Tag: bad dentistry

What Should A Good Porcelain Crown Look Like?

Dentistry is a unique profession. We don’t just deliver a service, but we also deliver a product. Porcelain crowns, or caps, among many other type of restorations are delivered on a daily basis in a dental practice. So, what makes one dentist different from another? Why does one dentist charge more? What could the big difference be?

Here is a quick example of the difference between a good crown and a bad crown.

The sole purpose of a porcelain crown is to repair and preserve the tooth, mimicking its original shape and function. The color should match the existing teeth, so it blends in.

This is what we expect from a GOOD crown:

  1. Perfect Fit
  2. Matching contour to the neighboring teeth
  3. Straight emergence profile from the gum tissue
  4. Good contact between the teeth and the opposing biting surface
  5. Good color and stain match to neighboring teeth

Common errors seen in a BAD crown:

  1. Poor fit of crown – Results in recurrent decay, sensitivity, quick failure of crown.
  2. Over contoured crown – Results in inflammation around tooth, gum disease, recurrent decay and quick failure of crown.
  3. Crown fits on tooth like hat on a hat rack – Result is same as #2
  4. Crown is either too tight between teeth, too light or no contact at all – Results in food impaction, and consequent recurrent decay.
  5. Crown looks like a marshmallow or corn kernal rather than a tooth.

So now you know what a good crown should look and fit like. Now why are not all crowns made like this? Simply put, making a good crown is an art and requires a high level of skill. It takes time, and time is money.

The dentist needs to deliver a perfectly prepared tooth, a perfect mold of that tooth, and a perfect prescription to what he/she wants from the technician.

The technician needs to perfectly trim the model, perfectly build the crown on the model, and perfectly adjust that crown on the model. Then the dentist needs to try this crown on the tooth first, make any necessary adjustments, and then cement the crown perfectly. There is no room for error!

Preparing the tooth takes time and skill. Taking a perfect mold takes time and skill. The less a dentist gets paid for a procedure the less time he/she can spend on it. It is a simple matter of economics. It is a business. Running a dental practice is very expensive and there is significant cost involved.

Now, once a perfect mold exists the crown needs to be made by a highly skilled technician. The more skill the technician has the higher the cost. It is a very simple formula. You get what you pay for!

All these steps and requirements put together are what it takes to make a good crown. A bad crown is not much better, and sometimes worse, than no crown at all.

The difference between a good and a bad crown is immense – the aesthetics are better, the fit is better, the longevity is better.  Would you expect to pay the same for a good and a bad crown? Of course not. A crown should last a very long time – decades. So, if the cost difference is less than a few pennies per day over the lifespan of the crown, why not get the good crown?

At Ideal Dentistry we only place good crowns because that is the right thing to do.

Keep smiling.

EVERYBODY’s a “Cosmetic”,”Natural” and now “GREEN” Dentist

Cosmetic Dentist, Natural Dentist, Holistic Dentist, Comprehensive Dentist… Every wonder why people jump on a bandwagon?  Well, it is all about economics, unless you are one of the originals.  Dentistry is not much different than Beanie Babies, Rubber Bracelets and Crocs.  There are fads that dentists jump on because they are popular.  Unfortunately with a profession such as dentistry you can’t just suddenly become a natural/organic or cosmetic dentist, you have to “be” one from the beginning.  Here are a few examples why you need to be careful:

Everybody is a Cosmetic Dentist

Cosmetic dentistry became popular in the 80’s with the advent of veneers, porcelain and white plastic fillings.  What a great option patients now had.  You could replace your old fillings or get new ones that matched your teeth!  These new materials came with new rules of how to place them.  This resulted in a significant amount of failure of these materials, and still does, as they are very technique sensitive.

Regardless, dentists began calling themselves “Cosmetic Dentists” just because it was popular, yet they had made no changes in their skill set warranting this title.  Today everybody is a cosmetic dentist.  Who wants to got to a “non-cosmetic dentist”?  This of course completely invalidates the description and creates incredible confusion (and lots of bad cosmetic dentistry).  Looking around Louisville I have found everything from “Advanced Cosmetic Dentistry” to “Specializing in Cosmetic Dentistry”.

Well, truth be told, there is no speciality in cosmetic dentistry and advertising such is considered fraud.  “Advanced Cosmetic Dentistry” should only be advertised if you have advanced cosmetic training.  Check the dentists “advanced” training or ask what that means.

