Today’s article is all about teeth. We have covered mercury amalgam fillings many times before, but what about other dental procedures? Today we cover crowns and dental implants. Since 80-85% of disease starts in the mouth, getting clear on our best options for health and longevity is a must.
This article has been medically reviewed by Dr. Charles Penick, MD
Why Do People Typically Get Crowns?
Crowns are used to protect, cover, and restore the shape of teeth when fillings don’t solve the problem. Crowns are used to restore or improve the function and stability of teeth if they are cracked, broken, decayed, or have undergone root canal work. Some people get them purely to enhance their smile or to help restore the ability to chew and bite normally without pain.
Typically, crowns are made from metals, porcelain, resin, and ceramics. Each material (which we will explore later) has its pros and cons, but the bigger problem is the crown itself. Although none of the above sounds alarming and might sound like a great solution to dental issues– crowns provide a solution that comes with some potentially detrimental side effects.
The Dangers of Crowns
The problem with crowns is multifaceted. Right off the bat, let’s highlight that they very often contain mercury underneath them 1. As a neurotoxic heavy metal that bioaccumulates in the body over time, mercury has no place in the mouth long-term, whether amalgam fillings or crowns 2.
If you find a dentist that puts in mercury-free crowns, the next issue is the process itself, which removes about 75 to 85% of the tooth’s enamel. The irony here is genuine since “saving” the tooth with a crown actually destroys most of it.
Dental decay is generally present when it comes time to get a crown, and the go-to procedure taught in dental school is simply to get rid of it by removing it. Depending on where they studied, some dentists were trained to be more aggressive in their methods, others more conservative, but the general consensus with decay is to remove it.
After removing much of the hard outer enamel shell of the tooth, there is a softer layer called dentin, followed by the pulp layer that contains all the nerves. The dentin layer is filled with soft dentinal tubules that keep the tooth hydrated, adding flexibility 3. This dentin layer is generally destroyed by installing a crown, which essentially smothers the tooth.
Although this solution may seem ideal in the short term, the long-term studies suggest that crowns come with some hefty side effects. Every year, the likelihood of needing a root canal on a tooth with a crown goes up 4. Root canals are no joke and carry their own host of problems.
Teeth are alive. The only hard part of the tooth is the enamel, and everything else is living tissue; it has nerve endings that run from the body into every one of your teeth 5. So shaving its protective armor and capping it with a synthetic material does not come without consequences!
Is All Dentistry Dangerous?
Modern dentistry began in the 1700s; it’s a relatively new field. 6. Like medicine in general, practicing doctors typically are stuck in an old paradigm of information. The individuals practicing dentistry daily generally don’t have time to stay up to date with modern dentistry. Instead, they rely on the often outdated tools taught to them in medical and dental school.
Mainstream dentistry schooling does not explore holistic modalities of dentistry. However, there are increasingly added certifications and memberships for continued education that provide dentists with the latest up-to-date wisdom of methods to help save and restore teeth instead of grinding them down, removing them, or introducing unnecessary synthetic materials into the mouth 7.
What is Biomimetic Dentistry?
Biomimetic, it’s a fancy name, but it’s a simple concept broken down into two parts. Bio means life, and mimetic means copying. Biomimetics is the scientific approach to reconstructing teeth that have broken down, rather than grinding them down further and sticking something over them. Biomimetic dentistry focuses on rebuilding the tooth and keeping as much tooth structure and integrity as possible. The mission of biomimetic dentistry is to protect the nerve, and the whole method hinges on introducing the least amount of stress to the tooth as possible 8.
How to Prevent a Crown with Biomimetic Dentistry
Preventing the procedure of getting a conventional crown is best done through preventative measures so that no dentist would even suggest a crown to fix any problems. However, that is not always possible, so this section will highlight prevention, what to do if a dentist has recommended you get one, and what to do if you’ve already had the procedure done.
Prevention is Ideal
The three major dental problems that lead to crowns are cavities, gum disease, and a bad bite 9. The first two are generally caused by an imbalance, either of the oral microbiome or nutritionally 10-11.
Balancing the oral microbiome is done by avoiding anti-bacterial agents (found in certain kinds of toothpaste, mouth wash, and in the chlorine from tap water) as well as fluoride. Being balanced nutritionally requires a holistic approach to diet, following principles from the Weston A. Price diet, full of high-quality animal protein and fats 11.
