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A Collapsed Bite

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I wonder if you can advise me. I am very self conscious about my smile. When my mouth is at rest, but not completely closed, there is just a black cavern. You cannot see my teeth at all. My jaw also hurts from years of grinding my teeth, which I just found out recently was an issue. My dentist made a night guard for me to wear at night. When I wear that, my jaw hurts less and it gives the slight appearance of my teeth being visible. This makes me think I need to add something to my teeth to make them “show up”, plus it may help with the jaw pain. I asked my dentist about it and he suggested porcelain veneers. Before I make such a big investment, I want to make sure it is the right choice. Have you seen patients in my situation? If so, what worked for them?

Caroline

Dear Caroline,

woman holding her jaw in pain

I am glad that you wrote. I think I know what has happened here and if it is not done right it can completely mess up your bite and leave you in a lifetime of pain. As for porcelain veneers, while if you see an excellent cosmetic dentist it would help with the appearance related issues, it would not solve the root of your problem or the jaw pain, which is like TMJ Disorder as the result of the grinding.

Based on what you have described, it sounds like your teeth grinding has led to a collapsed bite. I wish a dentist would have intervened sooner and protected you from this. However, that is water under the bridge and you need a solution. When your teeth are that ground down, the only real solution is a full mouth reconstruction. This is done by crowning the ground down teeth in order to get your bite in proper alignment and occlusion. However, this is one of the most advanced procedures in dentistry and has to be done very carefully.

A dentist would have to do this starting with provisionals to make sure everything lines up perfectly. It takes years of post-doctoral study to be able to do this well. Look at Dr. Marion’s bio to get an idea of the type of training a dentist would need to work on your case.

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

Porcelain Veneers or Invisalign?

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I have been saving up for quite some time to get my smile makeover done. There’s nothing too major. I want the color whiter, there are some chips here and there, and I have one slightly crooked front tooth. It’s not crooked enough where I ever considered braces. However, my dentist is suggesting I have Invisalign done before getting the porcelain veneers. He said that way there wouldn’t be any need for tooth preparation because he’s using Lumineers. I am not too keen on the idea of adding another 9 months to my smile makeover. Is this completely necessary? I thought porcelain veneers could make a tooth look straight. Am I misunderstanding anything?

Patricia

Dear Patricia,

invisible braces

Bear in mind that I haven’t examined you, but I am skeptical of what your dentist is telling you. In almost all cases, you would either do porcelain veneers or Invisalign–not both. You had the right idea that porcelain veneers can make your teeth look straight. My guess is your dentist is trying to get you to do the Invisalign because he doesn’t know how to shape teeth with porcelain veneers.

He also suggested Lumineers for your case, which is a brand of porcelain veneers highly marketed to inexperienced cosmetic dentists as being “easy to place” because they don’t require tooth preparation. However, in most cases, Lumineers end up looking bulky without some tooth prep. Not to mention inexperienced cosmetic dentists do not generally know how to produce beautiful results. Smile makeovers aren’t taught in dental school.

At this point, you have two choices if you want to get porcelain veneers, I would get them but with a different dentist. Look at their smile galleries to make sure you like the type of results they get. You want to know that they can produce beautiful, natural-looking smiles. Also, make sure they have some type of beautiful smile guarantee.

A second option is to do get Invisalign or another brand of invisible braces to straighten your teeth and whiten your teeth simultaneously using the clear aligners as teeth whitening trays. This will be significantly less expensive than porcelain veneers, but will take longer. You mentioned a few chips on your teeth. You didn’t mention how many or how large, but in most cases, these are repaired with some dental bonding.

Truthfully, wanting all three things repaired, which is what would be necessary for a complete result, the porcelain veneers will be a better idea. I just don’t think your current dentist is the one to do it. He sounds to be in over his head but not wanting to admit it.

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

Porcelain Veneers and Invisalign?

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I want to upgrade my smile. I need them whiter and my two front teeth are a tad crooked. I was thinking of getting porcelain veneers. My dentist suggested I get Lumineers, but before that he wants me to get Invisalign to straighten those two teeth. I just want to get a sort of “second opinion” before going through all that.

Amara

Dear Amara,

invisible braces

Bear in mind when I give you an answer that I haven’t seen your case, so I’m giving generalities here based on what you’ve written. In general, you would either do Invisalign or porcelain veneers, not both. Porcelain veneers can make your teeth look straight. You mentioned it is only your two front teeth which are crooked, which shouldn’t be too complicated. It’s possible your dentist is just in over his head and he doesn’t know how to fashion porcelain veneers except under the ideal conditions.

Rather than say that, he is suggesting you use Invisalign to fix the crooked teeth and then he’ll place Lumineers. That brings me to another reason I think he is in over his head. Lumineers is a particular brand of porcelain veneers that is heavily marketed to inexperienced dentists as being easy to place. Your case is a smidge more complicated.

