Fluorosis stains on my son’s teeth

I have a question about my 9 year old son’s teeth. He has severe fluorosis stains on his permanent teeth (the central and lateral incisors on both top and bottom), and our dentist doesn’t seem very concerned about this. My son is in braces already, even though his 12 year molars are not in, because he is so self-conscious about his teeth. The braces will straighten his teeth, but we need to figure out what to do about the blotches and stains. They look terrible, like the teeth of an 80 year old chronic smoker. What would be your recommendation?

Thanks,
Alice in Cedar Rapids

Dear Alice,

I think the first thing you must think about is seeking the advice of a different dentist. If you feel that your current dentist is not very concerned about the appearance of your child’s teeth, then he is not the one you want helping you deal with severe fluorosis stains. You need to seek the services of an expert cosmetic dentist.

The stains you describe do indeed sound like fluorosis stains, which indicates that your son consumed too much fluoride while his teeth were still forming. This could have been from the public water supply, or even from habitual swallowing of fluoridated toothpaste. If fluorosis is the source of the staining, then merely bleaching his teeth is not an alternative. The procedure is safe for children, but it will not remove the stains. Mild fluorosis stains can be addressed with direct bonding to cover the blotches and stains, but more severe stains will require porcelain veneers.

This problem is beyond your family dentist, especially if he seems indifferent to the self-esteem issues your son is experiencing with his teeth. You want the services of an experienced and talented cosmetic dentist, one who is sensitive to your son’s embarrassment about his teeth.

In terms of timing, the braces will have to come off first. When your son’s orthodontic treatment is complete, it could be possible that his front teeth may still not have fully erupted, so your cosmetic dentist may advise you to consider a direct bonding procedure as a temporary solution before placing porcelain veneers.

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Considering Clear Choice Dental Implants for my awful teeth

My whole mouth is in horrible shape, I have very few good teeth left. I’m embarrassed to smile, talk, and have a hard time chewing. The worst part is I’m a 30yr. old single man that has no confidence in myself due to being embarrassed by my teeth. I was considering Clear Choice Dental Implants because I like the idea of having all my teeth replaced with a more permanent solution and hate the idea of dentures at my age. I called for a free consultation and they warned me it would probably run $25,000 to $35,000. I can’t afford that! My parents set back some money when they sold a house to pay for my teeth to be fixed but not that much. Do you have any suggestions for me that will help me?
- Brad from Georgia

Brad,
That seems almost criminal to take all your teeth out at age 30 and place implant-retained dentures. And going to Clear Choice - they usually use the short-cut all-on-four dental implants technique, which puts all the implants in the front and leaves the back of your jaw so that it will eventually atrophy. By age 50 you will have practically no jawbone left in the back of your mouth.

My suggestion is to find a dentist who will work with you and your finances and phase the treatment, and save what teeth you can. If your financial resources are limited, just have the most essential things done now, and work at it gradually, so that over a period of years you get back into good shape.

Then while you’re doing that, try to focus also on preventing further deterioration of your teeth by eliminating snacking. A lot of people don’t realize that when they get a lot of cavities, it’s often because they’re snacking all day long. If this applies to you, you can save yourself a lot of future grief by severely limiting the snacking. No amount of brushing can keep your teeth clean enough if you’re snacking all day long.

Posted in Dental Implants, Tooth Decay | No Comments »

A mouthguard to prevent my crowns from cracking from my epilepsy.

I have epilepsy, just partial seizures, and I also have a mouthguard, one of those that sticks out of my mouth, beyond my front teeth. I have crowns on my front teeth, the upper ones. I was wondering if this mouthguard is good for these crowns, or if it will crack them. If I didn’t have epilepsy and just had bruxism, will this mouthguard crack my crowns too? Also I was wondering if the mouthguards that are sold in stores, like the ones that you form to your upper teeth, are any good. Won’t these crack your crowns too? Thank you for your help on these subjects. Respectfully, Julie from Wisconsin. 

Dear Julie,
The mouthguard, if it is put in right, will protect your porcelain crowns from cracking during a seizure or from bruxism or other physical contact.

