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.

How Much Teeth Whitening Do I Need Before Lumineers?

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I want to get a smile makeover. My dentist is suggesting Lumineers. They are pricey, so I’m not sure how many of them I can afford. I can do six but it looks like my smile is pretty wide. That means my other teeth will show and I’ll have two different looking teeth. I was looking around for information on alternatives and came across your site. It looks like as long as I whiten my teeth, the others will blend in with the Lumineers, right? Is there a way to know how much whitening I need as far as length of time?

Sandy

Dear Sandy,

Teeth Whitening Trays

It is good you are doing some research. I think this will save you some real anguish. First, yes, teeth whitening is a great option when you can’t get quite as many veneers as you need for the width of your smile. In fact, it is a common recommended step when it comes to getting a smile makeover.

I could not tell you with any certainty how much whitening you would need. That depends on a lot of factors, such as how white you want your smile makeover to be and how long you can tolerate wearing the bleaching trays. The basic principle is the longer you can wear the trays each day, the faster your teeth will whiten.

I wanted to bring up the Lumineers, though. This is just one brand of porcelain veneers. I’m a bit concerned that this is the brand your dentist is suggesting. It is highly marketed to inexperienced cosmetic dentists and there are other options. The biggest problem with Lumineers is that the company who owns them insists that dentists use their laboratory. Unfortunately, this lab is not known for their artistry. Most expert cosmetic dentists have a ceramist they prefer to work with at a specific lab. One they can trust to create the results they’ve designed.

I’m going to suggest you get a second opinion with another dentist on the type of porcelain veneers to get. If it is a matter of cost and this dentist is cheaper, I suggest you go ahead with the teeth whitening, which will greatly improve your smile. Then, save up for the dentist who can do your smile makeover correctly. This way you end up with results that thrill you instead of disappoint you.

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

Fixing a Tooth Gap

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I have the same dentist I have used since I was a child. He really is past retirement age and I’m worried he’s not keeping up with advances. I went to him because I’ve always had a tooth gap that I wanted to fix, but was not in a financial position to do anything about it. Now I am. My dentist is suggesting I see an orthodontist for braces. I don’t really want a mouth full of metal for a couple of years especially because I’m in a professional position. I’m hoping there is another option. I suspect there is, because my dentist doesn’t even do teeth whitening. Any direction you can point me would be greatly appreciated.

Kate

Dear Kate,

You were wise to write. If the only thing you have is a tooth gap, there are much better options. The three that come to mind immediately are Invisalign, dental bonding, or porcelain veneers.

Orthodontics: Invisalign

Image of Invisalign Aligners

If you want to actually close the gap, then I would go with Invisalign. These are the modern take on braces for adults. Instead of using metal wires and brackets, they use clear aligners to close your teeth. No one will even know you are wearing them. Even at a conversational distance they are invisible. These will close the gap for you in no time at.

Cosmetic Dentistry: Dental Bonding or Porcelain Veneers

Dental Bonding

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

Dental bonding uses composite material to fill in the gap. It has to be done freehand, so I would only want an expert cosmetic dentist to do this procedure. When done well, it will blend in with your natural tooth structure perfectly, as pictured above. This used dental bonding to repair a chipped tooth. Once the bonding is on, the color can’t be changed, so if you were wanting to whiten your teeth at any point in the near future, I would get the teeth whitening done before the bonding.

Porcelain Veneers

I would only recommend porcelain veneers if there was more than just a tooth gap that you were wanting to fix. This is typically used for a complete smile makeover. It’s what celebrities use to get that Hollywood smile. Veneers can change the shape, size, and color of your teeth. Like bonding, it requires an expert cosmetic dentist. It also won’t actually close the gap, but will cover it. This is the most expensive option, so I would only use this if you wanted a full-smile makeover.

This blog is brought to you by East Cobb Cosmetic 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.

Lemons for Teeth Whitening

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Is it possible to use lemons or lemon essential oils to whiten your teeth? I’ve been looking at ways to whiten my teeth at home without having to use the Zoom Machine that my dentist has. It makes your teeth super white and I am looking for something more subtle and natural because of my age. I’m going on 72.

Penelope

Dear Penelope,

An image of lemons

The problem with using any type of lemon product for whitening your teeth is that it will contain citric acid. If you rub it on your teeth, it will etch them. While it may make the teeth look a little whiter by removing some surface staining, this will only be temporary. That is because the etching damages the surface of your enamel, which will cause the teeth to pick up more stains. In fact, I recommend not brushing immediately after drinking a citrus drink for that very reason. You will grind the acid into the enamel with your toothbrush. If you must brush immediately after, do yourself a favor and swish some water around in your mouth in order to neutralize the acid first.

The safest way to whiten your teeth is with professional tooth whitening through your dentist. While it is true that Zoom Whitening will get your teeth very white, it is not your only option. There are take home bleaching trays that you can do.

Your dentist will custom fit the bleaching trays to your exact bite and provide you with professional strength whitening gel to wear in them. If you don’t want your teeth very white, that is no big deal. You simply wear the trays until you get to the level of whitening you are comfortable with. Once you reach the level you wanted, you simply stop wearing the trays.

It is hard to get a precise color, but you can get close. If you are looking for something precise, you could get porcelain veneers. These can be made to any color you want. However, they are more designed for complete smile makeovers. Porcelain veneers are fantastic if you want to change more than just the color of your teeth, such as the shape and size. However, if all you want to do is whiten them, veneers would be overkill and way too expensive.

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

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.

Solution for a HUGE Tooth Gap

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I have a large tooth gap. I think my dentist said it was about 8-10 millimeters between my front two teeth. I didn’t want braces, so he suggested snap-on smile. I paid for the x-rays and the dentist sent everything in to the company. I received a call this week telling me I’m not really a good candidate for that procedure. He said we could look into Lumineers. These cost a whole lot more than the snap-on smile. If it is my only option, I will bite the bullet. Before I did, though, I wanted to get another opinion on how to handle this.

Mike

Dear Mike,

Image of Invisalign Aligners

I am glad you wrote. Please, please don’t move forward with the Lumineers plan. First, the gap between your two front teeth is substantial. This is large enough to fit another tooth in. It would take one of the top cosmetic dentists in the country to do this correctly. Your dentist said he would “look into” Lumineers. This tells me that he is not trained in cosmetic dentistry. Lumineers is just one brand of porcelain veneers. While the Lumineers brand is highly marketed to inexperienced cosmetic dentists as being easy to place, most expert cosmetic dentists find the Lumineers brand inferior. Plus, being easy to put on the teeth has nothing to do with the skill required to make them beautiful and natural looking.

You don’t have to have braces to get the gap closed. I would look into getting Invisalign. These use clear aligners to straighten your teeth instead of the metal wires and brackets that are used with traditional braces. Even at a conversational distance, noone would know that you are straightening your teeth.

Invisalign has another hidden benefit. The aligners can double as teeth whitening trays. Your dentist can provide you with whitening gel that you can wear in the aligners at a time that is convenient to you. This allows you to straighten and whiten your teeth simultaneously.

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

How Can I Get My Porcelain Veneers White Again?

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When I first got my porcelain veneers they were really white. Lately, they’ve been picking up my coffee stains. I don’t want to give up coffee, but I’d like to get them as white as they were again. I know that over the counter whitening won’t work, because I tried it, but would the whitening from my dentist work?

Greta

Dear Greta,

A porcelain veneer being held up to a tooth

I am glad you wrote. How you handle this will depend on the reason for the stains. The glaze on your porcelain veneers is extremely stain resistant. In fact, they are more stain resistant than even your natural teeth. This would repel even coffee stains, except maybe for temporary surface stains. The solution to that would be to get Supersmile toothpaste. This uses a chemical enzyme which safely removes surface stains from both natural teeth and cosmetic dental work. Never use the type of whitening toothpastes that are commonly sold. Most of them contain abrasives that will damage both your natural teeth and your dental work.

However, if the glaze has been removed from your porcelain veneers, this will not work. Unfortnately, neither will teeth whitening, which only works on natural tooth structure. There are a few things that can damage the glazing on your porcelain veneers. Two of them can happen at your dentist’s office, so I will start with those.
1. The use of a Power Prophy Jet. Don’t allow your hygienist to use this on your cosmetic work, or even dental crowns. This will completely remove the glazing on your dental work and it will not take long for the veneers to pick up stains.
2. Acidulated fluoride. This won’t completely remove the glaze, but will etch it, giving you pockets of stains.

One thing you can do that will damage the veneers is using the type of whitening toothpastes that are commonly sold. Most of them contain abrasives that will damage both your natural teeth and your dental work.

If the glazing has been removed or damaged you have a couple of options. The first is to replace them. If your dentist damaged them because of one of the things mentioned above they should help with that cost. A second option is to see an expert cosmetic dentist who has the skills and equipment to polish them back to their original shine. It will not be the same as the glaze, but it will remove the stains as well as help them to avoid stains a bit better. From there, Supersmile toothpaste will really help keep the stains off.

