Healthy Mouth and a Healthier You

Cosmetic Dentistry and Teeth Whitening: Ask the Dentist

Dentist Steven E. Roth, DMD, answers your additional questions about cosmetic dentistry and teeth whitening.

Question:

What are the symptoms that tell you when or if you need dentures?

Answer:

There are no specific symptoms, and dentures are a treatment choice. Before a person loses all of their teeth, they have probably had gum and/or decay problems. There are many levels of treatment for these conditions. If all of your teeth have to be removed, there are other options. Dental implants, for instance, are root-shaped titanium fake teeth that can be placed in the jawbone so dentures do not have to be worn. See your local dentist a soon as possible for a diagnosis and treatment plan.

Question:

I am 31 and too young to be losing my teeth. After years of depression, it seems as though my oral health went with my spirits. Now I am trying to regain. I have decaying teeth at the top that need to be replaced. Are there any inexpensive treatments you can suggest?

Answer:

I agree that you are too young to be losing your teeth. Depression can de-motivate patients from seeing the dentist and from normal hygiene habits. Try to see your local dentist a soon as possible for a cleaning, X-rays, and diagnosis visit. It is highly possible that prompt treatment can save your teeth.

Question:

I recently got dentures (upper and lower), which I hate. I know I will eventually adapt, but if I could hit the lottery, it would be all implants for me. Anyway, my bottom dentures seem to collect all the food on both sides of my mouth when I eat. It's like a garbage dump. If I had two implants put in, would the dentist shave down the sides of my dentures? It feels like I have too many teeth. In addition, is it possible to have dentures on the bottom without back teeth on the plate? Glue does not hold my dentures in on the bottom, either. Any suggestions would be appreciated.

Answer:

Dentures can be very difficult to get used to. They need to be removed and rinsed as much as possible. Implants can solve a whole lot of problems. I strongly suggest that you seek implant treatment.

Question:

I had my teeth whitened at the dental office for over $600. Shortly after that, I had a dental implant preparation, and I was prescribed chlorhexidine gluconate 0.12% oral rinse for two weeks. And it turned my teeth brown. The dental staff assured me that the stain could be polished off. After a cleaning, the front teeth were OK, but my back teeth are still very brown, both on the surface and in between. I repeatedly brought this to the dentist’s attention before the cleaning. But the problem is still there. I am planning to get more implants in the future. Is there a different oral rinse I can use that will still be effective in preventing infection after implant surgery?

Answer:

Without knowing all of the facts, it is difficult to comment. The chlorhexidine rinses are the best after implant surgery procedures and the stain can be polished off. Perhaps another cleaning will do the trick!

Question:

What over-the-counter or home remedies can be used to maintain white teeth?

Answer:

Every pharmacy in America has white strips and whitening toothpastes that can give you a whitening result. However, the best results are always attained when a professional is guiding the treatment. There may be reasons that you aren’t a good candidate for whitening and only a dentist can tell you.

Question:

Eight months ago, I saw a dentist who told me that I needed a bridge for the upper left side of my mouth. Since getting the bridge, I have noticed the bottom center of it is discolored and blackened. I tried to remove the discoloration with a brush. But that didn’t work. How did this happen? What can be the solution? Please help me.

Answer:

I would go right back to the dentist who performed the treatment, with your questions. An educated patient is a happy one!

Question:

I have tooth decay and many fillings from years ago, after having braces and not visiting the dentist along with my orthodontist. Can tooth whitening help or will it make my teeth look worse?

Answer:

Tooth decay forms from the acid created by the plaque that is left on your teeth! Whitening will not help that. Oral hygiene, cleaning, and restoration of the decay is the best course for you. After that, you can then whiten your teeth.

Question:

What are the benefits of dental implants over regular dentures and bridgework? Can large segments or entire arches be replaced? Also, what are mini-implants? How invasive are the procedures? How expensive are these procedures?

Answer:

Dental Implants are titanium artificial tooth roots. Single implants are great because they enable us to treat a missing tooth with a “one tooth solution”. Multiple implants allow us to treat an entire arch or a partial arch with either fixed or removable prosthetics. Implants do involve surgery and the expense is determined by how much work is involved.

