Veneers, typically crafted from durable porcelain or composite resin, do not decay. These materials are non-porous and impervious to the bacterial acids that cause cavities in natural tooth enamel. However, the natural tooth structure underneath the veneer remains susceptible to decay, meaning a cavity can still form on the underlying tooth.
How Cavities Form Beneath Veneers
Cavities can develop on the natural tooth structure beneath a veneer due to a compromised seal between the veneer and the tooth. This bond can degrade over time, leading to marginal leakage. Gaps can form at the edges of the veneer, allowing oral bacteria, food particles, and acids to seep into the space. These trapped substances then erode the underlying enamel and dentin, initiating decay.
Inadequate oral hygiene, particularly around the gum line and veneer margins, contributes to this issue. Plaque, a sticky film of bacteria, accumulates in these areas if not thoroughly removed through daily brushing and flossing. This plaque produces acids that demineralize the tooth structure, leading to cavity formation even under an intact veneer. The junction where the veneer meets the natural tooth is vulnerable to plaque accumulation.
Pre-existing decay, if not entirely removed before veneer placement, can continue to progress beneath the restoration. Residual microscopic decay or new decay forming shortly after placement can worsen undetected. Comprehensive dental assessments are important before cosmetic procedures.
Gum recession also poses a risk, as it can expose the root surface of the tooth, which is not covered by the veneer. The root surface, composed of cementum and dentin, is softer and more permeable than enamel, making it vulnerable to decay. Receding gums can expose this susceptible area, allowing cavities to form on the natural tooth root below the veneer line.
Preventing Cavities on Veneered Teeth
Maintaining excellent oral hygiene is fundamental to preventing cavities on veneered teeth. Brushing twice daily for at least two minutes with fluoride toothpaste removes plaque and strengthens underlying tooth enamel. Daily flossing cleans between teeth and along the gum line, where plaque accumulates at the veneer’s edges. Incorporating an antimicrobial mouthwash can further reduce bacterial load.
Regular dental check-ups and professional cleanings are important for early detection and prevention. Dentists can identify subtle signs of marginal leakage, gum recession, or early decay. Professional cleanings remove hardened plaque (calculus) that cannot be eliminated by brushing and flossing alone, safeguarding the tooth structure beneath the veneer. These routine visits allow for proactive intervention.
Dietary habits play a significant role in cavity prevention for veneered teeth. Limiting sugary foods and drinks reduces the fuel source for decay-causing bacteria. Acidic beverages and foods can erode enamel, making the underlying tooth more susceptible to decay. Rinsing the mouth with water after consuming such items helps neutralize acids and wash away food particles.
Avoiding harmful oral habits helps preserve the integrity of the veneer and its seal. Habits like nail-biting, chewing on ice, or using teeth to open packages can chip or crack the veneer, compromising the bond. A damaged veneer can create pathways for bacteria and acids to reach the underlying tooth, increasing the risk of decay.
For individuals who grind or clench their teeth (bruxism), wearing a custom-fitted nightguard is a proactive measure. Bruxism can place excessive stress on veneers and their adhesive bond, potentially leading to micro-fractures or loosening. This stress can compromise the protective seal, creating openings for bacteria to infiltrate and cause decay on the natural tooth structure.
Addressing Cavities on Veneered Teeth
Several indicators may suggest a cavity beneath a veneer. Sensitivity to hot or cold temperatures, or discomfort when consuming sweet foods, can signal underlying decay. Discoloration, appearing as a dark spot or shadow visible through the veneer or along its margin, can also indicate demineralization. Persistent bad breath or a foul taste, not resolved by brushing, might also suggest bacterial activity.
Dentists employ various methods to diagnose cavities under veneers. Visual inspection remains a primary tool, where the dentist examines the veneer margins for signs of leakage or discoloration. Dental X-rays, particularly bitewing radiographs, can reveal decay forming between teeth or beneath restorations. Transillumination, using a bright light, can also highlight shadowed areas indicative of decay.
Treatment options for cavities beneath veneers depend on the extent and location of the decay. For very small cavities, a dentist might sometimes access and fill the decay without removing the entire veneer, provided access is sufficient and the veneer is not compromised.
More frequently, if a cavity is larger or significantly compromises the tooth structure or the veneer’s bond, the veneer typically needs careful removal. Once the veneer is off, the decay can be thoroughly cleaned out and the tooth restored with a filling. After successful treatment, a new veneer is usually fabricated and bonded to the tooth.
In cases of severe decay that has significantly damaged the tooth structure or reached the pulp (nerve), more extensive treatments may be necessary. This could involve root canal therapy to remove the infected pulp, followed by a crown instead of a veneer to provide comprehensive coverage for the weakened tooth. If the tooth structure is too compromised to save, extraction may be the only viable option.