Dear Dr. Hall,
I had full mouth smile makeover done (veneer crowns) in January 2017, 12 upper teeth and 10 lower teeth. After they put permanent crowns on, I felt sharp pain on teeth #5 and #13 (upper second premolars). The dentist did crown height adjustment 3-5 times, finally the pain went away, but tooth abscesses formed on top of both #5 and #13 teeth within 4-6 weeks. The dentist x-rayed and said the teeth nerves had died, and I need root canals. I was upset and didn’t realize that nerve damage could be a risk involved in veneer crowns. I remembered I asked if there is any risk doing smile makeover during consultation, I was told there is no risk. The X-ray showed that my teeth nerve are fine before the procedure. I am confused and don’t understand what is going on.
The dentist said he didn’t know why, it rarely happened, I am the unlucky one. He referred me to an endodontist to perform the root canal procedure, and the endodontist found more teeth showing no response to cold test, also my gum flared up, swollen and very painful. So far I have had root canals done on 4 teeth (#4, #5, #13, #14), and #12 needs a root canal too, just matter of time. The tooth #3 starts feel strange too. Dr. did agree to pay half of the cost of the 4 root canals, but I am worried it will be an ongoing nightmare. What if the crowned teeth one by one goes bad over the time? I am very frustrated and feel misled. It not only financially cost me, but also add lots of stress on me. Please tell me what i should do and I need some advice. Thanks!
Sincerely,
Jenny from Texas
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Jenny,
To answer your question, I first need to lay down some terminology so we’re clear in what we’re talking about. I’m a big fan of clarity in communication, which requires precisely defining what words mean.
Porcelain Veneer Preparation
You’re saying you had “veneer crowns.” But a porcelain veneer is one thing and a porcelain crown is something very different. A porcelain veneer requires very light shaving of the front surfaces of the teeth—sometimes no shaving at all is required. I found this photograph that illustrates a typical porcelain veneer preparation. Maybe half a millimeter of tooth structure has been shaved off, and the porcelain will be bonded over this.
Porcelain Crown Preparation
This second photograph shows a typical porcelain crown preparation for the same two front teeth. Much more tooth structure has been removed.
It appears from your description that what you had done were porcelain crowns, not porcelain veneers. It is very rare that a porcelain veneer preparation on a tooth will end up making it need a root canal treatment. But a crown preparation will go much deeper into the tooth, increasing the risk of a pulp exposure, resulting in an infection of the pulp and the need for a root canal treatment.
A smile makeover, by itself, does not require any aggressive grinding down of the teeth, which is what must have been done in your case. If your teeth had large fillings or decay before getting your makeover, then grinding them down was necessary. If that is the case, it wouldn’t be surprising if some of those teeth ended up needing root canal treatments. Anytime there is a lot of decay or large old fillings, there is a risk of teeth getting infected. But I would call that procedure a full-mouth reconstruction, not a smile makeover.
But if this that you’re calling a smile makeover was just for aesthetic reasons, then your dentist was much more aggressive than he needed to be, and I believe he should be responsible for the cost of the damages he caused. If you weren’t told of any of these risks up front, he is especially vulnerable.
A smile makeover should be done with porcelain veneers whenever possible, to avoid problems like you are having. There is even a trend in recent years for excellent cosmetic dentists to place what are called ultra-thin porcelain veneers, which require even less preparation than is shown in the photograph above. Some even try to do the makeover without preparing the teeth at all. But many dentists who aren’t expert in cosmetic dentistry simply don’t know how to do porcelain veneers very well, and so they resort to full coverage crowns. Porcelain veneers aren’t taught in dental schools—they’re a cosmetic procedure for which a dentist should get post-graduate education.
As far as what you should do now, I don’t know what to tell you. You don’t really have any option, if you want to save these teeth, besides having the root canal treatments done. And it’s curious that your dentist is offering to pay half the cost of the root canal treatments. This seems to indicate that he is feeling some guilt over this. If that’s the case, I would press him to pay the whole thing.
About what to expect long term, it’s hard for me to tell for sure from here. My guess would be that any teeth that end up having problems, you will find out within the first few months and then things will stabilize.
Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
Dear Dr. Hall,
Thanks so much for your reply. Yes, I should be more accurate about the procedure that I have received, it is porcelain crowns, full mouth restoration. I agree that my dentist took more aggressive approach than it is necessary, and I was not fully informed. One thing I forgot to mention is that although I don’t have any cavity or fillings, I do have habit of grinding teeth for years. Is it possible that I am not a good candidate to have such an invasive procedure due to teeth grinding? and as result, it causes nerve damage.
Sincerely,
Jenny from Texas
Comment from Dr. Hall:
Jenny,
If you grind your teeth severely and have worn them all down, yes, often then a full-mouth reconstruction may be needed, which is what you had—crowns on all, or almost all of the teeth.
This type of procedure is one also that a dentist needs more than a dental school diploma to be qualified to treat. There are some excellent post-graduate institutes that teach complex restorative dentistry, which is what this is when a dentist rebuilds the entire bite. There are the Dawson Academy and the Pankey Institute both in Florida, the Las Vegas Institute for Advanced Dental Studies, and Spear Education in Arizona are all postgraduate training institutes that can train dentists in doing this type of work.
If your dentist doesn’t have any of these credentials, it still may be that he did everything right, but I would get a second opinion from a dentist who has graduated from one of these centers just to look over your case.
– Dr. Hall
Hi Dr. Hall: I have eight front porcelain veneers. I recently thought I had a sinus infection due to swelling and pain in my cheek, next to my nose. I went to Urgent Care and told the doctor I thought I had a sinus infection, as I had them before. He said I could have a periapical tooth abscess. . . .
– Gail
Gail goes on to tell her who story, and her question, I think deserves its own blog post, which you can find here: http://www.mynewsmile.com/blog/root-canal-ruin-porcelain-veneer/