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How Much Is Needed for a Smile Makeover?

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I’m a little confused about smile makeovers. I was told that THE procedure for this was porcelain veneers, but when I went to see my dentist for this, he is suggesting I have teeth whitening, Invisalign, and porcelain veneers. Is all this REALLY necessary? I was under the impression that porcelain veneers can make teeth look straight. The only thing I have like that is one front tooth goes just slightly over the other. I would think you could shave that down, though I am not a cosmetic dentist. Am I misunderstanding something here?

Susan

Dear Susan,

porcelain veneer being placed on a tooth

There are a few things going on here. First, you are correct that porcelain veneers are the way to go if you are getting a smile makeover. You mentioned that you are not a cosmetic dentist so maybe you did not understand how they worked. The trouble is your dentist may not be a cosmetic dentist either. Believe it or not, cosmetic dentistry is not a recognized specialty. Any general dentist can do cosmetic dentistry regardless of the amount of training they’ve received. That leads me to answer your questions. Some of what he said could be necessary and one is not.

Let’s start with the teeth whitening. Unless you are placing porcelain veneers on every single visible tooth, then teeth whitening will be a good idea. You did not mention how many porcelain veneers you are getting. Most smiles are 8-10 teeth wide. Unless you are getting that many veneers, the whitening will help the adjacent teeth to blend in nicely and is less expensive than additional veneers. Just make certain that you do the teeth whitening before the veneers.

The Invisalign is a completely different story. Some cases are so complicated that it might be necessary, but from your description, it is NOT necessary in your case. An experienced cosmetic dentist could definitely make those teeth look straight. I don’t think your dentist is an expert cosmetic dentist. That is why he is suggesting Invisalign. It will help compensate for what he is not capable of doing on his own.

My suggestion is you find an expert cosmetic dentist to do your case. You will be much happier with the results. To find one with real expertise and proven artistry, I would look on the mynewsmile.com website. These are some of the best cosmetic dentists in the country.

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

My Daughter’s Dental Crowns are Ugly

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Years ago, when my college-aged daughter, was a middle-schooler she had a fall that caused some tooth trauma. Two teeth were crowned and one of them even needed a root canal treatment. One of the crowns has turned gray over the years, so we were looking for a solution. We went to this dentist who provided two porcelain veneers for us. Whle they are more attractive than what she had, we’re still not too thrilled. The biggest thing is that one tooth is still darker than the other. The second is that one of the teeth are thicker, which he said was due to the fact that he was trying to cut down on some of the grayness of that tooth. He also said that we have unrealistic expectations. Do we? I feel like after $5,000 she should feel confident about her smile. Am I being overly critical?

Morgan

Dear Morgan,

Porcelain Crowns

I will say up front you are not being overly critical to want two front teeth to match in color and size, especially when you are paying a cosmetic dentist to do it. That being said, I want to clear one thing up before we get into the solution to this. You said he was giving you porcelain veneers, but that previously she had crowns. Once you have crowns, they can only be replaced with other crowns. Unless of course, your dentist was planning on placing porcelain veneers on top of her dental crowns. However, that would be a dumb thing to do because they are less secure and an equal amount of work for the dentist. My suspicion is that he gave her porcelain crowns and called them porcelain veneers. Crowns go all the way around her teeth, which means the tooth structure is ground down quite a bit.

For now, I’m going to go on the assumption she actually has crowns, but the principles I’m about to share are the same either way. While getting a single porcelain crown to match a front tooth is extraordinarily hard and takes the top 1% of cosmetic dentists, getting two crowns to match should not be that hard. This dentist is not the best dentist for you. I believe your dentist is in over his head. While I can tell you the procedure to help, your best bet would be to find a dentist who does not need to be taught.

The first thing I want you to do is ask for a full refund from this dentist. Then, look on the mynewsmile.com website. They have a find a cosmetic dentist link. You input your zipcode along with the distance you are willing to travel and they will bring up a list of skilled cosmetic dentists in that area. Everyone they will recommend has been prescreened for both their technical training and skill as well as their artistry. They’ll be able to give your daughter a smile she will be proud to share.

