Will Medicaid Cover Porcelain Veneers

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Between my cancer and my bulimia, my teeth have taken a huge hit. I need to do something about them but do not have a lot money. Is there a possibility Medicaid will cover something like porcelain veneers because it is a medical condition?

Stacey

Dear Stacey,

dental crown versus a porcelain veneer

 

Unfortunately, Medicaid, if they cover anything, will only cover the least expensive procedure. So, if they decided they would cover this situation with your teeth (which I honestly doubt) then they would cover you having all your teeth pulled and getting dentures because that would be the least expensive solution. Although, that would be a horrible solution. That is one of the problems with government run healthcare of any kind. It’s sort of a bottom line situation only. They care less about the patient and more about the financial considerations.

When it comes to bulimia, it is the backs of your teeth that take the brunt of the damage from the vomiting. Porcelain veneers only cover the fronts of your teeth. If the damage is to the back, you may need porcelain crowns, which surround the tooth.

However, as I said above, Medicaid will not cover this. It is something you would want to save up for and get done right. I would talk to your dentist about the damage to your teeth and see if he has recommendations to help in the meantime. At the very least, you will want to get some fluoride treatments in order to help fortify your teeth while you are saving up for a solid cosmetic solution.

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

Should My Dentist Be Able to Match My Implant Crown?

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I want your advice as to whether I am being too picky. I had a dental implant made for a tooth that could not be saved after an accident. It’s a front tooth so I want it to match the other front tooth. My dentist has tried three different implant crowns, but none of them have matched. She’s frustrated with me and thinks I should just be grateful I have a tooth because “It is not her fault my tooth is between two dental crown shades.” Am I being too picky? Isn’t there a way to blend two shades together to make something closer?

Amy

Dear Amy,

I’m glad you wrote. You are definitely not being too picky. Plus, it was unfair of your dentist to push this off on you as if you were at fault for her lack of skill by not making her job simple enough for her. My suspicion is she does not have much training in cosmetic work, which is absolutely necessary to match a front tooth.

Color map a cosmetic dentist would createWhile the standard shades that your dentist referred to are adequate for back teeth, they do not quite cut it for front teeth as you have discovered. Your front teeth are exposed to direct light, which reveals all the variants in your teeth. The problem isn’t your natural shade color. There isn’t a shade that directly matches any tooth. When your teeth are hidden away toward the back, close is good enough.

For front teeth, your dentist has to pull out any artistry and color theory training he or she has received. Yours hasn’t. When a dentist needs to match a front tooth, they will draw out a “map” of your tooth, similar to the one to the one here, then mark for the ceramist the various tints and stains needed to give the tooth the correct blend.

It’s pretty apparent your dentist does not know how to do this and I don’t think she’s going to invest in the training needed. My suggestion is you pay for the dental implant but ask for a refund on the implant crown, so you can get it done properly somewhere else.

Discuss the procedure with any potential new dentist to make sure they are willing to do this properly. Here are some things to consider. Ask them if they will use a temporary try-in paste for you to approve the look and match of the porcelain crown before bonding. If they say no, move on. If they say yes, ask them how many times they’re willing to re-do it to make sure it is an exact match. The only acceptable answer should be as many times as is necessary.

It would be a miracle for even the best cosmetic dentists to get a perfect match the first time when it comes to a front tooth. Most will require two or three try-ins, so don’t panic when the first one doesn’t necessarily work. Just know you will get a tooth you can be proud to show.

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

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Both my lateral incisors have been a bit of a disaster. One of them is congenitally missing. The other is slightly deformed. I’m planning on getting this fixed. All of it. What do you recommend?

Amaya

Dear Amaya,

dental implant being placed in three stages

I’m glad you wrote. The first thing you’ll want to do is make sure the space is appropriately opened for the tooth replacement. Invisalign is the ideal treatment for this. You can straighten them invisibly and comfortably— no metal wires and brackets. Then it is time to make your smile beautiful.

Depending on the color of your teeth, you may want to whiten them. The reason for that is once your restorations are made, their color is permanent. You don’t want to have them a color you won’t completely love. If you are pleased with the color than no worries. You can skip the teeth whitening.

Once it is time to replace the tooth, I suggest a dental implant. This is the best tooth replacement around. It will be like having a healthy, natural tooth there. You will need to find a dentist who is experienced in placing dental implants. It requires post-doctoral training, so make sure you ask the dentist where they received their dental implant training. Dental school isn’t enough. If they’re offended by the question, they are not the best dentist to do it. Move on.

As for the deformed tooth. I haven’t seen the tooth, so a lot of it will depend on the shape and condition of the tooth. What I recommend for that is you see a great cosmetic dentist. Have them look at the tooth. Based on that examination they will either suggest a dental crown or a porcelain veneer. Make sure you check out their smile gallery to make sure you like the results they get. If you do, make a quick call to their office to make sure the images are from cases the dentist did himself and not just stock photos.

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

Will a Root Canal Treatment Damage My Porcelain Veneer?

