A Cavity with Porcelain Veneers

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I have four porcelain veneers. One of them now has a cavity. My dentist wants to remove the porcelain veneer and replace it with a dental crown. Is this absolutely necessary?

Catina

Dear Catina,

Porcelain Veneer being placed on a front tooth

I am glad you wrote. My suggestion is that you get a second opinion before going through with what your dentist is suggesting. In practical terms, only about 2% of dentists are able to match a dental crown to a porcelain veneer. In addition to that, the decay would have to be quite significant for your tooth to need a dental crown. I would say at least 20% of your tooth would need to be decayed to necesitate a crown.

When you have a porcelain veneer, the most susceptible part of the tooth to decay is the edge of the porcelain veneer. Your dentist may either not have the comfort level or skills to do a porcelain veneer or he doesn’t have the tools to do a composite filling on the edge where you likely have the decay. This may be why he is suggesting a crown which is a less specialized treatment. But, this would require grinding down a significant amount of your tooth strucutre. You do not want to do that unless it is absolutely necessary.

Get a second opinion by a skilled cosmetic dentist. When you do, make sure it is a blind opinion. By that I mean do not tell them who your dentist is and what they suggested. Just tell them you want a second opinion on the tooth. If they ask for the dentist or the diagnosis, explain that you want a blind, unbiased opinion. They should understand that. The reason for this is because the dental community is small and they probably know each other. You don’t want him feeling pressured not to say anything negative about a friend’s diagnosis.

This blog is brought to you by East Cobb Dentist Dr. Susan Dennis.

Gums Inflamed After Porcelain Veneers

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I had two porcelain veneers done. They were placed on my two front teeth because one of the teeth had a chip and he needed to do both teeth to match them. Here’s the thing. Ever since I had the veneers placed, my gums have been inflamed and painful. I went back to the dentist and they insist they’ve never seen this before and accused me of not brushing them properly. That really annoyed me because I’m a grown woman and know how to brush my teeth. I’m especially careful to be diligent because these two porcelain veneers were quite expensive. I went back again and asked them to take a more careful look. At that point, he removed some cement that had been left. While that helped some, they still hurt. Do you know where I go from here?

Corin

Dear Corin,

A single porcelain Veneer being placed on a tooth

I’m pretty sure YOU are not the problem. In general, when someone gets work done on their teeth they are actually more careful about their oral hygiene, not less. It is more likely your dentist is the real problem here. I haven’t examined your porcelain veneers, so it would be difficult for me to diagnose the exact problem, however, I can give you some possibilities.

The first thing that springs to mind you’ve already have some evidence for— not cleaning off all the excess cement. At one of your checkups, you mentioned he removed some cement, so obviously this was at least part of the problem. All the cement he removed in your follow up visit should have already been gone when your veneers were originally placed. This is a common issue with inexperienced cosmetic dentists. Smile makeovers aren’t taught in dental school, so a dentist has to invest the time and training to develop the right skill.

The next two possibilities have to do with the margins. If the margins are uneven where the veneer meets the tooth it can cause issues. Sometimes the margin by the bottom of the gingival sulcus, can actually end up too far under the gumline. That would also lead to irritation.

An unlikely possibility, but still in the realm of possibility, is an allergic reaction to either the porcelain or ceramic used. These are rare but have been known to happen.

Where Do You Go From Here?

What you need is a second opinion from another cosmetic dentist. Don’t ask your dentist for a recommendation. Whoever he picks will be unlikely to want to say something against his peer. When you go, make sure it is a blind second opinion. Don’t tell them who did the work. Just tell them your problem with the gums and ask if they can see what is causing it. If they ask who did the work, tell them you want to know his diagnosis before you give that information.

The Correct Replacement for a Chipped Tooth

Before and after dental bonding

I want to mention one other thing. You said your dentist did this to repair a chip. Typically a chipped tooth would be repaired by dental bonding. This is what was done in the image directly above. My guess is your dentist recommended veneers because he doesn’t yet know the bonding procedure. It’s too late now, of course, but if this were to happen to you again, I’d want you to be armed with the right knowledge.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Porcelain Veneers and Gum Disease

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I had a set of porcelain veneers done about 7 months ago. I liked them, but I’ve been having some problems and I’m wondering if the porcelain veneers are why. It didn’t happen until after I got them. It started with the gums feeling sore. I thought that might be because I had new veneers. Then I noticed occasional bleeding when I brushed. I went in for my first checkup since getting them and they’ve said I’m developing gum disease and I need to do a better job brushing. Here’s the thing, I’m pretty fastidious when it comes to brushing and flossing and haven’t changed my habits. That’s especially true because I invested all this money in my veneers and want to keep them clean as well. So, if it isn’t me, is it the veneers? Is this common? Is there a solution?

Brooke

Dear Brooke,

a porcelain veneer being placed

I’m sorry you’re going through this. If your oral hygiene is sound, then something else is going on. Because this started after your porcelain veneers procedure, it is natural to suspect them. However, they do not cause bleeding gums or gum disease. What can do that is the porcelain veneers not being properly placed.

It sounds like your dentist doesn’t understand how to get them flush against the teeth. When this happens, it causes a little shelf between the porcelain veneers and your gums. This is known as bulky margins and is a huge problem for you.

Here’s the thing. when you have that shelf, food and other forms of bacteria get trapped in there. They’re very hard to get out. This leads to decay. It will ruin your porcelain veneers and your teeth. You don’t want to go from a porcelain veneer to a porcelain crown unless you have to.

Get Your Porcelain Veneers Re-Done

This has to be replaced. Fortunately, if you can get another dentist to verify that is the problem, you can get your original dentist to replace them for free. The key to getting a good second opinion though is two-fold.

First, never ever tell them who did the work. Dentists are colleagues and friends. It’s hard to say something negative about a peer. If they don’t know who the dentist is it takes away the feeling of disloyalty. They’re just giving an honest, unbiased opinion.

Second, is don’t tell them what you think it wrong. Just tell them the symptoms and let them make the diagnosis. If it turns out to be bulky margins, he can help you get that refund you need to get this fixed properly.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.