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

Dental Bonding Doesn’t Match and Falls Off

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I have tetracycline stains and my dentist said dental bonding would take care of it. It has not worked out at all like I wanted. First, the color doesn’t match and it is pretty obvious. Plus, you can still see some of the tetracycline stains through it. As if that weren’t bad enough, the bonding fell off after just three days. I went back for him to repair it. At the time, I told him about the color problem so he made them thicker, which looks weird in its own way. Now they have fallen off again just a few days later. I called him back and he said they’re not meant to be permanent so I should not have high expectations. However, I was told they’d last up to five years, this is like just a few days. What should I do?

Calorie

Dear Calorie,

before and after dental bonding for a chipped tooth

As you can see from the image above dental bonding can blend in quite naturally with your teeth. I think the biggest problem you are facing is the skill and technical knowledge of your dentist. Both dental bonding and tetracycline stains are some of the most advanced procedures in cosmetic dentistry. You should be aware that cosmetic dentistry is not a recognized specialty. Any general dentist can call themselves a cosmetic dentist regardless of the amount of training they have invested (or not invested) in.

I think your dentist is in way over his head. Dental bonding should not fall off, especially after just a few days. As for the color, if he is an inexperienced cosmetic dentist, he probably doesn’t even have the colors and other materials necessary to make things blend well. An additional problem in dealing with tetracycline stains is making the teeth opaque enough to cover the stains, while translucent enough to look natural. That is not an easy accomplishment, even for a skilled cosmetic dentist.

Honestly, the better treatment for you would be porcelain veneers and not bonding. It is more permanent, decades rather than years. Plus, it is more stain-resistant. I don’t think your dentist is the one to do it. Here is my advice. Do not let him “fix” this. instead, ask for a refund. Then, we’re going to get you to a highly skilled cosmetic dentist.

Finding an Expert Cosmetic Dentist

Because there is not a recognized specialty in cosmetic dentistry it is hard for patients to know who has the skills and who doesn’t. There is a website that strives to help patients in your position. A retired cosmetic dentist runs the mynewsmile.com website. He prescreens all dentists that want to be listed on his site. They cannot purchase their way on. Instead, they have to show their training credentials, in addition to proving their artistry and skill on cases they’ve completed. Any dentist he lists can provide you with a stunning smile.

This blog is brought to you by New Orleans Cosmetic Dentist Dr. Duane Delaune.
Click here to learn about our free virtual smile makeover consult.

My Mouth is Collapsed

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I have always had problems with some teeth grinding. I wear a mouth guard at night as a result. That is the only time I feel like people can see my teeth and my jaw even hurts less. When I am not wearing it, my jaw hurts, you can’t see my teeth even when I smile, and I’m having trouble pronouncing some letters. My dentist is suggesting porcelain veneers. I just want to make sure I understand all my options. Is this the way I should go?

LeeAnn

Dear LeeAnn,

Woman holding her jaw in pain

I want you to be very careful here. While porcelain veneers could improve the appearance, if your dentist has artistic skill with cosmetic work, it will not solve the pain your are in. It sounds like your bite has collapsed as a result of the teeth grinding. This is going to lead to TMJ Disorder, which will put you in even more pain.

The solution in a case like yours is to have a full-mouth reconstruction, which means putting a crown on every tooth in order to build your bite back into the right position. However, this is the single most advanced procedure in general dentistry. It is not taught adequately in dental school. You will need a dentist who has invested a lot of post-doctoral training in both TMJ Treatment and Reconstructive Dentistry.

If this is done incorrectly, you will end up in more pain than before. In your position, I would look for a dentist who has significant training in one of the following institutions.

  • The Pankey Institute
  • Dawson Academy
  • The Las Vegas Institute for Advanced Dental Studies

The first two are located in Florida. The last one is (obviously) located in Las Vegas. They will have the knowledge necessary to make sure when they do build up your bite, they do it correctly.

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

Having Doubts about this Lumineers Case

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My husband purchased me a Lumineers package for my birthday. I went in and had all the planning and tooth preparation done and then was just waiting for them to arrive. Several weeks passed and then the cosmetic dentist called and said that something is wrong with the impressions and they need to be re-done. Is this a common thing? As my husband had already paid should I be worried that he is just going to keep our money and not actually ever provide the Lumineers?

