I had 3 crowns cemented two weeks ago. They were recommended by my dentist in order to strengthen 3 teeth that had large 20 year old amalgam fillings that needed to be replaced but were too big to fill and crowns were recommended.
Since they started working on my teeth, the crown prep, impressions, temporary crowns, permanent crown cementation, the total work lasted 6 weeks. For the entire 6 weeks, since the beginning of the process, I have had severe dry mouth, a sore/burning tongue, and tingling/numbing feeling on the side of my mouth with the crowns. I was worried I might be allergic to some dental material being used but the dentist insists it can’t be an allergic reaction since there are no other allergy symptoms occurring. I even went for bloodwork with my primary care doctor to see if anything else could be causing the dry mouth but all bloodwork came back fine.
Is it possible that my body is rejecting the crowns, can I be allergic to some material, or is it completely unrelated? I just can’t figure out what’s causing the dry mouth that started as soon as they started working on my mouth. The dry mouth is also making it hard for me to adjust to the feeling of the new crowns because my cheeks and tongue keep sticking to them and adding to the foreign feeling in my mouth. I am so miserable.
Any advice would be appreciated.
Sandra from California
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I don’t know where your dentist gets this idea, “it can’t be an allergic reaction because there are no other allergy symptoms.” There are varying intensities of allergic reactions with a variety of symptoms. With what you’re experiencing, it certainly sounds to me like an allergic reaction is indeed a possibility. But I can understand why your dentist would want to be in denial over that possibility because the solution, if you are allergic to anything in the crowns, would be to replace the crowns, maybe at your dentist’s expense. Now I’m not saying that what you’re experiencing is for sure an allergic reaction. I’m saying that is a possibility that should be checked out.
Here’s what I would do first—find out what these crowns are made of. You didn’t say anything about what type of crowns they are. If there is any metal in them, that’s where I would start. If there is, ask your dentist for a copy of what is called the identalloy certificate. This is a certificate that dental laboratories are required to provide dentists that lists the exact composition of any metallic alloys used in any dental restoration they make for the dentist. If there is any nickel in the metal, that is a prime candidate for an allergic reaction. Other possible metals that could be causing a sensitivity reaction could be beryllium or chromium. If the crown is metal-free all ceramic, a sensitivity reaction would be very rare, but I wouldn’t totally cross it off.
If you run into any roadblocks with this, I would get a referral to an allergist.
I would also add that it’s possible that the condition in your mouth is stress related (i.e. burning mouth syndrome). Since you had this reaction from the beginning of the work before the crowns were put into your mouth, that could be an explanation. If nothing else seems to provide an adequate explanation, maybe an allergist would be able to help you figure out if burning mouth syndrome is a contributing factor.
(Please see the comments below where I learned from Sandra’s initial response that the crowns were metal-free zirconia, and then 5 months later, where Sandra discovered that this was not an allergy at all but burning mouth syndrome, very possibly triggered by the stress of the dental work.)
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
Thank you Dr. Hall for your answer. The 3 crowns are all zirconia I believe. I was thinking if it is an allergy then maybe it’s not to the crown itself but maybe to the cement they used for both the temporaries and final crowns. But your idea that it could be stress related is also good. I do believe I have been clenching and grinding my teeth more at night since this entire process started. It has been extremely stressful since I ran into problems with the crowns since the beginning and they had to be sent back and redone. That’s why it took 6 weeks to complete. One of the crowns was already cemented on when they realized it was too bulky so I had to go back the following week and get it cut off and a new impression taken. Needless to say, I will not be going back to that dentist because the “final” crowns they did still feel extremely bulky and too flat on the “biting side” since the bite for these crowns had to be adjusted multiple times. It’s been a nightmare.
Response by Dr. Hall
I’d be very surprised if you’re having an allergic reaction to zirconia—it’s a very biocompatible material. An allergy to the cement would be very transitory if it existed. Stress reactions can mimic allergic reactions.
I will say that a well-done crown should blend into your mouth so well that you don’t notice it’s there.
These crowns feel horrible, but I do not want to go back to the original dentist since I’ve had such a bad experience and this was the second go around and they’re still too bulky. She of course says they’re fine and I just need to get used to them. I’ve had a crown before, I have one that’s 5 years old and I never had any discomfort with that one. These definitely have to be redone. 2 are for molars and 1 is for a premolar. If I do for some reason have a sensitivity to zirconia, what would be the next best option? Also, when should they be redone? I don’t want to put too much stress on the nerves/roots and end up needing root canals.
