1. Is there a difference in quality among various types of veneers and crowns?

Absolutely-on many levels. The quality of materials used and skill of the operator is as important as how well it looks and fits. We are lucky to live in a time in which the materials we use are far better than what was available even 30 yrs ago. While testing the Space Shuttle, NASA had terrible problems with the ceramic tiles breaking and falling off. The research on these issues brought about new ceramic materials and adhesives that have changed Dentistry forever. We can now bond ceramics to the tooth so that they actually become one, and continued research has created materials that are stronger and look even more life-like.

Because there are variations in strength and esthetics between materials, it is important to discuss your concerns and priorities with the Dentist at the beginning. Like anything else, the end result depends on what we start with, combined with skillful technique. So, what are your primary concerns? Esthetics, function, long life; all of the above? Let your Dentist know- that will make it easier to choose the materials and techniques that will be used to customize your case.

The technology available today allows us to create almost anything that patients want. Whether you want a perfect ‘Hollywood’ smile, or one broken tooth repaired to match the stained one next to it, the options are incredible. While we strive to create restorations that look completely natural, it means nothing if it doesn’t match your expectations.


2. What is bonding and how is it different from a veneer?

The quick answer is that there isn’t a quick answer (better get some coffee!)- as these terms have been used interchangeably by both the public and professionals. Both procedures address similar problems, and this leads to some of the confusion we see. Even more confusion arises because of the term ‘bonding’ itself, so let’s start there.

In general terms, bonding refers to a chemo-mechanical process of adhesively attaching one substance to another. Just a fancy way of saying ‘gluing’. So, placing a tooth colored filling, using epoxy to fix a broken cup, or patching a hole in a fiberglass canoe are all basically the same at this level. They involve one material being attached to another. Because of this, you’ll sometimes hear that the Dentist has ‘bonded‘ a filling or crown.

When talking about fixing a tooth, bonding can refer to anything from patching a small chip to replacing a filling or doing a ‘Chairside Veneer’, which covers the entire surface of the tooth. ‘Veneers’ refer to porcelain veneers that are made in a laboratory and adhesively ‘bonded’ to the tooth at a separate appointment.

Essentially, regardless of what it is made from, a veneer is a layer of material bonded onto the front of a tooth to improve appearance, much like the acrylics you get at the nail salon. Usually, every effort is made to keep the tongue side of the tooth intact to maintain strength. Both are used to repair stains, chips, fractures, rotations, etc. in teeth in which, while they have esthetic issues, aren’t severe enough to grind the tooth down for a crown. OK, so what’s the difference between bonding and veneers? (Finally!)

Bonding is usually done in the office, and often in one appointment; it’s largely reversible, more conservative with tooth structure, easier to match to adjacent teeth, and less costly. On the down side, it’s more subject to wear or breakage, can lose its polish(which can be rejuvenated), and may wear off in 8-10 yrs. At that time you can replace them with more bonding or porcelain veneers.

Veneers have the advantage of often looking more life-like, they’re stronger, and keep their shine better, plus they have less potential for staining and don’t wear off. And because they require two appointments, you will wear temporary veneers in the interim, which gives you and the Dentist time to evaluate them for shape, size and position. Anything you want changed can be done BEFORE the real ones are made.But, they’re somewhat more expensive, less conservative (need to remove more tooth), and therefore not reversible. Plus they require more than one appointment and you often need to wear temporaries between appointments (which is also a good thing- see above).

Various types of ‘no prep’ veneers have recently become popular. These are porcelain veneers that require very little removal of tooth structure, and so are quite conservative. However, they are indicated ONLY in very specific types of cases; mainly ones with an excess of space or slight rotations to correct. Still, if you have the right type of case, they CAN be the best of both worlds. Quiz tomorrow…


3. What can be done for excessive gum tissue?

This is what people refer to as a ‘gummy smile’. You see it when people smile and you see too much gum tissue between the teeth and upper lip. This is normal in children when their permanent teeth first erupt, after which the gums begin to recede and show more of the tooth. Sometimes this does not occur, and is one of the main causes of a gummy smile, the other cause being a problem with the length or attachment of the lip.

