I have porcelain veneers and one of the teeth got a cavity under one of the veneers. My dentist wants to take off the veneer and replace it with a dental crown. I’m not very keen on this idea. Is it completely necessary or is there something else I can do to preserve the veneer?

Alana

Dear Alana,

My gut reaction here is for you to get a second opinion. Here is why.

First, for a tooth to need a dental crown, the cavity would have to be pretty substantial. In general, a crown isn’t necessary until a cavity consumes over 1/3 of the tooth. I find it hard to believe a tooth with a porcelain veneer would be that far gone. If he is suggesting a crown on a tooth that doesn’t need it, that tells me he is not comfortable replacing the veneer and is falling back on a dental crown, that he does feel comfortable with. This could be because he does not know how to bond the composite filling to the veneer. Do not try to push him into this. You don’t want to push a dentist out of their comfort zone. The results are rarely good.

At the same time, you wouldn’t want him placing a crown on your tooth either. First, it is a much more aggressive treatment. He would have to grind that tooth down to a nub. I don’t think you want to do that unless it was completely necessary. Secondly, if he is pushing you toward a crown when it isn’t necessary it does mean that he does not have much cosmetic skill. This will make it nearly impossible for him to match the crown to the remainder of your teeth. I would not let him try.

When you go to get this second opinion, I want you to make sure it is with a dentist that has the cosmetic expertise you need. My suggestion is you look for a dentist who has reached accreditation with the American Academy of Cosmetic Dentistry. AACD accredited dentists are the top cosmetic dentists in the world. It takes passing stringent exams as well as a board of examiners who look at a large number of specific cases cases they’ve done to make sure their artistry is worthy. Their work has to be stunning to pass.

One precaution. When you go, make certain it is a blind second opinion. That means you don’t tell him who the dentist was that you go to or what his recommendation is. If he asks, just tell him you want a blind second opinion. He should be fine with that.

This blog is brought to you by Tulsa Cosmetic Dentist Dr. Jerome Cha.