More toothy matters

Abstract

More and more patients are indulging in dental aesthetics; some get them done professionally and some others resort to ‘DIY’[1]. As anaesthetists we have a responsibility to identify the dental prosthetic work and protect it during anaesthesia. I would like to bring to the attention of readers another form of the dental work which might pose a hazard during anaesthesia. I recently came across a patient who had a gold crown on one of his incisors (Fig. 2). Normally, gold crowns are well fixed and one doesn't expect them to come off easily. I was very surprised and amused when during the pre-operative conversation this patient reached up to his teeth and pulled his gold ‘crown’ off. This was not a regular crown but a dental ornament used to hide his slightly deformed tooth. Gold crown in situ. The new fashion of dental jewellery is fast becoming a craze amongst the young and trendy in Europe and USA. These dental ornaments come in various designs. Some are manufactured from the same alloys as dental prostheses, others consist of multicarat gold coating and incorporate special glass or precious stones and are claimed to be non-allergenic. These stones and other items are usually professionally glued to the tooth surface. The latest trend, however, is to have detachable tooth coverings like the one described in my patient. These can be either a single tooth ornament or even more elaborate dental grills made of various coloured metals and stones. These grills are usually custom made and are well fixed to the teeth. The new economical versions, however, come with wax moulds which provide a temporary fixture and a questionable fit. These dental ornaments are potentially hazardous. Apart from the risk of accidental dislodgement of individual components during anaesthesia, they carry a risk of dental caries, gum diseases and bone damage due to bacterial colonisation. The base metals used in their manufacture also pose a risk of allergic reactions. As clinicians we have to be aware of fashion trends and their risks. Some of the dental ornaments may be indistinguishable from the regular traditional crowns. Therefore, one has to be vigilant and test the integrity of every ‘crowned’ tooth.