My dentist tells me that I need crowns. I can accept crowns for the root canal teeth, but he wants to crown all six front teeth. There is nothing wrong with the other 3 - he tells me that he wants to do them so that they match. He said the porcelain would not match my other teeth.

Should I seek a second opinion?

Thank you,
- Pam from New York

Pam,
I haven’t seen you or your teeth, so take these comments in that context.

Just from what you’re telling me, it appears that your dentist either lacks confidence in his ability to match the color of your crowns to your existing teeth or doesn’t want to take the extra trouble that would be required to do that. Dentists can match porcelain to teeth perfectly. There are various tints and basic shades so that any color or color pattern can be matched. But it takes an understanding of color that many dentists don’t possess, and an eye for color. And it’s extra trouble - it may take a couple of appointments and sending the case back to the dental laboratory a couple of times to get that perfect match. This is troublesome for the dentist. If it were me, I would not accept the extra crowns on the teeth that have nothing wrong, but would find someone who was willing to color match the crowns to my existing teeth.

But there are other important issues here, too. What kind of crowns are being done? Many dentists who have little artistic sense do the type of crown they were trained to do in dental school - porcelain fused to metal. These crowns approximate the appearance of your natural teeth but are opaque, tend to have a lifeless look to them, and eventually develop a dark line at the gumline. Now the worst thing for you to do would be to try to push your dentist out of his or her comfort zone by asking for an all-porcelain crown when he would prefer to do a porcelain-fused-to-metal crown - that can invite disaster. But I advise, when you need a crown on a front tooth, going to a dentist who is comfortable doing the newer more difficult technology of the all-porcelain crowns.

Now I want to qualify this answer by saying there may be something about your case I don’t understand that makes it desirable to crown these other three teeth. But just from what you’ve told me, I would recommend you seek another opinion and see if you can find a better answer.

Links:
Plano emergency dentist
Visit the website of Plano dentist Dr. Marc Whitmore
Plano mercury-free dentist

First question is, what is this appliance called? Where can I get one, or talk to someone about how much they cost, how they really look when they are done, and whether or not they have to do anything to my teeth for me to wear it? How long does it take to get one?

Thanks for your help,

Grady in Manchester, New Hampshire

Dear Grady,

You are talking about a Snap-On Smile, and it is manufactured by a dental lab in New York. Snap-On Smile appliances are a kind of temporary smile makeover. People use them sometimes as costume props for the theater, or for big events like weddings or reunions. This is not meant to be a permanent appliance.

Your dentist will have to send in a model of your teeth to the laboratory, and after that it takes about two weeks for your appliance to arrive. It should just snap right over your own teeth, with no alterations at all, and it should be fairly comfortable when in place. The Snap-On Smile will make your teeth seem larger and bulkier, so be prepared for that.

A word of caution—for best results, you should really consult with an experienced cosmetic dentist, and have them send in the model. When you get ready for a permanent solution, porcelain veneers might be an option for you.

My regular dentist does not do dental implants, and he suggested I start shopping around to find someone who could do this procedure for me. I visited the Clear Choice Dental Implant Center because they have a reputation for being one of the best facilities in the business. They were very polite, and professional, and I was really impressed with their facility and the thoroughness of their exam. Then came the sticker shock. They told me it would cost more than $55,000 to do full upper and lower implants. When I questioned how it could be so high when I already had all of my teeth removed, they said that there is not any kind of discount for that because they offer free extractions with their dental implants.

That just doesn’t make sense to me! I know from first hand experience that removing all of a person’s teeth takes a considerable amount of time, skill and equipment. For them to say it is “a package deal” makes it seem like they are more concerned with making an extra buck than they are about giving me the care I need. I am not without resources, but there was no way I was going to come up with $55,000 for the procedure, and I was not interested in talking to their financing specialist.

I checked with another facility, and they quoted me a price that was less than half the Clear Choice quote, and also took into consideration that they would not have to do extractions.

What do you make of this? I know Clear Choice has an excellent reputation for being the top place to go for dental implants, but such a dramatic difference in cost is difficult to understand. How do they get away with charging those prices?

