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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.

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.

Will Oil Pulling Whiten My Teeth?

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I am curious about what your thoughts are on oil pulling. I’ve read that this can whiten your teeth naturally. I’m very big on doing everything I can naturally to help my body, for instance, I watch what I eat and exercise. In fact, it was my yoga instructor who suggested I try oil pulling when I told her I was disappointed in my smile. It needs some brightening and has started to show its age. Will it work? And more importantly, will it do any harm?

Sadie

Dear Sadie,

Teeth Whitening trays

It’s great to hear about people who are anxious to take care of both their bodies and their teeth. Great job! For those who have not heard about this before, bear with me as I briefly describe oil pulling. This is part of the Ayurvedic practice in India and is used as a natural remedy. Using something like sesame or coconut oil, they swish the oil around in their mouth for about 15 minutes then spit it out. The thought process is that the oil will absorb toxins and keep the mouth healthy.

Will It Whiten Your Teeth?

It’s unlikely. It could lift some surface stains, but so will brushing regularly. If you are looking to get rid of stains that have gone beyond the surface of your teeth, the only way to do that is through a teeth whitening procedure that uses a special type of gel containing either hydrogen peroxide or carbamide peroxide. These will sink deep into the teeth opening up the tubules and allowing the peroxide to oxidize all those years of accumulated stains. Nothing else will do the same thing.

Will it Do Any Harm?

On balance, no. There are some precautions to take. Make sure your oils are not expired or caustic. Never swallow the oil. Other than that, you just don’t want to ignore your regular oral health care such as brushing, flossing, and check ups with your dentist. Oil pulling does not replace those.

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

Lemons and Teeth Whitening

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Is it possible for me to whiten my teeth at home with lemons? I read about it on a natural health website, but wanted to verify before I wasted a bunch of lemons or, even worse, damaged my teeth. I have not had much success with the over the counter whitening kits and I really want white teeth but my dentist only does Zoom, which is out of my budget.

Megan

Dear Megan,

Lemons

I am so glad you wrote. It was very wise on your part to verify something you read on the internet. While lemons could temporarily make your teeth look a bit whiter, eventually they will actually end up looking darker. This is because lemons have citrus acid. When that acid gets onto your tooth enamel it will micro etch the surface of your teeth. Those etches will cause your teeth to pick up stains much faster. With continued use, you could weaken the enamel of your teeth. You will find that people who suck on lemons have the same problem.

This is the same issue that happens to patients who are suffering from bulimia. The acidic nature of vomiting means that their teeth are slowly wearing away because of all the acid.

If you are determined to use an over the counter whitening kit, Crest Whitestrips do work, but you have to buy a LOT of kits to get the same amount of teeth whitening you could with a dentist.

If you want professional strength teeth whitening but do not want Zoom, you could go to another dentist just to get your teeth whitening kit and get started then return to your dentist for your regular dental care. Be aware that most dentists will make you get a cleaning done before they will whiten your teeth. This is to ensure there are no problems with your teeth. It’s also to make sure there is no plaque that can lead to splotchy results. You can just tell them that you are happy with your dentist for your regular care, but do want to whiten your teeth.

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.

Can You Over Whiten Teeth

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My dentist told me that I’ve whitened my teeth so much that it has become impossible to match my teeth to dental work. I need a dental crown on a lateral incisor and he said my teeth are too white to get a good match. Shouldn’t he have warned me about that? He’s the one doing all the whitening.

Melissa

Dear Melissa,

Old Vita Shade Guide

Based on what you have said, my guess is that teeth whitening is the only type of cosmetic dentistry that your dentist actually does. Here is why I think that. When dentists match a tooth to a color for dental work they use a shade guide. For years, there was only one type of shade guide (pictured above).

Then, in the 1990s, teeth whitening became massively popular. One thing people don’t realize about teeth whitening is that not only does it remove stains, but they can also make the teeth whiter than their most natural white color. As teeth whitening gained in popularity, dentists began noticing that patients’ teeth were whiter than the whitest shade on the shade guide.

Updated shade guide

Updated Shade Guide

Fortunately, as this happened more often, the shade guides caught up. They added an extension that matched the new whiter shades of people’s teeth. Dentists who do a lot of cosmetic work, have the updated shade guide (pictured directly above).

While I am aware that you can just tell your dentist about this updated shade guide and get your crown matched that way, I do not think that will be your best option. This tooth will be very visible when you smile. You will want a dentist with cosmetic skills to match this tooth exactly. It requires more than just the initial shade match. Your dentist will have to give the ceramist instructions that add tints and stains around the tooth to help it mimic the variations in a natural tooth. If he doesn’t even have the correct shade guide, then he will not be able to create a good shade map for the ceramist. You will be better off having your dental crown done by a dentist who does a lot more cosmetic work.

