A Collapsed Bite

I need some help and advice. My “smile” is a disaster. When my mouth is relaxed, you can’t see my teeth at all. When I’m smiling, it takes an extraordinary effort to get my teeth to show. I am a grinder and have jaw pain. To help with that, I wear a nightguard. When I’m wearing that, it helps. Would investing in porcelain veneers help with this situation?

Ben

Dear Ben,

A man in pain needs to see a Salem Emergency Dentist

I am glad you are writing before making any decisions. What you are dealing with requires a dentist with advanced training. The wrong, inexperienced dentist can absolutely destroy your bite. I haven’t examined you, but based on what you’re describing you are dealing with both a collapsed bite and TMJ Disorder.

Opening your bite would be the solution. Porcelain veneers aren’t going to help without doing that first. Once that is done, you may not even need the veneers. However, this has to be done very carefully. You’ll need a dentist with extensive experience in doing a full-mouth reconstruction.

The thing which is most important for you to know is that it needs to be done first with temporaries. Before any permanent restorations are placed. Do not allow anyone to permanently bond anything onto your teeth until the provisionals are successful. So, what will successful mean?

  • You are completely out of pain.
  • You can see your upper teeth normally.
  • You absolutely LOVE how your smile looks.
  • You have no speech problems.

To get that combination will require a very special dentist, but they are out there. First, look for their restorative dentistry training. This has to be post-doctoral training. You want them to have had training in one of these schools: L.D. Pankey Institute and the Dawson Academy in Florida, and the Las Vegas Institute for Advanced Dental Studies.

Additionally, we want to make certain they can create a beautiful smile. I would look for an AACD accredited dentist. These dentists are proven in both their technical skill and as well as their artistic ability. Finding a dentist with these combined qualifications, you’ll go from having a smile you can’t show to one you are thrilled to share.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Can Porcelain Veneers Cause a Lisp?

I have had the absolute worst luck with my smile makeover. I’m on dentist number three. Here’s what happened.
Dentist #1: The porcelain veneers literally crumbled and fell off. I got a refund.
Dentist #2: They fractured the very next day. I got a refund.
Dentist #3: They seem too long and I’ve started to lisp as a result. The dentist insists that my lisp isn’t from the porcelain veneers, but I never had one before. Can porcelain veneers cause a lisp?

Samantha

Dear Samantha,

A dental tool holding up a porcelain veneer

Man, you have had the worst luck with “cosmetic” dentists. This is a great illustration of a point we’ve tried to warn patients about. Most dentists cannot do cosmetic dental work. Because there is not a recognized specialty in cosmetic dentistry any dentist can do cosmetic work. However, that doesn’t mean they have developed the skills to do them. For instance, smile makeovers such as you’d get with porcelain veneers are not taught in dental school.

The result is what you’ve experienced. They dabble. Dabblers create cosmetic dentistry horror stories. You’ve had the misfortune of three of them. Truthfully, there are a small percentage of dentists who’ve truly invested in learning how to do cosmetic dental work.

The easiest way for a patient to find those is to either find a dentist who has reached accreditation with the American Academy of Cosmetic Dentistry or who are listed on mynewsmile.com. AACD accredited dentists passed exams to show their technical knowledge and have presented a large number of cases they personally did to show they have the artistry required to do great work. The mynewsmile.com website doesn’t something similar. While they don’t give the dentists exams, they do verify that they have done significant post-doctoral studies in cosmetic work. They also have to provide visual evidence of their artistic skill in doing a smile makeover.

As for your porcelain veneers, yes, they are very likely the cause of your lisp. Both when veneers are too long and when they are too thick, it will result in speech problems. You need to get a refund from dentist number three.

Moving forward, I want you to find a recommended dentist from one of the sites I mentioned. If you go to aacd.com, make sure you look for an accredited dentist. That is different from being a member. Anyone on mynewsmile will be a good choice.

This blog is brought to you by Salem, MA Cosmetic Dentist Dr. Randall Burba.

