Recently, I got two porcelain veneers placed on my front teeth. Ever since then, I have been having inflammation issues on the teeth with the veneers, as well as the neighboring tooth. When I called in I was able to get in right away with the dental assistant at the cosmetic dentist. She was surprised because she hasn’t ever seen something like this with veneers.
Do you think it could be caused from the way I’m brushing my teeth? That seems to be the only thing they are thinking is causing it because I may be going too easy on brushing me new veneers. But, I don’t feel like I’ve changed anything about my dental hygiene routine. I have been trying to pay more attention to them lately when I’m brushing my teeth and now they are very tender and almost feel like they’re burning.
When I went in for another regular dentist appointment which was several weeks later, the dentist noticed some rough patches on the surfaces behind my teeth. So, he removed some of the cement. I do feel like that’s helped but there is still some inflammation.
Since the cosmetic dentist didn’t seem too concerned, do you have any advice as to what may be causing this. I don’t want to assume it will work itself out and then end up with a more serious dental problem. Since the dentist noticed some extra cement that wasn’t cleaned off, do you think that is what could be causing the problem.
In the research I’ve done it sounds like the temporaries are typically cleaned. But the dentist didn’t do that and explained that ‘etching’ would be enough. However, I don’t feel like she ‘etched’ my entire tooth for either of them. Also, I had to wear the temporary veneers for five weeks before I could get the permanent veneers placed.
I did go see a periodontist and they said the margins seemed fine. Basically, they said to return in a couple months if it hasn’t improved.
Is this all just a wait and see thing? Any recommendations you may have would be greatly appreciated.
-Patricia in Missouri
Patricia,
It is frustrating when a dental professional blames an issue on not brushing properly. In all actuality, it sounds like there may have been an issue with the placement of the porcelain veneers.
Cosmetic dentistry is not a regulated field within dentistry. However, there are some organizations that will provide extensive training and provide accreditation and fellowship to dentists that pursue this high standard of care. If there was gum inflammation as a result of any type of cosmetic dentistry, the American Academy of Cosmetic Dentistry (AACD) accreditation examiners would reject it. Therefore, if your cosmetic dentist would have submitted your case, it wouldn’t have been accepted. If the gum tissue isn’t healthy, the case will not pass.
Most patients who get cosmetic dentistry work done are meticulous about their oral hygiene. This is kind of a natural response in that they just invested a lot of money in aesthetics and improving their smile, they want to make sure they take excellent care of it.
Now, since I haven’t seen your case in person, it is difficult to tell you exactly what happened with your case and what has caused your inflammation. However, here are some possibilities for what may have taken place.
This diagram illustrates how a porcelain veneer should fit on the front of the tooth, in relation to the gum tissue.
The most common issue with post-operative inflammation in cosmetic dentistry is likely due to excess cement not being removed or cleaned properly. This issue occurs more often in dentists who don’t do a lot of porcelain veneers in their practices. A cosmetic dentist who does a lot of porcelain veneers will have a meticulous system in place and likely will track the veneer by curing the cement near the middle of it and clean off any excess before it hardens. It is quite surprising that the excess cement was discovered during a routine cleaning and not when you went back into your cosmetic dentist when you initially brought this issue to their attention. That should have been one of the things they checked when you were experiencing and complaining of inflammation and irritation. Additionally, any excess cement left behind should have been addressed in the initial appointment when the veneers were placed.
Another thing that you mention is the extended period in which you wore temporary porcelain veneers. Five weeks is a long time to wear temporaries. If the inflammation was caused by the temporaries, the permanent veneers shouldn’t have been placed until your gums calmed down and were healthy again. If there was inflammation present, then there would have been issues with the bonding process. In your case, that doesn’t sound like what is happening.
If the veneers were placed too far under the gumline, that could also be a problem. Inflammation can be a result if the margin isn’t properly spaced and it is encroaching on the gum
Or it may be something entirely different. For example, it is possible that you are having a reaction of some sort or sensitivity to the porcelain or one of the agents that was used. This is not common but may be a possibility.
Etching doesn’t sound like the issue here either since the veneers seem to be staying in place and it hasn’t caused an issue with the veneer bonding to the tooth.
All that to be said, I realize that doesn’t help you directly or give you any specific cause or recommention. The best thing for you to do at this point is to seek a second opinion. If things are improving after getting the cement removed, then it is likely that the cement was causing the issue. And it should heal in time. If not, a second opinion couldn’t hurt.
This post is sponsored by Barrington cosmetic dentist James T. Gavrilos, DDS.