One of the teeth was broken in half diagonally, and the other is cracked all the way across. We could not locate the part of the tooth that broke off, and I wondered if that was part of the reason he felt he could delay treatment. He told us the root has to “desensitize”. I don’t want to demand treatment right now if it will hurt her down the road, but I do NOT want to wait almost a month to get this fixed.

What should we do? Thanks very much for your help and advice.

Katie in Michigan

Dear Katie,

There is no medical reason to delay treatment. Your dentist’s full schedule may actually be a bit of a boon – unless your general dentist is also an expert, experienced cosmetic dentist, you don’t want him taking care of this for you. In a situation like this, our office strongly recommends choosing an expert cosmetic dentist to make the repairs.

Becuase of your daughter’s age, you probably won’t want to go with a porcelain crown at this time, though she may need one later. Direct dental bonding would be the recommended treatment for the broken tooth, but that is an artistically and technically demanding technique that only the most talented cosmetic dentists can do well. These are the most visible teeth in her mouth, and you want them to look good. When she gets older, she can be fitted with a porcelain crown (or two, depending on the degree of damage to the other tooth), but in the meantime, you do not want her to be embarrassed every time she smiles.

What are my options to get this fixed? Please tell me about everything, from most to least expensive, so I have as much information as possible when I go in to get this done.

Jose in Augusta, Maine

Dear Jose,

I’m afraid there really isn’t any kind of option to fix this that would fall into the “less expensive” category. The only way to make those crowns look attractive is to remove them and replace them with porcelain crowns.

The problem is not anything that your dentist did when he or she placed the original veneers. The problem is within the structure of the porcelain fused to metal crowns. If your dentist tries to drill away the metal, there will still be a real problem with color match between the base of the crown and the now-visible root of the tooth. One could attempt to do direct bonding to blend it in, but it is unlikely to look any better than the dark line did.

This leaves you with two choices: new porcelain crowns, or live with the line. If you do decide to go with new crowns, make sure you go to an expert cosmetic dentist, and insist on porcelain or ceramic crowns. Unless you have grinding issues, those materials should be strong enough for teeth in the front of your mouth.

The cost of porcelain crowns can vary from about $1000 to $2000 per crown, so six crowns will be a significant investment. You should be able to find a cosmetic dentist who will make sure the treatment plan fits your dental needs and your budget.

Is it safe to use over the counter whitening products on porcelain veneers? Will it damage the finish, or change their color at all?

Thanks,

Will in San Diego

Dear Will,

First, over the counter teeth whitening products will not cause any harm to your Lumineers, but it won’t change the color of them, either. I hope you got the color you wanted when you had them done, rather than trying to match them to your lower teeth.

Cosmetically speaking, you can get away with having upper teeth that are whiter than the lower ones, but having whiter lower teeth does not look good.

If you are unsure at all about whether or not you should bleach the lower teeth, consult with a cosmetic dentist. You may also want to consider having an in-office teeth whitening, such as the Zoom whitening  we offer in our Cleveland office.

I am writing because I want to really understand all the options before I take her to another dentist. Do you think I should try a pediatric dentist? She has refused to open her mouth for our regular dentist or any of his assistants, and they suggested I try someone who specializes in pediatrics. I’m also trying to figure out if she has to get the badly decayed teeth pulled, or if there is another option. Should I request white fillings, porcelain onlays, or porcelain inlays?

And finally, do you think she will have to be sedated to get this done? Our regular dentist suggested this might be necessary, but that seems so extreme.

Thank you for your advice,

Adrienne in Tulsa

Dear Adrienne,

Let me address your specific questions first. Yes, you should seek a pediatric dentist who is qualified to do sedation dentistry. Delaying treatment will only make the problems worse.

Though she only has baby teeth in her mouth right now, it is best for her to keep those teeth in place until her adult teeth begin to come in. Not only does she need them to eat, they help maintain the spacing for her adult teeth. If some teeth must be pulled, she will have to have a space maintainer or her permanent molars will ultimately push forward and seriously disrupt her spacing, with the likely end result of substantial orthodontic costs.

As for the type of treatment you should request, you shouldn’t. It is always best to chose a dentist you trust, and then trust them to chose the treatment. Without an examination and x-rays, I could not offer competent advice on your options. It is good that you are familiarizing yourself with the terminology and different kinds of treatment, as it will make it easier for you to understand when your dentist talks about treatment options. Dental care for young children is usually focused on short-term care. If part of a baby molar is missing, most dentists will place an inexpensive crown, often made of stainless steel. This is meant to be a temporary fix, to hold the spacing for the adult teeth when the baby teeth fall out.

