All I Want Is My Two Front Teeth
February 15, 2009 5:36 PM   Subscribe

An accident in the girl scouts cost me my two front teeth. Years later, I'm not sure I'm satisfied with my smile. Am I just being silly, or is there something I can/should do about this?

When I was a little kid I broke my two front teeth in a wild game of freeze dancing. The caps I got were slowly eaten away over time, and developed dark brown lines on them. However, because this was a cosmetic and not a medical issue, my dental insurance refused to cover replacing them. So I basically spent my middle school years with brown front teeth. Needless to say I was teased mercilessly about this. I developed the habit of never, ever smiling with my lips open.

Eventually the nerve beneath my teeth became infected (thanks, insurance company) and I had to have the caps taken out to do two root canals. They were replaced with much better caps that looked like normal teeth. I was told that when I was all grown up I'd have to get them replaced, yet again, with permanent caps that fit my grown-up mouth.

2-3 years ago, I went to the dentist to get this last procedure done. The new caps were pretty good but they still don't look quite right to me. For one thing, they're a different color than the rest of my teeth (although none of my teeth are sparkling white - I'm pretty bad at brushing regularly, I think in part because of all of this mess).

They're also pressed a little too high up on my gum line, causing the gums to form a swollen red rim around them. I thought I had gingivitis or something but my new dentist told me this was from the caps. He suggested I go back to the dentist who had given me the caps and get new ones, but my family has moved and anyway, I am no longer on my parents' dental plan. The dentist said my insurance would not cover a cosmetic procedure (when have I heard that before?) and that if I wanted to pay out of pocket it would cost several thousand dollars.

These caps are much better than the ones I had in middle school, however I still feel self-conscious about them. I still try not to smile with my lips open, and when I do, I worry that people are noticing my damn teeth - which is frustrating because I want to just be enjoying whatever made me laugh/smile, damn it!

Anyway, here's a picture of my smile:
(It's kind of low quality, if people need better pictures to judge, let me know and I'll take some more.)

What do you think? Is it totally unnoticeable and I'm just obsessing over nothing? Or is there something worth fixing there? I will readily admit my perspective is totally skewed - middle school teasing will do that to you.

Also, if it should be fixed - how would you go about fixing it? I would prefer not to blow half my savings on what is essentially a vanity. I thought maybe I could go to my new dentist (I've switched yet again, since I live in a new place with a new job) and say that the swelling in the gums was causing me pain (it doesn't) and that they bled when I touched them or brushed my teeth (they do). Would that be enough to get my insurance to cover it?
posted by shaun uh to Clothing, Beauty, & Fashion (18 answers total)
Best answer: The teeth look fine-- don't know that you'd get a good ROI on the thousands it would cost to do implants or whatever. I see what you mean about the gums looking inflamed, that does seem like a legitimate medical issue. You may want to go over to HDS and see what they think. You'd be a great medical assessment there, for a low exam fee, and probably a low fee to do work overall.
posted by No New Diamonds Please at 5:45 PM on February 15, 2009

You have a lovely smile. I wouldn't notice your caps but I would definitely notice your reddened gums. Gums in a constant state of inflammation are not a vanity issue but a health issue.

I'm a little surprised by your new dentist's response, he's passing the buck and ignoring your gums' health.You should get a second opinion.
posted by jamaro at 5:53 PM on February 15, 2009 [1 favorite]

I also think your teeth look fine and agree that the issue seems to be the reddened gums; that's what the eye is drawn to in this picture. I would go to another dentist and present this as an issue of your continually swollen gums, not as a cosmetic issue. Definitely tell the new dentist that the gums bleed when you touch them or brush your teeth; that shouldn't be happening.
posted by OolooKitty at 6:01 PM on February 15, 2009 [2 favorites]

Your teeth are fine - smile!, but the gums need some treatment, which has got to be a legitimate medical matter.
posted by Dee Xtrovert at 6:01 PM on February 15, 2009 [2 favorites]

IANAD--Have the chronic inflammation examined and treated. This not a normal consequence of dental work--in spite of "shaky" dental habits I am quite sure that inflammation of the front teeth is not where one is likely to have a chronic gingivitis. Smile, looks good to me. Good Luck
posted by rmhsinc at 6:01 PM on February 15, 2009 [1 favorite]

Best answer: your teeth look fine - really. I would see if there is anything they can do to stop them from irritating your gums, (bleeding when you brush can't be good) but the teeth themselves look pretty perfect to me.

