my situation ended up worse. The first time I was with my dentist and mentioned headaches. He told me it is probably because I grind my teeth and the situation is to crown all my teeth. It wasn’t done correctly, and my bite ended up at a slant. I managed to grind those down too and was in more pain than ever. I went to see another dentist who called himself a TMJ specialist. He placed me in some kind of bite splint for two years. Now my bite is too far forward on my lower jaw. The pain is unbearable. I don’t know who to turn to at this point. What do you recommend?

Katherine L.

Dear Katherine,

Woman holding her jaw in pain from TMJ disorder

Treating TMJ properly requires training.

One of the problems you are facing is that being a TMJ Dentist is not really a specialty. Any dentist can call themselves a TMJ dentist, regardless of the amount of post-doctoral training they have. It seems you have been seen by two dentists who did procedures that were over their heads. The first dentist botched your full-mouth reconstruction. This is one of the most advanced procedures in dental work and does require a great deal of post-doctoral training. Then, when your procedure was done, knowing you were a teeth grinder he should have provided you with a mouthguard. For that matter, why didn’t he provide you with a mouth guard to begin with? Why wait until your teeth were ground down and you needed them to be crowned? He was not serving your best interest.The second dentist left you in the orthotic way too long. These are meant to be temporary.

So, where do you go from here? They have left you with a serious case of TMJ Disorder at this point. You need a dentist with the training to give you proper treatment. I would look for someone who trained at the Dawson Academy, the Las Vegas Institute for Advanced Dental Studies, or the Kois Center. All of these have excellent TMJ Training Programs.

One other bit of advice. Do not think you have to choose between form and function. Whatever crowns your new dentist places, the first thing you need to make certain of is that your crowns fit comfortably. They should feel perfectly natural and your bite come together naturally. In addition to that, you want them to look beautiful. When they are placed, make sure the dentist does it with a temporary try-in paste. You should get a chance to look at the aesthetics of the bite in several different lightings. If you are not happy with how they look, then you need to have the dentist send them back and redo them until you are. A patient deserves a healthy, natural bite that looks beautiful as well.

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

Are Veneer Crowns a Thing?

Posted on by .

I am frustrated and worried after getting a full smile makeover of veneer crowns. He did twelve teeth on top and ten on the bottom. The temporary veneer crowns felt okay, but after the permanent ones went on, I started having problems. My dentist looked it over and said that on one of the teeth there’s an abscess and also has the nerves dying. He sent me to an endodontist to have the root canal done and that dentist found four more teeth that failed some kind of test and needed root canals too. My dentist told me there were no risks to this smile makeover so I’m really frustrated and confused. I went back and asked him about it and he said I was just unlucky and he’s never seen this happen. He’s offered to cover half the cost of the root canals, but I’m still out of a LOT of money here and I’m worried the rest of the teeth are going to have the same problem one by one. Have you heard of this happening before?

Elaine

Dear Elaine,

I’m a bit concerned by what I am hearing and I want to start by defining some terms. There are porcelain veneers and there are porcelain crowns, but there is not anything called veneer crowns. So, right off the bat, we need to figure out what you received. Based on the need for root canal treatments, I think you received dental crowns and NOT porcelain veneers. If your dentist told you he was giving you porcelain veneers, but gave you crowns, he could be in a lot of trouble. Here’s how to tell which you have.

Porcelain Veneers Versus Porcelain Crowns

porcelain crown prep

Tooth preparation for dental crowns


With dental crowns, your teeth have to be ground down to nubs in order to fit the crown. You will notice it fits completely over your tooth and you’ll be able to feel them on the back of your teeth as well. This is a much more aggressive treatment and should not be used for a smile makeover unless there were extenuating circumstances that necessitated it. You didn’t mention anything that made me think you needed crowns rather than veneers.

porcelain veneer prep

Tooth preparation for porcelain veneers

With porcelain veneers, you do not need much tooth structure removed at all. Typically, a dentist will remove a few millimeters, about the depth of a fingernail. These cover the front of your teeth and hug the sides a little but will not be on the back of your teeth. It would be extraordinarily unusual for your teeth to need a root canal with a veneer.

I think your dentist gave you crowns. I also think he was too aggressive in the tooth preparation which is why the nerves are dying. My suspicion is he knows that as well because he offered to pay for a portion of the root canal treatments. I would press your dentist into paying for all the root canal treatments. This should not have happened.

