I planned to get porcelain veneers and my prior dentist said it was fine. I had a couple of really tiny cavities, but he told me that he would probably be removing those areas to do the porcelain veneers anyway and that if they were deep, he could fill them a little first. I was going to go forward with treatment with him, but my husband unexpectedly got a job in another state, so we packed and moved quickly. Now I’m with a new dentist and he says I have to have crowns because the decay is just too big. Moreover, he says he wants the crowns to have metal underneath them for strength. It’s only been two months and I don’t want crowns or metal. Could the decay really have grown that fast or is there something up with his diagnosis? — Amelia
Dear Amelia,
It can be incredibly difficult to determine the extent of decay, even while looking at x-rays. Tooth decay doesn’t follow any rules or guidelines for growth either. It may spread like wildfire on one tooth and move incredibly slow on another. In these situations, it’s really a judgment call as to what treatment will work best. Some dentists will see an impending need for a crown and want to start with it right away, to save the trouble of having to retreat later. Others may explain the challenges involved and prescribe the least-invasive treatment available as a starting point.
With that said, there are a couple red flags here. Generally speaking, a dentist who works extensively with cosmetic procedures will not recommend porcelain-fused-to-metal crowns on front teeth. It’s difficult to make them look natural and, as the gums recede over time, you’re likely to get a gray line at the gumline. Most dentists also agree that the front teeth don’t need the strength afforded by metal, as opposed to the back ones, which are continually grinding and chewing.
It’s not possible to assess whether you’re still a candidate for porcelain veneers online. However, you should get a second opinion, and preferably one from a doctor who specializes in cosmetic dentistry.
This blog is brought to you by Dr. Alana Macalik. For more information on the services she provides, visit her Arlington cosmetic dentist website.