Porcelain veneers or crowns for tetracycline stains?

I’ve seen two different cosmetic dentists about dealing with my tetracycline stains. They’ve recommended two very different solutions. The first dentist, who is well within my budget, wants to do porcelain crowns on the visible teeth. The other one, who goes several thousand dollars over my intended budget, wants to do porcelain veneers. Is there anything wrong with doing the crowns?

Cassie

Dear Cassie,

porcelain veneer being held up by dental tool

Before we get into the cost difference, I’d like to talk about the different procedures. With dental crowns, you have to have a great deal of tooth structure removed. If those teeth don’t need that structure removed, you are weakening them unnecessarily.

Ask yourself why a dentist would choose to use a procedure which is unnecessarily aggressive. My guess is, it is the only procedure he’s comfortable with. Every dentist places dental crowns. That doesn’t mean they are skilled in cosmetic work.

With porcelain veneers, you only have to remove a minimum amount of tooth structure, about the thickness of a fingernail. You can always switch from veneers to crowns. But, once you have dental crowns, you will always have to have dental crowns.

Choose the Dentist Carefully

Tetracycline stains are among the most challenging cosmetic cases there are. Whatever is used needs to be opaque enough to cover the stains completely, but still be translucent enough to reflect light and look natural.

I would say only the top 1% of dentists in the country could do it beautifully. You need one of those dentists. I would recommend you look on the mynewsmile.com website. They screen every dentist who wants to be listed on their website.

No one can pay to be listed. They have to provide background on their cosmetic training as well as visual proof of their artistry.

One last thing, price doesn’t always give a good picture of the skill of the dentist. Some really bad dentists have high prices. Some really great dentists have average prices.

This blog is brought to you by New Orleans Cosmetic Dentist Dr. Duane Delaune.

does teeth whitening cause cavities?

I’ve been doing teeth whitening off and on for most of my adult life. I take a lot of pride in my appearance and having a bright smile is important to me. Nobody ever said that it could damage my smile. To be fair, I don’t get a lot of cavities, but my teeth are more sensitive these days and I hear that’s a warning sign. Since I started reading up on it, I’ve stopped using whitening toothpastes and do not plan to use the system I got from my dentist anymore, but I’m worried I’ve caused irreversible damage. If it has caused damage, is there anything I can do to reduce the risk?

Sincerely,

Thad

Dear Thad,

custom-fitted teeth whitening trays

It sounds like you got a mix of inaccurate information and half-truths. Let’s break down what healthy teeth are like, how cavities form, and how teeth whitening products work.

Your Enamel is Strong and Packed with Minerals

Your enamel is the hardest substance in your body and it protects the under layers of your teeth. However, the enamel shouldn’t be thought of as unchangeable or impermeable. For example, people who brush really hard or grind their teeth can wear it down over time. Plus, acid can cause the minerals to seep out of your teeth which leaves them susceptible to decay. And, believe it or not, your teeth are actually porous as well. Your tubuals, which provide a pathway from the outside of your tooth to the inside, are typically closed shut though.

Under Optimal Circumstances, Your Teeth Will Remineralize

Bacteria and the things you put in your mouth, including food and dental products, can change your oral pH, and once you have an acidic mouth, teeth demineralize. The opposite is true as well. If you can restore pH and have healthy minerals in your saliva, your teeth will pick them up. This in mind, if you constantly create an acidic environment and never give your teeth a chance to remineralize, you will have weak spots in the enamel and decay can set in. This is why fluoride is such a huge thing. It can strengthen teeth even if they aren’t given the ideal remineralization environment.

Teeth Whitening Products are NOT Inherently Dangerous

Products designed to whiten your smile are not the enemy, but they do come with some side-effects, depending on what you’re using.

Acidic Products: Generally speaking, teeth whitening products are acidic, but not all are. That’s a worry if you constantly use one that is lower than a 7.0 pH and never get your mouth back to the neutral state or aren’t using fluoride to help remineralize. Chances are, however, you’re using a fluoride toothpaste. Unless you’ve actively looked for one that isn’t, it’s standard practice to include it. You may also struggle with this more if you aren’t a great brusher or delight in acidic or sugary foods, such as coffee, sports drinks, citrus fruits, and sodas. (The bacteria which causes decay noshes on carbohydrates and releases acids as a byproduct, which is why sugars contribute too.)

