Fixing a Tooth Gap

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I have a medium-sized tooth gap. My dentist is suggesting we do Lumineers, but I am on kind of a tight budget at the moment. Would I better off getting braces? I’m not too keen on that idea because I’m in my early 30s, but I am ready to get rid of this gap.

Leslie

Dear Leslie,

I’m glad you wrote. I am not going to recommend you go with Lumineers. It is a rather large overtreatment for your situation. The good news is, you can fix this without ugly metal braces. You have two good choices here.

Option One: Dental Bonding

before and after dental bonding

In most cases, dental bonding is the solution. It uses a composite bonding to close up the space. In the picture above, you see it used to repair a chipped tooth. This is not something any dentist can do. You will need to go to an experienced cosmetic dentist, especially since it has to be done freehand. I am not going to recommend you use your dentist for this. My guess is he suggested Lumineers because he doesn’t know how to do dental bonding. The Lumineers brand is often marketed to dentists who are inexperienced with cosmetic dentistry as being easy to place. That is likely why he suggested it. If he does this, you won’t like the results.

One thing to note. While the color can be made to match your teeth perfectly, the color is permanent. If you decide to whiten your teeth in a year, your natural teeth will whiten but your bonding will not. Because of that, I often suggest if you plan on whitening your teeth to do so before you have the bonding done. This will save you money in the long run.

Option Two: Invisalign

Invisalign Aligners

If the only thing you want to fix about your tooth alignment is the gap, then dental bonding is the way to go. It is faster and cheaper than the option I’m giving you now. However, if there are other things about your bite that need to be realigned, it will be worth it to get Invisalign. These are sometimes called invisible braces. That is because they use clear aligners to straighten your teeth. There are no wires or brackets either. No one will even know you have orthodontics on.

Either one of these will work for you and will be a better and less expensive option than your dentist is suggesting.
This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Crooked Discolored Teeth

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I am 37 years old and recently divorced. I have discolored and crooked teeth. This is a point in my life where I really do not need to feel ugly. At this point in my life, braces are the last thing I’ll want. Are there other ways of improving my smile given my issues?

Joan

Dear Joan,

Invisalign Aligners

I am sorry to hear about your recent divorce. That is a difficult and trying time. You certainly deserve to feel attractive at any point in your life, but especially at a time when everything else feels up in arms. Fortunately, there is a way to improve both aspects of your smile at the same time, and you won’t have to wear a mouth full of metal.

You have a couple of options. I’ll start with the least expensive. Your crooked teeth could be repaired with Invisalign. These are sometimes called invisible braces. Instead of the traditional metal wires and brackets, it uses clear aligners to straighten your teeth. Not only does this allow you to straighten your teeth without anyone knowing, but it does so in a fraction of the time that the metal braces would.

They also have the additional benefit of allowing you to whiten your teeth at the same time you are straightening them. The aligners can double as teeth whitening trays. This saves you additional money.

If the only thing you are concerned about is the discoloration and crookedness, this is the way I’d go. If, however, you have other things about your smile you would like to repair such as their length or character, then getting a complete smile makeover with porcelain veneers would be the way to go. These are high end and what celebrities use to give themselves that Hollywood smile. With porcelain veneers you can change the shape, size, and color of your teeth all at the same time.

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

Will Invisalign Work with Missing Teeth?

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I have two congenitally missing lower bicuspids and have grown up with crooked teeth. One of the lower bicuspids had to be pulled because of decay. I’ve spent a lifetime embarrassed about my smile. I don’t think having a mouthful of metal will help with how I feel about my smile. Someone recently told me about Invisalign. I would like to use that but don’t know if it can work around missing teeth. I’ve had an orthodontist say no and a regular dentist say yes. I want to believe the dentist but that may be because I really want a pretty smile. Any advice?

Trina

Dear Trina,

Invisalign Aligners

I’ve often found that orthodontists are more conservative with Invisalign because their training is in orthodontics. Dentists who work with Invisalign have invested more time with it and are more comfortable with it. In fact, Invisalign works well around missing teeth. I’d go with your dentist.

