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.

August 26, 2017

Titanium or Zirconia Implants?


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Dr. Hall,
I have 3 titanium implants now and have heard that zirconia, brand name CeraRoot, might be a better option because the titanium might cause neurological ill effects. What are your thoughts about which might be better for the patient?

Best, Sandra

Sandra,
I would recommend the titanium implants. I have one myself. I am not aware of any research that suggests any adverse neurological or other biological effects of titanium on the human body—it is one of the most biocompatible of all materials.

I don’t have a problem with the zirconia implants, but there is much less experience with them, and I don’t know any reason to vary from the time-tested success of titanium implants. Titanium has been used for decades, not only in dental implants but in joint and bone replacements all over the body.

There is a certain appeal to metal-free dental implants because there are some metal sensitivities that cause problems that some people have with certain dental work. But a blanket condemnation of metal in the human body isn’t justified, in my opinion. Remember that there are certain metals, such as iron and zinc, that perform essential functions in our biology and are essential ingredients of our diet.

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.

November 30, 2016

Allergic to her removable partial denture


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Dr. Hall,
I have been sick for over 2 years after having upper and lower partials put in. I’ve had sores in my mouth on my tongue. I complained to my dentist over and over. My dentist just referred me here there and everywhere. I finally went to Mass General Hospital and I am in fact allergic to several metals one being nickel. My questions is, can having these partials in my mouth for this long (I felt better at night when I took them out) however, never feeling quite right as I had to put them back in 7 or so hours later to go to work. Would this make you physically sick?
Thank you in advance for your advice.
Ginger from Massachusetts

Ginger,
I am continually surprised by these cases that come to me about metal allergies and people tell me that their dentist doesn’t have a clue. This is fundamental and important.

To answer your question, yes, you can definitely become physically sick from constant exposure to metals to which you are allergic. Of course I can’t diagnose from here, but it is entirely possible that your sickness from the date of having these removable partial dentures comes from your metal allergies.

I had one rare case in my practice of a woman who was allergic to mercury. While most of my patients didn’t want mercury-containing amalgam fillings in their mouths, for this woman it was imperative to get rid of them because she had a confirmed and very rare allergy to mercury. We had several appointments to take out all of her amalgam fillings and replace them with composites. After the first appointment, she developed a rash on her throat and chest and had some difficulty breathing because of the amalgam dust that we had created during this procedure. From then on we draped her to avoid any additional exposure and gave her a nose mask to breathe through during these appointments. I remember when she came in for her six-month checkup after all of this was completed and I asked her if there was any change in how she felt. She told me that she had been troubled with arthritis, but since the amalgam was removed the arthritis was gone. I am confident that her arthritis was related to her constant exposure to allergens.

Many metallic removable partial dentures are made with an alloy called Vitallium, which is composed of chromium and cobalt and has no nickel in it, but there are less expensive alloys that do have nickel in them. Or they could have other metals that provoke reactions.

About 10% of women and about 1% of men will test positive for nickel allergy. “Are you allergic or sensitive to any metals?” should be a standard question on every dentist’s medical history form, if they use any metals in their restorative materials other than precious metals. But sadly, it isn’t. Most women with these sensitivities will know that they have to wear hypo-allergenic earrings, and the dentist should get this information before treatment. Though there are a growing number of dentists now who only provide metal-free restorations–if that is the case then of course they don’t need to ask this.

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.

January 5, 2016

Multiple allergies to dental materials

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Dear Dr. Hall,

I have patch tested positive to many metals and chemicals. I had a root canal 5 years ago that got botched and the file was broken. I then went to an endodontist and he tried to go through the top to remove the file, but ending up going through the bottom and cutting. It has never felt right and I went to a dentist who said I had an infection under it. I was diagnosed also by allergist at my local university hospital with TILT, same thing as multiple chemical sensitivity. I know I have allergies to dental cement, formaldehyde, cobalt, chromium, titanium, and many chemicals. Right now I have very bad eczema from all allergies, but I am in pain and just want this root canal tooth pulled and cultured to see what type of infection it is. I am looking for a dentist. I will travel for someone knowledgeable on type IV metal allergies. Could you help me?

Thank you,
Lisa from Mississippi

Lisa,
I’ve been stewing over your question since I first saw it a couple of days ago. That’s quite a tough situation that you have.

I don’t think you necessarily need a dentist trained in your specific allergies, and I don’t know that there is any such dentist. What you need, I think, is a dentist willing to work with you and to work around the list of allergies that you have. And I think for that, you need to call around and ask offices if they are willing to do that.

