Dr. Mike Malone’s Blog

I am in my early 20’s and just recently graduated from college. For almost as long as I can remember, my front teeth have been discolored. I have ALWAYS taken really good care of my teeth (no cavities!), but my mother told me the discoloration was caused by an illness I had as a small child. Now I am trying to get my professional career off the ground, and I feel like my teeth are making an awful first impression.

With the support of my dentist, I have tried almost every over-the-counter teeth whitening product available. If anything, my teeth look WORSE now. The spots did not change in color one bit, but the contrast with the surrounding tooth material (which whitened considerably) is even more noticeable and ugly. Now my dentist is suggesting a “trial” treatment, where he will grind away at the spots until they are gone. The problem is he doesn’t know how much he will have to grind, and I just cannot imagine how this will ever look good!

What about professional whitening? I just really need to get this issue addressed. My teeth are holding me back, and my self-confidence is really taking a beating. I don’t want potential employers to think that I am the type of person who doesn’t even properly care for their teeth!

Thanks so much for your help,

Leta in Albany

Dear Leta,

First and foremost, find a different dentist. Your current dentist obviously does not understand the principles of teeth whitening or he would not have had you wasting your time and money on repeated attempts of the same treatment. Professionally whitening is unlikely to yield the results you want, either. And the idea of grinding away the spots could go horribly wrong.

You need to seek the services of a talented, experienced, educated cosmetic dentist. Make sure you thoroughly check their credentials, and ask to see pictures of their work.

Depending on the severity of the spots, there is a very small chance that a technique called microabrasion might work. This is often used with white spots, but is only effective with brown spots when they are very superficial.

If the spots are small, dental bonding may work to cover them. This is one of the most difficult and artistically demanding skill sets in cosmetic dentistry, so make very sure the dentist you chose is not just competent, but exceptional. If bonding will not work, porcelain veneers may be a solution. Both of these treatments require a high degree of artistry and skill.

I hope you can find the right dentist to help you.

I had braces for two years, and have just recently had them removed. Ever since they were taken off, I have noticed that my teeth are incredibly sensitive to temperature. If I try to eat or drink anything hot or cold, it is really painful. I can also feel rough patches and dips on the front of my teeth, almost as if the enamel is gone. Could my orthodontist have damaged my teeth when she removed the brackets? I am also noticing that my teeth seem to be getting darker every day. I don’t drink coffee or cola very often, but my teeth seem to soak up every stain like never before.

What should I do? I did not go through two years of ortho to have ugly teeth!

Thanks for your time,

Savannah from Council Bluffs

Dear Savannah,

I don’t think your orthodontist caused this damage, though it is not unheard of that damage can happen during bracket removal. The patches you describe sound like areas of decalcification. These are areas where your teeth have lost some minerals, and those areas are porous, which is causing the staining you are seeing. Those spots may eventually turn brown, and even chip away, leaving pitted holes in your teeth. I am sure this is NOT what you envisioned as you went through orthodontic treatment, and that missing enamel is what is making your teeth so sensitive.

Teenagers are not always as diligent as they should be about brushing their teeth after eating, and when a teen has braces, the problem is magnified. The brackets allow food to sit against your tooth, and underneath the brackets, the acid in your saliva that helps digest food is busy working away at the surface of the tooth. The extent of the problem becomes really evident when the braces come off.

It is important to address the issue before it gets any worse. Bleaching will not help the stains. It will probably make them look worse, so I would not recommend going that route. If the damage is just to a few small spots, a treatment choice might be dental bonding. Freehand dental bonding is one of the most challenging cosmetic dentistry techniques from an artistic standpoint, and if it is not done well, you will not be happy. Make sure you chose a cosmetic dentist who is trained and experienced. Direct dental bonding requires a very high degree of artistry and technical skill that very few dentists possess.

If the damage is extensive and/or severe, you may be looking at porcelain veneers. That is a daunting prospect after two years of orthodontic work, but it is better to be prepared.

If you have friends that still have braces, you can be their cautionary tale. People with braces simply MUST brush after every single time they eat. At the very least, they must rinse thoroughly with water if brushing is impossible. It is very frustrating to go through all those years of ortho work, only to continue struggling with dental issues when you are done.

