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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.

This Full-Mouth Reconstruction is a Disaster

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I need some help. My teeth were in bad shape. I’ve had six dental implants placed and the dentist is placing crowns on the remaining teeth. The implants are done and now he’s on the dental crowns. It doesn’t feel like the sides of my mouth are even. The teeth on one side hit, but not the other. My jaw hurts all the time. While it ached a little before the treatment happened, now it is constant. My dentist said he meets all the checkpoints and thinks I am just not used to having crowns in my mouth. How long should it take me to get used to this? What if I don’t?

Emma

Dear Emma,

woman holding her jaw in pain

Whenever you are crowning all the teeth, the way your dentist is, it is known as a full-mouth reconstruction. This is a very advanced procedure and very few dentists can do it well. I am not certain your dentist has the training necessary to do this correctly and it sounds like you are going to have a disaster on your hands. Your dentist said he met all the checkpoints. However, one of the basic checkpoints is that the teeth come together naturally and simultaneously. His comment that you are just not used to having dental crowns doesn’t give me any more confidence in him either. When dental crowns are done properly, you don’t notice them at all. There is no “getting used to them”.

The reason you are in so much pain is your teeth are not occluding properly. This is essential and will only lead to more severe problems if not repaired. So, where do you go from here?

My suggestion is you find a qualified dentist to look at your case. I suspect it will need to be redone. Look for a dentist who has done extensive training with one or more of the following post-doctoral training institutes:

  • The Pankey Institute
  • The Dawson Academy
  • The Las Vegas Institute for Advanced Dental Studies

Based on your description, I think the case will need to be re-done. Have the dentist check your dental implants as well. If you only need the crowns re-done and not the implants, ask for a refund on crowns only. If both need to be replaced, my suggestion, in that case, is instead of a refund you ask for him to pay to have the work replaced at the dentist of your choosing. This is because the cost of replacing implants is more than the original procedure— a result of needing bone grafting to replace the bone lost during the removal of the original implants.

This blog is brought to you by Dr. David Marion who tries to be the best dentist in Duluth, GA.

Two Vastly Different Dental Implant Plans

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I had a bridge replacing four front teeth. The bridge was anchored by the canine teeth. Now the canine teeth have come loose. I went back to the clinic where I had the dental bridge done and they suggested a partial denture to replace all those teeth (including the canines) and then another for a missing lower molar. I have found the partial to be incredibly uncomfortable. Now they’re suggesting using mini implants to replace the upper teeth. I decided to get a second opinion. This doctor had a vastly different treatment plan. He wants to do a bridge on the lower molar because he said one of the adjacent teeth needs a crown anyway. Then he wants to place three regular-sized dental implants one where each of my canine teeth were and a third directly between them. When that’s done he will attach another bridge to the implants. His plan is considerably more expensive. I’m totally confused as to which is right and am trying to not just let the price difference dictate my decision. Do you care to be the tie-breaker?

Bruce

Dear Bruce,

Right up front I am going to tell you that the second plan is by far superior, but I want you to understand why. Let’s start with the mini implants the first dentist is suggesting. These are not meant to support individual teeth, including dental crowns. They don’t have the necessary strength. Instead, they can sometimes be used to help stabilize a denture, but even then, they won’t be as strong as traditional dental implants.

At some point, likely sooner rather than later, these mini-implants will fail. Then what will you do? When dental implants fail, they take bone structure with them. In order to have new implants placed, that bone structure will have to be filled back in. Now you’re talking about needing bone grafting surgery even before you can have the surgery to replace the mini implants. All for a procedure that will likely fail again.

Your second dentist’s recommendation has solid engineering principles behind it. I want you to peek at this picture below.
cantilever bridge diagram

The way your previous bridge was designed, it put the abutment teeth (the anchors for the bridge) on your canines. There are a lot of twisting forces in this position involved when we bite or chew. It wouldn’t surprise me at all to learn that it didn’t take long for the abutment teeth to come loose, which is why you are now losing them.

Full-sized dental implants can support a single tooth, so replacing those canines with them is a fantastic solution. But, wouldn’t attaching another bridge to them have the same problem as your previous bridge? Yes, except, the second dentist is suggesting a third implant directly between them to help stabilize things. This will prevent that twisting motion, enabling the implants for your bridge to remain secure, possibly for the remainder of your lifetime.

Go with the second dentist. He has a much better understanding of dental implants, tooth structure, and biting forces.

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