Why Do I Have a Black Line Around My Crown?

Many times we see patients who ask us this very question:

photo of a black line at the gumline of a dental crown

Black line covered by bonding on this dental crown.

Why is there a black line at the gums with my crown?

As you can see on the photo to the right, there is a dental crown on an upper front tooth. In this case, because of an unsightly black line right where the crown meets the tooth, bonding was placed over it. Unfortunately, that didn’t make things look much better.

A black line at the margin of a dental crown can develop for many different reasons. Those reasons will be discussed in detail later on in this article.

But the most important point is that an ugly black line can be fixed!

Before and After Photos Fixing a Black Line

Don’t believe that you can fix these cases? Thing again! Let’s look at some before and after photos of patients we’ve helped:

Amazing before and after photo of fixing a black line on a dental crown

Before and after photo showing the dramatic fix of a black line around an old crown. With a new all ceramic crown (specifically an e.max crown), his smile was transformed immediately! Photos and dentistry Dr. Nicholas Calcaterra.

This patient of ours from West Haven lived for many years flashing this every time he smiled. He did not believe that it could be fixed. We believe we convinced him otherwise. What do you think?

Fixing it took extreme attention to detail and a new all ceramic crown. Note the shade match – it matches the adjacent teeth so well you can’t even tell it’s a crown!

Why Are There Black Lines?

You can see black lines for several different reasons. These can include:

  • Placement of a porcelain/metal crown in a way so that the underlying metal is visible. This could have been avoided with an all ceramic one.
  • Significant recession of the gum tissue following placement of the crown.
  • Significant darkening of the underlying tooth so that its shadow becomes visible under a very thin layer of porcelain.
  • Leakage and/or staining from an old filling on the tooth under the crown.
  • Caries (a.ka. decay or a cavity) that develops at the margin.
bad black lines on front tooth crowns

Black lines – along with brown colors – visible on these front crowns. We DID NOT do these crowns!

The above photo shows three front teeth. The black and brown originate from several factors – the use of porcelain/metal crowns, recession of the gums, and leakage/staining from old fillings. Ouch!

Black Lines Can be Fixed!

As the before and after photos show, nearly all cases of black lines can be corrected. To do so, your dentist first must understand why it occurred, and then he/she must pay extreme attention to every detail to correct it.

Are you unhappy with your front crowns? Interested in learning to see if we can improve the appearance? Call us at (203) 799 – 2929 or visit this page to request an appointment.

 

We use American Dental Labs

formaldehyde is not found in Chinese dental crowns

Formaldehyde has not been found in crowns from China but other toxic chemicals have.

Most of you reading this probably can remember – or perhaps are dealing with – the Lumber Liquidators scandal involving Chinese products containing formaldehyde.

You may be asking what this has to do with dentistry and dental crowns. We’ll get to that.

Formaldehyde is a known carcinogen that is used to embalm tissue in addition to being employed in many industrial applications. In the Lumber Liquidators case, elevated levels were found in many of their flooring products, which were attributed primarily to lax oversight along with insufficient standards from their Chinese suppliers.

I’ll Take the Dental Crown Without Lead Please.

Unfortunately, dental crowns fabricated in China but tainted with toxic chemicals have been found in the United States.

dental crowns from China can contain lead

Does this crown contain lead?

In this 2008 ABC News story, a woman in Ohio received a new dental bridge with a very poor fit. After talking to the dentist – who worked at Aspen Dental – she had it tested and found it had high levels of lead. The lead levels were five times higher than what is allowed in children’s toys (source: CPSC). But remember, toys are not permanently cemented in anyone’s mouth and are not in 24 hour contact with saliva!

When she talked to that Aspen Dental office, she was told the bridge came from China.

This is not an isolated phenomenon restricted to the United States. This report out of Australia talks about crowns from Asian countries tainted with different heavy metals. And this report from the UK talks about Chinese crowns and the lack of oversight of the materials used.