So, if you are looking for cosmetic dentistry, be diligent in your research or you will certainly be disappointed with what you get.

Everybody is a Natural Dentist

You knew it was coming!  All the stores are going organic. “Going Green” is one of the biggest trends ever.  So, what are Dentists advertising?

You got it, natural and green dentistry!  Be prepared to see a significant influx of dentists advertising the need to “remove your amalgam fillings now”, even though most still place that type of filling!  Does that make sense?  Here is the common scenario I can already see; “Dr. ____, for the last 15 years you have been plugging amalgam/silver mercury in my and my families mouth. Now I see you advertising that these fillings are bad and you want to remove them?  Why do you still place them then?” 

This will happen all the time.  For the record, the ONLY silver mercury filling I placed after dental school was the one I was required to place to pass my board examination over 12 years ago!  Every since I graduated I have taught my patients the same philosophy behind amalgams.  As a matter of fact, the only silver mercury filling I placed was on my brother and I then, after the boards, removed it and replaced it! 

So when it comes to natural dentistry, once again, check the credentials.  What makes a dentist natural?  How is the dentist living a natural life themselves?  What type of fillings do they have in their mouth?  All critical questions.  Remember, choose someone that “walks the talk”, not just chases the current trend.

 My patients know what I stand for as I probably talk their ear off about it all the time.  The beauty is that I have not been chasing the trends that are emerging, but rather am one of the dentists behind the changes you see in today’s world.

I stand for beautiful cosmetic dentistry performed in a comfortable patient oriented environment and delivered in the most natural and tooth preserving manner possible.  Period.  Cosmetically speaking nobody has more experience or training.  I founded a natural dental products company over 8 years ago to get out the word about my natural approach to dentistry.  Today I am expanding on my natural dental products company and am creating a simple system that will allow you to become cavity free, naturally!

NOT so “Cosmetic” Dentistry

What is the difference between a Cosmetic Dentist and an Accredited Cosmetic Dentist?  Well, the difference is in the details.

Understanding facial aesthetics, not just teeth, is critical. The goal with every cosmetic smile makeover is to improve the whole smile, the whole face, the whole person, not just the teeth.

Here are a few cases I found online that are touted as “Smile Makeovers“. You be the judge. Are these smiles complete? What is missing? More after the pictures.

Please remember, these cases are NOT MY DENTISTRY!

Do these cases sound like “Smile Makeovers?”

  1. A smile goes from one corner of the mouth to the other.  Teeth are framed by the lips and need to follow the lip line.  A “black corridor” will result if one side of the smile, or frequently both sides, are neglected.  This dreaded black corridor makes the person look like they have no teeth on that side when they smile, especially in photos!  Who wants that?  How is that “cosmetic/aesthetic?” All these patients above spent a lot of money on their smiles, significantly more than their insurances would ever cover.  Why would you not finish the case and get rid of that black corridor?  Until that is done right, it is not a “smile makeover”, but simply a few veneers on some teeth.
  2. Bulky.  Teeth are not bulky, why are so many veneers bulky?  They shouldn’t be.  It does not look real, and it is not good for the teeth.
  3. Shine through.  Meaning, you can see the prepared tooth shine through the porcelain.  Look at the last before and after.  Can you see the darkness in the middle of the two front teeth? That is of course ignoring the blackness of the back lower teeth and the black corridor on the top side.

Long story short, everyone is a cosmetic dentist, but if you are going to invest in your smile, why not see someone who has the experience to give you a result that really can be called a Smile Makeover?

Most of our Smile Makeovers are Smile Redoes.  Who wants to go through this whole process twice, not to mention pay twice?

That is what being an Accredited Cosmetic Dentist is all about.  Having the experience to do it right the first time!

Second Opinion Roundup

Here are some pictures of “second opinions” I have given and what my thoughts were.

When patients tell me that I am “more expensive” then another dentist in town, I can not help but imagine what type of dentistry this patient really want in their mouth. My answer, always, is to have the patient compare apples to apples, and oranges to oranges.

If you are looking for high quality dentistry that looks beautiful, is made by a top laboratory technician, and is designed and maintained to last (experience matters, but a lot of bad experience does not count!), then I am the dentist for you.  On the other hand, if you want the cheapest and are not really worried about what is put into your mouth/body, how it fits or functions, or how long it will last, then I most certainly am not.

