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Is this burning mouth syndrome or a zirconia allergy?

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Dr. Hall,
I had 2 zirconia crowns put in during December 2019. Since then I’ve had a dry sticky tongue along with a burning in my throat. I’ve been to 3 ENT Doctors. Acid reflux was ruled out, mouthwash ruled out and the 3rd doctor said it’s burning mouth syndrome. My dentist said there’s been no allergy associated with zirconia. It’s now July 2020 and if anything it’s gotten worse. I need more dental work but that’s out of the question. I had lingual nerve damage that took a year to go away caused by dental work. I wish someone here had ideas. This has caused not only discomfort and pain but also depression.

One additional comment. During this last procedure a laser was used for tooth extension. Drilling of course was also done During this procedure a lot of water was used to protect surrounding teeth. I had difficulty breathing and had to stop the procedure as I regurgitated water. This put a great strain on my throat and I’m wondering if a connection is there. This has also affected speech. Please go away!

– Jeff

(See Dr. Hall’s answer below.)


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Jeff,
I would be careful ever telling any patient that allergy to some dental material is impossible. Rare, but I wouldn’t ever want to say impossible. There are some weird allergies out there that are extremely rare. And I have seen some reports of allergy to zirconia, though those are unconfirmed. (Click here to read this report of an allergic reaction to zirconia implants. The report sounds credible on a superficial level, but it would be nice if they had documented where this case came from. They don’t say whether this happened in their office or someplace else, so I wonder if this is just a rumor they heard. The lack of documentation leaves me having to categorize this report as hearsay.)

Having said this, to me your case sounds to be most likely burning mouth syndrome, so I am agreeing with the third ENT doctor. While I have heard it said that the cause of burning mouth syndrome is unknown, I have consistently seen a clear pattern of connection to traumatic dental experiences and dental anxiety. You not only have all the symptoms of burning mouth syndrome, your experience points clearly to that. You had this previous damage to your lingual nerve which would make you very anxious about the dental procedure and add greatly to the stress you would feel. You mention a high level of difficulty with the water and the great strain on your throat during the procedure. And now you have lingering problems with speech as well as depression.

Look at the comments numbers 8, 9, and 10 on the post I linked to burning mouth syndrome, and you’ll see a couple of people sharing stories of dry mouth and burning tongue after highly stressful dental experiences.

My recommendation? In my experience, a high level of dental anxiety is best treated with conscious sedation. If your dentist doesn’t offer that, I would find one that does. Your anxiety may even be great enough that you need IV sedation. This could achieve a successful, anxiety-free dental experience. I have seen that be a tremendous relief to many patients. In some cases it has totally cured their anxiety. In all the others, it has reduced it, usually greatly. You said you need further dental work—that would be the way to do it.

I wish you well.

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.

Is zirconia radioactive?

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Dr. Hall, you have kindly answered a dental question for me before. Currently, I am wrestling with what would be the healthiest option for a crown for me to have placed on a lower molar (next to last) which has a 30-plus-year-old crown on it and which required dental surgery to remove severe infection so the tooth could be saved. It seems my dentist saved the tooth but he wants me to return in five weeks to remove the old crown and place a new one. He mentioned zirconia but I understand this material is extremely difficult to remove should I have further problems plus I have read there is radioactivity in this material. I considered e.max and then Encore PFM which has 4o% palladium. I am confused over what would be most healthy in the long run and my dental appointment is looming. Dental issues are definitely life changing. Any clarity you can provide me would be so appreciated. Thank you.

– Sandra from Mississippi


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Sandra,
So which is the safest crown? It probably has less to do with the three materials you mentioned and more to do with the expertise with which the crown is crafted. Your greatest danger with a crown, among those three excellent materials, will be with recurrent decay, which will be minimized by having a precisely fitting crown. And if your dentist was able to save this tooth from a severe infection, that’s a good sign that he may have the skills to make an excellent, well-fitting crown.

Yes, there are trace amounts of radioactivity in zirconia. Some zirconia materials used in dentistry are refined to minimize that radioactivity. But even without that, the amount is extremely small. There is also radioactivity of a similar amount in brick, stone, and concrete. Actually, there is even some radioactivity in water.

