Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

September 16, 2017

I have a titanium allergy and think I have a titanium post in my tooth


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Dr. Hall,
I have recently been diagnosed with a titanium allergy. I have two crowns on my left side, upper and lower. I have various odd symptoms that have been addressed with my dentist. They have been checked out and I’ve been told everything “looks” fine. The dull ache surrounding my upper remains. I’m wondering if I have a titanium post and if this is possibly contributing to this dull ache and possibly other unexplained ailments throughout my body. Where do I go from here?
– Jennifer from Kentucky

Jennifer,
Titanium allergy used to be considered very rare, but with the increasing use of dental and orthopedic implants, which almost always use titanium, there are increasing reports of titanium allergy. The MELISA Medica Foundation, which conducts the MELISA test for metal sensitivities, estimates that as many as 4% of the population could be allergic to titanium. However, this test has been criticized as generating false positives, and my guess would be that titanium allergy is less prevalent than that.

Titanium is a very biocompatible metal, apparently due to its high corrosion resistance. Given this corrosion resistance, I would not think that the presence of titanium in a post inside of a tooth would affect tissues outside of the tooth, but I guess that would be possible. If you want to investigate that, I would just go to the dentist that put the post in your tooth and ask if it is titanium. Your dentist should have a record of the type of post that was inserted. I will add that there should only be a post in your tooth if the tooth has had a root canal treatment.

Metal posts are often used in root canal teeth to help retain the buildup that is placed in the tooth and the buildup in turn helps retain the crown on the tooth. For many years, stainless steel posts were the standard. Stainless steel contains nickel, and it is estimated that 10 to 20% of people are allergic to nickel. It was assumed that this wasn’t an issue, because the post was sealed inside the tooth and not in contact with living tissue. Then, about 30 years ago, it was discovered that corrosion products from the stainless steel could leach through the teeth and many dentists, including me, switched to using titanium posts.

Could your dull ache be from a metal sensitivity? I would say that it could. I would wonder if there is any metal in the crowns you have—that is something worth checking also. There could also be a problem with the occlusion of the crowns. In any of these scenarios, everything would “look fine,” but that doesn’t mean that everything actually is fine.
– 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.

April 24, 2017

I have metal allergies and want a dental implant


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Dear Dr. Hall,

I completely love your web site and enjoy reading so much of the wisdom you pass on to worried people.

I am in the UK and want to ask your opinion. I am 61 so an old bird now however, I have always tried to look after my teeth. Over the past few years I have lost the teeth at the farthest back on both sides. I would love to think that if I managed to get a nest egg, I could have implants to make my teeth whole again. However, I have the severest metal allergy I think possibly doctors have ever encountered. I am proven allergic to nickel, cobalt, and a flutter to mercury. I cannot wear jeans, sandals with buckles and have to avoid all clothing with any form of metalised thread or adornments. Therefore, I know that implants may be a problem. Can you please advise me is there anything on the market whereby posts are made of some material which is not metal based. If there was I could perhaps start saving for my two implants and when I am really old, not fly into a panic when I lose a front tooth. I would be so grateful for your advice. Sorry to have gone on.

Hugely grateful.
Jane from Essex, UK

Jane,
Yes, there is a good solution for you. You actually have a couple of choices.

First, nickel allergies are not all that uncommon, and many people have problems with cobalt. That shouldn’t scare you away from a titanium dental implant. I advise avoiding nickel in particular in any dental restorations or appliances because there are so many people with sensitivities to it. When you say you have a “flutter to mercury,” I’m not sure what that means, but it shouldn’t be an issue with dental implants because practically all of them are pure titanium and titanium is an extremely biocompatible material. If you’re uneasy about it, it shouldn’t be difficult to get an allergist to test you for titanium allergy.

I wouldn’t assume that because you are allergic to some metals, even if those allergies are severe, that you can’t have any contact with metals. After all, there are metals known as minerals that are essential to our diet–iron, zinc, and calcium are all metals.

But if you’re even uneasy about titanium, there are dental implants that are made out of zirconia, a super-strong ceramic. This is the only metal-free dental implant I’m aware of. It might take some work to find a dentist who will place zirconia implants, but there are some.

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.

October 6, 2016

Metal present in dental ceramics


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Hi Dr. Hall,
I like your website–it is informative.
I am a naturopath and need a crown. I’m concerned over some of the materials used. After my research, so I far like the look of the ceramic crowns (is this glass?) and wondering what Vita ceramic is made out of. I’m finding it hard to get an answer. I basically don’t want any with metals or lithium as I have thyroid issues.
Thank you,
Vanessa from New Zealand

Vanessa,
Any crown that is all ceramic is not going to have any metal in it. But I’m reading between the lines of your question, and I think you are asking about avoiding any metal ions in the crown. I don’t believe this is going to be possible to do, as there are metal ions in every dental ceramic I am aware of.

Let’s get into a little chemistry. Iron is a metal. Rust is iron combined with oxygen–iron oxide. While rust isn’t a metal, it has metal ions in it. And while you wouldn’t want to eat metallic iron, of course, iron ions are essential to life. They’re an important ingredient of our diet, since the hemoglobin in our blood has iron ions in it. The iron in our blood is what gives blood its red color.

