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.

Porcelain Crowns Versus Porcelain Veneers

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I am concerned about a procedure that I have coming up and need to make a decision. I had a porcelain veneer on one front tooth and a porcelain crown on another. They never quite matched each other in color. Now my porcelain veneer has broken and my dentist said the lab is pressing him to do two dental crowns in order to get them to match perfectly. I’m not crazy about this idea because I don’t want to grind down a healthy tooth for another dental crown. Is that the only way to get them to match?

Sylvia

Dear Sylvia,

Porcelain Veneer being placed on a front tooth

 

I am not too confident in the dentist you have doing this for a few reasons. First is the initial color mismatch. While dental crowns and porcelain veneers have to use different types of color maps in order to get the same results, it is possible. He should never have bonded them on if he didn’t have the match right to begin with. This leads me to my second concern.

Porcelain veneers by themselves are very fragile and can be easily crushed or broken. It is the bond that makes them strong. If your dentist had properly bonded them, it would be highly unlikely the veneer would have broken to begin with.

A third issue I see is his excuse. He said the lab is pressuring him. It is the dentist who tells the lab what to do, not the other way around. So, either he is not being honest with you and is lying to make an excuse or he’s letting a subpar lab boss him around. Neither of those is a great option.

My advice is to get a different dentist to do this procedure. It may take several try-ins even with an excellent cosmetic dentist so be patient while he or she gets it right, but they will be able to get it right. They will need to use a temporary try-in paste for the porcelain veneer that is being replaced. You should get to look at it in a variety of different types of lighting. If they do not match, your dentist should send it back to the lab with new instructions in order to make the changes you need before it is permanently bonded on.

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

Which Type of Crown is Best?

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I have to get a dental crown and my dentist has given me three choices: A PFM crown, an all-porcelain crown, or a same-day crown. He told me to let the scheduler know which I want when I call to make my appointment. The problem is I don’t know which is the best one for me to get. Honestly, I don’t even know what PFM means. Do you have any advice?

Bethany

Dear Bethany,

I’m glad you wrote. I wish your dentist would have taken the time to explain everything to you, but don’t worry, we’ve got you covered.

PFM and All-Porcelain Crowns

PFM stands for porcelain fused to metal crowns. Basically, it means that they are dental crowns that have a metal base to them. I would only do these on a back tooth. That is because PFM crowns, while stronger, are not as attractive. First, they have to be made more opaque in order to cover the metal base. Second, eventually, there will be a dark gray line that appears on your gum line. This will be visible when you smile. Because of that, I only advise these if you are getting a dental crown on a molar.

If you are getting dental crowns on a front tooth, then I would suggest you get an all-porcelain crown. These will look much more natural than their metal based crowns.

Same Day Crowns

Block of porcelain for a CEREC crown

Same-day Crowns, also called CEREC crowns are all-porcelain but are milled by a machine in the office while you wait. This enables you to get your crown the same day as your appointment. While they are all-porcelain, if you want them on one of your two front teeth, I would make sure your dentist understands color theory and the tints and stains available for same day crowns.

Traditional all porcelain crowns are milled by hand. The technician will use a variety of porcelain to mimic the variations in a tooth. CEREC crowns are milled from a single block of porcelain so they will not have those variations. The dentist will need to add those with the tints in order for them to look natural. So, if you’re doing them on front teeth, ask your dentist to show you some before and after pictures of cases he or she has done on front teeth so you know what type of result you will get.

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

Tetracycline Stains and No Money

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I have had tetracycline stains on my teeth since childhood. All the research says to put porcelain veneers on your teeth to cover them but my dentist doesn’t do porcelain veneers. He does do crowns, which he has suggested we use. Even that, however, is out of my reach. Are there any other alternatives?

Callie

Dear Callie,

smile with tetracycline stains

I am very glad you wrote. For the benefit of others reading, who may not know what tetracycline stains are (pictured above), I am going to give a brief explanation. Tetracycline is a prescription medication. If you take it before your permanent teeth are formed, which generally happens at the age of twelve, it will deposit in the dentin of your teeth and show up as a dark brown or gray stains.

The best solution to this is porcelain veneers, which would need to be done in the hands of an expert cosmetic dentist. Covering tetracycline stains is one of the most advanced and tricky procedures dentists have to do. They have to make the cover opaque enough to cover the dark stains, but still translucent enough to look sparkling and natural.

