Tag Archives: Salem MA cosmetic dentist

Straightening Teeth with a Missing Teeth

I never had braces as a child. It’s always bothered me. I want to do something about it now that I’m an adult. I keep hearing about invisible braces, which sounds much better to me than those silver ones all my friends in middle-school wore. The one thing that worries me is I have two congenitally missing mandibular bicuspids. Do I need to get dental implants for those spots?

Katherine

Dear Katherine,

A woman putting in her Invisalign aligners in two stacked images

Invisible braces could refer to one of three things. First, they could be referring to the clear braces you can get these days. They still go on your teeth like the traditional metal wire and bracket braces, but it uses a less visible material.

A second possibility is lingual braces. These are also the traditional type of braces bonded to your teeth, but they are placed behind your teeth where no one can see them. Many child stars have worn these when they’re in the middle of filming a series where they didn’t (or couldn’t in the case of a historical series) want the character to have braces. They’re useful for straightening in secret, but they have a couple of drawbacks.

They can be uncomfortable on your tongue which will bump up against them quite a bit. Braces make oral hygiene trickier because of all the materials you have to get around and the food that continually gets trapped in them. Lingual braces are even harder to keep clean because of their location. You could end up with a lot of unnecessary decay if you don’t stay on top of your tooth care.

Invisalign — Your Best Invisible Braces Option

While both of the above options could be considered “invisible braces”, there’s a much better option. Invisalign, though not technically braces, is an orthodontic system which straightens your teeth in significantly less time than traditional braces. These use clear aligners (think teeth whitening trays) instead of wires and brackets. Even at a conversational distance, people will not be able to tell you’re wearing them.

Because you’re talking about your lower bicuspids, it’s not necessary to get dental implants. Invisalign will close the spaces in your lower arch. Though, if you wanted to, you certainly could get implants placed where you’re missing teeth are. To do that, however, you’d need to work with an experienced implant dentist who also understands orthodontics. This way your work can be done in such a way as to preserve the needed space for the implant.

This blog is brought to you by Dr. Randall Burba. Check out his smile gallery.

Can a Diabetic Get All-on-4 Dental Implants

After my husband died I really struggled. I stopped taking care of myself. I gained 100 pounds, developed diabetes, and even developed gum disease which led to losing several teeth. I didn’t care. Then, one day I was at a park and smiled at a little girl and she asked if I was homeless. I realized then, things had to change. I have a full life ahead of me. I started eating right. I joined a gym. I’ve almost completely lost all the weight I gained and I no longer have gum disease. I asked my dentist about what he recommended for my missing teeth and he suggested all-on-4 dental implants. I was super thrilled about the idea of having a full mouth of teeth again. But, I went home to do some research and learned that diabetics shouldn’t get them. I don’t want to pay all that money if it’s not going to work. What should I do? I really want teeth again.

Carra

Dear Carra,

illustration of a dental implant

First, let me add my condolences. Don’t be too hard on yourself regarding how you dealt with your grief in the beginning. It’s almost suffocating to lose a loved one and we all seem to lose ourselves at first too. You should be really thrilled with the incredible progress you’ve made since then. I think the healthy changes you’ve made are remarkable.

For the most part, dental implants have a 98% success rate when done by an experienced implant dentist. There are some factors which make patients more at risk for implant failure. The biggest of these are:

  • Gum Disease
  • Smoking
  • Uncontrolled Diabetes

You’ve already taken care of your gum disease, which is huge. A responsible dentist will NEVER give a patient who has gum disease dental implants. There’s no way for your body to retain them well, just like when you suffered from gum disease, they couldn’t retain your natural teeth. They will fail. Because you’ve already turned that around it’s not a worry for you.

You didn’t mention anything about smoking, which I hope means you’re not a smoker. Smoking lowers your blood flow in your gums which increases your risk of infection, a leading cause of dental implant failure. You also increase your risk of redeveloping gum disease.

Your diabetes is under control, so again, Yay! not a problem for you. I think you’re likely a good candidate for dental implants.

Are All-on-4 Dental Implants the Right Choice for You?

The only real reason to do the All-on-4 procedure rather than traditional implants is bone loss. Sometimes, with gum disease and tooth loss, you lose so much jawbone structure you don’t have enough to retain dental implants. All-on-4 is one way to get around that. However, there is a better, more reliable option.

If you don’t have enough bone to support traditional dental implants, I’d consider getting bone grafting done. It will build back up your bone structure. Then you’re free to get whatever procedure you want. I hope this helps you make your decision.

Best of luck and congratulations on all your hard work!
This blog is brought to you by AACD Accredited dentist Dr. Randall Burba.

