Tag Archives: getting a second opinion

gums inflamed after porcelain veneers

I had porcelain veneers placed on four teeth almost a month and a half ago. Since they’ve been on, my gums have been inflamed. I went in to see the hygienist and she said it is probably that I’m babying the teeth and not brushing well enough. I can assure you that is not the case. Then, at my one-month follow up the dentist removed some excess cement. That helped a little but it has been a week and a half since then and they are still inflamed. My dentist doesn’t seem concerned but I’m worried, not to mention in pain. What do you recommend?

Kay L.

Dear Kay,

Our experience has been patients love their new smiles so much, after getting porcelain veneers, they tend to take better care of them, not worse. Isn’t it a tad annoying when medical professionals blame the patient when they can’t figure out what is wrong?

Cosmetic dentistry is both an art and a science. The health of the gums is one of many things the American Academy of Cosmetic Dentistry looks at in evaluating cases when dentists are working toward accreditation.

The lateral incisors, in this case, received porcelain veneers. Because of the gum inflammation on these teeth, this case would be rejected as unacceptable by AACD accreditation examiners.

In the case above, the gum inflammation on the lateral incisors would be an indication this dentist did something wrong, causing the case to be rejected by accreditation examiners as a means of demonstrating competency.

While there are several reasons your gums could be inflamed, I’m leaning heavily toward your dentist not removing all the excess cement. You said he removed some at your one-month follow-up appointment. When done properly, all the excess cement would have been removed immediately after they were bonded. There shouldn’t have been any to remove at the follow-up appointment.

A couple of other possibilities would be uneven margins or the porcelain veneers going too far under the gumline. To truly know what is going on, though, you’re going to need to see an expert cosmetic dentist.

Getting a 2nd Opinion from an Expert Cosmetic Dentist

The first thing I want you to do is go to the website of the American Academy of Cosmetic Dentistry. (aacd.com). They have a link to find a cosmetic dentist. However, make sure you check the boxes for an accredited dentist. Membership is easy. AACD accreditation requires real skill.

Pick one which is reasonably close to you and schedule an appointment for a second opinion.

Finally, make sure when you go, you get a “blind” second opinion. This means you won’t tell them which dentist did the work or anything they said could be the problem. You want the accredited dentist to give his unbiased opinion without anything to sway him.

Best of luck.

This blog is brought to you by Lousiana Cosmetic Dentist Dr. Mike Malone.

porcelain crowns turning yellow

I had some porcelain crowns done about six months ago. When I first received them, they were beautiful. I loved how they looked. Unfortunately, they are already turning yellow. I don’t think it is anything I’m doing. I do drink one cup of tea in the mornings, but water the remainder of the day and I brush regularly. Do you know what’s going on? I thought they were supposed to be stain resistant.

Elaine

Dear Elaine,

woman smiling with a dentist

Yes, porcelain is very stain resistant. That means, if you truly have porcelain crowns, something went wrong. I haven’t seen your crowns so it is hard for me to tell you exactly what happened. However, I can give you some possibilities.

If you see a general dentist who doesn’t do much cosmetic work, then it is possible the hygienist or the dentist did something to damage the glaze on your porcelain crowns. It’s been six months since the crowns were placed and that is about the time you would have gone in for a checkup and cleaning.

Some things which damage the porcelain include:

  • The hygienist using a power prophy jet during the cleaning process. This would feel fine at the end of your appointment, as well as look normal, but the glaze would be gone and you’d quickly begin to pick up stains regardless of how good your oral hygiene was.
  • Acidulated fluoride. Some dentists use this, but it will chemically eat away at your glaze.
  • If your dentist made any adjustments to the crown, he could have ground away some of the surfaces.

Get a Second Opinion from a Qualified Dentist

As I mentioned earlier, not all dentists are familiar with cosmetic work. Because of that, they may not even recognize what went wrong with your crowns.

I’m going to suggest you see an expert cosmetic dentist in order to get a knowledgeable second opinion. To find that level of expertise, I’d like you to go to the mynewsmile.com website. Any dentist they recommend, will have the knowledge you need to get to the bottom of what is going on with your crowns.