Some family dentists who are not skilled in cosmetic dentistry try to make up for this by doing porcelain crowns. I will be honest with you, any dentist that suggests dental crowns for this is a big red flag. They are telling you, “I can’t do porcelain veneers, but I’m totally willing to grind down healthy tooth structure to rake in money for what I do know.” If they don’t do porcelain veneers, they are not skilled enough in cosmetic work to make these crowns look good. Even most dentists who do porcelain veneers don’t have the skills for tetracycline stains.

Tetraycycline Stains and No Money

You have a few options. First, you can leave the teeth as they are while saving up for the high-end (and higher priced) procedure. This obviously would depend on how long it would take you to reach your goal.

Second, you can have teeth whitening done. When you do this, know that it won’t be done in one tube of gel. In fact, you will have to be persistent, but if you are, it will work. One thing to note is I don’t recommend Zoom Whitening for this. It is more expensive than the take-home trays whitening. It is a fantastic whitener, but you will need too many sessions for it to be financially do-able for you. Of course, you could do one zoom appointment to get a jump start and then do the rest with trays. As far as tray teeth whittening goes, see if your dentist offers or is willing to purchase kör whitening for you. This is the most potent gel available.

Your final option is to have the teeth whitening done while saving up. This allows you to make some progress if it is going to take you a long time to get to the cost goal. If you choose this, you may even find you are happy enough with your whitening results that you no longer feel the need for porcelain veneers. Just bear in mind it will take a while for the whitening to really make a difference.

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

Will Medicaid Cover Porcelain Veneers

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Between my cancer and my bulimia, my teeth have taken a huge hit. I need to do something about them but do not have a lot money. Is there a possibility Medicaid will cover something like porcelain veneers because it is a medical condition?

Stacey

Dear Stacey,

dental crown versus a porcelain veneer

 

Unfortunately, Medicaid, if they cover anything, will only cover the least expensive procedure. So, if they decided they would cover this situation with your teeth (which I honestly doubt) then they would cover you having all your teeth pulled and getting dentures because that would be the least expensive solution. Although, that would be a horrible solution. That is one of the problems with government run healthcare of any kind. It’s sort of a bottom line situation only. They care less about the patient and more about the financial considerations.

When it comes to bulimia, it is the backs of your teeth that take the brunt of the damage from the vomiting. Porcelain veneers only cover the fronts of your teeth. If the damage is to the back, you may need porcelain crowns, which surround the tooth.

However, as I said above, Medicaid will not cover this. It is something you would want to save up for and get done right. I would talk to your dentist about the damage to your teeth and see if he has recommendations to help in the meantime. At the very least, you will want to get some fluoride treatments in order to help fortify your teeth while you are saving up for a solid cosmetic solution.

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

Should My Dentist Be Able to Match My Implant Crown?

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I want your advice as to whether I am being too picky. I had a dental implant made for a tooth that could not be saved after an accident. It’s a front tooth so I want it to match the other front tooth. My dentist has tried three different implant crowns, but none of them have matched. She’s frustrated with me and thinks I should just be grateful I have a tooth because “It is not her fault my tooth is between two dental crown shades.” Am I being too picky? Isn’t there a way to blend two shades together to make something closer?

Amy

Dear Amy,

I’m glad you wrote. You are definitely not being too picky. Plus, it was unfair of your dentist to push this off on you as if you were at fault for her lack of skill by not making her job simple enough for her. My suspicion is she does not have much training in cosmetic work, which is absolutely necessary to match a front tooth.

Color map a cosmetic dentist would createWhile the standard shades that your dentist referred to are adequate for back teeth, they do not quite cut it for front teeth as you have discovered. Your front teeth are exposed to direct light, which reveals all the variants in your teeth. The problem isn’t your natural shade color. There isn’t a shade that directly matches any tooth. When your teeth are hidden away toward the back, close is good enough.

For front teeth, your dentist has to pull out any artistry and color theory training he or she has received. Yours hasn’t. When a dentist needs to match a front tooth, they will draw out a “map” of your tooth, similar to the one to the one here, then mark for the ceramist the various tints and stains needed to give the tooth the correct blend.

