Root canals and crowns?

[Delster]

So nessvan's thread about her root canal sparked a few alarm bells about my own root canal, and I wondered if I could seek some advice from anyone who's had a root canal. I'm mulling over what my dentist has told me and I'm unsure what to make of it all.

For background, the tooth in question is a front tooth that was very badly banged in an accident when I was a child and likely died very soon after. So, about twenty years ago. I had braces as a teenager and the orthodontist noted this tooth was dead but didn't recommend any treatment on it, he just said the orthodontics would likely accelerate its darkening in colour. Which, they did, much to my irritation ever since.

I changed dentists when I got my first job and this new dentist had an endodontist look at the dead tooth. A root canal was recommended to save the tooth and I had that done five years ago. It cost me a small fortune but the procedure was easy and painless as there was no live root left in there at all.

Now here's the complicated part. The tooth was not crowned. No-one recommended a crown. No-one mentioned the possibility of a crown. In fact, the root canal was described to me as a way to avoid a crown or an implant in later life. The tooth has a permanent filling on the back of it, and my dentist had recommended internal bleaching to bring it to the same colour as my other teeth. Recently, at a check-up, a different dentist was filling in for my usual dentist. This new dentist said I should have had a crown immediately after the root canal and that root canaled teeth were "brittle" and my tooth could fall out of my head at any moment. She said that the very next time I bite into anything the tooth will "crack in two". Naturally I was horrified and asked her to double check this with my usual dentist and ring me to let me know what the story was. Well a couple of weeks went by and no word so today I called and complained about the delay getting back to me, and about the general lack of information I've been given all along this treatment process. I gave the secretary a list of things I wanted to know and they rang back within fifteen minutes. Particularly I was concerned to know about the likely prognosis for my root canaled tooth without a crown on it. So, here's what I was told...

Root canaled teeth do become more fragile and usually need to be crowned. Apparently, this often this needs doing straight away. However, in my case my tooth is super healthy so it wasn't necessary at the time of treatment and it isn't necessary now. My dentist believes I have another five to seven years before the tooth will need a crown. My dentist still wants to do internal bleaching on it, which was something the new dentist had said wasn't safe. Apparently the new dentist is unfamiliar with internal bleaching and didn't understand me when I asked about it (this in itself shocked me - I'm never going to let that woman near my mouth again!). My dentist says the internal bleaching will not in any way weaken the tooth, or shorten the life span of it before I need the crown. So if I go ahead with that, my front teeth will be the same colour again (always good), and without risk to the root canaled tooth. Oh and at considerably less expense than the crown. Like, 1% of the cost of a crown.

So, if you made it through my toothums novel, what I'm wondering is whether this all sound too good to be true? Are dental practices just waaaaay different over here or something? It all seems so different to the ladies' experiences nessvan's thread.

 

[tiffanytwisted]

Delster, I had a similar situation with a front tooth and I do have a crown.
A few years ago while playing with my dog I hit my mouth on his head. A few days later one of my front teeth started turning gray. The "hit" to the mouth had damaged the nerves/blood supply so badly that I needed a root canal. They did the root canal from behind the tooth and filled it with a temporary filling. It took a few weeks for the crown to be made. I was told at that time to be careful what I bit into because they worried that if I bit something hard the tooth could break. I don''t remember there being a discussion about NOT having a crown, I was under the impression that if they did a root canal they would also do a crown.
Good luck!

 

[Delster]

Thanks Tiffany

When a person gets a crown, what is usually involved? I''ve been told it means having your natural tooth filed down to a stump and then a false one is fitted over it. My dentist says she is unprepared to file away a strong healthy tooth, and at considerable expense too, when it is likely to last another five to seven years. She wants me to keep my natural tooth as long as possible.

 

[nessvan12]

Delster,

to answer you at the end of my thread, I haven''t got my crown yet. My appt is on March 4th for the crown. I''ve never had one so I''m not familiar with the process. Not sure if the tooth has to be filed down and all of that. My dentist did tell me to be careful when chewing hard things to ensure I don''t crack the tooth (it''s a molar in the back). He put a temporary filling in there and made my appt. for next week. I sure hope you get the answers you are looking for.

 

[ejsarkar]

Hi Delster,

I can sympathize. I had a cavity when I was pregnant with my first son four years ago. Did nothing about it (because I was scared of dental work while pregnant) and then needed a root canal. They just put a filling over it. The root canal wasn''t done well so I needed another one and they put a crown on. Yes, they file down the tooth and put a crown over. (I hated the crown) Under the crown, my tooth was still falling apart so my tooth was pulled out a few weeks ago.. I am awaiting a dental implant.

If I were you, I would definitely try to keep my real tooth-- just go for regular checkups to see how it''s doing. 5-7 years is a long time and if it''s a front tooth, your real tooth will look so much better than a crown. It''s worth trying. You could still get the crown if the bleaching doesn''t work or makes your tooth too brittle.

Good luck.

 

[somethingshiny]

Delster~

My front tooth was knocked almost completely out when I was 10, a horrible trampoline bounce gone wrong. We had no insurance and no money so my mom just kind of shoved it back in. After 3 more times of it getting knocked out and replaced (it was always holding on by a "thread"), it finally began to take hold again. It went a funny color for a while but then went back white. The first time I went to the dentist, I was 16. At that time I was told the tooth was "healthy considering what had happened". I finally got a root canal a couple years after that. I did not get a crown right away although I had been told to. I just didn''t have the money. The tooth was fine for about 4 years. Then it cracked and part of it fell out (right in the middle of work.) Luckily, there was a dentist next door who put in a temporary filling. I wore the temporary filling for over a year before I got it crowned. So, yes, it is necessary to crown a "dead" tooth. But, I''m guessing you''re getting contradictory info because one dentist is aware of situations like mine.

