Porcelain Veneer Cracked

I had a set of 10 porcelain veneers done to lengthen my teeth. They are stunning and I’m in love with my smile. I’m not wealthy, but recently received an inheritance which allowed me to get the smile of my dreams. I went to the best cosmetic dentist around. I’m truly thrilled with the results. Here’s my problem. I can’t afford this office regularly. After I had my veneers done I planned on going back to my normal dentist for things like check-ups. I’ve only had the veneers for about 5 months and one of them has cracked. I’m a little embarrassed about going back and worried I won’t be able to afford it. The crack is horizontal about a fifth of the way up my lateral incisor. I’m worried it will fall off. What do you recommend?

Lizzie

Dear Lizzie,

A single porcelain veneer being placed

Normally, a well-bonded porcelain veneer will stay on even if it has a crack. However, because of the location of your crack and the fact your dentist had to add length to your teeth, I’m worried there’s not much bonding in that location to hold it on. Because of that, this needs to be repaired.

While porcelain veneers aren’t guaranteed to last forever, they’re certainly meant to last for more than the amount of time you’ve had them. In fact, when well taken care of, they can last for upwards of 20 years. I think your dentist will likely repair it at no charge or for a very low fee. I wouldn’t let fear of the cost stop you.

You were smart to invest wisely in an expert cosmetic dentist for your work. Don’t feel guilty about not being able to go there for your regular checkups. The best cosmetic dentists realize some patients come to them just for their cosmetic work and have all their general dental work done elsewhere at a more affordable practice.

If they ask you about scheduling your six-month checkup while you’re there, just be politely upfront with them about your financial situation. They shouldn’t be offended.

A Note on Porcelain Veneer Care

The best toothpaste for your porcelain veneers would be Supersmile. This is specially formulated for cosmetic work to keep it stain-free without damaging the glazing.

Because you’re going to your general dental clinic for your checkups, the hygienist might not be familiar with taking care of cosmetic work. Two things to tell her (or him) to avoid are a power prohy jet (or anything similar) and acidulated fluoride. Both of those will take off the glazing from your porcelain veneers. The glazing is what makes them so stain resistant. If that comes off, they’ll quickly start picking up stains and be ruined. Teeth whitening won’t fix them. They’d have to be replaced.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Can Dentures be Attractive?

I’m losing my teeth and have to decide between dentures and implants. I don’t want to spend a fortune, which is what implants cost, but I also want an attractive smile. I only know a couple of people with dentures. With one of them, their face looks pinched as if the dentures are too small for them. Another, the teeth look obviously fake. If I end up getting dentures, can they be made to look attractive?

Bethany

Dear Bethany,

An illustration of both a denture and a dental implant

Dentures can be made to look beautiful. Whether or not that happens depends on the skill of the dentist. Your friend who has fake looking dentures has a dentist who hasn’t invested in time in cosmetic training. The friend whose face looks pinched, it likely isn’t because their dentures are too small. Instead, they are likely facing what is known as facial collapse.

When your teeth are removed (or fall out), your body recognizes that. As a result, it wants to be as efficient as possible with the minerals in your jawbone. Without needing to support your teeth with them, it resorbs them to use elsewhere in your body. This has the unfortunate effect of slowly shrinking your jawbone. This is what has given your friend’s face that crushed look. Eventually, there isn’t enough jawbone left to even support your dentures.

This is something to consider before settling on getting dentures alone. The implant-supported dentures prevents this problem. Your dentist will place four to six dental implants in your jawbone. This enables your body to interpret this as you still having teeth. Because of that, it leaves your jawbone intact.

Getting Beautiful Dentures

Whether you get dentures or implant overdentures, you will want them to look beautiful. Finding an expert cosmetic dentist will do that. My recommendation is you look at the mynewsmile.com website. This website lists cosmetic dentists. A dentist can not just pay to be listed there, though. In order to be listed, they have to verify their post-doctoral training in cosmetics as well as show they have artistic skills by providing visual evidence of cases they’ve personally done.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

How Long Can I Wait for a Dental Implant?

