Do I Need to Get a Second Opinion from a TMJ Dentist?

I went through about two years of braces when I was a teen and I stuck with it. I even wore the retainer like I was supposed to for years. Now my dentist says my bite isn’t right. He wants me to get crowns on all my teeth to fix it. In all fairness, I’ve already had a couple of cavities, and I think we got on this because I said I wanted my teeth whiter, but getting crowns everywhere seems excessive to me. Should I get a second opinion from a TMJ dentist about my bite,  or is what he’s telling me on the up and up?

Lance

Dear Lance,

A second opinion from someone with significant training in TMJ dentistry  would be a good idea. There’s a whole lot going on here and it’s unclear why your dentist made the recommendation he did.

TMJ problems are serious, and they do need correction, but based on what you’ve documented here, I’ve seen no indication of you haven’t indicated that you have any TMJ symptoms. Those would include jaw pain, popping, grinding, clicking, or generalized mouth pain, and migraines. These symptoms would make me suspect TMJ.

As for having the crowns done, this is one way to go about correcting bite issues, but there are also less invasive and less expensive ways to go about doing it, too.

Wanting whiter teeth is no excuse to jump in and get crowns either. Unless you’ve had work done on your front teeth, you can just have teeth whitening done, for a fraction of the cost and without affecting healthy tooth structure. Even if you do already have dental work on those teeth, you can have it replaced after whitening so it all matches.

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Is It Possible to Get a Refund for Lumineers?

All I wanted to do was close a gap between my two front teeth and correct a chip on one from when I was a kid. My dentist told me that Lumineers was the way to go, and he promised me a beautiful smile, but he wanted to do all six of my top front teeth to make sure it matched. I was a little uneasy about it because I really just wanted the middle two done.

He said he couldn’t make it look nice unless I did all of them. Ok. I went along with it. We went through the prep day and everything seemed fine, but the day I went in to have them put on, one of them was cracked in the box. Really. I can’t believe they didn’t realize it was broken until I got there. He then says he’s going to put the rest on and send that one back, and another one breaks while he’s cementing them. So, I go around looking goofy for a couple of weeks and go back for the other two, but they don’t match. He agrees to reorder them, and while we’re waiting, a third one breaks. I just want to be done with this. I have been waiting for months at this point and he still hasn’t gotten it right. Is this a common problem with Lumineers? If so, do I have grounds to request a refund?

Thanks,

Art

Dear Art,

Lumineers, as a whole, can sometimes look okay, though it really depends on how skilled the dentist is. Unfortunately, they’re often marketed to inexperienced dentists as being easy to place. Those dentists jumped right in and started giving them to patients. It’s under these circumstances that there are usually a lot of complaints about breakage, though having one arrive broken is certainly rare.

As for requesting a refund, you can always ask. He’ll probably want an opportunity to correct the work, though if he’s unskilled, any new work will likely wind up exactly the same.

If you decide to have them re-done by another doctor, it’s best not to ask for the brand name. Many doctors who are incredibly skilled at cosmetic work use a similar ultra-thin veneer, though they use an in-house or local lab to make them. It’s also wise to ask for before and after photos of the doctor’s actual patients, so you can examine his work. Be certain they’re not stock photos. Some will offer those, or images of patients who have had the same treatment, but they’re useless if they don’t showcase the doctor’s personal skill. Best  of luck to you.

It wouldn’t hurt to get a second opinion by a more experienced cosmetic dentist. They might put some pressure on your current dentist to refund your money.

FYI, the typical treatment for a chip and tooth gap is dental bonding, not Lumineers.

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Tired of Re-doing my Composite Bonding

I’ve had composite bonding for about six years and I’ve already had to re-do it twice. I do need to do something. I have a tooth gap and three different front teeth are chipped. I’m just tired of replacing them. What are my other options? My dentist suggested crowns, but my teeth are healthy so I’m not too keen on that idea. Are those the only two options?

Helen C. – North Dakota

Helen,

Yes, there is a much better option than either dental bonding or dental crowns. But, it’s generally used for total smile makeovers. Porcelain veneers can change anything you want to about your smile. It can change their shape, size, and color of your teeth. While bonding only lasts a few years, veneers last for many. With proper care, well over a decade. It’s the same procedure that celebrities use to remake their smiles.

I wouldn’t pressure your dentist to do the procedure though. If he didn’t mention it, it’s likely because he isn’t comfortable doing it. If you press him, he may do it to please you and it wouldn’t turn out nearly as well as you’d hope.

That doesn’t mean you’ll have to switch dentists to get this repaired the way you want. I’d just recommend going to an experienced cosmetic dentist for your porcelain veneers and your family dentist for everything else. Just make sure when your dentist does your check up, the hygienist doesn’t use anything like a prophy jet or other ultra-sonic cleaner on the veneers. That will take off the glazing.

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My New Dentist Is “Mercury Free” Do I Really Need to Remove My Fillings?

I have a few amalgam fillings. They’ve never really given me a problem. However, my dentist retired and the new one is “mercury free”. I’ve only seen him twice, but both appointments he’s stressed that he’d like me to replace the fillings because of their mercury content. Is this really necessary?

Drew B. – Indiana

Drew,

First, I’m going to give you the politically correct answer. The American Dental Association (ADA) still says that amalgam (silver) fillings are safe. So, technically, according to the ADA you’re fine just leaving those fillings where they are.

That being said, they really have no idea how safe they are. The studies aren’t addressing how much mercury is being released into your system over your lifetime. Nor does it address if there are daily activities that cause more to be released or at what point mercury begins to create a negative impact on your health.

There have been studies that show eating, drinking, or brushing your teeth can release mercury in older fillings. Unfortunately, most of the studies done use a static model that doesn’t mimic real world conditions.

It’s up to you whether or not you replace them. Most mercury free dentists would prefer them to be replaced. It is up to you. If they’re old, that would increase the amount of mercury being released into your system. In that case, I’d definitely replace them. Just make sure your dentist knows how to do a sanitary amalgam removal.

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