I have a problem with tooth discoloration that cannot be handled with standard professional teeth whitening. My stains are from taking tetracycline when I was young. My regular dentist has offered to perform treatment for this discoloration, but something tells me not to put my trust in someone whose experience is in general restorations, like fillings. (Is it wrong to question this?)
My smile is important to my work due to the heavy interpersonal interaction required of me. It affects my overall earnings! So, I have scrimped and saved to the tune of $30,000 in order to invest in the appearance of my teeth. I have consulted with two cosmetic dentists. One will do the necessary work for a little less than my budget. However, he wants to solve my concern with porcelain crowns. The other dentist suggested only three crowns, and porcelain veneers on all other teeth that are visible when I smile. If I were to choose this dentist, I would have to finance about $10,000 on top of the money I have already saved. I don’t want to put off treatment, and I wonder how to know which dentist I should choose. What are your thoughts?
The skepticism you have is certainly not wrong. Many general dentists are not fully trained in the performance of high-quality cosmetic smile makeovers. The fact that your dentist offers this service is not an indication of his abilities, nor of his training. You are in need of the highest caliber of work on your smile. That being said, there is no harm in consulting with your dentist to ascertain his cosmetic dentistry training. If you feel comfortable that he has completed advanced courses, you then want to see photos of cases he has performed before you proceed with care.
You should also be aware that covering tetracycline stains is one of the most difficult of smile makeover procedures. Tetracycline-stained teeth are dark, and the surprising thing to many dentists who treat these for the first time is that the color gets darker the deeper they prepare the teeth. Then, when they try to mask these stains, they tend to make one of two errors. Porcelain tends to be translucent, and they will generally tend to make veneers too translucent, so that the dark color shows through. If they don’t do that, they will almost always make them too opaque, giving the teeth a pasty, fake look. When you ask for photos, ask to see photos of other cases of masking tetracycline stains to see if they can do this difficult procedure.
One assurance would be to go to an accredited cosmetic dentist. One of the purposes of the accreditation program of the American Academy of Cosmetic Dentistry is to help the public have an assurance that the dentist has expertise in cosmetic dentistry.
Now, regarding crowns vs. veneers . . . We believe in preserving tooth structure as often as possible. A crown requires a far greater extent of reduction than veneers, and thus it increases the risk of a number of consequences. Front teeth that have crowns on them, especially if it is all the front teeth, are more susceptible to breaking off. If the treated tooth breaks, you may have to have it extracted and replaced with a dental implant. If aesthetic improvement is the only reason for treatment, go with the more conservative option of porcelain veneers. In our La Jolla office, porcelain veneers are preferred to crowns, unless there is a need for tooth repair.
When it comes to pricing, there are a number of factors involved. Typically, pricing should not vary significantly from one cosmetic dentist to the next. However, some dentists who are extraordinarily talented may charge premium prices for their work. Others charge more simply because it seems logical. Price is not your only indicator of quality. In fact, it may be a poor one. If you choose to work with a cosmetic dentist for your smile makeover, discuss your preference for veneers with the less-costly dentist who wants to do crowns. Pay attention! If he does not seem comfortable doing the work you request, chances are he will not do a very good job.
Consider an alternative as well. Perhaps you can have your top teeth veneered, and just have your lower teeth whitened to match. The lower teeth can always be done later. Also, find a dental office that offers a “beautiful smile guarantee.” This indicates that the dentist will not perform permanent treatment until you are fully satisfied with the appearance of your new smile.
This blog is sponsored by La Jolla dentist Dr. Stephen Doan.