It’s pretty apparent your dentist does not know how to do this and I don’t think she’s going to invest in the training needed. My suggestion is you pay for the dental implant but ask for a refund on the implant crown, so you can get it done properly somewhere else.

Discuss the procedure with any potential new dentist to make sure they are willing to do this properly. Here are some things to consider. Ask them if they will use a temporary try-in paste for you to approve the look and match of the porcelain crown before bonding. If they say no, move on. If they say yes, ask them how many times they’re willing to re-do it to make sure it is an exact match. The only acceptable answer should be as many times as is necessary.

It would be a miracle for even the best cosmetic dentists to get a perfect match the first time when it comes to a front tooth. Most will require two or three try-ins, so don’t panic when the first one doesn’t necessarily work. Just know you will get a tooth you can be proud to show.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.
Click here to learn more about smile makeovers.

Problem Lateral Incisors

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Both my lateral incisors have been a bit of a disaster. One of them is congenitally missing. The other is slightly deformed. I’m planning on getting this fixed. All of it. What do you recommend?

Amaya

Dear Amaya,

dental implant being placed in three stages

I’m glad you wrote. The first thing you’ll want to do is make sure the space is appropriately opened for the tooth replacement. Invisalign is the ideal treatment for this. You can straighten them invisibly and comfortably— no metal wires and brackets. Then it is time to make your smile beautiful.

Depending on the color of your teeth, you may want to whiten them. The reason for that is once your restorations are made, their color is permanent. You don’t want to have them a color you won’t completely love. If you are pleased with the color than no worries. You can skip the teeth whitening.

Once it is time to replace the tooth, I suggest a dental implant. This is the best tooth replacement around. It will be like having a healthy, natural tooth there. You will need to find a dentist who is experienced in placing dental implants. It requires post-doctoral training, so make sure you ask the dentist where they received their dental implant training. Dental school isn’t enough. If they’re offended by the question, they are not the best dentist to do it. Move on.

As for the deformed tooth. I haven’t seen the tooth, so a lot of it will depend on the shape and condition of the tooth. What I recommend for that is you see a great cosmetic dentist. Have them look at the tooth. Based on that examination they will either suggest a dental crown or a porcelain veneer. Make sure you check out their smile gallery to make sure you like the results they get. If you do, make a quick call to their office to make sure the images are from cases the dentist did himself and not just stock photos.

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

Will a Root Canal Treatment Damage My Porcelain Veneer?

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I just had eight porcelain veneers done and now I found out one of them needs a root canal treatment. I’ve read that a root canal treatment can turn a tooth dark and I don’t want that to ruin my veneer. I really like them. I can’t imagine why I’d need a porcelain veneer. I’ve been so careful taking care of them because I’m happy I finally have a smile I like and I don’t want it ruined. What do you recommend?

Lisa

Dear Lisa,

I’m concerned about why you needed the root canal treatment to begin with. I hope this wasn’t the result of your dentist being too aggressive. When teeth are being prepared for porcelain veneers, it doesn’t take much. At the most, your dentist should remove about half a millimeter.

photo of tooth preparation for porcelain veneers

The photo directly above shows a depth limiting diamond bur being used to prepare some teeth for porcelain veneers. Using a tool like this helps protect the tooth from the dentist going too deep in the preparation. Some dentists get carried away and will reach the dentin. Others will actually do porcelain crowns and just call them porcelain veneers. When doing a crown the dentist has to grind the teeth down to nubs.

Protecting the Beauty of Porcelain Veneers with a Root Canal

There is a way to help prevent the darkening of the tooth which needs the root canal treatment. Most of the darkening comes from the root canal filling material itself. This can be significantly reduced by following the procedure I’m about to outline.

1. Have your dentist clean out all the material from the crown of the tooth.
2. He or she should then place a white fiberglass post into the root.
3. Fill the remainder of the space with a light/white colored composite material.

Doing this will delay any darkening for quite a few years.

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

Crowns or Veneers for Tetracycline Stains?

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I have tetracycline stains that I am ready to get fixed. I’ve seen two dentists— my regular general dentist and a local cosmetic dentist. My dentist suggested porcelain crowns. He’s done a crown for me before and it looked very nice and natural. The cosmetic dentist suggested porcelain veneers. The cost for the dental crowns is half the price of the porcelain veneers. I want to do this right. These teeth have bothered me for years. But, is there a significant reason to spend the extra money for the porcelain veneers?

