Tag Archives: AACD accredited dentist

Botched Tetracycline Case

I’ve had tetracycline stains most of my life. Originally, I had some work done by having dental bonding done over them, but it was time to replace them. I’d since moved to another city and couldn’t see the original dentist. My new dentist suggested we do six dental crowns because it would “hide the stains better.” I did not do adequate research and just trusted what the dentist told me. Now I regret it. The crowns show the stains underneath, especially in fluorescent lighting. Plus, you can tell these are crowns because they look so different from the adjacent teeth.

What do I do here? He’s offered to send them back to the lab, but I’m not sure the results will get any better. Is it okay to ask for a refund?

Lannette

Dear Lannette,

Tetracycline stains are among the most difficlut cosmetic procedures to do. The stains are so dark and so deep, it takes real skill to get the repair opaque enough to cover the stains while still having that natural translucent look. Your dentist likely had good intentions but was in over his head.

Warning Signs He Didn’t Know What He Was Doing

First, he suggested porcelain crowns instead of porcelain veneers. This automatically shows he is not comfortable with cosmetic dentistry. Dental crowns, for this type of procedure, means unnecessarily grinding down healthy tooth structure.

Second, he suggested only six teeth. When we study in dental school we learn about front and back teeth. The first six are considered the front teeth. However, dentists who study cosmetic dentistry, do not divide things into anterior and posterior teeth. Instead, we talk about the aesthetic zone. This is the number of teeth visible when you smile. For most patients, that is eight to ten teeth. Not six.

With those adjacent teeth showing with the dark stains, it makes it obvious your front teeth are crowns.

I agree with you that this dentist is not going to be able to make it any better. I suggest you just ask for a refund. Then go to an experienced cosmetic dentist to do this. The best cosmetic dentists are AACD accredited, so I would look there. Unfortunately, once you have dental crowns placed you are stuck wtih crowns. The good news is an excellent cosmetic dentist can make them look natural and beautiful.

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

Porcelain Veneers With an Overbite

I am finally in a position where I can get a beautiful smile. I’ve had tetracycline stains on my teeth for years, which always left me self-conscious about my smile. I wanted to get porcelain veneers but my dentist said my overbite will prevent that because my top teeth pretty much completely cover my bottom teeth. Instead, he is suggesting four porcelain crowns. I have some questions though. First, have you heard of my type of bite being an issue with porcelain veneers. Second, Do I whiten my bottom teeth to come close to matching the top?

Melissa M.

Dear Melissa,

Porcelain Veneers require real expertise.

I am glad you wrote before going through with this procedure. I have some concerns about your dentist’s qualifications to give you a beautiful result. Let’s start with his choice of treatment–porcelain crowns. When dentists suggest porcelain crowns when a patient asks for porcelain veneers, it is most often because they are not comfortable doing porcelain veneers but don’t want to admit that to their patient.

I will give your dentist credit for his creative excuse, even if it is totally invalid. When you have an overbite, porcelain veneers actually make more sense. Veneers only cover the front of your teeth and hug the sides a smidge. Dental crowns have to go around the whole tooth. If your top teeth are covering your bottom teeth, that will be a challenge.

A second issue is your dentist suggesting four dental crowns. Unless you have an unusally narrow smile, this means your adjacent teeth, with their tetraycycline stains, will be visible when you smile. Most smiles need somewhere between eight to ten veneers to get all their visible teeth.

For the bottom arch, it is possible to have some teeth whitneing done, but tetracycline stains can be pretty resistant to most whitening methods. Kor Whitening has had the best results with these type of stains.

The Key to a Beautiful Smile Makeover

The one constant in beautiful results will be tied to the dentist you choose to do your porcelain veneers. Smile makeovers are not taught in dental school. On top of that, cosmetic dentistry is not a recognized specialty. A dentist has to decide to get the post-doctoral training necessary to produce beautiful results.

