Bleeding Gums After Crown Placement: Seeking Dental Solutions

Q: Bleeding Gums After Crown Placement: Seeking Dental Solutions

Hello Ms. <br>Zhao： If you have completed your orthodontic treatment and still have periodontal issues, you should undergo periodontal treatment. <br>Once your periodontal health improves and there is no more bleeding from the gums, you can then assess whether the fit of your ori

After getting a fixed dental prosthesis on the lateral incisor, there is bleeding when using dental floss?

Dear Doctor,
I had my first dental crown placed in February of this year, specifically on a lateral incisor.
However, since then (June), I experience bleeding whenever I use dental floss, and using an interdental brush causes an unpleasant odor.
Initially, I visited the original clinic (Clinic A) where the crown was placed, and the dentist mentioned that bleeding and odor due to inflammation were normal.
Later, I consulted another clinic (Clinic B), where the dentist indicated that the crown was poorly made, with protruding edges that trap debris, leading to inflammation and bleeding, and suggested that it needs to be redone.
I felt it was unfair to rely solely on one clinic's opinion, so I decided to seek a second opinion from a major hospital's dental department (Clinic C), which specializes in prosthodontics.
The specialist there examined me and noted that the bone in that area was not developing properly and that I had periodontal issues.
They advised that even if the crown were redone, the underlying problems would persist, and I would need to see their periodontics department for treatment before considering a redo.
After that, they performed a cleaning on that tooth, which was extremely painful and made me cry.
They used a strong water jet on the gum line, and afterward, they touched the bone in that area, asking if I could feel it.
I experienced significant bleeding when I spat, and even now, pressing on the gum around that tooth still causes pain.
I am now unsure whose advice to follow.
Should I consult a third clinic? I keep wondering where the problem lies, and it’s driving me crazy.
When I visited Clinic B, the dentist mentioned that I had several small cavities that needed attention, which was shocking because during my visit to Clinic A, the dentist had assured me that my teeth were fine, even after cleaning.
To give you an idea of my oral hygiene routine, I use dental floss before brushing my teeth every night, followed by an interdental brush.
I use Listerine mouthwash 1-2 times a week, and my toothpaste is Lion's "Kushi" toothpaste, which I chose because I read that it has a high fluoride content.
Additionally, I only have the first lower molar remaining on the right side, as the other molars were extracted after root canal treatments during my childhood.
My current dilemma is: what should I do? Should I discuss this with the original clinic and the dentist? However, I feel they might not take responsibility since they initially claimed everything was normal when I first raised concerns.

Ms. Zhao, 20~29 year old female. Ask Date: 2023/06/27

Dr. Zeng Guanghui reply Dentistry

Hello Ms.
Zhao: If you have completed your orthodontic treatment and still have periodontal issues, you should undergo periodontal treatment.
Once your periodontal health improves and there is no more bleeding from the gums, you can then assess whether the fit of your original braces is inadequate.
If the fit is poor, it is recommended to remove the braces and redo the treatment.
Dr.
Tseng Guang-Hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2023/06/27

More Info

Dear Patient,
Thank you for sharing your concerns regarding the bleeding gums after your crown placement. It sounds like you've been through quite a journey with your dental health, and I understand how frustrating it can be to receive conflicting opinions from different dental professionals. Let's break down the situation and explore potential solutions.

Firstly, bleeding gums, especially after the placement of a dental crown, can indicate several underlying issues. The most common causes include gum inflammation (gingivitis), improper crown fit, or even more serious periodontal disease. Given that you have experienced bleeding when using dental floss and have noticed an unpleasant odor, it is crucial to address these symptoms promptly.

From your description, it seems that the crown may not be fitting properly, as indicated by the second dentist's assessment. A poorly fitting crown can create spaces where plaque and food particles accumulate, leading to inflammation and infection of the surrounding gum tissue. This can explain the bleeding and the bad odor you are experiencing. If the crown's margins are not smooth or are protruding, they can irritate the gums, making it difficult to maintain proper oral hygiene.

The third dentist's evaluation, which pointed out potential bone issues and periodontal problems, is also significant. Periodontal disease can lead to gum recession and bone loss, which may complicate the situation further. If the underlying periodontal condition is not treated, even a new crown may not resolve the bleeding and discomfort.

Here are some steps you can take to address your situation:
1. Seek a Comprehensive Evaluation: Since you have already visited multiple clinics, it may be beneficial to return to the dental clinic that specializes in prosthodontics (like the one you visited last) for a thorough evaluation. Ask for a detailed examination of both the crown and the surrounding gum and bone health. They may recommend X-rays to assess the condition of the bone and the fit of the crown.

2. Consider Periodontal Treatment: If periodontal disease is confirmed, it is essential to address this issue first. Treatment may involve deep cleaning (scaling and root planing) to remove plaque and tartar buildup below the gum line. This can help reduce inflammation and promote healing of the gums.

3. Discuss Crown Replacement: Once any periodontal issues are managed, you can discuss the possibility of replacing the crown if it is determined that it is not fitting correctly. A well-fitted crown should not cause discomfort or bleeding when proper oral hygiene is maintained.

4. Maintain Good Oral Hygiene: Continue your current oral hygiene routine, but consider using a softer toothbrush and being gentle around the crown area. You might also want to consult your dentist about the best mouthwash to use, as some may be too harsh for inflamed gums.

5. Communicate with Your Dentists: It’s important to have open communication with your dental providers. If you feel that your concerns were not adequately addressed by the first dentist, express your feelings and seek clarity on their recommendations. A good dentist will appreciate your proactive approach to your dental health.

6. Consider a Third Opinion: If you still feel uncertain after your next visit, seeking a third opinion from another reputable dentist or a dental specialist may provide you with additional insights and options.

In conclusion, your situation requires careful evaluation and possibly a multi-faceted approach to treatment. Addressing the underlying periodontal issues is crucial before considering any further restorative work. Remember, your oral health is a priority, and it’s essential to find a dental professional who listens to your concerns and provides the care you need.

Wishing you the best in your dental journey, and I hope you find relief from your symptoms soon.

Sincerely,
Doctor Q&A Teams

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