Dr. Sam: HELP!! (for real this time...I can honestly say that I'm scared out of my mind)?

Question

I got a few crowns about four months ago and since then the gums directly above them have been tender and dark. I got braces about a month after this. Everything was fine until about three weeks ago when the gumline just above the crowns became inflamed. I went to the dentist because i thought I had gingivitis but he said according to the x-rays everything looked fine. He thinks I may have a small gap or hole between the crown and my gum. I was given a prescription for pain relievers and antibiotics even though he said they won't do much. He said that the periodontist may have to cut parts of my gum out and my gums might inflamed due to plaque getting trapped in my gums. He said that I may have to get the crowns redone.
Do you think this is something to be dealt with asap or can it wait a month? What do you think is happening and what might happen if I do nothing but brush three times a day, floss daily, use Crest Pro-Health Rinse daily and use a flouride rinse daily?

By the way, the general dentist I went to was NOT the same dentist who did the crowns.

Yes, I won't lie...my crowns are porcelain fused to metal and I don't like the aesthetics.

Answer 1

I'm here, but a little busy lately...

Again and as always, please remember that I have not seen you or your x-rays and I am just speculating so that you might have a better understanding of what questions to ask the person who is actually treating you.

My first impression is that you should not immediately notice a change in your gums when you get crowns. Maybe for a day or three, they will be irritated after having the cement cleaned away and so on, but they really should return to pretty much normal within a few days. This suggests to me that the edge of the crowns (the "margins") might not be technically the best possible, because this alone will canuse gum irritation. I can't see or judge your crowns, but that is a red flag for me.

If you want to wait a month, that is up to you. Again, I just can't see your gums, can I? Unless you have something really horrible going on, a month will not usually make THAT much difference. I am guessing that you want to wait until January 1 for a new insurance year. Go ahead with the antibiotics for now and see what happens in the next couple of weeks. Things don't generally move so fast that they are irreversible with minor gum irritations.

I would suggest that you see the periodontist and try to read between the lines and get his/her comments on how the crowns fir your teeth. Since your dentist refers patients to this periodontist who relies on referrals for a living, you may not get a direct answer, but he/she won't tell a boldfaced lie,either.

In the meantime, you are right. Just step up your home care to as nearly perfect as you can possibly manage.

Answer 2

There are 2 possibilities:
1. As mentioned above, the margins might be poor. Any dentist should be able to assess this, and a periodontist isn't about to cut your gums because it won't help you. The crown margins must be either smoothed (difficult), or the crowns removed and new temporary crowns placed until the gums resolve, then new crowns made. Antibiotics are pointless and too many are given out willy-nilly for incorrect problems like this - you can't cure gingivitis due to poor margins using antibiotics.
2. However, from your description of dark gums, I would be more likely to think that the metal alloy in the crown is non-precious i.e. of low or zero gold content. Just like cheap metal in earrings can cause skin problems, so can cheap metal in crowns. The original dentist will know the type of alloy he asked the lab to use, so that's where you should start. If he's used less than 80% gold content, then this is the likely problem. The crowns would have to be replaced, no other way. But again, temporaries first until the gums heal.
BTW, Crest Pro-Health Rinse only contains cetylpyridinium chloride. Despite their advertising spiel, this is not going to help you (or anyone) at all. A waste of money. You could try a real antibacterial mouthwash containing chlohexidine gluconate e.g. Peridex (USA), Corsodyl (UK),... If your gums are due to poor margins and hence plaque buildup, then this will clear it up. But if it is a skin reaction to cheap metal, then it will make no difference. Try it and see - you can diagnose yourself.

Answer 3

I'm sure Dr. Sam will be along shortly to answer your questions.

While you're waiting for him, let me comment from a financial perspective: If your crowns were placed only 4 months ago, the dentist who did them should be responsible for any charges to fix them. Unless you did something completely irresponsible (as in chew nails, smoke crack, or drink battery acid), the doctor should make this right.

A conversation between your orthodontist and restorative dentist should take place - soon.

OK, I'll step back and wait for Sam...where are ya?

Answer 4

i would get a second opinion from another dentist if you don't get satisfaction from yours, it sounds like it may be badly done crowns to me. if the area where the crown meets your tooth is not sealed or not smooth it will irritate your gums and cause you problems

Answer 5

GO BACK TO THE DENTIST WHO DID THE CROWNS AND HAVE THEM EVALUATED. THERE SHOULD BE A SMOOTH TRANSITION FROM THE TOOTH TO THE CROWN. IF THERE IS NOT, PLAQUE TRAPPED IN THIS AREA CAN CAUSE AN INFLAMMATORY REACTION WHICH IS LIKE WHAT YOU DESCRIBE.

Answer 6

My score was 34. 31 TO 40 POINTS: Others see you as sensible, cautious, careful & practical. They see you as clever, gifted, or talented, but modest. Not a person who makes friends too quickly or easily, but someone who's extremely loyal to friends you do make and who expect the same loyalty in return. Those who really get to know you realize it takes a lot to shake your trust in your friends, but equally that it takes you a long time to get over if that trust is ever broken.

Answer 7

You really should get this checked out ASAP. If it is periodontial gum disease then it needs to be taken care of with proper treatment. You really do not want the infection to travel any further in your body....it can cause other issues that you may not want to deal with.