Dental Crowns: When You Need One and What to Expect

A crown is one of the treatments I end up explaining most often, and it is also the one patients walk in with the most wrong ideas about. Some people hear the word and assume it is cosmetic. Others hear it and assume the tooth is beyond saving. Usually neither is true.

Most of the time a crown is the opposite of giving up on a tooth. It is what we do to keep one.

What a crown actually is

A crown is a cover that fits over the whole visible part of a tooth, down to the gumline. I reshape the tooth a little so there is room for it, and then a custom-made cap is cemented over the top permanently. It takes over the chewing and holds what is left of the tooth together.

Most crowns today are ceramic — zirconia for back teeth that take heavy force, or a more translucent porcelain for front teeth where appearance matters most. Gold and porcelain-fused-to-metal are still used and still work well, particularly on molars. Which one I suggest depends on where the tooth sits, how much force it takes, and how visible it is.

When a tooth needs one

• A tooth that has cracked, or lost a sizable piece

• A back tooth that has had a root canal

• A filling so large there is not enough tooth left to hold another one

• Decay that has spread under and around the walls of the tooth

• A tooth worn flat from years of grinding

• The top of a dental implant, which is a crown arrived at by a different route

Why another filling is not always the answer

This is the part worth understanding, because it is the reason I sometimes recommend a crown when a patient was expecting a filling.

A filling sits inside the tooth and depends on the walls around it to stay put. When those walls are still thick, that works fine. When they have been thinned out by decay or by a previous large filling, chewing starts to act like a wedge, pushing them apart. Eventually one of them fractures, and sometimes the crack runs below the gumline — which is how a tooth that could have been saved turns into an extraction.

A crown works the other way around. Because it wraps the outside of the tooth, chewing force squeezes it together instead of splitting it apart. That is also why I push for crowns on molars after a root canal. A treated tooth is hollowed out and more brittle than it looks, and it is carrying the hardest chewing load in your mouth.

What the appointments are like

The usual version takes two visits. At the first, I numb the tooth, reshape it, and take either an impression or a digital scan. You leave wearing a temporary crown while the permanent one is made, generally about two to three weeks. At the second visit the temporary comes off, we check the fit and the bite, and the real crown is cemented in.

The temporary is the part people underestimate. It is held on lightly on purpose, so it can come off. Go easy on anything sticky or chewy, and when you floss that tooth, pull the floss out sideways instead of snapping it up — snapping is what pulls temporaries loose. If one does come off, call us. It is a quick fix and not an emergency, but we do not want the tooth sitting uncovered for days.

What to expect once it is on

• Some sensitivity to cold or pressure for a few days to a couple of weeks is normal

• The bite should feel even. If the tooth feels tall, or you notice yourself hitting it first, come back — adjusting it takes a few minutes

• Brush and floss it exactly like a natural tooth, because there is a natural tooth underneath it

That last point matters more than most people realize. The crown itself cannot get a cavity, but the tooth at its edge certainly can, right where the crown meets the gum. That border is the most common reason a crown eventually needs replacing. Crowns are durable, not permanent, and how well you clean around one has more to do with how long it lasts than almost anything else.

Questions worth asking before you start

If a crown has been recommended and you want to feel settled about it, these are all reasonable things to ask: what material you are getting and why that one for this particular tooth, whether the tooth needs a root canal first, and what the whole thing will cost. On that last one, ask for a written estimate with your insurance applied before treatment begins. We are glad to put one together, and you should not have to guess.

And if someone has told you a tooth needs a crown and your instinct is to wait, say so out loud. Sometimes waiting is perfectly reasonable. Sometimes waiting is how a tooth that needed a crown ends up needing an implant. I would rather talk through which of those you are looking at than have you decide alone.

This is general information rather than a diagnosis — your own tooth needs to be examined and X-rayed before anyone can tell you what it actually needs. If you have a tooth that is cracked, sensitive, or carrying an old filling you have been quietly worried about, come in and we will take a look.

Hashimi Dental, 3701 Market St. Suite E, Riverside, CA 92501