Dear S.O.
This sounds a little strange to me, not to use the tooth for several months. What is going to happen in several months that is going to now make it safe to eat on this tooth? Either the tooth is strong enough to eat on or it isn’t. But whatever, I wouldn’t advise you to go against the advice of your dentist. He or she knows how strong they made this repair.

A composite repair on a front tooth isn’t as strong as the original tooth. In most cases, it should be strong enough for basic, normal use, but not always. It depends on the configuration of her bite.

The nicest repair of a tooth injury like this is to simply take the piece of the tooth that broke off, if you can recover it, and bond it back into place. Kind of like gluing the tooth back together. This requires a strong background in bonding techniques on the part of the dentist.

I would recommend that when your niece is a little older (say 12-14 years old), that you have an all-porcelain crown placed by an expert cosmetic dentist. Repairing one front tooth is a very difficult cosmetic procedure that requires extra training in color mapping. It needs to perfectly match the adjacent tooth, which is tough to do. And it will also be much stronger if done with newer high-tech ceramics that expert cosmetic dentists are familiar with. You have some excellent accredited cosmetic dentists in Connecticut, and that’s a good route to go.

Links:
Read more about dental bonding.
Read about the new Snap-On Smile.

However, there is a posting on the mynewsmile blog that came to our attention. Someone who was using Crest Whitestrips had a tooth that became so sensitive that it needed a root canal treatment. It reinforces what we have been telling patients for a long time, that the safest way to bleach your teeth is under the direct supervision of a dentist.

Read the posting about Crest Whitestrips risks.

Calvin,
The shape of your front teeth can affect your speech. You had a gap between your front teeth closed with direct dental bonding. Just closing the gap shouldn’t permanently affect your “s” and “z” sounds, but thickening the teeth or making them longer could affect that.

One of the special areas of cosmetic dentistry training is phonetics. Since the shape of the front teeth affects speech, cosmetic dentists need to understand this. Your dentist probably didn’t have enough training to do this right.

As far as fixing this, I’d recommend you check the mynewsmile.com website – they recommend excellent cosmetic dentists all over the country, and see who their recommended Iowa cosmetic dentists are. That website is run by a cosmetic dentist who personally screens every dentist they list.

Thanks!
Rob from New York

Rob,
It takes repeated acid attacks to cause decalcification of your teeth. One meal won’t do it.

And one thing that fluoride does is that it aids in the remineralization of early decalcification lesions. So your fluoride in your mouthguard was a good idea. If you do have a spot of demineralization, I would use the fluoride several times.
But be sure you spit out the excess fluoride. It isn’t good to swallow that concentration of fluoride repeatedly, which is why it is given as a prescription.

Related links:
Read about microabrasion to erase spots on your teeth.
Read about DURAthin Veneers.

- Gary in Georgia

Gary,
I can’t prescribe anything for your particular case, since I can’t examine you, but I can give you some principles, and you can take it from there.

When people get cavities from sipping soda all day long, it tends to start at the gumline, and the incisal edges of the teeth are intact. If this is the case–if the cavities are not extensive and you’re just dealing with decay spots that involve maybe 1/4 or 1/3 of the tooth surface, you may be able to have your smile fixed with direct dental bonding. But you should go to an expert cosmetic dentist for this. The fillings will need to be shaded and blended so that they look lifelike. When the incisal edge isn’t damaged, it makes the repair much easier. But it’s important that your dentist has done a lot of this work and has an extensive inventory of composite bonding materials to match the shade, translucency, and texture of your teeth. A regular family dentist won’t have that much experience with this and won’t stock all of those materials.

If the damage is more extensive, or if you want a more durable result, you may need to go to porcelain veneers that cover the entire fronts of the teeth, or porcelain crowns that cover both the front and back. Both of these two options cost about the same, because they’re about the same amount of work. But the porcelain veneers are much more conservative. The upside of this option is that you can have the smile of your dreams as a result, if you go to the right dentist/artist.

The direct dental bonding would be considerably less expensive than porcelain veneers if the cavities are more conservative.

A great source to find an excellent cosmetic dentist is the mynewsmile.com cosmetic dentistry website. Go to their find a cosmetic dentist page, and look in Georgia and see what you can find.

Steve,
That’s good that your dentist has agreed to re-do the porcelain veneers. I’d take him up on that.

The problem with the second set of three veneers probably came from the way the laboratory made them, but the dentist needs to take full responsibility for the lab’s work, because you have no direct dealings with the lab. When the lab work is unsatisfactory, the dentist should send the work back until it is fixed.

Once the glaze is gone on porcelain veneers, the surface becomes a magnet for stains. And things can stick more easily.