Some people also question whether or not there is an allergic sensitivity of some people to zirconia. We had one report of that and then it turned out to be a case of burning mouth syndrome. And yes, zirconia is very difficult to remove, but that is the dentist’s problem, not yours. He or she may wear out a diamond bur or two trying to get it off if that ever becomes necessary, but that won’t hurt your tooth any. The e.max crowns are also difficult to remove, porcelain fused to metal not so much.

If you are allergic to a lot of things, an all-ceramic crown would seem to be a good choice. The two popular, strong ceramic materials are zirconia and lithium disilicate. The CEREC crown-in-a-day is made out of lithium disilicate. The e.max crown is made of a lithium disilicate core veneered with feldspathic porcelain. It can be made highly aesthetic and has become very popular with dentists because of its strength, aesthetics, and the ease of working with it. I have one of those on a first premolar. But if you want the safest, longest-lasting crown on a lower first molar, cast gold would be the material of choice. Whether or not that would show would depend on how wide your smile is. I have crowns on three of my second molars, and they are all cast gold. Gold can be cast to a very fine margin, won’t ever break under the most severe oral stresses, and is extremely biocompatible. After gold, the strongest material for a crown for a molar would be zirconia.

– 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.

Is palladium a toxic metal? My crown has palladium in it.

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Dr. Hall,
Recently from my periodontist who also does cosmetic dentistry I was fitted with 6 high noble porcelain-fused-to-metal crowns. I knew they were PFM crowns but later I discovered they are Encore crowns and contain 40% palladium. I have read of the toxicity of this metal and am concerned that there is such a high percentage of it in my crowns. I am now considering having them removed and considering e.max or even zirconia, whichever is the most inert. I hope you will advise me on what steps I should take.
Thank you for your time.
– Sandra from Delaware


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Sandra,
I was struck by your question because I had never heard of palladium toxicity, and I try to keep myself informed of these things. Many dentists, I feel, are much too casual about metal toxicity issues. You can check other posts in this blog where I list various metals used by some dentists that cause sensitivity reactions. But palladium? I decided to do some research to see where this idea comes from.

In the movie Iron Man 2, Tony Stark has an arc reactor that keeps him alive and powers his armor, and this arc reactor has a palladium core. In the movie, the palladium is poisoning his blood. In the real world, however, palladium is a noble metal and a member of the platinum group, and is fairly biocompatible. Yes, there are compounds such as palladium chloride that are toxic, but that is very different from the pure metal. And remember, that we are not talking about putting this metal into the tissue but only putting it into a situation where you are in superficial contact with it.

Also, in doing an online search, I discovered a natural health website that alleged that palladium is a heavy metal that is highly toxic. (not true—palladium is a precious metal that is actually fairly light.) To put their claims in context, near the bottom of the page is a link for visitors to get themselves tested to see if they have palladium toxicity. The link takes us to a page that urges visitors to send in $325 for a hair mineral analysis. So if we follow the money it seems that we are discovering the motivation for their mis-information.

Almost every dental alloy that is used in making crowns and bridges has palladium in it. Like platinum and gold, palladium doesn’t corrode. Its presence in a dental alloy lends a certain amount of stiffness to the alloy, so it is pretty much required in stress-bearing dental bridges. Alloys without palladium tend to be very soft.

Here is a chart of dental alloys manufactured by Aurident for use with porcelain-fused-to-metal crowns. Aurident is one of the leading manufacturers of dental alloys.
a chart of dental alloys used with porcelain fused to metal crowns, showing the percentage of palladium in the alloy
You can see the percentage composition of the various alloys. Au is gold, Pt is platinum, Pd is palladium, and Ag is silver. Notice that palladium, while it isn’t in every alloy, it is a component of more alloys than any other metal. When it isn’t present, the metal will be softer and will be more yellow in color. Soft is good in some situations. It makes the metal easy to burnish so that it fits tightly to the tooth. But a soft metal without palladium can also make the restoration susceptible to bending or breaking. The second column, labeled “class,” shows how the alloy is categorized. The square icon with the HN means high noble. These are alloys that have at least 40% gold and a total of at least 60% noble (precious) metals, of which palladium is one. Sometimes these alloys are simply called “gold,” and the term “porcelain fused to gold” is used. The triangles with the N are noble alloys that have at least 25% precious metals.

Even with gold alloys used in gold crowns, almost all of them have palladium in the alloy.

In my mouth, four of my crowns have metal in them—three gold and one porcelain-fused-to-metal—and I am pretty confident that each of them has some palladium content.

