I had a veneer placed on my front tooth and I just went to a different dentist for a cleaning and they said: they can see the tooth that is behind the veneer and this shouldn't be. Do you think the veneer was not cemented on properly or could it have been from me not wearing my night guard every night. I grind my teeth b/c I take the medication Lamictal, this is one of the side effects of the medication. Also the new dentist is saying I may have damage to the gums and bone, I not sure what she means, I have to go see a peri. dentist for gum cleaning. The Doctor that did the veneer said: from his xrays he can see from his xrays that he cemented the tooth properly. the new dr. is saying he did not do it properly, also there is a filling behind the tooth, should this be. Also as I take the drug lamictal waht is the best tx plan for my teeth going forward.
Person's Gender: Female
Person's Age: 39
Hi, thanks for using JustAnswer.com!
you've provided lots of good information that I'm reviewing...
ok let me start by clarifying for you what a "veneer" is, as lots of patients have heard the term "veneer" a lot but do not really know what one is. A veneer is simply a porcelain facing, usually pretty thin, that is formed at the lab and then bonded onto the front of the tooth. The treating Dentist usually, but not always, has to take a little bit of some of the enamel tooth structure away to properly make room for the veneer. In this way, when the veneer is seated to place, the edges of the porcelain should exactly fit into the space the Dentist has prepared. The junction at the edges of the veneer should therefore be perfectly smooth from the porcelain to the natural tooth.
The way the veneer is shaped at the lab and the color, translucency, brightness, etc. of the porcelain used allow the veneer to achieve the desired cosmetic changes to the appearance of your teeth. Since the veneer covers essentially only the front of your natural tooth - just what shows when you smile - if you look behind the veneer, you can see the natural tooth just sitting there. But you need a dental mirror to be able to see the backs of the upper front teeth. So, I'm a little unclear what the Dentist means that you are not supposed to "see the tooth that is behind the veneer".
If he/she means that when looking closely at the veneer from the front
that a small portion of the natural tooth under the veneer can be seen beyond the edge of the veneer, that is a different issue
that does have to do with how the original Dentist who placed the veneers shaped the teeth to receive the veneers - sometimes it can be very tricky to figure out exactly how to prepare the shape of the teeth just right so that when the veneers come back from the lab and are bonded in place they exactly cover every part of every tooth that can be seen from every angle when the patient smiles
If the original Dentist was careful in bonding the veneers in place and checked the fit of the veneers with xrays, you don't have to assume that they were cemented incorrectly. If that was the case, the new Dentist would have easily found this and would likely have commented about this to you. If you are satisfied with the appearance of the veneers and they fit correctly - which we're assuming they do, otherwise the new Dentist would have mentioned it to you - then the fact that a little bit of the underlying tooth structure might be showing would really just be a technicality and probably not of clinical significance.
Now, the issue of your grinding your teeth...
the lamictal medication you take is some very serious medicine and could have the side-effect of increasing your tendency of teeth-grinding, technically known as "bruxism", if you already have that habit. The very 1st thing I would tell you is that this habit is VERY bad and can have very damaging effects on your teeth, gums, supporting bone (under the gums) and jaw joints, known as the TMJs (temporomandibular joints). I then tell all my bruxism patients that during the time that you are awake, the botXXX XXne is that you DO have control over this habit. I tell my patients that our teeth are designed to FIT together, but they are designed to NEVER BE together, that is, they are designed to NEVER be touching, other than for an instant when you are chewing. So during the day, if you find that your teeth are in contact, even if it seems to you to be very light contact, the teeth are NEVER supposed to be touching! The muscles that control the lower jaw are working much too much when the teeth are kept in contact, even if it's light contact. The correct position of the lower jaw is as if you say the letter "N" and then stop before finishing saying it: the tongue is parked up into the palate and there's a small space between the upper and lower teeth.
and the lips are lightly touching.
this should be your rest position: "LIPS TOGETHER, TEETH APART".
Now, very easy for me to say all this...MUCH more difficult for you to comply if you've been grinding/clenching/tapping your teeth since forever. However, the "tough-love" botXXX XXne is that they're your teeth, it's your jaws, they your gums and it's YOUR habit to try to break. Another problem with chronic bruxing is that research shows that if you have what would normally be a little bit of gum disease, perhaps some mild gingivitis due to not-so-great home plaque control, in the presence of bruxism, the damaging effects are MULTIPLIED. This means instead of having an easily managed case of gingivitis, you might develop full-blown periodontal disease as a result of the negative effects of your chronic bruxing. This might explain the referral to the Periodontist for the "gum cleaning"
So, finally, what is the best tx plan for your teeth, going forward? First: "LIPS TOGETHER, TEETH APART"!! Believe what I'm telling you and really try to be aware of never having your teeth together, as best you can, even though you're on that medicine. I think you can do it, eventually, if you really put your mind to it. The habit may have been there a long time, so it might take a long time to break it, but it's important that you try. However, when you're asleep, that's a different story: you don't have control of the habit. Therefore, it's critically important that you wear that nightguard every night...if it's not comfortable, take it back to the Dentist who made it and ask him/her to adjust it if possible. Also, while you're trying to break that habit during the day, use the guard too. Get your gums taken care of at the Perio. office; if you're happy with the appearance of your veneers, just maintain them with great home plaque control and regular visits to this new Dentist.
I've given you lots of information to look at. I hope it helps. If you get any other information from your Dentist and you want to run it by me, direct your questions to me and I'll be happy to try to help. Good luck! If you're satisfied with this Reply, feel free to hit the "Accept " button and to leave positive feedback, if you'd like...this helps me help others with their dental questions.
General/Cosmetic Dentist, Boca Raton, FL