During a crown, they do file your tooth down to a nub. Then they use an antiseptic stuff all around the tooth before placing the crown material on. The crown extends to your gum line and around the tooth. They put a blue light on it that sets the material and then file the "tooth look" into it. (like the grooves on the chewing surface) All in all it is quick and painless.

 

[tiffanytwisted]

Date: 2/26/2008 11:04:40 AM
Author: Delster
Thanks Tiffany

When a person gets a crown, what is usually involved? I''ve been told it means having your natural tooth filed down to a stump and then a false one is fitted over it. My dentist says she is unprepared to file away a strong healthy tooth, and at considerable expense too, when it is likely to last another five to seven years. She wants me to keep my natural tooth as long as possible.

That''s exactly what they did. They filed it down to a stump and then fitted the crown over it. I have to warn you that it''s not pretty. The "filing" seemed to take awhile and we took a break, at which point I had to use the restroom, and unfortunately my dentist has a mirror in his office. I have to say I would rather not know what the "stump" looks like. I looked like a toothless redneck hillbilly. They actually then fitted a temporary crown over the stump while the permanent crown was being made.
If they think your tooth is strong enough then it seems to me that you could keep it. I *think* my dentist prior to the root canal mentioned that depending on how the root canal went I might have been able to keep my tooth for awhile. But after the root canal he seemed to think the tooth wasn''t very strong. It felt very thin to me.

 

[Delster]

Ausable you poor thing you're really been through the wars! I hope the implant works out great and you can finally have some peace from all the dental treatments...

Somethingshiny You could be right, the temp dentist may have seen a tooth that became damaged after a root canal and she may be wary of leaving it uncrowned. My usual dentist is super thorough and I find it reassuring that she sent me to a specialist for the root canal rather than having a go herself. Maybe I'm an unusual case. My dentist swears blind my tooth is sound and very unlikely to be damaged through normal use. Your injury does sounds a lot worse than mine was - my tooth never fell out or even became loose and it only discoloured after I had orthodontics. That must have hurt when you knocked it out! Ouch!

Tiffany - lol you must have gotten a right shock in the mirror! Oh my gosh!

Hmmm, thinking about it, my tooth doesn't feel weak or thin. I mean, I have no sensation in it of course, but it doesn't feel any less 'substantial' than my other teeth if that makes sense. I do avoid chewing or biting with it though, always have, ever since the accident.

 

[scarleta]

Delster: First no one can tell you that the tooth is going to "crack in two" when you bite on something.That is impossible to predict.Any tooth even a healthy one can do it any time and no one can predict when.It may or may not ever happen..Let''s hope it won''t..
I have had root canals done and no crowns after.I also had crowned tooth that needed root canal years after the crown was put on.( much worse scenario) So you just never know..
As for internal bleaching vs crown in the future I would just wait ( if you can ) for the crown.I would not do bleaching now and crown next year or so.Whatever you do to the tooth takes away a bit and if yours is weakened and brittle just leave it.There is no harm doing a crown now if you really want to match it..

 

[Delster]

Scarleta thanks for the reassurance and the info! My tooth isn''t weakened or brittle though and I have no intention of doing a crown next year. My dentist says my tooth is strong and healthy and I can wait five years, maybe even seven years, or longer.

 

[HappyAnniversary]

Hi Delster, I work in a dental office and this is our policy--crowns are recommended on all posterior teeth after a root canal--every posterior tooth without exception-- BUT many anterior teeth do very well without crowns given they don''t have large fillings or significant fracture lines on them, especially with younger people. Internal bleaching can be very successful and the only down side is the cost I think we charge about $200-250 for it, so its not inexpensive. I wouldn''t want to wait 5-7 years with a front tooth that is darker, so I give two thumbs up on the internal bleaching and trusting your dentist''s recommendations. Think about it--he could be making money on you with a new crown but he is saying, no I don''t think you need it--that sounds very ethical to me.

Now--given you know which tooth is the root canal one, I also think it would be wise to be gentle with it and not bite down on really hard things. I would recommend not biting on hard things for anybody with any tooth regardless of if it has had a root canal! Who in the heck invented corn nuts?? Must have been a dentist wanting more business.

 

[Delster]

HappyAnniversary thank you that''s really useful information! My dentist wants €60 for the internal bleaching, plus €50 to replace the filling afterward. I think that works out roughly at the same price as you quoted. To me that seems very cheap - fillings alone routinely run around €110 in Dublin

I''m super gentle with that poor tooth already and always have been. I think I learned the habit when I was little after the accident, and then when I had braces. I simply cannot imagine ever biting straight into an apple or even a bread roll

Um, what''s a corn nut?

 

[HappyAnniversary]

http://www.planters.com/cornnuts/index.aspx?pn=WHATARETHEY


There is the official corn nut link. I consider them bar snacks. You know, you go to a bar for a beer and they have those free SALTY snacks that make you buy more beer. They are very very hard and really can fracture teeth. My dentist swears one of his crowns is from biting on corn nuts. Wikipedia said they soak the corn kernel for 3 days then season and deep fry? Good luck with the tooth decision.