Porcelain veneer emergencies – What to do.

What should you do if you have a veneer crack or break-off?

This page covers the subject of emergency care for situations where you discover a cracked veneer or find that a portion, or even all, of your porcelain dental laminate has come off your tooth.

As a quick preview, here’s a list of the initial steps you should take in response to veneer emergencies.

The remainder of this page provides details about how to (and why you should) carry out the steps above.

• If instead you’re looking for information about how your tooth might be fixed, we discuss that subject here: Repair options for lost or damaged porcelain veneers.
• If you’re looking for information about what you should not do, read this page: Can you super glue your lost porcelain veneer back on?

Lost dental veneer emergencies – What usually takes place?

Most porcelain veneer emergencies involve the situation where the restoration has either:

• Fractured – Broken, chipped, etc…, usually with some portion of the restoration, possibly relatively large in size, coming off.
• Completely debonded – All of the veneer has come off. (Hopefully as an intact unit.)
• Cracked. – The veneer remains on your tooth but a visible crack or craze line is apparent in it.

1) Checking your tooth to determine what has happened.

FYI – Be careful with this step. If there are any portions of your broken veneer still attached to your tooth, these shards of porcelain can be sharp. When investigating, take precautions with your fingers, lips, cheeks, and especially your tongue so they don’t get hurt.

a) What to look for.

There are really only three possibilities that may have occurred.

• 100% of your veneer has come off, in pieces or as an intact (whole) unit.
• One portion of your laminate has broken off with the other part still remaining attached to your tooth.
• You have a cracked veneer. There is a visible crack in the veneer but both parts remain on your tooth.

1) Cases where all of the veneer has come off.

In terms of creating an emergency situation, this is probably the least troublesome of the two possibilities.

When investigating, you’ll probably find that:

A tooth that’s lost 100% of its veneer.

• Your tooth’s front surface definitely does feel different. But not in the sense of jagged and sharp but instead mostly just rough.

  (Remember, when your veneer was made your dentist probably trimmed back your tooth’s front surface just a little. And that’s what your tooth should feel like, roughened (by the trimming process) but still relatively flat and smooth. (See picture.)

• When looking at your tooth, you’ll probably notice that it doesn’t have the same glass-like glossy sheen as your other teeth. And you’ll find that it’s also slightly smaller than before and its color may be off.

▲ Section references – Roman-Rodriguez

A broken porcelain veneer.

Sharpness may be an issue.

2) Cases where the veneer has cracked and a portion of it remains on your tooth.

In terms of creating an emergency situation, this is usually the more troublesome scenario. That’s because due to the way the veneer has cracked, there is typically some residual tooth sharpness to contend with. (Discussed below.)

As far as exactly what you’ll find when you investigate, there’s not all that much to explain. You’ll both see and feel that there are now portions of your tooth that are missing (missing portions of the veneer actually).

How much that is missing can range from a very large section to just a small piece. Either way, however, the important thing to be aware of is that this change, big or small, has probably formed a sharp edge somewhere on your tooth. So be careful with your new situation.

3) Cracked veneers.

With this scenario, the broken laminate remains attached to your tooth but has a visible crack or craze line in it.

With cracked veneers, there will be a question about how firmly the broken parts are still attached to your tooth. It may be that one or both halves have debonded and are only held in place by mechanical forces (meaning the way they interlock with each other, the tooth, and even neighboring teeth).

If you can feel the crack with your finger or tongue, or if the alignment of the separate pieces seems askew to any degree, chances are that one or both of the pieces are no longer firmly bonded.

2) Checking your broken veneer.

Once you have realized that something has happened to your veneer, your initial reaction will be to spit out whatever pieces are in your mouth. However, even after spitting, investigate again to make sure all the shards have been removed.

A good idea is to gently rinse your mouth and spit out into a bowl where the liquid can be examined for additional pieces. That way, you stand a better gauging if you’ve gotten all of the pieces out or not.

As you spit or rinse, make sure to keep your teeth apart and not bite down. If perchance your veneer came off fully intact, you don’t want to break it.

This veneer debonded but luckily remained intact.

Reattachment will be possible.

a) What you’re hoping to find.

• If you only find one piece and it’s fairly sizable, then there’s a chance that your tooth’s laminate may not have broken but instead debonded (come off whole without breaking).

  This is a big deal because if it has, your dentist can probably reattach it.

• If instead you find that your veneer has cracked into pieces, the bits are probably of little more than a curiosity to your dentist. Having them won’t assist in the repair process.

FYI – Since what will be needed to fix your tooth is so dependent upon precisely what has occurred, we’ve dedicated an entire page to this subject: “Damaged porcelain veneer repair – Options and possibilities.”

b) Inspecting your veneer.

Use the following points to help you get an idea if your veneer is still fully intact or not.

The internal surface of a debonded veneer.

Look for a confluent outline form with no sharp breaks.

