Crowns

Crowns

Most people have heard of the terms “crown” and “cap” in regard to dentistry (they are interchangeable, and dentists prefer the term crown), but few actually understand what a crown is.  This blog will explain this, along with why they are necessary, what types of crowns are available in modern dentistry, and what to expect if you are in need of one.

What is a crown?

There are actually two meanings of the word “crown” in dentistry, which can sometimes make things confusing.  We will define both here, and the rest of the blog will pertain only to the second definition.

  1. Crown – the portion of a tooth exposed to the mouth, which excludes the roots (even any root structure that is visible through gum recession). This definition describes an anatomical portion of a tooth. The crown is covered in enamel. Under this definition, every tooth has a crown.

  2. Crown – a dental restoration of a tooth in which all of the enamel has been removed and replaced with a new material. Crowns can be made out of metals, ceramics, or temporary materials. A crown should completely cover the entire exposed portion of the tooth, and the edge (margin) of the crown typically rests near the gum line of the tooth.

 

Why do certain teeth need crowns?

  • Very large cavities – In some cases, the integrity of the tooth is undermined by a very large cavity. Once all of the decay has been removed from the tooth, there must be an adequate amount of solid, healthy tooth structure to support a filling. If there is not enough tooth structure remaining to hold a filling, then the entire tooth must be covered by a crown in order to restore it to its proper shape for chewing. In this situation, if a filling were placed instead of a crown, it could only be considered a short-term solution at best.

  • Fracture – The enamel covering a tooth is one solid, continuous layer. A visible fracture or crack means that the enamel is no longer able to do its job of protecting the tooth from bacteria, food, and chewing forces. Interestingly, cracked teeth do not always cause pain. A crown’s role in “fixing” a cracked tooth is the total replacement of the enamel layer with a new solid, continuous material, which splints the underlying tooth structure together.

  • Lack of adequate coronal tooth structure – Just as a very large cavity can deprive a tooth of the necessary amount of tooth structure, a large filling or even missing tooth structure can do the same. The crown restores the tooth to its original shape, size and strength to provide proper function.

  • Root Canal Treatment – When a tooth has had a root canal, the nerves and blood vessels have been removed from the inner, hollow chamber of the tooth. They are replaced with a filling material called gutta percha. Because the tooth no longer has a blood supply, it no longer has a source of hydration and becomes dried out and brittle. This brittleness makes the tooth high risk for cracking. A crown is placed over a tooth that has had a root canal in order to prevent such cracking so that you can keep the tooth for a long time. A root canal is a significant investment in the life of a tooth. If the tooth is not properly covered and protected with a crown, that investment could be wasted.

What are the different types of crowns?

There are many different materials available for crowns today. Each material has pros and cons, listed below. What is most important is that your dentist select the proper material for each individual tooth. At our Dental Centers in Freeman, Parkston, and Viborg, we prioritize each patient as an individual with distinct and specific needs. You will never get a “one size fits all” recommendation. Our doctors take all of the pros and cons of each material into consideration when selecting the right crown for your particular needs.

Material

Pros

  • Gold

-Requires minimal removal of tooth structure

-Least damage to the opposing tooth

-Studies show best longevity and lowest chance of developing new cavities underneath

  • Porcelain-fused-to-metal

    -Better cosmetic appearance

    -Very durable and strong to withstand chewing forces

  • Zirconia

-Good cosmetic appearance with no dark metal

-Strongest material available, almost impossible to break

-Can withstand heavy clenching or grinding forces

  • All Porcelain

    -Best cosmetic appearance, most like a natural tooth with translucence and shading

    -Can achieve micromechanical bond with tooth structure

Cons

  • Gold

-Metallic appearance, not cosmetic

-Can wear down over time and can develop holes in its surface when worn too thin

-Can cause a reaction in patients with metal sensitivities or allergies

  • Porcelain-fused-to-metal

-Not cosmetic enough for front teeth due to opaque appearance and possible gray line at the gums

-Porcelain can fracture away from the metal

-Porcelain biting surface can damage the opposing tooth

  • Zirconia

-Can sometimes appear opaque

-Require more removal of tooth structure

-Very abrasive and damaging to opposing teeth

-Higher incidence of long-term post-operative discomfort

  • All Porcelain

-Requires most removal of tooth structure

-Most likely to crack or chip

-Porcelain biting surface can damage the opposing tooth

What can I expect at my dental appointment for a crown?

