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.

Are Cracks in Porcelain Crowns a Dental Emergency?

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I’ve had four porcelain crowns on my front teeth for a bit over ten years. One of them has always had a slight defect, but you couldn’t see it, just feel it if you rubbed your tongue over it. Now, I can feel it AND see it. It looks like a little line toward the bottom of the crown. Would this be considered a dental emergency? I don’t want it to break when I am out in public.

Carol

Dear Carol,

Woman covering her mouth

I’m glad you wrote. I would not consider this a dental emergency, but I would start making plans to get this replaced. There are a couple of considerations here.

  • Do you just want to replace all of them at the same time, or just one at a time as needed?
  • Are you happy with the color of your teeth?
  • If you choose to do them one at a time as needed, is your dentist an expert cosmetic dentist?

There are some benefits to doing them all at once, but the obvious drawback is that it will cost significantly more money. So, are the benefits worth the cost? First, you won’t have to worry about when they are going to need to be replaced because you have already taken care of them. Second, you won’t have to run to the dentist every time one of them is nearing the end of its life. You can go in and get them all replaced, one appointment and you’re done. Whether that is worth it is dependent on your individual circumstances.

I wouldn’t necessarily recommend replacing them all if they were just a few years old, but you’ve had yours for a while. Just don’t get them all replaced because your dentist says that is the only way to match them. That is an indicator that he or she is not an expert cosmetic dentist and you want front teeth that are beautiful.

I mentioned tooth color earlier. The color the crowns are made with is permanent. If you are happy with the current shade of your teeth then you are good to go. If you are considering teeth whitening then the time to have it done is before you have your crowns made. This way the shade can match the new color. Teeth whitening does not change the color of crowns so if you decide to do it later, you will have to replace the crowns again in order to get them to match.

This blog is brought to you by East Cobb 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.

Can Invisalign Fix Misaligned Teeth?

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I went to see my dentist, who also does braces, about having my teeth straightened with Invisalign. He told me that it really doesn’t work with misaligned teeth and I need to do traditional braces. I am a bit confused because a friend of mine, whose teeth were frankly worse than mine, used Invisalign. I just feel I am too old to have a mouth full of metal, but guess if I have to I will.

Betty

Dear Betty,

Invisalign Versus Braces

I am not sure why your dentist said that Invisalign did not work for misaligned teeth. That is exactly what it was designed for. I can think of some possibilities.
1. Maybe he knows how to do braces but isn’t certified to do Invisalign so he is steering you toward what he knows.
2. Maybe there is something complicated about your case that you didn’t mention, though I doubt it if your friend had worse teeth and did fine.
3. Maybe he is thinking about how when Invisalign first started, they would only work for the ideal cases. Now, however, the procedure is much more advanced and can align just about anything, with the exception of unusually complicated cases.

My suggestion is you look for an Invisalign certified dentist and get a second opinion. I bet there is a good chance that you are a candidate for this treatment.

A Hidden Benefit to Invisalign

On top of not having metal wires and brackets, as well as working faster, Invisalign has an additional benefit of allowing you to whiten your teeth at the same time. Ask whatever dentist you end up with to provide you with some teeth whitening gel. The aligners can double as whitening trays and you can just wear the gel for any length of time you are comfortable while you are straightening your teeth. It is like getting a mini smile makeover.

This blog is brought to you by Marietta Dentist Dr. Cristi Cheek.
Click here to learn about our free virtual smile consultation.

Dentist Said Overbite Means I Can’t Have Porcelain Veneers

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I wanted to get a smile makeover, but my dentist said I cannot have porcelain veneers because my top teeth cover my bottom teeth in what he calls an overbite. Instead, he wants to do six dental crowns. Will that work? Should I get my bottom teeth whitened so they’ll match the crowns on my top teeth?

Farah

Dear Farah,

dental crown versus a porcelain veneer

We see this a lot with family dentists. They don’t have cosmetic dentistry training and do not know how to do porcelain veneers, so they tell their patient that they need porcelain crowns. There are a few things to be aware of with this.

First, smile makeovers are not taught in dental school. Putting one crown on a decayed tooth is a LOT different than doing a smile makeover with crowns. If he can’t make porcelain veneers look beautiful, he can’t make dental crowns look beautiful. You will not want him to do your smile makeover.

Second, as pictured above, dental crowns require your natural teeth to be ground down to numbs. If they are healthy, why would you want to do that? Porcelain veneers on the other hand only require minimal tooth preparation.

Third, if you have an overbite, it makes more sense to get veneers instead of crowns. Porcelain veneers only go on the front of your teeth and hug the sides a bit. Porcelain crowns on the other hand have to go around the entire tooth. They will bump up against your bottom teeth.

My advice, find a dentist who is experienced in placing porcelain veneers to do your smile makeover. Make certain they place your veneers with a temporary try-in paste so you get a look at them before they are permanently bonded on. If you are not thrilled with the results, they should go back to the lab.

As for the teeth whitening, you will want to whiten both the top and bottom arches before having the veneers done. Most smiles are eight to ten teeth wide. If you only get six veneers, you will want the adjacent teeth to match.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.
Click here to learn about our free virtual smile makeover consultation.

Should I Switch Dentists in the Middle of My Implant Procedure?

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I’ve paid my dentist almost $10,000 dollars already and I am worried he is not up for the remainder of the procedure. The price was to cover extractions of teeth #5 and #7, bone grafting, Maryland Bridges as temporary replacements, dental implants, and crowns for each tooth. Thus far, we’ve done the extractions and bone grafting. He’s provided me with the Maryland Bridges but they keep falling off. This worries me not only because it is super inconvenient to have to constantly have to return to the dentist to have my work or repairs done, but also because I’m concerned he just isn’t up for the remainder of this procedure. What do you think? Am I overreacting and fretting over nothing or is there cause for concern?

DeeDee

Dear DeeDee,

Illustration of a dental implant

There is nothing wrong with you switching dentists in the middle of your dental implant procedure. In fact, your dentist is ethically obligated to provide all the labs and diagnostics to the new dentist. Given what you have said, I am actually going to recommend that you do switch for a couple of reasons.

First, he is using a Maryland bridge as a “temporary” tooth replacement. This is not a temporary replacement because in order for it to stay in properly there is a need to make a small groove in your tooth. Anything that changes the structure of your tooth is not temporary. Instead, he should have suggested something like a dental flipper. These are less expensive and don’t necessitate any changes to the teeth.

Second, he wasn’t able to properly bond the Maryland bridge. That is much less of an advanced procedure than the dental implants you need. You need to look for a dentist with dental implant training and experience. That training needs to be post-doctoral.

One other note, the dental implant crowns can be made any color necessary to match your teeth. You should be aware that whatever color is made is permanent. Once it is bonded on, no changes can be made. If you are considering teeth whitening at some point, then I suggest you do it before having your dental implant crown made. This way it will be the right color for the permanent smile you’d like. If you decide to wait until after the crown is placed and then whiten, you will have to replace the crown for it to match.

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.

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

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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.