Porcelain or MetalFilter

September 11, 2009 2:00 PM

How bad is tooth sensitivity from gold inlays?

I just got the bad news from my dentist that, despite brushing and flossing daily (really, I'm a nerd about flossing!), I need a whole bunch of cavities filled. Several of these are on teeth with existing fillings, on which he wants to place inlays.

I have the option of either getting gold or porcelain inlays. I actually kind of like the idea of having gold in my teeth; I'm not terribly bothered by the aesthetic aspect, since they're back molars that already have silver amalgam fillings in them. And gold fillings would cost about fifty dollars less a tooth after insurance--which, considering the inlays are going to cost around five hundred dollars each, isn't a huge savings, but it's still a nice dinner out.

This previous ask.metafilter post suggests that gold fillings are superior in most aspects except for aesthetics (again, not a concern) and sensitivity. Back then, a mefite described a gold crown as "exquisitely cold-sensitive." I already have some sensitivity in these teeth because of the caries, but, well, I love a nice hot tea. And ice pops in the summer! Do you have any experiences with gold inlays and tooth sensitivity? Is it really so bad that I'd be better getting porcelain, despite issues with wear and fragility, and despite the fact that I find the idea of gold teeth to be sort of wickedly awesome?

posted by PhoBWanKenobi to health & fitness (14 comments total)

I've had a Gold Crown since childhood... had a tooth that had two cavities filled already on it, then got another cavity... so it became a crown (is this technically the same as an inlay?)

I have never noticed more sensitivity.

I can't imagine that you'd ever notice the diff betw. porcelain and gold. Maybe one in 1000 people might notice it... dunno.
posted by Jiff_and_theChoosyMuthers at 2:07 PM on September 11

Thanks, Jiff! Here's wikipedia's run-down of the difference between inlays, onlays, and crowns. Essentially, a crown is an onlay that covers a whole tooth.
posted by PhoBWanKenobi at 2:08 PM on September 11

interesting reading - except for the cringeworthy photos (that happened in my mouth?!)

So, at least under the crown description, it would seem that the amount of contact near the root would be at least *as* much as an inlay... so it seems that my experience might be of some use in reference. no?

Anyway... my S.O. didn't know I had a crown in back of mouth (second to last tooth) for quite a while after we'd begun playing tonsil hockey... I can't imagine why asthetics would matter in general for folks unless they're going on TV in HiDef broadcasts or the like.
posted by Jiff_and_theChoosyMuthers at 2:16 PM on September 11

Do you trust this dentist? Old fillings do go bad and need to be replaced, but getting a bunch of new cavities if you really are that nerdy about dental hygiene sounds odd. It takes 48 hours or so for bacteria to do damage to healthy teeth, so if you are brushing twice a day and flossing once per day I think it would be sort of hard to do that poor a job.

I might go for a second opinion b4 I let him start drilling.
posted by COD at 2:19 PM on September 11

Do you trust this dentist? Old fillings do go bad and need to be replaced, but getting a bunch of new cavities if you really are that nerdy about dental hygiene sounds odd.

I missed a dental cleaning and this is the second time in the past five years or so that something similar happened (then, I missed several cleanings and also had a ton of cavities). It's a new dentist, but my old one was an unbearably nice guy who liked to say things like "there are several weak spots on your teeth but we'll check on how those are doing in six months." This guy showed me on the X-rays where the problems were, decay on several of my cusps in a mirror (where I've had pain on and off for years) and suggested I get a second opinion from my old dentist (who he said he was "mad at for not filling these sooner"). He also suggested an electric toothbrush and a fluoride gel to stop the progression of weak spots on other teeth. I didn't get skeezy vibes from him, and I seem pretty prone to this sort of tooth problem, generally.
posted by PhoBWanKenobi at 2:28 PM on September 11

I have two gold crowns. They're less likely to break or break your other teeth than porcelain, and they're cheaper.
posted by solipsophistocracy at 2:38 PM on September 11

I got a gold crown on a backmost molar and it was indeed very sensitive for about a year and a half. My current dentist (not the one who put the crown on) saw me about a year after I got the crown and I was still very concerned about the sensitivity. He said he'd had several done in the past and they were sensitive for a while as the nerve desensitized or something, but that it should last about a year and a half. Sure enough, within a couple of months the sensitivity was declining and now it's very rare that I notice anything. For context, I'm a total princess-and-the-pea type, physically, so my teeth have always been sensitive. Now my molar is no worse than any other and may in fact be less sensitive than it was before.
posted by katemonster at 3:50 PM on September 11

My husband has gold inlays and crowns (multiple) and recommends them to anyone anytime dental work comes up. He has "thin" enamel, sensitive teeth, and has had A LOT of dental work, and feels that the gold material mitigates his sensitivity and is worry-free as far as breakage (there is nothing worse than dental work crumbling or breaking in your mouth). Recently, he's had the opportunity to be a part of some cutting-edge work and studies being done at a R1 dentistry college, working with their endos and dentists there to take care of a root canal among other things in his very back teeth and they heartily concurred that gold is and has been a superior material for these kinds of repairs.

Always talk it over with your on dentist or endo to see what is best for your mouth, but my husband loves his mouth full of pirate teeth.
posted by rumposinc at 3:59 PM on September 11

I have a gold inlay in one of my incisors. No problems. I recently got a gold crown on a rear molar. Very, very sensitive to cold.
posted by Doohickie at 8:24 PM on September 11

Do you grind your teeth, OP? My awesome student dentist recommended gold for a back molar crown this summer after learning that I'm a tooth-grinding TMJ case; apparently porcelain back there wouldn't have worn as well.

I've been really happy with it and noticed no problems.
posted by fairytale of los angeles at 9:17 PM on September 11

I was irresponsible as a teenager (didn't floss) and got infections in between my last pair of upper back molars (both left and right). My dentist in Korea recommended gold inlays, and so I have four of these puppies. Nationalized health coverage is pretty awesome, but it didn't cover most of my dental work, so I had to pay as much as you (maybe a little less). But the longer term benefits are definitely worth it.

None of my amalgam inlays have lasted as long, as they cracked or chipped or whatever. And you have to bust out a good $100 to fix those each time. It all adds up, so in the end, coughing up the extra to get $500 gold inlays isn't that much.

I would definitely, definitely recommend the gold ones. Like others above me, I did sense some mild sensitivity, but it definitely goes away. I love tea and ice cream too!

(Side note: Since moving back to the US, my dentist here tells me that many American dentists don't do gold work anymore, since it requires a lot of skill and they're troublesome to set up, with teeth molds and etc. Basically, they're all lazy and just want to do less work for the $. I recommend you make sure your dentist is reliable and talented. Maybe get in touch with previous clients who can vouch for him - or not).
posted by hellomina at 9:49 AM on September 12

Sounds like I might get some sensitivity, but that the benefits of gold will be myriad over time. Thanks all!
posted by PhoBWanKenobi at 10:15 AM on September 12

I have five gold crowns, and just got my first ceramic. I also had a fairly large gold onlay installed just last year, and it's still sensitive to cold. I'm okay with my crowns though, but a mitigating circumstance is the teeth under most of my crowns have been root-canaled so they've no nerves left to feel anything.
posted by Rash at 1:42 PM on September 12

Final follow-up: because metafilter is usually right, I followed COD's advice and got a second opinion. While I do have 12 cavities, the second dentist thought they could all be handled with fillings, as, he said, they're not very big or deep.

Had I followed the first dentist's advice, I would have gone for gold--but this will save me a bunch of money. Second opinions are awesome. Thanks again!
posted by PhoBWanKenobi at 4:28 PM on October 12