Porcelain fused to metal crowns for front teeth?

I recently asked my dentist about getting veneers for my top front teeth, which are quite worn and have a gap. He recommended porcelain fused to metal crowns, which I had never heard of. I did some research, and it seems to me like this is the LAST kind of crowns I would want on my front teeth. I read everything I could about the different kinds of crowns available, and asked him (tactfully, of course) if he could do something like Zirconia, or some other kind of all-ceramic crown.

He was rather abrupt in his reply. He said that he and his partner will only do porcelain fused to metal crowns, period. I tend to grind my teeth, and would prefer not to wear a night guard, and for these reasons he will not even discuss porcelain crowns with me, saying they will not hold up.

My dentist and his partner both have very impressive credentials, and their prices certainly seem to indicate that they are top-of-the-line. I’ve never had any reason to doubt him before, or question his judgment, but everything I’ve read about crowns indicates that porcelain fused to metal crowns on the front teeth never look realistic.

Is it true that occasional teeth grinding without a night guard rules out ceramic crowns for me, such as Zirconia? I have been wanting to get this done for years, and I want my teeth to look good when we’re done. Can you offer any advice?

Wilson in Sacremento

Dear Wilson,

My advice is to get a second opinion.

Even under intense stress, Zirconia crowns are strong enough to work on your front teeth. As an additional selling point, Zirconia crowns can be made thinner than porcelain fused to metal. This means that less of your teeth must be shaved away to place them, which will leave your tooth structure stronger.

Despite your dentist’s excellent credentials, he may not truly be committed to excellence in appearance-related dentistry. His credentials may really indicate that he excels at making things work well, rather than worrying about how they will look. Many highly educated dentists seem to consider the cosmetic aspects of dental repairs to be beneath their notice. Your dentist’s insistence on porcelain fused to metal crowns on your front teeth indicate strongly that he is more concerned about function than he is about the artistic quality of his work.

I strongly advice that you make no effort to push your dentist or his partner to do something they do not want to do. This is almost always a mistake.  You do not have to sacrifice form for function–a skilled cosmetic dentist can certainly come up with a functional solution for you that will be beautiful as well. Rather than pushing your dentist to place something he is not comfortable with, you should consider finding a dentist whose abilities and aesthetic sense are more in harmony with your preferences.

One more thing: I ask you to reconsider the use of a night guard. As you get older, your teeth can break off at the gumline from continued grinding. If you bend on using the night guard, you may find that your current dentist will be willing to reopen the discussion about the types of crowns he will place for you.

Posted in Dental Crowns, Porcelain Crowns | No Comments »

Damaged front teeth on my 10 year old child

My child was playing on some wet playground equipment yesterday, and she slipped and fell. She broke one of her top front teeth off, and the other has a diagonal crack in it. Our regular dentist said he will not be able to fix it until next month! He says that the root needs time to become less sensitive, or something–I don’t really understand why he wants to wait.

I want to get this fixed right away! I am fine with going to a new dentist, but I need to know what he is talking about with the root being sensitive. Is it customary to wait, with this kind of injury? The appointment he offered us is nearly 4 weeks away.

Thanks for you advice,

Celeste in L.A.

Dear Celeste,

There is no medical reason to delay this treatment. If you have the piece of the tooth that broke off, a skilled cosmetic dentist might be able to reattach it.

Which brings me to the most important point: You should be very careful to choose an expert cosmetic dentist to do this treatment for your child. Most dentists do not have the skills and training to repair/replace your daughter’s front teeth so that they look natural and match each other in terms of translucency, color and size. As your child is 10, I am assuming these are her adult teeth that have been damaged.

From what you describe, I think direct dental bonding will work best to effect this repair of your child’s tooth if you do not have the piece that was broken off, or if it is unusable. Direct dental bonding requires tremendous skill and artistic ability, so be very sure that you have chosen the right dentist for the job. Ask to see pictures of his or her work, and check credentials carefully.

When you daughter is older, she may need a crown on one or both of the teeth, depending on the extent of the damage. In that situation, too, you will want to make sure the dentist you go to has the proper training and artistic skills to do a beautiful job.

Best of luck to you in locating someone to help you and your child.

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Can my infected teeth be saved?

Hi I went to the dentist today as my gum was red and litlle bit swollen, dentist took an x-ray and told me that i have infection and they cannot treat it anymore as it is too late to do anything about it. She told me that we have to take two teeth out. Do you think there are any other ways to avoid tooth extraction? should I go to another dentist?
- Ella from the UK

Ella-
I don’t know if these two teeth are hopeless or not, but I can maybe be helpful.

Just because a tooth is infected and the gum is red doesn’t mean that it can’t be saved. Most cases of tooth infection can be treated - with root canal treatment, or gum disease treatment.

I am suspicious. If you have serious gum disease, I believe I would be hearing different things from you. Now I wasn’t there to hear what they told you, so I don’t know this. I’m just trying to plant questions to help you get more complete answers.In the case of serious gum disease, this should have been stated clearly, and there should have been a very direct discussion about what to do about ALL your teeth, not just two. If this isn’t what happened, then it means that either 1) you don’t have serious gum disease, and therefore these teeth don’t necessarily need to be extracted, or 2) they were negligent in dealing with your gum disease. So I would seek a second opinion.

Another link:
Naperville emergency dentist - Dr. Newkirk

Posted in Gum Disease, Root Canal Treatment, Uncategorized | No Comments »