Elle

Dear Elle,

Advertisement with Lumineers including a woman smiling and a single veneer being held by a tool

I have some concerns here, but not that you will not get your smile makeover. My concern is you are going to get your smile makeover and hate it.  Here are some things you need to know. First, cosmetic dentistry is not a recognized specialty. This means any dentist can call themselves a cosmetic dentist regardless of the amount of training they’ve received. Second, smile makeovers are not taught in dental school, so that training is imperative for a dentist to do a respectable job at these procedures. This leads me to Lumineers themselves.

Lumineers are simply a brand of porcelain veneers. However, they are a brand that is heavily marketed to inexperienced cosmetic dentists. I have a very bad feeling that your dentist falls into this category for a reason we’ll go into in a moment. Almost all expert cosmetic dentists do not like the brand. This is mostly because the company insists you use their lab, which is not known for its artistic results.

As for your dentist and the impression, that is a completely different concern. While it is not totally unheard of for impressions to need to be re-done,  and it happens to even the best dentists, it is the duration with yours that has me concerned.  The lab would have known right away that something wasn’t right and contacted your dentist. Maybe because he is so new that he was embarrassed and didn’t contact you right away. But, the length of time tells m that either he held onto it or he sent it back to the lab, telling them to try to work with it, but it was so bad they said no work could be done.

Here is one thing you can do to protect yourself when it comes to cosmetic work. Insist your dentist use a try-in paste when the Lumineers finally arrive.  This is a water-soluble gell that allows you to have your Lumineers tried on without permanently bonding them on. You should then get a good look at them in several lights. Only give your approval for them to be bonded on if you are pleased with how your new smile looks. If you aren’t, tell your dentist what you aren’t thrilled with and he should send them back to the lab to be redone until you are thrilled.

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

The Secret to Very White Teeth

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I have been using whitening toothpastes for years and never seem to get very white teeth. I’ve about given up and am now looking at getting Lumineers at the suggestion of my dentist. It looks like it can give me very white teeth, but I wanted to make sure I am on the right track with this before investing that much money. Any advice?

Melissa

Dear Melissa,

Zoom Whitening

You have a few good options. Before we get into that, I’d like to discuss why your whitening toothpaste hasn’t worked.  These don’t actually whiten our teeth as much as scraping them clean. Whitening toothpaste uses an abrasive on your teeth, which removes the stains. However, it also will scratch the surface of your teeth. This has the unfortunate effect of damaging the surface of your teeth, in turn making them pick up stains more.

I’m a bit concerned that your dentist jumped from whitening toothpaste straight to Lumineers. It is massively more expensive than some of your other options. Lumineers are one brand of porcelain veneers. It’s a highly marketed brand. Unfortunately, it is mostly marketed to inexperienced cosmetic dentists. This rarely goes well for the patient. Plus, porcelain veneers are not intended for simply whitening your teeth. Instead, they are for total smile makeovers. If that is what you want, then great. Get porcelain veneers. They can be made as white as you’d like. They can also change the shape and size of your teeth. It’s important you choose an excellent cosmetic dentist to do that procedure.  If you decide to go that route, I suggest you look for a dentist that is listed on the mynewsmile.com website. These dentists are pre-screened for their training, technical knowledge, and artistry. They cannot just pay to get listed.

If you are not looking for anything quite that expensive, then you can get your teeth very white by doing professional teeth whitening. Doing bleaching trays can get them very white and you can do it at your convenience. If you want them white super fast, then you can go with Zoom Whitneining which will whiten your teeth in just one appointment. Unlike with porcelain veneers, you won’t need an exceptional cosmetic dentist for either teeth whitening procedure. Pretty much any dentist who offers the services can do them without any problem.

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

Lumineers over Crowns

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I have old dental crowns that look horrible. I’d like to get veneers and am told that the Lumineers brand can go over dental crowns. Would I be a candidate for this? How do I go about finding a dentist to do it?