It’s important you follow some basic guidelines when getting a second opinion to make sure the dentist isn’t influenced in his or her decision. Dr. Hall has a post on porcelain crowns. In the last paragraph, he gives some tips on getting an unbiased second opinion.

This blog is brought to you by Lafayette, LA Dentist Dr. Mike Malone.

Do CEREC Crowns Last Longer than Regular Crowns?

My dentist told me I need three crowns. I was shocked because my last checkup didn’t show any decay. He wants me to get CEREC crowns. I like the fact that they can be done in one appointment. But, my insurance only covers the older crowns. Is it worth the extra cost? Do they last longer than the regular crowns?

Elliot

Dear Elliot

Machine for CEREC Crowns
CEREC Crowns are Milled by Computer

When you’re talking about the longevity of crowns, it’s not as much whether you use CEREC or traditional. The length of time any crown lasts, regardless of the kind, depends on two factors—the skill of the dentist and the habits of the patient.

On the patient end, it’s important you keep up with your home care. Regular brushing and flossing are a must. The dentist has several responsibilities. They have to choose the right materials. They have to know the proper techniques for attaching the crown. Traditional crowns are cemented. CEREC crowns are bonded, which is a completely different (and more involved) technique.

Two dentists can make the same crown. One will last five years; the other will last ten. It wasn’t a difference between the type of crown as much as the skill of the dentist. Don’t hesitate to ask your dentist how long his crowns typically last.

The Differences Between CEREC and Traditional Crowns

There are two advantages to CEREC crowns. The most obvious one is you can have all three of your crowns completed in one visit. Second, they’re milled by a computer which generally helps with their fit. They’re actually great for side teeth. Some cosmetic dentists don’t like placing them on front teeth because they’re milled from a single block of porcelain. In that case, they feel they can craft them better traditionally.

Another weakness for CEREC crowns AND traditional all-porcelain crowns are on back teeth. They can’t always hold up to the pressure of the biting forces your molars have to take. In that case, you’d want either a metal-based crown or a zirconia crown if you have any metal sensitivities.

No matter what crown you choose. Once the crown is made, the color is permanent, so if you’ve been considering teeth whitening be sure to do it before you get your crowns if they’re in a visible place. If they’re all back teeth, that won’t matter. You can get your crowns and then whiten later.

Consider a Second Opinion

One thing you said bothered me. You mentioned your last checkup showed no signs of decay and suddenly you need three crowns. That sounds just a bit hinky to me. While it’s possible that you could have decay that spread quickly, if you get regular cleanings there should have been some sign of decay.

This blog is brought to you by Dr. Mike Malone.

Unhappy with porcelain veneers

My daughter had four porcelain veneers placed on her front teeth to help with some crookedness. We couldn’t do orthodontics because of some previous damage. He was afraid the teeth couldn’t take the movement. Unfortunately neither she nor I are happy with the results. They just don’t look as natural as we were led to believe, yet our dentist insists they look gorgeous. We didn’t even get to see them before he bonded them on. Can we get our money back? Why do people rave about porcelain veneers if they look so fake?

Desiree B. from Boston

Desiree,

Actually, porcelain veneers, when done artistically, look fantastic. I suspect your dentist is not a true cosmetic dentist. One of the problems with cosmetic dentistry is that any general dentist can call themselves a cosmetic just by learning a few procedure. Unfortunately, it takes significant post graduate training to become artistic enough to make porcelain veneers not only natural, but beautiful.

A true cosmetic dentist would try on the veneers with a temporary paste and let you look at them in several different lights. They would want to be sure you were absolutely thrilled with them before they bonded them on permanently. Another thing that makes me suspect your dentist isn’t a true cosmetic dentist is that he tried to convince you the veneers were beautiful. In dental school we are taught the dentist knows best. But, when it comes to cosmetic dentistry it is the patient who knows best. We are treating your self esteem. If you don’t love them, it’s not done.

As far as getting your money back, that might be tricky. If the only thing wrong with them is you don’t like their appearance, he has no legal obligation to give you your money back. You could try.  I would also go to a truly qualified cosmetic dentist and get a second opinion. If at all possible, go to a dentist outside of your area and don’t tell him who the dentist was. See if the second dentist thinks the work was done poorly. That may help your case.