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Brian LeSage, DDS, FAGD, FAACD

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Dentist over-prepared my teeth and veneers fall off

The past year has been an immensely frustrating experience with porcelain veneers that keep falling off. My dentist repeatedly bonds a veneer back on when it falls off, but it seems that another one falls off within a few months. This has happened three times. I suspect that before this year ends, all eight veneers will have fallen off at least twice.

When I received the veneers in the fall of 2019, my dentist said they would last 15 to 20 years. It makes me nervous to think that I will have this experience for the next 14 years. My anxiety level is high whenever I return to her office. When she removes a veneer, I can no longer look at the tooth behind it because the veneered teeth look like small pegs. Although my dentist said she wouldn’t take off much tooth enamel, I don’t think I have any enamel left.

My dentist prescribed ten Ativan tablets for whenever a veneer falls off. She advised me to take one about an hour before the appointment for anxiety. I am insulted that my dentist thinks sedating me is the solution to her sloppy work. It is probably time to switch dentists, but with teeth that are small pegs, I wonder if another dentist can do any better. What is the best way for me to handle this situation? Thank you. Huong from Seattle

 

Huong,

A single porcelain veneer held by dental forceps

Porcelain veneer

We are sorry to hear about your experience with porcelain veneers. It seems that you have realized that what is happening is not normal, and it is best to get a second opinion from an advanced cosmetic dentist. Your dentist’s approach is questionable in several areas.

Preparing your teeth for porcelain veneers

Advanced cosmetic dentists conservatively prepare teeth for porcelain veneers—removing a half millimeter or less of tooth enamel. Conserving tooth enamel for porcelain veneers has several advantages:

  • Smoothness – Conservative preparation avoids a bump at the margin where the veneer meets your gumline
  • Stability – Dental cement that bonds porcelain to your teeth adheres to tooth enamel better than dentin—the layer beneath the enamel.
  • Healthier – Bacteria more readily seeps behind veneers bonded to dentin and promotes decay

Preparing teeth for porcelain crowns

Although crown preparation is more aggressive than preparation for veneers, preparing teeth for crowns still requires a conservative approach. Otherwise, the crowns will not stay on. When a dentist prepares a tooth correctly, a proper retention form will keep it secure even with dental cement.

Your dentist’s aggressive preparation of your teeth was too much for crowns or porcelain veneers, so your veneers are loose and falling off. Looseness allows saliva and bacteria in, promotes decay, and can contribute to bad breath.

Sedation with Ativan

After 24 hours, half the dose of Ativan is still in your bloodstream. It can take a couple of days for your body to eliminate the drug. Many dentists commonly use Halcion for sedation, which lasts about three hours—enough time for a dental appointment. It seems that your dentist’s sedation techniques are also too aggressive for bonding a veneer back on.

Is your dentist liable?

Your dentist is legally liable for your veneers for these reasons:

  • Grinding your teeth down to numbs for porcelain veneers that will not stay on
  • Compromising your oral health—your teeth risk breaking
  • Providing unstable dental work—your veneers fall off

Some options are reporting your experience to the state dental board, consulting a malpractice attorney, and submitting negative reviews about your experience. But those actions will not restore your smile. You need help from an advanced cosmetic dentist.

Schedule a porcelain-veneers second opinion

We recommend finding an accredited cosmetic dentist for a second opinion, followed by an exam. The dentist will explain your treatment options for correcting your smile makeover. Your new dentist might be able to help you get a refund.

But your oral health and how you feel about your smile are most important. Search for accredited cosmetic dentists with a lot of experience. You can schedule two consultations if it will increase your confidence that you are choosing the right dentist. Ask each dentist how many cases like yours they have handled.

 

Before-and-after minimal prep porcelain veneers from Beverly Hills dentist Brian LeSage

With minimal preparation, Dr. LeSage’s patient received eight porcelain veneers

Accredited Fellow of cosmetic dentistry, Dr. Brian LeSage, sponsors this post. Dr. LeSage has developed and published a classification system for porcelain veneers preparation.

Is a crown the only solution for a dark, front root-canal tooth?

Last summer, I fell and knocked out my left front tooth. My dentist saw me right away, put the tooth in the socket, and bonded it in place. He also did a root canal on the tooth. In a few months noticed that my tooth was getting dark. When I saw my dentist in December, he said that I might need a crown. After doing some online research, I wonder if a crown on a front tooth is wise. Is there an alternative to doing a crown? I wouldn’t be so fussy about this, but I completed Invisalign treatment in 2017 and got my teeth whitened. And it’s a front tooth that’s affected, so I am more concerned than I would be with a side or back tooth. Thanks for your suggestions. Khalid from Lincoln, NE

 

Khalid,

You were wise to research before agreeing to a dental crown for a front tooth. Although a crown can strengthen a front tooth against chipping, it will make the tooth more susceptible to lateral stress. If you have a heavy bite, it increases the risk of the tooth breaking off.

