Archive for the ‘Porcelain Crowns’ Category

Bulimia and damage to teeth

Monday, May 16th, 2011

I’ve had bulimia since 1990. I’ve been seeing a therapist for the last five years, and finally feel like I have things under control. I will always have bulimia, but now I am in control of the disease instead of the other way around. I’m finally at a healthy weight, and my skin looks nourished and healthy. The one thing I can’t change with diet, though, is my teeth. They are very badly damaged from more than 20 years of abuse. They are chipped, discolored and really thin, and they don’t fit together like they should. One side sticks out when I open my mouth to bite something, and I’ve been getting headaches.

I think I really need to see a specialist for all this. I need someone to help me with my bite issues, and I really want to improve the appearance of my smile, too. Should I see someone for the bite first, and then address the cosmetics, or vice versa?

Thanks,

Kelly in Sacramento

Dear Kelly,

If you find the right cosmetic dentist, you could address both issues with the same professional, which would really be ideal.

The issues with your bite are likely the cause of your headaches, and it sounds as if it is a temporomandibular joint issue, commonly known as “TMJ”. TMJ treatment will get everything back in alignment and functioning properly, so your nutrition is not compromised and your headaches ease or cease.

Because you have so little tooth structure left, you will probably have to have dental bonding before anything can be done to address the appearance of your teeth. Traditional dental cement is not strong enough to hold dental crowns in place when there is very little tooth structure to work with.

This will not be a quick fix, unfortunately. You are probably looking at porcelain crowns for all of your teeth. The improvement in appearance and function will be dramatic, but the price will be steep.

Best of luck to you as you move into this healthier phase of your life.

York PA cosmetic dentist Dr. Currie’s dental office sponsors this blog.

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My TMJ disorder is really complicated

Monday, January 17th, 2011

I really hope you can help me. My TMJ has been making my life miserable for years, and no one I turn to for help seems to be able to give me a long term solution.

Because of a severe teeth grinding habit, I had crowns put on all my teeth about ten years ago, when I was only 21 years old. They were not done right, and now the crowns are worn, and I have a lot of clicking and pain when I move my jaw. The new dentist I talked said my jaw is crooked, and that there is a slant on both the upper and lower jaws. I also have a lot of trouble with infections in my gums. And though this may not seem that important, they are just plain ugly! They don’t look real at all, and were never what I would call attractive. I am only 31 years old, and these things add at least a decade.

I went to a dentist who said he does “neuromuscular dentistry”, but it seems like I am worse rather than better! After two years of treatments, my crowns are wearing in different places, and now I have an open bite. I know I need some extensive work done, but I don’t know who to trust to do it! Should I go to a prosthodontist, or a cosmetic dentist? I learned my lesson with the neuromuscular guy - this time around I will be checking credentials and making sure they have TRAINING in what I want them to do!

I am worried that things are too screwed up to be fixed. Will a competent dentist be able to tell where my natural bite is supposed to be? And do I have to settle for these ugly kind of porcelain crowns because they are stronger? I just want this fixed. It is consuming my life!

Theresa in San Diego

Dear Theresa,

You’ve had a rough time of it! And chronic pain is awful to live with.

You were on the right track, looking for a neuromuscular dentist, and on the right track now in saying that you will be closely scrutinizing credentials and training.

You need to seek out a dentist who has both cosmetic dentistry training and experience and training in TMJ treatment. A dentist who is trained in neuromuscular dentistry could also be a good choice, but you are understandably leery in that arena. You are correct in stating that it will be difficult to determine where you natural bite should be, and you’ll need a top rate professional to help you do that. And never be afraid to closely examine the information they provide about their training and experience.

As to choosing between form and function, there is no need to. Porcelain crowns can be both beautiful and strong enough to last for many years, particularly if your misalignment issues are addressed and the grinding eases up.

Best of luck to you.

This blog provided courtesy of York PA dentist Dr. Currie.

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Are porcelain crowns often used for smile makeovers?

Friday, December 31st, 2010

Recently, I had a complete smile makeover done. The results are just amazing, but one small thing has puzzled me. When I got home and was checking out my new smile from every angle, it looks to me like my dentist used porcelain crowns rather than porcelain veneers, like we discussed. The porcelain seems to go all the way around my tooth, instead of just covering the front.

Is there a reason for this, customarily? And was I charged more for the porcelain crowns as opposed to the veneers? Don’t get me wrong - I am crazy about my new smile, and have received tons of compliments on it. I am just a little worried that there was something wrong with my teeth that made the dentist chose crowns over veneers. Is there something I should maybe be watching for down the road?

Kelly in Seattle

Dear Kelly,

There is not a percentage or measurement that really pinpoints when a porcelain veneer becomes a porcelain crown. Most cosmetic dentists charge the same or nearly the same amount for the two procedures, as they require about the same amount of time and work to complete.

It is indeed quite common to see smile makeovers done with porcelain crowns for cosmetic reasons, so you should not be concerned about any unknown conditions. Your dentist might have used crowns to support teeth weakend by fillings, or to make a change in your bite. Certainly, a responsible dentist would have told you about any issues that would require special attention from you or your regular dentist.

Crowns are a more aggressive treatment than veneers with more of the natural tooth structure removed, so it would be worth your time to ask your cosmetic dentist why he or she chose to go with crowns. Most dentists try to do the most conservative treatment possible, so there should be a good reason for choosing crowns over veneers.

