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Duluth, GA 30097

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Dental Bonding Looks Terrible

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My daughter, who is eleven years old, had a accident. The result was that it broke out the middle of the tooth where it looks like she has an empty picture frame with some pieces missing. Our family dentist suggested to repair it with dental bonding. The bonding was horrible. It’s uneven to the point of being lumpy. It’s also too short. I don’t know what to do. She’s devastated and I don’t blame her. Is there a way to fix this?

Amanda

Dear Amanda,

Before and After dental bonding

I’m sorry this happened to your daughter. I know she is distressed. As you can see from the image above, dental bonding can be done beautifully as well as blend naturally to the remainder of the tooth structure.

The good news is that this can be fixed. However, it will require a different dentist. Dental bonding is an advanced cosmetic dentistry procedure that has to be done freehand. Very few family dentists invest in the post-doctoral training necessary to do cosmetic bonding. They have some bonding experience from fillings, but that does not qualify them for what your daughter needs.

More good news. I’m relieved that your dentist did not recommend dental crowns for your daughter. Many inexperienced cosmetic dentists would have done that. However, the pulp of a child your daughter’s age is very large. Doing a crown on them would likely kill the pulp and require a root canal treatment. Secondly, the tooth is still erupting. that means the margin would be exposed not only making it obvious she’s wearing a crown but put her at risk for decay.

My suggestion is that you ask for a refund on the bonding. Hopefully, he has the integrity to realize his work was subpar and not want to damage the self-esteem of a child. Then, you need to look for a dentist who has invested in post-doctoral cosmetic training. As an added precaution, I would recommend that you also take a peek at their smile gallery. You want to see what type of results they get with their work. If you don’t love it, find someone else. If they don’t have a smile gallery, then they do not do enough cosmetic work for you to even consider them.

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

Crowning Teeth to Treat TMJ Disorder

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I have TMJ Disorder that I wear a mouth guard for. While it has improved, I’m still having problems. My dentist is suggesting that this is because I’ve worn my teeth down to nubs. What she wants to do is put crowns on all of my teeth in order to fix my bite. She says it will completely solve my TMJ issues. This seems rather radical to me. Is this even a legitimate treatment?

Walter

Dear Walter,

Woman holding her jaw from TMJ pain

Placing dental crowns on all of your teeth is a legitimate way to treat TMJ disorder. It is designed to get your bite into the right alignment so that your jaw, especially your temporomandibular joint, is also in proper alignment and you are no longer in any pain. This is know as a full-mouth reconstruction. I would say though that this is a highly specialized treatment. You would want someone with advanced training.

Going to dental school is not enough in this case. You want someone with post-doctoral training. Otherwise you could end up in a worse situation than you were in to begin with. It has to be done very carefully, starting with provisional treatment first and making sure everything is properly placed and comfortable before building up the permanent crowns.

I would look for someone with training from one of the following institutions:

  • The Pankey Institute
  • The Dawson Academy
  • The Las Vegas Institute for Advanced Dental Studies
  • Piper Education and Research Center

It’s possible that your current dentist has the needed training. Starting with a mouthguard was spot-on. I like that she didn’t just jump to the most expensive treatment and went with the least invasive first to see what type of results you’d get. She seems to know what she’s doing. You’re probably safe sticking with her. Just make sure that your dentist does the temporary crowns first and you are completely comfortable with the treatment.

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

Will Dental Insurance Help with Dental Implants?

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I need to get some dental implants but am having some financial problems. Is there a dental insurance I could get that would pay for the procedures?

Jen

Dear Jen,

dental implant diagram

When it comes to dental insurance and dental implants, if you already have insurance it will likely pay for a percentage of the procedure. It will not cover the entire cost. How large a portion depends on the policy you have. In most cases, insurance is more likely to cover the least expensive option. In the case of a tooth replacement, that would be a removable partial denture, which has a lot of problems.

If you do not already have dental insurance, then don’t expect to purchase a plan and think it will cover any portion of your dental implant. Usually, with new policies, they’ll immediately cover things like cleanings, etc. However, big procedures, such as dental crowns or dental implants will have a waiting period. This is often about six months to a year. The reason for this is there are people who try to purchase insurance, get the super expensive procedure, and then drop the policy. Companies would go out of business quickly if they allowed that.