Minimizing Tooth Discoloration After Root Canal Treatment

After root canal treatment, a tooth may discolor. But before treating the discoloration, a dentist may x-ray the tooth to check for external root resorption, which can occur with tooth trauma.

What is external root resorption?

External root resorption is a condition that occurs when blood vessels and connective tissue from surrounding structures invade and damage your tooth roots. If you are experiencing external root resorption, your dentist must treat the issue before proceeding with cosmetic treatment.

Correcting tooth discoloration

If your tooth roots are sound, a highly skilled cosmetic dentist can minimize the tooth discoloration.

One treatment method includes these steps:

  • Clean out the crown and remove root canal filling materials and cement
  • If the tooth has begun to discolor, treat it with internal bleaching
  • Fit the tooth with a flexible fiberglass post and seal the opening
  • In a few years, if the tooth begins to discolor, use a single porcelain veneer to conceal the discoloration and match the color, translucence, and gloss of your natural teeth.
A single porcelain veneer held by dental forceps

A single porcelain veneer may conceal front-tooth discoloration

Your tooth requires aesthetic training and experience that most general dentists do not have. Schedule a second-opinion appointment with an accredited cosmetic dentist. He or she has proven skill in advanced dental aesthetics and passed rigorous oral and written exams. The cosmetic dentist will eventually need to examine and x-ray your tooth before explaining your treatment options.

Best wishes.

 

Accredited Fellow of cosmetic dentistry, Dr. Brian LeSage of the Beverly Hills Institute for Dental Esthetics, sponsors this post.

 

Painful deep cleanings and deep pockets that won’t go away

Before my hygienist did a deep cleaning two years ago, I had a one-year plan to get porcelain veneers. My plan failed because, since the cleaning, I have deep pockets that do not heal. I’ve switched dentists since then, but I still have pockets in my gums. My teeth are so painful and sensitive that I canceled my last cleaning appointment. I didn’t have any significant problems with my teeth before the deep cleaning. I want porcelain veneers to close a front gap and make my teeth look uniform, but my teeth were healthy. I was advised to ensure my teeth and gums were healthy before I received porcelain veneers. So, the hygienist did a deep cleaning, and now my mouth is ruined. Who can help me? Thank you very much. Kanai

Kanai,

Thanks for your inquiry. You have aggressive gum disease that the team at your dentist’s office is not controlling well.

Is a Deep Dental Cleaning Painful?

When a dental professional completes a deep cleaning correctly, it can be painful. A local anesthetic is used to numb your gums. When gums are inflamed or infected, it requires cleaning your teeth to where teeth and gums attach. After the cleaning, you might have some swelling and minor bleeding.

What’s Causing Your Tooth Sensitivity and Pain?

The tooth sensitivity and pain you describe have a source other than deep cleaning. You probably have an aggressive infection. Sometimes, deep cleaning can provoke an existing infection, and based on your description, you probably have a flareup.

What can a dentist do to help?

  • Antibacterial agents can help.
  • A dentist might prescribe antibiotics while you have deep cleaning appointments.
  • Your dentist can schedule four or more appointments, if needed, within two or three weeks.

When Your Dentist Can’t Control Your Gum Disease

When a dentist can’t control your gum disease, we recommend that you find another dentist. The problems you describe are appropriate for a periodontist (gum specialist) to evaluate. Although your teeth and gums might have been healthy in the past, you now have a severe gum disease that must be treated to prevent tooth loss.

Talk to the periodontist about:

  • Your oral health history
  • Your experiences with your previous dentists and the type of pain you feel
  • Your goal for a smile makeover with porcelain veneers. Although it might take some time to realize that goal, the periodontist will explain when you can expect to reach it.
A single porcelain veneer held by dental forceps

Healthy gums contribute to healthy porcelain veneers

As you get closer to restoring your oral health, look for advanced cosmetic dentists, and schedule two consultations. A highly trained and experienced cosmetic dentist will design a smile with veneers and ensure it is healthy. They will bond your veneers without irritating your teeth or gums. When your periodontal treatment is complete, you will have already found a dentist to complete your smile makeover.

Best wishes for a steady recovery.

This post is sponsored by Dr. Brian LeSage, an accredited Fellow of cosmetic dentistry in Beverly Hills.