Ellie

Dear Ellie,

single porcelain veneer being held up by a dental tool

A Porcelain Veneer

I’m glad you are asking questions. The first thing you need to know is there isn’t a recognized specialty in cosmetic dentistry. Just because a dentist calls themselves a cosmetic dentist doesn’t mean they are better. Nor does the fact that they charge more. That being said, I wouldn’t have the crowns done.

Tetracycline stains are one of the most difficult types of cosmetic cases a dentist can work with. They have to make the porcelain opaque enough to cover the stains while translucent enough to still look natural. When it comes to tetracycline stains, the porcelain crowns are an overly aggressive treatment.

The teeth have to be ground down quite a bit in order for there to be room for the dental crowns. This weakens the teeth and puts them at risk of breaking. Often dentists inexperienced in treating these type of stains recommend the crowns because they aren’t confident in their skills doing porcelain veneers. So the fact that your dentist wants to do the much more aggressive crowns is a red flag.

Additionally, there is no guarantee after you unnecessarily grind these teeth down that the crowns will be good enough. I know you said he’s done a crown for you before and you were happy with it. However, doing one crown is very different than dealing with a smile makeover, especially when tetracycline is involved.

Recommended Treatment for Tetracycline Stains

Most cosmetic dentists will suggest porcelain veneers. This can change anything and everything about your teeth— the shape, the size, the color. This is the go-to procedure for celebrities who want a smile makeover. It can do more than cover your tetracycline stains. It can give you the smile you’d always dreamed of having, not only covering the stains you are embarrassed by, but giving you a superstar smile.

Check the Dentist’s Results

I highly recommend you don’t just choose between these two dentists. You have a world of dentists available to you. But be careful in your choice. This is a very difficult cosmetic dentistry procedure, and it may be hard to tell if the dentist has enough skill to do this right. What I would suggest is to ask to see before and after smile gallery photographs of tetracycline cases they’ve personally done. If they can’t show you that, keep looking for another cosmetic dentist.

You also need to insist they do a temporary try-in of your porcelain veneers when they’re done. There is a try-in paste which will allow you to see the veneers on your teeth without bonding them. This enables you to look at them in various lighting and determine if they are what you wanted. If you’re at the right dental office, the dentist will be willing to send the case back to the laboratory and not bond them on if you are at all hesitant about how they look.

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

Do You Have to Quit Smoking for Dental Implants?

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I want to get dental implants to replace some missing teeth. My dentist said he won’t place them unless I quit smoking. Is this really necessary or is he trying to force his own agenda on me?

Kevin

Dear Kevin,

An image of a dental implant crown being placed in three stages

I don’t think your dentist is trying to force an agenda on you. Instead, he’s trying to give your dental implants procedure the best chance at success.

The Risks of Nicotine with Dental Implants

  • The Reduction of Blood Flow

Any form of tobacco, including cigarettes, vaping, smokeless tobacco, or dipping restricts your blood vessels. In some cases, it cuts off the blood flow completely.

  • Poor Osseointegration


    • One of the keys to a successful dental implant procedure is when the implants fully integrate with the bone. With reduced blood flow, this hinders healing which slows down the integration. This will lead to a loose implant which will fall out.

    • Increased Risk of Infection

    Because your reduced blood flow hinders healing, it increases your risk for infection at the implant location. The leading cause of dental implant failure is an infection.

    Options for Dental Implants When You Smoke

    Obviously, you can accept the risk and move forward. You will be able to find a dentist willing to provide the procedure even while you smoke.

    On the other end of that spectrum is to quit smoking. You can talk to your doctor about options to aid you in that process. There are options to help with the withdrawal symptoms.

    Another possibility is to meet somewhere in the middle. You can quite for several weeks before the surgery and during the healing time. Then, when everything is secure, you can smoke again. However, you may find during that time period that you don’t really need that tobacco as much as you thought you did.

    A Cosmetic Consideration with Dental Implants

    Smoking causes serious tooth stains. Often, patients want to get a whiter smile when they’re replacing their teeth. You may want to consider getting your teeth whitened before having your implant crowns made. This way they can match the porcelain crowns to your new, whiter tooth color. Giving you a youthful, healthy looking smile.

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