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Clear Braces versus Invisalign

This may sound strange, but I didn’t know “clear braces” and “Invisalign” were different things. I talked to my dentist about doing Invisalign and he sent me for a consultation with the orthodontist, who then began talking about clear braces. We went through the whole process of treatment plans, impressions, x-rays, insurance, and they even took my down payment. I don’t know if I ever should have caught on, but I know they never explained it to me.

So, the big day comes where I think I’m getting my aligners and they start messing around with my teeth, so I finally ask if all that is necessary since I’m just there to get my aligners. That’s when they tell me they’re putting real braces on my teeth.

I’m 34. I work in a professional setting. I didn’t want regular braces. So, then the orthodontist comes back over and explains how I really have to use regular braces to correct my smile and how he’s certain he explained that to me. He didn’t. I know he didn’t. But, he makes his case and I go along with it. Disappointed, but I figure, at least they’re clear.

We’re a month in and they’re a hideous shade of yellow. I look ridiculous. My teeth look gross, like I don’t brush them. And no amount of brushing them is helping.

Would this have happened if I did Invisalign? Should I have insisted on it? And, if I should have done that, is it too late to switch?



Dear Eric,

Invisalign aligner
Invisalign: The adult solutions to braces

I’m sorry you are having such a frustrating experience. Theoretically, any kind of plastic can yellow like that, but you don’t see it as much with aligners because people aren’t supposed to be eating or drinking with them in and you replace them every couple weeks.

You May Still Be a Candidate for Invisalign

The good news is, you still may be a candidate for Invisalign. While it used to be only the most ideal cases were candidates for Invisalign, these days they can take on all but the most challenging cases.

It sounds like this orthodontist’s communication skills are lacking. You can ask him about switching over, but it doesn’t address the underlying issue—they didn’t give you all the information you needed. It’s worthwhile to have a consultation with another dentist or two to see if you’re a candidate for the aligners.

You Might Also Be Able to Fix Your Yellow Braces

Usually, the bands get changed out once per month, so you’re either due for a change or coming due for one. That will give you a chance to start fresh. Unfortunately, if you have habits like smoking, it’ll be an uphill battle to keep them clear.

Ultimately, the choice is yours—only you know whether it’s worth the trouble of trying to switch at this point. However, if you’re a candidate, you can switch at any point. If you decide to switch dentists, which I would not blame you for, he is ethically obligated to send all the diagnostic x-rays, etc. to your new dentist.

This blog is sponsored by Lafayette, LA Dentist Dr. Mike Malone.

cerec crowns on front teeth

I was in a car accident and damaged both my front teeth. I need to get crowns on them. I am trying to decide between regular crowns and CEREC crowns. Is one better than the other?


Dear Benjamin,

porcelain block for CEREC crown

CEREC crowns are made out of single block of porcelain. This will give it a very uniform look. This works fine on most teeth. However, our front teeth are much more visible and exposed to light.

Natural teeth aren’t uniform. Look at this image of a tooth directly below. There are varying levels of translucency and opaqueness depending on where you are on the tooth.

image of a tooth

When a dentist does a traditional crown, it is built in layers with varying shades of porcelain. This can make a crown look more natural. However, even then, you’d need an expert cosmetic dentist because this takes a high level of skill.

If you really want a CEREC crown, then having an expert cosmetic dentist is even more important. They need to have a high level of skill in color theory so they can use various stains to give it that variated look while keeping that natural translucency.

Cosmetic Considerations with Dental Crowns

The dental crown can be made to match your teeth exactly. However, the color is permanent. If you are happy with the color of your teeth, then you do not need to take any further steps. However, if you want your teeth any whiter, the time to take care of that is before having the crowns designed.

In that case, your first step is to have your teeth whitened. You can do that in one appointment if you see a dentist who does Zoom Whitening.

Then, give it a couple of weeks for the color to calm down. That’s when your dentist can match the permanent color for you.

When you’re talking about front teeth, whether you get a traditional or CEREC crown, you will need a dentist capable of the skills required. I suggest you see an AACD accredited dentist.

This blog is brought to you by Louisiana Cosmetic Dentist Dr. Mike Malone.

Invisalign with Missing Teeth

I have two missing second bicuspids and want to get my teeth straightened. I feel like I’m too old for braces. I was thinking of getting Invisalign. I went to see an orthodontist and he doesn’t think Invisalign is all it is cracked up to be. He wants me to get traditional braces. Is that my only option?