Question:

For the past 10 years, I've had a black spot on one of my upper front teeth. It's grown a lot bigger since I first noticed it, but it is not painful. I've had multiple dentists look at it. One dentist told me he didn't know what it was and not to worry about it until it started to hurt. Another one said it was decaying and I needed to get it taken care of, before I had to have a root canal or had to have it pulled. It's bigger than the tooth, but it doesn't hurt at all. Is this something that needs to be taken care of immediately? Will it require a root canal or can I just get it taken out or filled? It's in the front so I don't want to leave a gap there. Also, the tooth beside it is chipped on the bottom. Can that be "shaved” or “chiseled down" so it's not jagged? Thanks for your help.

Answer:

Please go to a dentist that you trust and feel comfortable with. Get a diagnosis, and get the recommended treatment. Your problem could be decay, staining, tooth or root resorption. All of these problems can be treated.

Question:

I am on Coumadin, and I find it hard to locate a dentist that will work with me. I have two teeth, one on top and one on the bottom. I do not want dentures. What do you suggest I do so that I do not look like Bucky the Beaver?

Answer:

Coumadin affects the clotting of your blood. With only two teeth remaining, you have two options - dentures or implants. Please find a dentist that can work with your medical physician to provide the proper treatment for you.

Question:

I had permanent golds put in today. I need to take them out because I can't really chew or eat. How will the dentist take them out? What is the procedure?

Answer:

By “permanent golds,” I assume you are talking about gold crowns or caps. I would return to the dentist for an evaluation of why they are hurting. It is possible that a simple bite adjustment is all that is needed.

Question:

What do you do after a bleaching treatment? Do I need to brush my teeth?

Answer:

There are a whole set of postoperative instructions for bleaching treatment. These include avoiding red colored drinks and foods for 2 days and avoiding coffee and tobacco. Brushing and flossing are essential to keep up your oral health and your whitening result. In my office, we give patients a post-op instruction sheet to follow. Ask your dentist for one.

Question:

I had a cap that was glued to a post, which was inserted in my gum. The post came out of the gum. Can I use temporary cement to put it back in?

Answer:

Whenever patients think about treating themselves, I caution them to take a step back. You might do something that will destroy the root under the gum. Or you might do something that causes a potentially serious infection. Please call your local dentist for help. DO NOT TRY TO TREAT YOURSELF. It is dangerous!

Question:

I have gold crowns in the back of my mouth on both sides. It looks ugly when I laugh. How can I change that and what will it cost?

Answer:

Gold crowns were the best fitting crowns we could make in dentistry for many, many years. Today, there are many tooth-colored options that are aesthetically superior, and that fit as well as gold. You will have to ask your dentist for the fees. I recommend you see your dentist for a consultation. In my office, we do a consultation with an up-front fee quote.

Question:

Is 54 years old too late for braces?

Answer:

It is never too late for braces, as long as the teeth, gums, and underlying bone are healthy. Straighter teeth can give you a more comfortable bite, more cleanable teeth, less chance of decay, and a better-looking smile.

Question:

I have extra "gum" right above my two front teeth. In the past, I have always been told that to remove this is strictly cosmetic. But my current dentist's office is telling me that it can actually cause gum recession. Is this true?

Answer:

I do not know what the extra gum is, but it sounds like you might have a muscle attachment that is connecting too low on your gums. This can cause recession. If you have this removed it will make the area much healthier.

Question:

Will an extraction get rid of bad breath?

Answer:

Most bad breath is caused by an infected tooth, inflamed gums, or a stomach problem. So the answer is maybe. If the tooth is being extracted for an infection, the bad breath may go away. If not, you may need to look further.

Question:

Can you have a bad tooth pulled and then wait a year after to replace bone and have a dental implant inserted?

Answer:

Theoretically, yes. But I believe it may be better to do the bone graft at the time of extraction. Ask your dentist if there are any payment arrangement options that you can use to help you pay for the treatment you need.

Question:

How safe is the whitening process? Is it effective long-term?

Answer:

The most important step in the whitening process is to make sure you are a good candidate for the whitening. There are many effective and safe products out there and your dentist can best tell you what will work for you. Remember, DO NOT start whitening without getting a complete dental exam, X-rays, and a hygiene appointment.

Question:

The veneers on my two front teeth keep coming off. Why? What can I do? I'm afraid of losing them.