My Dental Bonding Turned Yellow

I had dental bonding placed on four front teeth. I was happy with finally having front teeth which didn’t looked so damaged and chipped. I tend to grind my teeth so that was a problem. I wanted to take care of them and started brushing with baking soda. I’ve only had them for less than a week and they’re already turning yellow. Did the baking soda have a chemical reaction with the bonding? Will teeth whitening fix them?

Kelly

Dear Kelly,

before and after dental bonding

There are a couple of things going on here which are setting off warning bells in my head. First, is the care of your dental bonding. I’m concerned that your dentist didn’t seem to give you any post-operative care instructions for your bonded teeth. This could have prevented this issue.

While you had good intentions in trying to take good care of your bonded teeth, you weren’t instructed on how to do that. Unfortunately, baking soda is quite abrasive and will eventually wear off the protective polish on your bonded teeth. If you really want to take good care of them, I am going to suggest you switch to Supersmile Toothpaste after this is fixed. This is specifically designed to clean and protect cosmetic dental work. It’s perfect for natural teeth as well.

As for teeth whitening, it will not work on your dental bonding. It only works on natural tooth structure, which means your natural teeth will get whiter, but the bonded teeth will be unaffected. This will make them look worse, not better.

Because you’ve had them for such a short period of time and your dentist didn’t instruct you in their care, I suggest going back to your dentist and asking him to fix them at no charge. If he knows the polishing technique, he can do it that way. Otherwise, he’ll need to just re-do them.

A second possibility is that your dentist used inferior materials when he placed your bonding. I hope that is not true. The only way to know with certainty is after you have them fixed. If you are caring for them properly and they turn yellow again, it is his material.

I’m also providing a link here, which gives you a lot of information on dental bonding. If you scroll toward the bottom, it will tell you how to care for them.

Bruxism and Dental Bonding

Another thing which has me concerned is your teeth grinding. When you clench or grind your teeth it will lead to damage. You’ve experienced this yourself and it is why you had the bonding done in the first place. However, without addressing the cause of the damage, the bonding won’t hold up any better than your natural teeth did.

It doesn’t sound like your dentist has addressed this. There is a simple solution too. Have him fit you for a nightguard and your dental bonding, as well as the remainder of your teeth, will be protected. Without it, they’ll end up ground down to nubs and you’ll eventually need a full-mouth reconstruction.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Should My Dentist Pay for My Bone Grafting for My Dental Implant?

I lost a tooth almost 12 years ago. I plan on getting a dental implant now that finances are better. However, when I went in for my consultation, my dentist mentioned I’ve lost bone in that area and will need some grafting done. My sister told me that he could have done a socket preservation procedure when he first took out my tooth and I wouldn’t need the grafting now. She recently had a tooth out and her dentist recommended it. Should my dentist pay for my grafting? I’m pretty sure he never offered that option to me when my tooth was removed.

Melanie

Dear Melanie,

illustraition of a dental implant next to natural teeth

The socket preservation procedure your sister referred to was fairly new back when you had your tooth removed. We didn’t have much data at oll on how well the procedure worked. The cost was often prohibitive for patients. Even today, not all dentists offer the treatment option.

The procedure is quite similar to a bone graft and is done by placing bone material in the socket which can fill in the gap over the years. There is still very little data on the longevity of the procedure. Even some successful cases had to have some bone grafting done later anyway, though less than they would have if they hadn’t done it.

Bone Loss after Tooth Extractions

When any teeth are removed, your body recognizes that. In an effort to be as efficient as possible with your body’s resources, it will begin to resorb the minerals in your bone to use elsewhere. 40-60% of your bone is lost within the first three years, though the rate of absorption slows significantly after those first few years.

I don’t think you have a case to get your dentist to pay for your bone grafting. Even if he didn’t offer the procedure to you at the time, which in all honesty there is no way to know, because it was a procedure just getting started he didn’t do anything wrong not suggesting it.

You Don’t Have to Pay for Dental Implants all at Once

You can pay for the bone grafting, then take a break. The implant procedure is paid for in two phases. First, the dental implant itself. Then there is a period of healing while the bone integrates with the implant. This is an imperative step. Without it the implant will fail.

Once that is completed, then the second half of the procedure will commence along with the second payment. That is when the dentist will place the dental crown on top of the implant.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.