When I was in practice, I was willing to work with people with multiple sensitivities, and I would have some of them come to me with a list of dental products that they were sensitive to. These were Cliffords tests. They are controversial, and I didn’t want to get into the controversy, but I would honor the findings of the doctor that had run the tests, and we would avoid all of those materials for which the patient tested sensitive. I know from interviewing many dentists that most are not willing to deal with issues like that, but a few are. In the dental marketing that I do, when a dentist is willing to work with those Cliffords tests, we market them as holistic dentists.

I can think of a couple of dentists I know who are within reasonable driving distance (2-4 hours) for you who might be willing to accommodate you. If you’d like me to call and ask, let me know, and I’ll get back to you.

Or another option would be to run a search yourself in Google for dentists who hold themselves out as holistic. And then call the office and tell them about your problems and see if they’re willing to work with you.

Thanks,
Dr. Hall

Do you have a comment? 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, 2015

This dentist wants to do gum surgery, while admitting she doesn’t understand the problem

Dr. Hall,

My front teeth developed little ‘holes’ on the surface when I was a teenager and in my 20’s. I initially had some of them bonded. That was in the 80’s. This bonding yellowed with time. So my dentist suggested crowns and veneers. My 2 front upper teeth have veneers. The 2 teeth next to the front teeth on both sides have crowns. These were done in 2003.I had no problems with this until about 3 years ago. Suddenly the gums around these teeth became inflamed. I am now 49 years old. My dentist isn’t sure what is going on. We have tried an all natural antibacterial liquid (I forget the name) with no luck. I get my teeth cleaned faithfully every 6 months. Flossing every day doesn’t help resolve this. This inflammation improves at times and gets worse at times, but it never goes away completely. I do have other crowns in my mouth. On my bottom teeth on both sides I have 2 crowns and a bridge. I also have 2 other caps in molars on my upper teeth. There is also inflammation around those but not nearly as bad. The gums around the remainder of my natural teeth are just fine.
Could these changes be because I am in peri-menopause?
I find it odd that it took 10 years for this to occur. Also, my dentist suggested trimming back the gum tissue. She won’t guarantee that this will fix the problem. I think she wants to do it for cosmetic reasons. Or she may know there is a structural/mechanical problem with the fit of the crowns but doesn’t want to admit it. I don’t want to go through this gum procedure if it’s just a bandaid and the problem will return. So far all this inflammation has not caused full on gingivitis or bone damage (so they say). The gums sometimes get friable and look almost ulcerated. Also, on a side note a few months ago I developed lichen planus on the checks of my mouth (not in the front). This is very frustrating. Sometimes my gums are sore. Sometimes they look just terrible and you can see the red border around my front teeth. It seems my teeth have separated between 2nd and 3rd tooth on both sides counting from the front teeth.
Should I have this procedure? It’s only on the front teeth. What about the inflammation on the other crowns in the back? This is what makes me think it’s systemic. Again this is just around the crowns and veneers.
Any thoughts, suggestions?
Thanks for your time!
Donna from Philadelphia

Donna,

You have a very interesting question here.
When you have gum inflammation around teeth with crowns, there are about five possibilities that come to mind.

  • One is that the cement wasn’t fully cleaned out from around the crowns.
  • Another is that there is some problem with the fit of the crowns.
  • A third is that the crowns go too deeply under the gumline.
    For all three of these situations, the reaction would have been immediate–not delayed ten years.
  • Another possibility is to have some kind of allergic reaction to the material in the crowns. This would happen with porcelain fused to metal crowns where a cheap metal was used containing nickel or some base metal. Usually the metal sensitivity reaction is immediate, but it doesn’t have to be. But veneers should be all porcelain with no metal in them, and you are having the same reaction around the teeth with the veneers, so that seems highly unlikely.
  • The fifth possibility is simple gum disease, aggravated by some things that are going on with your general health. That’s not to say that the causes are simple, but that the disease is a common one and there are some straightforward things to do to address it.