If they only cover a portion, is it worth it to you to get dental implants? Absolutely, if you can. They are the closest thing to having a healthy, natural tooth in your mouth again. They will be completely secure, protect your bone structure, and not require and structural changes to your other teeth.

If you cannot afford implants, there are other reasonable options. The next best choice for you would be to get a dental bridge. This suspends a false tooth between two dental crowns. This makes the most sense if you need a crown on one of those teeth already. But, if you don’t and can’t afford the implant, it is a good, sturdy tooth replacement.

This blog is brought to you by Duluth, 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.

Should She Go Through With This Full-Mouth Reconstruction

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I had been grinding my teeth for years without noticing or having a dentist tell me. I recently moved and my new dentist was very concerned about the condition of my teeth. Some of them in the back were tiny nubs. She asked me some questions and believes I have TMJ Disorder. It made sense as she talked about the symptoms and would explain a lot about things I am going through. She suggested a full-mouth reconstruction. The bottom is done. It was a highly emotional experience for me and one I am not sure I want to go through again for the top arch. I chose a color that was darker than my dentist suggested, but now that it is done, I feel it is still too dark. I also miss the unique defects in my smile that I felt made me…me. These bottom teeth are just oo perfect. Do I have to finish the full mouth reconstruction? My dentist thinks it will do more damage to my bite if I don’t and she thinks the upper teeth being so much smaller and darker than the lower teeth will look odd. She is leaving it up to me and said, she’s given her thoughts and will not pressure me to conform to them. I’m paralyzed with the fear I’ll make the wrong decision. Do you have a recommendation?

Carol

Dear Carol,

I am sorry this has been so difficult for you. Up front, I want to make sure you understand that because I haven’t examined you or seen any of the diagnostics, anything I tell you will be based soley on what you said.

it sounds like the things that concerned you were 1. The color wasn’t what you were hoping for. 2. The teeth were too perfect looking and lost its quirks.

The color would be hard to change unless you had the dentist do them again, but if it is the color you picked you’d have to pay for them again. As for the quirkiness. You can get that easily…as long as you get the right dentist. Expert cosmetic dentists would likely trample over one another for an opportunity to design a smile with some character. Most patients just want the perfect Hollywood smile. Your request would put them in heaven.

While you could leave things as they are I have some concerns. You do not want to leave a full mouth reconstruction half done without a good reason. This is expecially true when you are already dealing with TMJ Disorder. Plus, the ceramics on the bottom teeth will damagae natural tooth structure as they butt up against on another. My suggestion is to complete the reconstruction but do it with a dentist who has the skills to create the look you want. They will need expert cosmetic training as well as advanced restonstructive training. It’s a tall order, but they do exist.

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

360 Veneers Disaster

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I went to my dentist asking for e-max veneers. He said he thought I would be a better candidate for 360 veneers. I specifically asked how much tooth structure had to be removed for the 360 veneers. They assured me not much at all would need to be removed. I agreed to their suggestion. When I first got the temporary veneers, a few of them kept falling off. I noticed then that my teeth were down to small nubs, which was much more removal of tooth structure than they implied I would need. I expressed my concern about them falling out all the time. They assured me that when the permanent ones were bonded on that would not be an issue. Yet, like the promise about the tooth structure, this has not proven to be the case. So far two have fallen off. They tried a different cement, but yet some structures are still falling off. Now they’re talking about ordering a special stronger cement. I’ve just lost confidence in them. While I am relieved that I haven’t swallowed any of them while I have slept, I am living in complete fear of them falling off in public. Do you have any advice for me?

Emily

Dear Emily,

I am going to be blunt in telling you that you were taken advantage of and misled by your dentist. My first clue was when he told you 360 veneers. There is no such thing. Porcelain veneers only go on the front and hug the sides a little. If the restoration for your smile makeover went 360 degrees around your tooth, then it was porcelain crowns.

tooth prep for porcelain veneers A second hint of their unethical behavior was the nubs the created of your teeth. When your teeth are prepared for porcelain veneers, only a small amount of tooth structure is removed, as pictured to the left.

You described a small nub, which is what is used to prepare teeth for porcelain crowns. That is two times they have lied to you.