There is a hidden benefit to Invisalign as well that you can’t get with orthodontics. The clear aligners that Invisalign uses can also double as teeth whitening trays. This will give you a mini smile makeover while saving you money on teeth whitening.

Once your teeth are in their correct placement, you will want to replace the missing teeth in order to keep them retained in the right place. There are several options in replacing missing teeth, but in your place, I would want dental implants. They are the most like having healthy natural teeth in your mouth again. Talk to your dentist about all the tooth replacement options available to you and you can decide what is best.

Be aware that not every dentist is trained in dental implants. It is possible you’ll have to go to one dentist for your Invisalign or another for your dental implants. A third option is finding a dentist skilled at both. Whichever way you go, you will be able to have the smile you always wanted.

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

Smile Direct Club Complications

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I am not sure how familiar you are with Smile Direct Club. It is a mail-order invisible braces service that compares itself to Invisalign, but less expensive. Does it work? Sometimes. When it doesn’t, though, it is a disaster.

We came across this video on YouTube from a Smile Direct Club user. For the sake of time, we have a shortened version of it. The full version, which is about 20 minutes, can be seen on YouTube.

Here is some background. This patient is entering her 6th month with Smile Direct Club. She is striving, without success, to place her new aligners in. After about twenty minutes, she gives up. The original video was posted in December of 2018.

In a follow-up video, we learn what happened. SmileDirectClub mistakenly shipped her month 5 aligners in month 4 and then shipped the month 4 aligners in month 5. This meant that in month 6, when she should have been finishing her month 5 treatment, she had actually gone backward to month 4’s position. This made it extraordinarily difficult to place her new aligners in.

While you make think what is the big deal? It is a huge deal. Imagine a doctor getting two different patient’s x-rays mixed up. As a result, they gave the treatment to the wrong patient and the patient who actually needed the treatment is left without the necessary health care. This is malpractice and could lead to serious consequences.

For this patient, starting the month five treatment early put a great deal of stress on her teeth, risking root absorption. Then, going backward this means additional stress was put on her teeth. I would love to see some before and after x-rays of her tooth roots from his mix-up on the part of Smile Direct. I’m fairly confident there will have been some root resorption which will put her at risk of tooth loss.

Another huge problem is that the patient is left to figure this out for herself. Fortunately, she made this video which alerted the company they were getting some bad press. There really isn’t follow-up with this company so most patients are left completely on their own.

If you are going to get invisible braces, like Invisalign, my suggestion is you do it through a dentist where you will get constant follow up care to make sure your treatment is going according to plan. And, who is there to make safe adjustments if it is not.

Invisalign has a hidden benefit as well. The aligners can double as teeth whitening trays. So, if you ask your dentist for some professional strength whitening gel, you can straighten and whiten your teeth at the same time, giving yourself a mini smile makeover.

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

Does Smile Direct Club Work?

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I know it probably seems weird that I am asking you, a dentist, about an online orthodontic service when you sell Invisalign. But, I live clear across the country from where you practice, so you won’t lose any business by telling me the truth. Hahaha. So here is my question. Every time I get on Facebook, I see an ad for Smile Direct Club. They do have quite a few good reviews. But, I thought before I invested in it I would like to get a real dentist’s opinion. Does Smile Direct work?

Rebekah

Dear Rebekah,

SmileDirectClub Advert

I’m glad you wrote. And don’t worry, you aren’t the first person to ask about this particular service. My duty is to ensure those who are seeking dental advice from us get the best and understand their options. So, never hesitate to write with questions. Yes, I am not surprised you see the ads a lot. They are heavily advertised. As for the good reviews, that doesn’t surprise me either, but not for the reasons you think.

Recent investigative journalism has uncovered Smile Direct Clubs’ habit of only offering refunds to unhappy clients if they sign a release saying they won’t post any negative reviews and will remove any negative content they have already placed. In other words, we won’t get a true picture of their reviews because patients with bad experiences don’t talk about it in order to get a refund.

However, let me just go into what we know for a certainty about how this program works.

