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Floss is catching under her veneer

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Dr. Hall,
I just got a veneer, but when I floss the floss seems to catch under the veneer. I talked to my dentist about this and she says that it should be fine since my gum is covering it but I don’t think is normal since germs can get lodge inside and make it easier to get a cavity. And getting a cavity so close to the root would be awfully and probably need more treatment.
I want to explain more what I mean when I say it goes under. I floss hug my teeth when I get to the gym line and surround it my floss completely disappears and I can feel it under.

– Dotti from San Francisco

(See Dr. Hall’s answer below.)


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Dotti,
a drawing showing a thin porcelain veneer over the front of an upper incisor toothIt sounds like you have an overhang, and, if I am understanding you correctly, I disagree strongly with your dentist. An overhang is a margin irregularity that comes from the dentist having problems with the impression that was taken after your tooth was prepared for the veneer. The impression didn’t accurately record the end of the preparation making it so the laboratory technician couldn’t create the veneer to leave a smooth finish line between the veneer and the tooth. drawing of a thin porcelain veneer over an upper incisor tooth, showing a slight overhang where the veneer doesn't meet the tooth smoothlyThe end result needs to be that the veneer replicates the original contour of the tooth at the gumline, as shown in the top drawing on the right. The bottom drawing shows a slight overhang—there isn’t a perfectly smooth transition from the veneer to the tooth. If that occurred with a veneer I had placed, I would replace it for no charge.

There are two significant problems with having an overhang on a dental restoration. Yes, you are correct that it can lead to decay just under the margin. That happens sometimes. But it almost certainly will irritate the gums and lead to gum disease. I would expect the gum to be at least a little puffy around this tooth, and maybe even red and bleeding.

What to do? I would ask your dentist to replace the veneer. If she refuses to do that, you will maybe need to find another dentist to replace it and you will have to pay for that. In the meantime, I would be sure to floss this area carefully, getting the floss under the overhang. Floss at least once a day.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

Is rinsing with peroxide harmful to veneers?

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Dr. Hall,
I had six porcelain veneers done in South America, and now I have redness and swelling. Someone told me I could rinse with peroxide to help get rid of the inflammation. Will that damage the veneers?
– Claire from Georgia

(See Dr. Hall’s answer below.)


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Dear Claire,
No, peroxide won’t have any negative effect on your porcelain veneers. But let me explain why that won’t solve your problem.

There is something wrong with your veneers and it needs to be fixed or you’ll continue to have serious problems with gum disease on these teeth. While dental tourism is a way to save money on dental care, the risk is that you have a lot of poor quality dentistry in other countries and there are very few legal protections that you get in those countries. I even received one email from a distraught patient who had serious difficulty with dental work done in Costa Rica and discovered that she broke the law and she had to flee the country because they wanted to prosecute her for complaining publicly about the dentist.

Here are the possible issues that could be causing your gum inflammation:

  • The veneers don’t meet your teeth under the gumline precisely. The margin between the porcelain veneer and the tooth needs to be seamless and smooth. If there is what we call an overhang, it will catch food debris, be a breeding ground for bacteria, and be a permanent irritation to your gums.
  • The veneer can be overcontoured at the gumline. If there is an extra bulge in the veneer at the gumline, that can also provide a trap for food debris and bacteria and cause gum inflammation.
  • There can be hardened cement that hasn’t been cleaned off the tooth. This will leave a very rough surface there.

If the underlying problem hasn’t been fixed, there is nothing you can do to protect your gums. If a cosmetic dentist applies for accreditation with the American Academy of Cosmetic Dentistry, one of the first things the examiners will check in examining his or her work is whether or not the gums of the affected teeth are healthy. If they aren’t healthy, the dentist won’t pass.

Then we need to address possible complications in using a peroxide rinse to treat gum inflammation.

Peroxide will kill the bacteria in your mouth and can be used to fight gum inflammation. But there is a complication with that. There are a number of strains of bacteria in your mouth, not all of them bad. There is also a yeast organism in your mouth—candida albicans. This yeast, if it is allowed to predominate, can cause thrush, a painful inflammation of the mucosae in your mouth. Nutritional deficiencies can allow this yeast to predominate. Another way to allow this is to kill off the bacteria in your mouth with a peroxide rinse (peroxide will not kill the yeast). To avoid this, you don’t want to rinse with peroxide longer than two weeks.

So, no, peroxide won’t damage your veneers at all. But that can’t be a permanent solution to gum inflammation.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

Bleeding between my two front crowns

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Dr. Hall,
In 2016 I had 6 anterior crowns placed. I have had problems with bleeding between 8&9 (the front two teeth) and sloughing of skin. I asked for a certificate of the alloys used but received no real information as to the composition of alloys used. I did note, however, that e.max was not referenced in this “certificate” but instead GC LiSi Impress. I have tried researching the materials in this product but quite honestly the only thing I can find, besides the marketing from the company, is a thread started by lab technicians. Can you tell me anything about this product?
Thank you.
Carol from Huntsville, AL

(See Dr. Hall’s answer below.)


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Carol,
I’m assuming that all the crowns were made from the same material. So, if you were allergic to the crowns you would be having inflammation and discomfort around all of them, not just between the front two. Also, I have not heard of an allergy to dental work causing bleeding. This sounds more like there is some problem with catching food particles or some other functional problem between those front two teeth—a margin that has an overhang or something in the shape of the crowns that causes food particles to get trapped there. My recommendation would be to be sure you floss there. And then, if you floss, notice if there is a ledge under the gum that catches your floss—this would indicate an overhang that your dentist needs to correct.

As far as the material in the crowns, it sounds like it’s GC LiSi Press. The reason your dentist couldn’t give you an identalloy certificate is that certificate shows the metals in the crown, and these crowns are metal-free. GC LiSi Press is a high-density lithium disilicate. I haven’t heard any reports of allergy to lithium disilicate, and researching it right now I can’t find any credible reports of documented allergy.
– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

Her Gums Are Inflamed After Getting Veneers

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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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Anna,
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.

close-up photo of a smile showing gum inflammation on the lateral incisors

This is a photo of a case where porcelain veneers were done on the two lateral incisors. The gum inflammation showing on these teeth would cause this case to be rejected by AACD accreditation examiners.

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—something called an overhang. 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

Read about other cosmetic dentistry horror stories.

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

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.

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