Dr. Frank Vascimini, Sound Bites, 01/22/13

Q: When I was a younger child, I chipped my front tooth at the base. I was told the root died and I had root canal on that tooth.

I’m currently 44 years old, and about 16 years ago, my dentist in Birmingham, Ala., replaced the crown I had on that tooth with a porcelain to metal (I believe) crown.

The tooth itself is perfect and the color is perfect. My complaint over all these years is the gum tissue above my tooth is dark. It is not the top of the crown meeting the gum that makes it appear dark, as it is dark well above that area.

Is it the metal post coming through giving that appearance, or is my gum tissue actually dark due to the deadening of the root?

Do I have any other options to get rid of the appearance of the darker gum tissue?

I would appreciate any insight or input you might have regarding this issue.

A: This is a great question. The first thing that comes to mind when someone says “discolored gums,” localized to one area, is what is called an amalgam tattoo.

Amalgam is commonly referred to as a silver filling. It is the most common filing material used in the mouth.

On occasion, some of the amalgam fillings enter the area between the tooth and the gums and can cause this discoloration, or tattoo, over time. I have also seen it happen when a tooth is removed at the same appointment as a filling is placed.

If the amalgam finds its way into the extraction socket, it can cause a discoloration, or tattoo, over time. I doubt this is the scenario with you because it is unusual to use a silver filling in one of the front teeth.

You mentioned there was a post and it might be coming through the tooth. Was this ever mentioned to you? If so, it is a good possibility it is causing the discoloration. My only concern is if it were coming through the tooth, you would likely know about it through some sort of symptom.

One way to figure this out is to take a series of X-rays at different angles. If this were inconclusive, you could have a 3-D scan of the area done that will alert you to this immediately.

Another thought is how far below the gum did the tooth break before the crown was put on? If it was quite far, per a dentist’s judgment, your tissue might be having a response to the metal in the crown. If this were the case, removal of the crown would prevent any further staining, but the stain that is there will remain.

Undoubtedly, you want to know what to do about the discoloration. Assuming the source of the stain is figured out and eliminated, I feel a gum graft done by a very competent periodontist would make the most sense. They should be able to remove the stained tissue and replace it with tissue from elsewhere in your mouth.

The contour of this tissue is difficult to make perfect even in the best of hands. My suggestion to you would be to know that something can be done to make things look better, but be prepared to do some additional work for an ideal outcome. Things like remaking the existing crown can be expected. Recontouring of the graft tissue, as well as surrounding area, might be needed as well. Depending on the condition of the adjacent teeth some work might be needed on them as well.

This is a tough situation; however, when approached properly from the start, I am certain you will experience an improvement. Start by talking to your dentist about it.

If for any reason you do not have the confidence in him or her after the conversation, do yourself a big favor and search until you find someone who you can have 100 percent confidence in. Good luck and thanks for the question.

Dr. Frank Vascimini is a dentist practicing in Homosassa. Send your questions to 4805 S. Suncoast Blvd., Homosassa, FL 34446 or email them to him at info@MasterpieceDentalStudio.com.