Response by Dr. Hall,
I can’t imagine that you’re sensitive to zirconia, though some rare instances of sensitivity to zirconia have been reported in the literature. As far as materials for crowns, there are several other options. I don’t know where these crowns are, and that would affect the choice of material. One option, of course, would be the same material as your other crowns.
I’m hoping I’m not sensitive but the fact that all this started once that first crown was cemented has me thinking it might be related. I have found a few people online that have had similar reactions to their Zirconia crowns, such as dry/burning mouth, sour taste coming from the crowns, tingling/numbness near the crowns. Those are all things I have experienced so right now that’s all I can think can be causing my symptoms. I’ve even had bloodwork done to rule out any other conditions or syndromes and everything came back fine.
The crowns are for teeth #13, 14, and 19. Would all porcelain crowns be a bad choice? I have one other crown that I have had for 5 years and it’s a PFM. I could go with that but I’m not happy with the dark line that appears at the gums after a few years. Also, if I were to get them redone, how long should I wait in order to not risk causing any further damage to the nerve and needing root canals? This whole situation has made it difficult to enjoy my daily life and I’m just trying to figure it all out.
Comment by Dr. Hall:
If you have any tendency to clench or grind your teeth, all-porcelain may not be strong enough on your molars. You have a couple of options. The e.max crowns are made of lithium disilicate veneered with porcelain, and that could be a choice for all of these teeth. They are very strong. Or, you could have porcelain fused to gold on the molars (#s 14 and 19) where the gumline isn’t visible and then do all porcelain on the premolar (#13). There would be no issue with the gumline being visible on your lower molar, and, if you have a normal width smile, the gumline on the upper molar would also not be visible. During my practice, I did many porcelain fused to gold crowns on first molars and never had an aesthetic complaint. But if you have a very broad smile, that upper first molar can sometimes be fully visible all the way to the gumline.
Thank you Dr. Hall. So the e.max crowns are different from zirconia? If I have a sensitivity to zirconia then the emax should be fine?
Also, as an experienced dentist, is there any other reason why all these issues would arise as soon as the first crown was cemented? I feel like it has worsened the longer I’ve had these crowns in and it’s making me physically ill. It’s like I can taste the crowns. Not very pleasant. Not to mention I’m still convinced these crowns were poorly made. They do not feel comfortable at all. It feels like they are putting pressure on my gums. #14 puts immense pressure on the lingual gingival margin. They also feel like pieces of plastic in my mouth. I never had these issues with the PFM I had put on 5 years ago. That one never took any getting used to. It was comfortable from the beginning but these feel so bad in my mouth and it’s almost been 6 weeks for #13 and 3 weeks for #14&19. – Sandra
Response from Dr. Hall:
Right. There are two relatively new high-strength ceramics. One is zirconia, the other is lithium disilicate. The e.max crowns are made on a foundation of lithium disilicate and veneered with porcelain for better aesthetics.
It’s hard for me to tell what is wrong with your crowns without seeing you, but if the crowns don’t feel comfortable, there is something wrong with how they were made. You shouldn’t feel any pressure on your gums. If you want to share where you are in California, I may be able to come up with an excellent dentist who would be able to take care of this for you.
Thank you so much for all of your continued help. It is truly appreciated. I’ve had such a bad and traumatic experience with the last dentist that I don’t know what to do now. I don’t want to return to her office because I don’t trust her. I would rather go somewhere else, even if it’s means paying out of pocket again. This whole situation has been extremely traumatic for me.
I’m located in Southern California, Los Angeles County. Close to LAX. If there is a good dentist you recommend, I would definitely look into it.
Thanks again, Sandra
Response by Dr. Hall,
Sandra, I’ll email you privately with my recommendation. There are several excellent dentists I know who could solve your problem for you, but there is one in particular that would be my first choice.
Nancy Silliman says
Hello! I’m having the same issue, zirconia crowns that are causing irritation in my mouth. What did you finally do? Did you get relief? Obviously everyone is different and some people react to zirconia. I myself am a nonsecretor so I have lots of weird reactions. Any other info would be greatly appreciated, I think my dentist thinks I’m crazy. Well yeah, when your mouth is constantly on your mind it is rather disturbing. Thank you – Nancy Stillman
Response by Dr. Hall
Here’s the last communication with Sandra, who emailed me directly rather than using this comment form:
Thank you again for all of the continued help. I believe my new dentist didn’t understand the level of discomfort I was in and she believed my dry mouth was being caused by my stress and clenching in my sleep.