A few years ago I had my front teeth fixed up because there was a bit of a gap that really bugged me. I showed them to a friend after, proudly saying "look, no more gap!" his response? "there was a gap?" he'd never noticed - and this was a co-worker that I saw every day, and who had a great sense of humour, so he probably saw me smile every day, but had never noticed what I thought was a major flaw. What I'm getting at is: we tend to judge ourselves a lot more harshly than others do, you really shouldn't worry about your smile - it's nice, use it! (I can totally relate to your story, though, - I got a lot of teasing at school too - kids can be mean little creeps!)
posted by 5_13_23_42_69_666 at 6:03 PM on February 15, 2009

Like others said, it's not the teeth - it's the gums that are noticeable. I would try to get a referral to a Periodontist, which specialize with gum problems. He/She would be able to tell you if it's a medical problem more so than a cosmetic problem.
posted by texas_blissful at 6:11 PM on February 15, 2009 [1 favorite]

Your teeth look fine, but your gums look kind of unhealthy. Maybe flossing daily would help, if you don´t already do that. I´d try a different dentist, perhaps there is a way to deal with this other than replacing the caps.
posted by yohko at 6:14 PM on February 15, 2009 [1 favorite]

Hey! You've got exactly the same thing I've got, except in my case it was saying hello to a brick wall mouth first while playing soccer in Grade 5, and when mine sheared off they went in a diagonal pattern so it almost looked like fangs. When I got mine replaced back then they were telling me that the caps would need to be redone in 18 - 24 months. That was about 22 years ago... One did fall off when I was opening a plastic package with my teeth about 10 years ago and I had it replaced with whatever they had on hand at the time white enamel wise and after a while I really couldn't tell you which one it was since they both look the same again.

As far as the noticing side of things, *I* notice the caps when I look in the mirror, but pretty much nobody else does. Most people when I mention it are surprised, then ask to see them and squint looking close and then get the "Oh yeah..." look on their face, and looking at your picture I would have to say yours look a lot harder to spot than mine, so I doubt anyone would even pick up on it without you first mentioning it. So I vote for obsessing over nothing.
posted by barc0001 at 6:15 PM on February 15, 2009

I failed to brake on my bike as a teenager and ended up rolling -- noisily and very hard -- into a neighbor's garage door. I've struggled with the cap issues just like you. The first one I had was replaced in Boston by a dentist who did a shoddy job and I'm in the process of getting it replaced because of sensitivity and a gum issue similar to yours. Like the above posters said, you don't want the swollen gums ... not good. Outside of that, I know how important a smile can be and if your smile makes you uncomfortable enough, go ahead and save up and get it spruced up. There's so much they can do now. I'm using some tax money to get a little space between my bottom teeth (that no one seems to notice but me) all prettied up. Good luck!
posted by notjustfoxybrown at 6:15 PM on February 15, 2009

The teeth look fine but the gums thing has got to be a legitimate health issue. Bleeding gums = generally not good, although not uncommon.
posted by Medieval Maven at 6:30 PM on February 15, 2009 [1 favorite]

I think the teeth look fine - but based on my own experiences, I'd say the irritated gums are most certainly not a normal part of the root canal/crown procedure. I've had 8 crowns and never experienced any irritation - except, of course, to the bank account. Insurance companies are getting better about accepting crowns as a dental necessity rather than a cosmetic procedure, especially after a tooth has had a root canal - implants, though, still are rarely covered.
posted by chez shoes at 6:55 PM on February 15, 2009

I have crowns (I think we're talking about the same thing - not just a face or veneer but a replacement of the full upper part of the tooth?) on both my front teeth as well, the current disposition of root canals stemming from a childhood accident. I have some appearance issues with them as well (different from you but similar, some appearance issues at the gumline and the color slightly off, ironically because I got mine color-matched when I was a smoker and since I've quit the surrounding teeth have gotten whiter but not the crowns) - I've asked many people about it it's clear to me that people just don't really notice them unless I direct them to look closely.