When caused by insufficient eruption, it is often found that the teeth themselves are of proper length, but just don’t show enough. This might easily be corrected by recontouring the gums, sometimes in one visit. In other cases the teeth have not erupted from the jawbone far enough and this will require either surgery to expose more of the tooth (you’re back to normal in about a week) or Braces at the Orthodontist to help the teeth to erupt into proper position.

If the lip is the problem- whether it is too short, or the muscles are too active, we can fix that too. Correction requires a simple one visit surgical procedure to either release the lip muscles, or free up the lip to move more easily.


4. Is cosmetic dental work expensive?

Cosmetic treatments can range from the very conservative, such as recontouring a crooked or chipped tooth, to full mouth rehabilitation. Consequently, the associated costs will vary greatly as well.

Occasionally you will see someone with a front tooth that is slightly crooked, or has a corner broken off; these can many times be treated with simple recontouring of the tooth- that is, reshaping the enamel (the outer layer of the tooth). Whitening teeth is another cost effective way to get a ‘smile lift’ without breaking the bank. The other end of the scale is a full set of 20+ veneers, which can cost as much as a new car.

Fortunately, there are a number of third party financing companies that make this type of treatment very affordable. One major company is CareCredit, which is accepted at Dentists, Plastic Surgeons and Vets. Many large banks also have entered this market, so look around for the best deals. Most offer up to 18 months at no interest, which makes it much easier to afford.


5. What about my dental insurance? Will it cover this?

First, understand that dental coverage is determined by the policy that your employer purchases. Whether your policy covers only emergencies and cleanings, or everything from cleanings to crowns and orthodontics depends on the contract that your employer sets up with the insurer. That said, many employers buy a policy because they are told it covers procedures at ‘100%’, but later find that it is 100% of a fee set by the insurance company (the UCR). In reality, these fees often have little to do with true costs, and generally range from 20-80% of the actual charge. Additionally, when dental insurance began in the 1960’s, the average yearly benefit was $1000, and crowns cost $100. Now, in spite of increasing insurance premiums, the average yearly benefit is still $1000, but crowns cost about $1300; so you can see that what you get for your insurance dollar has decreased greatly.

Much like medical insurance, dental insurance will usually not cover cosmetic procedures- IF they are being done for purely cosmetic reasons. But there are some plans that do, and also that’s a big ‘if’. Teeth that are out of position, stained or cracked (but not broken) will fall into this category- the types of problems that are purely appearance related.

However, this does NOT mean that any treatment on a front tooth will be declared as cosmetic and denied by insurance. I have talked with many patients who thought that cavities in front teeth would not be covered, assuming that it would be cosmetic, and therefore denied. This is not true, as long as your policy covers fillings.

To be sure, discuss this with the insurance expert at your Dentist (usually NOT the Dr.!!), they can then check with your carrier to see what, if any, coverage might be available.


6. What causes the discoloration of a tooth?

The most common causes are staining and trauma.

In many cases external stains can be removed by brushing or whitening either professionally or at home. We generally tell people that anything that will stain a white t-shirt has the ability to do the same thing to your teeth, so a little caution will go a long way. If you brush and rinse after eating or drinking things that could cause stain, it will form much more slowly, if at all.

Trauma can cause the pulp inside of the tooth to bleed, which can cause the tooth to darken. This type of discoloration is much harder to remove, as it occurs from within, but isn’t hopeless. It just takes different techniques, and will often take longer. Over-the-counter whiteners won’t help here; you will need to have it treated professionally by either your General Dentist or at the Endodontist.

Less common are certain drugs which may cause staining- most commonly the ‘cycline’ antibiotics- tetracycline, doxycycline, minocycline, etc. These can cause the dark blue/gray color you sometimes see affecting all the teeth. Take home whitening will help remove this, but it can take a LONG time… I have seen cases where the whitening trays were worn for 6 months before any change occurred. Once it starts though, it goes more quickly. These cases are rare though. The important thing here is to be aware of what medications your children are taking, and if you have any questions… ASK! The word is out on these antibiotics, so it’s rare for a Physician or Dentist to prescribe them to anyone who might be affected unless there is a definite need.