Finally, I ask you to look carefully at your daughter’s eating habits. The kind of decay you are describing has been “fed” all day, every day, for quite some time. If you allow your daughter to eat many small amounts all day long, you will continue to see this pattern of decay throughout her childhood. Have scheduled times for meals and snacks, and make sure she is brushing after each and every time she eats.

Best of luck to you and your daughter.

I went for a consultation with an orthodontist, but he said treatment with braces would take about two years. The reunion is less than a year away, so braces are simply not an option. No way am I showing up with a mouthful of metal. Is there anything faster?

Thanks,

Eric from Hanover, NH

Dear Eric,

I can tell you about two different ways to get beautiful, straight teeth in just a few months. Rather than going back to an orthodontist, you’ll need to locate a cosmetic dentist who is fully trained, experienced and expert.

Invisaligninvisible braces could straighten your teeth in as little as 6 to 9 months, if your teeth are not too crowded. If they are very crowded, it could take as long as a year, but it doesn’t often take any longer than that. If you decide to go with Invisalign and are not quite finished with your treatment at the time of the reunion, you could always remove the aligner for the party, then put it back in place when the festivities are over.

Another option would be porcelain veneers. This could be a great choice if your teeth are also discolored or misshapen. Porcelain veneers are thin pieces of porcelain that are placed over your teeth to create the appearance of perfectly straight, even, white teeth.

The most important choice you will make in this situation is which dentist to go to. It is very important that you go to an expert cosmetic dentist with training and experience in both porcelain veneer placement and Invisalign treatment. That way the dentist will help you make an educated decision about which treatment will work best for your individual needs.

Treatment with Invisalign requires certification, so that should be fairly easy to determine. But any dentist can say they do porcelain veneers. Be very careful to review credentials, and ask to see examples of their work. Technically, porcelain veneers are not that difficult to place, but getting a beautiful, appropriate, realistic result requires a high degree of artistic skill. Very few dentists possess this level of aesthetic sensibility.

I just graduated from college, and am trying to start my new professional life. I feel like these ugly teeth are really making a bad impression, but don’t know what to do about them. Under the guidance of my dentist, I have tried just about every over the counter teeth whitening product there is. I don’t have very much money, and though the kits are not individually expensive, they are starting to add up. So far, all that has accomplished is to make my teeth look even worse. The spots seem even darker than they did before.

Now my dentist wants to “try an experiment” (her words). She wants to use a grinder to wear away the front of my tooth until the discoloration is gone. I do not claim to be any kind of dental expert, but this sounds like a really bad idea! She admits that she does not know how much she might have to take off, and I am having horrible visions of what the end result of this might look like.

There has to be another way. What about professional whitening? I am tired of making a bad first impression. I am hard-working, well educated and meticulous, but my teeth send exactly the opposite message! Please help me get this figured out.

Thanks a lot,

Gretta in Belhaven, North Carolina

Dear Gretta,

You are smart to be cautious, especially when your dentist uses a phrase like “try an experiment”. From the sounds of things, you need to seek a new dentist. Your dentist clearly does not understand the basic principles behind teeth bleaching, and letting her conduct her “experiment” with grinding could lead to catastrophe.

I strongly suggest you seek the services of an experienced, expert cosmetic dentist, even if you have to drive a fair distance to do so. Please trust me that it will be very worth your time and effort to put this matter in the right hands.

As you have noticed, your smile is a huge part of the first impression you make on people, and you are at a point in your life where that first impression is incredibly important. If at all possible, I would advise you to invest in porcelain veneers. You do not mention any issues with any of the rest of your teeth, so it is possible that getting veneers for only those teeth that are discolored could make a dramatic difference in your smile.

If porcelain veneers are not a possibility, dental bonding may work just as effectively to deal with the discolored spots on your teeth.

You need the advise and guidance of an expert cosmetic dentist to make the decision about which course of treatment to pursue. Use caution, and ask about the dentist’s training and credentials. A truly expert cosmetic dentist will be a member of the American Academy of Cosmetic Dentists at the very least, and preferably accredited through them.

What I am wondering is if my orthodontist damaged my teeth when she removed the brackets, and if so, what can I do about correcting these problems? I didn’t go through two years of braces to watch my teeth get uglier every day.

Katie in Traverse City, MI

Dear Katie,

Likely this is not the result of anything your orthodontist did. The removal of the brackets and cement is a fairly simple procedure.

