Gum Inflammation after Porcelain Veneers

I recently had a smile makeover done. The results improved my smile, so I’ve been very careful to be diligent with my oral health care. Since then, my gums have become inflamed. I went back to the dentist after a month and the hygienist tried to blame me for not brushing enough. When the dentist came in he did remove some excess cement which helped a bit. Should I ask for a recommendation for a periodontist?

Liza

Dear Liza,

It is infuriating when dentists blame the patient. We have always found when we do a smile makeover with porcelain veneers, the patients love their new smiles so much they are even more diligent with their care than they were before. It is much more likely that the dentist did something wrong. In fact, I know yours did.

Inflammed gums with porcelain veneers would fail an AACD accreditation review.

If a dentist is trying to obtain accreditation through the American Academy of Cosmetic Dentistry, one of the things the review committee will look for, in addition to the beauty of the results, is the health of the gums. For instance, if the picture above would have been submitted, it would have failed because the two lateral incisors are inflamed.

You mentioned that your dentist removed some dental cement at a one-month follow-up appointment. This should have been done at the initial appointment. A skilled cosmetic dentist will cure the cement in the center of the porcelain veneers and then remove the excess cement while it is still soft and cannot irritate the patient’s gums.

One issue, if your gums are still irritated after he removed some cement, that means there is still some there that needs to be removed. If that isn’t the issue, it could be that the margins of the veneers are off. This means the veneers aren’t flush the way they should be.

When the margins aren’t properly set, then things can get trapped there causing both irritation to the gums as well as decay underneath the veneers.

Getting to the Bottom of the Problem

You mentioned going to a periodontist. While they are gum disease specialists, they will be unlikely to be able to tell you what is the root cause of the problem. If it is the margins, the porcelain veneers will need to be re-done in order to protect your teeth.

I’m going to suggest that you have an expert cosmetic dentist look at this. Either go to an AACD accredited dentist or one recommended by mynewsmile.com. These dentists are all pre-screened for their technical knowledge as well as their artistry. They will know exactly what is wrong with the veneers and can advise you on what your next step should be.

If it turns out the margins are the problem and the dentist needs to re-do them, it should be done at your dentist’s expense, not yours.

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

Did Coconut Oil Damage My Tooth?

I have had a small amount of decay on my tooth. I prefer natural medicine and a friend told me if I used coconut oil it would heal my cavity. I’ve been using the coconut oil for 3 weeks and now my tooth is hurting something fierce. Did the coconut oil damage my tooth?

Caroline

Dear Caroline,

Woman grabbing her jaw from pain.

The coconut oil didn’t harm your tooth, but it didn’t help it either. I haven’t examined you, so this is just going on an understanding of basic dental and tooth function, but I suspect your decay went deep instead of wide and now you have a tooth infection.

Unfortunately, this is going to take more work than if you had just gone to the dentist when the decay first appeared. I realize you were doing your best to take care of your oral health based on the information your friend gave you, but that information is false.

At this point, we don’t have anything that can heal a tooth, especially something as simple as using coconut oil. If we did, we’d certainly market it. Think of how many more people would come to the dentist’s office if it meant healing their tooth instead of filling it.

To date, the only way we have of dealing with decay is to physically remove the decay. That is done with a filling, a root canal treatment, or an extraction.

Where do you go from here?

Any time there is tooth pain, it is considered a dental emergency. You don’t want to chance leaving an infection to spread. That can be very dangerous because of how close your heart, lungs, and brain are to your jaw. It is much safer to deal with it right away.

Because you prefer natural medicine, I am going to suggest you see a mercury-free dentist. This way, if you need a filling at all, it will be a composite filling, instead of an amalgam filling which is loaded with mercury.

It is always better to nip these things in the bud instead of letting it develop too far.

Best of luck to you. I’m sorry this happened. I’m sure you are very careful with your teeth.

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

Pain after Filling

I recently had a silver filling replaced with a composite filling. I was careful to go to a mercury-free dentist so they would know how to safely remove the silver filling. It’s been a couple of weeks and I am still having some weird sensitivity and pain. Here are my specific symptoms:

  1. Medium pain when chewing
  2. Mild sensitivity to cold
  3. Tingling in lower right jaw where the filling was replaced

Does this mean there is something wrong with the filling or is this normal?

Luke H.

Dear Luke,

Man holding his jaw in pain

I appreciate how thorough you were in listing your symptoms. The only additional thing I wish I knew was how large and/or deep the filling was. Additionally, I wanted to add that it was wise of you to go to a mercury-free dentist for this filling replacement. Too many patients think any dentist can remove their amalgam (silver) fillings and end up swallowing or inhaling a lot of mercury. Going to a dentist who knows how to do a sanitary amalgam removal is imperative.

Now, onto your question. I’ll go through your symptoms one by one and do my best to point you in the right direction with this filling.

Pain When Chewing

Because your pain is moderate, there are two possible causes that come to mind. The first is if the filling was large, it could have changed your bite somewhat. A second possibility is trauma to the ligament. Our teeth have ligaments attached to help them. The filling process could have caused some aggravation or trauma to that ligament. This should get better over time. I would take some ibuprofen to help with the pain and give it some more time.

Let me differentiate this from sharp pain, for the benefit of others reading this. Sharp pain when chewing is indicative of bonding failure. In that case, you’d want to have the filling replaced.

Sensitivity to Cold

While this is a routine problem with silver amalgam fillings, it also can happen with composite fillings if the decay was deep. This is because the dentist has to get close to the pulp and it can irritate it making it sensitive.

As long as this is getting better over time, then this is a normal issue and nothing to worry about. If it does not get better or worsens, then further diagnostics are needed.

Tingling in Jaw

This seems to indicate to me that your dentist used some numbing medication and hit the sweet spot directly. The nerve he or she was aiming for goes to the teeth, lip, and chin. Some residual tingling is normal when the dentist was so close. (A good thing for you during the procedure). This will gradually wear away and be of no concern.

If you get to four weeks and there is no improvement or the pain increases, I would see an endodontist and have them x-ray the tooth. They are great at radiographic diagnosis. They can let you know if a root canal treatment is necessary.

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

Durathin or Lumineers?

I plan on getting a smile makeover but am having a hard time deciding between Durathin or Lumineers. So far, I like the images of the Durathin veneers better. Is there a huge price difference between the two?

Evelyn

Dear Evelyn,

A dental tool holding up a porcelain veneer

I want to try and make a course correction about how you are going about this. Instead of thinking about porcelain veneers as an item purchase, you would be closer to reality if you thought about it as commissioning an artist to create a portrait.

In that case, you wouldn’t be deciding between what brands of paint you want for the portrait, you’d be considering the skill of the artist and letting them choose the best paint for the job.

Creating a smile makeover is an art form. Unfortunately, it is an artform that isn’t taught in dental school. A dentist has to choose to get that training post-doctorally. What you need is a dentist who has invested a significant amount of time in training and developing their technique and artistry. They are the ones who can provide you with a stunning smile.

One thing you will find is not many of them like the Lumineers brand. This is because their company, insists you use their lab, which isn’t known for producing beautiful results. This also may be why you like the Durathin images better.

Proven Cosmetic Dentists

When you are looking for an expert cosmetic dentist to do your smile makeover, the best cosmetic dentists are AACD accredited. These dentists have passed stringent exams and have provided visual evidence of a large number of cases they’ve done, which is carefully examined by a panel of experts for both their technical skill and artistry.

Any dentist can join the American Academy of Cosmetic Dentistry, but only the ones who pass this rigorous process can be accredited. You will be pleased with any smile they create for you.

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