• Obviously, when you look down on the veneer’s convex (shiniest) side, it should look exactly like a tooth. The edges on this side will generally be rounded and smooth to the touch. (See picture up above.)
• The veneer’s internal (concave) surface may be harder to assess. Its outline form will typically look relatively symmetrical. The edges on this side, however, can be expected to have some sharpness to them.
• You can also evaluate your tooth. If you see broken segments still attached to it, you obviously have your answer. (Be careful. Shards of porcelain like these can be sharp to your fingers, tongue, cheeks, and lips.)

  As mentioned above, usually the dental bonding material (“cement”) that originally held the veneer in place will come off with it, leaving bare tooth structure (enamel) showing.

c) Store your veneer carefully.

If you find that your veneer seems fully intact, and if you can get it to your dentist’s office without cracking it, doing so may save you the cost of having a new one made. So, wrap it up in some bathroom tissue and then place it in a hard protective container, like a medicine bottle.

If instead you find that your veneer is broken, go ahead and save the parts you’ve found to show to your dentist, but most likely they’ll only be a curiosity to them.

Checking a cracked veneer.

This is the case where there is concern about how firmly the broken pieces of the laminate are still attached to your tooth.

From a standpoint of appearance, having a cracked veneer, as opposed to one that has come off, offers the benefit that your tooth will still have a fairly normal look. However, from a safety standpoint, having a piece of a veneer come off unexpectedly, especially while speaking or eating, could lead to lacerating your lip.

For safety’s sake, you should, gently, investigate how firmly your cracked veneer is still attached to your tooth. Rinsing with water could be a way of gently dislodging loose pieces. Gentle pressure from your tongue or finger could be used too.

Even if you determine that the pieces seem firmly attached, you must consider your tooth extremely fragile. No forces should be directed to the tooth at all for fear that its veneer will break off.

3) Let your dentist know you have a problem.

You will, of course, need to contact your dentist’s office and report to them what you’ve experienced. And armed with the information you’ve accumulated, you should be able to give them a pretty full accounting.

Having this information, along with providing an update on how you and your tooth are coping with your new reality, they can then make arrangements with you for your tooth’s evaluation and repair.

4) What to expect in the meantime.

a) Cosmetic emergencies.

Most veneer emergencies are probably best described as just cosmetic ones. Usually, no significant problems will exist or crop up with your tooth other than the fact that it simply doesn’t look right.

That’s not to say that a person’s cosmetic concerns aren’t important or valid. However, your ability to get these types of issues resolved, permanently or even temporarily, will simply depend on your dentist’s availability in scheduling you for an appointment.

No good home remedy solutions exist for resolving cosmetic issues. Possibly placing white dental wax over your tooth (explained below) can temporarily improve its appearance. We can’t imagine any scenario where a dentist would encourage any sort of self-treatment in reattaching the veneer, so don’t.

b) Your tooth will probably be just fine.

While you may notice some sharpness or transient air or thermal sensitivity associated with your tooth (both discussed below), you can generally expect that it will be OK.

You may not remember but …

In most cases, when your veneer was originally placed only a minimal amount of your tooth’s front surface was trimmed away. And in some cases, like when Lumineer® veneers (ultra-thin porcelain veneers) are made, possibly no trimming was performed at all.

And because it’s the norm that a veneered tooth has been altered so minimally, the outlook for its health and wellbeing, just because its veneer covering has come off (all or a portion of it), shouldn’t be expected to be a major concern between now and when you get in to see your dentist.

If you need more reassuring –

With many veneer cases, no temporaries are placed. That means that the patient’s teeth are left uncovered (like your tooth that’s lost its veneer is now) for the entire one to two weeks while their permanent laminates are being made.

Extenuating circumstances.

All of what’s stated on this page only applies to situations where a veneer has debonded or fractured under relatively passive circumstances (like unexpectedly biting into something hard). The outlook for veneered teeth that have undergone direct trauma is a different matter and the health outlook for the tooth might be different. This type of situation requires evaluation by your dentist before more can be known.

c) What you are likely to experience with damaged veneers.

Since your tooth has lost its veneer, and therefore some or all of its front covering, …

• You may notice that your tooth has increased sensitivity to hot or cold foods and beverages.
• In a similar fashion, your tooth could possibly display some level of air sensitivity, like when drawing cold air into your mouth.
• You may find roughness or sharpness associated with your tooth, especially in cases where a part of the broken veneer remains attached to it.

What should you do?

As basic precautions for teeth that have broken or lost veneers.

• It only makes sense that if something tends to irritate your tooth you should avoid that activity. So minimize its exposure to hot and cold extremes and air.
• Avoid any activities or habits that will direct forces to the tooth (biting, chewing, teeth clenching).
• Manage the difficulties you experience using first-aid measures. (Discussed next.)

5) First aid and home remedies for lost or broken veneers.

1) Apply white dental wax over the tooth.

If you do experience trouble with air or thermal sensitivity, or especially surface roughness, placing a protective layer of wax over your tooth can help to provide relief.