When it comes to a bad bite, some factors include clenching, rubbing, and teeth grinding. These habits can destroy the teeth and cause gum recession; they can cause the teeth to break along the gum line and destroy the tooth’s enamel 12. Before undergoing a corrective procedure with a dentist, make sure you manage stress levels, which play into clenching and teeth grinding. A dentist can also fit you out with a protective plastic-free mouthguard to wear at night that should be custom-made to fit your teeth.
If you get these three factors under control, you should avoid nearly all the root causes of problems that lead to crowns.
When It’s Too Late for Prevention
If you’re already in the position to get a crown, the first step is to pause and find a dentist who is certified in biomimetic dentistry. Crowns are the go-to for general dentists, but a biomimetic dentist is trained to save the tooth first. Unfortunately, with only approximately 500 dentists certified in biomimetic dentistry in the country, it may require travel… but to actually remineralize and save your tooth now could save you from needing procedure after procedure down the line.
The golden standard to know if you can save your tooth is sensitivity. If your tooth is sensitive to the cold or heat, there is a nerve ending here, meaning that the tooth is still alive 5. So no matter how bad the decay is, a tooth can be restored entirely using biomimetic dentistry.
If You’ve Already Had a Crown
If you’ve already had a crown, there are a few possibilities. Depending on how aggressive the shaving of the enamel was, a crown can be removed; the tooth can be built up and sealed correctly underneath. However, this is not a common procedure; you may have to travel to a biomimetic dentist who knows it’s possible and believes in dental restoration.
Getting your crowns re-done by a biomimetic dentist can ensure they are done in a way that provides the least amount of stress to the tooth and the mouth. Firstly, any underlying mercury or metal is removed.
If your decay was removed super conservatively, then the bonding can be laid in one small layer at a time to make the bond extremely reliable. Unlike other crowns, this method can last a lifetime without the risk of needing a root canal down the line.
Is There Ever A Place for Crowns?
There may be some rare instances where crowns are simply unavoidable. If the decay is so bad that the destruction to the enamel is already done, then there may be no other option than to cover it up. That being said, the process should be done using a more flexible material that is more biocompatible with your body. No metals are to be used, and the crown can be made using all-porcelain.
There may be a rare instance where the destruction is already so bad that you’re going to be covering the whole tooth and building it up. However, it’s still ideal for building the tooth up on the inside with a more flexible material and put the outer part with the crown if we had to. The other time that we’ll do a crown in my office, for example, is if I’m replacing old crowns. A lot of the old crowns have metals under them.
But before resorting to a crown, and even if you have had one installed in the past, the big question to ask is, is there still sensation in the tooth’s nerve. If there is, a biomimetic dentist should be able to save the tooth and rebuild the layers of the tooth entirely, without any need for a crown or subsequent root canal 5.
Is There Ever A Place for Metal in the Mouth?
Avoiding any metal in the mouth is always the best option. This applies to all procedures, including crowns. As we have explored, many crowns are installed with a layer of mercury, but even if the material is less toxic, it can still cause issues 1. If there are dissimilar metals in the mouth, an electric current is generated. Called a “galvanic” current, it is generated by the transportation of metal ions from the dental metals into your saliva 13. These currents can interfere with various operations in the body, including the energy flow of the body’s meridians. The human body is an electrical unit; you do not want to add any electrical interference, especially if they come from neurotoxic materials like mercury!
The one-time metals are essentially unavoidable is when an implant is needed. Although people may lean towards ceramic, the choice between titanium and ceramic isn’t always clear-cut.
Titanium vs. Ceramic for Implants
The two leading materials for an implant are titanium or ceramic. Although we have just highlighted that you should avoid all metals in the mouth, the most biomimetic option would be titanium for a few reasons 14.
First of all, titanium has more flexion than ceramic. A key driver of biomimetic dentistry is causing the least amount of stress to the body. When it comes to teeth, having a little bit of flexion is normal and healthy; too much rigidity can lead to cracking, amongst other problems 14.
The second reason is that ceramic implants are, in fact, zirconium implants, which are considered a ‘transitional metal.’ Although not a complete metal, it will still generate an electric current in the mouth 14.
