Dr. Hall,
I had 10 porcelain veneers placed and two crowns on each side 2nd to last tooth. The final temps looked and felt great. When the permanent teeth were put on I was having trouble speaking. Biggest problem is my tongue is very uncomfortable. It feels like it is too big for my arch and resting on the back of my bottom front teeth.
What is making my tongue sit low in my mouth. My dentist can’t figure it out. Could it be the back of front teeth are too thin? or maybe the two crowns that were put on premolars?

Thank you,
Susan from New Jersey

Susan,
It’s going to be hard for me, not seeing your case, to really tell what is wrong. But your question gives me a helpful starting point for saying something about smile makeovers and speech.

As far as your case, porcelain veneers, if that’s what they are, in most situations shouldn’t be affecting your tongue or your speech. They sit on the fronts of your teeth, so your tongue shouldn’t feel any difference. But some dentists actually do porcelain crowns for smile makeovers and call them porcelain veneers, so that’s a possibility for you. Crowns cover the entire tooth.

If you do get a smile makeover of porcelain crowns, that will have the potential to affect your speech. Expert cosmetic dentists are trained in the effect of the teeth on speech and will be careful about the contours of the crowns and how they affect your tongue. The thickness of the crowns on the lingual surfaces (the insides of the crowns) will affect the pronunciation of certain letters. The length of the front teeth and the positions of the incisal edges of those teeth will affect other letters. The height of back teeth will affect others. To assess all these effects, any new smile that changes any of these critical measurements in your mouth should be tested in provisional restorations first, and the provisionals should be adjusted to accommodate your speech to where they feel comfortable to you before the design is finalized in porcelain.

But you said that the temporary teeth looked and felt great and you only had trouble when the permanent teeth were put on. Something isn’t right there. What is usually done is that an impression is taken of the temporary smile makeover and that is sent to the dental laboratory so that the ceramist can duplicate that result in porcelain. That must not have happened exactly that way in your case. Either the dentist didn’t send those models to the ceramist (maybe only a photograph) or the ceramist didn’t follow the instructions.

Having said all that, ordinarily patients will adjust to new positions of the teeth and speaking will feel normal to you again after a while. If a couple of months go by and you still have problems, I would insist that it be fixed, even if it involves re-doing the case and/or referring to a different dentist.

Dr. Hall

Follow-up – Turns out, this was just the beginning of Susan’s problems. Read what happened to her when the dentist tried to fix the problems and what Dr. Hall said in response. See the follow-up to problems speaking with new porcelain veneers.

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