She Needs to Leave This “Cosmetic” Dentist

I went to see a dentist who advertises as a cosmetic dentist. I mostly wanted them whiter and brighter. I also have a slightly crooked front tooth, but it really isn’t that crooked, certainly not enough to pay for braces. I wanted to get some porcelain veneers on my upper arch. But, the cosmetic dentist I saw wants me to do Invisalign first and then get the porcelain veneers. If the tooth is only a little crooked, is that really necessary?

Madeline

Dear Madeline,

Invisalign Aligner

I want you to find a different dentist to work on your smile makeover. While I am sure he calls himself a cosmetic dentist, there are a couple of things that bother me here. You should be aware that cosmetic dentistry is not a recognized specialty. Any general dentist can call themselves a cosmetic dentist regardless of the amount training they have invested in.

I have a strong feeling your dentist doesn’t have much training. Under normal circumstances, you would either need porcelain veneers OR orthodontics, not both. Porcelain veneers, done skillfully, can make crooked teeth look straight. He obviously does not know how to do this, so he is setting up the ideal situation for himself. This does not inspire confidence in me with his abilities.

Doing smile makeovers are not taught in dental school. In order to learn how to do them well, a dentist would have to invest in significant post-doctoral training.

If you want a smile makeover done well. You want a dentist with the highest skills.

However, there is something else for you to consider. If the only thing wrong with your teeth is you need them whiter and brighter, plus there is one crooked tooth you could save a significant amount of money by instead doing Invisalign with tooth whitening. In fact, the Invisalign aligners can double as the teeth whitening trays thereby saving you even more money. Unless there is something else you want to change about your smile, that is what I would recommend.

However, if you decide you still want to have porcelain veneers done, perhaps because you want the fastest solution, then I would look for a dentist with more expertise. In fact, I would only go to a dentist who is AACD accredited. These are the best cosmetic dentists because they have the proven skills and artistry.

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

Staining on Porcelain Veneers only one year later

I had porcelain veneers done just a year ago. I was told these would last for many years. I’m actually still paying them off. Yet, they’ve already started staining. Should I be worried?

Carol

Dear Carol,

I wish I had a picture of your porcelain veneers. That would help me have a more precise idea of what went wrong. Without that, I can give you some generalities which should be helpful.

If the staining seems to be over the surface of the entire veneer, there are two possibilities. The first is that the glazing on your veneers was removed. This can happen if your dental hygienist used something like a power prophy jet or acidulated fluoride during your appointment. Both of these will damage the glazing, which does not only give your veneers their shine but protects them from stains.

A second possibility is that there is a gap between your porcelain veneers. This allows food and other bacteria to get underneath. Not only does that make your veneers look darker because of all the stuff caught underneath, but it pretty much guarantees you’ll end up with the tooth underneath becoming severely decayed.

Both of these issues are the fault of your dentist, and they should take responsibility for repairing it, which will mean replacing them.

If the staining is not all over, but rather at the top or the sides these are completely separate issues. The first problem can occur if there is a gap at the top of your veneers between that and your gumline. Like the other gap, it will cause both staining and decay. Your dentist will need to replace them.

The staining around the sides is much easier to deal with and is generally part of regular maintenance. There is usually a minimal amount of composite bonding around the edges of your teeth. The composite needs to be periodically polished. This is easily done and I would plan on doing it once a year. This is especially true if you smoke or drink staining beverages such as coffee or tea.

If the problem is one of the more serious issues that require replacement, but your dentist is uncooperative you may have to get a second opinion dentist to help you.

Sometimes a dentist is more willing to listen to a peer than a patient. I would make certain you go to an expert cosmetic dentist to tell you what is wrong with them, though. See if you can find a nearby dentist who is AACD accredited. These are the best cosmetic dentists in the country.

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

Dental Implants are Falling Out

I had dentures for a while and just really hated them. After doing some research, I decided to get implant overdentures, with eight implants total. This has cost me about $12,000. Yet, in less than a week three of them have fallen out and today a fourth one came out. Should I get a refund for those? Is there a way to get them back in? I really hated the removable dentures.

