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Fixing Enamel Hypoplasia

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I have had enamel hypoplasia for as long as I can remember. I’ve always been embarrassed by my smile as a result. For my Christmas present, my husband said I could have any cosmetic dentistry procedure I need that will make me more comfortable smiling. I am so freaking excited!! The only problem I have is that I do not know what procedure I need to get. Do you have a recommendation?

Madilyn

Dear Madilyn,

Examples of mild and severe enamel hypoplasia

What an exciting present for you! There is no better feeling than a smile that makes you feel confident. For the benefit of those who may not be aware of what enamel hypoplasia is let me give a basic rundown. Enamel hypoplasia is a either caused by a genetic defect or disease that happens during the development of your teeth. The result is that the enamel on  your teeth do not fully develop. The results can vary between  some decalcification, such as on the left or deep pitted teeth, such as on the right.

There are two good treatments for enamel hypoplasia. Which you get depends on the severity of your particular case. If you are dealing with mild hypoplasia, then dental bonding is a perfectly good solution. If you want your teeth whiter, make sure you have teeth whitening done before the bonding. Once the dental bonding is completed, the color can’t be changed.

If, however, you have more severe hypoplasia, then you will want to get porcelain veneers instead. While dental bonding can just be placed on the specific spots where your enamel is affected, porcelain veneers will cover the entire front surface of your teeth.

Regardless of the procedure chosen, you will need someone with post-doctoral training in cosmetic dentistry. These are both advanced procedures. You would be wise to take a look at their smile gallery. This will have before and after images of their work. You want to feel excited about the type of results they get.

This blog is brought to you by Duluth, GA Dentist Dr. David Marion.

Covering Tetracycline Stains if You Can’t Afford Porcelain Veneers

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I have had very discolored teeth since my childhood. They said it was because of some medication I took as a child. When I was in high school my parents spent practically everything they had to get me dental bonding. Now that I am older the bonding is completely worn out. I know the better solution is porcelain veneers, but I cannot afford that. Dental bonding is not much less. Is there any chance there are newer procedures that have improved which could help me get a prettier smile without porcelain veneersj?

Mandy

Dear Mandy,

teeth bleaching trays

Teeth Bleaching Trays

 

The medication you took as a child was likely tetracycline. If taken while your teeth are still forming, then it can cause brown stains on your teeth. If you cannot afford porcelain veneers to this and you have existing bonding you have options, but it depends on how the dental bonding was done.

If the dental bonding was placed over intact enamel, then there are sandpaper disks that can be used to remove the outdated bonding. It’s not too hard to do if they have training. In fact, some states will allow a dental hygienist to do it. If your state allows that, the fee should be a bit lower, which could save you more money.

Once the old bonding is removed, have your dentist make for you some custom-fitted teeth whitening trays like the ones pictured above. Then you will simply use some professional strength teeth whitening gel in the trays. You will have to be persistent and it will take a while, but you can get your teeth signficantly whiter. They won’t be as beautiful as they would with well done porcelain veneers, but you will no longer be embarrassed by your teeth.

Be aware you will want to stick with the tray and gel approach. Don’t let your dentist talk you into something like Zoom Whitening or Laser teeth whitening. While these are stronger, you would require so many treatments that it would quickly get too expensive. Just perservere with the gel and you will get results.

If, however, the dentist removed some of your tooth enamel before placing the dental bonding, then there is no other solution except for porcelain veneers. In that case, I would just wait and save up to have the porcelain veneers done. Don’t try to save money by using just a basic family dentist. Save up to do it right. Make sure the dentist has post-doctoral porcelain veneers training. I’d also check their smile gallery to make sure they can produce artistic results. Tetracycline cases are one of the most advanced cosmetic cases a dentist can do so you want to make sure they have th chops to do it.

This blog is brought to you by Decatur, GA Dentist Dr. David Marion.

Can I Get a Functional and Beautiful Smile?

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I had a full-mouth reconstruction done because of a combination of both tetracycline stains and the fact that I sometimes grind my teeth. While the new teeth look okay, my mouth has been hurting ever since. I can’t tell what the problem is but it hurts the most when I bite down to chew. I’ve been back to the dentist who did the reconstruction and he said everything looks fine to him. I don’t know what to do at this point and I’m barely eating. Is it possible to get a beautiful smile that still functions well and doesn’t hurt?

