Without this, your gums will be puffy and not healthy. This is one of the critical things I look for when I examine photographs of the work of cosmetic dentists that I recommend on this website.
Were your veneers made by the laboratory this way? Or did your dentist simply skip the step where the excess cement is cleaned off?
There are situations, such as with advanced gum disease or creating support to hold in a bridge where some front teeth may need to be bonded together in order to strengthen them. But to create that situation for an aesthetic procedure is something I would consider completely inappropriate.
Correct Porcelain Veneer Bonding Technique
Here’s an explanation of a typical method of bonding on porcelain veneers, which I used, and which I believe is pretty much accepted technique among cosmetic dentists, or something very similar to this. After priming the surface of the tooth with the proper etching and bonding agents, I would place the bonding composite in each veneer individually and then press each veneer onto its corresponding tooth, which would cause excess composite to squirt out the sides. I would then remove much of the excess composite with a cotton roll and then begin to cure the bonding composite. This composite is light cured, and dentists use a special high-intensity curing light that emits a particular wavelength chosen so that it activates the hardening agent in the composite. But rather than cure the entire tooth, I would use an ultra-small light tip (a 2-mm tip is shown here) so that I would cure only the composite in the center of the tooth. This would tack the veneer in place so that I could floss around it without dislodging the veneer. After thus tacking all the veneers into place, I would carefully floss around the teeth, making sure that all the excess composite was removed and we were left with smooth surfaces between all the teeth.
Once that was done, I would go back with a larger curing tip, similar to the 13-mm tip shown here, and cure all of the remaining composite, so that the veneer was solidly attached to the tooth. Then I would finish the case by going between the teeth with fine polishing strips, leaving everything with an ultra-smooth polished finish.
Dentists who don’t do a lot of porcelain veneers may not stock this ultra-small curing tip. Not using a tool like this means a lot of extra work, because cleaning off the excess composite once it is hard is time-consuming and laborious. Of course, if they just skip that step, it’s quick and easy.
The first step I list on my page about how to take care of porcelain veneers after they are placed is “brush and floss faithfully.” If you don’t do that, you risk getting decay around the edges of the porcelain, and you risk losing the teeth to gum disease. Not good.
So I would go back to this dentist, share what I have given you here, and see if he or she can fix this so you can floss. Meanwhile, continue using your Phillips Airfloss–it’s better than nothing. But be sure you don’t put a mouthwash in it that contains alcohol. Alcohol softens the bonding composite around your veneers.
About your toothpaste, I would disagree with your dentists in the UK, that Oral B Pro Expert toothpaste is anything special for general dental hygiene. I don’t believe there is any toothpaste that is anything special for general use. I look at the ingredients in the Oral B toothpastes and I see stannous fluoride, which other toothpastes have. It’s a fluoride compound. I actually think that sodium monofluorophosphate is a better ingredient for delivering fluoride, but stannous fluoride is okay. Some of the Oral B formulas have tartar control agents, which other toothpastes also have. Some formulas have whitening agents, but other toothpastes have those and they don’t really work anyway. Some have antibacterial agents, which, again, are present in other toothpastes. Nothing unique or special here.
There are two toothpastes that are specifically designed for maintaining cosmetic dental work. One is Rembrandt toothpaste, which uses aluminum oxide as an abrasive, which is especially gentle. The other is Supersmile toothpaste, which cleans the teeth with an enzymatic action that actually dissolves the protein pellicle to which the stains attach. Because it is so gentle and thorough, that is my recommendation for maintaining cosmetic dental work, and when I placed a set of porcelain veneers, I started each patient off with a complimentary tube of Supersmile.
If you learn anything more about why your dentist made it so you can’t floss between your teeth, I’d love to hear from you.
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A substantial amount of tooth structure was removed during the procedure of 3 fillings in my molars. Those teeth were not painful, so I do not understand why it was necessary. The edge of one tooth was removed with the filling overflowing on that part to replace it. A little bit disintegrated, thus a bit of gum is exposed. Food gets stuck there fairly easily.
I am curious as to what type of filling material was used. I think it might be amalgam glass ionomer. It is a lighter colour than traditional amalgam fillings, and different in texture.
Also, how long should those fillings approximately last before they need to be replaced? I am only 20 years old, so I don’t know how what options I have to make those teeth more functional and aesthetically pleasing. I am distraught.
– anonrocker in the U.K.
I can only guess at the type of fillings you got. It would help to know on what basis you are saying these were amalgam glass ionomers. Kind of sounds like they told you something about it for you to use this term “glass ionomer.” And you don’t say what was different about the texture.
I’ll take your word that it was indeed a glass ionomer restorative and guess from there. There is a product called Miracle Mix that is a glass ionomer mixed with a silver alloy, so it has a grayish color to it. It is used usually as a buildup material for a large cavity when the tooth needs a crown, and the crown is then done over this restorative. I also used it as temporary fillings when a person had a lot of decay that needed to be arrested quickly and economically. Then we would either go back and drill off the surface of the Miracle Mix and do a composite filling on top of it, or we would do a crown over it.
Miracle Mix comes packaged in little capsules similar to the way amalgam is packaged, and it mixes in an amalgamator, also the same as amalgam. It is very quick and easy to use (i.e. cheap). There is no mercury in it
A nice feature of this restorative is that it has a high fluoride release, so it resists any recurrent decay on the tooth. Another nice feature is that it has a moderate chemical bond to tooth structure, so the tooth is unlikely to break around it. A not-so-nice feature is that it isn’t very wear resistant. It has kind of a gritty texture to the surface, and it will both wear off and dissolve over time, so that it will likely last only 2-3 years.
The good news is that your teeth are probably just fine for right now, except for the place where the food gets stuck. That should really be fixed because it will promote decay and gum disease in that spot. The bad news is that you’re going to have to have all these fillings fixed later. You shouldn’t need to have the fillings replaced–just re-surfaced with something more wear resistant. Go back to the dentist and ask if this was indeed Miracle Mix or some other similar glass ionomer restorative, and then go from there.
About the amount of drilling. While it could be that the dentist drilled away too much, a tooth with a large cavity can easily be asymptomatic. In fact they usually don’t hurt. So it’s also entirely possible that the dentist didn’t drill away too much.
If you want quality dental care in the UK, my advice would be to get away from the government program. It’s nice that so many people are getting dental care. But there is little incentive in your government-covered dental care for excellence in treatment–all the incentive is to run the patients through and take care of what they need in the easiest, quickest way possible.
– Dr. Hall
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