Problem One: Missing Diagnostics

A good dentist will do a full mouth series of x-rays and a comprehensive dental examination. This would include looking for things such as signs of TMJ Disorder, tooth decay, and gum disease. Skipping this step can cause the patient a lifetime of pain and unnecessary dental work that could have been avoided. To me, it is inexcusable to skip this step.

Problem Two: DIY Impressions

In order to get a truly accurate treatment plan, it is imperative the impression is done carefully. That means there will be no bubbles, tears, or other defects. This step is so important that some dentists won’t even allow their assistants to take it. With Smile Direct, they just send you a kit to do your own impression at home. I find it doubtful this will give you the best orthodontic treatment.

Problem Three: Adding Space

Most cases of patients needing braces have crowded teeth. This means they will either need some shaving of a few teeth or some back teeth extracted. This needs to be done by a dentist invested in you and the case. Unfortunately, Smile Direct has a shortcut to this too and I worry about its impact on patients.

Problem Four: Inadequate Follow-Up

When you do a treatment, such as Invisalign through a dentist, you are getting follow up care every two weeks when you are given your new aligners. This prevents so many problems. While the treatment is pre-planned, sometimes our teeth don’t cooperate. Maybe teeth don’t turn the way they are supposed to or more space is needed than we originally thought. Without that follow up, your teeth could end up in a worse position than they were to begin with.

What does this mean for you? Well, you could try Smile Direct Club. It might turn out well for you and you’ll save some money. However, first I would get a complete examination from your dentist just to make sure you don’t have any underlying conditions that could cause a problem. But, you are taking chances. So go into it with eyes wide open.

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

A SmileDirectClub Concern

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Last month I wrote about some reviews customers of SmileDirectClub posted to illustrate potential concerns with using mail-order orthodontics. Today, I would like to look at an accusation levied against SmileDirectClub in a New York Times article. You can read the article in total here.

Does SmileDirectClub Hush Its Critics?

One of the concerns posited by the article is that for some clients to get a refund from the company when their treatment didn’t work, they had to agree not to post anything negative in addition to removing any negative posts or reviews on social media. According to the article, “When some of the customers requested refunds, SmileDirectClub asked them to sign the confidentiality provision. The agreement prohibited the customers from telling anyone about the refund and required them to delete negative social media comments and reviews, according to a copy viewed by The Times.”

Often potential patients rely on reviews to help them make a decision on whether to make a purchase, therefore the more complete the information the more likely the patient is to make the decision that is best for them. However, when some of that information is being suppressed, it makes it difficult for patients to see the whole picture.

While no dentist is perfect, after all, we’re human, when a dentist gets a bad review, their concern should be making things right with that patient, not hiding the review. One of the ways you can know when a practitioner cares is in how they handle problems. Any company, no matter what the field, if they have an occasional bad review but address the issue in good faith, then you know they care about their customers, or in a dentist’s case, patients. On the flip side, if you see bad reviews that are never even addressed you can know they don’t seem to care about making things right.

Why hide the reviews if they make things right? I can’t answer that on their behalf. One thing that makes me wonder, though, is out of the seven customers interviewed by the Times, more than half of them found the treatment made their bite worse and they had to seek outside treatment to get it fixed.

SmileDirectClub’s Litigiousness

A second concern the article brought up was how litigious the company is. In addition to suing Lifehacker over an article they published about the risks of using SmileDirect, they have also sued several dental boards for what they perceived as steps to make it harder to use their services.

Yet, while they seem very willing to jump into court themselves, they make each potential customer sign a form that they would not sue the company for any reason.

I will always stress the importance of doing any type of dental work whether traditional braces or invisible braces, such as Invisalign, under the care of a dental professional. Orthodontic treatment rarely goes as planned from start to finish and the dentist or orthodontist will make adjustments throughout the treatment for you to get the optimum results.

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

Is there a Benefit to Invisalign if Everyone is Wearing a Mask?

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I’ve been setting aside cash in my HSA for Invisalign treatment. It’s something I set up at the end of last year. Long before coronavirus was a thing, I worked out what my co-payments would be and broke it up across the year so that I could start treatment at the end of this year. I’m 37 and work in an office setting, so for me, the big draw was that I wouldn’t be stuck with a face full of metal braces as an adult. I know some people do, and I certainly don’t think anything less of them for it, but I really wanted to keep things low key for myself.

