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After my new crowns my bite feels awkward

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After crowns my teeth feel dry.

When I was a child I chipped both my front teeth in an accident – and the dentist corrected it with filling material as well building up the two on either side (the lateral incisors) to correct some gaps. I had them redone once in my 20’s. At age 50 they were looking pretty worn out so I decided to finally bite the bullet and have crowns done.

In order to even everything out I needed 6 new crowns #6-11. I had them done in January 2018. It was a major change because all the spacing changed on my top teeth making them hit my lower teeth in awkward ways. Not only was the bite heavy in some areas, but I also felt the need to tap my teeth together constantly. Since the crowns I have been back maybe ten times for adjustments, but I continue to need to tap them and I think I have developed burning mouth syndrome. Usually when I wake up in the morning everything feels great but by mid-morning the back of my front teeth are burning and I feel the need to tap the teeth together. The ONE thing that relieves them is to chew gum, so I am now chewing a lot of gum! I don’t even really like gum. On one appointment I went back and the dentist husband (they are a husband/wife practice) told me NOTHING was wrong with my teeth and reluctantly referred me to a gum specialist. I instead went to another dentist who was recommended and he checked out my crowns. He did say they were very nice and seemed very well placed. Is there anything I can do to make this uncomfortable feeling stop and do I need to have more adjustments to stop the tapping together? I feel like they may have made my teeth a little bit longer and that is the root of the problem.
– Laura from Maine


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Laura,
You’re telling me several things about these crowns feeling funny, and I don’t have answers for everything you’re telling me, but I’ll share what I do know.

Let me start with the entire treatment plan, which was replacing some very successful composite bonding with six crowns. That seems to me to be very aggressive over-treatment. I think that an expert, ethical cosmetic dentist would have just replaced the bonding.

So right away I am suspicious of the ethics of your dentist. And from the experiences you had afterward it gives me the impression that she may have gotten in over her head here. Maybe not. I’m just being as honest as I can with my impressions here. So let’s go to your complaints.

You’re saying your teeth feel dry, there is a burning sensation, you want to tap your teeth together, you think your teeth are a little longer. I don’t have answers for all of that. But one comment you made particularly attracts my attention. You made the comment about your bite, apparently in reference to how the bite felt right after you got the new crowns: “making them hit my lower teeth in awkward ways.” That’s a red flag and is what gives me the idea that there is something wrong with the treatment, that your bite wasn’t right. When crowns are done right, the bite will feel completely natural and comfortable. But from the start you are saying that your bite felt awkward and now you are feeling that you want to tap your teeth together all the time.

And then referring you to a gum specialist. Really? What does this have to do with your gums? The bite is off. Another dentist checked the crowns. That’s nice to know that the crowns look fine. But each crown can look like it is perfect, and the bite can still be off. When you do all six front teeth, there are certain occlusal principles that have to be followed. Not only do they have to all meet simultaneously in what we call centric occlusion, but they also need to provide anterior guidance. In addition, the canine teeth are very important and in most cases they provide what is called canine protection–when you slide your jaw side to side they will be the teeth that force all of the teeth apart. And then add to that the effect that the shapes of these teeth have on your speech and you have a very complicated situation. Something in all of that function has not been done right for you, and what you need is a second opinion from a dentist who knows a lot about occlusion. That training is not generally supplied to general dental students in dental school. Post-graduate training for dentists in all these complex occlusion issues is provided at the Pankey Institute, the Dawson Academy, Spear Education Center and the Las Vegas Institute. I would get a second opinion from a dentist who is a graduate of one of these institutions.

About the burning sensation and the dry feeling, yes, that could be burning mouth syndrome, which in my opinion is caused by stress. If you had your bite fixed, maybe that would go away.

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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.

A full-mouth reconstruction horror story

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Hi Dr. Hall,
I found you by searching on crowns and dry mouth.