Someday either the crowns I have will need replacing due to natural wear or I'll be able to swing the cost without feeling it's an unwise choice for spending. Until then, I'm satisfied they aren't causing any real problems. A third tooth I had done later (but stemming from the same accident) was done with a full porcelain (dental ceramic) crown and honestly it does just look nicer.

I don't think I would note your teeth if you didn't point them out. It's easy to get fixated on things particularly when you were once teased about them. Talk to your dentist about how it's affecting your gum health. In any event, it's really not the big deal you feel it is, but spending a couple thousand dollars to get something like this done properly eventually is hardly a frivolous plan either. But for heaven's sake stop using this poor excuse not to take proper care of your teeth. I bet if you brushed and flossed properly the inflammation would lessen. A relatively inexpensive bleaching would get the colors closer to a complete match as well. Beyond this, for the best outcome if you do eventually have this work done, it would be best to have a good dental care regimen in place, decide if you are the sort of person who wants to bleach periodically etc., so that if you replace them you have them color matched to your teeth at the optimal whiteness you want to (and are able to) maintain.
posted by nanojath at 7:06 PM on February 15, 2009

The gums don't look good.

I'm sorry that you were teased in middle school, but that is not the insurance companies' fault. Medical insurance usually doesn't cover cosmetic procedures; that's not some kind of tragedy in an unjust world, it's just the way things are.

You should go to a dentist, be honest with him/her about your dental history, and pay what you have to pay to get the situation taken care of.

Either that, or don't, and live the rest of your life without complaining to yourself or others that fate should have somehow intervened to make things different.
posted by bingo at 8:08 PM on February 15, 2009

I, too, have crowns for my two front teeth. Wiley Coyote/Roadrunner-style chase with brother ended up with face meeting door on Christmas Eve 1992.

Having highly visible crowns is psychologically a big deal. I have paid, and will continue to pay, large amounts to get results I am 100% satisfied with. If it's between paying $30,000 on a new car or something close to that on new teeth, I'll go with the teeth. After all, you spend 1-2 hours a day in a car and 24 hours a day with your teeth. The difference between good and excellent crowns is not noticeable to the average person (as comments here attest). However, the teeth are literally inside your head. You need to think they're top-notch or else you'll run into those problems of not wanting to smile, obsessing over the margins (that gap at the top), worrying about biting into apples, kissing strangers, etc.

One suggestion: If cost is a big concern, consider dental tourism. MeMail me if you wants some suggestions, as I have a dentist here in random South Asian country that I would trust with my life (U.S. degrees, as well).
posted by whitewall at 8:29 PM on February 15, 2009 [1 favorite]

definitely, definitely get your gums looked at. they don't look happy and i can't imagine they feel good. it could just be a case of the old dentist put your crowns on poorly. the new dentist should be able to take them off and reapply them for you in a way that won't make you hurt. this is certainly a medical issue and not simply a cosmetic issue at this point.

and, perhaps you may need to get NEW crowns because the ones you have are ill-fitting. if that is the case and your new dentist is good, you'll be able to get a color match that is closer to what your other teeth are (i didn't see a problem in the picture, but if you have a problem...).
posted by misanthropicsarah at 9:34 PM on February 15, 2009

Best answer: Dentist here. Your gums are inflammed directly as a result of the margins of your crowns impinging upon what we refer to as the biologic zone. there needs to be sufficient space between the place where the crown meets the tooth and the bone beneath for a normal zone of connective tissue, if this zone is violated one of two things happen, inflammation or recession, neither of which are acceptable especially in the two front teeth. I making an unofficial diagnosis here, based upon what you've told and the photo, but it sounds like one of the dentists you've seen has correctly noticed this and recommended replacement of the crowns.
Good documentation and a clear narrative to an insurance company will often result in coverage for replacement of the crowns and likely the crown lengthening surgery you will require to reestablish the correct biologic width. a good ceramist can match the shade of the crowns to your other teeth.
If your existing teeth are sufficient to restore, it will cost you less and likely result in a better outcome to build upon them.
Only you can put a price on your smile and its effect on your self esteem.
posted by OHenryPacey at 11:25 PM on February 15, 2009 [1 favorite]

Response by poster: Thanks for the advice, everyone! I will make an appointment with the dentist tomorrow. In the meantime, I will try to be better about brushing and flossing (flossing --> bleeding --> gross, but I've got to get over that).
posted by shaun uh at 7:30 AM on February 16, 2009

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