William from St. Louis

Dear William,

Your experience is not unusual, but do be careful about only considering price when you are evaluating your options. Poorly done dental implants can be catastrophic, and you want to make sure that the dentist you choose has been thoroughly educated in dental implant placement. Good luck.

Bruce in Newark

Dear Bruce,

There is not a rigid definition of when a veneer becomes a crown—the difference between a crown and a veneer is a matter of degree only. Both take about the same amount of work to place, and the fees are often the same or very close to it.

In terms of use in a smile makeover, it is not at all unusual to see crowns used in place of veneers on the front teeth. Your dentist may have had several different reasons for using crowns rather than veneers. You state that your teeth were sound, so it could have been done to control your bite.

I am a little surprised that your dentist did not explain his treatment plan to you before you had the work done. When you ask about this—and I do suggest that you ask, for your own peace of mind—I would expect there to be a good reason for going with a more aggressive form of treatment. Most cosmetic dentists will choose the most conservative treatment plan available to meet their ends, and porcelain veneers are definitely more conservative than crowns. For dental crowns, your natural teeth must be substantially reduced, while for veneers, only a thin shaving of the front surface of your teeth is necessary.

Augustus in Little Rock

Dear Augustus,

You shouldn’t wait TOO long. Within a couple of weeks, the teeth that surround the empty socket will begin to “drift” into the space. Our teeth move naturally to touch their neighbors, and to meet another tooth when you bite down. This phenomenon will also cause the tooth that should meet the now-missing tooth in the opposite jaw to super-erupt (grow to try and reach the missing tooth). All of this movement can seriously disrupt your bite, which in turn could lead to TMJ problems. All of these problems will add to your costs to correct if you let the situation get out of hand.

You’ve made a good choice to go with a dental implant to replace your tooth, but in the meantime you are going to need some kind of temporary tooth to act as a placeholder. Your dentist should fit you with a temporary partial denture (called a flipper).

Your dentist won’t be able to place the root form for the dental implant until the area is free of infection and fully healed. After that, the root form will need several weeks at least to become fully fused with the bone of your jaw, and only then can the permanent tooth be fixed to the root form.

Gloria in Abilene

Dear Gloria,

You might have a tough decision to make. Depending on how long you have been missing your upper teeth, your upper jaw may have deteriorated quite a bit. Many people don’t realize until it is too late that having all of your teeth removed causes your jaw bones to actually shrink. After several years, your jaw can deteriorate to the point where you can no longer wear a denture. It sounds like you might be there now.

And it is a sad truth that you will not find a dental insurance company that will pay for dental implants. If you consider the situation from the dental insurance company’s point of view, it would make little sense to sell you a policy and then pay out many times the cost of the policy for your dental care.

If you or a spouse has dental insurance available through a place of employment, that might be your best chance for getting any help at all with the cost of your dental implants. Though dental plans through employers generally offer the best service coverage, they rarely pay for dental implants. They will pay for the cheapest treatment, which is not going to be dental implants, and many companies have $500-%1,000 annual caps on services, which does not go far towards extensive dental treatment.

An alternative for you might be to get some dental implants to anchor an upper denture. Even a few dental implants will help slow the deterioration of your upper jaw bone.

Talk to your dentist candidly about affordable options.

Stephen in Boise

Dear Stephen,

I have to start the answer to your question with a question—do you want to bleach just your bottom teeth, or both the top and the bottom?

If you want to bleach just the bottom teeth, you should be fine. But the Lumineers will never get any whiter than they are right now, so I really hope you got them the shade you wanted.

If you were beginning the process of getting porcelain veneers in our office, we would encourage you to pick the degree of whiteness that you want for the upper teeth rather than trying to match the shade to your lower teeth (unless, of course, your lower teeth were already the shade you wanted). If you are trying to pace your costs for treatment, you can get by with whiter upper teeth, and then go back later and bleach the lower teeth to match the shade of the upper teeth.

To read more about the process of bleaching your lower teeth, read our page on Zoom Whitening.

I hope everything turns out OK for you.

Dear Monique,

It will comfort you to know that you are not alone—approximately eighty-seven MILLION Americans snore. What concerns me is that your snoring may be a sign of an undiagnosed sleep disorder that can have a serious affect on your health.