You haven’t mentioned anything about needing or wanting to change the size and shape of your teeth. Aside from the front teeth, you’ve only mentioned wanting to whiten their color. If that’s the case, porcelain veneers may not be necessary.

You can whiten and straighten your teeth all at once using invisible braces, saving you thousands of dollars. My suggestion is you get Invisalign to straighten your teeth. The aligners can also double as teeth whitening trays. Your dentist simply has to provide you with the whitening gel. Wear the gel while you’re straightening your teeth. When you are done, you’ll have beautifully straight, white teeth.

Additionally, these two procedures are simple enough they can be done even by inexperienced cosmetic dentists. If you were to get porcelain veneers, I would recommend you go to someone with more expertise.

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

Full-Mouth Reconstruction Horror Story

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I had twenty-year-old veneers that needed to be replaced. My new dentist said what I really needed was a full-mouth reconstruction. I trusted him but am now having serious doubts about this whole thing. The temporaries never felt right. Ever. I complained about them multiple times and he kept telling me that they were fine and things would be different when the permanents were in. Well, it’s not. I’m in pain and can’t even keep my mouth closed normally. My mouth is so dry I’ve been sucking on popsicles and drinking water non-stop. I feel like a water balloon and am miserable. I went back to the dentist complaining but he says he met all the check points and I’m just not used to crowns yet. Please tell me what to do? What is a reasonable amount of time for me to get used to this?

Gina

Dear Gina,

woman smiling with dentist behind her

You are in serious trouble here. This dentist has messed up big time. First, I’m trying to figure out why the full-mouth reconstruction was necessary to begin with. You said your porcelain veneers were old and need to be replaced. Fine. Do you know what the solution to that is? Replacing them with new porcelain veneers. A full-mouth reconstruction is a major overtreatment and one he hasn’t done correctly.

Your Dentist Blew it

When dealing with this type of case, which involves putting dental crowns on every tooth, the temporaries are worn to make sure everything occludes well and your bite is comfortable. If your bite was comfortable before but painful now, he did something wrong. Combine that with the fact you can no longer close your mouth when it is in repose and it sounds like your dentist opened up your bite too much. This is serious.

I don’t care if he says he met all the checkpoints. He didn’t. One of the first things to check is whether or not the patient can close their mouth normally and comfortably. So, either he is a liar or he doesn’t know what the checkpoints are. Neither of those bode well for either of you.

Your case needs to be re-done from the beginning. Please, for the love of all that is good, don’t allow this dentist to re-do it. Get a refund and get a different dentist to re-do your case.

Finding a Reconstructive Detnist

The first thing I’d like you to do is click here to read Dr. Marion’s professional bio. This is the type of dentist you will need to fix this properly.
This blog is brought to you by Duluth, GA Dentist Dr. David Marion.

I Hate My Lumineers

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I had four Lumineers placed. I was pretty specific about how white I wanted my smile. Because of that, I even had my teeth whitened ahead of time. But, when my Lumineers were placed they looked darker than I anticipated. When I asked my dentist about it he told me he had a “natural” stain put on the Lumineers so they wouldn’t look fake. I don’t think they would have looked fake with the color I wanted, so I don’t understand why he did that. He told me to give it a few days and I’d probably like them. I tried but didn’t adjust in my view. I called him back so he had me come in. When I did, he sort of drilled off some of the top layer with the stain to get to the whiter color underneath. Now, they are uneven and the color seems dull. They look awful. Is there anything which can be done to fix them at this point?

Candace

Dear Candace,

woman covering her mouth

I’m sorry for what you’ve experienced with this, especially given this probably cost you a pretty penny. I do have some good news for you, but first let’s go over the reason why this happened. You told him you wanted a very white smile, yet he still put a stain on the Lumineers to make them look natural. This tells me your dentist has not invested in a great deal of training in cosmetic work. That doesn’t surprise me. Lumineers is often marketed to inexperienced cosmetic dentists as being easy to place.

In dental school, dentists are taught they know what is best for the patient. This means you wanted a white smile and he felt it needed to look natural. As the dentist, he thought he knew best. If he’d invested in cosmetic training, he’d know this is different. You are creating the smile the patient wants. Therefore, it is the patient who knows best in these situations.

Second, his drilling of the upper layer. This was the wrong thing to do as you’ve discovered. He should have just re-done the whole case, especially given he didn’t follow your instructions as to what type of smile you wanted. Instead, he takes a short cut which essentially ruins your Lumineers. The bad news is actually the good news as well. Because he damaged them so badly, you are able to get a refund and have this done by a more experienced cosmetic dentist.

If a dentist is serious about cosmetic dentistry they will have a smile gallery on their website. The one thing I would do is call and make sure the before and after images of the work they’re displaying is work they have done themselves and not stock photos. Look at their photos. Do you absolutely LOVE the results? If not, look for someone else. Don’t be surprised if whichever dentist you end up with chooses a different brand than Lumineers. There are several brands of porcelain veneers and Lumineers isn’t know for its quality in aesthetics.

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