Do I really need that crown?
Do I really need that crown?
Many people come and go in our dental practice with teeth hurting and teeth with pending needs. Dentistry can be so preventative if people would only look at it that way. It would be hard for your family doctor to look at you and say, you're going to get sick next month, but in dentistry we can tell people, if you don't fix that tooth, it will start hurting soon.
The picture above shows a tooth with an obviously old filling, the tongue is on the right and the cheek on the left. There is an obvious crack in the tooth on the right side and another one on the left. Cracks can form from grinding your teeth at night while sleeping, clenching, biting down on a hard object such as a popcorn kernel, and just old fillings wearing out. A tooth with a large filling is at risk already because the insides of the tooth have been hollowed out to clean out decay. The amalgam filling is packed in to replace the decayed area. Amalgam fillings were originally thought to only last 7-10 years but I see them in teeth 15-20 years old. And no, in my opinion, these people are not suffering from some form of mercury poisoning. It's amalgamated- which means the mercury is combined with the silver to make a new material. A well done silver filling can last many years. But if it bothers patients, we tell them we would be happy to replace those fillings for you.
When chewing, teeth put an incredible amount of force on the object between them. That is why a crown is the obvious substitute for a broken-down filling of this size. The walls of this tooth will not support another filling, it is simply a waste of time and money because then the tooth is at risk for breaking a large corner off. Or worse, waiting on a time bomb like this means the tooth could crack all the way down to under the gumline between the roots. Now, you can no longer crown it, it must be pulled. A natural progression of a tooth like the one shown above would be a cavity forming beneath the filling or starting in the crack. From there, the tooth could abscess and the patient would present with pain, now needing a root canal and a crown. (more on this later). Or the tooth could continue to digress and eventually crack and break. Now a crown is definitely needed. If the tooth has only partially broken, it still might be possible to simply crown the tooth, but if the nerve has been damaged from the trauma, a root canal is needed. A crown simply covers the whole tooth like a ski cap on a head, so that is why it is also called a cap or crown. The entire tooth structure is then supported from the root edge up.
Why do I need a root canal if the tooth is already dying? The decaying material makes bacteria which starts coming out the bottom of the tooth showing as a dark spot beneath the tooth on an x-ray. Or it can be seen as a small red bump that releases a bad taste in the mouth. The nerve is dying and must be sealed off or the tooth will usually hurt bad. Antibiotics are given to heal the infection and the pain will subside. However, if the tooth is left untreated, the infection will come back. People can and do let this go sometimes and will present with broken teeth, or a half rotting shell of a tooth. Trying to cap a shell of a tooth is more difficult and can require a pin to help support the tooth. Plus if your toe or finger were rotting, would you just let it go if you didn't feel any pain from it? All those toxins being released in the mouth and body are not good for your heath. And yes, people have died from abscessed teeth. Your immune system is on constant demand working against this bacteria. But now you have the added expense of a root canal. Changing out the filling at first sign of a crack might have saved this from happening.
Once a root canal is done, the tooth can become brittle and so a gold crown supports the tooth for strength during chewing. A crown can be either all gold, or gold with a porcelain covering over the top to mimic tooth color. Sometimes the porcelain will break off the crown, but the gold is still in place underneath, and if needed, the tooth can be smoothed and is usually okay.
The sad thing is many fillings are placed in the mouth around the same time. Six year molars can have fillings by age 8-10 or usually in the teen years when brushing habits aren't as good. The 12 year molars can wait longer or decay soon after arriving in the mouth simply because of the age of the patient and location in the mouth. Unless the child is well disciplined in brushing their teeth, this is a prime time for many cavities to develop. Seeing a dentist regularly can avoid this. How you ask? Sealants can be placed in the mouth, fluoride administered and oral hygiene instructions given. Small cavities can be filled before before they progress into larger ones. Each time a filling comes out, it leaves a slightly bigger hole and a closer chance of needing a crown.
What if I just pull the tooth, I have lots of other teeth to chew with? Once a tooth is removed, several things start to happen. The opposing tooth that normally meets this now missing tooth will start to over erupt out of it's place. This exposes more of the root of the tooth which is not covered with super hard enamel. Now it is at greater risk for decay. And the empty space that remains causes drifting of the teeth around it. A tooth behind it will now drift forward or even start to lean slightly. Teeth in front can rotate and the occlusion changes in the mouth. The occlusion is how you bite your teeth together. If you have ever bit down on a new filling and it "hit" first, you knew it needed to be adjusted down to the level of the other teeth. When you have teeth shifting around in your mouth, this can become a problem. The only way to stop this or fix this is with a bridge. So now instead of one crown and that expense, you need two crowns on either side of the empty space connecting with a crown in the middle at three times the cost.
I say, get in to see your dentist and save money on the front end. It's your mouth!