Answer:

Without seeing you, it is hard to say. But there are several possibilities. The veneers may be made out of porcelain or composite resin. They can either de-bond, where the chemical adhesion breaks down, or they can break off. This can be caused by a traumatic event, grinding, or clenching. My best advice is to discuss it with the dentist who placed them. You can also call your local dental society to ask for help with a referral.

Question:

I was fitted for crowns for my six top front teeth on Dec. 23, 2009. To date, I still do not have my permanent crowns. Do I have the right to ask for a refund?

Answer:

That would depend on the reason why you do not have the crowns. I would discuss this with your dentist. If the answer were not satisfactory, I would call your local dental society for help.

Question:

When would a dental implant be medically necessary?

Answer:

Dental implants are titanium root fixtures that are surgically positioned in the jawbone to replace teeth. When a person loses his/her teeth, their digestion is affected due to the lack of food breakdown. As Charles Mayo said, people that keep all of their teeth live an average of 10 years longer. So, in answer to your question, having teeth is a medical necessity.

Question:

Can iron supplements (pills) cause damage to teeth and discolor dentures?

Answer:

Iron supplements can stain the teeth black. They can do the same for dentures.

Question:

I have a friend that has tooth problems. She does not have bad breath, but her teeth are chipped and they look rotten. She says it’s because she is anemic and had low iron levels during her pregnancy. Is this true and is there a cure? She is a beautiful woman and I hate seeing her go through this embarrassment. Thank you.

Answer:

It sounds like you are describing a case of genetic abnormality of the teeth, like enamel hypoplasia, or someone with a lot of tooth decay due to poor oral hygiene habits or lack of dental care. The good news is that there are many options to reconstruct your friend’s teeth, such as veneers, crowns, or implants. They can look great, feel great, and last a long time! Good luck.

Question:

Can you whiten your teeth while pregnant?

Answer:

NO! There has not been sufficient testing done on the effects of using a whitening gel while pregnant. Until such studies have been done on a larger scale, it is best to err on the side of caution. Manufacturers of teeth whitening products and teeth bleaching products generally recommend against using them during pregnancy for liability reasons. However, common sense dictates that unnecessarily ingesting anything should be especially avoided during pregnancy.

Question:

Do your permanent teeth grow as you get older?

Answer:

No, they do not grow. However, they can shift, move, or migrate due bone disease of to a loss of teeth or gums. If you feel that your teeth are growing, you should get to the dentist promptly for an examination and diagnosis.

Question:

I have a porcelain veneer, bridgework, and one crown. Can they be damaged by whitening toothpaste or over-the-counter whitening strips? I’m concerned about my front teeth.

Answer:

I do not think that they can be damaged, but if you are whitening the adjacent teeth be aware that you might change the color match. Also, if you are whitening the adjacent teeth, there is no reason to place the gel over the porcelain veneers.

Question:

How do you find a reputable dentist who specializes in porcelain veneers?

Answer:

There is no “porcelain veneer specialty.” However, there are dentists who emphasize cosmetic dentistry in their practices. In this instance, I would ask the dentist several questions. “How many cases have you treated? Are you affiliated with any cosmetic dentistry institutes?” And most importantly ask to see before-and-after photos of their work.

Question:

I haven’t seen the dentist in 12 years due to a traumatic experience. Now I have three teeth decayed down to the gums and several cavities that are a big problem. I know I need to go to the dentist, but what should I be looking forward to as far as procedures goes?

Answer:

I am sorry that you had a traumatic experience. The possibilities range from extraction, bone graft, and implants to root canals, fillings, or crowns. Perhaps you would be a good candidate for sleep dentistry or IV sedation. Contact your local dental society for help in obtaining a referral.

Question:

My teeth are worn down, and my bite has collapsed. I am missing #2 and #15. I do have #18 and #31. What can I do to open my bite back up? I have the resources to invest in cosmetic dentistry, but do not know where to begin. Thank you.

Answer:

The first step is an accurate examination, diagnosis, and treatment plan. Then there are probably several options for treatment. These options can be done all at once, or segmented over time. Once you find a dentist that you are comfortable with, it is essential that you fully understand the treatment and the ramifications of no treatment. Then you can make an educated decision on how to treat the problem.


Thank you for joining us for WebMD Ask the Dentist. Be sure to check in on July15, at 1 p.m. ET, when we’ll cover diabetes and dental care. Are people with diabetes at a higher risk for dental health problems? Sign up if you’d like an email reminder the day before our premiere event.