I have a tooth where decay grew under the crown. My dentist doesn’t feel he can get it all out and recommended I see an oral surgeon to pull the tooth and then come back for a dental bridge. I’m not too keen on that so I’m thinking of seeing someone else about the decay. I’ve also been doing some research and it looks like a dental implant will be a better option for replacing a missing tooth. I’ve got fairly new dental insurance which has six more months of a waiting period before I can get any coverage for work done. If I pull this tooth, how long can I wait before there are problems?

Catherine

Dear Catherine,

illustraition of a dental implant next to natural teeth

I’m going to be blunt and tell you that you are not being well served by your dentist. Most skilled dentists will do everything possible to save a tooth. What does he mean he can’t get all the decay out? Has he tried and failed? Based on what you said, he didn’t even bother trying.

Next, he suggested a dental bridge instead of a dental implant. Your research is correct. Yes, it is a much better tooth replacement than a bridge. The one exception to that would be if the adjacent teeth already need dental crowns. If they don’t, then you are just grinding down healthy tooth structure.

I’m sorry, but this dentist seems too willing to get rid of teeth. You can do better. I’m going to highly recommend you get a second opinion on this tooth.

Don’t Wait before Getting a Dental Implant

If, after getting a second opinion, it turns out the tooth cannot be saved, I wouldn’t recommend waiting more than a week or two (at the most) with that space empty. The teeth around it will start to drift or tip into the space, making a replacement difficult.

In fact, it can lead to serious bite problems, which can cause TMJ Disorder. Just like cleaning out the tooth properly with a root canal treatment before getting your original dental crown would have saved you the problems you are facing now, making sure that space is kept open will save you a lot of pain down the road.

I’d recommend something simple and inexpensive, such as a dental flipper, to hold the space for you until your insurance will cover your dental implant. Truthfully, even if you received the implant today you’d need a temporary tooth anyway. The site where the implant is placed needs both time to heal and for the bone to integrate around the implant before it can support an implant crown anyway, so this isn’t an unnecessary step.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Finishing Invisalign without a Dentist

I have moved and have the last three sets of aligners left for my Invisalign. If my treatment has gone very smoothly, can I just continue the treatment on my own or do I need to find another Invisalign dentist in order to finish?

Mary

Dear Mary,

Clear Invisalgin Aligner

There are times when an Invisalign case is more complicated. For instance, when some teeth need to be shaved to make room or when buttons are necessary in order to grip the aligners and help them shift. You said your case wasn’t complicated. So, in all honesty, you could probably finish off your treatment without needing another dentist if you have the aligners.

If you don’t, you can ask your original dentist to send them to you or he can transfer all your information to another dentist. He is ethically obligated to send all treatment and diagnostic information to your new caregiver.

In all honesty, because you haven’t had any issues and it doesn’t seem like there have been additional treatment processes necessary, you can probably get along just fine without another dentist. That will give you time to settle in and find a new caregiver you are pleased with.

Retainers after Invisalign

In almost every case, after orthodontic treatment, there is a need for a retainer. This helps train the teeth to stay in place and doesn’t allow them to scoot now that they are free. The mynewsmile.com website has a great post about wearing retainers. Because your last pair of aligners have your teeth in their correct position, these can double as retainers, which means you won’t have to pay for a traditional retainer. I have a suggested method for doing this.

  • Month One: Wear them all the time.
  • Month Two: Wear them only at night
  • Month Three: Wear them every other night
  • Month Three Test: If it is harder to put your “retainer” in, that means your teeth have moved and you’ll need to go back to every night for a while. If they’re fine you can move on
  • Month Four: You can try using them once a week, then not at all. Just keep your aligners available to periodically check them.

You should know those aligners can also double as teeth whitening trays, so when you’re ready to whiten your teeth, just ask your dentist for some gel.

Best of luck on your new location!
This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.