Expert: Mark Bornfeld DDS - 10/9/2007

Question
I recently started having a great deal of pain when flossing between the last 2 molars on the top right.  The last molar has a crown and had a root canal back in 2001.  The other tooth also has a crown - but it was not done recently either.  At my last cleaning (2 months ago) I was told I should have periodontal scaling & root planing on those 2 teeth.  I was also told to try to keep that area cleaner in the meantime and use Periogard.  Do you have any idea why I would suddenly begin having so much pain from flossing back there (aside from the fact that I am flossing more often)?  The pain lasts for up to 2 days from the time I floss.  I am using prescription strength pain relievers because it is so bad.  I also have developed a muscle twitch on the same side of my face 1/2 inch from the corner of my lip.  I have scheduled the periodontal scaling & root planing for asap (1 week from today) and do not plan to floss those teeth in the meantime (after the flossing earlier today).  I appreciate any suggestions. In addition, is it possible to become allergic to the metal used in crowns or posts?

Answer
Dear Karen,

It is sometimes difficult to determine any one specific reason why periodontal inflammation suddenly emerges in a previously healthy area. It is true that all gum disease starts small, and gets progressively more severe if not properly managed, until it grows beyond some threshold level of detectability. This could be an explanation for what has happened in your case, although there may be other contributing factors. Indeed, it is possible to develop sensitivity to a particular dental casting alloy after continual exposure, although this is more likely if the crowns are over about 25 years old, when  nickel, a strong allergen, was still used as a constituent. You should also reflect on the way you're flossing, since the use of excessive force can inflict injury on the gums. However, while I sympathize with your reasons for not flossing, I think that avoiding all flossing is the wrong strategy. Control of periodontal inflammation is best achieved by implementing effective oral hygiene, and flossing is indispensable in this regard. You should review your flossing technique with your dentist or dental hygienist to make sure you're doing it correctly.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY