Ever visited a dentist for some dental issue and you have been told that you need a crown?
I was recommended a crown in replacement of a filling once.
AND I AM A DENTIST!
Well! Apart from not giving you any place in the royalty, dental crowns/caps could be unnecessary and extensively damaging to the tooth, depending on the condition for what it has been recommended.
A dental crown is required for multiple reasons including after a root canal, to improve your smile design or provide strength to a badly damaged tooth.
Although having the purpose of strengthening the tooth, an improperly placed or designed crown can actually damage the tooth and further make it more prone to fracture.
What is a dental crown/cap?
A Dental crown/cap is an artificial tooth shaped structure that completely covers/encircles the entire tooth.
They are made up of multiple materials including stainless steel, ceramic, fusing metal to ceramics and zirconia. The material that is used depends on the strength and the aesthetic requirements.
The crowns are prepared in dental labs and are then fixed over the tooth using dental cements.
Prior to placing a crown/cap in the mouth the “preparation” of the tooth on which the crown needs to be placed is required in order to shape the tooth in a manner to receive the crown.
What is “Crown Preparation”?
It is a procedure undertaken at a dental clinic that shapes the tooth in a manner that a crown can be placed over the tooth.
Crown preparation can be done on living, non-damaged teeth if they are a support for a dental bridge, or on tooth with fillings or root canal.
The type and extent of shaping of the tooth depends on the material of the crown chosen that would be fixed. Hence the material should be decided prior to starting the shaping of the tooth.
After the shaping, a temporary acrylic crown should be placed over the shaped tooth to provide protection to the exposed shaped tooth surface. This temporary crown is placed until the definitive, final crown isn’t received from the dental lab. After which the acrylic crown is replaced by the permanent one and the procedure is completed.
In case of children the crown shaping is required which is the same as adults but the crowns are generally preformed stainless steel crowns that could be fixed on the same appointment as the shaping.
The confusion remains that although being a necessary treatment in many cases, the selection of the correct issue where a crown is required is extremely important.
Crowns if placed injudiciously can have a more destructive effect on the tooth (as a result of all the tooth shaping that is required to make space for the crown) than a beneficial effect.
To be an active decision maker for your own healthcare, you need to have an understanding of what are the absolute conditions when you say “Yes” to the procedure and when should you consider alternative treatment options.
1. After a root canal treatment: Root canal is generally done when there is extensive decay that involves the innermost layer of the tooth. As a result, the tooth is weakend after a root canal. It is almost necessary to get a crown affixed after a root canal to reinforce the strength in the tooth.
Sometimes, the tooth is extensively damaged and the crown can be placed only after a post and core procedure.
2. When you need a bridge to replace missing teeth: When there is one tooth missing between two teeth a bridge or an implant could be the preferable treatment. The simplest form of a bridge consists of 3 teeth (2 crowns on the surrounding teeth and one artificial tooth). The two adjacent teeth need to be shaped and placed with joint crowns. These surrounding teeth act as the support to the artificial tooth.
3. When a huge part of the tooth is broken: The regular filling materials do not have the strength to reconstruct very huge broken portions of the tooth. Thus, a crown may be required to construct the proper tooth structure and function.
4. You have a gummy smile and need a smile makeover: This is applicable essentially for front teeth. The type of crown used are known as veneers.
Consider Alternative treatment options when
1. There is a “not so large cavity” between two teeth: Incorrectly treated with a crown multiple times, a cavity between the teeth can be easily treated with a normal filling. A filling would have a considerably less amount of tooth loss when compared to a crown preparation.
2. There is generalized sensitivity in the mouth: In this condition the foremost step should be to understand the reason behind the sensitivity and correct the reason, rather than plan crowns in all the teeth that display sensitivity.
3. If there are extensive root cavities: A crown should NEVER be placed on damaged tooth structure. If the cavity in the tooth extends well into the root (can be seen in an x-ray) then a crown should NOT be placed on the damaged tooth and alternative treatment options should be considered.
4. If you have a habit of grinding teeth: Ceramic and zirconia crowns can be harder than the opposing enamel and cause its wear and thus if you have a Tooth grinding issue, it is important to address the issue before any crown is placed on the tooth.
5. If you have a metal base denture or multiple crowns made of different materials in your mouth: with different metals in the mouth the saliva acts as an electrolyte causing an effect called as electro galvanism. Thus in such cases metal or metal fused to ceramic crowns should be avoided.
Understanding the conditions in which placing a crown can be more damaging than helpful is extremely important.
If you feel you could have any of the above listed condition take an alternative opinion and find out the best treatment for you before undertaking the procedure.
The natural tooth structure is the most compatible for chewing, and it should be conserved unless the placement of the crown has greater benefits