Mystery gum inflammation

[petecap]

Would be grateful for any advice.

I currently have the following symptoms: unusual gum tenderness, rapid and recent recession of the gum in the same area, odd taste in mouth, discomfort (sensation of gum compression) that wakes me up at night. I have seen two dentists and an endodontist in the last two weeks, none of whom have diagnosed any problem needing treatment. I am concerned that they are missing something (decay under the crown?) as I do not feel the symptoms I am experiencing are psychosomatic. I am posting here for advice as I'm concerned enough to be considering asking to have the crown removed on my own recognizance, I recognise this might risk killing the tooth.

The symptoms are around a ten year old PFM crown on a molar (live tooth that I think weakened due to poor brushing discipline and cracked on top after biting on something hard). It has had a large gap with the adjacent tooth for a while but this has been OK for years with active tooth cleaning after meals. Nowadays my brushing and flossing discipline is good and dentists comment on this at the annual checkups. I have a full set of teeth otherwise, no recent cavities although many old ones.

About a month ago I got a seed stuck under this adjacent tooth and did not realize it for several days (floss and pick didn't get it out, interdental brush finally did). I had bad inflammation around the area and gum tenderness. This kind of thing has happened before but never as long and the symptoms have never been as bad. I started to find I had a metallic taste in my mouth on that side and the gum was painful. The gap between the teeth felt larger. Swishing mouthwash there feels uncomfortable. There is tenderness and discomfort around the gums in the area. Chewing is not painful.

Dental x-rays show no decay although the dentists caveat that they can't see decay if it is in the crown. The endodontist saw no sign of infection and suspects instead trauma from too vigorous teeth cleaning with picks and floss. A few days of being more gentle in cleaning has not changed anything. She did point out that the interdental papilla between the crown and the other tooth has disappeared - no dentist has pointed this out before and it matches my feeling that the space has recently become larger.

I feel out of options to address this issue, I am doing very occasional salt rinses, brushing gently with fluoride three times a day, and applying chlorhexidine digluconate as both the dentists advised. If the symptoms persist more than another week or two I strongly feel I will have no choice but to ask them to drill off the crown and see what is under there (would replacing it with gold be a stupid idea now that the tooth has been filed down for PFM? Dentists in my area, perhaps any area nowadays, don't seem to even consider gold, which I think is how I got the PFM crown to begin with.)

As I said, grateful for any advice. Frustrated that the dentists I have seen don't see my symptoms as a problem (or perhaps view it as likely to self resolve). How long would you wait to do something?

 

[Busybee]

Your dentists are right to ask you to wait because if it's only been a couple of weeks that is not long enough to see whether it's something more serious. These things can take a while to heal and settle. In the meantime they can be incredibly painful and distracting.

If you have a problem with the gum then it is not a good idea to change a restoration until it has resolved. If you have overdone the cleaning and flossing then you could have injured the gum. It might recover but it doesn't grow back.

I don't use mouthwash and I don't think it's helpful for sore gums. If chewing isn't painful then it's not likely to be the tooth. It might be the tooth but there are tests to check and if you have seen more than one professional I am sure they have done these. I can feel like it's the tooth when it is just the gum area. The gum area is really super sensitive.

if you have an infection it could take up to two to three months to show on x ray.

Gold restorations have pluses and minuses. They are really strong but they can develop a margin and buckle (letting decay in).

Are you taking vitamin C or ensuring you eat plenty of vit C rich foods to help healing?

Maybe you could post a photograph of the area?

 

[MattKW]

It's probably best to remove the crown. It sounds like you've had a good run with it but palliative treatment isn't working anymore. It may be as simple as re-establishing a good contact with the adjacent tooth, but that will need a crown. Having previously had a PFM, then it is best to replace with another PFM or ceramic. A gold will not add any advantages but cost considerably more because of the thickness you will now need. It is incorrect to say that gold restorations (sic) can develop a margin and buckle - that would be a soft gold alloy not used for crowns. There is no evidence that intake of additional Vit C will help you in this situation; a waste of time and money - replace the crown.

 

[petecap]

Hi Busy and Matt,
Thanks for the replies. I meant to say periodontist, not endodontist.
I will post pictures but they are poor quality ones I took myself, as the dentist did not take intraoral pictures.
I will discuss crown replacement with the dentist then, thanks for the tip about crown types. I had read that gold crowns are generally more durable, is that when they are designed thinner from the outset, taking advantage of greater tooth retention then? Wish I had known/thought about this ten years ago but I did no research at the time.
Question, if decay takes a few months to show up on X-ray, is that the time it takes for the decay to spread outside the area covered by metal? In which case would that mean it has already spread inside, possibly to the root? Or does decay in this situation generally start in the uncovered area that can be seen on X-ray?
I think I do have a diet with enough fruits and vegetables.
I do however have sinus issues that mean I sometimes wake up with my nose blocked, mouth open and dry -- I guess that could have exacerbated the gum issue, and the sinus issues might be worth treating as well?
Thanks again, really appreciate both of you taking the time.