Is a Cracked Porcelain Crown a Dental Emergency?

I had several porcelain crowns placed on my front teeth. They’ve served me well for over fifteen years. One has always had a minor defect you couldn’t see just by looking. My dentist told me about it and offered to do a different crown, but she did say that even our natural teeth have minor defects and it shouldn’t be a problem. I appreciated her honesty and her willingness to make an entire new one. I didn’t feel that was necessary and their longevity has born that out. Today, however, I noticed I can both see and feel the defect. I’m sure it needs to be replaced at this point, I’m just wondering if it is a dental emergency or I can wait. The original dentist has since retired and her replacement and I are just getting to know one another so I don’t yet have the same confidence in her.

Lindsey

Dear Lindsey,

A Dental Crown being Placed

It sounds like you and your old dentist had a wonderful doctor-patient relationship. It’s certainly hard to lose a trusted caregiver. Hopefully, her replacement will end up being equally honest and skilled. While this change in your dental crown isn’t necessarily a dental emergency, I don’t want you to get too comfortable and let this slide. You do need to be seen.

The fact that you can now see and feel the defect tells me it’s cracked. It will at some point completely break. Those type of things inevitably happen at the worst possible moments, like when you’re on vacation or out to dinner. It’s much better for you to get this dealt with well before it can become an emergency issue. Plus, it will give you peace of mind knowing it’s no longer at risk of breaking.

Who Should Replace Your Dental Crown?

You’re not familiar with your new dentist yet, so before you allow her to replace your porcelain crown, you will need to research her cosmetic skill. At the very least check out her smile gallery. It’s a collection of before and after pictures of cosmetic work she’s done. You can click here to look at Dr. Burba’s work to get an idea of the type of quality you want. These are front teeth so you want them to be beautiful when you smile.

Some dentists would try to persuade you to replace all the crowns so as to make them easier to match. That’s usually a sign they’re not top-notch cosmetic dentists. The crowns are aging, so if you want to go ahead and replace all of them, that’s fine. But, you mentioned they’re still in good shape. In that case, you really only have to replace the broken one.

Replacing a single crown to your remaining teeth takes an expert cosmetic dentist. I’d suggest you look for a dentist who’s reached accreditation level with the American Academy of Cosmetic Dentistry. AACD accredited dentists are experts in their field both in technical skill and artistry. They’ll match your crown perfectly.

This blog is brought to you by Dr. Randall Burba.

Replacing all Crowns because of One?

I had crowns placed on all my front teeth about 17 years ago. Since then, my dentist passed away. I’ve been happy with his replacement, up until now. One of my porcelain crowns started to feel loose. I looked at it closely and there’s a dark spot on the top edge. I went to see the dentist. He said there’s decay at the edge and the crown needs to be replaced. But, (and here’s the catch) he says I have to replace all of them if I want them to match. That’s a LOT of money. Is that really necessary or can I wait until they need replacing individually?

Mara Lynn

Dear Mara Lynn,

Side by Side images of dental crowns done by two different cosmetic dentists on the same smile. One is ugly. One is beautiful

Believe it or not, the images above are of the same smile. In both pictures the patient had dental crowns placed. The only difference was the quality of the cosmetic dentist she used. I’m guessing your current dentist is more like the one on the left. He’s not a cosmetic-oriented practice, therefore his skill is limited.

It sounds like the margins on your porcelain crown opened, leaving a little ledge ideal for the development of decay. At the very least, the one with the decay needs to be replaced.

When your current dentist says your crowns won’t match if he doesn’t re-do all of them at the same time, he not lying to you. He’s admitting the limitations of his skill. In this case, you have two choices.

Choosing a Cosmetic Dentist to Re-do Your Smile

  • Just replace the crowns as needed to save money.

You’ll definitely need a new cosmetic dentist in order to do it this way. A good cosmetic dentist CAN just match one crown to the rest of your teeth. They won’t need to do the entire arch. The first thing I’d do, though, is check all the crowns for suspicious marks and open margins. You’ll want to replace any of those at this go-round before they turn into decay. After that, it’s fine to just change them as you need to.

  • Replace them all at once to save time

Even though this is what your dentist suggested, he did it for the wrong reasons— to cover his lack of cosmetic skill. Because of that, I’m not sure you’d be happy with his results. I believe you’d be better served with another dentist in this case as well.

The top cosmetic dentists in the country are those who’ve reached the accreditation level of the American Academy of Cosmetic Dentistry (AACD). AACD accredited dentists create beautiful smiles. In fact, most of them even have a beautiful smile guarantee.

