Category Archives: Uncategorized

What’s the best temporary replacement tooth?

My 15-year-old daughter is missing her upper eyetooth. She had braces and after the braces came off, she had a retainer to wear during the day that had a fake tooth on it, along with a retainer to wear at night that did not have a fake tooth. She developed a reaction to the retainer, and when she would take the retainer out you could see the impression on the roof of her mouth and the roof was very red and inflamed.

We have three doctors trying to determine the best thing to do and I would like your opinion if you have time:
1. The periodontist wants to put in a temporary implant, (he will not put in a permanent implant because she is not 18) but the orthodontist says he has seen the patients that have had this done and it does not look good at all.
2. The orthodontist wants her to have a Maryland bridge done but her dentist has said the teeth will look grayish.
3. The dentist wants the orthodontist to make a different retainer that she will not have a reaction to.
– Stephanie from Georgia

Stephanie,
When I read comments like yours where you have opinions from different dentists and you’re concerned about the appearance, I look for how sensitive the different dentists are to appearance issues. In my opinion, that’s the key point you can take away from this. The vast majority of dentists are technician-minded and not that appearance conscious. Surprisingly, this is true of most orthodontists, too. People think of orthodontists as specializing in appearance-related issues, but most of them are dedicated to “straight teeth”, not to “beautiful smiles.” There’s a difference.

And with these comments, please realize that without seeing the case, this advice is partially guesswork.

Yes, a Maryland Bridge makes the teeth on either side a little grayish. Many dentists think that amount of gray isn’t significant, but to patients it is. The fact that your general dentist is sensitive to this issue is noteworthy.

A dental implant is the best permanent solution. So I’d plan on that in a few years.

For now, a removable retainer with the tooth on it, made out of a material that she isn’t sensitive to. There are a variety of materials to make these out of.

Bottom line – it appears to me that you should trust the general dentist here.

Related links:
Read more about your options if you have missing teeth.
One option is a dental bridge.
Click here to read more about fixing crooked teeth.
mynewsmile.com, the most popular cosmetic dentistry web site on the Internet, has a case of Dr. Malone’s posted with photos of a Maryland Bridge replacement. Dr. Malone did a porcelain veneer bridge.

Do I need crowns?

I have several old large silver fillings that are not bothering me but my dentist feels they all need crowned is this reasonable?
– Karen in Tennessee

Karen,
Yes, this sounds reasonable. Once a large silver amalgam fillingĀ has been in your mouth for a number of years, it begins to break down. It’s reasonable to take out the amalgam and do a crown before the tooth breaks.

And one of the disadvantages of the old-fashioned amalgam fillings is that it is very difficult to tell if they have decay under them until the decay has grown considerably. This is one of the reasons we like to do the white fillings in our office. The standard of care when you have large amalgam fillings would be to replace them with crowns when the margins of the fillingĀ begin to separate from the tooth or the margins develop defects.

If you wait until a tooth bothers you, that can be the most expensive way to do dentistry. Once they start bothering you, you will not only need crowns but may also need root canals.

Related links:
Read more about porcelain crowns

Problems with Lumineers

After a 2 month long ordeal with getting my lumineers and then having them redone due to pain and the color from one Lumineer to the next being greatly different, I was flossing as directed last Friday and the top of one lumineer cracked off. Then today, having my Mother’s Day lunch, Another Lumineer cracked into four pieces! There is a jagged piece still attached. I hate Lumineers and going back every 2 weeks to get them changed or fixed or redone. Also I can’t find any info on the better business bureau.
– Vanessa in Texas

Vanessa,
There are a lot of stories going around about problems with Lumineers. But the problem really isn’t usually with the material, but usually in the placing of the Lumineers. With their heavy promotion, where they talk about how easy they are to do, they are attracting a lot of dentists who aren’t thoroughly trained in cosmetic dentistry. They dentists have been to the two-day Lumineers course, but they need several years of going to extra courses to really be good at cosmetic dentistry.

Manipulating color is where most general dentists have the most trouble. You found that when you got your first set, because you said that at first the color was different from one tooth to another. To be lifelike, the porcelain needs to have some translucency, so the color of the underlying tooth strongly affects the final color. It takes considerable training and experience to know how to manipulate this color well.

Then when they began to crack and fall off, this is most likely due to a problem in the bonding technique. Lumineers and other brands of porcelain veneers get their strength from the strength of the bond to the tooth.

My advice is to keep with this dentist until he or she gets it right. It seems like the dentist got in over his or her head. They got the advertisements from the Lumineers people that made this all seem so easy, and they’re learning the hard way that it isn’t so easy.

One of the best ways to be sure that your cosmetic dentist knows what he or she is doing is to find one who is accredited by the American Academy of Cosmetic Dentistry, like Dr. Malone is. It’s a three-year process to become accredited, and the dentist has to pass a stringent series of examinations, including a review of the dentist’s actual work by a panel of examiners. You can’t get through that without a thorough understanding of cosmetic dentistry.

Related information:
Read about Dr. Mike Malone and his credentials