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Tooth issues can occur no matter what age you are. From the littlest child to the oldest adult, having good education when tooth issues arise is paramount. Have you ever wondered what parts make up your teeth? Why they are so strong?

Anatomy Of A Tooth

The anatomy of a tooth is actually quite simple. A tooth is made up of various layers that work together to give us our beautiful smiles. Every tooth is made up of multiple parts. These parts are as follows:

-Crown. This is the part of the tooth that you see when smiling. The crown is covered in a white colored material called enamel. Enamel is the hardest substance found in the human body. Even though enamel is very strong, it can easily be broken down by the acids produced by oral bacteria and the acids found is many popular drinks like soda.

-Dentin. Dentin is the layer right beneath the enamel.  Although not as hard as enamel, it’s hardness rating is comparable to that of bone.  Another great quality of dentin is it’s flexibility.  For example, if you bite down on a very hard food, the dentin is able to flex a little bit and can keep your tooth from cracking like it might if teeth were just made of enamel.

-Pulp. This is the inner most layer of the tooth.  The pulp provides bloodflow and nutrition to the tooth. The pulp also allows for the nerves to enter the tooth. Without proper bloodflow and innervation of the nerves a tooth will die. The pulp of a tooth is removed during root canal therapy. This procedure allows your dentist to save the tooth for form and function. Once the pulp is removed from a tooth it becomes more brittle with an increased risk of breaking. This is why dentists often recommend placing a dental crown over a tooth that has received root canal therapy.

-Root. This part of the tooth is hidden under the gum tissues. This can be visible when the gums recede as can happen during periodontal disease. The root is what anchors the tooth inside the bone allowing for support during chewing of food. One other portion of the root is called cementum. The cementum is a thin layer that anchors the tooth to the bone thru the periodontal ligament.

-Periodontal Ligament (PDL). The main function of the periodontal ligament is to attach the teeth to the bone.  The peridontal ligament also sends sensory information to the brain.  For example, if you are eating some popcorn and bite down hard on a popcorn kernel, your jaw suddenly opens to alleviate the pressure.  The periodontal ligament sends that pressure signal to your brain, causing that reflex. The tooth doesn’t feel the pressure since the tooth is only capable of sending pain messages to your brain.

-Gingiva (GumTissue). The gums form a collar or sheath around the teeth that protects the underlying bone.  When you stop brushing your teeth for an extended period of time, the gingiva become red and puffy as the body begins the inflammatory process. This is the body’s way of defending against the plaque that has built up.  If you completely stop brushing, the gingiva will eventually start to lose the war against plaque and recede from around the teeth resulting in periodontal disease that can eventually loosen your teeth.

-Bone. The bone holds the whole tooth in its place.  The bone is constantly remodeling itself. This is in response to various forces it experiences in the mouth.  For example, if you have braces on, there are forces pushing on the teeth.  The bone remodels itself to help the tooth move to the position in which it is being pushed.

Different Types Of Teeth

Every tooth in the mouth has a specific function. The teeth in your mouth are as follows:

-Incisors. These are the sharp, chisel-shaped front teeth (four upper, four lower). They are used for cutting foods.

-Canines. These are sometimes called cuspids, these teeth are shaped like points and are used for tearing foods.

-Premolars. These teeth have two pointed cusps on their biting surface and are sometimes also called bicuspids. The premolars are used for crushing and tearing.

-Molars. These teeth are used for grinding, these teeth have several cusps on the biting surface.

Conclusion

An educated patient is an informed patient who can make smart decisions regarding their dental and health care. Our teeth are quite strong but they are under constant bombardment from outside forces at all times. If you are experiencing any tooth issues see your dentist immediately to put your mind and dental health at ease.

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.

Conclusion

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.

Conclusion

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 Marielaina Perrone DDS

Not All Dental Crowns Are Created The Same!

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.

Dental Crowns Marielaina Perrone DDS-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 madeDental Crowns Marielaina Perrone DDS 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.

Conclusion

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.