Snoring happens when your airway becomes partially blocked, such as when your tongue falls back as you sleep. This narrowed airway causes your throat to vibrate, which is snoring. In many cases, your body continues to get adequate oxygen and no harm is done.

However, snoring may be a sign of sleep apnea, which is an interruption in breathing or an episode of shallow breathing while you sleep. If you experience any of the following, your snoring may actually be a symptom of sleep apnea:

• decreased memory
• depression
• excessive daytime sleepiness
• personality changes

Sleep apnea can have a detrimental effect on your long term health, up to and including strokes and heart attacks, so clearly it is to be taken seriously! You should consult your regular physician about this problem, to determine if and to what degree you have sleep apnea.

A dentist like Dr. Malone can help you stop snoring, and treat your sleep apnea. Dr. Malone can provide you with a custom made oral device such as a SomnoMed that you wear when you sleep. This comfortable device is very effective in treating snoring and mild to moderate sleep apnea.

Hope this helps you get back to sleep!

I talked to an orthodontist who told me it would take more than two years with braces to straighten my teeth. I asked him if there wasn’t a faster way, and he kind of avoided answering. I did not feel like he was comfortable talking to me about anything except the regular braces.

Do I have any other alternatives?

Thanks,

Jordan from Kalkaska

Dear Jordan,

If the orthodontist you consulted was only comfortable talking about traditional braces, then you are smart to seek help elsewhere. Rather than consulting with a different orthodontist, you should seek the help of an accredited and experienced cosmetic dentist that can offer you some great alternatives to traditional wire-and-bracket braces.

If your teeth are crowded and crooked, two different kinds of treatment could give you a stunning smile in just a few months. Invisalign braces can straighten your teeth in as little as six to nine months, depending on how crooked they are. Even if they are very crooked, treatment with Invisalign rarely exceeds a year.

Even if your Invisalign treatment is not complete in time for your wedding, your teeth would certainly look much straighter, and the aligners could be removed for your wedding day pictures or other festivities.

The fastest solution would be porcelain veneers. Porcelain veneers do not straighten your teeth, but make them appear to be in perfect alignment. This may be a great solution for you if your teeth are also stained or discolored.

A word of caution regarding veneers, though: be very, very careful when selecting your dentist! Many dentists think they can place porcelain veneers, but they lack the artistry and aesthetic sense to create a truly beautiful, natural smile makeover. Just because a dentist advertises that they do cosmetic dentistry does not mean you won’t be paying to have the whole thing redone down the road. Make sure they have received the specialized training, and have the artistic sense to do beautiful work.

The smartest thing you could do would be to talk to an expert cosmetic dentist who does porcelain veneers AND Invisalign braces. Only a dentist who is skilled in both treatments can give you a truthful, educated opinion on which procedure will work best in your individual situation.

I hope this helps!

I’ve been trying to find out about dentists in my area who can knock you out during treatment - I think they are called sedation dentists? What kind of risks are involved with this kind of sedation? I know it is going to take some time to fix my broken tooth, and I can hardly stand the thought of it.
–Felicity in Scottsdale

Dear Felicity,

First of all, know that you are not alone. Many, many people are incredibly anxious when they visit the dentist. Our practice here in Plano is an especially friendly place for such “dental cowards” - our staff has special training, so we can provide sedation dentistry for people who are extremely anxious about dental care.

Some people mistakenly call this sleep dentistry, but you do not actually go to sleep during your procedure. There are different levels of sedation, and different kinds of medications that are appropriate for different patients. The key thing to remember is that your dentist should really listen to you, to make sure your experience is as comfortable and stress-free as possible.

The sedation techniques used in sedation dentistry are very safe, and carefully tailored to suit your individual needs. I can’t give you a specific answer about the risks, because they vary depending on the type of medication, but your dentist should carefully discuss what techniques and medications will be best for you, and go over the potential side effects thoroughly.

Sedation dentistry can help you overcome your fear. Hopefully, one good experience will lead to another, and you will be able to pursue regular dental care. Good luck!