I talked to her again yesterday calmly and explained everything in detail. She said that she would take the crowns off this Saturday and put in temporaries to see if my mouth settles down and the symptoms go away. Then we’ll work together to figure out what material would be best for me and not cause another sensitivity/reaction. As of now she’s thinking emax would be best but she wants to consult with a colleague who is very experienced with dental materials and different allergies to see what he recommends since I have a Zirconia sensitivity.
So far I feel better about the situation and hope that with her help I can finally begin to feel better and move on from this entire situation.
Thank you once again.
Sandra from California
Hello, unfortunately I suffer from a similar issue for the last 7 months (!). The symptoms began immediately after crown prep so it’s probably not an allergy to the crown materials.
Apparently this condition is very rare. I went to 3 dentists and 2 mouth specialists, had blood tests and ultrasound of the salivary glands without any findings. Only recently I did allergy test to dental kit and found out I’m allergic to quaternium-15 which is a formaldehyde releaser. Could this be the root cause?
I’ll appreciate if Sandra and Nancy can share what eventually worked for them. This is very frustrating having a sticky mouth and sleepless nights for such a long time.
Hello – this is Sandra checking back in. Unfortunately it has been 6 months from my original dental work and my symptoms remain. The zirconia was eventually removed and replaced with eMax, but that was no help. I have had multiple blood tests run and have been to many doctors. I went to an oral pathologist at USC and was diagnosed with Burning Mouth Syndrome. They said it could have been triggered by the dental work. One of the anesthetic injections could have hit or irritated a nerve or the anesthetic itself could have caused neurotoxicity. The exact cause is unknown. I was told it could eventually go away but it can take months or even years. All the extra dental work I had done trying to “fix” what I thought was the issue only made all my symptoms worse. Sorry I couldn’t be more help. I’m still trying to figure it all out myself.
Response by Dr. Hall –
Sandra, after you told me that the crowns had no metal in them, I was actually thinking it was something like burning mouth syndrome, which in my opinion is brought on by stress. This is a syndrome which has an unknown cause. So when they say it was caused by an irritated nerve, that’s a pure guess. The cause is unknown. I don’t buy the irritated nerve theory because the symptoms would be confined to the area innervated by that nerve, and that isn’t the case. Being caused by stress is more in keeping with what we know of the physiology of stress. Plus, it seems to occur right after stressful experiences.
Hi Sandra, sorry to hear what you’ve been going through. I have the same problem. The following morning after having a zirconia bridge fitted I woke up with my tongue burning. There are days when my tongue/mouth is fine and other days when it is really distracting from being able to relax or think or think about anything else. I did have a lot of dental work done around this time as well as the bridge and the bridge was the final thing I had done. I think I may have had too much done in too short a space of time that triggered the burning mouth syndrome. It has been ongoing now for almost a year.
Although I would not have considered it was stress that caused it, as the morning after the zirconia bridge it started seemed more than a coincidence, however, I also had this condition decades ago after dental work. I went through all kinds of treatment and in the end in desperation had my front tooth out which resulted in me needing the bridge. Eventually after months the worst of the burning went away with the help of medication. Now I have the problem back again I am more inclined to think it is a stress reaction even though it happened the day after the bridge was fixed. If I hadn’t had this problem many years ago I would definitely have thought it was due to an allergic/sensitivity to zirconia. Prior to this bridge being replaced my other one was PFM (Porcelain fused to metal)(Palladium metal inside porcelain) bridge and I had that one for 19 years without problems but was replaced due to gum recession at my dentists recommendation.
I hope you find a resolution soon, as this condition really does affect quality of life and has caused me to feel very depressed on occasions, not including the cost of the dental work, but finding after trying to look after your teeth you end up with another problem.
All Best wishes.
I would also like to thank Dr Hall for this fantastic site where he addresses all kinds of dental conditions openly and honestly. I just stumbled into it last night after looking up, yet again, burning mouth syndrome, which I seem to do regularly now dependent on whether my mouth is having a burning/stingy tongue day. I would also just add that I have stopped using toothpastes with SLS and try to avoid spicy foods or other acidic foods that tend to increase the burn, but not sure if this makes any difference to be honest, but definitely know that using sensitive toothpastes made my mouth much worse so avoid them too.
Thank you Dr Hall, as having read through some of your replies yesterday it reinforced that I probably do have burning mouth syndrome and not a dental allergy to zirconia and I felt more reassured about it being a stress reaction which I hope will eventually resolve.
I had 2 zirconia crowns put in during December 2019. I’ve had a dry sticky tongue along with a burning in my throat. I’ve been to 3 ENT Doctors. Acid Reflux was ruled out, mouthwash ruled out and the 3rd Doctor said it’s burning mouth syndrome. . . .
