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.

Am I Allergic to These Crowns?

Dr. Hall,
 

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.

Thank you,
Sandra from California
 


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Sandra,
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.
 
Dr. Hall

(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.

All ceramic vs porcelain-fused-to-gold crowns

Dr. Hall
I am having crowns replaced over tooth number 4 & 5. There is, as I believe, no cosmetic value of using pure porcelain versus Crown Porcelain fused to High Noble. There is a significant extra cost of $200.00 per each pure porcelain. In general, would a pure porcelain fused to a High Noble versus pure porcelain be just as effective over the long term?
– Garry from California


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Garry,
First, I like to talk about terminology so we know exactly what we are talking about. We should be saying all-ceramic crowns, not all-porcelain. Porcelain is only one of various ceramics that have been used for crowns and even some dentists gloss over this terminology. Few dentists are placing all-porcelain crowns on back teeth these days because they are very technique sensitive and are much weaker than the newer high-strength ceramics, lithium disilicate and zirconia. The eMax crown, which I believe is the most popular crown being used by dentists today, features a lithium disilicate core with porcelain baked over it. Lithium disilicate has reasonable aesthetics—it is white and somewhat translucent—but it comes in blocks and is shaped by milling, so the technician doesn’t have the ability to manipulate the color the way porcelain color is manipulated. Porcelain comes in a paste and it is placed, shaped, and then baked. So the ceramist can apply various colors and translucencies of the paste in different layers over the lithium disilicate core with a great deal of control over the aesthetics.

My guess would be that your dentist is talking about putting all-ceramic crowns on your teeth numbers 4 and 5, which are the first and second premolars on your upper right. So your question is, should you get porcelain fused to high noble (otherwise called porcelain fused to gold) instead.

Cosmetic dentists consider upper first premolars to be in the smile zone on almost all patients. Practically everyone will show that first premolar prominently when they smile. It may not be prominent when you look at yourself straight on in the mirror, but it is very noticeable from the side. For me, I would not want a crown made of porcelain fused to gold or any other metal here because there will be a significant risk of a dark line showing at the gumline. The dark line comes from the metal foundation showing through right at the margin of the crown.

Behind that first premolar, in my smile, the teeth are all in the shadows, so the aesthetics is much less critical there. In my mouth, I do have a porcelain fused to gold crown on one of those teeth. I also have a crown on my upper left first premolar, and that crown is an eMax.

So my answer is that I disagree that there is no cosmetic value here. Having said that, if you were my patient and wanted the porcelain fused to gold crown on your first premolar, I wouldn’t fight you on that. But then I probably wouldn’t have the issue come up because I would charge the same fee for either crown. A porcelain fused to high noble crown is a premium crown, and I charged more for that than for a porcelain fused to noble (semi-precious metal) crown. But I don’t understand why the all-ceramic crown needs to be more than the porcelain fused to high noble.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

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.

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