Dental Veneers

[DiveSoCal]

Anybody out there diving with veneers?
I had veneers covering my front two teeth for five years prior to any diving. During this time they remained intact and I experienced no problems.
Since I began diving, three years ago, the veneers have broken down (cracked and detached from teeth) on five separate occassions. Although, this has never occurred during a dive.
My dentist is perplexed by the inability of the veneers to stay intact. I feel that the weekly diving is to blame.
I'd like to inform my dentist if there are people successfully diving with veneers and the dental secrets (if any).

 

[DennisW]

My wife has been diving with veneers for years with no problems. However, she only dives a few times a year and not weekly. I can't explain the problem, though unless you are biting your reg very hard or there is some reaction between the adhesive and salt water. I am assuming it is salt water.

 

[Laurence Stein DDS]

DiveSoCal

Hi, sorry to hear about your veneers. I'm a dentist, and a DAN referral specialist. Scubadoc forwarded your question to me.

Unfortunately, nobody will ever know exactly why your veneer(s) delaminated.

I am going to make several assumptions before I "speculate" on a possible answer. First your laminate veneers are on your front teeth (they are used for bicuspids as well). Next, I'm assuming that your dentist recemented the laminate back onto the tooth it separated from.

The most obvious reason would be pressure from your bite during diving. However, if you use a standard regulator mouthpiece, your front teeth probably don't touch when biting on the tabs located in the bicuspid and molar areas of your mouth--unless you position your lower jaw forward. If you are able to make contact with the ends of your front teeth in a standard mouthpiece, you can exert a lot of pressure on the edges of the teeth and break them. A custom bite would contact the front teeth and it would be possible to press against them though I would expect a custom bite to equally distribute the bite forces rather than focus them on individual teeth.

Laminate veneers are recommended for teeth missing as much as one third of their crown structure. More than that, there may be too little tooth to bond to and a cap is usually a better treatment plan. Normally, the bond strength of laminates is nearly as strong as the original tooth. I've seen laminated teeth that have suffered a traumatic injury and the laminate stayed on the broken tooth!

There is a huge variation in bonding cement strengths. Different brands have different bond strenghts. This bond strength can be affected by a number of factors. Moisture and cleanliness of the tooth and laminate prior to bonding is critical to forming a good bond. The surface treatment of the porcelain is critical prior to bonding--it is normally etched with hydrofluoric acid prior to bonding and a coupling agent called silane is applied immediately before cementation.

If the laminate that came off was recemented, it might have an old layer of bonding cement on its surface. Old bonding cement is just a plastic and with time, picks up moisture--compromising future bonds to it. Sometimes, this layer of cement can be removed with an air abrader device, the surface re-etched with hydrofluoric acid and resilanated. The cement is not affected by water or depth once it is set--having been properly applied.

Something as simple as the blue colored light your dentist uses to harden the cement can cause problems. As the bulb gets older, the color shifts. Bonding cements are VERY SPECIFIC for the wavelength (color) necessary to initiate and complete hardening of the cement. An old bulb may appear to be good but it might not be putting out the specific color at the specific power needed to properly harden the cement.

Since bonding started, there has been at least 5 generations of bonding materials. Each was better than the last. Newer cements are usually stronger than the older ones and less technique sensitive.

If the same tooth comes off over and over again, It may we be that new cement is being applied over old cement. If different laminates are coming off, I would be suspicious of the cement or the cementing technique (including the light).

The material the laminate is made of also affects strength. They can be made of porcelain, composite (plastic), pressed ceramic, resin-glass, etc. They all have different strengths and different weaknesses. Each year several "new" veneer materials come out and several dissappear. It is extremely difficult to select perfect material.

In all fairness, I don't know any dentist who does veneers that hasn't had some come off for "no reason". There is nothing that a dentist can make that some patient can't break.

Your bite may play a factor. If you clench or brux your teeth you may eventually weaken the cement. The dive was the straw that broke the camels back. On the other hand, a well cemented laminate can often be chipped at the edges by a strong bite--without delaminating.

I know that I haven't really answered your question and probably have raised a few questions you will want to ask your dentist. If the laminate(s) keeps coming off, make a new one. Properly done, most laminates will stay on for years under NORMAL use. BTW, chewing ice or biting fishing line is NOT normal use.

Regards and safe diving,


Laurence Stein DDS,

:doctor:

 

[Laurence Stein DDS]

DiveSoCal,

Me again, Toothdoc...my dive buddy has 6 laminate veneers on his upper front teeth. He has never broken them diving. However, he insist on chewing on plastic soda straws and manages to break or chip one on occasion. They are about 10 years old.

You might call him my annuity policy!--Yeah, he gets a break!