(See the rest of Jeff’s question and Dr. Hall’s answer in this post: Is this burning mouth syndrome?
Brooke Blake says
Oh boy, where do I begin! I considered zirconia, because I had a bad reaction to a poor quality porcelain/fused to metal. My dentist thought it could be either the metal alloy, the silica in the porcelain or the cement. I too was tested and told it might be ‘stress’
The fact is, I’ve had extensive dental work for over 50 years, and never had a ‘stress” reaction before to other crowns, or any other work.
But I AM allergic to silica, eugenol and certain acrylic composites.
Zirconium crowns are relatively new on the scene, and I didn’t want to take a chance.
My point here is that YES, you can have a bad reaction to some materials, and yet still not test “positive”.
I also had a dental allergy test panel done by a lab in Colorado, which showed an allergy to Palladium.
If your body is rejecting a substance, the reaction may be subtle, or unconventional, and so be dismissed.
But, these syndromes after Zirconia was put in are very similar. Betcha in a few years, it will be well acknowledged that this is a legit problem with Zirconia. Until then, soldier on, get them out, and use the tried and true materials.
Sandy Shardlow says
I am not sure how your symptoms are now but this sounds like a classic latex allergy. I too, recently had the same treatment ie. crown and two white fillings. I was left with a burnt throat, nostrils, it felt like my airways had closed up and had to really gulp to clear my throat. My lips and side of my face were all numb, I was heady and nauseous.
At least if it is a latex allergy you know that this needs to be avoided in the future.
All the best
Marilyn Batchelder says
Two months ago I got a crown and my mouth has been having strange symptoms ever since. . . .
(To read the rest of Marilyn’s question and Dr. Hall’s response, see this post:
I have a reaction to Emax crowns. Do not listen to your dentist, he will tell you it’s not Emax but believe me it is. I was told it was the cement, three times different dentists cut off my Emax crowns and replaced them with Emax yet again. My latest dentist had the ordacity to tell me to put Vaseline inside my mouth at night to relieve the irritation. He still won’t accept it’s the Emax. He told me all porcelain would have the same reaction. That is not true as I never had a problem with my crowns before Emax. I could write a book on bad dentists 🦷. They are not reporting adverse reactions when they should do. We should put more on the internet and warn people.
You can be allergic to ceramics. Any ceramic with lithium oxide in it gives me an allergic reaction. I tried zirconia and emax. They both have lithium oxide and both made my moth burn. I got some captek (gold) fused to Ivoclat Inline ceramic that works. There is no lithium oxide in the Inline ceramic. It has been known for years that lithium disilicate ceramics are more cytotoxic than feldspathic ceramics. Look up a paper from 2008 titled “In vitro cytotoxic response to lithium disilicate dental ceramics.”
Response by Dr. Hall:
A couple of things.
First, while e.max has lithium in it, zirconia doesn’t. The e.max crowns have a foundation of lithium disilicate, not lithium oxide.
I did look up the study you cited, and yes, it is from a reputable scientific journal and yes, it does show inhibition of mitochondrial activity in mouse fibroblasts that were in direct contact with lithium disilicate. But I wouldn’t treat that study as definitive proof that there is a problem with lithium disilicate. First of all, the study was in vitro, meaning that it was conducted under artificial laboratory conditions, not in a real-life situation. Usually those in vitro studies need to later be confirmed by studies involving real-life clinical situations. So the conclusion is that there MAY be a problem with lithium disilicate that needs to be corroborated by further study. Second, the study involved direct, intimate contact of living tissue with the lithium disilicate, a condition that doesn’t occur with crowns that are above the tissue. That situation would occur if the lithium disilicate were implanted in the jawbone, much as a dental implant. It doesn’t occur with a crown that is put on a tooth. Finally, the study showed that the mitochondrial inhibition decreased substantially after the samples were aged in artificial saliva. That suggests that any inhibition may be temporary.