Lacey

Dear Lacey,

Woman holding her jaw from TMJ pain

I am sorry this is happening to you. I’m curious as to the shape your teeth were in before the full-mouth recontruction. If there was nothing wrong with your teeth with the exception of the tetracycline stains, I am confused as to why he used dental crowns instead of porcelain veneers. If there was minor damage from teeth grinding, then wearing a mouth guard would help with that, even with the porcelain veneers, which are the typical treatment for a smile makeover.

As for the dental crowns, if your mouth hurts when you bite down, then everything is NOT fine. You can get a beautiful and functional smile, however in order to do that you need to see a dentist who has training in both cosmetic work as well as neuromuscular dentistry. This would include training in TMJ Disorder.

I think you will need to get a second opinion on your reconstruction case. It could be as simple as some of the crowns are sitting too high. However, it could be more serious. A full mouth reconstruction is one of the most advanced porcedures a dentist can do. If he or she doesn’t have the right training, then it can completely throw off your bite leading to painful TMJ disorder.

When you get your second opinion, you will be better served if you make sure it is from a dentist who has the right training. I would look for someone who has training from one of the following institutions:

  • The Pankey Institute
  • The Los Vegas Institute of Advanced Dental Studies
  • The Dawson Institue

They can give you the right diagnosis for what is wrong with your reconstruction, as well as make any necessary repairs.

This blog is brought to you by Duluth, GA Dentist Dr. David Marion.

My New Dental Crowns are Turning Yellow

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I had very white teeth and was ready to take the next step in improving my smile by getting a smile makeover. I spoke to my dentists and he suggested six porcelain crowns on my upper front teeth. I selected the whitest color available to me. Yet, when the crowns were put in, they did not seem to be the whiteness I had intended for them. Now, to top it all off, the dental crowns are starting to turn yellow. I haven’t even had these a year yet. Can I whiten them along with my teeth? How do I keep them from turning yellow again?

Melody

Dear Melody,

Extended shade guide

First, I want to make sure your dentist is using the updated shade guide. Before teeth whitening, the whitest shade was B1. Now, with the popularity of teeth whitening, the shade guides have been updated and BL1 is now the whitest. That may be the issue with the color discrepancy.

That doesn’t, however, explain the new staining. If your crowns are truly porcelain crowns they should be very stain resistant as long as the glaze on the porcelain is intact. This leaves me to wonder if something happened during one of your dental appointments to damage the crowns. Two possibilities are if the hygienist used an acidulated fluoride or a power prophy jet.

With the acidulated fluoride, it will etch the surface of the crowns, leaving the crowns very susceptible to staining. The power prophy jet can remove the glazing, causing staining take place even faster. Unfortanately, teeth whitening only works on natural teeth, so that would not be a good solution for you. The first step is to find out if the glazing has been damaged. I recommend seeing a good cosmetic dentist who can examine your crowns and ask them to give you an idea of why these are picking up stains.

One other quick question. I’m curious as to why your dentist chose crowns for this smile makeover. The standard for that type of procedure is porcelain veneers because it removes much less tooth structure. Was there damage to these teeth that required crowns?

This blog is brought to you by Duluth, GA Dentist Dr. David Marion.

What are the Best Materials for Implants and Crowns?

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I am getting a smile makeover, which will probably include at least eight dental implants on my upper arch. I am trying to do my homework ahead of time and have some questions. First, as far as implants go, are the Astra Implants from the UK reliable?  I also wondered if zirconium was okay for crowns. I did read that porcelain fused to metal can leave a black line, but wanted something strong. I’m worried zirconium will be clear colored, though. Any help you can give will be appreciated, my appointment is coming up fairly soon.

Valerie,

Dear Valerie,

An assortment of titanium and zirconia dental implants.

 

I am glad you are trying to do research. However, I would like to steer you in a different direction. The most important thing to research is the dentist doing your dental implants procedure. That has a much greater impact on your result than the materials used. Before we get into what to look for, I want to ask you a question. You mentioned that the reason for your dental implants was a smile makeover. However, unless the teeth needed to be extracted, that is a gross overtreatment. The typical procedure for a smile makeover is porcelain veneers which hardly removes any tooth structure. A dental implant requires you to lose the entire tooth.  I just want to make sure the implants were necessary before you go through with this.