Now COVID is in full swing and I’m still working from home. If my job gets moved back to the office, I’m told we’ll all be wearing masks all day. That in mind, nobody will ever see my teeth anyway. That’s a bit of a bummer, isn’t it? If this becomes a “new normal,” there may be no reason to do cosmetic dental work like braces because nobody will see your smile anyway. The point being, at least during treatment, chances are nobody will know what type of braces I go with. The traditional metal ones are a bit cheaper and I could probably start with treatment now if that’s what I’m going with. But, if I hold out for the clear ones, I’m going to give it a couple more months. Is there still a benefit to using the clear ones or should I just jump in with the metal?

Thanks,

Debra

Dear Debra,

Invisalign Aligners

Great question! Lots of adults prefer the clear aligners simply for aesthetics, but there are quite a few other reasons to choose them over traditional braces as well. First, I’d like to address a separate issue. Braces often get lumped in with cosmetic dental treatment, but that’s a bit misleading. When your teeth are misaligned or crowded, it’s difficult to clean between them no matter how careful or diligent you are. That ultimately leads to cavities and gum disease. Orthodontics can be a vital tool in the long-term health of your teeth and gums. There is also an issue of a misaligned bite leading to TMJ Disorder and migraines.

That said, let’s look at five more ways clear aligners may be the better way to go.

Invisalign may move your teeth faster.

Traditional braces are cemented to the front surface of your teeth. That’s where they apply the pressure required to get teeth to move. Aligners give gentle nudges along a greater surface area, which means they can usually move teeth faster. Some cases with Invisalign are done in half the time as traditional braces.

You’ll have fewer dietary restrictions.

Ever try eating a tough steak, corn on the cob, or caramel with braces? It’s a nightmare! If you manage to do it without breaking anything, you’ll still have your work cut out for you when it’s time to brush after. Conversely, you can remove aligners when you’re ready to eat and brush uninhibited after. Eat whatever you like…even popcorn.

It’ll be easier to clean your teeth and gums during treatment.

Braces can be a great tool, but a lot of people have difficulty cleaning around them in general. To that end, it’s quite common for people to develop stains or decalcified spots on their teeth during treatment. One of the most common questions cosmetic dentists get after teens finish braces is how to get rid of the spots that developed.

Additionally, many also develop gingivitis, where their gums become inflamed and will bleed when brushed. This is more because it is difficult to get floss or floss picks between the braces, so plaque builds up and bacteria flourishes. Again, you can remove clear aligners, so you won’t have this battle on your hands with Invisalign.

Aligners are usually more comfortable and result in fewer dental visits.

True, there will always be a bit of discomfort as you swap out aligners, just as you’d have some discomfort during orthodontic adjustments, but at least with aligners, there’s no metal digging into tender tissues and no wires that can snap and poke you. This also means you’ll have few, if any, emergency dental visits. Considering treatment may go faster overall too, you could spend a whole lot less time in the dental chair.

You Can Simultaneously Whiten Your Teeth.

An underused benefit to aligners is they can double as teeth whitening trays. This enables you to straighten and whiten your teeth at the same time, giving you a mini smile makeover at a fraction of the cost.

Clear aligners are still a great choice, even if you’re the only one who will ever know you’re wearing them. Best of luck to you!

This blog is sponsored by East Cobb Dentist Dr. Cristi Cheek.

How Often is the Dentist Necessary During Invisalign?

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I live in Alaska and the nearest Invisalign dentist to me is over two hours away. Would it be absolutely necessary to return every two weeks for new aligners? That would be quite a hardship with me for work.

Rose

Dear Rose,

Braces side by side with Invisalign

Much of how often you’d need to go to the dentist will depend on two things: First, the philosophy of the dentist and second, the complexity of your case. Each dentist is a little different in how they handle the distribution of Invisalign aligners. For instance, some dentists will only want to see the patient once a month and prepare them two sets of aligners. Others are more sticklers.

