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Archives for August 2020

Form AND Function with TMJ Treatment

Posted on by writeradmin.

I had a serious problem with my bite when I started grinding my teeth. I’d ground them down to nubs. He put crowns on each of my teeth. However, I don’t think he did them right because now I have a slanted bite both upper and lower, plus a crossbite. I feel I’m in worse condition than I was before. I decided then to go to a neuromuscular specialist. He put me in an orthotic for a little over two years, which opened up my bite. Now my crowned teeth are ground completely down to nubs. Again, I am in worse condition than I started. I also learned that there isn’t a neuromuscular specialist, which makes me feel I’ve been swindled. I am out a fortune and in horrible pain. I didn’t even talk about how bad the crowns looked to begin with but both of them said I could have a healthy bite and a decent smile, but it would never be a Hollywood smile. I wasn’t asking for a Hollywood smile, but rather, I was looking for a natural-looking smile.  This one looks like beige-ish chicklets. Is the bite even fixable at this point? If so, can it look like a normal smile?

Madeline

Dear Madeline,

a woman holder her jaw from TMJ pain

You have been through a lot with dentists. Though you were thinking rightly in wanting a neuromuscular dentist, as you have discovered, there isn’t a recognized specialty in neuromuscular care, though it does actually take a significant amount of post-doctoral training in order to do it well. You are dealing with a serious case of TMJ Disorder at this point, even more so than when you started treatment.

I will say right off the bat, though you will need a tall order in a dentist, you will not have to choose between form and function. You will need a dentist with expert post-doctoral training in both TMJ Disorder and Cosmetic Dentistry. Both have to be post-doctoral because what is taught in general dental school isn’t enough for your situation.

Look on the mynewsmile.com website. These dentists are prescreened for their technical skill and artistry. They cannot pay to be listed on the site, they actually have to have the skills needed.  Once you have found all the dentists listed on that site within a reasonable driving distance to you, that is when I’d like you to look a their TMJ training AND experience

How to Find a Qualified TMJ Dentist

There are several schools that have great TMJ programs. Here are some of them:

  • Dawson Academy
  • Kois Center
  • Las Vegas Institute of Advanced Dental Studies
  • The Spear Insititute

While there are others, these are among the best schools.

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

 

 

Contouring Teeth

Posted on by writeradmin.

Ever since I had my braces, off the jagged edges of some of my teeth have bothered me. Can this be fixed? If so, would it be done by my regular dentist or is it something the orthodontist would do? I like how straight they are now, but would like smooth edges.

Misty

Dear Misty,

Congratulations on getting your braces off and having lovely straight teeth. The repair for the jagged edges on your teeth is called tooth contouring or cosmetic contouring. You would only want this done minimally on just the enamel of your teeth. Often orthodontists will do this for minor issues at the end of your case. However, if yours didn’t, I wonder if has some complicated issues to it. In that case, I would be very careful who you had do the contouring for you. In choosing a cosmetic dentist to do it, I would likely aim for someone who has real expertise in dental cosmetics. The mynewsmile.com website has a “find a cosmetic dentist” link. They prescreen anyone who wishes to be listed and only the best cosmetic dentists will make the cut. You can’t just purchase your way to a listing.

An Example of Dental Contouring

before and after dental contouring and dental bonding

In the case above, there was some tooth contouring done to smooth out the appearance of the teeth. Then, the dentist added some composite bonding to the sides of the teeth to create a beautiful, aesthetic result. You want to find a dentist who can give you this type of results. Whether or not you are in need of the additional work of dental bonding.

If You Add Bonding

I don’t know your goals for your smile. You may be perfectly content with the contouring work and nothing else. That is fine. If you do decide there are spaces you’d like to close with bonding, it will save you money if you think long-term. When you get bonding done, the color made is permanent. If you will be doing teeth whitening anytime in the next few years, do it before you get the bonding done. This way, you can have the bonding color made with the new brighter, white color.

You don’t have to. If you decide to wait and whiten later, just bear in mind that only natural tooth structure will when. The bonding will stay the same original color. The only way to get them to match at that point is to replace the bonding.

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

Porcelain Veneers don’t Match

Posted on by writeradmin.

I had several porcelain veneers and one dental crown placed. When the temporary ones were done, they looked too long.  Because of that, I asked they be made a little shorter. The did that, but they don’t seem to match. My two front teeth are slightly different sizes. I didn’t really get to see them the second time around, they just cemented them on. I’m hoping they can be made to match. Is that possible after they’ve been bonded on?

Maralynn

Dear Maralynn,

a porcelain veneer being placed on a tooth

You paid your dentist to give you a beautiful smile and you should get one. Though, I can tell right away your dentist isn’t a true cosmetic dentist. The reason I can say that so confidently, is he never tried them on with a temporary try-in paste first. A true cosmetic dentist wants to be certain their patients absolutely love their smile. Anything less than that is unacceptable and would be re-done until the patient is happy. Additionally, front teeth are extremely important to your smile. It is fairly standard that they would have to be the same size.

Yes, it is possible to fix this issue, but it will mean re-doing the porcelain veneers. I would talk to your dentist about this. When he does re-do them, tell him you’d like to see them with a temporary try-in paste first to make sure it was what you had in mind. When you ask him to re-do it, be nice about it. Not that I think you won’t. Hopefully, he will care enough about the quality of his work and patient satisfaction to do something about this issue.

One problem you may face is it is what is considered the standard of care in dentistry. If they are functional and look decent, it won’t matter if you don’t like them. That is the only standard of care.

This is one of the negative “side-effects” of cosmetic dentistry not being a recognized specialty. It is up to the dentist how much time and training they invest in creating beautiful smiles, which leaves the patient at a distinct disadvantage in knowing who does beautiful cosmetic work and who doesn’t.  If you ever decide to get more cosmetic dental work done, my suggestion is to look for your dentist on the mynewsmile.com website. They pre-screen cosmetic dentists for their technical training and artistry. They cannot simply purchase their way onto the list.

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

 

 

Dental Bonding Disaster

Posted on by writeradmin.

I had several teeth get have dental bonding done because of abfraction lesions. Before this (aside from the lesions) my smile was beautiful. Now, it looks darker, dull, and feels rough. Is it possible for this to be removed and re-done to where the teeth look natural or will it damage the underlying tooth to replace it? Also, one of them popped off. I’m guessing that is not normal.

Meagan

Dear Meagan,

An image of an abfraction lesion.It is a real shame you are dealing with this. And you are right that having your dental bonding pop off isn’t normal. Let’s start with abfraction lesions for the benefit o those who may not know what they are. As you can see from the picture to the left, the gum tissue has pulled away from the tooth.

We used to think this was from brushing too hard, but now we believe it has much more to do teeth grinding or clenching, which will cause the tooth to flex a little. This weakens your tooth which will lead to the tissue being worn away at the gumline. Your dentist can fill these areas with dental composite material and it shouldn’t be that hard.  Obviously, for your dentist it was.

This dental bonding can be re-done, possibly even resurfaced without having to re-do the whole thing. Your dentist should either be willing to re-do them or to give you a refund so you can get them done elsewhere by someone more qualified. If he re-does them, it is important that he uses a more flexible dental bonding material, such as Silux Plus and Renamel. Using this type of material that can flex a bit will ensure they stay put and not pop out on you anymore.

As for getting it to match, that shouldn’t be that hard, yet he is still struggling with it.  It can be made to mate to match perfectly. Don’t let your dentist tell you otherwise.

dental bonding before and after

Directly above is a case Dr. Delaune did on some gapped teeth which should give you some idea of how well direct dental bonding can blend into the natural tooth structure and still look beautiful.

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