I chipped my front tooth and several crowns have fallen off the stump

Q. Hi there, I chipped my front tooth some years ago and after various crowns falling off the ‘stump’ that was left, the stump rotted completely and was removed. It was replaced with a metal rod to which a crown veneer (?) is now attached. I am happy with the appearance of the tooth but the gum above the tooth has got progressively more discoloured over the years. I am concerned about this as I haven’t heard that this is normal and it is understandably bothering me as it is my front tooth and so visible to others. My NHS dentist informed me that the grey was in fact the top of the metal peg showing but I’m not sure if I believe this as the gum actually looks grey. Furthermore, i’m sure that it has changed colour- going from a pale grey to a darker grey over the past few years. My dentist also informed me that I was being too aggressve with my teeth brushing and that the reason you could see grey was because I had brushed the gum back and that I should stick to a more gentle, circular cleaning motion in order to reshape the gum. I tried this over a period of several months- in fact I am still following his advice, but I can see no change. I want to know whether this is a problem you have encountered before? And if there would be any cosmetic dentistry service available to remedy it?

 

A. Thank you for your question. I am sorry to say this but you need to find your self a good private dentist who knows about cosmetic procedures and occlusion, ( the science of jaw movements and how teeth fit together).

From your history it sounds like you have occlusal problems. If your tooth chipped while you were eating something it was probably interfering with the lower teeth on chewing and too much pressure was being put on the tooth. I am assuming you have good oral hygiene in which case the failure of your subsequent crowns can also be attributed to this. The constant added pressure on the tooth will have caused it to weaken over the years and this is why you are now left with a root and a metal peg. To check whether your existing crown is getting too much pressure you need to place you index finger on the front face of the crown and tap your back teeth together. If you feel any movement of the tooth that is crowned is interfering with your bite. This moving sensation is called ‘ fremitus’. If this is the case then this crown will also fail and eventually the root will fracture and you will be faced with needing an implant.

I have a feeling that the crown is getting too much pressure. My reasons are as follows;

1) Your gum is receding. This has absolutely nothing whatsoever to do with tooth brushing techniques. When too much or the wrong types of pressure are put on teeth the gums can migrate upwards and recede because of the trauma. The gums are attached to the teeth and the extra pressure is thought to cause the tooth to flex around the junction of the enamel and root. It is good to use circular motions when tooth brushing but it will never grow back or reshape favourably.

2) The tooth seems to be getting darker. This can happen to teeth when continually traumatised. Having a metal peg in place doesn’t help situation.

3) You have experienced continual failure of that tooth and any restoration that has been placed on it.

You can definately get this problem resolved by finding a privatedentist that knows what he/ she is doing. White pegs can be used now and the new crown can be made of porcelain only and fabricated so that it is the correct position in your jaw

Dr Komal Suri Smile Design Dental 33 High Street, Wendover, Buckinghamshire HP22 6DU Web: www.smiledesigndental.co.uk  Tel: 01932 223 479 View My Profile Dr Suri

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