All I want is no-prep veneers, but dentists won’t do it

I am trying to find a dentist to give me no-prep veneers. Last month, I had three consultations with top cosmetic dentists, and none of them would agree to do no-prep as I asked. They basically said that I wouldn’t like the results. Not that I’m going to take legal action, but isn’t this a patient rights issue? After reading some patient stories online about tooth preparation and seeing pictures on Instagram of people recording their porcelain veneers’ journey, I’m concerned. Their teeth look like tiny toothpicks after preparation! Although I want veneers, I don’t want my natural teeth butchered. How can I find a cosmetic dentist to do no-prep veneers? Thank you.  Alma from Nevada

Alma,

Thanks for the inquiry. You have the right to request no-prep veneers, and you might find a dentist who will give them to you with the understanding that you might not like the results. But if you visited three top cosmetic dentists who agree that no-prep veneers are not the best option for your case,  there is probably a good reason. Dr. LeSage would need to examine your teeth to discuss your case, but consider some of the facts below.

What Are No-Prep Veneers?

No-prep veneers are porcelain veneers that a dentist bonds to the fronts of your natural teeth without altering your tooth structure. No-prep veneers differ from minimal preparation when a cosmetic dentist removes minimal front tooth enamel before bonding on veneers.

Minimal preparation can help a veneer fit well from the gumline to the edge and look natural—not bulky. A cosmetic dentist minimally prepares a tooth by removing a fraction of a millimeter of tooth enamel—not by filing, cutting, or grinding down healthy tooth structure.

Not Every Patient Is a No-Prep Veneer Candidate

Although porcelain veneers are an ideal solution for many smile makeovers, advanced cosmetic dentists agree that not every patient is a candidate for no-prep veneers. Without preparation, it might be impossible to use porcelain veneers and achieve the smile you want.

  • Veneers add to tooth structure – Veneers as thin as 0.3 mm add a little thickness and length to your teeth. Unless you have small teeth, veneers can make your smile look thicker or a bit bulky without preparation.
  • Tooth shape – If a tooth is crooked, a portion of it sticks out. A cosmetic dentist must trim back the tooth to get a beautiful result after bonding a veneer to it. Without preparation, a veneer will cause the tooth to stick out even further.
  • Margin between the veneer and tooth – In many cases, if a tooth is not prepared, after the dentist bonds a veneer on, there is a bump where the porcelain begins. Without a smooth margin between the veneer and tooth, you can expect a slight bulge at the top of all your veneers.

Porcelain Veneers with Minimal Preparation

Dr. Brian LeSage of Beverly Hills has a published porcelain veneer classification system in the Journal of Esthetic and Restorative Dentistry. Advanced cosmetic dentists like Dr. Lesage minimally prepare teeth to preserve tooth enamel, ensure a firm bond between your teeth and veneers, and achieve lifelike results. Dr. LeSage leaves a minimum of 80% tooth enamel when preparing teeth for veneers. If you choose an accredited cosmetic dentist, you can avoid aggressive preparation as you have seen in photos in online articles and on social media. Read our post about what happens when a dentist over-prepares teeth for veneers.

Evaluate Your Smile Goals

We understand that you don’t want tooth preparation for your veneers. Below are a few questions to ask yourself to help you make an informed decision.

  • Do I fully understand how my smile will look with or without preparation for porcelain veneers?
  • Am I willing to accept the predicted results if I refuse preparation?
  • Am I open to reaching an agreement with an advanced cosmetic dentist for minimal preparation?
  • Have I asked about other cosmetic dentistry options for achieving my smile goals?

 

Before-and-after minimal prep porcelain veneers from Beverly Hills dentist Brian LeSage

Dr. LeSage placed eight porcelain veneers on this patient’s upper front teeth

Best wishes.

This post is sponsored by Dr. Brian LeSage, an accredited Fellow of cosmetic dentistry in Beverly Hills.

My dental bonding keeps falling off

My dentist applied bonding to my teeth to cover fluorosis stains, but the color was uneven, and I could still see the stains through them. About four hours after I got home from the dentist, the bonding fell off four teeth. When I returned to my dentist to fix the bonding, I also told him that the color was weird, so he added another layer of bonding. This time the bonding fell off in less than a week. My dentist said that the problem exists because my bite is off, and I need to wear a mouth guard at night to cushion the bonding. That didn’t help. Now my dentist’s explanation is that bonding is a temporary fix, and it will only last about five years. I don’t understand why he didn’t explain all this before I agreed to get bonding. Besides that, I am starting not to trust my dentist. If I switch dentists, can I get a refund? – Geoff from Montana

Geoff,

It’s appropriate to switch dentists because you didn’t receive what you paid for—dental bonding to conceal fluorosis stains and enhance your smile. And the results of your dentist’s work are a basis for getting a refund.