I’d have your dentist re-do the entire set. This seems strange, to have the dentist send back three of the veneers and bond the other three. In our office, if some of them didn’t fit, we would have sent the whole case back. That’s the easiest way to make sure that they all fit together and look good together.

Reserve your seat today, because space is limited!

Tuesday, May 11, 2010 from 10 am to 7 pm.

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Bryce,
There is one answer to both your questions, and that is that your dentist may not really know how to do porcelain veneers. It’s possible that they simply aren’t bonded on properly.

Now maybe there is something you’re doing to knock them off, but when porcelain veneers are bonded properly, they become like a solid part of your tooth, and they can’t be removed – if you ever replaced them they would have to be ground off.

Black stain that seeps in under the porcelain veneer comes from leakage. If the porcelain veneers aren’t bonded on properly, there would be a microscopic gap between the porcelain and the tooth where bacteria and tiny food particles can get in. This causes a dark stain on the teeth – it usually looks black.

To get a first-hand evaluation of what is going on, my suggestion would be to go to an expert cosmetic dentist. They would be able to get rid of the stain and then bond your porcelain veneers on properly, if that is the problem. If you want a recommendation for a dentist, check out the mynewsmile.com website. They screen dentists for ability to do porcelain veneers and other cosmetic dentistry procedures. Dr. Cohen is their recommended cosmetic dentist in Glenview.

The first set of crowns looked really bad—thick yellow and badly contoured. The second set looked much better. The bottoms were still somewhat yellow but we were going to put them on and try to use a liner on the bottom to block out the yellow. He tried different colored liners and they made the crowns look blue or gray. So he made another more opaque set of crowns. They look like the porcelein a sink is made out of. I let him put them on because I figured if he tried again I don’t know if they would look better or worse but the front upper 4 look particularly bad. The lab tried to make them look more “natural” and blended some translucent color and it looks like gray streaks and spots. I didn’t notice to what extent until I got home and looked at them more closely.

Is there anything I can do at this point?
- Kim from California

Kim, It sounds like your dentist and the lab are in over their heads on this one. Tetracycline stains are tough for general dentists. You really need special training in color management to deal with these, and family dentists who just dabble in cosmetic dentistry tend to have the problems you are experiencing. The stains are very intense, and the dentist will either make the crowns or veneers too translucent, which makes it so that the dark color shows through, or they make them too opaque – what we call “refrigerator white”, which ends up looking really fake. And, to compound the problem, your dentist works with a general dental lab, and they don’t have experience or training with these issues either.

To get this done right, you really need an expert cosmetic dentist. There is a website, mynewsmile.com, that is dedicated to recommending dentists who are artistic enough and have extensive training to do smile makeovers. Dr. Cohen is their recommended cosmetic dentist here in the northern Chicago suburbs. You can check and see if they recommend someone close to you. If you had started with an expert cosmetic dentist, they would have been able to give you a beautiful smile with more conservative porcelain veneers, rather than having to do the more aggressive crowns on all your front teeth.

Shari,
White spots that you see on your teeth after braces are removed are generally areas of decalcification.

When you have traditional braces, metal or ceramic brackets are bonded to your teeth. These can be taken off fairly easily at the end of your treatment, and then the teeth are polished remove any residual cement. I would be surprised if there was any significant damage to your teeth by your orthodontist, though I suppose this isn’t unheard of.

But what most often happens, especially with teenagers, is that they aren’t so very careful with brushing their teeth when they are wearing these braces. The brackets catch food. Ordinarily, the food would slough off your teeth. But the bracket catches the food, and it sits there for hours. And underneath the food, acid-producing bacteria are active.

When the braces are removed, that’s when the damage becomes obvious. There can be white spots where the teeth have lost some minerals. These white spots are porous and will attract all kinds of stains, and may eventually turn brown. If they are severe enough, they will chip away, leaving little potholes in your teeth. There may even be soft spots of decay underneath some of the spots. And if there are spots of missing enamel, yes, your teeth could be quite sensitive.

Teeth bleaching won’t help – it may actually make the spots look worse.

If the damage is confined to a few spots, then the treatment would be spot bonding of composite to cover over the spots and restore the damaged enamel. If the damage is widespread, you may need porcelain veneers.

The lesson: tell your friends who still have braces on that they need to brush their teeth after every time they eat anything. If you’re out in a social setting and can’t brush, then at least excuse yourself to the rest room and swish away the food. Not only does this food damage your teeth, but it smells terrible.

One of the advantages of Invisalign invisible braces is that there are no metal brackets to catch food. When you eat, you take out the removable aligners and put them back in when you’re done.