Why Dental Products from China?

Money is saved by doing dental crowns in China but quality is compromised

Some dental offices – mostly Corporate Chains – use Chinese labs to save money.

Unfortunately, many dental offices, particularly corporate chains, will use Chinese labs because of one thing: $$$.

We get inquiries, fliers, and emails at least once a week from Chinese labs. The numbers are compelling – a Chinese crown can cost approximately five times less than what we pay to our Connecticut labs. But in nearly all cases, the quality is very poor, and there is no accountability if lead, cadmium or other toxic and dangerous materials are permanently embedded in the restoration.

As the saying goes, you get what you pay for.

Our Commitment to You

we use Connecticut labs for our dental crowns

We use Connecticut labs almost exclusively!

In our office, we ONLY use labs that fabricate the restorations in the United States, with most of them based in Connecticut. This allows us to make these commitments to you, our patients:

  • All dental restorations placed in our office will have been fabricated under the strict regulations of the FDA (Food and Drug Administration).
  • We are able to provide you with the exact “ingredients” used in our crowns.
  • You will never have to worry about toxic or improper chemicals being used in our restorations.

And lastly, since we use Connecticut based labs 99% of the time (we occasionally use a lab based in Missouri for special cases), we are helping to support the Connecticut economy and provide jobs to Connecticut based lab technicians. It’s a win-win-win situation for everyone… our patients, our Connecticut dental labs, and us!

 

 

Your Rights to Your Dental X-rays

In Connecticut, you have a legal right to x-rays like these.

You have a right to your x-rays!

We are a modern, tech-savvy dental office providing no-pressure quality dental care in Orange, CT. Because of this, we’re busy. We’re growing. We get tons of new patients.

Quite frequently, a patient wants to transfer to our office. But they run into roadblocks in their attempts to get their dental x-rays sent to us. This is just not right!

We often have to educate patients that their radiographs belong to them. No office should be withholding them. See below for details on your legal rights to your x-rays.

Your Rights to Your Dental X-rays in Connecticut

We went straight to the source – Connecticut General Statutes on Medical Records. We’ll summarize the key points:

  • Any dental patient may request, in writing, a copy of his/her dental records. This includes dental x-rays. The office must provide the records (except under certain conditions, see bullet #2). From CGS § 20-7c(c).
  • A dental office can only withhold this information if a dentist believes the information could be detrimental to the patient or result in the patient causing harm to him/herself or someone else. From CGS § 20-7c(d).
  • An office may charge up to $.65 per page to copy records, as well as appropriate charges to duplicate x-rays. Note that most good dental offices are digital and will not charge to email x-rays. From CGS § 20-7c(c).
Photo of money - your x-rays cannot be held hostage if you owe money.

An office CANNOT refuse to give you your radiographcs over an unpaid bill or an outstanding balance. Image courtesy Flickr Commons.

Note that even if you owe the office money, they cannot refuse to release your records. This is a common tactic used by corporate dental chains owned by Wall Street firms. They cannot use an outstanding balance as an excuse!

What to Do if an Office Refuses

It is highly unfortunate that some offices do this. We’ve seen this most frequently with corporate offices such as Aspen Dental who offer free cleanings and x-rays. They just don’t want you to go elsewhere! Here’s what to do:

  1. First, ask them politely, either by phone or in person.
  2. You will likely have to fill out a specific HIPAA compliant form authorizing the release. You can fill it out in person or you can fax it or even scan it and then email it. A phone call or email request alone is NOT sufficient. This has to do with HIPAA – see below.
  3. If they refuse, you should politely tell them that CT General Statutes requires them to release the x-rays. If that doesn’t work, you can also indicate you plan on calling the CT Department of Public Health to file a complaint.
Corporate Dental Chains like Aspen Dental often refuse to release x-rays

Many Corporate-Owned dental chains like to illegally deny access to your x-rays.

