Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

May 13, 2011

Gum inflammation after porcelain veneers – a big red flag.

Dr. Hall,
I got 8 veneers in December of 2010. My gums continued to be tender and slightly inflamed for several weeks and I asked my dentist if this was normal. He looked at my gums and told me I just wasn’t flossing my teeth with good enough technique, and that was why my gums were inflamed.

Then at the beginning of March, I noticed a fistula above tooth #10 so I contacted my dentist immediately. He took x-rays at that time and told me I have a root canal and needed it treated ASAP. He brought another dentist into his office to do the root canal treatment, so I assumed that the dentist was an endodontist. The root canal treatment took 4 hours and my gums remained inflamed for 3 weeks (fistula still there). When I went back to the dentist with my concern, he then told me I needed an apicoectomy. At this point I asked if the dentist who had performed the failed root canal treatment was an endodontist, and when I found out it was a general dentist I decided to seek out a second opinion from someone else.

I went to Dr. —– (a dentist on the referral list), who has referred me to an endodontist who is “the best.” Dr. —– told me that most likely the area will heal on its own and there is no need for an apicoectomy. He said my gums were inflamed because there was cement on the veneers that was causing my gums to stay chronically inflamed! After Dr. —– scraped that cement off, it has only been a few days and already my gums are less tender than they’ve been in months.

Now I’m really concerned that some major mistakes were made with my veneers because the dentist did no wax-up and was not able to address any of my concerns with the esthetic look of the veneers after the procedure. (One tooth appears chipped, and the dentist told me it was “just the anatomy of the tooth.” Another tooth feels like it is cracked. And I’m not completely sure if the teeth are all completely vertical because they look slightly slanted or off-centered. They definitely look better than my teeth looked before getting the veneers, but I can’t say that look perfect or absolutely stunning. They just look like normal teeth.)

Basically, I want my money back for what he did to my teeth! It sounds like he was negligent in leaving concrete on the veneers, which caused my gums to remain inflamed. And then he did NOTHING when I told him that my gums were red, sore, and inflamed until it was too late. And then he was negligent again by bringing a general dentist into his practice to perform a root canal. According to Dr. —–, the x-rays show that the dentist did an “overfill” on the root of tooth #10 and this was why he was wanting to do an apicoectomy. Is there anything I can do to get my money back for these chipped, cracked veneers which caused me to have a root canal?
Jamie from Southern California

You have quite the interesting story. You’re a good example for people looking for smile makeovers – showing the need for an expert cosmetic dentist. I wish I had money to run ads on TV warning about that.

When you told me your dentist’s answer to your gum inflammation was that you should floss more, I knew you were in trouble. For anyone doing porcelain veneers, this is a huge red flag and is a big indication that the dentist did something wrong. One of the criteria I use to evaluate the cosmetic dentistry of dentists I list on this website is the health of the gums in the “after” photographs – they should be at least as healthy afterwards as they were before, if the work is done right.

Here’s the deal for your case. To get any satisfaction, you’re going to have to be willing to make the dentist worry that you’ll be trouble for him. I’m sorry to have to put it that way, but I’m basing this on the way he has treated each of your complaints so far – dismissive, not truthful. He needs to worry that this could turn into a peer review case, or could get to the dental board, or could result in a malpractice action. And if you can get him worried about this, that is what will motivate him to refund your money.

And then you need to realize that your esthetic complaints won’t go very far. Since cosmetic dentistry isn’t a legally recognized specialty, the standard of care for esthetic work is the level of quality that would be expected of an average dentist, which is pretty low.

But you do have two areas of common negligence – the cement left behind, which caused gingivitis, and the root canal overfill. Both of these caused pain and suffering, and have threatened the health of your teeth. So you need to let him know that you are aware of these problems, and also let him know that you have another dentist to back you up on these claims. If you were to bring an action against this dentist, having another dentist willing to testify to the negligence is necessary. I wouldn’t reveal the name at this point, but I would let him know that you have that “arrow in your quiver.” And the fact that a general dentist did the root canal is not of itself a problem. Many general dentists do great work with root canal treatments, especially on front teeth, which are pretty easy. But there does seem to be an issue of competence with the dentist taking four hours to do a root canal that should have taken half an hour.

So I would tell this dentist that you have been to an expert cosmetic dentist, a dentist of international prominence, who told you that he had been negligent, but that you want to make it easy for him, so all you’re asking for at this point is a refund.

I hope this is helpful.

I’d be interested to know how this turns out. Please write back and let me know your next step and what your dentist says.

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

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