Penny

Dear Penny,

Implant overdentures

You should absolutely get your money back on those failed implants. To be honest, I wouldn’t have too much confidence in the ones that are left either. The current estimated failure rate for dental implants is 5%. Your dentist’s failure rate is 10 times that in just a week.

Most dental implant failures come from poor surgical placement. However, you mentioned you have been in dentures for a bit. You didn’t mention how long. When your teeth are removed, your body begins to resorb the minerals in your jawbone. It is possible, depending on how long you were in dentures that you did not have enough bone to retain the dental implants. That is something your dentist should have caught with his diagnostics.

My first recommendation to you is to see a dentist with real dental implant training, such as with Dawson Academy or the Las Vegas Institute of Advanced Dental Studies. Have them look at your implants and see if they can tell you what went wrong. If you had adequate bone support and it was a problem with the dentist’s surgical placement, then don’t just ask for a refund. Instead, ask for him to pay to have the new implants replaced by a dentist of your choosing.

This is because it will cost more to repair this than it did originally. Losing or removing dental implants takes bone with it. The missing bone structure will have to be replaced in order to have a succesful outcome the second time around. That can be done with bone grafting, but your dentist should cover that if you had enough bone to begin with.

If you didn’t have enough bone to begin with, then you would only need a refund. You would have needed bone grafting to begin with in that case.

You should not have any trouble getting a refund on this, especially if you have a second dentist advocating for you.

Best of luck. You can still get the implant overdentures you want!

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

cLEAR cHOICE OR cOSTA rICA FOR dENTAL iMPLANTS?

I am trying to choose between Clear Choice Dental Implant Centers for all-on-4 dental implants or going to Costa Rica for traditional implants. A dentist here said I am not a candidate for the traditional implants because of my bone structure. Clear Choice said they can work around that, but I’ve heard Costa Rica will place implants when dentists here won’t. Do you have any experience with these scenarios?

Ben

Dear Ben,

Implant Overdentures

You are asking me to choose between the lesser of two evils. Here are my problems with both of those options. Let’s start with Clear Choice. They pretty much do the all-on-4 dental implant procedure for most patients. However, while the procedure can be useful in certain situations, it is also risky. If one part of it fails, the whole thing has to be completely re-done. A second issue with Clear Choice is there is no significant follow-up care. This puts you at risk of post-procedural complications.

One of the problems with the dental implant procedure is it isn’t adequately taught in dental school. Dentists have to take post-doctoral training in order to develop the skills necessary. Too many dentists are delving into this for the income stream, but without adequate training. It is one of the leading causes of malpractice cases at the time I write this post.

Now, take the worst dentist in the United States and you will still be better off than if you went to Costa Rica for this procedure. You say they are willing to do cases that dentists here will not. Of course they are! They don’t have to worry about your dental implant failure. You will be back in the States with zero recourse, and they will be raking in their profits. It is a no-lose proposition for them and a total gamble for you.

And what will you be gambling? Here are just some of the complications you could deal with.

  • You could lose a large portion of your jawbone, leaving you a dental cripple.
  • They could place the implant on a nerve, leaving you either in constant pain, no feeling at all, or even paralysis in the area.
  • They could perforate your sinus cavity.
  • Infection could set in.
  • The implants could be too short or too thin to retain properly.
  • They could be loaded prematurely leading to dental implant failure.
  • They could come loose.
  • You could end up with peri-implantitis.

Your safest option is to go to a solo practice here in the United States where there are standards of care and patient recourse if something were to go wrong. Look for a dentist with post-doctoral training.

I know your dentist said your bone structure would preclude you from receiving the implant procedure you want. However, with a bone grafting procedure, you will build back up the lost bone structure and can get the best replacement possible. Instead of an all-on-4, I would look at getting implant overdentures.

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