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If you’re looking to get in on “tattooth,” the latest (but not exactly recent) ink trend, know that the term “tattoo” is actually a misnomer here.

Tooth tattoos don’t involve inking your pearly whites the way you would your skin. Instead, a dentist applies the design to a dental crown before placing it on the tooth. In other words, you need to get a crown in order to get a tooth tattoo.

The concept of tooth tattoos and dental adornments isn’t new. Early Maya dentists applied gemstones and precious metals to teeth. In ancient Japan, along with other parts of Asia, many women practiced ohaguro, staining their teeth black as part of their beauty regimen

Let’s be clear: It’s not safe to tattoo your actual teeth.

Traditional tattoos done with needles inject ink into the dermis, the layer of skin just beneath the epidermis, or surface layer. Your teeth have no skin.

What’s more, they’re protected by enamel, so it’s pretty much impossible to tattoo them. Attempting to actually tattoo your teeth would only damage them, not to mention hurt quite a bit.

As for getting a designed dental crown? To date, no clinical research vouches for the safety of so-called tooth tattoos. That said, no evidence points to them being unsafe, either.

For starters, you visit a dentist, not a tattoo studio. Not all dentists offer tooth tattoos, so you’ll need to do your homework to find one who does.

Once you’ve found a dental practice that offers tooth tattoos, book a consultation with the dentist. Before choosing a design, you’ll most likely need an oral exam, just to make sure you’re a candidate for a tooth tattoo.

Dental crowns are caps placed over cracked, damaged, or severely worn down teeth. You’ll typically also get a crown after a root canal to help protect your tooth.

Crowns can be made from various materials, but you’ll need a ceramic or porcelain crown for a tooth tattoo.

Once your dentist determines that you’re a good candidate for a crown:

  1. They’ll prepare the tooth for the crown by removing all cavities and trimming the tooth to create a base for the crown.
  2. They’ll make an impression of the trimmed tooth and surrounding teeth.
  3. Then, they’ll place a temporary crown on your tooth to protect it until your new crown is ready.
  4. You’ll choose your tooth tattoo design.
  5. Your dentist will send the impression to a lab where the crown will be made. An artist will apply the design to the crown and seal it to protect from erosion.
  6. Once the crown is ready, usually in about 2 weeks, you’ll go back to the dentist to remove the temporary crown and have the new one cemented to your tooth.

Any aftercare for your tooth tattoo is mostly the same as the aftercare for any dental restoration. Your dentist will give you specific instructions to follow for the first day or two.

Generally speaking, the more careful you are with your teeth, the longer your crown will last.

To get the most life out of a crown:

  • Practice good oral hygiene by brushing carefully twice per day.
  • Floss daily — it won’t affect a permanent crown.
  • Avoid chewing hard foods or things like ice, especially if you have a porcelain crown.
  • If you grind or clench your teeth at night, talk with your dentist about using a mouth guard.

A tooth tattoo probably won’t hurt any more than getting your plain old run-of-the-mill crown, which isn’t a painful process, thanks to anesthetic and (in some cases) sedation. But the pain level of crowns can vary from person to person.

You might experience some mild discomfort during a root canal, or while the dentist preps your tooth for a crown.

Most of the time, topical and injectable anesthetics work well to numb any potential pain.

You might have some pain once the numbing wears off. Again, the level of pain can vary based on your personal pain tolerance level, but you can usually manage it with over-the-counter pain relievers and a warm saltwater rinse.

Experts haven’t conducted any research yet exploring the possible risks of tooth tattoos or crown tattoos. But experts generally don’t recommend modifications to your teeth, unless they’re performed by a licensed dental professional.

Getting a crown is generally safe when done by an experienced dentist, but as with any procedure, some risks and complications are possible.

These include:

  • tooth sensitivity
  • gum disease
  • chipped or loose crown

When getting a tooth tattoo after a root canal, an infection is another possible complication. This risk comes from the root canal itself, though, not from the design on the crown.

The design should last the life of the crown — typically 10 to 15 years, based on 2018 research. How long it lasts depends on factors like proper fit and placement and your oral health habits.

“The tattoos are permanent and encased in a layer of clear glaze,” explains Brian Sperry, a ceramist who creates crown tattoos for D&S Dental Laboratory.

“They will not fade but can still be chipped if the crown is mistreated, or subjected to excessive wear and tear outside of normal mastication. This has only happened once in my direct experience,” Sperry says.

Practicing good oral hygiene will help your crown last longer.

If you get tired of your tooth tattoo and want to get rid of it, your dentist can remove the design with just a few minutes of gentle grinding.

The cost can depend on how complicated your design is, but typically starts at around $150 for the crown design.

This price *doesn’t* include the cost of the procedure, the crown, and other associated costs, like dental X-rays or a root canal.

Tooth tattoos aren’t technically tattoos at all.

If you’re disappointed that you’re not a candidate for a gnarly tooth tat, just look on the bright side: Your teeth are intact, and you don’t have to sit through a dental procedure. Silver linings.

Adrienne Santos-Longhurst is a Canada-based freelance writer and author who has written extensively on all things health and lifestyle for more than a decade. When she’s not holed-up in her writing shed researching an article or off interviewing health professionals, she can be found frolicking around her beach town with husband and dogs in tow or splashing about the lake trying to master the stand-up paddle board.