My opinion, Sandra—you don’t have anything to worry about, and as long as you are happy with how they look and aren’t having an allergic reaction, I would leave well enough alone. There are some instances reported of palladium allergy. If that is your situation, you will have symptoms such as redness in the gums around the crowns and/or an itching or burning sensation there.

Switching to zirconia? While rare, there are also some instances that have been reported of zirconia allergy. I had one woman write to me who, after going the rounds with several dentists, finally decided that she was allergic to the zirconia in her crowns. I have decided never to tell someone that it’s impossible for them to be allergic to some dental material. Sometimes it seems that putting anything artificial in your mouth carries at least a tiny amount of risk. Wouldn’t that be ironic if you are having no reaction to the palladium and switch to something else only to find out that you are actually allergic to the new material!

– 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.

My dentist wants to wait till the nerves settle down before replacing my crowns

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Dr. Hall,
My dentist convinced me to replace all my old amalgam fillings even though many were still stable. She was going to replace them with either composite or crowns depending on the size of the filling and how much tooth structure would be left. Anyway, we started on the project, and about six weeks ago she did three zirconia crowns for me. These crowns are so uncomfortable for me. They feel bulky to me, they press on my gums to the point that sometimes it hurts, and my bite feels off, making these teeth sore. It’s causing me a lot of stress, which especially concerns me because I have a new baby that I am nursing, and it’s like the stress is affecting her. She hasn’t been able to sleep lately and has been waking up crying all the time.
So I canceled the rest of her treatment plan. But of course she refuses to refund the money for the 3 crowns because she’s convinced they are fine and says if there is any problem, she will fix it. I don’t trust her to fix it though.
But now I have gone to a new dentist, and I want her to re-do these crowns. I realize that I will have to pay for this out-of-pocket, but I really want to get this done. But this new dentist says she does not want to touch my crowns until I give the nerves time to heal and lower the risk of needing root canals. But that can be months. I don’t know if I can wait that long.
 
– Gail from New Jersey
 


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Gail
I’m confused by the reluctance of your new dentist to replace these crowns, saying that the nerves need to heal. The problems you have with the crowns—pressing on the gums, bite is off, they feel bulky—have nothing to do with the nerves of the teeth. If those nerves were irritated, there would be heightened sensitivity to cold in those teeth. While it doesn’t sound like your first dentist has a strong level of expertise when it comes to crowns, it doesn’t sound like your new dentist has a firm understanding of dentistry either.
Yes, a crown preparation, where the dentist is cutting deeply into the tooth, can be irritating to the nerve of the tooth—in some cases highly irritating. But removing an existing crown is only mildly irritating, if any at all. If, indeed, the nerves had been highly irritated by the first crown preparations, which it doesn’t seem like has happened, six weeks would be enough time for them to settle down.
I wish you well and hope you get this problem solved. I see no reason for a delay in replacing these crowns, and I am very wary of the level of expertise of this new dentist of yours. She is displaying timidity in tackling this problem—not a good sign at all. I warn patients in several of my blog posts about how easy it is to push some dentists outside of their comfort zone, and she is giving you a red flag here that she isn’t comfortable re-doing these crowns. Maybe what is making her timid is the difficulty in grinding off zirconia crowns. They are very tough and very hard to grind off, especially if they are bonded on. The worst thing you could do would be to urge her to go against her instincts here.
If you’d like help finding a dentist who could do a good job on this for you, let me know and let me know exactly where in New Jersey you are. I know a number of excellent cosmetic dentists there.
Good luck,
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.

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

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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.

Why does my crown keep falling off?

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Dr. Hall,
I have had a crown put on by a dentist and it was done same day. No temporary. Not sure what type of material he used for the crown. It fell out three times in less than a year. I went to a different dentist on the fourth time it fell out and he replaced the setting with a new one stating the other dentist didn’t create a good setting. This new crown is Zirconia Porcelain and it has fallen out twice in a month. He is suggesting a full porcelain crown on the same setting as he states the cement is adhering to my tooth but not the crown. He says the all porcelain has a more rough underside to adhere to the cement better. Any suggestions on what my next move should be?
– Stephanie from North Carolina

Stephanie,
Your same-day crown was a CEREC crown or a similar type that is milled by a computer in the dental office while you wait. But when properly prepared and bonded on, it will stay on permanently. It’s not the material your crown is made of. Gold crowns, porcelain crowns, CEREC crowns, zirconia crowns–all of them can be made to stay on solidly, permanently. I have most of those types of crowns in my own mouth and they stay on just fine.