Dear Katherine,

Invisalign aligner
Invisalign: The adult solutions to braces

My guess is your orthodontist is more comfortable with traditional metal wire and bracket braces. However, Invisalign should work fine in your case, though you may have better success with a dentist who treats with Invisalign than with a traditional orthodontist.

It will do fine with the missing teeth. It could close the spaces so that you wouldn’t even need to replace them with dental implants. However, let your dentist evaluate that.

If he thinks replacing the teeth is necessary, just make sure he has post-doctoral training in restorative dentistry.

A Fun Benefit to Invisalign

There is another perk to Invisalign aside from straightening your teeth. Because the aligners are custom-fit to move your bite, they are very snug. This makes them ideal for doubling as teeth whitening trays.

Your dentist can provide you with whitening gel that you can place in your Invisalign aligners at a time convenient to you. This allows you to straighten and whiten your teeth at the same time. It’s like getting a mini smile makeover at a discount.

This blog is brought to you by Lafayette, LA Dentist Dr. Mike Malone.

Popcorn Kernel Leads to open Heart surgery

Adam Martin in recovery. Photo courtesy of SWNS

I saw an article yesterday that emphasized how quickly things can turn dangerous with a dental issue. You can read the article in its entirety here, but I will sum it up.

Adam Martin, a 41-year-old man in the United Kingdom, had a popcorn kernel stuck in his tooth. He’d tried various ways to remove it with no success. Soon afterward, he started feeling sluggish. He thought is he was coming down with something. It quickly escalated and he took a trip to the hospital.

After some diagnostics they realized a tooth infection had quickly spread to his heart and ate away at his valves. He now required emergency open-heart surgery.

When Adam spoke to reporters, he said, “If I had gone to the dentist in the first place, none of this would have happened.”

Dental Infections Can Lead to Death

Your teeth and gums have direct and short pathways to your heart, lungs, and brain. Tooth infections and gum disease can cause serious problems, just as they did for Mr. Martin.

If you have tooth pain, it often means you have a tooth infection. It needs to be checked out as soon as possible. Most dentists reserve time for dental emergencies, such as an abscessed or broken tooth. You simply need to call your office and let them know what is going on.

Preventative Care Saves Money

I know dental care can sometimes seem expensive, but did you know NOT going actually costs you more money? Going to the dentist just twice a year prevents most cavities, especially if you are following up with good home care practices.

If you do happen to get a cavity, it is caught early. A small composite filling costs significantly less than letting it grow and needing a dental crown, which costs hundreds of dollars more. If you let it grow from there, you’re also talking about a root canal treatment or possibly even an extraction and dental implant. That is thousands of dollars more.

This blog is brought to you by Lafayette, LA Dentist Dr. Mike Malone.

Metal showing on my maryland bridge

I’ve had a Maryland Bridge for 20+ years. I’ve never had any problem with it. However, a week ago I needed a crown placed. In order to get a comfortable placement, my dentist had to adjust my bite a bit, which included grinding a bit on the Maryland Bridge. The next morning, I noticed a silver spot where the metal was showing through. I went back and he said the problem was likely because I grind my teeth. He bonded a composite filling on it, but that was gone by the next day. He still insists it is from my grinding and says there is nothing more he can do to fix it. I’m finding that hard to believe as I’ve not had a problem with this bridge until he messed with it. It’s a little intimidating to argue with him, though. What do you recommend here?


Dear Penny,

Diagram of a Maryland Bridge
Maryland Bridge

While I haven’t seen the tooth, I think you and I both know that he is the culprit here. However, he’s the dentist and therefore in the authoritative position which makes it tricky for you to confront him, especially if his pride interferes with his integrity.

One thing I’d like you to do is get a second opinion. Some dentists will even give you a free second opinion. They’ll be able to tell if he caused the damage. If you drag a metal explorer over glazed porcelain, it won’t leave a mark. However, if the porcelain has been ground on with a dental bur, a distinct mark on the porcelain will be visible.

Once the second dentist has armed you with the information you need, you may be able to get him to admit his error. In truth, every dentist has had this happen. The shame is more in not being willing to try and make it right.

A Possible Fix for Your Bridge

There is a possible way to fix this without having to replace the bridge. It is worth a try, though it doesn’t always work. When your dentist placed the composite filling. it doesn’t sound like he did anything to prepare the metal.

Here’s the procedure I’d recommend. You are welcome to show him this post. There is one bonding cement which will bond to metal— Panavia.

The first step will be to grind away more metal to make way for the materials needed. Then, use a micro-etcher to prepare the spot. From there, prime the metal and then add a thin opaque layer of Panavia over the metal and cure it. After that is when your dentist can place the composite.filling.

