While the dental crown itself cannot become decayed, the underlying tooth structure can. A dental crown is placed after careful shaping and preparation of the tooth surface and then inserted over the remaining tooth structure to restore the crown to its proper form and function.
How Does The Tooth Get Decay Under A Dental Crown?
The most vulnerable part of the interface between the dental crown and the tooth is the area where the edge of the crown meets natural tooth structure. If you are not maintaining good oral hygiene (brushing and flossing) to remove the plaque that lives under the gumline, you can develop a cavity on the underlying tooth and root areas. Once decay develops, it can progress quickly into the tooth and move up and under the crown, undermining the support for the dental crown. The following things can happen if you get tooth decay on a tooth with a dental crown:
–Simple Dental Filling Placed At Margin Of Dental Crown. If the tooth decay is caught early enough, there are times where a simple filling can be placed to restore the tooth. This is only done when complete removal of decay can be accessed from the area. The seal is not as strong and leakage can occur under the dental crown over time.
–Root Canal Therapy. If the tooth decay gets close to or invades into the nerve of the tooth a root canal will be needed to save the tooth. If the tooth has already had a root canal performed, it will need to be rebuilt back up so that a new crown can be placed.
–Crown Lengthening. A crown lengthening is a dental procedure where a portion of the bone surrounding a tooth is surgically removed to allow the dentist access to decay that might run down the side of the tooth. This gives access to restore the tooth and also allows for proper placement of a new dental crown.
–New Custom Dental Crown Fabricated. In most cases, a new crown will be needed to ensure a proper seal and proper coverage over the existing tooth.
It is important to maintain good dental hygiene but it really becomes important once you have dental crowns. A dental crown generally lasts anywhere from 5-15 years if properly taken care of. If they are not cared for they will not last as long and could develop a bigger issue. The big tip here is to always maintain good dental hygiene and see your dentist regularly to check the crown edges for leakage and decay.
Dental emergencies seem to arise at the most inconvenient times. Some dental emergencies are serious while others are inconveniences at best. Anyone who has had a temporary crown or a permanent dental crown/onlay/porcelain veneer should be aware that it could eventually come off. They may be able to be placed back on, or may need to be completely replaced…But why does it happen?
How Do Dental Crowns Stay On Your Teeth?
Dental crowns are placed over your prepared tooth using a special adhesive cement. This cement has the ability to bond to both your natural tooth structure as well as the inner lining of the dental crown. Depending on the type of dental crown your dentist will use a different type of cement. The shape of the tooth is also important in keeping the crown on. The tooth is prepared by the dentist to be “retentive”, meaning that the shaping of the tooth itself helps to keep the crown on as well.
Why Would My Dental Crown Come Off?
–Tooth Decay. A tooth that has a dental crown needs to be kept clean through brushing, flossing and rinsing. Tooth decay can still occur at the margins of the dental crown, (where the crown edge ends and the tooth begins) and eventually make their way up and under the dental crown. If tooth decay does occur under a crown, it may need a new crown to be fabricated or if the tooth decay progresses far enough a root canal may be needed to salvage the tooth.
–Sticky, Chewy Foods. This can occur from continual use or just one time chewing a sticky piece of candy. Generally, over time these sticky, chewy foods can slowly break the cement seal and work a dental crown loose. If it is just pulled off from a candy, your dentist will examine both the tooth and the crown to ensure there is no tooth decay or damage to the tooth or crown. If all is well, your dentist may be able to simply recement the crown and you will be on your way.
–Crown Damage. A dental crown is a man made tooth shell that is capable of fracturing or breaking over time. Our teeth absorb extreme amounts of force on a daily basis. The metal or porcelain on a crown can wear through, chip, or fracture.
–Oral Habits. Yes, our habits can effect the longevity of a dental crown. Bad habits include teeth grinding (bruxism), clenching, nail biting, ice chewing, using teeth to open packages and bottles, chewing on pens, etc.. These forces will break porcelain, wear metal, and stress the adhesive bond causing the dental crown to loosen over time,.
–Small/Short Teeth. This can usually be overcome by your dentist “building” your tooth back up with dental resins but in some instances all of the teeth are shorter due to teeth grinding. The shortness is directly related to a decrease in retentiveness. This creates an issue over time, as the crown adhesive is working doubly hard to maintain its place on the tooth.
–Cement Breakdown. This can occur when the margin seal is broken causing the cement to leak out, or if a small amount of blood or saliva gets under the dental crown while cementing. If there is any moisture (saliva or blood) on the tooth upon cementation this can cause a weaker bond to develop for the cement. This will lead to a loosening of the crown over time. Simple fix in most cases is to just recement the dental crown back on either using a different cement or ensuring the area is clean and dry.
–Poor Fit. Sometimes a tooth is not prepared ideally, an impression of the tooth is distorted, the lab creates a poor fit to the tooth, or it is not completely seated on the tooth during cementation. When these issues occur, leakage of bacteria and saliva occur under the crown and loosen it.
