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.

Why Are My Porcelain Veneers Sensitive?

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I just had six new porcelain veneers placed on my upper teeth, from eye tooth to eye tooth. Love love love my new smile! There’s only one drawback: they are so sensitive. Just about anything sets them off, but especially cold things. I know it’s only been five days since I had them placed, but it seems like the sensitivity should have gone away by now. Why are they so sore, and is there anything I can do about it?

Thanks,
Kennedy

Hey Kennedy, great question. First of all, congrats on your new smile! It’s an exciting time, to be sure. Let’s see if we can get to the bottom of this.

Why are new porcelain veneers sometimes sensitive?

The Preparation

There are a number of possible causes that your porcelain veneers can be sensitive, beginning with the initial appointment. When your teeth were prepared, a very small amount of your natural tooth structure was removed, about a half millimeter. The idea is to remove enough enamel to accommodate the veneer, but not so much as to compromise the integrity of the tooth. Occasionally, this removal thins the enamel enough that some sensitivity occurs. This is more common with patients who already had sensitive teeth.

The Bonding Process

When it comes time to place your new veneers permanently, your dentist will bond them directly to your tooth. This involves first acid-etching the enamel, which opens the tiny dentinal tubules and prepares the surface for the bonding agent. This can sometimes cause you some temporary sensitivity. The bonding agents may also occasionally cause some people temporary sensitivity as well.

Normal Recovery

Whenever a tooth is treated, especially if any type of preparation is involved such as removing decay, reduction of tooth structure for a crown or veneer, or bonding/cementing certain materials, sensitivity following the appointment can result. This is temporary and the tooth will calm down over time.

After any new crowns, bridges, or veneers are permanently placed, there is always an adjustment period. At this appointment, your bite will be adjusted and the fit fine-tuned and customized for you. There may be a “high spot”, or a small area where the teeth are out of alignment and the occlusion needs to be adjusted. Even if it’s a very small amount, it can cause pronounced discomfort. It’s a simple matter to fix by adjustment, and the tooth will calm down over the following few days. This is a bit different from the sensitivity you are describing, but it is worth mentioning to your dentist if this doesn’t resolve soon.

The Margins

Typically, porcelain veneers should fit directly against your teeth and snug up to the tooth’s natural gum line. There should be no gaps between the veneer and your gums, or the veneer and the back of your tooth. These areas should feel smooth and should fit with integrity. If any areas persist that are not protected by the veneer or by enamel, sensitivity will result. This can also result in bacteria and other foods getting trapped, so it will be important the dentist resolve this in order to protect you from decay.

How Long Should I Wait?

Typically, we assure patients that their teeth should calm down within a week or so, give or take. You are not quite a week out from your appointment; these teeth may just need a bit more time to adjust. If it does not subside, or if it worsens, call for an appointment right away. In the meantime, using a toothpaste designed for sensitive teeth and a mouthwash with fluoride (alcohol-free) should help alleviate symptoms.

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

Don’t Be Fooled By 360-Veneers

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I’m so heartbroken. I went to my dentist to get porcelain veneers to finally get a pretty smile. He told me I would be a better candidate for 360-degree wrap veneers. I asked if that would take off too much structure and his response was “hardly any.” I trusted him and put myself in his hands. I think I made a huge mistake. The temporaries they gave me kept falling off but he told me that was because they don’t use strong cement. Now, I have the permanents and though the look is a little better than my natural smile, it is not the gorgeous smile I was hoping for. The worst part is the permanent ones keep popping off too. Three times now. Plus, my teeth when they come off look like little nubs. That is not the “hardly any” he told me. I’m afraid to go anywhere because they keep falling off. The dentist asked if I’d been following his instructions and I have. I don’t eat anything hard. I cut up my food very tiny. It doesn’t matter, they are still coming off. They’re talking about a new cement, but I’ve lost confidence in them. What do I do?

Carol Anne

Dear Carol Anne,

I am very sorry this happened to you. Being generous, I am going to say your dentist is ethically challenged. You should know there is no such thing as 360 wrap veneers. That is a “synonym” for dental crowns. Below is a picture of porcelain veneer tooth preparation.

toot preparation for a porcelain veneer

Tooth preparation with porcelain veneers

As you can see from the picture above, only a few millimeters of structure is taken off the front of your teeth. This is because veneers do not wrap around. That is what crowns do. You mentioned your teeth look like little nubs. My guess is they look a bit like the picture below.

tooth prep for dental crowns

Tooth preparation for dental crowns

Why Give Me Crowns Instead of Veneers?

One of the first things dentists learn how to do in dental school is a dental crown. So, they graduate knowing how to do that. Though, your dentist seems to struggle with even that basic skill. Porcelain veneers, on the other hand, are a cosmetic proceedure. Cosmetic dentistry is not taught in dental school. Instead, dentists have to voluntarily take post-doctoral classes in the procedures.

Because of that, dentists who do not invest in that training will steer their patients toward dental crowns instead of saying, “I don’t know how to do those.” It’s one thing to steer your client in another direction. It’s totally a different thing to lie to them about what they are getting, which is what happened in your case.