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I just had eight porcelain veneers done and now I found out one of them needs a root canal treatment. I’ve read that a root canal treatment can turn a tooth dark and I don’t want that to ruin my veneer. I really like them. I can’t imagine why I’d need a porcelain veneer. I’ve been so careful taking care of them because I’m happy I finally have a smile I like and I don’t want it ruined. What do you recommend?

Lisa

Dear Lisa,

I’m concerned about why you needed the root canal treatment to begin with. I hope this wasn’t the result of your dentist being too aggressive. When teeth are being prepared for porcelain veneers, it doesn’t take much. At the most, your dentist should remove about half a millimeter.

photo of tooth preparation for porcelain veneers

The photo directly above shows a depth limiting diamond bur being used to prepare some teeth for porcelain veneers. Using a tool like this helps protect the tooth from the dentist going too deep in the preparation. Some dentists get carried away and will reach the dentin. Others will actually do porcelain crowns and just call them porcelain veneers. When doing a crown the dentist has to grind the teeth down to nubs.

Protecting the Beauty of Porcelain Veneers with a Root Canal

There is a way to help prevent the darkening of the tooth which needs the root canal treatment. Most of the darkening comes from the root canal filling material itself. This can be significantly reduced by following the procedure I’m about to outline.

1. Have your dentist clean out all the material from the crown of the tooth.
2. He or she should then place a white fiberglass post into the root.
3. Fill the remainder of the space with a light/white colored composite material.

Doing this will delay any darkening for quite a few years.

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

Crowns or Veneers for Tetracycline Stains?

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I have tetracycline stains that I am ready to get fixed. I’ve seen two dentists— my regular general dentist and a local cosmetic dentist. My dentist suggested porcelain crowns. He’s done a crown for me before and it looked very nice and natural. The cosmetic dentist suggested porcelain veneers. The cost for the dental crowns is half the price of the porcelain veneers. I want to do this right. These teeth have bothered me for years. But, is there a significant reason to spend the extra money for the porcelain veneers?

Ellie

Dear Ellie,

single porcelain veneer being held up by a dental tool

A Porcelain Veneer

I’m glad you are asking questions. The first thing you need to know is there isn’t a recognized specialty in cosmetic dentistry. Just because a dentist calls themselves a cosmetic dentist doesn’t mean they are better. Nor does the fact that they charge more. That being said, I wouldn’t have the crowns done.

Tetracycline stains are one of the most difficult types of cosmetic cases a dentist can work with. They have to make the porcelain opaque enough to cover the stains while translucent enough to still look natural. When it comes to tetracycline stains, the porcelain crowns are an overly aggressive treatment.

The teeth have to be ground down quite a bit in order for there to be room for the dental crowns. This weakens the teeth and puts them at risk of breaking. Often dentists inexperienced in treating these type of stains recommend the crowns because they aren’t confident in their skills doing porcelain veneers. So the fact that your dentist wants to do the much more aggressive crowns is a red flag.

Additionally, there is no guarantee after you unnecessarily grind these teeth down that the crowns will be good enough. I know you said he’s done a crown for you before and you were happy with it. However, doing one crown is very different than dealing with a smile makeover, especially when tetracycline is involved.

Recommended Treatment for Tetracycline Stains

Most cosmetic dentists will suggest porcelain veneers. This can change anything and everything about your teeth— the shape, the size, the color. This is the go-to procedure for celebrities who want a smile makeover. It can do more than cover your tetracycline stains. It can give you the smile you’d always dreamed of having, not only covering the stains you are embarrassed by, but giving you a superstar smile.

Check the Dentist’s Results

I highly recommend you don’t just choose between these two dentists. You have a world of dentists available to you. But be careful in your choice. This is a very difficult cosmetic dentistry procedure, and it may be hard to tell if the dentist has enough skill to do this right. What I would suggest is to ask to see before and after smile gallery photographs of tetracycline cases they’ve personally done. If they can’t show you that, keep looking for another cosmetic dentist.

You also need to insist they do a temporary try-in of your porcelain veneers when they’re done. There is a try-in paste which will allow you to see the veneers on your teeth without bonding them. This enables you to look at them in various lighting and determine if they are what you wanted. If you’re at the right dental office, the dentist will be willing to send the case back to the laboratory and not bond them on if you are at all hesitant about how they look.

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

Do You Have to Quit Smoking for Dental Implants?

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I want to get dental implants to replace some missing teeth. My dentist said he won’t place them unless I quit smoking. Is this really necessary or is he trying to force his own agenda on me?

Kevin

Dear Kevin,

An image of a dental implant crown being placed in three stages

I don’t think your dentist is trying to force an agenda on you. Instead, he’s trying to give your dental implants procedure the best chance at success.

The Risks of Nicotine with Dental Implants

  • The Reduction of Blood Flow

Any form of tobacco, including cigarettes, vaping, smokeless tobacco, or dipping restricts your blood vessels. In some cases, it cuts off the blood flow completely.