Often, when dentists steer patients toward porcelain crowns instead of porcelain veneers it is because they are not comfortable with the advanced cosmetic procedures. They tend to want to convince you of the procedure they are comfortable with instead of admitting the skills they lack. In this case, your dentist can’t even do the basic crown procedures. This is distressing because it is one of the first things dentists have to learn to do. You shouldn’t even be able to graduate dental school without having the ability to successfully place dental crowns. Most dentists go their whole careers without having a crown fall out. That has not been the case for your dentist.

So, what is my recommendation? You need to find another dentist. One with post-doctoral training in cosmetic dentistry as well as artistic skill. Look at the bio on their website. Then look at their smile gallery to see what type of results they create. They may even be able to help you get a refund on your badly done work. After all, a basic expectation is that the work will actually stay in!

This blog is brought to you by Dr. David Marion, who was honored by the International College of Dentists as being one of the top dentists in the world.

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.

I’m Concerned About Her Full-Mouth Reconstruction

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I have been going to the same dentist for six years. In that time, I’ve had four dental crowns placed on front teeth that have the metal foundation. This has caused some ugly gray stains on my gums and the crowns keep chipping. She repairs them but charges me for every repair, which I am a bit sick of. So, I went to see another dentist Dr. P—- (name withheld) to get these done right. He told me I need a full mouth reconstruction because my bite is completely off. The temporary crowns look fine, but they hurt when I try to eat. I hope this changes with the permanent ones. My dentist feels it will. As far as the appearance, the one thing I am concerned about is the eye teeth. I would like them a little longer. Do you think it will be too late to fix that? Am I being too picky? I don’t want to upset my dentist because he is much better than the last dentist I went to see.

Asia

Dear Asia,

Dental Crown Being Placed on a tooth

I am very glad you wrote. Not only are you not being too picky, you are not being picky enough. The first thing I want you to do is call your new dentist and ask for the lab order to be placed on hold until you have temporary crowns that fit properly. Then make sure your dentist knows you will not go forward with this until the temporaries are right. You should have no trouble with eating or anything else. They should feel perfectly natural. Putting the permanent ones in will not change how they feel because they are modeled after the temporaries. If the temps hurt, the permanent ones will too.

Another concern I have is the dentist you are using. When I looked him up, there is no advanced training listed that qualifies him for this procedure. Doing a full-mouth reconstruction is one of the most advanced procedures around. I am honestly not certain he is qualified to do this. In fact, I am going to recommend you get a second opinion by someone who does have the advanced training necessary.

I can’t stress enough how important this is. If this isn’t done correctly, he can completely mess up your bite, leaving you with a lifetime of pain and TMJ Disorder. When you are looking for that second opinion dentist, look for someone who has training at either the Pankey Institute in Florida or the Las Vegas Institute for Advanced Dental Studies.

I am going to suggest you get the second opinion before letting your dentist do anything else.

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

I Can Smell My Husband’s Dental Implants

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My husband recently had two dental implants placed. I can smell them. I have chemical sensitivities and I am certain this smell is because my husband’s dentist gave him the metal implants. I tried to talk him into seeing a natural dentist but he thinks they are “hokum”. The smell is so bad that I even have to sleep with my face under the covers. It almost smells like rubber. I think he should remove them and do the metal-free ones, like you offer, but the dentist says he only does the metal ones. What information can you give me that will convince the dentist these need to change?

Sunny

Dear Sunny,

illustration of a dental implant next to a tooth

I think there is something else going on with your husband’s dental implants than just them being metal. The reason I say that is because these metal implants are made out of titanium, which is very inert. There is no smell. You can even ask his dentist to let you see one so you can smell it yourself. I am not doubting that there is a bad smell, I just do not think it is coming from the dental implants.

The more likely possibility is that there is debris and other bacteria getting caught under the dental crowns that are attached to his implants. This will give off a nasty smell. Some people have more trouble with their oral hygiene when dental restorations are involved. Here are a couple of things which may help that. First, have him floss with a waterpik. That will get to more debris. Second, about once a week he can rinse with some peroxide. He won’t want to do that every day or it will lead to an oral yeast infection. Every once in a while is okay though.

What you don’t want to do is have your husband switch these unnecessarily. When dental implants are removed it takes bone with them. That means he will need TWO more surgeries in order to replace implants that are completely functional. One to graft bone into the area and another to place new implants. That is a lot ot put your husband through.

Try the things I mentioned first and see if that solves the smell issue.
This blog is brought to you by Decatur, AL 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.