There are two main factors for retention of a dental crown–the bonding strength of the cement, and the shape of the tooth preparation. Of those two, the shape of the tooth preparation is far more important. If the tooth is prepared with only a slight taper, a crown can be cemented with a very weak cement and it will still stay on. If it is prepared with a lot of taper, some of the strongest cements will not hold it on.

I’m not saying that getting a good bond between the crown and your tooth wouldn’t solve your problem. The strength of the cement is a factor. And I know very little about your tooth and the techniques these dentists used. But I do know that a tooth prepared with good retention form will not have a crown falling off three times in less than a year, regardless of the cement used. So even though I know very little about your tooth, I’m pretty confident that it was prepared with inadequate retention form.

So what should your next move be? I would find a dentist who knows how to do crowns that stay on. In 23 years of dental practice, I never had a crown fall off of any that I did for my patients, so I know it can be done.

For further understanding of this principle, of creating a crown that stays on, see my blog post from about nine months ago, “The main reason your crown probably fell off.”

I hope this is helpful.
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.

Fluoride in Supersmile toothpaste

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Dr. Hall,
Does Supersmile toothpaste come without fluoride? My search was “do zirconia crowns stain” This site told me how to properly take care of my bridge. Happy I found this. Thank you for providing this information.
Susan from Arizona

Susan,
You’re right that Supersmile is a great product for keeping stains off teeth. However, all Supersmile products have a small amount of fluoride in them.

Fluoride is a naturally occurring mineral, and it’s virtually impossible to avoid ingesting it. When it is in toothpaste, the object is for it to bathe your teeth briefly in a small concentration of fluoride, which helps re-mineralize early decay spots. And then you rinse and spit. But otherwise, most natural well water has some fluoride in it, as well as canned juices and vegetables, soda, milk, and most other products that are liquids or that are processed with water. When I practiced in Iowa, we would sometimes have families come in from surrounding farms who drank well water. We would get samples of their well water and send it in for analysis. It always had some fluoride in it.

The efforts of dentists to encourage the use of fluoride is, to me, an evidence of the basic altruism of the profession. It does reduce tooth decay, which means less work for dentists. And while is is possible to get too much fluoride , in small amounts it is very healthy. It is of the same elemental family as table salt (sodium) and potassium. You can get too much sodium, but getting no sodium would be fatal. And the right amount of potassium is also essential to life, but if it is injected directly into a vein, it could stop your heart and kill you.

About your zirconia crowns or bridge – they should be very resistant to stain. Usually the core is made out of pure zirconia and it has a porcelain coating baked onto it. As long as the glaze on that porcelain is intact, it should resist almost any kind of stain. The advantage of Supersmile toothpaste is in its gentleness to the margin of the zirconia crown, which is a luting composite that would be vulnerable to stain and also to wear.
– 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.

Finding a cosmetic dentist in the Cayman Islands

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Hi there Dr Hall,
Many thanks for such helpful information on your website. Your support is greatly appreciated! I currently reside in the Cayman Islands, my front right tooth slightly overlaps my front left tooth. Is there anyone you could recommend in Grand Cayman, so many cosmetic dentists I don’t know where to start. I have visited one, whom suggested getting all my teeth whitened, then 2 zirconia crowns on both front teeth as sister teeth. Are there any other options to compare, or does that sound wise. I am 34 with 2 young kids and finally want not to be too embarrassed to smile.

Many thanks
– Denise

Denise,
What you’re telling me about what this dentist wants to do makes me nervous. The idea that he or she wants to do zirconia crowns on these front teeth rather than bonded porcelain makes me think that he or she is not comfortable with bonded porcelain. Bonded porcelain would be preferable to zirconia. Zirconia is great for back teeth or bridgework, but I wouldn’t recommend it for an esthetically critical situation on your two front teeth. And I would think the ideal treatment would be porcelain veneers anyway, not crowns at all. Doing two or more crowns on front teeth can put you at risk of breaking them off from lateral stresses.