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

Tooth Replacements for Hockey Players

Posted on by .

Can you tell me what the best tooth replacement is? I’m a hockey player and have lost two teeth this season. I want something pretty sturdy in case I get hit in the mouth again. This just hasn’t been my season.

Bran

Dear Bran,

hockey player with a missing tooth

I am sorry to hear you have been having a rough season. Hockey is a tough sport as it is. When it comes to replacing teeth, the usual answer is the best tooth replacement option is a dental implant. However, your circumstance is a tad more complicated than most because your replacement tooth is likely to get hit again.

A dental implant is the premiere tooth replacement because it mimics your natural tooth’s engineering with a root form and a crown. However, when you break a tooth you are not as likely to take the root of your tooth with it. A dental implant, because of the way they are bonded with the crown is the opposite. If you lose the crown there is a good chance the implant will do some damage to your surrounding bone. We don’t want to risk that.

However, you do want the root form there in order to ensure you don’t start having bone resorption in the area, which will make it harder to get an implant later.

My suggestion is you have the root form of the implants placed, which will preserve your bone in that area, but delay the dental crowns until you are done with your hockey career. Some dentists even do same day crowns, which will speed that process up when the time comes. That doesn’t mean that you have to keep gaps in your smile.

I’d like to suggest you get something inexpensive, such as a dental flipper. These can fill in the gaps, but will come out easily if you are hit in the mouth again. This way there is no serious damage done to your jaw, which could require reconstructive surgery.

Best of luck to you and I hope next season is a winner for you!
This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Touch Up Teeth Whitening

Posted on by .

I am having a crown replaced and before making a final decision on the color of the crown I want to touch up my teeth. I had them whitened back when I first received my crown about four years ago. Of course, my teeth have picked up stains since then. How long should I use the whitening gel each day to get them back to the color I want?

Mary

Dear Mary,

tooth bleaching trays

I am going to answer your question about teeth whitening touch-ups, but before I do I wanted to address something about your dental crown. You said your crown is only 4 years old and already needs to be replaced. In general, a crown should last a minimum of 5 years. Well made crowns, coupled with good care from the patient, can last upwards of 15 years. I’m concerned about the skill level of your dentist if yours only lasted four.

Sometimes patients will go to the dentist with the cheapest fees thinking they will save money. Often, though, that backfires. Let’s say your dentist only charges $500 for a crown, but another more skilled dentist charges $1,000. You may think you are saving money by going to the cheaper dentist, but if his crown only lasts four years and the more expensive crown lasts closer to fifteen or sixteen years, you’ll be paying $500 four different times. You actually ended up paying double the amount than if you’d have gone to the skilled dentist to begin with. That’s not including the hassle and lost time having to go back and forth for each new crown.

Now, let’s talk about that teeth whitening. The basic principle with teeth whitening is the longer you can tolerate wearing the whitening gel, the faster your teeth will whiten. To get whiten the fastest, my suggestion is either to have Zoom Whitening done. This is an in-office procedure that whitens your teeth in one appointment. The main advantage to this is speed. There are two disadvantages, though. It is more expensive than bleaching with trays and you have little to no control over how white they get.

Your second option is to have bleaching trays made by your dentist. You can use your old ones if you still have them. Then, try wearing the gel overnight. Not only is this a longer stretch of time than most people can do during the day, but the gel is more effective at night. This is because your saliva level goes down at night so there is more potency available with the gel. If that is difficult for you and causes sensitivity, then you just wear them for as long as you can during the day. How many days that is necessary depends on how white your goal result is.

The one hard and fast rule is to give it a week or two between the time you complete your teeth whitening and the time you have the crown made. This gives the color of your teeth time to settle.

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

Dentist Won’t Give Me a CEREC Crown on a Front Tooth

Posted on by .

I have to get a dental crown on a front tooth. My dentist has the CEREC machine but tells me he won’t use it for front teeth. I don’t understand that. Shouldn’t that be my choice? I’d really like to have it done in just one day.

Carol

Dear Carol,

porcelain block for CEREC crwons

I think what your dentist is trying to tell you is that it will not look the way you want if you do it on a front tooth. CEREC crowns are milled from a single block of porcelain. That means the crown will be uniform in color. If you look at your front teeth in the mirror, you will notice they are not uniform. The level of translucency changes as you go from the top to the bottom of the tooth.