Dr. Hall, I am an analytical chemist and I know what I am talking about. Many zirconia crowns have small amounts of lithium oxide in them. When I say lithium oxide I mean lithium in the oxidized state. If you check the Ivoclar website they list the composition of emax as 57-80 % SiO and 11-19 % LiO. So I know lithium disilicate has silicon in it. There is another type of ceramic called Obsidian that is a lithium silicate. It took me a long time to discover the composition of the crowns because the companies keep that as a trade secret. I had to write a letter directly to James Glidewell and he told the staff at his lab to tell me what the zirconia crowns I had were made from. It was a zirconia framework with Noritake Cerabian ceramic. A representative at Henry Schein gave me the list of ingredients for Cerabian and it had 0.5% lithium. The company considers that a low enough amount to not be considered a lithium disilicate, but it irritated my moth just as badly as emax. My problem was not temporary. It got reduced by polishing the crowns with diamond paste but it did not go away until a year later when I had them replaced with captek fused to Inline crowns. These are anterior crowns that have direct contact with my tongue so I need them to be biologically compatible. Please take this seriously Dr Hall. Having these lithium ceramics in the mouth is excruciatingly painful for some people. You can read the stories that people here are telling and in other online forums. As I told you I am an analytical chemist and I have been studying this issue for over 10 years now. I am very discouraged that more studies have not been done. It is probably because such a low percentage of people have the adverse reaction. I assure you that it is real. – Dave
Response from Dr. Hall,
Thanks for the clarification. It does indeed sound like you know what you are talking about, and it looks like you have investigated this matter carefully. I was unaware that there is some lithium oxide in some zirconia products.
I should have mentioned in my first comment that I don’t doubt your allergic reactions. You are right that there is little attention paid to these rare allergies, but they are pretty important to the people affected, which is why I make these discussions public.
I do think that the vast majority of people don’t need to be concerned about reactions to e.max crowns. I have one of them in my own mouth and intend to leave it there. I am wondering if there is a dental restorative material for which no one has ever had an allergic reaction. Goodness, there are people who are allergic to themselves.
Marjorie Stansel says
I am pretty sure that burning mouth/lips is caused by an allergy to zirconia. Although the allergy is rare, it does exist. Not only did the use of zirconia implants cause burning mouth/lips, but I had extreme pain in my lower jaw immediately after placement of two zirconia implants. One actually fell out about 8 days later, and the dentist removed the other. After three different antibiotics and a dose pac, my pain has lessened, but the burning lips remain.
Brenda Franklin says
Thank you Dr. Hall for your helpful advice.
Neil Walker says
I have had two e.max crowns fitted including root canals. I now suffer from burning mouth and lips, gum pain. dry mouth, and sinus problems. I had no problems before or during treatment, only when my permanent crowns were fitted.
My dentist says he’s going to remove these, so hopefully symptoms go away.
Adam Becker says
I had a porcelain crown on #19 replaced with a zirconia crown and had 2 fillings done with the composite on #1 and #16 in early March 2022. About a week after I had the work done the I started having a very itchy throat, burning sensations in my nostrils and dry mouth. I thought this was all allergies at first but I continued to have an itchy throat and dry mouth daily. I started looking into possible zirconia allergy since I had never heard of it before. All these symptoms I had started after the zirconia crown was installed. I found other reports online made by people with the zirconia crowns having rare reactions & my same symptoms. I’m making an appointment to have it replaced with the porcelain again. Most of the reputable dental websites I’ve visited report zirconia is very biocompatible and that it’s impossible to have an allergic reaction, while other websites report allergies are very rare.
Hopefully this works, if not I’ve read the composites can also illicit a toxic response so I’ll get those replaced with gold if replacing the zirconia doesn’t resolve these symptoms.
Thank you Dr. Hall for your advise & hosting this blog and to all those posting comments, all of this information has been helpful.
does anyone in this chat get better after zirconia / emax crown removal ?
Richard Lepre says
I have ten zirconia crowns and they have all been burred down trying to fix my occlusion – after the first adjustments I developed hives on the inside of my lips and gums, and no dentist seems to be able to figure out where these hives came from or how to deal with them . . . .
Dr. Hall has answered Richard in a separate blog post. To read the rest of Richard’s problem and Dr. Hall’s answer, click here for his post, “The dentist keeps adjusting but his bite is still off.”
Kari Hicks says
I had 4 porcelain lined with gold crowns replaced. I never had problems with them.
Starting from the temporaries, my gums burned and my eyes started oozing. I wasn’t told till the day they put the permanent crowns on that they were the zirconia. I have had constant burning gums, ruining nose, sinus drainage down my throat gagging me. I have metal allergies and chemical allergies. idk if it’s the crowns or the cement but I am absolutely miserable. How do I find out what is causing this? – Kari Hicks
Response by Dr. Hall:
I would go to an allergist to see if this is an allergy. But if it’s an allergic reaction to the zirconia, why did it start with the temporary crowns before any zirconia was put in your mouth? Also, are the burning gums just around the crowns or in your whole mouth? If it’s in your whole mouth, it would suggest burning mouth syndrome and not an allergy. But the allergist should be able to give you a definitive answer.