Last evening at t-ball practice my youngest daughter was hit in the mouth with a bat. One of her front teeth on the top broke right off, and the other one has a crack all the way across it. We took her to our family dentist first thing this morning, and he said he won’t have time to fix it for three weeks. Three weeks! That just seems crazy to me. Everything I’ve ever heard or read about damage to teeth says that you should “get to a dentist right away”. Well, what is the point of that if they aren’t going to fix it?

One of the reasons our dentist gave for the delay is that the root of the broken tooth needs time to “desensitize”. Is that customary? If it is, then I guess we will wait, but my instinct is to take her to a different dentist, one who will treat this with some urgency.

I hope you can answer this quickly. I don’t want to wait, but I’d like some expert advice about what to do.

Nora in Bar Harbor, Maine

Dear Nora,

Your instincts are correct – there is no reason to wait to address this.

If you have the piece of the tooth that broke off (and see this response promptly!), an expert cosmetic dentist might be able to reattach that portion of the tooth. If you don’t have the piece or it is too badly damaged, a likely procedure to repair both teeth is direct dental bonding.

For this reason, I strongly suggest you chose an expert cosmetic dentist for this procedure. Direct dental bonding requires more than excellent technical skills and training. It requires artistry. The bonding material must be color matched and placed with an eye to the gradients of color that comprise her natural teeth. Only truly gifted cosmetic dentists can do really beautiful direct bonding work.

You don’t say how old your daughter is, but because of your reference to t-ball I am guessing that she is under 10. Direct bonding is a great solution for younger patients. When she is older, she will probably need a single dental crown for the tooth that was broken, but your dentist will have to make that decision when the time comes. If the other tooth is severely damaged, both front teeth may need crowns.

I need to know if dental bonding can be removed without doing any damage to my teeth. I asked my dentist to fix the gap in my front teeth (they were chipped, too, so there was a V-shaped gap). I have not had a lot of experience with this kind of dental repair, but I don’t think he did a good job at all! I’ve seen pictures on the web that look so much better than what my teeth look like right now. There is still a gap, and you can tell where the bonding material begins and my teeth end. In the pictures I’ve seen, the bonded teeth look completely natural. What should I do?

Marcus from San Antonio

Dear Marcus,

I am sorry to hear that you’ve had such a bad experience. You are right in expecting better results. Very few dentists really have the artistic skills to do beautiful bonding work. It is one of the most difficult cosmetic dentistry procedures to master, and requires a high level of training and aesthetic sense.

The good news is that dental bonding is reversible, and can be taken off with a special sandpaper that all dentists have. There should be no damage whatsoever to your teeth.

I hope you won’t let this experience discourage you from seeking a new dentist to complete the procedure to your satisfaction. Look for a cosmetic dentist that is accredited by the American Academy of Cosmetic Dentistry (AACD). ANY dentist can say they do cosmetic dentistry, but it requires many, many hours of specialized training and education to achieve accreditation. I encourage you to seek out someone who can show you pictures of dental bonding work, to reassure you that they have the skill set to do the kind of beautiful work you see in pictures on the web. Good luck!

I have porcelain veneers on the front six teeth. A small piece of my front tooth recently cracked and the dentist was able to put some bonding to match. However, after two months, the color is already that dark pasty color and it doesn’t match anymore. Is this normal? I’d rather not replace a whole veneer for a small repair. Should I bond a lighter color so when the color “comes down” a little, it matches the veneer?
- Jim in Michigan

Jim,
There are many different types of composite bonding material for your teeth. Most dentists stock a basic, “all-purpose” composite that really isn’t well suited to doing cosmetic dental bonding on front teeth. While I don’t know for sure without seeing your tooth, it sounds like this is what has happened. These all-purpose materials can tend to stain easily. Other composite bonding materials aren’t very color-stable.

There are bonding materials for your front teeth that take a high polish, are very color-stable, and don’t stain very easily, and that is what you need. I would suggest finding a dentist who is more expert in cosmetic dentistry. A dentist who is accredited by the American Academy of Cosmetic Dentistry should find your porcelain veneer repair to be fairly routine.

These cosmetic dentistry procedures often require more expertise or more specialized materials than most dentists possess. So go to the expert for this, and then go back to your family dentist for your routine maintenance, if you’re pleased with your dentist.