In your place, you need an expecially well-trained dentist. Tetracycline stains are one of the most challenging cases. Your dentist will have to get the veneers opaque enough to cover the stains but still look translucent to give it that natural reflective shine. To get this result, I would look for an AACD accredited dentist. These are the top 1 % of cosmetic dentists in the country.

This blog is brought to you by Boston Cosmetic Dentist Dr. RAndall Burba.

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.

Dentist Pulled My Implant Out

I had a dental implant placed on a front tooth. I wasn’t thrilled with how it ended up looking. It was obviously fake next to the other teeth. However, it was better than having a gaping hole in the front of my mouth. A week after the crown was placed, the implant felt loose. I called the office and they told me to come on it. The dentist said the crown was likely loose and he would just rebond it. He had a little trouble getting it off until he got a tool, but when he did, the implant came out with it. Does this normally happen? He said they can re-implant it but I’m nervous.

DeeAnn

Dear DeeAnn,

No, this does not normally happen. However, in your case I am going to call this a blessing in disguise. I am having a hard time fathoming the level of incompetence this rises to. First, when a dental crown is loose, it is easily removed. He would not need a special tool at all.

It was obviously the dental implant that was loose the entire time. Because this implant was defective and unattractive, it is fortunate that your dentist accidentally pulled it out. Now you have the right to demand he pay to have it repaired properly.

Do not just ask for a refund. Instead, I want you to insist he pay to have it replaced by the dentist of your choice. This is because it will be more complicatted to replace the implant and dental crown. You lost bone when he ripped it out. That bone is necessary in order to retain your implant. In order to place it, you will need bone grafting done to build the area back up.

Finding the Right Implant Dentist

Dental implants aren’t really taught in dental school so you need a dentist who has invested in post-doctoral training. You also want to make sure that they have a high success rate with their dental implant procedures.

At the time I’m writing this dental implant failure and the consequences of poor placement is one of the leading dental malpractice suits. Ask about their success rate. I’d like you to see someone with a 95% or higher rate.

In addition to their implant training, you need to consider how skilled they are in cosmetic dentistry. You are replacing a front tooth. As you’ve discovered, getting a perfect match is essential for a beautiful, natural-looking smile. In your place, I would want an AACD accredited dentist to work on my implant crown.

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

How Do I Touch Up My Whitening Before Getting a Dental Crown

I have to get a dental crown on a front tooth. Because I read the color is permanent, I’d like to touch up my teeth. I had them whitened a few years ago and they’ve been picking up stains again recently. I asked my dentist for some extra whitening gel, but he couldn’t give me an idea of how often and long to use the gel to get my teeth back where they were.. Are there any standards for this?

Meagan

Dear Meagan,

Teeth Bleaching Trays

I’m a little concerned your dentist could not advise you on this. The principles of teeth whitening are fairly simple. It is the easiest cosmetic procedure dentists do. Given his inability to answer this question, I have serious doubts he’ll be able to provide you with a dental crown on a front tooth that looks natural and matches the adjacent tooth.

Crowns of front teeth are much more difficult because of how directly the light hits them. It takes an expert cosmetic dentist to do them beautifully. If you want to stay with this dentist for your dental crown, make sure he uses a temporary try-in paste when your crown is ready and allows you to see it in several types of lighting. If you don’t like how it looks, he needs to re-do it. Don’t let him bond it on.

You may be better served by finding a different dentist to do your crown. The best cosmetic dentists are accredited with the American Academy of Cosmetic dentistry.

How Much Teeth Whitening?

As to how much teeth whitening, the principle is fairly easy. The longer you wear the whitening gel, the faster it will whiten. If you’re in a hurry, I suggest wearing it overnight. First, that allows it to stay on your teeth longer. Second, your saliva production goes down at night which means there will be less dilution.

If you prefer wearing it during the day, that’s fine too. Just wear it for as long as you comfortably can.