If that doesn’t work, your best option is to replace the bridge.

This blog is brought to you by Lafayette, LA Dentist Dr. Mike Malone.

Solution for huge tooth gap

I have a large tooth gap. It was last measured at 9mm. I thought about doing Snap-on Smile, but after all the tests and things, it turned out I wasn’t a candidate for that procedure. I’m too old for braces, so I’m thinking about Lumineers. I have scheduled an appointment with a Lumineers certified dentist in a couple of weeks but thought I’d check and see if you thought that was a waste of my time and money.


Dear Kevin,

I am very glad you wrote before going through with this plan of Lumineers. While I am sure you could find a dentist willing to do it for you, it would end up a disaster!

The size of your gap is enough to fit another tooth. Unless the dentist is a top of the line, expert cosmetic dentist you are going to end up with something that looks ridiculous. And I will tell you right off the bat, dentists who advertise as placing Lumineers tend to be at the bottom of the barrel of cosmetic dentists.

The Lumineers company markets themselves to inexperienced cosmetic dentists as being easy to place because they don’t require any tooth preparation, the way other brands of porcelain veneers do. There are two problems with that.

One, that rarely turns out looking anything but bulky. Some people have described it as horse teeth. And, two, there is a whole lot more to creating a beautiful smile than just the tooth preparation.

An Invisible Alternative to Braces

side by side compairison of braces
Braces versus Invisalign

You mentioned you were too old for braces. Has your dentist discussed Invisalign with you yet? These are sometimes called invisible braces.

Both people in the image above are wearing orthodontics. The one on the left is wearing traditional braces. The one on the right is wearing Invisalign. No one will be able to tell you are wearing them even at a conversational distance.

With the size of the gap you are talking about Invisalign would be my number one recommendation for repair. It has an added benefit as well. Invisalign uses clear plastic aligners to straighten your teeth. Those aligners can double as teeth whitening trays. This will allow you to straighten and whiten your teeth all at once.

If you don’t like the idea of any orthodontics, then you will need to go with porcelain veneers. However, as I mentioned above, you will need an expert cosmetic dentist in your case. I would only see an AACD accredited dentist to do your porcelain veneers case, if that is what you decide on.

This blog is brought to you by Lafayette, LA Dentist Dr. Mike Malone.

A maryland bridge between two crowns

I have two dental crowns that are on top of dental implants. I am now losing the tooth between them. Is it possible to have a Maryland Bridge placed there and attach it to porcelain crowns?


Dear Kay,

Diagram of a Maryland Bridge
A Maryland Bridge

While technically the answer would be “Yes, you can place a Maryland Bridge between two porcelain crowns.” it is not easy. Ideally, you would want to bond the wings of the bridge to tooth enamel, which would give you your strongest bond. Bonding to porcelain crowns is tricky, Very few dentists even know how to do that and it may not hold up.

Hopefully, your dentist had foresight. Realizing you had two dental implants with a tooth between them, he or she should have thought about what to do if the middle tooth needed to be replaced.

Planning ahead, you would place the implants in a way that the abutments are parallel to one another. Then, instead of cemented crowns, you would use screw-retained crowns. That way, when the middle tooth needs to be replaced, your dentist would simply unscrew the two crowns and replace them with a single dental bridge.

If your dentist didn’t plan ahead for that, you always have the option of having a third dental implant placed there.

Whatever you decide, it is going to take a dentist with advanced skills, so choose who does your procedure carefully.

This blog is brought to you by Lafayette Dentist Dr. Mike Malone.

Thumb Sucking

I sucked my thumb until I was in junior high school and was finally able to quit. Now I’m an adult with a huge overbite. Is it possible to fix this without metal braces?


Dear Cami,

Invisalign aligner
Invisalign: The adult solutions to braces

I’m glad you wrote. It is never too late to repair and improve the appearance of your smile. Plus, because of the advancements in orthodontics, you no longer have to wear ugly and uncomfortable braces with their metal wires and brackets.

My suggestion is you see a dentist who offers Invisalign. These use clear aligners. No one will even know you are wearing them, even at a conversational distance. One of the hidden benefits is the aligners can double as teeth whitening trays. This will enable you to straighten and whiten your teeth at the same time, though you don’t have to.

Thumb Sucking

I’m saying this for the benefit of parents who have a thumb sucker. Don’t panic! Most children give the habit up by the time their adult teeth start to come in.

