DO I REALLY NEED A CROWN?
Crowns are “full-coverage” dental restorations. When a tooth has a cavity there are several signs that indicate that a crown may be needed to protect the tooth. One, if the cavity has dissolved more than 1/4 of the tooth structure and effects the structure and strength of the tooth. And two, if the cavity goes down to the nerve. Similarly, crowns also may be needed when a tooth has a fracture or needs a root canal for another reason, such as trauma.
Crowns hold a tooth together and are especially important when a tooth needs to bear excessive loads. For example, in a tooth in the back of the mouth, like a molar; the biting forces are over four times that of the front of the mouth. A large cavity or a root canal has a high risk of fracturing the tooth. This is especially true if you have a habit of clenching or grinding your teeth, chewing hard items like nuts or ice, or play active sports. Therefore, to protect your tooth and make sure it is healthy for as long as possible, a crown is recommended to hold the tooth together and protect it. Using a night guard if you clench or grind your teeth or a mouth guard if you play sports can help to increase the life of the crown.
WHAT TYPES OF CROWNS ARE THERE?
There are three main types of crowns commonly used in the US:
Gold Crowns
Gold crowns have a track record of usually lasting the longest and also being the most conservative. By this we mean, the least amount of tooth preparation is needed to fit a gold crown. This is because gold crowns tend to be thin, thus requiring minimal preparation of the tooth. Because they adapt well to where the tooth meets the crown, they protect the tooth longer against recurring cavities. Gold also goes well in high load bearing areas. Gold crowns wear at about the same rate as tooth structure, so that means if you have a crown which bites against a tooth with no crowns or fillings, a gold crown will be healthier for that “opposing” tooth. Gold crowns also work well for people who clench or grind their teeth for this very reason. Another instance when gold crowns work well is for patients who have a collapsed bite or have less room between their molars, as these crowns ultimately need less room due to their thinness.
Note that not all metal crowns are gold, even if they are gold in color. Some metal crowns, even though they look gold, are made of something called “base metal”, which research has shown has a shorter longevity than gold. It is important to ask about the material the crowns are being made from to make a decision with your doctor about what crown is right for you.
Porcelain fused to metal crowns
These crowns have a gold layer underneath a layer of tooth colored porcelain which shows on top. They can be a more esthetic option as compared to a gold crown and come in many variations. The design of these crowns can vary and will be dictated by your doctor to the lab which fabricates the crown. Depending on the needs of the patient and their tooth, the gold may be completely covered by the tooth colored porcelain or may be seen on one or more sides of the crown. If these crowns fracture or crack, as long as the metal underneath is intact, the tooth remains protected.
Again, it is important to ask your dentist if the metal underneath the crown is “base metal” or gold. You can make a decision together to choose the metal that is right for you.
All porcelain crowns
These crowns have no metal underneath and are usually the most esthetic option. They reflect light very similarly to natural tooth structure and are a great option for someone who wants to have a beautiful and esthetic smile. They are also a great option for patients who have base metal allergies. There are many different options as to materials for these all porcelain crowns. Most porcelain crowns are made of zirconia, which can withstand a lot of pressure and are preferred for patients with a clenching or grinding habit. Others are a little softer but offer optimal esthetics (front incisors, for example). The majority of crowns that are done in the US currently are all porcelain crowns.
HOW LONG WILL A CROWN LAST?
This is a challenging question because the life of a crown is dependent on many things, such as your home care brushing and flossing habits, your genetics, the development of your tooth when it was formed, the bacteria inside of your mouth, your diet and more.
To give your crown the longest life possible, you should brush for 2 minutes twice a day and floss once a day. You should also see your dentist at least every 6 months (some patients may need to go more frequently) to make sure your mouth is clean and your crown is healthy. At every checkup, your dentist will check the margins of the crown, the weakest area where the crown meets the remaining tooth, to see if there are any cavities forming underneath. If you do get a cavity under the crown in the future, the earlier that cavity is caught, the better the prognosis for that tooth.
At Smile Always Dental, if you get a crown at our practice, we guarantee that crown for 5 years as long as you follow our recommendations. Click here to learn about our Smile for Life Loyalty program.
WHAT HAPPENS IF MY OLD CROWN BROKE OR FELL OFF?
You can make an emergency appointment at your earliest convenience to see Dr. Jyothi. If possible, save the crown which came off intact, wash it off with water, store it in a Ziplock bag, and bring it with you to your appointment. If the remaining tooth has no cavity underneath and the crown still fits onto the margins of the tooth, Dr. Jyothi will be able to cement it back on to the tooth. If the crown broke in a way where the tooth is no longer sealed off or if the tooth has a cavity under it, the tooth will need a new crown, which Dr. Jyothi will explain in detail to you with the use of pictures and x-rays. More rarely, a crown breaks with some of the tooth or the cavity progresses too deep to save the tooth. If that is the case, Dr. Jyothi will partner with you to explain your options to find a solution which is right for you.
DOES IT HURT TO GET A CROWN?
When we prepare your tooth for a crown, we give you a numbing solution which helps the procedure feel as pain-free as possible. You will be awake the entire time, and it generally feels no different than a filling. A part of your mouth will be numb and all you will feel is us some occasional pulling on your lip or cheek and lots of water to protect your nerves. Many patients choose to bring in music to listen to during this procedure, but we also have TV’s mounted, so you can distract yourself by watching your favorite show.
CAN MY CROWN GET A CAVITY?
A crown, by definition, has a healthy tooth underneath it which it is protecting. Yes, your crown absolutely can still get another cavity underneath. There are many things you can do to protect your crown, which includes brushing for 2 minutes twice a day and flossing every day. You should also see your dentist at your recommended recall, which for most people is every 6 months.
WHAT WILL HAPPEN IF I DO NOT GET A CROWN WHEN ONE IS RECOMMENDED?
Crowns protect the teeth underneath them. When a dentist puts a crown on your tooth, they remove all of the cavity underneath, put a filling to build up the rotted-out tooth structure, and then cap the tooth with the crown to hold it together. The gap between a tooth and a well-made crown is less than 100 microns (very small!) which prevents bacteria from getting under that crown to create another cavity.
It is challenging to predict exactly when, but if you postpone getting a recommended crown, your tooth could break to the point beyond repair. If there is an active cavity on the tooth on which the crown is recommended, that cavity could go to your nerve, cause pain, swelling and infection in the bone. This can even become a systemic infection, which in very extreme cases can lead to death.
QUESTIONS TO ASK YOUR DENTIST
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Why am I getting this crown?
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How deep is the cavity under this crown?
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What are the chances I may need a root canal?
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What type of crown am I getting?
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Is there metal in my crown and if so, how much will show?
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Are there any factors which make this crown complicated?
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Given that predicting the life of a crown is very challenging, how long do you estimate I can expect this crown to last?
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Do I have any other options besides a crown?