In addition to that, your dentist can’t even make crowns that stay in. He deceived you and the work is not functional. My suggestion is for you to ask for a refund and then find a cosmetic dentist that can actually fix this for you. Unfortunately, you are stuck with crowns now that your teeth are ground down, but that doesn’t mean you can’t have beautiful crowns that give you the smile you wanted AND will stay put. By the way, you should be able to eat whatever you want without them falling out. He’s trying to blame you for his incompetence.

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

Can No-Prep Veneers Work for Anyone?

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I was wondering if no-prep porcelain veneers can work for any patient or if it is best with a certain type of smile, such as someone with thin, tiny teeth? I told my dentist I wanted a smile makeover and he is suggesting the Lumineers brand because they are no-prep. I just want to make sure that my teeth won’t look bulky as a result. I have a big smile.

Candice

Dear Candice,

Lumineers advertisement

I am glad you wrote. While no-prep porcelain veneers can work in some cases, most smiles will need some type of tooth preparation. One of my concerns with your dentist suggesting that brand right away is that Lumineers is a brand that is highly marketed to inexperienced cosmetic dentists as being easy to place. While not prepping teeth does make the placement a bit easier, it has nothing to do with the skill necessary to make them look beautiful.

I would be cautious here. Ask your dentist to show you before and after pictures of Lumineers’ cases he has actually done himself. Many patients have complained they were too bulky and opaque. Some even have gone so far as to compare them to horse teeth.

If it turns out you are a good candidate for no-prep veneers, most skilled cosmetic dentists prefer different brands of porcelain veneers. This is because the Lumineers’ parent company insists dentists use their lab, which is not known for its artistic results. There are many different brands, including no-prep. Each has different qualities, so which brand your dentist picks will depend on the type of smile you want to create.

If you look at your dentist’s smile gallery and are not blown away, do not let him give you your smile makeover. This is a huge investment and you want it done by someone who has the technical training and artistry to give you the stunning smile you’ve been dreaming about.

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

Can Teeth Be Bleached to Match My Eyeballs

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I want to whiten my teeth to where they are as white as my eyeballs. Is that possible or am I being unrealistic?

Percy

Dear Percy,

Teeth Bleaching Trays

I find some of the questions I get to be fascinating. This is one of them. The answer would depend on how white your eyeballs are. At some point, whitening hits a wall. Additionally, it is hard to pinpoint a specific color with teeth whitening. When you think you have reached the level of whitening you want and stop whitening, there is always some oxygen released that changes the color a bit.

The best way to get a specific color and match your teeth to something is with porcelain veneers. These are more expensive than teeth whitening. I will caution you against price shopping on them though. Porcelain veneers are used for complete smile makeovers. This skill is not taught in dental school. Because of that, dentists have to invest in post-doctoral training to learn to do them well. To make it even more challenging, there is a need for artistry in order for the results to look both natural and beautiful. Artistic skill takes time. Not all dentists are created equally in this. You will often find that those dentists who are significantly cheaper than the standard, there is a reason. You don’t want to end up as a cosmetic dentistry horror story.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.
Click here to learn about our free virtual smile makeover consultation.

 

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.

Dentist Said Overbite Means I Can’t Have Porcelain Veneers

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I wanted to get a smile makeover, but my dentist said I cannot have porcelain veneers because my top teeth cover my bottom teeth in what he calls an overbite. Instead, he wants to do six dental crowns. Will that work? Should I get my bottom teeth whitened so they’ll match the crowns on my top teeth?

Farah

Dear Farah,

dental crown versus a porcelain veneer

We see this a lot with family dentists. They don’t have cosmetic dentistry training and do not know how to do porcelain veneers, so they tell their patient that they need porcelain crowns. There are a few things to be aware of with this.

First, smile makeovers are not taught in dental school. Putting one crown on a decayed tooth is a LOT different than doing a smile makeover with crowns. If he can’t make porcelain veneers look beautiful, he can’t make dental crowns look beautiful. You will not want him to do your smile makeover.

Second, as pictured above, dental crowns require your natural teeth to be ground down to numbs. If they are healthy, why would you want to do that? Porcelain veneers on the other hand only require minimal tooth preparation.

Third, if you have an overbite, it makes more sense to get veneers instead of crowns. Porcelain veneers only go on the front of your teeth and hug the sides a bit. Porcelain crowns on the other hand have to go around the entire tooth. They will bump up against your bottom teeth.

My advice, find a dentist who is experienced in placing porcelain veneers to do your smile makeover. Make certain they place your veneers with a temporary try-in paste so you get a look at them before they are permanently bonded on. If you are not thrilled with the results, they should go back to the lab.

As for the teeth whitening, you will want to whiten both the top and bottom arches before having the veneers done. Most smiles are eight to ten teeth wide. If you only get six veneers, you will want the adjacent teeth to match.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.
Click here to learn about our free virtual smile makeover consultation.

What Else is Needed with Porcelain Veneers?