On a side note, you’ll be much more comfortable using sedation dentistry to have that much work done in one sitting. You can simply go to sleep (if you want to) and when you wake up all the work is done.

This blog is brought to you by Dr. Randall Burba.

New Crown hurts

I got a new crown a few weeks ago. It hits my other teeth funny, which makes it hurt every time I bite. I went to my dentist. He looked at it and said it’s fine and to give it time. I have given it time and it’s still hurting. What do I do?

Cammi

Dear Cammi,

Woman holding her jaw in pain
Damage to a bite can lead to TMJ

“Give it time.” That’s dentist speak for, “I don’t know how to fix this.” Here’s what needs to happen. This crown needs to be adjusted. It’s likely the crown is just too high. When you bite down, the other teeth are hitting the crown before it meshes. The pain you’re experiencing is just part of the deal. If this isn’t adjusted, it can do damage to your bite. Fortunately, there are things your dentist can be doing to deal with this.

First, he needs to determine if the crown problem is simply it is sitting too high. If so, a simple adjustment can fix everything. If that doesn’t work, there is a next step. He can have you bite down on a bite registration paper. Where it registers the bite too high he can make some adjustments.

Of course, dentists with advanced training wouldn’t have this problem to begin with. If they did, they’d fix it with a properly made crown. The key this time is to get you out of pain and make sure your bite doesn’t get damaged. The last thing you want is TMJ Disorder.

What Type of Dentist Can Treat TMJ?

Neuromuscular dentistry requires advanced training. Traning you can’t get simply by going to dental school. It needs post-graduate training. Don’t hesitate to ask where they received their TMJ training. Some schools that are very reputable are:

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

This blog is brought to you by Dr. Randall Burba.

Porcelain Veneers Staining After Months

I am thinking I did something terrible. My dentist told me that my porcelain veneers would last for years. But, I’ve only had them for a little over seven months and they look awful. They were fine, even at my six-month checkup and cleaning. It was after that they started picking up stains. I don’t know what I did. I thought I was super careful. I researched and got a special toothpaste that’s supposed to be for porcelain veneers called Supersmile. Was that a scam? Did that mess them up? Can this be fixed? I’m embarrassed to tell my dentist, but I really love these veneers.

Cathy

Dear Cathy,

A single porcelain veneer being held up by a dental instrument

You didn’t do anything wrong. The Supersmile toothpaste isn’t a scam. It’s actually the absolute best toothpaste you could have purchased for your porcelain veneers. Great job looking that up. It’s something your dentist should have told you about when you first got the veneers placed.

My suspicion is it’s your dentist’s office that made the terrible mistake. It sounds to me, based on the timeline you’ve given that your hygienist didn’t understand the proper care of porcelain veneers and used something on it like a prophy jet during your cleaning.

This would have removed the glaze from your veneers, leaving them dull and susceptible to staining. Without the glaze, they’ll never look good again.

What Do You Do If Your Glaze Is Removed on Your Porcelain Veneers?

Because it’s your dentist’s office that likely did this they need to fix it. There is a special procedure which requires a special diamond polishing technique which could restore the glaze. Unfortunately, it’s such an advanced procedure I doubt your cosmetic dentist knows it, especially if they didn’t even know how to properly clean your veneers.

My guess is they’re going to have to replace your veneers completely. If they give you any problem with that, you can show them this post. Or, maybe go to another cosmetic dentist for a second opinion. Sometimes, not wanting to look bad in front of your local peers is a great motivator.

This blog is brought to you by Dr. Randall Burba.

How Do I Know If My Dentist Is the Best for My Smile Makeover?

I’m worried I should go to a different dentist for my smile makeover. He’s a really nice man, but when I suggested I get porcelain veneers he said that crowns would be a better option. I told him I didn’t want to grind my teeth down when they’re healthy. He said he was willing to get certified to place Lumineers for me. He’s super sweet and I love that he’s willing to learn something to help me but I’m not sure I want to be his first case, especially because this will essentially wipe out my life savings. What do you think?

Carrie E.

Dear Carrie,

Woman with beautiful smile

Your gut instinct is right. It does sound like you have a very caring dentist, but he won’t be the best dentist for your smile makeover. You need someone who’s had significant training and skill in cosmetic dental work. It takes a lot of training and artistry. It doesn’t mean you have to switch dentists altogether. Just for your smile makeover. You can still see your regular dentist for everything else.

Look for a dentist in your area who is accredited with the American Academy of Cosmetic Dentistry (AACD). These are the dentists who have the skill you need to create a gorgeous smile. In fact, most of them have a beautiful smile guarantee.