I don’t understand all these cosmetic dentists you are talking about. I just googled cosmetic dentists in the Cayman Islands and looked at several websites and couldn’t find anyone I would trust with even the simplest cosmetic procedures, much less something as involved as what you are telling me. Even in the United States, fewer than one dentist out of fifty could do a beautiful job on your case. I would be surprised if you could find a dentist in the entire Caribbean area who could do a nice job on this. Quite frankly, I would fly in to Miami and have someone there do this. Dr. Sam Sadati near West Palm Beach is one I know personally who would do beautiful work for you. You could have your teeth whitened there locally and then get the two veneers or whatever your case requires done in Florida.

Why spend money to give you a mediocre cosmetic result and then possibly end up with damaged front teeth besides? Spend a little extra for a couple of trips to Florida and get it done right.
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.

My cosmetic dentist wants to use Zirconia crowns

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Dear Dr. Hall
To find an accredited cosmetic dentist I used your website. The dentist was not aware of using bonded all porcelain crowns for front teeth, the accredited cosmetic dentist relied on the advice of the lab tech. The lab tech refused to use bonded all porcelain on front crowns (upper)and insisted the dentist use Zirconia. Who is more knowledgeable or experienced in accredited cosmetic dentistry, the lab tech or the dentist? Thanking you in advance for your prompt reply.
Gina from Connecticut

Gina,
I’m not sure I understand what you’re saying.

Are you saying that you went to a dentist that we recommended on mynewsmile.com, and that this dentist had not heard of bonded, all–porcelain crowns for front teeth?

If so, I’d like to know, and I’d like to know which dentist that was.
And how was it that the lab tech was asked?

l want to try to figure out what happened with your case and then see if I can help you.

Thanks,
Dr. Hall

Dr. Hall
When I mentioned to Dr. N. Summer Lerch of New Haven,CT that I was looking for an accredited cosmetic dentist that would be skilled in bonded all– porcelain crowns for front teeth. Dr. Lerch did not confirm or acknowledge your findings that bonded all-porcelain crowns for front teeth would have the strength that Zirconia would have. Dr. Lerch relied on the lab tech’s recommendations for the crowns. Actually the lab tech refused to make the crowns in stackable porcelain. Unable to find another dentist at that time because I was charged in full for payment of my crowns on the day the lab tech refused to use stackable porcelain on front crowns.
If all this is confusing I will include my home phone if you have questions.
Thanks
Gina

Gina,
Zirconia crowns ARE stronger than bonded all porcelain. They have no metal, and while they are not all-porcelain, I would call them all-ceramic, and their appearance is excellent. They can be made beautifully translucent. A conventional porcelain is usually baked over the zirconia framework, and the end result can be made to look so natural that you could not tell them from natural teeth.

I don’t believe that your dentist was unaware of bonded all-porcelain, but rather than for your situation she felt that zirconia would work better. I’m not in a position to second guess that recommendation, not being able to examine you.

Which particular crowns should be used in a given situation is a matter that depends on a number of factors. I don’t recommend that patients try to push their dentist into using a particular type of crown, because often part of the decision is based on what works well in the hands of a particular dentist, and this will vary from dentist to dentist. Rather, I recommend that each patient find a dentist whom they trust and has the skills necessary to produce a beautiful result, and then give that dentist free rein to choose the material that works best for them in each particular situation.

Dr. Lerch was carefully considered before I recommended her on this website, and I am absolutely confident that she could produce a beautiful result for you. She has been on the accreditation examining board, which means that her esthetic talent and technical ability are highly regarded among her peers.

As far as relying on information from the lab tech, when a dentist has a trusting relationship with a skilled laboratory technician, yes, we often use them as a source of information on new materials. Zirconia is an up-and-coming material that many top cosmetic dentists are turning to, because it is so strong and can be made highly esthetic. And when it comes to the technical information about the strength of the material and its suitability for various situations, then yes, we will turn to the technician. I have criticized on this blog dentists who use the laboratory technician for a shade-matching appointment, because an excellent cosmetic dentist needs to have a great eye for color and an ability to communicate color. But the dentist and the technician are a team and each brings expertise and talent to every project.

I’m skeptical that the laboratory technician made the final decision in your case. If you were giving me trouble over my choice of material, I might use the lab tech’s opinion to help avoid arguing with you. When we as dentists are faced with a difficult patient who wants to push us into a treatment we know will be sub-standard, it’s easy for us to say things that may seem to that patient to be unreasonable. I’m inclined to believe that Dr. Lerch was showing integrity in your case, but I can see how it wouldn’t appear that way to you.
Dr. Hall

Related information:
Read more about porcelain crowns.
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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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