Damaged front teeth on my 10 year old child

My child was playing on some wet playground equipment yesterday, and she slipped and fell. She broke one of her top front teeth off, and the other has a diagonal crack in it. Our regular dentist said he will not be able to fix it until next month! He says that the root needs time to become less sensitive, or something–I don’t really understand why he wants to wait.

I want to get this fixed right away! I am fine with going to a new dentist, but I need to know what he is talking about with the root being sensitive. Is it customary to wait, with this kind of injury? The appointment he offered us is nearly 4 weeks away.

Thanks for you advice,

Celeste in L.A.

Dear Celeste,

There is no medical reason to delay this treatment. If you have the piece of the tooth that broke off, a skilled cosmetic dentist might be able to reattach it.

Which brings me to the most important point: You should be very careful to choose an expert cosmetic dentist to do this treatment for your child. Most dentists do not have the skills and training to repair/replace your daughter’s front teeth so that they look natural and match each other in terms of translucency, color and size. As your child is 10, I am assuming these are her adult teeth that have been damaged.

From what you describe, I think direct dental bonding will work best to effect this repair of your child’s tooth if you do not have the piece that was broken off, or if it is unusable. Direct dental bonding requires tremendous skill and artistic ability, so be very sure that you have chosen the right dentist for the job. Ask to see pictures of his or her work, and check credentials carefully.

When you daughter is older, she may need a crown on one or both of the teeth, depending on the extent of the damage. In that situation, too, you will want to make sure the dentist you go to has the proper training and artistic skills to do a beautiful job.

Best of luck to you in locating someone to help you and your child.

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How to close a gap between my front teeth.

May I ask you a question about bonding? When I was about 13 I had my top two front teeth bonded to close the gap in my front teeth as I hated it. I am now 33 still have it bonded it has chipped slightly but has worn very well. However my dentist never closed the gap fully so I still hate my teeth.

I want to go to a cosmetic dentist and get a second opinion on what to do next as my dentist wants to do veneers which I am a bit scared to have done. I just would like the bonding redone but my dentist says that it might not rebond as well the second time around. Is he right? Should I put up with the smaller gap and old bonding as I am scared of opening a can of worms and having it redone then it doesnt bond as well? What do you think?
- Joanne from the U.K.

Joanne,
It’s funny, but when dentists aren’t very good at direct dental bonding, they come up with all kinds of reasons why bonding won’t work for certain situations. But closing a gap between two front teeth is best done, in my opinion, by direct bonding.

If the gap is large, there can be a problem in making them look natural, so it can be advisable to do something besides the direct bonding, like re-shaping the adjacent teeth in various ways to make the lateral incisors a little larger or at least to appear larger, to balance out the sizes of all the front teeth. But for a basic “gap,” you want direct bonding.

The fact that you have old bonding on your front teeth doesn’t matter. It may help to know that even porcelain veneers have to be bonded - it is the same chemical process to bond porcelain or to bond composite. If you can bond one, you can bond the other. So if you can fix the gap with porcelain veneers, you can fix it with direct bonding. The difficulty with direct bonding is that it requires artistic ability since it is done freehand.

So you need to go to a dentist who is an artist to have this done - a dentist who is passionate about cosmetic dentistry.

Please visit the website of Seattle cosmetic dentist Dr. Brian McKay

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My bonding is turning yellow

I had my teeth bonded at least 10 years ago but now they are turning yellow. Is there anything that I can use that will tone down or get rid of the yellow. My daughter is getting married in October, this has bothered me for quite some time but I don’t have the money to redo my bonding and with the wedding around the corner, I really wish I could do something about it.
- Annette from Virginia

Annette,
When you have dental bonding done on multiple teeth, that is the major drawback - the bonding will discolor over time. I’m guessing that your teeth haven’t looked good for a number of years. Usually extensive bonding only looks good for a couple of years.

The cheapest treatment over the long term is porcelain veneers. They are more expensive initially, but the color and gloss last for many years.

Depending on how deeply stained your teeth are, the yellow may be able to be polished off by an artistic cosmetic dentist. You need someone that does a lot of cosmetic dentistry and you can see photos of their beautiful results so you can tell if they are truly passionate about the appearance of their work.

Other links:
Read more about dental bonding.

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Does bonding come off when you chew hard substances?

Question:
Does bonding just fall off a tooth with chewing a hard substance?
- Mike in Georgia

Mike,
Dental bonding involves the application of a composite material to the tooth. It is different from porcelain veneers  in that it is made out of composite, not porcelain, and it is shaped on the spot by the dentist rather than baked in an oven by a dental laboratory and later bonded to the tooth. To read about veneers, see our Seattle porcelain veneers page.

The bond to the tooth is very strong, and ordinarily it doesn’t come off. But sometimes it does. It will come off if:

1. It hasn’t been bonded on properly.
2. It is abused. Normal chewing of hard substances wouldn’t be abuse. We mean things like playing a contact sport without mouth protection, biting on metal or rock or other very hard substances, or getting struck in the mouth.
3. You have a problem with grinding your teeth or other occlusal problems, including certain TMJ disorders that haven’t been addressed or taken into account by your dentist.

Or it could be a combination of the above factors that causes the bonding to fail. For example, if the bond is only moderately strong instead of its full strength, it will be more susceptible to lesser degrees of the bottom two problems.

If your bonding has come off because of normal chewing of a hard substance, I would suspect that there could be some improvement in how the bonding was placed. Sometimes dentists don’t fully analyze your chewing patterns so as to shape bonding to be able to withstand normal mouth function. That’s my guess about what has happened, but I could be wrong, since I haven’t examined you. 

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