I have a cavity on a tooth that has a veneer and my dentist wants to take the veneer off and replace it with a crown. This seems strange to me. What would you suggest?
Connie from Littleton, CO.
(See Dr. Hall’s answer below.)
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There are several things to consider here. I wish I knew a little more about your case, this cavity, and your dentist, but my gut reaction is not to let this dentist replace your porcelain veneer with a crown. I would get a second opinion, and I will explain how to go about that and why. And I would like to explain a couple of other things about your situation.
First, the chances that this dentist and his dental laboratory will be able to match the crown to the veneers on the rest of the teeth are slim. Maybe 2% of dentists would be able to do this. I have a number of emails from frustrated patients whose dentists tried to match a crown to a porcelain veneer with poor results.
Second, you don’t say how big this cavity is, but it would need to be pretty big before a crown would be needed. While a porcelain veneer is very conservative, with only a small amount of enamel needing to be shaved on the front of the tooth, a crown on a front tooth is a very aggressive treatment, requiring the tooth be ground to a stub. You would need to have a substantial portion of the tooth decayed before a crown would be justified, like at least 20% of the tooth or more. While I don’t know the specifics, my suspicion is that this dentist is very unfamiliar with porcelain veneers and feels much more comfortable doing crowns, and that is what is driving this preference. Also, the cavity may be on the edge of the porcelain veneer (that’s the most susceptible place on a porcelain veneer tooth for a cavity), and your dentist may not have the training or the equipment needed to bond the composite filling to the veneer, which will need to be done to get this filling to last.
If you have or want porcelain veneers, it is very important to understand the difference between a general family dentist and an expert cosmetic dentist. I won’t try to give much advice about that in this post. I discuss that on the home page of this website, linked in the previous sentence. If you have a smile makeover with veneers and your regular maintenance dentistry is done by a family dentist, when you have some maintenance work on your veneers, I would ask for a polite leave of absence from the family dentist and have an expert cosmetic dentist help you with that need. If it required substantial travel, it would be worth it. Most family dentists will claim to be able to do cosmetic dentistry because they don’t want to lose that business. But it takes a rare artistic inclination and a certain passion to be able to do it well. I have a file full of emails from patients who had beautiful work done by a previous dentist that was ruined by a subsequent dentist who simply didn’t have the artistic inclination and training needed. Find a dentist recommended on this website, or find one who proudly displays beautiful work on his or her website, with a clear indication that the dentist actually did that work.
Note that I am not flatly saying that this dentist is wrong. While unlikely, it is possible that he or she is an expert cosmetic dentist and that this cavity is large enough to justify going to a crown. I am just strongly recommending that you get a second opinion.
Finally, just a comment on how to avoid this situation. When you’ve got porcelain veneers, your teeth become particularly vulnerable to new decay right at the margin where the porcelain meets the tooth. The good news is that it is not difficult to prevent this decay. Limit your frequency of eating, because each meal or snack launches a separate decay attack. It’s not how many sweets you eat—it’s how often you snack. And floss faithfully every day. Flossing will clean that margin.
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