Allergic to the Metal in her Crowns

This is a follow-up e-mail from Carolyn in New Jersey. She asked about the types of metals that are used in porcelain-fused-to-metal crowns.

Dr. Hall,
Thank you very much for your informative answer.

At this point, my last concern is aesthetics. I seem to be reacting to a metal in my porcelain-fused-to-metal crowns. (Tongue inflammation where the tongue touches the metal parts of my crowns, inflammation in the skin on the lips and around the mouth, and general facial inflammation).

I saw the metal shell underneath each of these porcelain crowns just before they were placed in my mouth. I hadn’t been informed, first, that such a metal shell could or would exist under the porcelain, so there was no time to halt the procedure in order to seriously question the makeup of that shell. It was rough, grainy, and very dull silver-colored. I suppose this is the “black” that is now appearing near the gums. I’m guessing this would have to be a “base” metal. It certainly wasn’t “shiny.” More like the lowest grade of industrial steel.

In addition, I’d asked for a gold surface on top of some of the the porcelain crowns. I had no metal in my mouth prior to this and my goal was to have only gold, if any metal at all. I have a TMJ problem so a forgiving metal was needed on some surfaces.

Understanding completely that there is no “pure gold” for the mouth and that all gold comes as an alloy, I still cannot believe that these surfaces on top of the porcelain crowns are actually gold. They are quite dark silver now, “hot” to my tongue, they burn my tongue, and now the tongue is swollen in those places. I do have an all-gold crown, in the back of my mouth, to compare these dark silver metal surfaces to. The all-gold crown looks, feels, and acts like gold. It’s beautiful and feels good. These “gold” surfaces on top of the porcelain-fused-to-metal crowns, however, look and feel so dark and so hot. I’m suspecting an electrogalvanic reaction between the upper metallic surfaces and the baser metals at the gumline.

I’d questioned the gold content of these upper surfaces (because they looked silver) and received the answer that the colors can be different due to the fact that the gold comes as an alloy. But “this degree of different” is really strange. If my white gold ring began to look this way, I’d take it back to the jeweler for a refund.

So I’m trying to gather intelligent background information, independently, on what I might have received in my mouth that is causing my mouth and tongue to burn, and my facial/lip skin to become so inflamed with scaly red patches around the mouth. I realize that no one but my dentist can give me the chemical composition for sure. I just wanted to have a ballpark idea of what might be happening to me before I approached him on this.

In general terms in the profession: Is it possible for a patient who has paid in full for such crowns to go back, a mere two or three years later, and receive from the lab the exact metallic composition of each crown that they produced for me?

Any further information on any of these points would be greatly appreciated. I understand completely that only my dentist can give me the “bottom line” on my own case. I’m just looking for accurate ballpark info so that I do not permit myself to be led astray.

Does the black at the gumline, therefore, give evidence of a “base metal” having been used for the metal shell under the porcelain crown?

Thank you.
Carolyn

Carolyn,
No, the black line at the gumline doesn’t give any clue as to what metal you have in the crowns, nor does the rough appearance of the metal on the inside of the crown (it is left rough to be more retentive – a shiny surface would slip off the tooth more easily). But your sensitivity gives a strong clue. I would give at least 95% odds, based on your reactions, that nickel was used in your crown, as that is the metal that usually provokes this kind of reaction. That is one of the base metals.

And to answer your previous question, yes, the dentist should retain documentation of what alloy was used and its composition. The dental laboratory is required to send to the dentist what is called an identalloy certificate that lists the composition of the alloy that was used, and the dentist is required to retain this. The dentist bears responsibility for insuring that you don’t have this kind of reaction. Do you have any history of metal allergies, such as a reaction to any metals in earrings? We always asked whether people had any reaction to metals, and flagged the charts of those patients who had metal sensitivities, so I would know when to avoid base metals. Although we got to where we simply didn’t use them on anybody because of the risks involved, except for Medicaid patients, where the government specified that they wanted us to use base metals, because they were cheaper. If your dentist didn’t ask you this, then he or she is responsible for this and should make it right with you.
Dr. Hall

Dr. Hall,
Again, thanks so much. I very much appreciate your insight and your time.

The one overwhelming thing known about me by the dentist and his staff is my multiple chemical sensitivity. That reality looms larger than my name, at this point. I have been my dentist’s “chemical education,” with all the difficulties and humorous moments that implies.

Although mercury made me miserable (all those teeth fell apart and the mercury was incidentally removed before these metal-shelled crowns were installed) I never had a nickel allergy to report! I supposed now I will.

Carolyn

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