If you make a big deal out of it, there’s a good chance it will backfire and make it harder for your child to quit. If they get to the point where their permanent teeth are coming in and they can’t seem to quit, let them know you can help.

You don’t have to take them to a pediatric dentist and do anything expensive. The simplest solution is to purchase Thum. This is a bitter-tasting liquid you can “paint” on their thumbs. Most of the time they stick their thumb in their mouth without even meaning to because it’s a subconscious habit. This liquid will help them realize it.

This blog is brought to you by Lafayette, LA Dentist Dr. Mike Malone.

dentist didn’t get my color right

I went to get a smile makeover with porcelain veneers. I wanted a very white smile and was very clear with my dentist about that . In fact, I told him I wanted one of those super white Hollywood smiles. I heard him tell his assistant to make it an A1. I assumed that meant the whitest possible. I remember that specifically because my husband loves A1 steak sauce and I thought, he’d love his steak and I’d love my teeth. I know differently now that isn’t what he should have ordered. When the smile came back, the shape and size were fine, but I was disappointed in the color. I went home and did some research, because I felt sure he ordered the whitest. I thought maybe he didn’t remember that and the lab got it wrong. I’ve since found out that he should have ordered a BL 1. I went back and asked him about it. He said he ordered a BL 1 so that’s what I have. I’ve looked at pictures. What I have is an A1. I don’t know what to do. I feel like he’s just lying. Can this be fixed?


Dear Paula,

bleached tooth shade guide

First, I’m going to say I am super impressed with your research capabilities. There are a number of dentists who haven’t figured out what you have, as you’ve discovered with your current dentist.

You’ve also pretty much figured out that he is lying, though I know it pains you to think that of your medical practitioner. You could call him on it and ask to see the order he sent to the lab. I doubt he’ll give it to you. If he does and it doesn’t say what you very specifically remember, you can know he doctored it. Getting a copy from the lab should confirm that and things will not go very well for him.

A true cosmetic dentist would never be satisfied if his patient wasn’t. He would make the changes without hesitation. Your dentist may be decent, as you said he managed to get the shape and size correct, but he obviously is failing in his color theory.

The shades you see above didn’t use to exist. Dentists had A1 as the whitest shade. However, as teeth whitening became more popular in the 1990s, manufacturers realized they had to update their guides, hence the bleaching attachment.

In your place, I’d just tell your dentist you aren’t satisfied and ask him to re-do the porcelain veneers with the color you requested. You didn’t get the smile you paid for.

If he gives you a hard time, go to the website and find one of their recommended dentists in your area. Often a quick call from a peer will change their tune.

This blog is brought to you by Lafayette Cosmetic Dentist Dr. Mike Malone.

Three Different Color Teeth with Porcelain veneers

I had four porcelain veneers placed on my front teeth. Unfortunately, the two in the very front are turning gray. This has left me with three different colored teeth. First, there are my natural yellow teeth, which still show on either side of my porcelain veneers. Then, there are the white veneers next to them, and the two front teeth which have turned gray. I feel this whole endeavor has been a disaster. What can be going on and what can fix it?


Dear Marla,

A single porcelain veneer being placed on a tooth

The main problem you are facing with your smile makeover is the inexperience of your dentist. First, the porcelain veneers on your front teeth are defective. This can happen to a new cosmetic dentist. However, an even more basic error was made.

If you are only getting four porcelain veneers and your teeth are yellow, your teeth need to be whitened before your veneers are placed. Your dentist didn’t even know enough to do that.

As for the grey veneers, there are two possibilities I can think of immediately. I couldn’t tell you which without a photo, but I can describe it to give you an idea of what to look for.

If they are uniformly grey, then it’s likely the glaze has been removed somehow. This destroys your porcelain veneers because the glaze is what protects them from picking up stains.

If the gray is uneven, you may have what is known as microleakage. This means the bonding isn’t done correctly and you’ve got things getting between the porcelain veneers and your teeth. This will not only give them a splotchy look, but it will lead to decay.

Fixing a Porcelain Veneer Disaster

Because your family dentist is in over their head, I don’t think they’re going to be able to fix this. You need to ask for a refund and have this case redone by an expert cosmetic dentist. They’ll likely first suggest you whiten your teeth. Then they’ll do the case from scratch.

My suggestion is look to see if there is a dentist who is accredited by the American Academy of Cosmetic Dentistry in a reasonable distance from you. AACD accredited dentists are the top cosmetic dentists in the country. They will provide you with a stunning smile you will be proud of.

This blog is brought to you by Lafayette, LA Dentist Dr. Mike Malone.