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

Luster Premium Teeth Whitening

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I received an advertisement for Luster Premium Home Whitening. It’s a little cheaper than what my dentist’s office quoted when I called them so I am wondering if it actually works and if it is safe.

Emma

Dear Emma,

teeth bleaching trays

Teeth Bleaching Trays

I periodically review these type of things at patients’ requests. While they all have downsides in comparison to professional teeth whitening, most of them have a valid whitening ingredient. In the case of Luster Premium, that is not true. There is not a valid whitening ingredient in this product. The only whitening that takes place with this is due to a pigment in their “super whitener” — zinc oxide. This sticks to the teeth and makes the teeth look temporarily whiter. It does not actually whiten them. The pigment wears off. I am convinced that the positive reviews they have are from people who saw the whitening difference from the pigment and wrote the review not realizing it would quickly wear off.

If cost is the only thing keeping you from getting teeth whitening done by your dentist, you could put some money aside every few weeks or possibly talk to your dentist to see if he or she is open to allowing you to have a payment plan with them. If they say no and you are anxious to do it right away, an over the counter product that works is Crest Whitestrips. It is much weaker than the type of whitening you would get with your dentist but it will work. Another issue is it will only cover the front six teeth. Most smiles are at least eight to ten teeth wide. If that is you, you can use extra strips.

Honestly though, by the time you purchase enough kits to get your teeth really white, you would have spent less money if you would have just saved up and had it done right with your dentist. Plus, you can keep the whitening trays and, in future years, when you need a touch up you will just need to purchase the gel which isn’t nearly as much money.

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

Opinion of Premium Home Whitening Kit

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I keep seeing advertisements for a Premium Home Whitening Kit. I would love to whiten my teeth but my dentist is sort of high in cost. I wondered if this kit actually works and if so, is it safe?

Laura

Dear Laura,

teeth bleaching trays

Teeth Bleaching Trays

I’ve looked into this kit. It has one great thing going for it and one issue that sort of underwhelms the benefit. First, the great thing. It uses a whitening ingredient of 36% carbamide peroxide. This is a valid whitening ingredient and will whiten your teeth.

The downside to this kit is the bleaching trays. These are sort of DIY trays and they will not fit well. That means saliva will get into the trays, which will dilute the whitening ingredient, in turn rendering it less effective. In addition to that, it will allow the diluted gel to leak out of the tray making it where you are getting even less of the whitening effect.

If you look at the image above, you can see the type of teeth whitening trays your dentist would prepare for you. These are custom fit to your bite, which keeps the whitening gel in and the saliva out.

Bottom line, you would have to use quite a few kits to get the same benefit you would out of going to your dentist. My suggestion is you speak to your dentist. Tell him that you would love to whiten your teeth but are having trouble meeting his price. It’s very likely he would allow you to pay it out.

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

White Spots After Braces

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My daughter had braces for almost three years. When they were removed, we noticed white spots on her teeth. We spoke to our dentist about it and he suggested we just have her teeth whitened to even it out. The problem is, it didn’t even them out. Her teeth are whiter, but so are the spots. What do we do now?

Lacey

Dear Lacey,

A professionally-made take-home custom tray for teeth whitening.

While I am certain your dentist meant well, he does not really understand how teeth whitening works. As you have discovered, teeth whitening will whiten the tooth structure evenly. It is not designed to even out color.

Let’s start with what those white spots are and then I will give you the next step to take. When you have white spots after braces, those are decalcification spots— pre-cursors to decay. This is fairly common after braces, especially in children and teenagers because those metal wires and brackets are difficult to get around when you are brushing your teeth. That is just one of the reasons I often recommend Invisalign to my patients instead of braces. These do not have any metal wires and brackets. Plus, they are removable, which makes oral hygiene a breeze.

The correct way to deal with these is to have a cosmetic dentist gently remove the white spots with some microabrasion. Then, he or she will recover the area with a composite dental bonding. I am going to suggest you don’t go to your regular dentist for this. It is a rather advanced cosmetic procedure, way more advanced than teeth whitening. Plus, it has to be done freehand. You really need someone who has expertise to do this. One thing to do is check out their smile gallery. Look specifically at their dental bonding cases. If you like the results you see, that will be a safe dentist for you to see. One word of caution. Double check that the images are cases the dentist has done and not just stock photos.

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