The Best Way to Care for Your New Smile

Now one thing to understand is your dentist won’t know the right way to care for your new smile after you finally get it. The important thing will be to make sure they don’t use anything like a prophy jet or other power jet to clean your teeth. That will remove the glaze from your porcelain veneers and they’ll quickly become ruined.

He sounds like a responsible dentist. It might not be a bad idea for him to learn about how to properly care for them for your further cleanings and check-ups. I bet he’d be willing to do that, especially because he offered to get certified in Lumineers for you.

By the way, tell him if he’s truly interested in learning about placing porcelain, not to waste his time with the Lumineers seminar. He’d be better off learning about true aesthetic dentistry at somewhere like LVI. Obviously, he’d probably take that better from a peer than a patient, so feel free to show him this post.

Best of luck with your smile makeover.
This blog is brought to you by Dr. Randall Burba.

Can a Cosmetic Dentistry Disaster Be Fixed?

I spent a small fortune on a smile makeover. The “teeth” aren’t nearly as white as I wanted. My dentist says it’s because they need to look natural. They’re also a little wider than I expected. One of them keeps falling off. I’ve had my dentist put it back on three times, which he has done without charging me. But, he’s getting tired of it because the last time he casually mentioned that it’s a tooth that didn’t need much work and probably doesn’t need the veneer anyway.  I don’t think he wants to keep putting it back on. I don’t know what I’m doing to keep knocking it off. Can this be fixed?

Stacey L. – Virginia

Stacey,

He said what!? Seriously?  Believe me, you’re not the problem. This dentist is.  I’m sure he’s a fine family dentist. He’s just not the best dentist for your in this situation. Though not a recognized specialty, cosmetic dentistry is an entirely different beast than general dentistry.

To do it well requires significant post-graduate training and an artistic eye. Some things can’t be taught. Ideally, you’ll want a dentist is who is accredited with the American Academy of Cosmetic Dentistry (AACD). That’s more than just a membership. These dentists are among the top cosmetic dentists in the world.

You’re not the problem with this porcelain veneer falling off. He is.  He’s not bonding it properly. Yet another evidence he doesn’t have the skill required here. And to answer your question, yes, it can be fixed, just not by this dentist. If it falls off again, don’t go to him. Go to a qualified, skilled cosmetic dentist to get a second opinion on your case. It’s possible you can get a refund and have it done by someone who can give you a stunning smile. One that is as brilliantly white as you dreamed.

This blog is brought to you by Dr. Randall Burba.

Is This White Sore in My Mouth Cancer?

I’ve got this painful white sore in my mouth. It’s making it hard to eat. Do I have cancer? Should I see a dentist?

Missy P. – Kentucky

Missy,

I couldn’t tell you if it was oral cancer without examining it.  Before you panic, though, it could just as likely be a canker sore. Your dentist should be doing regular examinations for oral cancer. If you don’t have a dentist, you can see an emergency dentist if it turns out not to be a canker sore.

True canker sores usually clear up between 10-14 days. It will just be a matter of managing the pain until then. There are oral antiseptics you can purchase over the counter.  They won’t take care of all the pain, but they can take the edge off of it.

If it doesn’t clear up in that amount of time, it’s time to get it checked out.  As I said before, if you don’t have a regular dentist an emergency dentist will see you. I have seen that most people who avoid the dentist do so out of fear.  There are dentists who are compassionate with fearful patients, who have methods of giving you a pain-free dental appointment.

This blog is brought to you by Dr. Randall Burba.

My Dentist Has Me Terrified I’m Going to Be Humiliated

I’m caught between a rock and a hard place. I want dental implants, but can’t afford them. I’m stuck with dentures. But, my dentist keeps telling me these horror stories about people’s dentures falling out in public situations. I’m terrified I’m going to be humiliated. Is this a given? Am I eventually going to be on one of the “funniest videos” shows?

Amanda L.  – Missouri

Amanda,

I think it is unfair for your dentist to try to scare you into a procedure. He’s supposed to tell you the pros and cons of each procedure, but not this way.  This is histrionics.

The real downside to dentures as opposed to dental implants is the loss of jawbone. When your teeth are removed, your body begins reabsorbing the minerals in your jawbone to use elsewhere. Eventually, that causes your jawbone to shrink and your dentures to slip.

Let me say, that takes several years to happen, so you have a couple of options. First, you can get snap-on dentures. While they’re not as ideal as implants, they’re a great option for people in your position. They anchor the dentures to your gums. You can get them as few as two implants. You can get more, of course, but two are the most affordable.

That also helps with your second option. Get dentures (or snap-on dentures) while saving up for implants. You can gradually add more implants as you’re able.

This blog is brought to you by  Dr. Randall Burba.