More light hits your front teeth than others. This means all those subtle differences are more noticeable. If you want a beautiful front tooth, that matches the one next to it exactly, you will be better off letting your dentist do a traditional crown. These are made from several varieties of porcelain, which enables the dentist to shape it with all those varying changes in translucency.

Dental Crowns and Tooth Color

One other thing you need to be aware of is the permanency of color with dental crowns. While they can be made any color you’d like, the color is permanent. Your natural teeth may pick up stains, but the porcelain on your crowns is more stain resistant.
The color they are made is the color they’ll stay.

If you like the current color of your teeth, then no worries. You can move forward, confident you will be happy with the color your dental crown was made. However, if you are considering getting your teeth whitened, the time to do it is before you have your crown made.

If you decide to do teeth whitening later, your natural teeth will whiten, but the dental crown will not. The only way to get it to match your new color is to replace it. Having the whitening done ahead of time will save you money.

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

Full Mouth Reconstruction for White Teeth

Posted on by .

I have one dental crown and 3 porcelain veneers. The tooth with the crown had a root canal treatment, so it was already there. The gumline by this crown is showing a black/gray line. The veneers are starting to show their age as well. I asked my dentist about replacing these. He wants to do crowns on all my teeth because they’re not very white and this will take care of both issues at once. My concern is the choice. Why crowns instead of porcelain veneers?

Patty

Dear Patty,

tooth bleaching trays

I just want to make sure I’m understanding you correctly. Your dentist wants to crown all your teeth because they aren’t very white? Really? I have so many concerns about this. First, the solution for teeth that aren’t very white is to do teeth whitening. Not only does that preserve all of your tooth structure, but it is also significantly less expensive.

You brought up one of my second concerns. Why crowns instead of porcelain veneers? I can tell you why. Dentists who aren’t comfortable doing porcelain veneers, will steer their patients toward dental crowns. Here is the problem with that. Smile makeovers are not taught in dental school. Porcelain veneers should be a basic skill for any cosmetic dentist. However, there are plenty of cosmetic dentists who do them, but do them badly. You don’t want that either.

When you have a dentist already letting you know he can’t do porcelain veneers, run away from that dentist doing any cosmetic work on your teeth.

Crowning all your teeth is known as a full mouth reconstruction. This is one of the most advanced procedures a dentist will have to do. Not only is there the cosmetic aspect of it, which your dentist has already hinted he’s not qualified to do, but getting the proper occlusion of your teeth also takes significant post-doctoral training, which I doubt he has. If it is done wrong, you could end up with TMJ Disorder and a lifetime of pain and migraines.

My suggestion is you let him do the teeth whitening and then find a cosmetic dentist to replace the crown and veneers. Look at their smile gallery to see what type of results they get in order to get an idea of their skill level. Though, make sure it is their own work and not just stock photos. If they don’t have a smile gallery, they are not a cosmetic dentist at all.

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

Maryland Bridge Between Two Implant Crowns

Posted on by .

I have two dental implants and just lost the tooth that is between them. My dentist is tinkering with the idea of putting a Maryland Bridge between them. Have you had experience with this type of restoration? Does it work okay to put a Maryland Bridge between two crowns?

Reuben

Dear Reuben,

Maryland Bridge

I don’t think this is going to be your best viable solution for a few reasons. First, while a Maryland Bridge sounds easy to place on the surface, it is actually a bit more complicated than most dentists think. The best material to bond it to is tooth enamel. In your case, that isn’t an option. Your dentist will be trying to bond it to porcelain, which is harder.

Secondly, for a Maryland Bridge to have any security they need a groove etched into the adjacent teeth for the wings. Because you have a dental crown, there is a good chance it the groove will end up taking things to the metal base which makes it even harder to retain.

Ideally, your dentist would have anticipated that with two dental implants you might one day need a third. Then he or she could have made the implants parallel to one another and used screw-retained crowns. This way, if you lose the middle tooth, it becomes a simple matter of turning your two crowns into a dental bridge.

Seeing as that is not possible, I would first suggest seeing if you can fit a third dental implant in there. That would give you the most secure retention.

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