Everett

Dear Everett,

Lumineers over Crowns Advertisement

 

Above you will see an advertisement Lumineers placed years ago marketing this very concept.  While I am certain you will be able to find a dentist to do this for you, what I’d like you to do is go over the information I’m about to provide and ask yourself if that’s what you want.  First, let’s talk a little bit about Lumineers. They are simply one brand of porcelain veneers. This particular brand happens to be highly marketed to inexperienced cosmetic dentists. As a result, those are usually the type of dentists you will find that place them.

Dentists with expertise in cosmetic dentistry almost always prefer other brands. This has more to do with the fact that the company that owns Lumineers, DenMat, requires dentists to use their lab, which is not known for its artistic results. When it comes to getting a beautiful smile, you are better served by finding an expert cosmetic dentist and letting them choose the best brand to give you the results you want.

Should You Put Veneers Over Crowns?

Problem One:

Placing veneers over crowns is going to be bulky looking. If you consider that many patients find Lumineers themselves too bulky, you may find yourself feeling like you have horse teeth.

Problem Two:

There will be bonding issues. It is much more secure when you bond porcelain to natural tooth structure than it is when you bond porcelain to porcelain. This means you are at a greater risk of bonding failure. Additionally, your crowns are getting old. What if the bonding for those fails? Now you have double the risk of bonding failure– One from your old crowns and another from the porcelain veneers being bonded onto the crowns.

The Solution to Old Ugly Dental Crowns

The best thing for you to do is simply replace the crowns you have. An artistic cosmetic dentist can give you a gorgeous smile with dental crowns just as easily as with porcelain veneers. I would look on the mynewsmile.com website and get one of their recommended cosmetic dentists to do this procedure for you. Most of them even have a beautiful smile guarantee.

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

What Else is Necessary with Porcelain Veneers?

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I want to get porcelain veneers. My dentist is fine with that but said he wants me to get my teeth whitened first and my crooked front tooth straightened with Invisalign.  I thought that porcelain veneers made your teeth whiter and could make a crooked tooth look straight. What else is really necessary with porcelain veneers?

Kelly

Dear Kelly,

a porcelain veneer being placed on a tooth

I can give you some guidelines here, but bear in mind that I have not examined you so it would be irresponsible to give specifics. In principle, you are right, porcelain veneers can change the shape, size, and color of your teeth. If that is the case, why would you need anything else?

Let’s start with the teeth whitening. Most dentists will suggest you whiten at least your bottom arch of teeth. Patients generally only get veneers on their upper teeth, so if you want your two arches to blend, whitening the bottom teeth is an inexpensive way to do that. You would only need to whiten the upper arch of your teeth if you were not getting enough porcelain veneers to cover the teeth that are exposed when you smile. Most people have a smile that is 8-10 teeth wide. Let’s say you were getting just six porcelain veneers. Then, the adjacent teeth would not match when you smiled. Whitening them will help them to blend.

The Invisalign is a whole different story. It is rare for a patient to need orthodontics and porcelain veneers. You mentioned you had a crooked front tooth. An experienced cosmetic dentist can make crooked teeth look straight with porcelain veneers. The exception to that would be if you had a pretty complicated orthodontic case. That doesn’t sound like you at all.

This gives me a clue to your dentist. It is quite possible your dentist is using Invisalign like a crutch. He doesn’t feel comfortable shaping crooked teeth with porcelain veneers so he only wants to work with the ideal cases. If it isn’t ideal he suggests other procedures until it is. This is a waste of your money and time.

I suggest you get the teeth whitening with him. It is inexpensive and useful.  Then, get the porcelain veneers with an expert cosmetic dentist. I recommend looking on the mynewsmile.com website. The man who runs this site is a retired cosmetic dentist. He prescreens every dentist who wants to be listed there for their training, technical knowledge, and artistry. Any one of them can give you a stunning smile makeover, without having to do unnecessary procedures to get there.