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I had planned on getting a smile makeover with porcelain veneers but my dentist keeps adding other procedures I need before I can get the veneers. Getting a full checkup and cleaning I understood. Getting Invisalign and teeth whitening seems excessive. Are these really necessary? I was under the impression that porcelain veneers can make your teeth look straight. The only thing I have that could “possibly”  need some orthodontics is one canine tooth that is a little in front of the adjacent tooth. It seems unnecessarily expensive to do that for one tooth.

Letticia

Dear Letticia,

porcelain veneers

 

I’m glad you wrote and can help give you some direction here. Let’s start with the teeth whitening. How much of this you need will depend on how many porcelain veneers you plan on getting as well as how wide your smile is. Let us say, just as an example, that you only plan on getting four porcelain veneers. However, when you smile, you can see ten teeth. If the veneers are very white, but your natural teeth are more of a taupe it will be very obvious that you have four “fake” teeth on your front teeth. If however, you whiten your teeth first, then the adjacent teeth will blend more naturally with your new smile makeover. If you are getting plenty of porcelain veneers on your top teeth, then the only teeth you may want to whiten is your bottom arch so it is not a stark contrast to your top arch. This is much more affordable.

The Invisalign is a completely different story. Based on what you described to me, you should not have to have any orthodontics before getting porcelain veneers. Your understanding of a smile makeover and what porcelain veneers can do is more solid than your dentist’s. The fact that your dentist does not know how to make those teeth look straight tells me he is not skilled enough in porcelain veneers. Don’t force him to do this. You will be unhappy with the results. Instead, find a dentist with more expertise. Look at some before and after pictures of work they’ve done to ensure you would be happy to have those results.

This blog is brought to you by East Cobb Dentist Dr. Christi Cheek.
Click here to learn about our free virtual smile makeover consult.

Crooked Discolored Teeth

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I am 37 years old and recently divorced. I have discolored and crooked teeth. This is a point in my life where I really do not need to feel ugly. At this point in my life, braces are the last thing I’ll want. Are there other ways of improving my smile given my issues?

Joan

Dear Joan,

Invisalign Aligners

I am sorry to hear about your recent divorce. That is a difficult and trying time. You certainly deserve to feel attractive at any point in your life, but especially at a time when everything else feels up in arms. Fortunately, there is a way to improve both aspects of your smile at the same time, and you won’t have to wear a mouth full of metal.

You have a couple of options. I’ll start with the least expensive. Your crooked teeth could be repaired with Invisalign. These are sometimes called invisible braces. Instead of the traditional metal wires and brackets, it uses clear aligners to straighten your teeth. Not only does this allow you to straighten your teeth without anyone knowing, but it does so in a fraction of the time that the metal braces would.

They also have the additional benefit of allowing you to whiten your teeth at the same time you are straightening them. The aligners can double as teeth whitening trays. This saves you additional money.

If the only thing you are concerned about is the discoloration and crookedness, this is the way I’d go. If, however, you have other things about your smile you would like to repair such as their length or character, then getting a complete smile makeover with porcelain veneers would be the way to go. These are high end and what celebrities use to give themselves that Hollywood smile. With porcelain veneers you can change the shape, size, and color of your teeth all at the same time.

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

Staining around Porcelain Veneers

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I had porcelain veneers placed a little over a year ago. I was told these were very stain resistant. What I am finding is that in this short time they are getting stains around them. While I do smoke, I didn’t think this should affect the porcelain veneers. Are they defective?

Stephanie

Dear Stephanie,

porcelain veneers

I wish I had a picture of these. It would help me see exactly what type of staining you are talking about. You were told correctly that porcelain veneers are very stain resistant. In fact, they are more stain resistant than your natural teeth. There are a few possibilities for what is going on here.

Staining on the Surface Area

If the staining is all over the veneers, then it could be that your hygienist accidentally removed the protective glazing by either using a power prophy jet or some acidulated fluoride during your last cleaning and check up. The glaze is what gives porcelain veneers their shine as well as helps protect them from stains. If that glazing is removed, it will not take long for the veneers to begin picking up stains.

A second possibility with these type of stains is that the bonding was not done properly. If there is a gap between the porcelain veneers and the tooth, this will mean that food and other types of bacteria can get trapped between the two. This will make the veneer looked stained. Worse than that, though, is the fact that the tooth will begin to decay.

A third possibility is that you don’t really have porcelain veneers. Some dentists, who are less than ethical, will actually place composite and call it porcelain.

In all three of these scenarios, your dentist would need to replace the porcelain veneers.

Staining on the edges

If the staining is just on the edges of your teeth, than it is more likely that it is the bonding cement that is picking up the stains. When you first had your veneers placed, that bonding cement was polished to a nice shine. A year is enough time for those edges to pick up stains, especially from cigarette smoke. When that happens, it is just a matter of upkeep. Your dentist or hygienist can get in there and use ultra-fine polishing strips to get in there and get them as beautiful and shiny as they were the first day.

I would consider this a part of regular maintenance. It is not hard and does not cost much, but will help make your smile beautiful.

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