Expert: Steven C. Scherr, D.D.S. - 12/17/2007

Question
Hello,

I am having problems with a new crown that was placed 2 months ago. I floss everyday, and my gums bleed a lot only between the crown and the adjacent tooth every time I floss. There is no open contact, but between this tooth and the adjacent one there is a space near my gum line.  I also have a metal taste in my mouth, and the tooth is also sensitive to cold and tingles/hurts at times.  I'm not sure why this is because it is a root canal tooth.  The crown itself shows what I think the dentist called overhang, around the top of the crown you can see metal.  The dentist that placed this crown also placed another crown at the same time that I had to have replaced due to open contact.  He's new, and maybe that's why I feel that he also improperly placed this one.  What do you think are causing my problems?
Thank you for your time, Dawn


Answer
Dawn,

Let's take a look at the possible causes:

1. The crown could be made of a material that you are allergic or hypersensitive to.  Some dentists use less expensive non-precious or low-precious metal alloys in the fabrication of a crown.  Most people do just fine.  However, some people cannot tolerate nickel and other components of these metals.  This could cause the symptoms you describe.

2. You are making a strong home care effort.  However, it is possible that you are ineffective at removing the bacterial plaque that collects beneath the gum line.  This can be due to one of 3 distinct problems.  The wrong cleaning aid may be in use.  For example, dental floss is a wonderful aid for cleaning between most teeth.  However, if there is a dip in the side of the root, floss will bridge across the indentation and leave much of the plaque behind.  There are other aids that are more effective under this circumstance.  A second possibility is that there is a mechanical problem with the crown that prevents effective cleaning.  I will address this more in a moment.  A third possibility is that the cleaning aids in use are not being used correctly.  Your dentist or hygienist can take a look at what you are doing and provide guidance.

3.  The crown junction could tuck deep beneath the gum line in the area of irritation.  If the crown margin is close to the lip of bone beneath the gum line, there is too little room between the bone and crown for the gum to fully attach to the tooth surface.  The gum tissue cannot attach to man-made materials like crowns.  This situation will cause chronic irritation.  This is corrected with surgery to reshape the lip of bone to expose more of the tooth for gum attachment.

4. The crown could be defective.  An open margin or decay at the margin could be present.  A ledge at the crown edge (overhang) creates a good hiding place for bacteria and food, contributing to gum irritation.

Dawn, it is not possible for me to tell you what is going on from afar.  I hope this gives you some things to explore.

Best wishes,

Steve