Abrasive Products: Many toothpastes lift surface stains with their abrasiveness. If you’re using a whitening toothpaste, there is some chance it’s abrasive and wearing down the enamel. As the enamel thins, you’ll have more sensitivity and may be more susceptible to decay. It also tends to sabotage your efforts. Many of them work by their abrasiveness removing the surface stains. Unfortunately, that also means they’re scratching your enamel which makes it easier to pick up more stains.

Professional Products: Professional-grade teeth whitening systems don’t just scrub off surface stains. They open the tubuals and oxidize from within, eliminating stains below the surface. The change is not permanent; the tubuals typically close up within a day or two. That’s why you’re told to avoid highly-staining foods and beverages altogether after treatment for a few days. Once they close back up, it’s business as usual. However, during those couple of days, you may experience some sensitivity. It doesn’t mean you’re more susceptible to decay though.

Fluoride Will Help

You don’t have to give up teeth whitening. However, you should take the sensitivity as a warning sign. Mention it to your dentist, so he can see if you’re already dealing with a cavity or have enamel erosion. If there’s no decay, fluoride, either provided in-office or via an over-the-counter gel or mouthwash, should help with any demineralization and sensitivity as well.

This blog is sponsored by New Orleans Dentist Dr. Duane Delaune.

Dental implants with metal allergies

I have a severe allergy to cobalt, nickel, and mercury. I’m in need of one filling and one dental implant. Is there a way to do this with my allergies?

Cassie

Dear Cassie,

a woman smiling from the dentist chair with her dentist smiling beside her
The key to a good outcome with your dentist is communication

Mercury-Free Dental Fillings

You will be able to treat both of these situations. We’ll start with the fillings because that is easy. You simply need to see a mercury-free dentist. They will provide you with white composite fillings and you’ll never have to worry about any mercury content.

Metal-Free Dental Implants

As for the dental implant, the metal allergies you mentioned shouldn’t affect you. Traditional dental implants are made from titanium which is extremely biocompatible. They’re used in many body replacements, including for hips.

If you are still concerned you might have an allergy to it, you can ask your doctor to run an allergy test. That is fairly simple. If it turns out you are allergic, there is still a way for you to get a dental implant.

They now make zirconia implants. These are metal free. The zirconia is just as strong as the titanium and is nicknamed ceramic steel. The reason dentists typically use the titanium is it has been in use longer and has a proven track record.

Most dentists are good at working around a patient’s limitations. For instance, there are anxious patients who need either extra patience and explanations or what’s happening or their anxiety is so strong they need some form of dental sedation.

If your dentist isn’t willing to work with you, I’d suggest finding a better caregiver.

This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.

whitening teeth with white spots

I have one tooth which has had two white spots on it my entire life, or at least for as long as I can remember. I like the white parts and want to get all my teeth to look that way. My dentist is suggesting I get Zoom Whitening but my sister says that won’t work that the spots will still be whiter than the rest. Who’s right?

Brianne

Dear Brianne,

Patient using Zoom Whitening light
Zoom Whitening Light

Your sister is correct. It worries me that you’re getting better advice from your sister than you are your dentist. He is supposed to be the professional.

Teeth whitening whitens teeth uniformly. This means that all the natural tooth structure will whiten, including the white spots. That doesn’t mean there isn’t a solution.

You can go ahead with the Zoom Whitening. This will get your teeth as white as possible in just one appointment. You’ll still have those two spots, but they can be fixed with either dental bonding or a porcelain veneer. Dental bonding costs less, but will have to be replaced a little more often.

Either procedure will require an expert cosmetic dentist. In your place, I’d look on the mynewsmile.com website. They pre-screen cosmetic dentists who want to be listed on their site for both their technical skill and artistry. Anyone on the list will do a beautiful job for you.

White Spots on Teeth

Sometimes there are white spots on teeth which are just the pigment. This seems to be your case because you’ve had it for as long as you can remember.

Other times, however, white spots are more serious. Usually, these are signs of decalcification and an early sign of decay. We see them most often with teenagers who’ve recently had their braces removed. These metal wires and brackets are hard to clean around. This is one of the reasons some parents prefer Invisalign for their teenagers.

This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.