Hello, I had my 8 front upper teeth fully bonded about 14 years ago to close in gaps between them. I have taken extremely good care of them and they have held up well, although they have stained now from food and drink. I have been told my only option for white teeth is to remove the bonding altogether,then bleach and rebond or go the more expensive route, porcelain veneers. My question for you is this… if the tooth is actually what has become stained and it is showing through the bonding, why wouldn’t bleaching work? If the coffee, tea, etc. got through, wouldn’t they bleach also?? Thank you.
- Patti from Minnesota

Dear Patti,
I think you’re being given good information.

I’m not clear whether you want your teeth generally whiter or you want the stains removed. If you just want the stains removed, the bonding could maybe be re-surfaced. The cosmetic dentist would just remove enough of the surface of the bonding to get rid of the stain, and then bond new material over that. But if you want your teeth whiter than they are, too, then you need to remove the bonding, have the teeth bleached, wait a couple of weeks for the new color to stabilize, and then re-bond.

We do a lot of direct dental bonding, and the bonding material can produce beautiful results. But the bonding resin is a little bit porous, and over the years it will absorb stain. This stain doesn’t respond to any of today’s bleaching techniques, even the state-of-the-art Zoom whitening that we offer.

If you were my patient, I would encourage you to upgrade to the porcelain veneers. Porcelain has the added advantage of being extremely stain resistant year after year. You could have the whitest shade of teeth you want, and as long as you have to have the bonding removed anyway, why not go for the porcelain?

Other links:
Read more about dental bonding.

I have had braces in the past and now have stains on my teeth. Can they be whitened either professionally or by in-store products, or will this harm my teeth? Some people have said that the teeth are now softer because of the braces. I realize that I probably caused this by not following through with a better cleaning process while I had the braces, but, now would like to correct the problem. Do the whitening products on the market cause problems with people who have had braces?
- Kathy from Oregon

Kathy,
I am guessing that your stains are uneven. Usually the stains that your teeth get after braces are spots where decay started around the brackets. They start out turning white and then become brown. And they’re in spots.

Bleaching is not the correct treatment for spots. It will make them look worse. Because, while it will whiten the spots a little, it whitens the unspotted parts of the teeth more. So the spots become more prominent. Bleaching is for dark teeth that are evenly dark.

What you need for your spots is tooth bonding. You need a cosmetic dentist who will remove the dark spots and then cover them over with composite bonding material. That will “erase” them and bring back your beautiful smile.

If you want to bleach, a Zoom whitening treatment before doing the bonding will make the white parts of your teeth whiter, and then the bonding material can be a lighter color. But you will need to do the tooth bonding - you can’t get around that.

One of the advantages of Invisalign invisible braces is that you don’t ever get this spotting of the teeth. The spotting comes when you don’t get your teeth clean after eating, and food debris collects around the brackets, and then the enamel starts to break down because the decay process starts around the brackets. With Invisalign, you can remove the aligners to eat and to clean your teeth. There are no brackets to collect food.

Dr. Malone,
I have a gap in my two front teeth in the top of my mouth. I want to close it but I don’t want braces. Are there any other methods I can use?
- Ashley from Alabama

Ashley,
There are several ways to close a gap between your two upper front teeth, and which way is best may depend on other conditions in your mouth.

If that is the only thing wrong, the easiest and nicest way to close it would be with tooth bonding. With tooth bonding, we add dental composite to the two front teeth and make them each a little wider, so that there is no more gap. I match the color and translucency of your teeth exactly, and shape and polish the composite so that you can’t tell anything was done to the teeth. You should be able to find an excellent cosmetic dentist in Alabama to do this for you. Don’t go to your family dentist for this - doing this right requires considerable artistic ability and special bonding materials and tints that many general dentists don’t stock. Look for a dentist who is accredited by the American Academy of Cosmetic Dentistry.

Another option is to do porcelain veneers. This is more aggressive, because the veneer will cover the entire fronts of the two front teeth, and may even involve other front teeth. But if there are other defects in the teeth, this may be the best.

Another option is to use Invisalign invisible braces. You said you didn’t want braces, but these aren’t conventional braces. There are no metal brackets, and the teeth are moved about twice as fast as they are with conventional braces.

The tooth bonding is by far the least expensive way to go, and the nicest way, too, if the gap is your only problem.

Other links:
Lafayette Louisiana cosmetic dentist