Crown Pain ... Gum Red and Swollen For Months

[Sherri]

I feel as if my gums are rejecting my crown.
I have pain, redness and tenderness at the gumline. Tooth #19 had a root canal last August 2006 and checked three times. The crown is perfect but I am in pain. At times the pain subsides and then for no reason it is unbearable. I do have recession and within three weeks of placement I continued to have recession. I thought I may be allergic to the metal or temp/perm cement, but I cannot find anyone to test me for this. I need help and am at a loss of what to do. I have had crowns before and had no problem.
This has been going on for months.
I have tried the warm salt water, Biotene, perio gel, Aloe Vera and on and on.............
I have seen several dentist who have no answers and advise against a non metal crown because it is a molar.
I want to pull this tooth to get relief.
Any help would be appreciated.
Thank you.

 

[Gordon]

It is possible to have a nickel allergy cause problems with PFM crowns. The other problem could be if the crown was infringing on the "biologic width" which sort of means that the margins are too close to the alveolar bone.
Removing the crown and seeing if the gum recovers with an acrylic temp crown would seem a sensible step, I can't understand why the dentists you have seen aren't willing to do this.

 

[Sherri]

Gordon,
Thank you for your response.
I have seen my dentist who stated that I am at the "biologic width" on #19 and that I do not have any sulcus.
He told me that the only way to get rid of the pain would be an extraction.
The dentist states that the crown is made of material that should not cause a reaction. No nickel only the finest metal.
He also said that a temporary crown would not solve this problem. It would be a temporary solution and that a ceramic or porcelain crown would not be good for a molar.

Right now I have my permanent crown (porcelain with metal) seated with non eugenol cement.
This tooth has suffered through so much trauma from several other dentists who felt what they did was right. I have had this tooth prepped 6 times, by different dentists who have had their own idea as to what is the right treatment. I have had a pulp cap, gingivectomy, root canal and an injection that caused trigeminal neuralgia.

I have had impressions that have ripped the inside cheek tissue off from top to bottom that left me with sores, rough hard tissue and exposed fordyce granules that are burning my mouth constantly.
This problem started almost two years ago when I was prep for a crown and did not know that the pain I was experiencing was from the doctor leaving part of the old silver filling with decay!

All my dentists were highly recommended.
Any information would be appreciated.
Also, if you know anything to do to help restore the inside of my cheek, reduce the fordyce granules and the treat the trigeminal neuralgia.

I also found out that tooth #30 has a crack and needs a crown.
I am so scared that this is going to happen on the other side.
Please help.............

This all started because I needed a crown.
Thank you

 

[Gordon]

The tooth is encroaching into the biologic width and you don't have a sulcus? Then you'll definitely get inflammation. Usually it's self limiting because the bone recontours itself away from the crown.

Women are more prone to allergic reactions from some of the alloys in PFM, probably something to do with jewelery. One of the new all ceramic restorations would be worth considering, either that or good old gold. The "temporary solution" would allow you to see if it was the biologic width encursion or the metal which was the problem... seems only sensible to me.

Trigeminal neuralgia is treated with Carbamazepine, it can be difficult to manage but it can be done. Best results are to gradually increase the dose and then when the condition is stable to gradually taper the dose off again. It's not good to take the Carbamaz constantly, the neuralgia can "break through" again and then much higher doses are required. Tapering off the dose avoids this.

Fordyce's spots are usually exacerbated by smoking.