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Can I get rid of this black line?

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I have had crowns on my front four teeth for many years. They are porcelain fused to metal crowns, and have never been exactly what I would call attractive. There is a black line right along my gum line that looks terrible. 

Is there anything that can be done to get rid of that line? I really hate it! I’ve recently come into a little money, and I think this is the perfect thing to spend it on. It is not a LOT of money, though, so I need to consider my options. From cheapest to most expensive, how can this black line be fixed? 

Sinead from Alabama 

Dear Sinead, 

I am afraid there is no such thing as a cheap fix for this. 

The issue is not in the workmanship, but in the structure of all porcelain-fused-to-metal crowns. Don’t let a dentist suggest that he attempt to drill away the black line. Even if he manages to get rid of the dark line, there will still be a serious issue with matching the color of your underlying tooth to the crown, and there is virtually no chance that that kind of procedure can be accomplished with even minimally satisfactory results. Even a dentist who is incredibly talented at dental bonding would be hard pressed to make this look right.You have two options. You can live with the black line, or you can get new porcelain crowns. Unless you have an incredibly severe teeth grinding issue and refuse to wear a night guard, there should not be any reason you can’t get all porcelain crowns for those front teeth.Depending on where you decide to have the work done, the cost for porcelain crowns is between $1000 and $2000 per tooth.

Local anesthetics haven’t worked for me

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I have awful teeth. I really do, and I really want to do something about it, but I have a problem that no dentist seems to be able to help me with. NONE of the numbing drugs used by dentists seem to work on me AT ALL. I am not experiencing any kind of adverse reactions to the drugs. In fact, if anything it is like I am under reacting! Several dentists have given me shot after shot after shot, trying to get my teeth numb, and it wears off almost immediately. I tell them I can still feel the tooth (even though my lip is totally numb), and they tell me it is all in my head.

This is not about an inability to deal with pain. My health has been poor, and I have lived with various painful conditions off and on for years. All of that kind of pales in comparison to what I go through in a dental chair.

Have you ever heard of this? I am tired of being treated like a “problem patient” and I really, really want to get my teeth fixed. I am afraid that I am going to have to be totally knocked out to get all my dental work done.

Thanks for helping me.

Sergei in New York

Dear Sergei,

It will relieve you to hear that yes, we have seen other patients just like you, patients that get so anxious that local anesthetics like Novocain that are used to numb treatment areas simply don’t work. For many of those patients, nitrous oxide (also called NO or laughing gas) relaxes them enough to let the numbing medications take effect.

As you have unfortunately discovered, not all dentists understand the complex phenomenon that is pain. When patients are extremely stressed or anxious, local anesthetics do not work as effectively, and wear off much more quickly than they should. If we have a patient that is not responding to what should be an effective dose of Novocain, we administer nitrous oxide, and then give them the Novocain once more. If they are still not responding properly to the local anesthetic, we suggest “conscious sedation”, which is an oral sedative administered before treatment. You are not totally sedated, but very few patients remember anything at all about their treatment when under conscious sedation. Some people call this kind of dentistry “sleep dentistry“, but technically the patient is not asleep.

Sadly, this is very often the case in people who have had traumatic dental experiences as children. That fear festers and grows, until even the most routine dental care is hugely stressful.

A good sedation dentist can help you break this cycle. You don’t have to “white knuckle” your way through treatments.

What happened to make my teeth so sensitive after braces?

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I am seventeen years old. Six weeks ago, I had my braces taken off. I was so excited, but now it seems like I am having nothing but trouble with my teeth. Now I have these weird rough places where the brackets used to be, and I swear my teeth look darker every day. I don’t drink much cola or anything like that, but it seems like everything I eat is staining my teeth! I brush all the time, but it doesn’t seem to help. I am also going crazy because eating anything hot or cold hurts like crazy!

Did my orthodontist do something wrong when he took off my brackets? I wondered that because the worst spots are where the brackets used to be. Should I try some teeth whitening stuff to get rid of the stains? I was really looking forward to getting the braces off. It took more than two years! And now they just seem to be getting worse every day.

Can you help?

Jonah from Maine

Dear Jonah,

It is pretty unusual to see damage from bracket removal, though it is not unheard of. What you are describing, though, does not sound like damage that would be caused by improper bracket removal. The spots you are describing sound like areas of decalcification. Decalcification is when calcium is lost from bone, in this case your teeth. Left untreated, areas of decalcification on your teeth can become cavities.

Your situation is not unusual in people who have had braces. Is it possible that you were not as diligent as you could have been about brushing your teeth every time you ate? Brackets catch food and hold it against the tooth, where the acid-producing bacteria in your saliva work on both the food and the localized tooth material for hours. As you are seeing, over the course of years of treatment that kind of daily damage to your teeth can take a heavy toll.

Don’t try to bleach your teeth with any over the counter products. It will likely make your teeth look worse, not better, and if you go in to an office for a teeth whitening procedure, an ethical professional would tell you the same thing.

Though it is difficult to hear this, the solutions involve more dental work. If the damage is confined to a few small areas, then a good cosmetic dentist can use dental bonding to repair the damage. If the damage is more extensive, you made need porcelain veneers.

If you have friends that still have braces, maybe you can serve as their cautionary tale. Tell them what can happen if they are not diligent about caring for their teeth.