The one hard and fast rule here is once your reach the level of whitening you are happy with and you are done with the whitening gel , you want to give it a week for the color to settle before having the color of your crown matched to it.

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

New Lumineers Over Old

I had Lumineers placed quite a few years ago. I’ve never been happy with the color. My dentist knew I wanted whiter ones, but his tech guy told him it wasn’t possible to get them that white. In recent years, I think that has changed because I see a lot of people with really white teeth. I’ve been told that I can’t whiten them, but my dentist suggested we place new Lumineers on top of old Lumineers to make them look better. Have you heard about that being done before?

Madison

Dear Madison,

porcelain veneer being placed on a tooth

The one thing I agree with your dentist about is that using teeth whitening will not help with dingy Lumineers. Teeth whitening only works on natural tooth structure. Everything else he’s either done or suggested in regard to this case, I have serious concerns about.

Let’s start with the original color. Even several years ago, you would have been able to get your smile as white as you wanted. One thing you should know is that Lumineers is just one brand of porcelain veneers. This brand is highly marketed to inexperienced cosmetic dentists. However, most expert cosmetic dentists do not prefer that particular brand. The main reason for that is the company that owns Lumineers insist dentists use their lab, which isn’t known for its artistry or skill. This may be why that particular technician didn’t get them white the first time.

The second issue I have is his suggestion of new Lumineers over old. This is a really bad idea for a few reasons. First, it is just as difficult to place the Lumineers on top of the old ones as it is to just replace them.

Second, the Lumineers will not bond as well to porcelain as it will to your natural tooth structure. This puts it at risk of bonding failure. Finally, the chance of bonding failure doubles because both the new ones and the old ones are at risk.

Getting the Smile Makeover You Want

If you truly want a smile you will be proud of, you will need to go to a different dentist to get it. If you are happy with him as your general dentist, you can still use him in that capacity. Many patients have one dentist for general work and one for cosmetic work.

While there isn’t a recognized specialty in cosmetic dentistry, there is a way to ensure you have a skilled and artistic cosmetic dentist. I recommend that you see an AACD accredited cosmetic dentist. These dentists are in the top 1% of cosmetic dentists in the country. They can create a stunning smile for you. In fact, most of them even have a beautiful smile guarantee.

Don’t be surprised if whichever dentist you end up with suggests a different brand of porcelain veneers. They will know the strength and weaknesses of each and based on what type of smile you want, they will pick the brand whose strengths will give you the most benefit.

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

A SErious Case of TMJ Disorder

I need some advice. In my late 20s I had all my teeth crowned because of severe teeth grinding. I don’t think it was done properly because those ended up ground down as well. In addition, my teeth are now on a slant and I have massive jaw pain. I became desperate and sought out a neuromuscular dental specialist. I didn’t know that wasn’t a real specialty and now worry I’ve been duped.

He had me in an orthotic for 2 years that opened up my bite too much. I’m worse off than I was at the beginning. I need to get this fixed. Here’s my questions. First, if there isn’t a specialty, how do I know who to go to for treatment? Second, do I have to choose between form and function? By that I mean is it possible to get someone who can give me a properly functioning smile that also looks good?

Marcy

Dear Marcy,

woman holding her jaw in pain

You’ve already learned some hard lessons. I’m sorry about that for you. I wish your dentist in your twenties would have recognized your teeth grinding and been proactive instead of allowing them to be ground down so far that it required you to get a full-mouth reconstruction. He or she gave you very poor care.

Now onto your questions. I am actually going to answer the second one first. You absolutely do NOT have to choose between form and function. It will take finding the right dentist, but there are dentists who are qualified in both treating TMJ Disorder and skilled in creating beautiful smiles. How you go about that will answer your first question.

