Dr Hall:
I had a crown put on my front right upper tooth and a veneer on the front top left. After this was done, my gums became inflamed, and they have not come back to normal after many months. I’ve seen a new dentist, a periodontist (who treated the gumline to try to fix), and most recently, a prosthodontist, because my new dentist and the periodontist were stumped about how to resolve this, as they think the Empress porcelain used on the crown is fine and that perio surgery might not resolve the gum inflammation and could risk cosmetic damage, so they said. The prosthodontist saw me yesterday, and she said it’s likely not a fixable problem. That the dentist that put in the crown went too deep and close to the bone, and that could be causing the gum inflammation. Furthermore, she stressed that if my gums aren’t treated it’s a health risk to me as inflammation there can lead to worse diseases, but I am not getting any solutions! She said perio surgery could possibly resolve this, but that cosmetic damage to the papilla(?) – the gum area between my two top front teeth – is quite possible as a result. I am so upset. I don’t want a health risk issue but don’t want to damage my smile via perio surgery (and there’s no guarantee the perio surgery will resolve the gum inflammation anyway!). Any ideas? THANK YOU.
– Mark from Maryland
Mark,
The porcelain crown and porcelain veneer have violated the biologic width of your teeth–they are too deep under the gums. The porcelain in Empress crowns is very gentle on the gums, so that’s not the problem. It’s interesting that this stumped your dentists for so long. This isn’t a widely understood phenomenon, because it’s a relatively recently researched concept. But I’m disappointed that they’re being so timid with recommending a solution. Your case is an interesting study in the “dentist personality.” They’re saying you should have the gum surgery, but it’s like they don’t want to say it too directly for fear of being sued. The prosthodontist wants to call the change in appearance of the papilla between the teeth “cosmetic damage.” But the damage has been done already, and I think you should have the surgery. Yes, that won’t look perfect, but it doesn’t look good now, and your present condition certainly isn’t healthy. You have gum disease on these two teeth. I don’t think you should just let that go. And I don’t think your prosthodontist thinks you should just let it go, either. She just wants to be sure you feel thoroughly warned so she doesn’t get flak when you see the results.
It’s not right to say there isn’t a solution. It would be more accurate to say there isn’t a perfect solution.
I hate that when they say, “there’s no guarantee.” Of course there’s never a guarantee, but what’s the point of dwelling on that? Ask what results you’re likely to get, and then go on recommendations. No wise dentist is going to “guarantee” anything.
Meanwhile, I would think an antibacterial rinse such as Peridex would help reduce the inflammation some. But be careful. Peridex stains the teeth, and if you use it, you should also brush with Supersmile toothpaste, since that’s the only toothpaste known that keeps this stain from forming.
– Dr. Hall
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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.
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