Regards,

Laurence Stein DDS

 

[malleycat]

Wow - great information about laminates! I do have a question about implants. I plan on having surgery done later this year (implanting posts and also gum-build up around the implant site) -- how long after this surgery should I wait before diving? I will have a total of 3 implants done - 2 on one side, one on the other -- lower back teeth (I know......what can I say? Not only does my family have a history of "soft" teeth, but I've had some pretty bad dentists in my day). Any information would be greatly appreciated!

Thanks!
Liz

 

[Laurence Stein DDS]

malleycat

Dear Liz,

Welcome to the bionic world of dentistry. I am a GP dentist in Miami, Florida. My practice is restorative, cosmetic and implant oriented. I am a DAN Referral Physician and have a PADI Divemaster rating. I am also a dental consultant for Scubadoc info@scubasource.com

Thank goodness I saved a previous answer to the same question. I'm rather long winded so it beats sore fingertips!

With regard to your implant question...There are several factors which will determine when you can return to diving.

Recently placed implants most probably should wait several weeks until you attempt to go to depth. In many of the designs of implants there are holes or slots at the deepest end to accumulate debris during the insertion process. This is not always the case but I would rather err on the side of conservatism. Bone chips and blood accumulate there when the implant is inserted. Initially, this material IS NOT VASCULARIZED. There is no research on the subject, but this is a potential space that could accumlate bubbles during off gasing on ascent.

Once the hole has had an opportunity to revascularize, you shouldn't run a risk of trapping gases there that could cause problems.

The next potential for problems is the fact that the new implant should not have a load applied to it. In some cases, the surgeon would want you to wait up to 6 months. Some of the newer implants can receive a load at about 18 weeks. If the implant is located under the skin, and the scuba regulator doesn't touch the skin overlying the implant, you may be able to dive sooner.

Commonly, surgeons place "healing abutments" which are long rounded screws which protrude through the gum into the mouth. This is to avoid a second surgical procedure at the time of implant activation. If you have this arrangement in your mouth, then there is a better chance that you could apply a load or force on the healing implant and destabilize it. Micro movement has been implicated in the failure of implants. Consult with your surgeon on this.

Another possible problem arises from the position the implant is placed in the jaw. If it is placed as far back in the lower jaw as possible, you should wait about 3 months before diving. You may be at a greater risk of lower jaw fracture. This is also true if you have had recent wisdom tooth extractions. This is the part of the mouth that you can bear down the hardest. Another problematic location is the upper molar area, if the implant has to be placed into a sinus which has had a "sinus lift". In this case the floor of the sinus was tilted inward and the sinus membrane is raised with it. Bone or bone with the addition of artificial bone will be placed in the space directly under the lifted sinus wall. When healed an implant will be placed here. In some cases the implant is place at the same time. Let the sinus heal some before applying additional barometric pressure on it. Again about 3 months in an uncomplicated case should be appropriate. If the implant is place after sinus healing then you must wait an additional time before diving. Again, consult your surgeon.

Once the implant is fully integrated, there is no reason not to dive. There will be no depth restriction. Interestingly, some patients report the conduction of cold from drinks, ice cream or cold air being conducted through the implant into the bone. It doesn't hurt but it does surprise the patient. In most cases, you will not notice it.

I hope this answers your question. If you have more questions, feel free to contact me at SteinDiver@aol.com.

Be patient and safe diving.


Laurence Stein DDS
(Larry)
:doctor:

 

[Laurence Stein DDS]

malleycat

OOPS! I made a mistake. Scubadoc's website is http://www.scuba-doc.com/ (Doc, please don't shoot me!)

Hmmm! Soft teeth--I saw your picture--looks like a soft drink (or maybe not so soft) to me!

Enjoy!

Larry Stein

 

[malleycat]

Hehehehe....I'll take your last comment as compliment! :tease:
Thanks so much for all the info -- the teeth have already been removed (2 years ago), and alas - I am just too poor right now to spend the $7,000 they're telling me it will cost (with 75% up front, of course). Who has that kind of money?!! Anwyay, I guess I better plan on getting all of this done early in the summer, as we take our diving vacations starting in November/December. Both of my parents, and my siblings, have all had trouble with their teeth - my dad eventually had his remaining teeth removed and had full dentures. My mom went through implant surgery a few years ago - with the whole build-up of the gums and all. I remember how much pain she was in, and am NOT looking forward to it! I have always been obssessive about my teeth ever since I had braces as a kid, but it seems that no matter what I do I keep getting cavities, the majority of them in the roots of my teeth. Argh!
Ok, I'm sure no one else on this board wants to hear my dental woes, so i'll end this!

Thanks again Larry!!!
Liz
:kitty:

 

[Laurence Stein DDS]

malleycat,

For what it's worth. Most implant is surprisingly pain free. Bone grafting however is more likely to cause a problem--especially the donor site.

I have had very few patients over the years that really complained about their procedures. So think positive--you might be pleasantly surprised.

Larry