As mentioned earlier, a dental crown coming off is a routine dental emergency but usually not a painful one. In many cases (if the dentist is unavailable), the patients try to temporarily recement their dental crown back on using fixodent (denture adhesive), toothpaste, or temporary dental cement from the local drug store. The best course of action is to see your dentist as soon as you can to ensure you do not experience any discomfort, do not swallow the dental crown, or permanently damage the tooth or crown.
Dental crowns are a type of dental restoration which completely covers and protects a tooth or a dental implant. Dental crowns are often necessary when a large cavity has destroyed a good portion of the tooth, leaving it easily fracturable. Dental crowns will restore its shape, strength, and improve its cosmetic appearance. Dental crowns are typically bonded to the tooth using a specialized dental cement (in dental implants they are sometimes screwed in place). Crowns can be made from many different types of materials. Dental crowns are generally custom fabricated using indirect methods.
Types Of Dental Crowns
Permanent dental crowns can be made from stainless steel, all metal (such as gold or another alloy), porcelain-fused-to-metal (also called a PFM crown), all resin, or all porcelain.
-Stainless steel. These short term use dental crowns are pre -formed metal shells.They are used on permanent or primary teeth generally for a few years, or as a temporary. The temporary crown protects the tooth or filling while a permanent crown is made from another material. For children’s teeth, a stainless steel crown is commonly used to fit over a tooth that’s been prepared to fit it. The crown covers the entire tooth and protects it from further breakdown. This type of dental crown also serves another purpose, to hold space in the mouth for the permanent teeth to move into. When the primary tooth eventually falls out of the mouth, the crown comes out with it.
-Metal Alloy. These dental crowns can include crowns made of gold , other precious alloys (for example,platinum, palladium), or a base-metal alloy or non-precious (for example, nickel or chromium). Purer gold is the softest yet easiest to get ideal fit, while non precious crowns are variable in hardness and strength. Non precious dental crowns tend to make the underlying tooth black as,over time, metals leach into the tooth, they may also have a very metallic taste. Metal dental crowns can be made very thin. This allows for minimal tooth structure to be reshaped in preparation for the crown. Another advantage is, that metal crowns are not as hard as porcelain. This “softness” causes much less wear on the opposing tooth. Metal dental crowns do not break or chip and tend to withstand biting forces well over time. However, metal crowns are not very cosmetic, can wear through, and generally are reserved for the areas not visible in the smile line.
-Porcelain-fused-to-metal (PFM). These dental crowns are the most widely and commonly used. They have the benefit of good fit and underlying strength from the metal.The underlying metal alloy may be any combination of precious or non precious as mentioned above. These dental crowns are more cosmetic, and are fabricated to match the color of the surrounding teeth. However, the porcelain outer layer will cause more wearing to the opposing teeth than a metal crown. The porcelain portion of the crown can also chip or break off over time. PFM dental crowns can be highly esthetic and look just like your natural teeth when prepared properly. Over time, with gum recession, a dark line may become visible at the gumline. This is the underlying metal of the crown. Depending upon where it is in the mouth, it may become a cosmetic problem. These dental crowns are able to be used for any teeth in the mouth.
-All ceramic, all porcelain, all resin. These dental crowns are the ultimate in cosmetic crowns. These provide better natural color match than any other crown type. These are also a good choice for patients with metal allergies of any kind. However, some are not as strong (example, Belle Glass) as porcelain-fused-to-metal crowns, some are stronger (example, Bruxzir crowns). These dental crowns tend to wear down opposing teeth more than metal crowns would. Because of the lack of metal, there will never be a black line to worry about. All porcelain crowns are the perfect choice for front teeth cosmetics, or any teeth that will be easily seen when smiling.
Dental Crown Tips
So, you have been told you need a crown to restore a tooth? The following are some things to ask or check on with your dentist to ensure you are receiving the highest quality care that will last over the long term:
–American Made? Many dentists save costs by resorting to using dental laboratories overseas in places like Costa Rica and China. They tend to be made with cheaper materials and lower quality recycled dental metals and porcelain. Ask your dentist where your crown is being fabricated, along with the laboratory slip to tell how much gold content or type of porcelain is being used.
–How long should it last? Is there any warranty for breakage? Dental crowns generally last between 10-15 years with proper oral hygiene, if a dental crown is made with inferior materials you can expect breakdown in half that time. Some labs will warranty a crown for up to a year. Especially important if you have chosen a ceramic, resin, or porcelain type crown. ask your dentist about this.
–Lab Created Provisional Dental Crowns. Sometimes to help you make decisions especially in a cosmetic area, a dentist may have a dental laboratory make a trial or provisional crown. This type of dental crown is generally made if there is healing required before the final processing of your new crowns. With lab created temporaries, you can literally see what your permanent crown (shape and color) will look like and whether it blends well with your smile. It also helps you determine if it is compatible with the health of your gum tissues and whether or not you can eat and talk normally. With a provisional crown (as opposed to a routine temporary crown), all the details are worked out ahead of time. There usually is an additional charge for this extra step as there will be a laboratory fee involved as well as extra chair time with dentist. Once you approve, your final crown is custom made to match the blueprint provided by the provisional, except that the final materials are stronger, of better quality, and look far more natural.