Ultimately the more natural reflex of a pure titanium implant makes it a more holistic choice overall. It’s important to note that the titanium must be pure because hundreds of knockoff companies blend alloys, which is no good.
Alternatives to Implants
Alternatively to getting an implant, someone could also get a bridge constructed that is bonded between the two teeth. A bond does not require shaving down any of the teeth, unlike getting two crowns on either side of a missing tooth to hold the false tooth in place. This double crown brings us back to the beginning of this article, promoting the likelihood of needing two root canals down the line, and losing much of the teeth’s natural enamel.
Many dentists will not perform a bonded bridge because they are afraid that they will break. Getting this type of procedure requires some responsibility on behalf of the patient because this type of bridge is less robust than a crown bridge. However, it is significantly more holistic and natural. Although not as solid as a traditional bridge, you will be protecting the integrity of your other teeth.
Summary
Although crowns are a common-place solution in mainstream dentistry, they are not without their risks. Crowns shave down the tooth’s enamel and engulf the tooth with a cap that often contains mercury. The procedure significantly increases the likelihood of needing a root canal down the line. An alternative is to use biomimetic dentistry principles through preventative measures or by saving and restoring the tooth. Biomimetic dentistry works to minimize stress in the mouth by replicating nature as much as possible.
Avoiding metal in the mouth is always ideal, but if it cannot be avoided, for instance, with an implant, pure titanium is the most biomimetic option. An alternative to an implant would be a bonded bridge, which is less sturdy than a crown bridge. Still, it protects the integrity of the two teeth and prevents getting any metal in the mouth.
Medical Disclaimer: This article is based upon the opinions of Dr. Daniel Pompa. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Pompa and his associates. This article has been medically reviewed by Dr. Charles Penick, MD for accuracy of the information provided, but Dr. Pompa encourages you to make your own health care decisions based upon your research and in partnership with a qualified health care professional.
References
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2 EPA, Environmental Protection Agency, www.epa.gov/mercury/health-effects-exposures-mercury.
3 Goldberg, Michel et al. “Dentin: structure, composition and mineralization.” Frontiers in bioscience (Elite edition) vol. 3 711-35. 1 Jan. 2011, doi:10.2741/e281
4 Edelhoff, Daniel, and John A Sorensen. “Tooth structure removal associated with various preparation designs for posterior teeth.” The International journal of periodontics & restorative dentistry vol. 22,3 (2002): 241-9.
5 Agarwal, Pankaj, and Ashu Agarwal. INDIAN JOURNAL OF DENTAL ADVANCEMENTS, Jan. 2012. Department of Oral Pathology and MicrobiologyKD Dental College and Hospital, www.rep.nacd.in/ijda/pdf/3.4.684.pdf.
6 “Dentistry in 18th- and 19th-Century America.” Encyclopædia Britannica, Encyclopædia Britannica, Inc., www.britannica.com/science/dentistry/Dentistry-in-18th-and-19th-century-America.
7 “The International Academy of Oral Medicine and Toxicology.” IAOMT, 29 Apr. 2021, iaomt.org/.
8 “Biomimetic Dentistry.” Nejad Institute for Biomimetic Dentistry, 10 Feb. 2021, www.nejadinstitute.com/what-is-biomimetic-dentistry/.
9 Kahn, Sandra, and Paul R. Ehrlich. Jaws: The Story of a Hidden Epidemic. Stanford University Press, 2021.
10 Wade, William G. “The Oral Microbiome in Health and Disease.” Pharmacological Research, vol. 69, no. 1, 2013, pp. 137–143., doi:10.1016/j.phrs.2012.11.006.
11 Price, Weston A. Nutrition and Physical Degeneration: a Comparison of Primitive and Modern Diets and Their Effects. Benediction Classics, 2010.
12 Liao, Sharon. “Tooth Grinding, Enamel Erosion, and Tooth Injuries: What Grinds Down Your Teeth.” WebMD, WebMD, www.webmd.com/oral-health/features/wear-down-teeth.
13 “Galvanism.” Eric Davis Dental, www.ericdavisdental.com/biological-dentistry/symptoms-of-toxicity/galvanism/.
14 Nejad, Matthew. “Zirconia Dental Implants Vs. Titanium Implants.” HELM | NEJAD | STANLEY, 31 July 2020, www.beverlyhillsladentist.com/blog/are-zirconia-implants-better-than-titanium/.
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