Dental implants are quite an advanced procedure. So advanced, however, that dental school is not enough training. It takes significant post-doctoral training to be able to do this the way it needs to be done. There is no way you can learn enough about the materials in the time you have. Plus, so much of it will also depend on your specific case. Look for a dentist with implant qualifications. As for the zirconium. That will be white, not clear. I hope that puts your mind at ease.

This blog is brought to you by Duluth, GA Dentist Dr. David Marion.

 

Porcelain Veneers and Teeth Whitening

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I need to whiten my teeth. Well…I want to whiten my teeth. What worries me is that I have porcelain veneers on only four of my teeth. It’s the teeth next to the porcelain veneers that need the whitening. My smile is about eight teeth wide. I wish I had the money to do more veneers so they’d all match but I didn’t. I want to whiten the teeth to match but I’m worried that the whitening gel will hurt the porcelain veneers. Will I damage them if I use something weak like Crest Whitestrips?

Corinne

Dear Corinne,

teeth bleaching trays

Teeth Bleaching Trays

I am glad you wrote. I wish your dentist would have whitened your teeth before doing your porcelain veneers. That is pretty standard operating procedure when a person can’t get enough veneers to cover the width of their smile. The good news is, while it won’t be as easy, it is still possible to get them whitened.

Crest Whitestrips will not do any damage to your porcelain veneers. In fact, neither will professional strength teeth whitening. If you decide to use the Whitestrips, you need to be aware of some limitations. First, they’re not very big. In fact, they’ll only cover your first six teeth. With four of them being veneered, that would mean you are wasting a significant amount of whitening. With them being only a fraction of the strength of professional whitening, I don’t think you’d be truly satisfied with them.

My suggestion would be to have your dentist make you custom fitted trays that can be shaped around your porcelain veneers. This will enable you to whiten those teeth at full strength, while under the care of a professional. Plus, you can keep the trays and use them for touch-ups every couple of years. Then, you’ll only need the inexpensive gel.

This blog is brought to you by Duluth, GA Dr. David Marion.

Dry Mouth After Full Mouth Reconstruction

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I had crowns put on all my teeth, top and bottom. Ever since the procedure, I’ve had a hard time keeping my mouth closed all the way and I’ve got horrible dry mouth as a result. My dentist did what he called opening my bite so that you could see more of my smile. I was really looking forward to having a beautiful smile but this is miserable. Should I have him grind them down? I feel all the money I saved up for this has been wasted.

Shannon

Dear Shannon,

woman covering her mouth

Putting crowns on all your teeth is known as a full-mouth reconstruction. This procedure is extremely complicated and is usually reserved for some of the more serious dental cases, such as advanced TMJ Disorder. It’s unusual to use it for cosmetic reasons. The standard procedure for a smile makeover is to use porcelain veneers. Substituting crowns for this tells me he doesn’t have advanced training in cosmetic dentistry so he did crowns, which he felt confident in. The problem is placing one crown is much different from than crowning all the teeth, which would take advanced reconstructive training. It appears your dentist does not have that either.

It appears when he opened your bite, he caused what is known as lip incompetence. This means your mouth does not close while it is in repose. There is good news and bad news here. First, the good news. Your dentist messed up and he messed up badly enough that this case will need to be redone AND it should be redone at his expense. You will get a second chance for that smile you have always wanted.

Now for the bad news. Lip incompetence, which leads to the dry mouth you are experiencing, can destroy the health of your teeth. Because of that, you will need to get this repaired rather quickly. Dry mouth means you are not getting enough saliva in your mouth. Most people don’t realize this, but saliva is one of the main defenses our teeth have in fighting decay. Saliva is loaded with bacteria killing minerals. Without your saliva, your teeth will quickly start decaying.

I want you to get a second opinion from an expert in reconstructive dentistry. Look for someone with qualifications like you can read about in Dr. Marion’s bio. If what I is think is going on, he or she can fix this at your original dentist’s expense.

Unfortunately, because you have dental crowns, you will always need dental crowns.
This blog is brought to you by Duluth, GA Dentist Dr. David Marion.

Whitening Porcelain Veneers

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My coffee drinking habit seems to have stained my porcelain veneers. Would having teeth whitening done get them to look as white as they used to? If not, is there something I can do? I used to be so proud of this smile.

Becky

Dear Becky,

A porcelain veneer being placed on a tooth.