–Always ask to see the crown before it is placed permanently in the mouth! This should be something most dentists do anyway but not all will. You want to ensure shape and color are to your liking before it is placed in permanently. If the color is off or does not feel right voice your concerns. If you truly are not happy with something that cannot be adjusted chair side ask for the crown to be remade. Crown aesthetics can be very subjective, and their beauty is very much in the eyes of the beholder. Both your input and your dentist’s professional experience should come together in giving you the smile you want.
Each and very dentist has a professional responsibility to treat to the standard of care for a particular dental procedure. Even if some dentists may use inferior products or dental laboratories they are still responsible that the dental crown fits properly and functions as it should.
Not all dental crowns are made the same,and not all dentists, or their labs, have the same skill, training, or experience. A well trained dentist will have no problems preparing and inserting a good functioning dental crown. It takes a skilled dentist and lab to make it look natural, without anyone knowing you even have a crown in your mouth. Dentistry ultimately is an art and choosing the right dentist for you will create a happier, healthier smile.
Dental veneers are wafer thin, custom fabricated shells of tooth colored materials designed to cover the front surface of teeth to improve your overall smile and appearance. These custom fabricated shells are adhesively bonded to the front of the teeth. This allows the cosmetic dentist the ability to change your teeth’s color, shape, size, or length.
Dental veneers can be fabricated from dental porcelain or from composite (resin) materials. Dental veneers can be used to create bright, white smiles with beautifully aligned, shapely teeth. Dental veneers also protect the surface of broken or damaged teeth, and may eliminate the need for more extensive treatments. Other advantages of dental veneers include durability, an improved smile, and the need for much less tooth structure removal compared to traditional or porcelain crowns.
Why are Dental Veneers Needed?
Dental Veneers are utilized for a variety of reasons in cosmetic dentistry. These reasons can include:
–Crooked Teeth. Some minor modifications can be done, which may eliminate the need for orthodontic movement.
–Genetics. Certain people are born with abnormal sized/shaped teeth, or gaps between their teeth that widen with age.
–Wear and Tear. Teeth wearing down is a natural part of aging. Aged teeth are more likely to be small, have chips, fractures, cracks or a generally uneven appearance.
–Worn Enamel. Over time, the thin, hard translucent substance covering your teeth (enamel) may become worn, see through, dull, or discolored. Such wear and discoloration may be natural or result from a genetic predisposition. However, it often results from consuming soft drinks, tea or coffee, smoking, using certain medications, etc.
Material Used for Dental Veneers
The most commonly utilized materials for dental veneers are composite resins and dental porcelain. Porcelain veneers are the more appropriate answer for severe cases involving dullness, wear, tooth discoloration, extensive chipping, cracking, gaps in teeth or uneven teeth. Composite bonding or just dental bonding is an inexpensive, effective and minimally invasive way to restore and correct small chips, cracks and discoloration in the teeth. Porcelain veneers generally require some reduction of the enamel tooth surface, while bonded dental veneers can oftentimes be done without tooth modification. Porcelain veneers are very strong, and do not change color. Bonded veneers tend to chip and pick up stain over time.
Techniques Used in Dental Veneers
Indirect Technique – This technique means that the composite or porcelain veneers are fabricated outside the mouth by a dental technician in a laboratory.
Direct Technique – This technique means that the composite veneers are created directly on your teeth by your dentist during your appointment.
When are Veneers Good Treatment?
The removal by a dentist of any natural tooth structure is permanent, so modern cosmetic dentistry has moved to offer patients the most minimally invasive options first. If your natural teeth are functionally and cosmetically adequate, dental veneers may not be the right treatment for you.
On the other hand, if you have any of the aforementioned cosmetic issues, your treatment options may include veneers. Dental Veneers do have the advantage of a proven ability to enhance the appearance of the mouth, smile and other facial features that are better supported by properly shaped teeth.
If modification of the tooth surface is necessary to achieve optimum results, some cosmetic dentists will recommend less invasive alternatives to dental veneers. One such alternative would be, teeth whitening for people with mildly discolored teeth who only want a whiter and brighter smile. If crooked teeth or alignment issues are involved, the teeth whitening alternative may also be combined with orthodontic treatments. Invisalign, full braces, or use of an orthodontic appliance for minor tooth movement may be all that you need to acquire the smile you desire.
Care of Dental Veneers
Care must be taken not to abuse dental veneers because the wafer thin porcelain shells or composite layers can be damaged or break. Your dentist may advise you against grinding, fingernail chewing, and biting directly into things such as carrots or pizza crusts. If you grind at night your dentist may recommend you wear a night guard while sleeping. It is even more important to have excellent dental hygiene, so that you do not get tooth decay forming under your dental veneer. You should also see your dentist for regular cleanings.
Dental Veneers Conclusion
Dental veneers, whether porcelain veneers or composite veneers, are a great option for those who wish to change their smile. Dental veneers give the cosmetic dentist and patient the ability to change color, shape, and size in an easy manner. As always, before pursuing dental veneers of any kind, please have a thorough dental examination and professional cleaning performed to ensure your mouth is healthy and able to withstand the new treatment.