Getting a Refund from Your Dentist

You can get a refund from your dentist if you can prove that your dentist did not meet the standard of care they promised. In your case, you paid for dental bonding to conceal fluorosis stains. Your bonding was faulty in several ways:

  • It didn’t match your natural tooth color
  • It didn’t conceal the fluorosis stains
  • It fell off

When you request a refund and state the above reasons for it, your dentist should readily give you your money back.

If our dentist refuses to issue a refund, you have options:

  • Present your case to a peer review committee
  • File a complaint with the state dental board
  • Inform your dental insurance company
  • Hire an attorney

What Are Fluorosis Stains?

Fluorosis stains are discolorations in teeth that can occur if you consumed too much fluoride as a child while your teeth were still developing. Fluorosis stains can be mild, moderate, or severe.

  • Mild fluorosis stains – Slight white spots on teeth might not require any treatment.
  • Moderate fluorosis stains – Stains can cover the entire front surface of teeth and make them look blotchy.
  • Severe fluorosis – Unsightly brown stains dominate the teeth.

Getting Treatment for Fluorosis Stains

A dentist needs advanced cosmetic dentistry training and artistic talent to conceal fluorosis stains. As a dentist applies dental bonding, they can see the results firsthand. Your dentist should have noticed that the color is off and the bonding was not working as intended. And a regular family or general dentist won’t have the needed bonding materials and shades in their office to give you beautiful results.

Mild to moderate fluorosis – When fluorosis stains affect the tooth enamel only, a cosmetic dentist might take theses steps to conceal it:

  • Grind out the discoloration
  • Apply a base layer of composite that has come opacity
  • Overlay the base with translucent composite
  • Polish the composite to a natural-looking gloss

Severe fluorosis – A cosmetic dentist will spend more time etching the teeth before concealing the stains. These steps follow:

  • Apply a liquid bonding agent and cure it with a light
  • Apply composite over the cured bonding agent and harden it
  • Polish the composite

Porcelain Veneers for Fluorosis Stains

Depending on your case, some cosmetic dentists might recommend porcelain veneers to conceal fluorosis stains. The condition of your teeth and the extent of the stains affect treatment recommendations.

We recommend that you schedule consultations with two accredited cosmetic dentists. Look for accreditation with the American Academy of Cosmetic Dentistry (AACD) or the American Academy of Dental Esthetics (AADE).

  • Ask about your treatment options
  • Ask to see the dentist’s before-and-after patient photos of cases like yours
  • Ask what results you can expect

 

Dr. Brian Lesage, an accredited fellow of cosmetic dentistry in Beverly Hills, sponsors this post.

Before-and-after composite bonding photos

Before-and-after composite bonding photos from Dr. Brian LeSage

Is my mouthwash damaging my porcelain veneers?

My sister told me that she read that mouthwash damages porcelain veneers. She texted me and said that I should get rid of my mouthwash because it loosens the bonding. I’ve been rinsing my mouth more often since the pandemic because I have a public-facing job. Although I wear a mask, I regularly rinse my mouth with mouthwash to kill the germs. Is my mouthwash damaging my veneers? Thank you. Krystin from Montana

 

Krystin,

The basics for maintaining good oral hygiene with porcelain veneers are flossing between your teeth, brushing them at least twice daily (but not over-brushing), and getting regular dental exams in cleanings. We recommend that you avoid abrasive toothpaste. Also, ensure you get your teeth cleaned by a hygienist trained to care for porcelain veneers and avoid using power polishing equipment and specific polishing agents that will scratch veneers.

Is mouthwash damaging your veneers?

Partial photo of alcohol-free mouthwash for porcelain veneers

Major mouthwash brands offer at least one alcohol-free option

Mouthwash will damage veneers if it is alcohol-based. Alcohol softens the bonding that makes your veneers adhere to your teeth. Alcohol-free mouthwash will not harm veneers.

Which mouthwash should you use?

Read labels—front and back—for all mouthwash products. Most mouthwash contains alcohol, but alcohol-free mouthwash is clearly labeled and safe to use if you have porcelain veneers. Most major brands offer at least one type of mouthwash that is alcohol free. Remember: read the labels carefully.

 

Brian LeSage, DDS, FAGD, FAACD, of the Beverly Hills Institute of Cosmetic Dentistry, sponsors this post.