Who Should Treat Your TMJ Issues

You want a dentist who has done post-doctoral training. The training that is given in dental school isn’t enough. Here are some of the top post-doctoral training centers for TMJ Disorder:

  • Spear Institute
  • The Dawson Academy
  • The Las Vegas Institute of Advanced Dental Studies

Once you’ve found a list of qualified TMJ dentists, you’ll want to see what type of cosmetic dentistry training they have. Ideally, you want a dentist who has achieved accreditation with the American Academy of Cosmetic Dentistry. AACD accredited dentists are in the top 1% of cosmetic dentists in the country.

It isn’t always easy to find a dentist with both of those qualifications in every area. If you’re having trouble finding a TMJ dentist who also is AACD accredited, you can also look on the mynewsmile.com website.

They have a “find a cosmetic dentist” link. This site is run by a retired cosmetic dentist and he pre-screens all the dentists who want to be listed for both their technical training as well as their artistry. They can’t just pay to be listed, they have to be qualified. On the list are many AACD accredited dentists as well as those who are on their way to accredidation, which takes years, and equally qualified.

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

Porcelain Veneers & Mouthwash

I have porcelain veneers that I love. I’m mixing up a homemade mouthwash to help care for them, but wanted to run the ingredients by you first:

8 oz. Boiled water (I also filter my water)
8 oz. Hydrogen Peroxide
1 T. Sea Salt

Do you see anything harmful about this?

Carmella

Dear Carmella,

porcelain veneer being placed on a tooth

I am glad that you love your porcelain veneers and want to take good care of them. While nothing in the DIY mouthwash you listed will harm the porcelain veneers directly, there will be a separate issue.

Hydrogen peroxide releases oxygen. This will kill bad bacteria that leads to gum disease, but it will also kill good bacteria that helps your mouth. If you use this regularly, it will lead to candida growth and an oral yeast infection. Using a peroxide rinse every once in a while is fine, though.

In most cases, you don’t need a mouthwash to take care of your porcelain veneers. Regular brushing and flossing should do it. If you want a special toothpaste to help keep them white, then I would recommend Supersmile Toothpaste. This is specially designed for cosmetic dental work.

Some patients, however, really feel they need a mouthwash. If you are in that category, the most important thing is making sure that there is NO alcohol in the ingredients.

If there is, the alcohol will soften the bonding and cause ditching and staining around the edges. Using an alcohol-free mouthwash will prevent that.

This blog is brought to you by Boston Cosmetic Dentist Dr. Randall Burba, an AACD Accredited Dentist.

Durathin or Lumineers?

I plan on getting a smile makeover but am having a hard time deciding between Durathin or Lumineers. So far, I like the images of the Durathin veneers better. Is there a huge price difference between the two?

Evelyn

Dear Evelyn,

A dental tool holding up a porcelain veneer

I want to try and make a course correction about how you are going about this. Instead of thinking about porcelain veneers as an item purchase, you would be closer to reality if you thought about it as commissioning an artist to create a portrait.

In that case, you wouldn’t be deciding between what brands of paint you want for the portrait, you’d be considering the skill of the artist and letting them choose the best paint for the job.

Creating a smile makeover is an art form. Unfortunately, it is an artform that isn’t taught in dental school. A dentist has to choose to get that training post-doctorally. What you need is a dentist who has invested a significant amount of time in training and developing their technique and artistry. They are the ones who can provide you with a stunning smile.

One thing you will find is not many of them like the Lumineers brand. This is because their company, insists you use their lab, which isn’t known for producing beautiful results. This also may be why you like the Durathin images better.

Proven Cosmetic Dentists

When you are looking for an expert cosmetic dentist to do your smile makeover, the best cosmetic dentists are AACD accredited. These dentists have passed stringent exams and have provided visual evidence of a large number of cases they’ve done, which is carefully examined by a panel of experts for both their technical skill and artistry.

Any dentist can join the American Academy of Cosmetic Dentistry, but only the ones who pass this rigorous process can be accredited. You will be pleased with any smile they create for you.

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