Dentistry - fillings/crowns/veneers

[SnottySundays]

I have decided enough is enough. I am unhappy with my front two teeth and have been for years and need to get something done, life is too short.

Both my front top teeth have fillings in. One came through with a patch of enamel missing, so had a white filling type thing placed on that from an early age. It also has a filling on the back, and another filling on the front. The other front tooth has a filling on the back too and recently cracked so has another filling on the front corner which is a poor colour match and obvious to me at least. So they look like a bit of a patchwork and I hate them. I hate smiling and I feel very self conscious about them.

My teeth in general have a few fillings, due to a combination of overzealous dentists (not my current one but a dodgy one who didn't even do xrays and lots of other stuff including not stopping when I told him to as anaesthetic not working) and admittedly poor oral hygiene and lots of fruit juice in my youth, as well as v deep fissures. But I am scrupulous about oral hygiene now, having learnt my lesson and my diet is much better. At my last check up I had no gum disease and no tartar at all. If it makes any difference to what I should have done, I look after my teeth now and will continue to. I also grind my teeth occasionally when stressed so wear a bite guard on my lower teeth at night which has helped that a lot.

But I am unhappy with my teeth and want something done. My dentist is NHS and also fairly conservative I think (and also I trust him) so will be asking his advice but I see a lot of dentists on here advising against veneers and I wondered why that was? I suspect I will end up with them crowned at some point anyway due to the number of fillings, should I just go for that now? I tend towards the "don't get anything done unless you need to" end of the spectrum myself but I have been unhappy for years and I feel enough is enough.

For the dentists out there, would you mind, as an NHS dentist, someone making an appointment just to talk about this? Or would you prefer someone to wait till next checkup? (Which is December)

Thanks all.

[SnottySundays]

In case it is relevant, I floss daily, brush twice a day and use fluorigard mouthwash daily (not at the same time as brushing). I really do look after them now!

[pinkfrocks]

why have MNHQ deleted your thread with some answers and left the one with no posts?!

[SnottySundays]

Probably because I asked them to delete it before anyone replied to it.

[SnottySundays]

I saw and read your reply though and thank you for it.

[Willdoitinaminute]

If you trust your NHS dentist I'm sure he will happily discuss and carry out any cosmetic work you are willing to undergo. NHS dentistry is only part of our job we are allowed to provide cosmetic work. It's the same as NHS just not deemed clinically necessary. However there are ethical issues.
I used to do a lot of veneers but now find that the modern composites ( white filling materials) do the same if not better job without having to remove any healthy tooth. In fact I recently saw a patient for whom we replaced a broken veneer with composite and the composite looks much better than the porcelain veneers.

[brownfang]

Hi SS, I started a similar thread the other day about veneers etc. I am seeing dentist tomorrow & can't decide if I'm being vain or so go ahead and pay a small fortune (argh).

[SnottySundays]

Thanks both.

willdoit what are the ethical issues if you don't mind me asking? I trust my NHS dentist to be ethical and not try and get me to have more than I want done, or be keen to remove healthy tooth, and he has been reticent about veneers in the past. I am just not sure if he is the most cosmetically gifted- he has done the most recent filling which doesn't match the tooth at all.

brownfang will have a look for your thread. Good luck tomorrow. I have made an appointment to see mine next week.

[pinkfrocks]

I think by ethical issues the poster means that the NHS has to decide if something warrants cosmetic treatment under NHS guidelines - not whether a dentist is being honest with the patient.

If you dentist has not carried out a routine filling very well then you'd be mad to let him do cosmetic work on you. He may be also limited by the materials he uses if it's NHS- there is a wider range and a better product range for private treatment .

[Willdoitinaminute]

NHS dentists can do private treatment that is not 'allowed' under NHS. The NHS provides clinically necessary treatment. If a patient requests a treatment that is not clinically necessary then the dentist is allowed to carry out the treatment under a private course of treatment, however they may decline to do it on ethical grounds.

All dentists are trained to the same standards and all dentists have to complete continual professional development. Ability varies and is not dependent on how many letters behind their name, courses they have attended or experience. Some are naturally gifted in cosmetic dentistry but choose to work within the NHS, others who are quite frankly of average ability specialise as cosmetic dentists.
I think you would be wise to ask your dentist for his ethical opinion and he will probably refer you to someone he trusts if he doesn't feel he has the skill required.

I used to do a lot of veneers, they are technique sensitive ( which basically means they need a high degree of skill, planning, correct choice of materials and a technician with a high level of skill) and I found that it was really important to understand what the patients expectations were before treatment. If you can't meet their expectations you don't do the treatment.

When tooth whitening was introduced I advised patients to try it before looking at veneers. Most patients wanted veneers to improve colour and whitening achieved better results without damaging the teeth, therefore it is seen as a more ethical treatment.

The standard question you ask yourself in the case of ethics is ' would you let your daughter/son have the treatment done?' If the answer is no then why carry out the treatment on someone else's daughter/son!

[SnottySundays]

Thanks Willdoit, that makes sense, and that was what I was hoping for from my dentist - an ethical opinion about what might be best for me, and a referral/recommendation if necessary.

I'm not too bothered about the colour of my teeth - they are normal, slightly yellowish tooth colour, slightly stained in places. They look like a normal set of straight-ish non-Hollywood teeth. But I want the front two to not look like so much of a patchwork, of fillings that don't quite match the colour of my teeth. I honestly don't know how obvious it is to other people, my husband says only if he looks closely. But it is obvious to me, and makes me ashamed of my smile. So if it can be fixed, then I want to do it.

Willdoit can I come and see you? You sound like a good dentist!

[SnottySundays]

OK if anyone is interested, I feel reassured.

I had a chat with my dentist - he is going to redo the fillings to try and get them looking better as an ethical, least destructive option. Then if I am not happy he will refer me on to someone he knows and trusts to look at other options. Which is what I was wanting really. I feel like I'm in the system, that it will be sorted out, and it may be a long road, but will be worth it in the end.

I am glad I went to see my dentist first - I feel confident that he is being careful, and ethical and doing the right thing for me.