I have a single dental crown and four porcelain veneers. They’re all quite old and need to be replaced. I spoke to my dentist about it specifically hoping to change the crown especially. He’s concerned that it won’t match the rest of my teeth that have turned quite yellow/beige-ish over the years. Because of that he wants to crown every tooth. I have a friend who had every tooth crowned from the same dentist and she’s been dealing with dry mouth ever since. Is there another option or is my dentist giving me the best plan?

Macy

Dear Macy,

I am very glad you wrote before moving forward with this option. This is massive and invasive overtreatment that could cost you over $30K and destroy your bite. If I understand what you are saying, he’s suggesting the additional crowns because your teeth aren’t white. Do you know what would solve that? Teeth whitening. With bleaching, you wouldn’t have to grind down any healthy tooth structure. Of course, your dentist wouldn’t make nearly as much money either.

And why crown the teeth that have porcelain veneers on them? In most cases, dentists who suggest crowns instead of replacing porcelain veneers generally do not feel comfortable placing veneers. Crowns, however, they do all the time. That’s their wheelhouse. However, that doesn’t mean they can do them artistically. They can do them functionally—if you’re talking about a single crown.

Unfortunately, your dentist is suggesting a full-mouth reconstruction. That is totally different. Crowning every tooth is an extremely advanced procedure, which requires significant post-doctoral training in reconstructive dentistry. If he hasn’t studied porcelain veneers, then he very likely hasn’t studied full-mouth reconstructions. If he opens your bite up too much, you will definitely struggle with both dry mouth and pain. In fact, you’ll probably end up with TMJ Disorder.

The Better Solution for Your Situation

What I’d like you to do, instead of what your dentist is suggesting, is first to have your teeth whitened. Even your dentist can do that. It doesn’t require any specific advanced training. Whitening your teeth will not affect your dental work in any way. It only affects the natural tooth structure.

After that, I think you need to get the next part done with a different dentist. It is very common for patients to see one dentist for their general dental work, then for their more advanced cosmetic procedures to go to an advanced cosmetic dentist. When you do this, you can just replace the crown with a crown and the veneers with veneers. There will be no need to damage any healthy tooth structure.

Finding an Advanced Cosmetic Dentist

Because there isn’t a recognized specialty in cosmetic dentistry, it makes it difficult for patients to know who is skilled and who isn’t. After all, any general dentist can practice cosmetic procedures regardless of the amount of training they’ve received (or haven’t received).

One thing you can do is look at the smile galleries of the different dentists you are considering. I would ask if the images you see are actual cases they’ve done or just stock photos. If they are stock photos, move on. If they are examples of their own work, this would be the work they are most proud of. If you are not super impressed, I would also move on. Find a dentist whose results make you wish you had that smile. They are the ones who can replace your work in a way you’ll be thrilled to have for your lifetime.

This blog is brought to you by San Antonio Cosmetic Dentist Dr. Imam.