No smile makeover with these porcelain veneers

I have four upper teeth that are misaligned and crowded. I went to a dentist for a smile makeover, and she recommended cosmetic dentistry as a faster solution than braces. The dentist said she would use bonding on my left lateral incisor, a porcelain veneer on my right lateral incisor, and shape my teeth for an even smile. She completed the word and said she shaped my lower teeth, which we never discussed. Her fee was almost $10,000.

One veneer is too small and has a gap near the gumline. And my teeth are still crowded and uneven. My dentist said that she overestimated what a veneer and bonding would do for my teeth, and now I need porcelain crowns and root canals for an additional $7000.

I quickly dismissed myself from her dental chair. I scheduled a second opinion with another dentist who says that he would recommend four veneers, but no root canals or crowns. His cost is $5200.

I would like to know how to get a refund from the dentist who did the veneer and bonding before giving away $5200 if this second dentist has a mistake in judgment. Thanks. Garland from Oregon

 

Garland,

We’re sorry to hear about your experience with a dentist who didn’t produce what she promised. You should be entitled to a refund. But you don’t sound confident about the second dentist either. How do you know that he will complete your smile makeover correctly? Dental schools don’t teach how to produce beautiful smile makeovers with porcelain veneers.

A Third Opinion or Cosmetic Dentistry

We strongly recommend that you get a third opinion. Look for a dentist with advanced training in cosmetic dentistry and porcelain veneers. Check for credentials with the American Academy of Cosmetic Dentistry or the American Academy of Esthetic Dentistry.

Getting a Refund from Your Dentist

Porcelain veneers before-and-after photos from Beverly Hills cosmetic dentist Dr. Brian LeSage.

Actual patient photos of porcelain veneers from Dr. Brian LeSage

Before you request a refund, it helps to have the backing of an expert cosmetic dentist who will document the problems with the first dentist’s work. Dentists are often sensitive to what their peers say about their work. Ask your new, experienced cosmetic dentist if they are willing to call your former dentist and explain why a refund is appropriate.

Additional options to help motive the dentist to issue a refund include:

  • Posting negative online reviews
  • Reporting the issue to the state dental board
  • Hiring an attorney

Best wishes.

Brian LeSage, DDS, FAGD, FAACD, of the Beverly Hills Institute of Cosmetic Dentistry, sponsors this post.

Will Peroxide Mouthwash Damage Porcelain Veneers?

I received porcelain veneers in January. My breath hasn’t been so fresh lately. I know that I should avoid mouthwash with alcohol as an ingredient. Two days ago, I made an alcohol-free mouthwash. I should have thought to ask before I made it. Is this solution okay for my veneers: 8 ounces of filtered and boiled water, 8 ounces of 3% hydrogen peroxide, and 2 tablespoons of sea salt? Not to worry. I won’t use it until I receive a reply from you. Thanks for your help. Jeannine

Jeannine,

It’s good that you know not to use an alcohol-based mouthwash when you have porcelain veneers. Although alcohol won’t loosen your them, it softens the bonding agent that secures the veneers to your teeth. And it causes ditching and staining around the edges of veneers.

Is Peroxide Mouthwash Safe for Veneers?

Your mouthwash recipe will cause other problems. Hydrogen peroxide is the active ingredient in your mouthwash. Although hydrogen peroxide bubbles, releases oxygen, and kills harmful bacteria in your mouth, it also kills many beneficial microbes. Without beneficial microbes, the harmful ones—including the yeast, candida albicans—will thrive.

It’s helpful to rinse your mouth with hydrogen peroxide for occasional or short-term use. But if you consistently use it—perhaps for two weeks—the candida albicans will grow, and you won’t have any healthy microbes in your mouth to stop it. You’ll get an oral yeast infection that causes the mucosal surfaces in your mouth to turn white and peel. Afterward, you’ll have raw, red, and painful patches in your mouth.

Alcohol-Free Mouthwash for Porcelain Veneers

If you want to use mouthwash, you can find several clearly-labeled alcohol-free brands. You can use them without damaging your porcelain veneers. Our advice is to brush your teeth and floss between them thoroughly. Diligent oral hygiene will minimize your need for mouthwash.

Before-and-after porcelain veneers photos from accredited fellow of cosmetic dentistry Brian LeSage, DDS

Protect your porcelain veneers from mouthwash that contains alcohol or hydrogen peroxide

Brian LeSage, DDS, an accredited fellow of esthetic dentistry in Beverly Hills, sponsors this post.

Will Peroxide Mouthwash Damage Porcelain Veneers?

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