Expert: Tony Appleton BDS DPDS - 11/8/2007

Question
QUESTION: Hi Tony
i had to have 4 root canal treatments and then 4 crowns put onto my teeth following a cycling accident. i was very happy with the work, which was conducted in germany and i now live back in the UK. however, on my lower jaw two of the teeth which are next to each other the gum seems to be receeding slightly. i can now see more and more of the 'metal' or shiny

substance that has been used to construct the base of my crown. it has

definitely receeded as when i touch it with my tongue at times i can feel

the cool surface where before i could not
do you have any advice on how i can improve gum health? i clean my teeth

twice a day with an electric toothbrush without fail, floss my teeth on

average 5.5 nights out of 7 and use listerine mouth wash 3-4 times per week
thank you in advance for any help with this matter
thanks and kind regards
Jonathan, 22, England

ANSWER: Hi Jonathan

It sounds like you are doing everything you should be doing to maintain good gum health, although to confirm this you should see a hygienist who can go through your regime with you and suggest modifications to improve it.

If you want to improve the appearance then realistically the only effective way is to replace the crowns - the metal margins are now visible, and it is virtually impossible to hide these margins. I would suggest a ceramic crown rather than a porcelain fused to metal crown would be preferable, as that gives a virtually invisible join if done correctly, and the overall aesthetics are superior.

Regards

Tony Appleton

---------- FOLLOW-UP ----------

QUESTION: Hi Tony

thanks for getting back to me so quickly. its not really the aesthetics im worried about. more the fact that the gum seems to be receeding - it is now lower than when the teeth were first constructed. is this normal? my fear is, naiive i know, that the gum is holding the tooth in place and if it receeds then the tooth will fall out! that seems very illogical as i write it but i remember my dentist saying that i need to keep the area as clean as possible in order for the gum to 'accept' the tooth
thanks and kind regards
Jonathan

ANSWER: Hi Jonathan

The recession is either due to a build up of plaque, or due to the margins of the crowns not fitting quite flush to the teeth. From how you describe your oral hygiene it sounds as though you have a good regime, but as I said earlier, seeing a hygienist will reinforce that. If the crowns are ill-fitting then they ought to be changed anyway.

It is unlikely (unless you have active gum disease) that the recession will actually go too much further - but I understand your concerns, so you need to rely on your dentist for advice.

Regards

Tony Appleton

---------- FOLLOW-UP ----------

QUESTION: ok, are there any other signs that suggest the crowns are ill fitting that i can look for? i dont think this is the case, he was an excellent dentist and very thorough..and im hoping in this instance you get what you pay for as he wasnt cheap either!

Answer
It is all to do with how flush the crown is with the tooth - really this can only be checked by your dentist by probing the junction of crown/tooth. There is inevitably a join and how pronounced this is will affect how much plaque traps around the join. Plaque then irritates the gum which becomes inflamed and this then leads to recession.

Some of the newer ceramic crowns can be made so the junction is virtually indistinguishable.

Regards

Tony