• Most drugstores sell white dental wax. (It’s frequently needed by orthodontic patients to cover over sharp brackets and wires.)
• Just squish a small, flattened piece of it over your tooth. Letting it work its way in between your teeth somewhat will help to hold it in place.
• Expect that the wax will dislodge easily, so remove it at times like before eating or at bedtime.

2) Wear your mouthguard.

In cases where the amount of sharpness associated with a damaged veneer is severe and can’t be managed, just wear your nightguard, sports mouthpiece, or with some designs, your orthodontic retainer.

If you don’t have one of these types of appliances, you might purchase a DIY mouthguard at your local pharmacy. (Forming these appliances involves heating them up, so if you are experiencing thermal sensitivity with your tooth, that might be a precluding consideration for this remedy.)

For cracked veneers.

Wearing an existing appliance can also be a precautionary/protective measure for veneers that have cracked but not come off.

However, if the alignment of any portion of your veneer seems askew to any degree (possibly evidenced by some change in the way your appliance fits or even just the way it looks), wearing your appliance may end up applying pressure to the shifted portion and dislodging it.

3) Getting assistance from your dentist.

While clearly not an at-home or DIY remedy, for situations where tooth sharpness is a factor that can’t be managed, don’t overlook calling your dentist’s office again.

Just because they can’t schedule a repair appointment for you immediately doesn’t mean that they won’t offer to have you stop by so they can buff down a sharp irritating point. Doing so should be painless and just take a few moments.

6) Your repair appointment.

Scheduling.

As far as receiving definitive treatment for your situation goes, you’ll usually find yourself at the mercy of your dentist’s schedule.

Generally, a lost-veneer scenario falls under the category of ‘cosmetic dilemma’ as opposed to an emergency where there are actual concerns about the health outlook for you and your tooth. But, of course, that doesn’t mean that complications can’t arise or that your cosmetic situation isn’t important.

• When you call your dentist’s office, be sure to give them a complete accounting of what’s transpired, what you’ve since noticed, and how that has affected you. They can then decide what level of attention you require.
• If anything changes before your appointment, make sure that you notify them so they can pass judgment on those issues too.

What type of repair will be made?

Because the range of possible repairs for lost veneers is so dependent on the specific circumstances of each case, we now discuss this topic on its own page.

• Repair possibilities for lost and broken porcelain veneers.

7) Hopefully, you can learn from what’s taken place.

For future reference in avoiding problems, it makes sense to take note of what activity broke, or immediately preceded the breaking of your veneer. (For example, fingernail biting and teeth clenching can place excessive force on laminates.)

Be sure to discuss your circumstances and thoughts with your dentist. They may be able to suggest some solutions too. (For example, the forces generated by nighttime teeth grinding can be mitigated by wearing a dental nightguard.)

Underlying causes of veneer fracture and debonding.

The type of veneer emergency that you’ve experienced can give your dentist a hint about what type of underlying problem lies at hand.

a) Debonding.

A porcelain veneer is a sandwiched affair, consisting of tooth, cement, and ceramic. When one debonds (comes off its tooth, primarily in one piece), the separation may have taken place either at the ceramic/cement junction or else the tooth/cement one.

What usually happens.

• Assuming that the original placement conditions were ideal, the most common failure point lies at the tooth and cement interface.
• The most likely cause for this is that the tooth surface to which the veneer has been bonded involves a high percentage of dentin (the tooth layer underneath dental enamel).

Explanation.

Dental materials will create a bond with dentin. However, the strength of this bond is far weaker than the one possible with dental enamel (use the link above for more details).

If a high percentage of the tooth’s surface is exposed dentin, the strength of the tooth-to-cement interface will be comparatively weak.

Solutions.

As explained above, a dentist can attempt to re-bond the veneer. Unfortunately, the same underlying condition will still persist (not enough tooth enamel is present to create a secure bond) and therefore further episodes of debonding may be likely.

Especially in the case of repeated failure, making a dental crown for the tooth instead may be the only lasting solution.

b) Fracture / Cracking.

Considering the thin, fragile nature of porcelain veneers, it may be surprising to most people that breakage or fracturing happens as seldom as it does.

These restorations work because when they’re bonded onto enamel, it’s the more rigid of the two and therefore tends to absorb most of the forces directed to the tooth.

Cracked veneers.

When a veneer cracks, it suggests that the opposite is the case. The forces applied have been directed to it instead of tooth structure.

As an example, when a veneer is bonded to primarily tooth dentin (the problem discussed above) the laminate is the stiffer of the two. This tends to focus forces applied to the tooth to the veneer, thus leading to fracture.

Chipped veneers.

In some cases, just a small chip may have broken off a porcelain veneer (like off of its biting edge).

This would simply be a testament to the fact that the tooth/veneer complex has been able to successfully withstand the pressures applied to it. However, the forces applied exceeded the internal strength of the ceramic itself.

The activity that caused the chipping might be a one-time event, like unexpectedly biting into something hard. But often it’s a parafunctional habit that is the problem and must be curtailed (clenching teeth, biting fingernails).