  • Poor Osseointegration


    • One of the keys to a successful dental implant procedure is when the implants fully integrate with the bone. With reduced blood flow, this hinders healing which slows down the integration. This will lead to a loose implant which will fall out.

    • Increased Risk of Infection

    Because your reduced blood flow hinders healing, it increases your risk for infection at the implant location. The leading cause of dental implant failure is an infection.

    Options for Dental Implants When You Smoke

    Obviously, you can accept the risk and move forward. You will be able to find a dentist willing to provide the procedure even while you smoke.

    On the other end of that spectrum is to quit smoking. You can talk to your doctor about options to aid you in that process. There are options to help with the withdrawal symptoms.

    Another possibility is to meet somewhere in the middle. You can quite for several weeks before the surgery and during the healing time. Then, when everything is secure, you can smoke again. However, you may find during that time period that you don’t really need that tobacco as much as you thought you did.

    A Cosmetic Consideration with Dental Implants

    Smoking causes serious tooth stains. Often, patients want to get a whiter smile when they’re replacing their teeth. You may want to consider getting your teeth whitened before having your implant crowns made. This way they can match the porcelain crowns to your new, whiter tooth color. Giving you a youthful, healthy looking smile.

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

Porcelain Veneers and Gum Disease

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I had a set of porcelain veneers done about 7 months ago. I liked them, but I’ve been having some problems and I’m wondering if the porcelain veneers are why. It didn’t happen until after I got them. It started with the gums feeling sore. I thought that might be because I had new veneers. Then I noticed occasional bleeding when I brushed. I went in for my first checkup since getting them and they’ve said I’m developing gum disease and I need to do a better job brushing. Here’s the thing, I’m pretty fastidious when it comes to brushing and flossing and haven’t changed my habits. That’s especially true because I invested all this money in my veneers and want to keep them clean as well. So, if it isn’t me, is it the veneers? Is this common? Is there a solution?

Brooke

Dear Brooke,

a porcelain veneer being placed

I’m sorry you’re going through this. If your oral hygiene is sound, then something else is going on. Because this started after your porcelain veneers procedure, it is natural to suspect them. However, they do not cause bleeding gums or gum disease. What can do that is the porcelain veneers not being properly placed.

It sounds like your dentist doesn’t understand how to get them flush against the teeth. When this happens, it causes a little shelf between the porcelain veneers and your gums. This is known as bulky margins and is a huge problem for you.

Here’s the thing. when you have that shelf, food and other forms of bacteria get trapped in there. They’re very hard to get out. This leads to decay. It will ruin your porcelain veneers and your teeth. You don’t want to go from a porcelain veneer to a porcelain crown unless you have to.

Get Your Porcelain Veneers Re-Done

This has to be replaced. Fortunately, if you can get another dentist to verify that is the problem, you can get your original dentist to replace them for free. The key to getting a good second opinion though is two-fold.

First, never ever tell them who did the work. Dentists are colleagues and friends. It’s hard to say something negative about a peer. If they don’t know who the dentist is it takes away the feeling of disloyalty. They’re just giving an honest, unbiased opinion.

Second, is don’t tell them what you think it wrong. Just tell them the symptoms and let them make the diagnosis. If it turns out to be bulky margins, he can help you get that refund you need to get this fixed properly.

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

Same Day Crown Disaster

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I have four crowns. One of them failed due to age. So I needed to get that re-done. The old crowns were done by a different dentist. The new dentist prefers to do same day crowns. I thought it would be great because I wouldn’t need a temporary and two appointments. I wish I hadn’t though. It looks awful. It’s obviously a fake tooth compared to the rest and one of the ones next to it is a crown as well. It that because it is a same day crown?

Deleth

Dear Deleth,

Block of porcelain for a CEREC restoration

Same day crowns are milled from a block of porcelain

Same day crowns (sometimes called CEREC crowns) are great restorations. If your crown looks fake, unless it is a very front tooth, it is not because it’s a CEREC crown.

The more likely problem is the dentist. Creating the look of a tooth is an art form. It is very likely your first dentist, who originally did your crowns, has a more artistic eye than your new dentist. There are many different skill levels when it comes to creating beautiful work.

You can ask him to re-do the crown to see if you get better results, however, if the problem is his skill, I doubt you’ll get any better results. My suggestion is you ask for a refund and try a different dentist.

Same Day Crowns On a Front Tooth

Above, I mentioned an exception to the problem being a same day crown. If it was on one of your very front teeth, that could explain it looking fake compared to the rest. CEREC crowns are milled from a single block of porcelain, which would look pretty uniform.

Our teeth aren’t uniform. Instead, they have varied subtleties and parts of it are more translucent than others. If you’ve got a uniform tooth next to a varied one, then it is going to look fake.

Because of this, most dentists prefer to use traditional all-porcelain crowns. They are made from several different blocks of porcelain in order to mimic the differences in your teeth.

The exception to everything I just said is if you go to one of the top 1% of dentists who will use color changes in the porcelain to mimic the variations. But, even they will need several try-ins before getting things exactly so.

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