In one instance, a new patient of ours wanted to get her x-rays from Aspen Dental. When the Aspen Dental receptionist refused, our patient took out her cell phone and began videotaping the interaction. Guess who then got her radiographs immediately?

Note that an office has up to 30 days to respond to the request. But most good offices will gladly respond within 48 hours.

A Note about HIPAA

HIPAA is the acronym for the law passed in 1996 that is responsible for the myriad of forms and signatures that are shoved down your throat at every physician, dentist, or hospital visit.

While the intentions of the law are good, it results in a huge burden for offices and patients. But please note that due to HIPAA requirements, you have to fill out a form authorizing the release of your x-rays.

References

A primer on your rights to x-rays written by an attorney with the CT Office of Legislative Research.

Connecticut Residents Grind Their Teeth Too!

A recent article in the Washington Post discussed teeth grinding and gave numbers suggesting that nearly half of the adult population in the Washington DC area either grind or clench their teeth.

The reporter apparently has never visited the stressed out state of Connecticut! Our experience in Orange treating thousands of patients has shown us that many Connecticut residents grind or clench too.

Teeth Grinding Photo on a Patient from Orange, CT

teeth grinding photo showing cracks and craze lines on front teeth

Craze lines or cracks on front teeth on one of our patients. This was from years of clenching at night.

The above photo is from a long time female patient in our office. She freely admits she is stressed – commuting into Manhattan a couple of days a week – as well as travelling across the U.S. for work. She has been grinding her teeth for many years. Even though we had recommended a nightguard, she did not follow our recommendation until she developed these cracks on her front teeth!

Bruxism (also known as teeth grinding)

Bruxism is defined as the involuntary grinding of your teeth, occurring most frequently while sleeping. According to the American Academy of Sleep Medicine, bruxism frequently occurs in highly determined people. And the research clearly shows that teeth grinding in adults is caused by and exacerbated by stress.

If untreated, bruxism can lead to:

cracked tooth from bruxism and grinding that needs a crown

A cracked tooth from years of nocturnal bruxism on our patient from Woodbridge. This tooth required a crown.

  • Visble wear on both the front and back teeth.
  • Broken or lost fillings.
  • Cracks so deep that the teeth require crowns and/or root canals. The photo to the right shows a crack that caused a tooth to need a crown.
  • Fractures leading to loss of one or more teeth so that dental implants are required.
  • Pain and/or dysfunction of the jaw muscles and temporomandibular joint (TMJ). These are collectively known as TMD (temporomandibular joint disorders).

In our office in Orange, we’ve seen it all – including all 5 findings in one patient!

wear of teeth from grinding and bruxism photo

Another Connecticut resident who grinds his teeth!

Treatment for Bruxism

Before we can even begin treatment, we need to establish that the clenching or grinding is still occurring. Many times patients will grind or clench their teeth for a period of time and then stop. But in most cases, the activity continues, especially for stressed out Connecticut residents.

NTI nightguard appliance for stressed Connecticut bruxers

NIT bruxism appliance for one of our patients.

The most common treatment option is a nightguard. As the name implies, a nightguard is custom fit protection for your teeth.

The nightguard to the left is one of many types we make. This is called an NTI.

One of the key mishaps that can occur is a “one size fits all” approach. There are many types of nightguards available, each for specific purposes. We spend a great deal of time analyzing our patient’s problems so that we make the correct type of appliance. Making the wrong type of nightguard can actually make things worse!

Once the appropriate appliance is made and used by the patient, the TMD symptoms will typically resolve, and the teeth are far less likely to break or fracture.

So, it doesn’t matter if you live in Connecticut or Washington DC. If you’re grinding or clenching, you need a nightguard. We are always available to discuss your symptoms and recommend the most appropriate solution.

We are open for all types of dental care.

We are currently open for all types of dental care. You can call us (203) 799 - 2929 to make or reschedule an appointment. New patients continue to be welcome. As always, our office exceeds the requirements recommended by the CDC, OSHA, and CT Dept of Public Health.