The mouthguards you can buy in the stores and then you heat them and apply them to your teeth, those usually work just fine, though I would have your dentist check the fit afterward to make sure they will give you adequate protection. Or you can have a custom mouthguard made by your dentist, and this will offer the surest protection but will be more expensive. For bruxism we usually make hard flat splits that snap on your teeth. For epilepsy it may be a softer material that will cushion better. But either one will work.

Other links:
Read about bulimia and teeth damage.

Posted in Porcelain Crowns, TMJ Disorders | No Comments »

Question about dental implants and dental insurance.

I’ve worn full upper dentures for many years, but they are not working for me anymore. My dentist says my jaw bone has deteriorated, and is recommending dental implants. He quoted me a number that took my breath away! There is just no way I can afford the cost of replacing all my upper teeth with dental implants, not without help. Do you know of any dental insurance companies that  would help pay at least part of the expense?

Heather in Raleigh

Dear Heather,

You are in a difficult position. If you have worn a full upper for many years, then your upper jaw bone has probably lost quite a bit of bone mass. Part of that “breath stealing number” might be for bone grafts in your upper jaw, which may be necessary if your jaw has deteriorated to the point that it can not support the dental implant root forms. Sadly, many people do not realize when they you lose teeth, you also lose bone at the site of the lost tooth. Your body reabsorbs the bone for use elsewhere in the body. If you’ve lost all your teeth, your jaw bones can deteriorate until you are unable to wear dentures of any kind, and you may develop a condition called “facial collapse.”

Your dentist is recommending dental implants in part to help halt this bone loss, and likely because it may well be the only option left open to you. Sadly, you will not find a dental insurance company that will pay for dental implants.

If you think about it from the insurance company’s position, it does make sense. Why would they sell you a policy and then turn around and pay for a treatment worth many, many times the value of that policy? It wouldn’t make sense, and they would not be in business long.

Most dental insurance policies will only cover the cost of the least expensive treatment. In this case, they would pay for a different set of dentures, but never dental implants. Even a policy through an employer, which is generally better than what you could purchase on your own, would have an annual maximum of between $500 and $1,000 payout for dental care.

Dental insurance works best when the dental insurance company sells to an employer. The dental insurance company passes on the cost of the dental benefits they pay out on to the employer (plus a little profit for the insurance company), and the employer pays the expenses with pre-tax dollars, as a benefit of employment.

Your challenge now is to find a way to get at least some dental implants in place, to help stop any more bone loss and perhaps provide an anchor for a new denture. Hopefully, your dentist can talk frankly with you about all your options, and will assist you in seeking financing. Best of luck to you.

Posted in Dental Implants, Dental Insurance, Dentures | No Comments »

What’s it like to replace porcelain veneers?

I have eight porcelain veneers on my upper front teeth that are twenty years old. They don’t look that great, they aren’t as white as I would like, and I don’t like the shape. I don’t think the dentist who originally did them was experienced in veneers at all. As I recall, he removed a lot of my existing enamel before he placed them. How difficult/expensive will it be to remove these old veneers and replace them? What kind of result can I expect?
- Tracy from California

Tracy,
Replacing your existing porcelain veneers is pretty much the same process as getting them in the first place, and will cost about the same. In California, expect to pay about $1200 to $2000 per tooth.

Since the veneers are bonded tightly to your teeth, they have to be shaved down and prepared just as if they were enamel. It isn’t even absolutely necessary that all the old porcelain be removed, but generally we like to remove any old restorative materials. There are special techniques that experienced cosmetic dentists use to selectively remove old restorative materials without having to remove tooth structure.

But this time go to a truly artistic cosmetic dentist. I’m sorry that you have been disappointed all these twenty years with how they have looked. But a good 98% of dentists simply aren’t artistic enough to create a beautiful smile. When you get them re-done, expect to be excited about how they look before you pass off on them. If you go to a truly artistic cosmetic dentist, that will be the case. And twenty years from now, you’ll still have a stunning smile.

Good luck.

Other links:
Read about Seattle Lumineers
Dr. McKay has a special interest in dental work for people with bulimia.

Posted in Porcelain Veneers | No Comments »