I follow the golden rule – “Treat others the way you want to be treated”.  I would never put something into one of my patients mouths that I would not put into my families mouth, period.  After all, all you really own in this world is your body, right?! 

I am getting carried away, sorry.  I just wish people knew what I know about dentistry, how it affects everything about you from soul to function.  That would keep the following examples from ever happening.

Local “cosmetic” dentistry.  Upon closer examination (besides the fact that the veneers are not good looking), the “real” problem this lady had was ignored.  Below is the picture of the lower teeth.

Note all the gum tissue is pulling away from the teeth!  That is a great way to loose teeth rather quickly.  This person need to see a gum specialist as soon as possible, plus determine why the “recession” is happening.

Needless to say, this is not very good “cosmetic” dentistry.  The “black triangle”  is a result of tissue loss and is very difficult to remove.

This may be hard to see at first, but I will explain.  The above patient has 2 premolars, or the 2 teeth to the right of the turned tooth, that are bigger than the molars, or the far right teeth.  These are really big and bulky crowns!  The tissue cant breathe, so it gets inflamed, bleeds easily and gum disease is the result.

When tissue bleeds, bacteria seep into the bloodstream and attack your system from the inside.  This is an all too common “one size fits all” dental lab.  The good news you ask?  This patient saved a few bucks by going to a lower priced dentist!  (Except of course now it has to be redone).  This dentist did not make less money then a high quality dentist would, he/she just charged less and hired a cheap lab (possibly in China) to make the new crown.  Who suffered in the end?

This picture is from the same patient above, only it is his other side.  Note how “small” his own two premolars are!  Don’t let that other dentist get a hold of those perfect little teeth, all they need is to have the silver mercury removed, minimally, and the tooth can be restored without cutting it down to a little stump.

This patient, I call him patch, has been to the same dentist for many years.  He came to me after a recent filling “just fell out”.  Well, almost every single tooth has a bunch of plastic patches on it, most surrounded by decay.  A “new” bridge was placed on the lower right side of the above picture (the patients lower left).  Everything else was “ok”.  Really?!  Well, I hate to be the messenger sometimes, but there is a significant amount of decay that should have been treated a long time ago.  Of course the patient is shocked, but I need to tell the truth about what I see.  Now we are “fixing” the mouth, not patching.

This is a great example of “if it does not fit into the mouth, grind a little more!”.  The black spot on the big tooth is where the porcelain has been ground off to make the crown fit into the space.  And even worse, the tooth to the right of the big crown has a monster patch that is fractured.  That little tooth needs a crown, a buildup, and possibly a root canal.  Maybe the tooth is even fractured itself and then it can not be saved.  Was it worth placing a super large plastic filling where they really don’t work?  And that crown, if you look closely, you will see that where the top touches the tissue the tissue is red and swollen.  That is a portal for bacteria into your system, and it bleeds if you touch it.  Not a very healthy situation.

Now, here is the next level of “if it does not fit, grind a little more”.  The gold/black spots on the teeth above are where the porcelain crowns were ground through to the underlying metal to make them fit in the mouth.  Just because the patient can’t see these areas does not mean they don’t exist!  This weakens the crowns, and is just not acceptable.

Here is another final example of a mega tooth.  This white blob is significantly larger than the original tooth, inhibiting everything from the flow of food to tissue health.  There is just so much wrong with this tooth that I don’t know where to begin.

Moral of the story, you own your mouth/your body, nothing else.  Take good care of it and it will take good care of you.

Is This Acceptable To You?

Yesterday I saw a new patient that had seen his old dentist regularly for years.

At his last visit his old dentist placed a small “filling”. Everything else apparently was fine!

So, to make a long and unfortunately too common story short, this patient has extensive decay and very poor dentistry. His oral hygiene is very good and with a little Ideal Dentistry this patient will have a great smile.  Thank goodness his true dental problems were discovered before it was too late!  It is very regretful that his old dentist practiced supervised neglect

What do YOU expect from your dentist?  Do you want the truth?  OR, do you want a false sense of security that everything is ok?  I firmly believe that it is YOUR decision what to do about “your” dental problems.  Once I have informed you of everything that is going on, YOU can make the decision that is best for you.  I will never be afraid to tell you the “truth” and give you a way to get back to good dental health.