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

My Lumineers Do Not Look Right

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I had porcelain veneers done almost 20 years ago.  I loved them but it was time to get them replaced as they had started to show their age. My old dentist had retired and I used his replacement. I wish I had not now. It has been a completely different experience.  First, even though I told him I wanted them to match my last porcelain veneers exactly, he made some changes. He used a different brand of porcelain veneers he called Lumineers because he said they were thinner and he was placing these over my old veneers. That sounded okay to me. But, then he also put a strain on the Lumineers, which he did not mention ahead of time. When they came in I told him I wanted whiter and he said to give it a couple of days and see what I think then. He felt they looked more “natural” this way.  I did and still didn’t like them. He told me to come in and he would “fix” it, if that is what you would call it. His fix was to sand off the front which had the staining. Now I am left with this dull underneath. What do I do?

Lorainne

Dear Lorainne,

lumineers advertisement

There are a couple of problems going on here.  First, the fact that he put Lumineers over old porcelain veneers is a problem. Porcelain sticks much better to natural tooth structure than to other porcelain. Now not only will you have to worry about the bonding of your new veneers failing, but your old veneers are eventually going to wear down as well and he attached the new ones to them. It is just as much work to place new over old as it is to just do them over. It doesn’t make sense that he did it the other way.

I’m not surprised he placed a stain on them to “make them look natural,” nor that he told you to give it a few days and you would get used to it. What he really meant by that is he didn’t want to do this over and he was counting on you to give up. Most patients don’t have your courage to stand up for themselves. A true cosmetic dentist would not bond on your porcelain veneers until trying them on with a temporary try-in paste and then letting you see and approve them. If you weren’t happy with the color he would never ask you to give it some time, but rather would send them straight back to the lab to be re-done.

He never did this. He may not even have the experience to know about a temporary try-in paste. When he suggested Lumineers, I knew you probably were not getting a highly skilled cosmetic dentist. Cosmetic dentistry isn’t a recognized specialty.  Any dentist can try the procedures regardless of their skill level. This particular brand of porcelain veneers is marketed to inexperienced cosmetic dentists as being easy to place.

Under normal circumstances, you would have no recourse. The standard of care in dentistry is functional. They don’t have to be beautiful, even for cosmetic work. However, once he ground down your Lumineers, they were no longer functional. He removed the glazing on them which is what protects them. Because of that, you have the right to ask for a refund.

Once that is secured, you can use that money and go to a true cosmetic dentist to have these re-done. Look for a dentist listed on the mynewsmile.com website. Each of those dentists are pre-screened for both their technical knowledge and artistry. They can not pay to be listed. Instead, they have to be skilled cosmetic dentists.

This blog is brought to you by New Orleans Cosmetic Dentist Dr. Duane Delaune. Click here to learn more about our cosmetic consultations.

Tetracycline Teeth and No Money

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I have tetracycline stains on my teeth. I had dental bonding placed on my teeth but they are old and chipping. I can’t afford the porcelain veneers my dentist thinks I should get. Is there a whitening option that will work for me? Or if there are ways to get porcelain veneers cheaper than my dentist offers them can you give me that tip? My dentist is one of those top cosmetic dentists so I know he is more expensive than most.

Katya

Dear Katya,

Photo of teeth whitening trays in a blue case.

Teeth whitening trays

I will answer your second question first. If you cannot afford to get porcelain veneers from a skilled porcelain veneers, please don’t go to a cheaper dentist. I can tell you countless horror stories of smile makeover disasters from patients who tried to save money by going to a cheap cosmetic dentist. This is especially true in your case because tetracycline stains are one of the most advanced types of cosmetic cases there are. If you cannot afford to have it done right you have a few options.

If your dentist placed the dental bonding over your dental enamel, you should be able to have your dentist remove the bonding with sandpaper disks. In some states, a dental hygienist can do this for you at a lower fee. Once the dental bonding is off, you can whiten your teeth. If you are persistant enough and stay at it long enough it can make a difference. It will not be a great as porcelain veneers but it will make a difference. Don’t use anything over the counter. They are not strong enough and it will be a profound waste of money. In that same vein, don’t use anything like laser whitening or Zoom whitening. Yes, they are stronger than the take home teeth whitening, but they are more expensive. You are trying to save money and it would take way too many sessions to make a difference.

On the other hand, if your dentist did remove some of the enamel on your teeth, the best you can do at this point is have someone smooth out the dental bonding while you save to get porcelain veneers done by a skilled cosmetic dentist.

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