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

New Lumineers Over Old

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I wonder if you can tell me what you think of the new Lumineers over old technique. My dentist originally gave me Lumineers that were not nearly as white as I wanted. At the time, the technology did not exist to make them as white as I wanted. I’ve tried whitening them with teeth whitening, but it’s never worked. My dentist did some research and learned the nature of Lumineers means that teeth whitening won’t work on them. Now, the technology has advanced that I can get my Lumineers whiter. I was thinking of having new ones placed on top of my old ones, which my dentist said is possible. I just don’t want to waste money if it is not a good idea, like the whitening we tried.

Callie

Dear Callie,

Lumineers advertisement

I’m going to tell you up front that your dentist is not qualified to redo your smile makeover. You should know that the technology was always available to make your Lumineers white. Your dentist probably just didn’t know how to do it. That doesn’t surprise me because the Lumineers brand is highly marketed to untrained and inexperienced cosmetic dentists. He should also have known that teeth whitening wouldn’t work. In fact, the whitening will only work on natural tooth structure. It is not limited to Lumineers. It will not whiten any type of dental work.

New Lumineers Over Old

While technically you can put new Lumineers over old ones, I don’t recommend it. It is just as much work to place Lumineers on top of one another as it is to completely redo them. However, it is double the risk because now you have two sets of bonding that can fail– the old bonding as well as the new bonding. You are safer just getting them redone completely.

It is perfectly okay to go to one dentist for your general dental work and another for your cosmetic work.  This is because doing smile makeovers is not taught in dental school. Instead, a dentist has to study it post-doctorally. Because there is no recognized specialty in cosmetic dentistry there is no way for patients to know who has invested in this training and who hasn’t.

What I would like you to do is to look at the smile gallery of some cosmetic dentists in your area to see who does beautiful work. Find a dentist whose smile makeovers are stunning. Don’t be surprised if the dentist you pick suggests a different brand of porcelain veneers. Many expert cosmetic dentists prefer a different brand.

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

Tetracycline Stains and No Money

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I have had tetracycline stains on my teeth since childhood. All the research says to put porcelain veneers on your teeth to cover them but my dentist doesn’t do porcelain veneers. He does do crowns, which he has suggested we use. Even that, however, is out of my reach. Are there any other alternatives?

Callie

Dear Callie,

smile with tetracycline stains

I am very glad you wrote. For the benefit of others reading, who may not know what tetracycline stains are (pictured above), I am going to give a brief explanation. Tetracycline is a prescription medication. If you take it before your permanent teeth are formed, which generally happens at the age of twelve, it will deposit in the dentin of your teeth and show up as a dark brown or gray stains.

The best solution to this is porcelain veneers, which would need to be done in the hands of an expert cosmetic dentist. Covering tetracycline stains is one of the most advanced and tricky procedures dentists have to do. They have to make the cover opaque enough to cover the dark stains, but still translucent enough to look sparkling and natural.

Some family dentists who are not skilled in cosmetic dentistry try to make up for this by doing porcelain crowns. I will be honest with you, any dentist that suggests dental crowns for this is a big red flag. They are telling you, “I can’t do porcelain veneers, but I’m totally willing to grind down healthy tooth structure to rake in money for what I do know.” If they don’t do porcelain veneers, they are not skilled enough in cosmetic work to make these crowns look good. Even most dentists who do porcelain veneers don’t have the skills for tetracycline stains.

Tetraycycline Stains and No Money

You have a few options. First, you can leave the teeth as they are while saving up for the high-end (and higher priced) procedure. This obviously would depend on how long it would take you to reach your goal.

Second, you can have teeth whitening done. When you do this, know that it won’t be done in one tube of gel. In fact, you will have to be persistent, but if you are, it will work. One thing to note is I don’t recommend Zoom Whitening for this. It is more expensive than the take-home trays whitening. It is a fantastic whitener, but you will need too many sessions for it to be financially do-able for you. Of course, you could do one zoom appointment to get a jump start and then do the rest with trays. As far as tray teeth whittening goes, see if your dentist offers or is willing to purchase kör whitening for you. This is the most potent gel available.

Your final option is to have the teeth whitening done while saving up. This allows you to make some progress if it is going to take you a long time to get to the cost goal. If you choose this, you may even find you are happy enough with your whitening results that you no longer feel the need for porcelain veneers. Just bear in mind it will take a while for the whitening to really make a difference.

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