Allergic reaction to porcelain fused to metal crown

I had a glass crown with metal fitted on my front tooth in November 2010.I recently noticed a brown discoloration between the crown and the gum margin. I thought that the crown had separated from the gum. I visited my dentist two weeks ago. He said that I had severe gum inflammation. He told me to apply an anti-inflammatory preparation for a week and then to report back to him.

Three weeks have passed and the gum is still inflamed. I spoke to my dentist and he wants me to have an allergy test done to determine which part of the metal is causing the allergy. This tooth has been crowned since 10 years of age after a severe blunt trauma to the tooth. At age 17 years the existing crown was replaced then at age 25 another crown was fitted. I had this crown for 28 years prior to the replacement last November. The gum has always been inflamed and the dentist told me that he noticed this last year. I wrote him a letter and told him that I was sensitive to metal and did not want it near my gums.I also told him of allergies and sensitivity to mercury fillings. My dentist would like to replace the crown with a ceramic one but my insurance which is CMSP only covers porcelain. Is there an allergy test available to check for metal sensitivity? I do not know what metal was used. What do you think of a porcelain anterior crown?

Kind Regards,
Denise from California

Denise,
It sounds to me like your dentist is making this way too complicated.

Let’s take this point by point. And I’m going to assume that what you are calling a glass crown with metal is what I would call a porcelain fused to metal crown.

If you are indeed having a severe inflammatory reaction, then yes, there is an excellent chance that you are allergic to the metal in the crown. But you mentioned that you know that you are sensitive to metals. So I don’t see what about this is so difficult. And you’re hinting that there are some insurance restrictions that they put on crowns, so did they do the cheapest porcelain fused to metal crown? It kind of sounds like it.

When the dentist received the crown from the dental laboratory, the laboratory was supposed to provide the dentist with a little certificate that is a square piece of paper maybe a couple of inches on a side that is called IDENTALLOY CERTIFICATE. Have him find that certificate or ask him to tell the lab to send him another if he can’t find it. Then read the certificate. My guess is that it says Predominantly Base and that its composition will show a significant amount of Nickel, which will be abbreviated Ni. It may also show other base metals, including Chromium (Cr) and Beryllium (Be).

A base metal alloy should never be used in a crown on a patient with metal sensitivity, because this is exactly what will happen. Your dentist is responsible to see that this doesn’t happen – regardless of any insurance rules or benefits. So your dentist needs to make this right for you or he is liable for the adverse health consequences that this will cause. And while an all-ceramic crown is an excellent choice for a front tooth and is generally much more esthetic, you don’t need to go to a completely ceramic crown to avoid allergic reaction. Simply upgrading the metal to a precious metal that contains no nickel or berylium will take care of the problem.

This blog sponsored by Naperville cosmetic dentist Dr. David Newkirk. Is Dr. Newkirk the best Naperville dentist?