Unfortunately, there are a lot of dentists who simply don’t pay that much attention to the health of the gums, and I am concerned that your dentist is saying that she doesn’t understand what is going on here.
I would recommend a second opinion for you. I don’t think this should be that mysterious–maybe to your dentist, but not to a dentist with strong knowledge about the gums. I would absolutely not let her do this gum surgery on you. I’m not impressed with her aggressive treatment for your yellowed bonding ten years ago. You’re a little suspicious that there might be some structural problem with the crowns that she doesn’t want to admit. That’s possible–there could be some irregularities in the fit of these crowns and veneers that aggravates the gum disease. Your being peri-menopause is probably a contributing factor, also. Hormone imbalances can exacerbate gum inflammation. You mentioned lichen planus. That condition is exacerbated by stress just as gum disease is. It’s possible that a good, thorough deep scaling of your teeth could take care of this, but I feel you need a dentist with more expertise.
Think about what your dentist is telling you–she doesn’t understand why this is happening and yet she wants to do gum surgery to address it. One of the most fundamental principles of health care is that you first diagnose, then you treat. Don’t let anyone attempt any kind of serious treatment here like gum surgery without first having a good diagnosis.
As I think over what you have told me, it’s a little puzzling why your dentist hasn’t referred you to a gum specialist (periodontist). You’re in Philadelphia. There have to be a number of gum specialists you could go see. Maybe she doesn’t want another dentist to see her work. Anyway, since she hasn’t referred you, just self-refer. Just find a periodontist with good reviews. If you have any doubts about who to pick, call a couple of well-respected general dentists and ask what periodontists they refer to. Don’t ask your dentist for a name because of this suspicion we have that she may be trying to hide something. But you do want the periodontist to contact your dentist after you’ve made the appointment and get records that will help him or her assess what is going on.
And then get back to me, if you would, on what they find out. I’d be interested to know what is discovered about your condition.

Dr. Hall

Read more about fixing a discolored tooth from a root canal treatment.

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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.

March 1, 2013

Is she allergic to the metal in her crowns?

Dr. Hall,
I am 64 years old…had metal fused porcelain crowns (5 upper front teeth) placed 4 years ago. After countless dentist visits, a nightguard, a guard for my bottom teeth, tensing of the jaw, etc., I cannot stop grinding my teeth. I am constantly aware of these crowns with the sensations I feel in the roof of my mouth. Do you think that maybe I cannot tolerate the metal? Previous to these crowns, I had gold backed crowns for 42 years which I never had a grinding problem. I have no peace and I am ruining my bottom teeth. Could I be allergic to the metal? (only because it actually feels “itchy” at the roof of my mouth.)

– Mae in Pennsylvania

Mae,

I need a disclaimer because of not being able to examine you myself, but just going from what you are telling me, it sounds to me like you have two separate problems.

The itchy feeling around the metal backings to your new teeth could well be from a metal allergy. Here’s what I would do: Ask your dental office for information on the composition of the alloy used in the metal of your porcelain fused to metal crowns. The laboratory would have sent them what is called a “Identalloy” certificate, which lists all the metals in the alloy. If you see “Ni” among the metals listed – this stands for nickel, and nickel allergies are fairly common.

Are you sensitive to any metals in earrings, for example? Women who have nickel allergies need to wear hypoallergenic earrings, and they have to be careful with what metals are put in their mouth.

Let me explain these dental metal allergies. In the medical history that the dentist took before starting any treatment, he or she should have asked if you have any history of metal sensitivities, and if you have anything like that in your history, the dentist should have prescribed metals for use in your mouth that have no nickel in them. The problem is, those metals are more expensive than ones that do have nickel. There are three expense classifications of metals used in crown and bridge work. The highest is called “high noble.” The gold backing you used to have would be in this category. Other alloys have high platinum. This type of metal makes a finer margin and is more malleable, meaning that it can be made to fit the tooth the best. The second highest is called “noble.” These will have a higher silver content, but will have no nickel or beryllium, which are metals that can cause sensitivities in some patients. They are somewhat malleable and make a very nice fit to the tooth, but not as high quality as the high noble.

The lowest category is called “base metal.” These are very stiff alloys and tend to be cast with small gaps between the metal and the tooth, so they don’t fit quite as well and they aren’t malleable at all. They will have some nickel in them and sometimes some beryllium.

Your new crowns may have also disrupted your bite. The metal sensitivity shouldn’t be causing you to grind your teeth, But if you had crowns on five front teeth, that has a strong impact on your bite and your bite could be thrown off to where it is making you want to grind your teeth. If this is happening to you, I would wear a nightguard every night until the bite is adjusted to where you don’t grind any more.

A particular problem if you have porcelain crowns on your front teeth that don’t have a full metal backing is that the porcelain on the upper teeth is highly abrasive to your lower teeth, and you will gradually wear down your lower front teeth. So I would get this fixed.

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.

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