Hi there Dr. Hall,
Two months ago, I had veneers put on my two upper front teeth. Since then, they have been inflamed, as well as one of the little teeth next to them. The cosmetic dental assistant told me she’s never seen this before and doesn’t know what is causing it, so it must be my brushing—as if I am not doing that enough and instead babying my teeth. However, I am a 48-year-old adult who knows to follow the rules and have followed them religiously. I keep my teeth very clean. But no matter what I do, they seem to stay inflamed and kind of burn a bit. After a month of this, at a routine follow up the dentist took a look at this and began to remove some of the cement and grind down the rough surfaces behind my teeth. That helped a little, but it’s still inflamed.
Given that this cosmetic dentist doesn’t seem concerned, I am wondering about next steps. Obviously, I don’t want this to turn into something worse. I am also wondering if this could all be caused by lack of cleaning the teeth during the veneer placement process. I had read that cleaning after temporaries was standard, but the dentist said that no, the etching she does would be sufficient. It didn’t seem like she was etching my entire teeth, and I had had to keep the temporaries on for five weeks before I could even get in for the actual veneers (due to them being booked up and then needing to make a cancellation). I did see a periodontist who said the margins seemed okay but that I should come back in a few months if the redness and inflammation had not resolved. What do you recommend I do, moving forward, to protect/save my teeth.
Anna from Minneapolis
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Isn’t that maddening when a professional falsely accuses you of something like not brushing well enough? The truth is that it is more likely that this dentist did something wrong.
When cosmetic dentists take their clinical examinations to become accredited by the American Academy of Cosmetic Dentistry, one of the things the examiners look at closely is the health of the gum tissue around their work. If that gum tissue isn’t healthy, they will not pass.
After getting cosmetic dental work, patients are almost always conscientious in their oral hygiene. There are exceptions, but most patients, out of love for how their teeth now look, are very good at taking care of them. Now without an examination I can’t tell you for sure what went wrong in your case, but let me give you the possibilities.
The most likely cause for post-op gum inflammation would be not cleaning off all the excess cement, some of which can easily get under the gumline. This is a particular problem with dentists who don’t do a lot of porcelain veneers. Dentists who do a lot of porcelain veneers will have a system for tacking on the veneer by curing the cement in the middle of the tooth and then cleaning off the excess cement while it is soft. What makes me extra suspicious that this happened in your case is that you said that at your one-month follow-up visit, your dentist removed some of the cement. All the excess cement should have been removed the day the veneers were seated.
Another possibility is that there is some irregularity in margins—some unevenness where the veneer meets the tooth. Now you said that you saw a periodontist who said that the margins “seemed okay.” To me, that is less than a ringing endorsement and it leaves me to wonder. Plus, if the periodontist is one that your dentist sends patients to, the periodontist will be very reluctant to criticize the work of the dentist. So I would keep that as a possibility. A better way to find out would be to go to an expert cosmetic dentist from our list and get a blind second opinion—one given without knowing who the dentist was who did the work.
Also, extended wearing of temporaries can cause gum inflammation. You said you did wear yours for five weeks, which is awfully long. However, inflammation caused by the temporaries would cause complications for bonding on the veneers, and it doesn’t sound like you had that problem.
Another possibility is that the veneers go too far under the gumline. If the margin between the veneer and the tooth is very close to the bottom of what we call the gingival sulcus, the veneer can encroach on what we call the gingival attachment and will cause inflammation.
A final possibility is that you are having a sensitivity reaction to the veneers. Allergy to porcelain or any other ceramic used for porcelain veneers is very rare, but there are known cases. I had a question on this blog recently from a woman who apparently had a rare sensitivity to zirconia ceramic.
So what to do at this point? I would recommend a blind second opinion. Trying to guess what has happened in your case, my best guess would be that there was cement left behind that your dentist later cleaned off a month later, which is why it is now starting to heal a little. And then it could well be that there is some minor irregularity in the margins which is causing the healing to proceed slowly.
I don’t think a failure to clean the teeth enough before placing the veneers would cause any gum inflammation. If the veneers are staying on, there was enough cleaning done. Etching ordinarily will clean off what needs to be cleaned for the bonding process.
– Dr. Hall
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