York PA dentist Dr. Currie sponsors this blog as a courtesy to people seeking dependable dental advice.

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Black line near gumline with porcelain fused to metal veneers

Sunday, October 31st, 2010

I’ve had porcelain fused to metal crowns for many years, due to a childhood accident that damaged most of my top front teeth. They have always looked pretty fake, but in recent years I have developed a black line right at the gumline. It is getting a little bit worse every year.

What can I do about this? Is there some way to do dental bonding over those spots on my crowns? Can you please tell me all my options, from most expensive to least expensive?

Samuel in Marlboro, SC

Dear Samuel,

I am afraid there is no inexpensive way to correct this problem.

The “fake” appearance you mention is the reason why few true cosmetic dentists will use porcelain fused to metal crowns on the front teeth. The problem is not in the skill of the dentist placing the crowns, but in the structure of the crowns themselves. The metal underneath the porcelain makes it impossible for the crowns to mimic the translucency of natural teeth, giving the crowns that fake appearance. The black line that troubles you is part of the structure of the crown, and becomes evident over the years as the gums recede. If a dentist were to try and drill away that dark material and bond over it, the end result would not be any kind of improvement over what you have now, and could likely look a great deal worse.

This leaves you with two choices. The first choice actually is inexpensive, as it involves doing nothing and learning to live with the dark line. The only other option is to get new porcelain crowns. This will not be inexpensive, though you may be able to find a dentist who will help you phase treatment so you can budget for each phase of treatment.

One final word-when you are searching for a dentist to help you with this procedure, make sure you chose an experienced, talented cosmetic dentist. Ask to see examples of their work, and check out their training and credentials. This is an expensive investment, but one that could pay enormous dividends in your confidence. Make sure you choose the right professional to help you.

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My dentist won’t do all-porcelain crowns for my front teeth

Monday, October 18th, 2010

My top two teeth are worn, and just recently what was a small gap has chipped into something a lot more noticeable and a lot less attractive. I’ve been talking to my dentist about getting porcelain crowns for a while now, and now it is time to get serious about it. The problem is, my dentist and I don’t agree about what kind of crowns should be used.

As soon as I knew I was going to go ahead with the procedure, I started researching what kinds of crowns I wanted to get. I decided on an all ceramic set, like Zirconia, but here’s the problem. My dentist won’t agree to do all porcelain or all ceramic crowns!

He says it is because I grind my teeth and will not wear a night guard, but after reading around I wonder if he just is not comfortable placing them. A lot of the sites I’ve looked at say that placing all porcelain crowns is more challenging that placing the porcelain-fused-to-metal ones he wants to use. My dentist doesn’t have any kind of smile gallery on his website, or any before and after pictures of all porcelain crowns. He does have impressive sounding credentials hanging on his wall, but I guess I’d really like to be sure he knows what he is doing.

I’d really appreciate an outside opinion on this.

Rolfe in Ohio

Dear Rolfe,

I would recommend seeking a second opinion from an expert cosmetic dentist. Zirconia crowns are strong enough to be used even with patients who have severe grinding issues. It could be, however, that your dentist is concerned about wearing issues with your lower teeth, if the grinding remains unresolved. If that is a potential issue, there are soft porcelains that can be used on the surface of the Zirconia crowns.

I think you may have hit on the key issue, which is that your dentist is not comfortable placing all porcelain crowns. It is very important that you respect this, and if you are fixed on what you want, you will need to seek the services of another dentist.

The last bit of advice is this: think about giving in on the night guard issue. Grinding can create tremendous damage, and sometimes the situation is worse with crowns. If you don’t address what sounds like the root cause of your current issue, you are only inviting those same issues to continue to create problems. Ongoing grinding can cause your teeth to snap off at the gumline, causing the need for dental implants or a dental bridge.

Good luck.

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My son’s front teeth are a mess!

Wednesday, September 29th, 2010

My 10-year-old son was jumping on the neighbor’s trampoline, and came down on his face on the frame (no safety net). Half of his left front tooth broke off, and there is a horizontal crack in the right one. We took him to the ER to make sure he did not have any other injuries, which thank God he doesn’t. This morning, I took him to our family dentist and couldn’t believe it when he told us we will have to wait nearly three weeks for his schedule to allow him to fix it! Are you kidding me?? When I asked him if he could recommend someone who could fix it right away, he said we need to wait anyway, to let the root desensitize. I’ve never heard of this before.

Is it medically necessary to wait? I want this fixed right away.

Thank you in advance,

Jennifer in Portland, OR

Dear Jennifer,

Medically, there is no reason to wait. I’m not sure why your dentist won’t recommend someone else if he is too busy to take care of this right now. Your letter kind of implies that there is not much a trusting relationship with this dentist, which is a good indicator that you may want to consider finding a new dentist.

You don’t mention whether or not you have the piece that broke off the tooth, and hopefully you do. An experienced and talented cosmetic dentist may be able to reattach the broken piece of tooth. If you do not have the missing piece of tooth, the most likely fix for a child this age is direct dental bonding. When he is older, he will likely need porcelain crowns on one or both front teeth.

Direct dental bonding is a very demanding procedure, both technically and artistically. Keep this in mind when you choose a dentist to do the repair. You should look for an expert cosmetic dentist with demonstrated skills in direct dental bonding, and one who is sensitive to self-esteem issues in kids. If you talk to a dentist and he or she seems to be dismissing the importance of the appearance of those front teeth in a child, seek another opinion.

Best of luck to you.

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