At our Dental Centers in Freeman, Parkston, and Viborg, crowns are made in a dental lab by a professional, certified dental lab technician. In order for a crown to be properly fabricated for your specific needs, you will experience a two-appointment process. At the first appointment, the tooth is prepared for the crown under local anesthetic. You should be numb and experience no discomfort during the preparation process. Once the doctor has achieved the proper preparation for your tooth based on the crown selected, either an impression or a 3D scan is taken. Both of these serve to communicate the exact shape of the prepared tooth from the doctor to the lab. The lab uses this to fabricate the prescribed crown. The process typically takes 2-3 weeks. During that time, you will wear a provisional or temporary crown to replace the enamel and cover the tooth. The temporary crown and your bite should feel comfortable after the initial post-operative sensitivity has worn off (on average, a few days). You will return for your second appointment after we have received your crown from the dental lab. At this visit, the temporary crown is removed, the underlying tooth structure cleaned, and the new crown fitted to your tooth. An x-ray is taken to confirm that the crown fits properly and allows no leaking of saliva or bacteria under the crown. The bite is adjusted, if necessary, and then the crown is cemented onto the tooth. You need to have a little caution when eating and cleaning the new crown for the first 24 hours. Afterward, you return to business as usual, eating and cleaning it like you would a natural tooth.

Want more information about crowns?

Call our office at 605-925-4999 (Freeman) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!

What Does it Mean to be High Risk for Cavities?

What does it mean to be high risk for cavities?

What is a cavity? 

A cavity is the destruction of tooth structure caused by a combination of bacteria, sugar and acid.  When bacteria in the mouth digests sugar, acid is produced.  The acid destroys enamel, just like it etches glass, and this process is called demineralization.  Once a cavity has grown through the outer layer of enamel, it cannot be reversed.

 What are the different types of cavities?

Cavities can form on any surface of the tooth, including the pits and fissures on the biting surface, smooth surfaces and any exposed root.  Pit & fissure cavities are the type that can be prevented by placing dental sealants before a cavity has formed.  Smooth surface cavities, most commonly in between the teeth, are discovered with bitewing x-rays, typically taken by your dentist once a year.  Root cavities can be seen on visual examination, or on an x-ray if they are large.

 

 How do cavities happen?

 Four things are required for a cavity to form: 1) acid,  2) sugar, 3) bacteria, and 4) time.  The bacteria present in the mouth thrive on simple carbohydrates, the sugars in most crackers, cookies, candy, soda, sports drinks, and most juices.  The more bacteria you have in your mouth, the more likely you are to get a cavity.  This factor emphasizes the importance of daily home care and regular dental cleanings.  The more sugar your teeth are exposed to, the more likely you are to get a cavity.  This factor emphasizes the importance of your diet.  The longer your teeth are exposed to sugar or acid, the more likely you are to get a cavity.  This factor emphasizes the importance of your habits (i.e. sipping on sugary or acidic beverages for long periods of time).  The more acidic your mouth is, the more likely you are to get a cavity. This factor also emphasizes the importance of diet, specifically acidic beverages like sparkling water, sports drinks, juices, and sodas.

 

What does it mean to be high risk? 

There are multiple factors that can make you high risk.  You may present with one or more of these factors:

·       Poor plaque control
·       High risk diet
·       Multiple existing restorations (like fillings or crowns)
·       Fractured teeth
·       Decreased salivary flow or dry mouth
·       Systemic condition
·       Active decay
·       Unsealed grooves and pits
·       In orthodontic treatment, either braces or Invisalign

 What can I do about it? 

By altering the four factors in the diagram, you can reduce your cavity risk.

  1. Acid – Reduce your intake of acidic foods & drinks (this includes DIET SODAS, coffee and tea), drink plenty of water, use sugar-free gum or mints to stimulate salivary flow, and control any acid reflux problems. Neutralizing the pH in your mouth may involve using recommended mouthrinses or gels.

  2. Sugar – Limit sugar intake, especially in between meals. Cut back on sodas, sweetened coffee or tea, sports drinks, or juices. Don’t chew sugar-containing gum, mints or other hard candy.

  3. Bacteria – Reduce the bacterial levels in your mouth by having your teeth professionally cleaned on a regular basis, and performing good oral hygiene at home. FLOSS!

  4. Time – Limit the length of time that your teeth are exposed to acid or sugar. Sipping on an acidic or sugary beverage is one of the most common causes of cavities. You may only drink one soda per day, but if you sip on it for several hours, you are increasing your cavity risk exponentially.

 

What if I don’t do anything?

Untreated cavities expand toward the nerve inside the tooth.  Large cavities can cause nerve irritation and sensitivity to hot and cold.  If the cavity reaches the nerve, causing it to become infected with the cavity’s bacteria, a severe infection and toothache can ensue. Not all tooth infections hurt, so evaluation of teeth with dental x-rays is important!   Tooth infections can extend through the root and into the surrounding jaw structures, and worst-case scenario, end in death by closing off the airway or spreading into the brain.

 

Call our office at 605-925-4999 (Freeman) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!