The type of glaze used with porcelain veneers is glass-like and quite stain resistant. Even drinking coffee should not have affected them. If they are picking up stains, it means they are damaged in some way. There are a couple of ways this could have happened.

First, if you’ve been using something abrasive on them while brushing your teeth, such as baking soda or over-the-counter whitening toothpaste. Because of their abrasiveness, these will scratch the glaze that protects your porcelain veneers, leaving them vulnerable to stains. A second possibility is that your hygienist used something to damage the glazing, such as a power prophy jet or acidulated fluoride. If it was something your dental office did, they are responsible to make this right. As such, they should replace them so that you have the glaze back.

If you are the one responsible, then you will need to be the one that fixes this. Teeth whitening will not whiten anything except your natural tooth structure, so that won’t help you. What can be done is either to replace them or to have your dentist polish them up. This will remove the stains and make them more stain-resistant. But, you’ll have to be careful because they will not be as stain-resistant as they were originally.

Your dentist should have talked to you about proper maintenance. It does not sound like that happened. The best toothpaste for cosmetic dental work of any kind is Supersmile Toothpaste. It is specifically designed for porcelain type work. Rather than using an abrasive to help whiten your teeth the way over the counter whitening toothpaste does, it removes the stains chemically using a protein pellicle. I highly recommend it.

This blog is brought to you by Duluth, GA Dentist Dr. David Marion.

A Full Mouth Reconstruction for Teeth Whitening??

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I have an old dental crown that really needs to be replaced. They’re quite old. I have several porcelain veneers about the same age. These were all done by a dentist from another city where I used to live. My new dentist wants to replace all my teeth with dental crowns. This suggestion is because my teeth are not very white and he thinks this is the best way to make sure everything matches. This seems rather drastic to me. Can’t I replace them all with porcelain veneers instead of dental crowns? That way I don’t have to grind down my teeth that are healthy. Isn’t that a better solution?

Kathleen

Dear Kathleen,

woman covering her mouth

Yes, that would be a better solution. However, I have an even better one that will save you a significant amount of money. Unless you have a reason for wanting veneers on the teeth that don’t currently have them, such as wanting a complete smile makeover, then the simplest solution to your teeth not being white enough is to do teeth whitening. I’m absolutely appalled he is suggesting crowning all your teeth instead of whitening them.

Such a procedure is known as a full-mouth reconstruction. It is one of the most difficult and advanced procedures there is. In order to do it properly takes extensive post-doctoral training. Not only that, but if your dentist doesn’t do it correctly, it can completely throw off your bite leaving you with painful TMJ Disorder.

Here is my suggestion. If you just want to replace the old dental work. First, get your teeth whitening. Then, get the dental work replaced. You will only need one crown. Replace the porcelain veneers with more veneers. However, I am going to suggest you find a different dentist to do this. I don’t trust this one. You will want one who does beautiful cosmetic work. Check out their smile galleries to see what type of results they get.

If you want a full smile makeover, you would do the same as above, but you could add more porcelain veneers to the procedure, rather than just the ones you need to replace. Again, you will need a dentist better than the one you have.

I hope this helps.
This blog is brought to you by Duluth, GA Dentist Dr. David Marion.

Will Teeth Whitening Fix My Dental Bonding

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My dental bonding has been picking up stains. They used to be very white. I was hoping to get them back to where they were.

Karl

Dear Karl,

Before and After Dental Bonding

Unfortunately, teeth whitening will only whiten natural tooth structure. It will have no impact on your dental bonding. You didn’t mention how long you have had this bonding or what type of stains you are dealing with. That will have some impact on the best advice to give you. Here is some general help, though.

If your bonding still has the polish on it and you are dealing with surface stains, I am going to recommend Supersmile Toothpaste. Unlike most whitening toothpastes that use abrasives which damage your bonding, Supersmile uses an ingredient Calprox, which will enzymatically remove the stains. It does this by dissolving the protein pellicle on your teeth and the stains attach themselves to the pellicle. Get rid of the pellicle; get rid of the stains.

However, if the polish to your dental bonding is gone, then they have been damaged and the best thing you can do is have them re-done. If you haven’t had these long, then I would go back to your dentist and see if he or she will be willing to fix them. If you have had them a while, it may just be time to replace them. Dental bonding does not last nearly as long as porcelain veneers, so I would expect to replace them every few years.

This blog is brought to you by Duluth, GA Dentist Dr. David Marion.