Similarly, sodium is a metal. As a pure metal, it is toxic, but combined as a metal ion with chlorine it is sodium chloride, or common table salt, and is also essential to life.

Other metal ions that are important ingredients in our diet include calcium, potassium, magnesium, zinc, copper, manganese, molybdenum, and cobalt.

Lithium is a metal that is in the same family as sodium. It is so reactive that it doesn’t occur freely in nature, so it is found naturally in its ionic form combined with other elements. Lithium disilicate is a ceramic that is very strong and has been developed in the past few years to be used in dental crowns. I have in my mouth an e.max crown, which is made of lithium disilicate.

Zirconium is another metal. Combined in its ionic form with oxygen, it is known as zirconia, and is a ceramic that is even stronger than lithium disilicate and has also been developed recently to be used in dental crowns. It is so strong that it can be used in bridges without requiring a metal framework, something that is very risky with other ceramics.

You mention Vita. Vita is a brand of porcelain. Porcelain is a conventional ceramic that has been used for many years for dental crowns. It isn’t very strong by itself, but when it is bonded to tooth structure, it is strong enough for crowns on front teeth and premolars. Dental porcelains are made with kaolin as a key ingredient. Kaolin is a clay that has silica and aluminum oxide. Aluminum again is a metal, but it isn’t aluminum metal that is in these crowns but aluminum ions.

Glass is pure silica (silicon dioxide). Silicon is not a metal, but glass isn’t strong enough to be used as a crown, though there are some crowns that use a layer of glass on the outside (Empress crowns). However, the glass they use in Empress crowns is a leucite glass that has aluminum tectosilicate in it.

So you can take all of this information and figure out what you want to do. I am not aware of any biocompatibility issues with any of these ceramics. However, if you were to ask me my opinion about which one would be least likely to provoke any biological reaction, I would say the zirconia.

– Dr. Hall

Do you have a comment or a question 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 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.

August 29, 2016

Removing a metal post in a tooth


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Dr. Hall,
I just found out my dentist inserted a stainless steel post into my root canal tooth–my upper molar. A temporary crown is placed over it now and a permanent crown will be placed in a week. My question is can the post be removed and a zirconia or carbon post (I don’t think he does those) be put in instead? I don’t want steel in my mouth even though he said it’s encased. My ears have been pulsating since. Please tell me it’s removable!
– Linda from Brooklyn

Linda,
Yes, a stainless steel post probably can be removed, though there may be some risk involved.

Let me give a little background on this to frame my answer.

stainless steel dental post

A metal post in a lower molar

When a tooth is “bombed out,” needing a root canal treatment and with little tooth structure left, a dental post is often placed in the tooth. This post can serve a couple of purposes. For front teeth and premolars, it can strengthen the tooth against horizontal fracture. For molars and any other teeth, it can also provide additional retention for the crown. If there is little of the original natural crown of the tooth left, the post, anchored in the root of the tooth, will help retain a buildup in the tooth, and the buildup retains the crown.

There is a history to the material out of which the post is made. In the 1970s and earlier, stainless steel was the material of choice for prefabricated dental posts. However, in the 1980s it was discovered that even though a post is cemented inside the tooth and doesn’t come into contact with the bloodstream at all, metal ions were found to leach through the tooth and into the bloodstream. Stainless steel contains nickel, which causes sensitivity reactions in many people (see some of our blog posts on metal allergies). To guard against potential reactions as you seem to be experiencing, many dental practices, including mine, switched to titanium, which is not only very strong but the most biocompatible metal available. In the 1990s, other materials were introduced for posts, including carbon fiber and fiberglass. More recently, zirconia has been used for posts. Zirconia is a ceramic that has high flexural strength and is also very biocompatible.

So yes, you have a legitimate concern about this stainless steel post. Your dentist should get with current technology. From what you are telling me, he isn’t into any of these newer post materials, most of which have been around for twenty years or more.

Now, as to removing the post that is in there, that could be tricky and, depending on the situation, you may not want to trust your dentist to do this but may want to see a root canal specialist or another dentist who feels comfortable doing this. It depends on how deeply the post goes into the root of your tooth and how well it is cemented. It may be possible to dislodge it with an ultrasonic tip. I remember one patient I had who was adamant about removing several metal posts in his teeth. I don’t remember why his posts were so difficult to remove, but I ended up telling him that I had to drill out all of these posts and I had him sign a paper acknowledging that I had told him there were serious risks in doing this, that I could perforate the roots of any or all of these teeth, leading to the loss of the teeth. He was willing to accept those risks. The good news is that I got out all of the posts without any accidents, but I remember it was very stressful for me.

If you feel that you are experiencing a sensitivity reaction to the post, I would put a halt to the crown procedure until you can have the post removed. Cementing a crown on the tooth will only make it more difficult, as your dentist would have to start by drilling through the crown, possibly ruining the crown.

Dr. Hall

Do you have a comment or a question 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 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.

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