Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

January 12, 2017

I have dry mouth ever since getting my new crowns


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Dr. Hall,
I had porcelain crowns for all upper and lower teeth. Ever since these were put in I have had dry mouth. This was a cosmetic procedure and I obviously regret doing it. I am wondering if there is anything I can do next. The dentist widened my bite so you can see more of my teeth when I smile and I try to remember to keep my mouth closed and breathe through my nose. I know the dentist can grind down the new crowns and try to match my original bite but not sure if that is really a good answer. Any ideas you have would be greatly appreciated.
– Randy from Pennsylvania

Randy,
So you had crowns on all your teeth–we would call that a full-mouth reconstruction. You wanted more teeth to show, so the dentist “opened your bite.” In lay terms, he or she made the crowns “taller” than your natural teeth were.

Unfortunately, this hasn’t worked out so well for you and now you are suffering from dry mouth–called xerostomia in clinical terms. This isn’t just an annoyance but is a real threat to the health of your teeth, which I will explain below. It’s caused by a condition that is called “lip incompetence,” which is defined as a lack of closure of the lips when the mouth is at rest. In other words, you have to consciously try to keep your mouth closed.

This was a serious mistake by your dentist, and in my opinion he or she should accept responsibility for getting this corrected. If he or she doesn’t, you have a valid case for malpractice damages. Was your dentist so attracted by the high fees from doing 28 crowns on you that they jumped into this case and got in over their head? That is possible. Dentists don’t get enough training in dental school on full-mouth reconstructions. This is a highly complex procedure, and there are several post-graduate training institutes that offer this advanced training.

The proper way to do a full-mouth reconstruction, especially if the bite is going to be opened, is to first open the bite temporarily by some mechanism. What I did was build up the back teeth with composite to test how far I could open the bite. It can also be done with temporary crowns, though that commits you to having crowns. As a patient, you should wear the temporary crowns or the buildups long enough that you can be sure you’re comfortable with the new opening. And the dentist should never open the bite beyond the point of lip competence. This is one of the key things that needs to be checked–with your mouth at rest, do your lips come together naturally or is it a strain to close them? This is the test that is used to discover how much you can open it. You never go past that point.

Saliva a Defense Against Decay

Many people don’t realize that your saliva has important defense mechanisms against decay. Besides its washing and buffering action, it contains antibodies that fight decay bacteria and minerals that help remineralize early decay lesions. A serious complication of dry mouth is a greatly increased decay rate. And don’t think that your crowns make you immune to decay. It isn’t hard for decay to get in at the margins where the crown meets the tooth. Also, dry mouth exacerbates gum disease.

What to Do Now

With what appears to be a lack of prudence and care by your dentist in doing this case, I wouldn’t ask him or her to fix it but would seek a second opinion. I will email you privately a dentist near you that I would recommend for this second opinion–I don’t want to publicly give any more clues about your location. Yes, the bite needs to be closed down, but grinding the teeth down may not work. It may be that your case needs to be completely re-done at the expense of your dentist. Proper shapes of the teeth need to be preserved in order for you to have a healthy bite. And if the crowns have a metal foundation under the porcelain, you don’t want to grind through to the metal.

So go to the dentist I recommend. If he feels that this is your dentist’s fault, ask him to help you get satisfaction from your current dentist. Based on what you’ve told me, it sounds like you could take this dentist to court for malpractice, but it’s always better to give them a chance to rectify the problem.

Dr. Hall

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

2 Comments »

  1. I just had my lower teeth and 6 upper teeth completed with crowns. I now have dry mouth and my teeth are very sensitive when I start talking. Confused about this happening. Can you give me some advice on it.
    Deborah

    Response by Dr. Hall:
    Deborah,
    You really haven’t given me much to go by. There are a lot of possible causes for dry mouth. Maybe you have the same situation as Randy above, but you haven’t given me enough information to be able to tell. And I don’t know what it means to have teeth sensitive when you start talking.

    Comment by Deborah — August 19, 2017 @ 8:28 pm

  2. Dear Dr Hall,
    I was searching around the net for similar problem… I also underwent cosmetic dental work, but with e.max veneers (from front teeth up to premolar upper and lower). Right after the heavy work, I suffered from cracked and dirty tongue. It becomes better after 1 month, I can eat and taste food again better than before. But the saliva is still not there yet. A recent check by a dentist showing only the salivary glands below the tongue are working, the others are not (though if I chew something, from times to times I can feel some salty saliva at the right cheek (the Wharton duct ?) – at the left I don’t know there might be no saliva or there is but it is not salty so I cannot feel it). In normal time (without trigger) I think no saliva or very few is coming from both cheeks)

    They have enlarged the upper jaw with the veneers, saying to fill the buccal corridor. But I do not feel comfortable with this, my old teeth were little bit the opposite, pointing more to the interior of the mouth. This could be the reason why the gum of the upper jaw is constantly dry, and my lips as well (I was very anxious that I got an allergy to all the materials which were used – but luckily no other symptoms, just the saliva problem).

    Have tried to drink, chew Xylitol gum, lemons … It just helps for a while. I’m not back to my normal life yet (about 3 months now). What should I do ? (By the way, an appointment has been made, they want to check for stones in my salivary glands – should I go / not go / do something else ? It can’t be that I discover a stone now in my glands after the veneer, it’s been many years without having to deal with dentists and related issues. I have a feeling like the ceramic “sucks” my saliva, like a newly formed brick and mortar which did not “drink” enough. :-()

    Thanks a lot,
    Hannah

    Response by Dr. Hall:
    Hannah – it’s pretty hard for me to tell what is going on without an exam. Plus we could be having some terminology issues with what you are telling me. If they did crowns instead of veneers, and by “enlarged the upper jaw” you mean they opened your bite, that could explain your dry mouth, and my answer to you would be similar to what I told Randy above. But that’s making a couple of big assumptions.

    Comment by Hannah — April 3, 2018 @ 6:22 am

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