Is your dentist overtreating your front teeth?

Recently, I had the pleasure of having a young woman referred to my office from a fellow professional to have her front caps replaced. Being young, 25 years old, It was obvious why she needed to have them replaced. Her crowns and gum heights were not symmetrical She was 17 when she had them placed due to extremely painful teeth after orthodontic treatment. She stated her teeth were not decayed but they were painful after her braces were removed. Her dentist recommended full coverage crowns on her 4 front teeth because he had stated veneers come off teeth and recommended crowns. She actually took out a loan by herself at this young age to have the treatment performed.

What is the difference between crowns and veneers?

Veneers are facings upon the front of the teeth which can be as thin as a contact lens or up to 1.5 millimeters thick. These are generally a very minimal preparation on the front of the teeth. The backs of the teeth are not prepared at all. They can generally be very thin at the gumline as to blend into the tissue without any notice and are healthy for the gum tissue. They can be made of porcelain or a hardened plastic. They are generally made in a dental laboratory.

Crowns come in several different breeds. Some have metal underneath of them for strength (thus the black lines on some crowns), with a white porcelain overlay or all porcelain. They are prepared by uniformly removing tooth structure from all surfaces in order to completely cover the tooth.

Once a crown needs to be replaced, you must replace it with another crown. Once a veneer needs to be replaced, you have more options of replacing another veneer or replacing with a full coverage crown.

Some dentists are not trained in preparing or bonding of the veneers. It is time consuming. The teeth have to be precisely bonded otherwise the veneer will come off. Clean up of the bonding agents can be time consuming for the dentist as well. This may involve removing the bonding agents with rotary instruments versus having an assistant clean the cement by gently scraping away the excess.

Is it easier and more productive for the dentist to prepare the tooth and have someone else take over? Of course it is. This maximizes the dentists’ time.

Some dentists charge less for veneers than they do for a full coverage crown. I am not sure why. The bonding process is more labor and time intensive. The laboratory fee may be about the same.
Are some dentists lazy and not presenting all of your options? It is possible that veneers are not in some dentists’ skill set. It is possible that most insurance companies will not cover veneers but will cover crowns. When you are uncomfortable performing a service, you do your best to substitute what you know how to do.

Is this in the best interest of the patient? What options is this young girl going to have by the time she is 45? She may need several root canal treatments due to the overpreparation at the age of 17. The nerve on this age of tooth are very large. There is a good possibility that one or more will need this sort of treatment over time.

When it comes to preparing veneers, conservative and minimal preparation are necessary to keep the enamel on the teeth for a stronger bond to the tooth.

Crowns will be placed depending upon the amount of decay, previous fillings, or to improve the bite relationship. Crowns may also be placed due to a difference in underlying tooth structure that a veneer may not be able to mask.

When it comes to having your front teeth replaced, do as this young lady did the second time around. Ask from dental professionals who they have heard does beautiful cosmetic work that they can actually eat without a problem. Ask the dentist to show you pictures of cases that he or she may have been treated with your similar condition and make sure the photos are of their actual work. If the dentist does not have a camera, this is a warning sign. Ask them if you were a member of their family, what would they do for them. Also, express to them what your goals and expectations are for treatment. If the dentist cannot see or understand what you are trying to express to them, they cannot treat it and it may leave you both frustrated. Ask the staff members working in the office if they were to trade places with you, would you let the dentist treat you (of course do this confidentially without the dentist in the room).

Dentistry is a great investment if it is conservatively performed correctly. It is expensive (in more ways than one) if it has to keep on being redone.