After traditional braces are removed, some patients have white spots on their teeth that are actually areas of decalcification. This often happens when patients weren’t as careful about brushing their teeth while they were wearing braces. I do not mean to cast aspertions upon your dental hygeine habits, but am just letting you know what generally causes the problems you are describing.

If people with braces do not brush their teeth immediately after eating, the food can sit under those brackets for hours, and the acid-producing bacteria is there, too, busily working away both on the food and on the surface of the tooth. The damage only becomes fully evident when the braces come off.

There may be white spots, which indicate loss of minerals in the teeth, and those white spots are pourous. They attract all manner of stains, and can eventually turn brown. If they are severe enough, they can chip away and cause the pitting you decribe, and some of those spots may be hiding decay. If the teeth are missing enamel, that could explain the sensitivity you describe.

Teeth whitening procedures will not help you, and it may even make the spots look worse. Spot bonding could help to cover the spots and compensate for the damaged enamel, but if the damage is extensive and severe, you may need porcelain veneers.

This is not a happy way to end your experience with braces, and is one of the reasons Invisalign braces are a great alternative to traditional wire and bracket braces.

Don’t delay in seeking help for this, and make sure you seek the services of an expert cosmetic dentist. Good luck.

Jane in Memphis

Dear Jane,

The problem with your white fillings was with the technique the dentist used, not with the fillings themselves.

The reason it is getting harder to find dentists who do traditional silver amalgam fillings is that there are a lot of problems with them. They are still the method taught in dental schools, so every dentist can place them, usually effectively. However, the material of the filling weakens the remaining tooth structure, they corrode over time, and more of the tooth must be removed to place them. Additionally, the amalgam material itself has been a source of ongoing controversy in the dental field, as it is nearly 50% mercury by weight. Current research cannot prove that the amount of mercury present in fillings is toxic, but it also cannot prove that it is NOT toxic. Ongoing clinical research may yield more conclusive data in years to come.

In the meantime, I would absolutely place white fillings for you, if you were my patient. The composite material in white fillings bonds to the tooth, which creates a stronger total structure than an amalgam filled tooth. White fillings contain no mercury, but they are more difficult to place, and not all dentists are trained to place them properly. White fillings must be placed following a very strict protocol, with a field that is completely isolated from saliva. No doubt the dentist who placed your white fillings years ago did not follow this protocol, and that was the source of your issues.

It sounds as if you are in the process of locating a new dentist. When you do choose one, let your dentist recommend the best treatment for your situation. It is very important that you don’t push your dentist out of his or her comfort zone by asking for a treatment that they are not well-trained to provide. If you decide that you want to go with white fillings, make sure the dentist you choose has the equipment and training to properly place them.

Am I overly concerned with these stains? My son is so embarrassed by his teeth. He almost never smiles. I want to do something about that.

Annette in Colorado Springs

Dear Annette,

Many general dentists are not well-equipped to be sensitive about self-esteem issues. If your son’s teeth are physically sound and functioning properly, then your dentist may not be concerned with what they look like. After his braces come off, I strongly suggest you seek the help of an accredited cosmetic dentistto help you address the staining. If the staining was uniform, I would suspect some other cause of staining and recommend bleaching, but the blotchiness you describe does sound like fluorosis.

If your son’s teeth have not fully erupted, it might be possible and prudent to do some direct tooth bonding to provide a short-term fix for the staining. If his front teeth have fully erupted, porcelain veneersare probably the best choice for dealing with fluorosis stains as severe as those you describe. There is no minimum age for placing porcelain veneers, so if you are working with a highly skilled and experienced cosmetic dentist who can factor in the degree of current and future tooth eruption, your son could have veneers placed right away.

Suzanne in Boston

Dear Suzanne,

It sounds like you are talking about a “Snap-On Smile”. Some people use them for a temporary fix, if time or budget do not permit a more permanent solution for a smile makeover. The appliance “snaps” over your teeth, and can give the appearance of a much whiter, straighter smile.

The Snap-On Smile appliance is not durable. It is not meant to be a permanent solution, such as porcelain veneers or porcelain crowns. Your dentist will not need to make any changes at all to your teeth—the appliance just fits right over your teeth as they are.

For the best results, I recommend looking for a skilled cosmetic dentist to help you order this product. As you might expect, the appliance will make your teeth look larger and bulkier, and if your teeth already protrude this appliance may not give you the results you are hoping for. Pricing for the appliance varies, and is determined by your dentist.

The procedure is fairly simple. Your dentist makes a model of your teeth, and then sends the model to the dental laboratory that makes the Snap-On Smile appliances (located in New York). After about two weeks, you should receive your Snap-On Smile.