Given the distance you have to travel and the state you live in, I suspect your dentist will be rather flexible. The exception being, as I mentioned earlier, is if your case is more complex. Some teeth don’t cooperate as well as others. In that case, it would be in your best interest to see him or her more often.

That doesn’t mean it has to be in person every time. With today’s modern technology, he could probably do some of your check-ups through Zoom. Ever since the coronavirus hit, many of us have had to adapt to doing things a bit differently and are becoming quite adept at distance treatment.

I cannot speak for the particular dentist you will be seeing, so please bear in mind this is not me saying you can go less often. I’m just saying it is possible.

A Fun Side Benefit to Invisalign

I don’t know if your dentist has mentioned this to you yet or not, but I thought I’d let you know a little benefit to using Invisalign that has nothing to do with straightening your teeth. Because the aligners are custom fit to your particular bite, they can double as teeth whitening trays. This will allow you to straighten and whiten your teeth at a fraction of the cost. Your dentist can provide you with the professional strength teeth whitening gel.

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

What Do You Do with HUGE Front Teeth?

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I am at my wit’s end. I really want to do something about my smile, but everything I read about smile makeovers talks about making teeth bigger. My problem is my two front teeth are too big. Plus, they stick out from the rest of my teeth. I look like a beaver in need of braces. I’m about to think my only option left is to have the teeth extracted and get dental implants that are the look of teeth I want?

Avery

Dear Avery,

Braces side by side with Invisalign

I’m glad you wrote before going forward with your plan to remove your front teeth. There are much better solutions than that. Bear in mind that I haven’t actually examined you and am just going from your description. There may be other mitigating issues I’m unaware of. However, let’s discuss things as if they’re pretty straight forward.

First, you will want an experienced cosmetic dentist. So make sure you check out smile galleries to see what type of results they get with their work. Second, there are ways to trim your teeth to remove the excess structure. Then, you can use Invisalign to get them into their proper position.

Invisalign is ideal for adults because they are invisible to those around you, even at a conversational distance. Additionally, they have a hidden benefit. The aligners used to straighten your teeth are custom made. This also allows them to double as teeth whitening trays, enabling you to straighten and whiten your teeth at the same time. It’s like getting a mini smile makeover.

I don’t know exactly what your teeth look like, so I want to give you a warning. If a lot of tooth structure has to be removed, you may find the dentin becomes exposed. If that is the case, you will want to have porcelain veneers placed over the dentin to protect them.

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

Switching Dentists Mid Invisalign

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While I am very happy with my Invisalign treatment, I am not happy with my dentist. The treatment itself is a dream. It’s easy to use. It’s comfortable. And I can brush my teeth just like normal. My dentist, however, is very inappropriate. He tells suggestive jokes and the way he looks at me gives me the heebie-jeebies. Is it possible to switch dentists in the middle of treatment?

Carol

Dear Carol,

a side by side comparison of traditional braces and Invisalign on someone's teeth

Traditional braces versus Invisalign

Any time you want to switch dentists, the dentist is under an ethical obligation to transfer all treatment information to your new dentist. You shouldn’t have any problem with that. If he gives you any trouble, you could always mention that you could report his behavior to the dental board instead of simply switching dentists. That should sober him up a bit.

I’m actually wondering if you should report it anyway. At the very least, talk to his assistant and see if that is something that just happened with you or if it was a consistent issue with female patients. Not that one is better than another. However, knowing if it was a pattern may help with the dental board. Many people have enough trouble with dental anxiety without adding in the additional pressure of feeling uncomfortable in the chair because of the dentist’s behavior.

I’m glad you are happy with your Invisalign treatment. It has a very high patient satisfaction rate. It will be very easy for you to just take up at the exact same spot with whatever dentist you end up with.

There is a hidden benefit you may not be aware of. The clear aligners you are using with Invisalign can also double as teeth whitening trays. Your new dentist can provide you with teeth whitening gel, which is quite inexpensive. Then, you will just add the gel to your aligners for at least twenty minutes a day. Before you know it, you have both straight and white teeth. It’s like getting a mini smile makeover.

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