A couple of months ago my dentist removed my 18-year-old veneers and restoration of my upper teeth 7 veneers and bridge was to begin. I complained every day about my temporaries and requested that he take them down on 2 separate occasions. My bridge fell out 3 times before permanents arrived. A little over 3 weeks ago he delivered them. The appointment was over in 40 minutes.

I’m suffering with my lip sticking, air stuck in my front teeth blowing bubbles, and my mouth is so dry that I’m eating popsicles all day and night for relief from dryness and the sucking I’m doing of my tongue and lip. I suck on my tongue and back of teeth so hard it burns! I can’t seem to stop sucking. What is wrong with me?!?! The porcelain is tough and rigid. He said he had to open my bite so I can show my teeth but I’m not showing teeth at all actually, it’s really really odd and the dentist claims I’m going to have to adapt because his “checkpoints” are perfect and textbook case. All I wanted was B1 shade and the hand press style porcelain that I’ve known my adult life! Please help me if you can.

I’m 42 and my second time in veneers and I’m miserable. I gained 3 extra crowns and a substantial gap in my bridge. With almost a month in, this can’t be healing tissue, is it?

Sofie from Michigan


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Dear Sofie,
No, this isn’t a healing issue. This is a “dentist screwed up issue.” You need to get this fixed and I’ll be blunt as is my style—you need this new work taken out and started over again. And I wouldn’t have this guy doing it.

Opening the bite requires crown work on at least every tooth in one arch—most typically it is done with a full-mouth reconstruction meaning every tooth is restored. And it needs to be done with great care. It needs to be done with temporaries first. At least it looks like your dentist did that, but it sounds like he didn’t respond to your discomfort. You wear the temporaries at the proposed new opening to make sure you are comfortable with it and function properly. You’re telling me that you “complained every day” about your temporaries, but it looks like your dentist plunged ahead anyway.

Your body has a certain amount of jaw opening that it is comfortable with. This amount of opening is tied to the muscle tension in your jaw muscles, as well as reflexes that are part of speaking. Opening the bite is indicated when there is bite collapse—you have worn down your teeth to where your mouth is over-closed. In that case, we open the bite to restore your normal vertical dimension.

A big part of the problem in your case is that your dentist opened your bite when I’m guessing that you already had a comfortable bite. He was doing it to get more of the upper teeth to show. That puts him into risky territory from the start. If this is correct, that your bite was already comfortable, opening would put you beyond your normal opening, and that’s when you get into these issues that you are having: lip incompetence (the lips when relaxed don’t close all the way) leading to dry mouth, speaking problems, and other issues. He claims that your “’checkpoints’ are perfect and textbook case.” No, I’m sorry, that’s not the case. The main checkpoint is does your mouth when relaxed close naturally, and it doesn’t.

A Warning

A side note and warning for you. DO NOT EAT POPSICLES to keep your mouth wet. That is one of the worst things you can do, unless the popsicles are sugar-free. Your dry mouth doesn’t have the proper amount of saliva, and it’s your saliva that has your defenses against decay. You are risking rampant tooth decay getting in under your crowns and ruining your teeth. Get something sugar-free to suck on.

What to Do Now

I’m sorry to have to break this to you, but you need your whole case re-done. And I would not have this guy do it. I’m sorry again, but I wouldn’t trust him. What has happened in your case causes me to question his ethics. This is a serious breach of professional care and admittedly I don’t know all the facts in your case, but from what I know he is liable for malpractice. Maybe he is a really good guy and was just trying to do the right thing. But the stakes are high here and there is a small minority of dentists who know how to do this right.

I’ll tell you what I’ll do. I’ll email you privately with a recommendation for a very good dentist with strong ethics and well trained in cases like yours. I don’t want to give a name like this publicly lest the dentists I don’t recommend get offended. And then I would ask this new dentist to contact your current dentist and ask him nicely to refund your money to keep you from complaining to the dental board, putting his license in jeopardy; or from going to a lawyer.

– Dr. Hall

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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.

Am I Allergic to These Crowns?

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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.)

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.

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


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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. In your case it appears to be 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, as you have explained it, 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

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 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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