Feb
Today I received a comment through my site that I’m sure is of interest to many people so I decided to post it for all to read and learn from. Here is the question:
Started with some surface cavities young that were filled and then in my twenties a dentist suggested doing crowns on those teeth and on some teeth some newer cavities.
Over the years, I started getting cavities at the lower edge of the crowns on the dentin of the teeth. In my 40’s, a second dentist removed some of the older crowns to repair the cavities in the dentin and suggested that all of my lower teeth, as well as few at the top, needed crowns so that she could “align my bite” properly by adjusting the spacing and the height of my teeth. Since then I’ve had numerous cavities below the edge of the crowns that has caused some of the teeth to have to be removed.
I have always brushed 2-3 times daily, flossed, and even applied special flouride pastes at night that were provided by the dentist. Still, I am missing teeth and have more that will probably follow.
Should either of the dentists have considered that the crowns were causing the dentin to be more easily exposed at the gum line? Where would I go to have my saliva tested? Should either dentist have recommended that the acidity of my saliva should be tested and considered that it may have been a possible cause for the acceleration of decaying along the gum line after the crowns were put on?
Thank you for any input you might have.
Gary
Dear Gary,
I’m so sorry to hear your plight. It is unfortunately too common. Oral acidity is off the radar of most dental professionals. It is just now really beginning to be on the fringes of being recognized in conventional offices outside of lemon sucking and bulimia.
More than one issue, in my opinion, has overlapped to exacerbate your condition. Somewhere something is snafu’d for you, and I don’t know where it is, not having seen you. You may, however, easily test your salivary pH: Google Hydrion pH testing paper 5-8 which is the urine and blood range. At 7, mineral ions are evenly traveling between the tooth exterior and saliva, your teeth have an even chance. At below 7, minerals are traveling from the tooth exterior into solution (demineralization). At above 7, ions are traveling from saliva to repair tooth structure.
First, very, very few teeth with failing primary fillings (the first filling in adult teeth) need a crown. And every dentist knows that a crown places the finish line on dentin where it is a potential point of failure. Crowns place the finish line in the “armpit of the mouth” at the gumline. Still sometimes a crown is the best service.
Well-placed, layered resin fillings or onlays (which provide protection and support while keeping the finish line high where it is most naturally cleanable) are more often the best choice by conserving tooth structure. Well-placed resin fillings and onlays are time consuming for the dentist due to their technical sensitivity. They are not often cost-effective for high production practices.
Second, no matter where the finish line is it must be maintained. The finish line of an onlay or crown is an added structural “stress”. Several factors must be occurring for actual tooth decay to take hold and progress. These are the presence of a pathologic biofilm (aka plaque), and a failing buffering system, saliva. I would also add positive fluid pressure flow from the body through the pulp, to the dentin and enamel of the tooth, via good systemic hydration and adequately functioning endocrine system.
Unfortunately, now that you have them you are stuck – another reason I don’t like crowns.
What will you do from here? By all means test your saliva. Try not to assume you currently get everywhere while brushing and flossing. Get plaque disclosing tablets. See where you are missing and let that be your guide. Keep a brush with you and dry brush a couple times a day in addition to your current efforts to keep things moving – forget about the toothpaste.
Use a remineralizing paste like MIPaste (available online) after any brushing.Don’t eat another piece of processed food. Google Weston Price Foundationto begin your diet education.
Hit the farmers market or grocery store and eat a high nutrition diet, no sugar (except what is minimally in foods). Hydrate!
Don’t cheat, but if you do, get back on and keep going.
Test your saliva again. Salivary alkalinity only follows systemic alkalinity.
When you’ve gained the confidence that things are under control, only then proceed with other dental work except that which is necessary to stabilize the cavities-Triage is a product your dentist might consider placing.
Avoid metal restorations-even porcelain fused to metal crowns – they are metal at the finish line.
Hope this is help full to you and others.
Best wishes,
Dr Cynthia