Crowns in Vancouver, WA

Hello, I am Dr. Roman at Pacific Park Family Dental, and today I want to answer some questions regarding dental crowns: what it is, why it functions the way it does, and why we prescribe it sometimes as dentists.

Why does a dentist recommend a dental crown?

There are a couple of instances where we go straight for the crown, but typically when I see that a tooth has had a lot of work done and most of the natural crown, the top portion of the tooth that actually does the chewing, is destroyed or missing structure, I recommend a crowning structure that will go on top of the tooth to help bind the thing together and protect it from falling apart.

Why does a tooth fall apart?

Typically, that's due to restorations. Many doctors place fillings on that tooth, and after a while, there are so many fillings placed that there's no more way to place a good filling to preserve the structure of the tooth. At that point in time, you place a crown, or you've had a cusp fall off, so a piece of tooth fractures off, but you can still salvage the tooth; then you just crown the thing.

Sometimes a patient comes to me and reports sensitivity on biting. One of the root causes of that sensitivity can be a fractured tooth. Not all the time will you get a tooth that breaks in half because of the fracture; sometimes it's just a hairline crack that starts to form, and the tooth nerve can start to feel that over time because of the flex texture of the tooth. So as soon as you bite on that compromised tooth, the tooth will move just a tiny bit, and that fracture will open and close just a bit, and your nerve inside the tooth will feel that and signal a problem. This is why you're feeling that little electric sensation when you're biting on that tooth. That can be the cause, and when my patients come to me and say, "Hey, I'm feeling this on my tooth like I'm biting on tin foil or there's a tiny electric shock when I'm biting on this," it's time to get a crown on that tooth.

How are dental crowns different for different types of teeth?

The process doesn't really differ fundamentally. You start with a tooth that was like this; you bring it down somewhat by shaving off the sides and the top, and then you put a covering on top of it, either made of metals, zirconia, or whatever material. The shape will change all the time. If we're working on the front teeth, of course, we're going to make aesthetic changes. For example, if I'm doing two teeth on the front, I want to make sure that the line is centered, not skewed or off-center, for you to have a good smile. We want to make sure those parameters are correct. For the back teeth, aesthetics are not so important, but the chewing ability is much more important. The contacts between neighboring teeth are very important so you don't get food stuck in there. So, front teeth versus back teeth have their own set of parameters, and some are more important than others that we look at.

Can front tooth crowns look natural?

Yes, they can, and here's what we do at Pacific Park Family Dental that's a little bit different and more tedious for us, but it gives us a much better result. Usually, the way you treat front crowns is you whittle down the teeth, put some temporaries on there, and the next visit, you get your finals. Here's the problem: as soon as you get your finals, this is kind of it. You're stuck with what you have, and if you tell your dentist, "Hey, I don't really like these crowns, can we get something else?" usually what ends up happening is they put the same temporaries back on, send the crowns back, and make a list of what you don't like, and those crowns get adjusted. Frequently, what you end up with is an imperfect product that you have to make compromises to, and then come up with rationalizations such as "Well, we can't move this tooth because of this," "We can't do this because of that," or "Well, the color is different because we whatever." I don't like making those excuses for my patients; I don't like making this type of excuse for my own work. So what I do is a little bit different. First visit: Yes, we whittle down the teeth and give you temporaries. Second visit: you don't get your finals; you get nicely made lab temporaries. This is as if we were giving you the final product, but it's made out of temporary material, and the nice thing is I can make any sort of changes that you tell me to make. If I can't make that change, I can figure out a way to mimic that change so it blends in aesthetically and you don't see the issue so much. I get one more appointment to work out all the little kinks that may be happening, so you're perfectly happy. After that appointment, we take a digital impression of everything that happened, send it to the lab, and after that appointment, you're going to get back zirconia or porcelain crowns that you really like, so you know exactly what you're getting. You're not diving into the unknown and saying, "Will I like it, or will I not like it?" This is why my patients ask me, "Well, I'm afraid I might not like these crowns." My staff has 100% assurance or certainty that yes, you will like these crowns, and not because the doctor is so great, but because the process we have created for the patient is very exact, and we listen to exactly what you say. So there's really no way you won't like those crowns because what you say, that's the changes that are getting made. So yeah, this is your smile; we want you to love it.

Will you need a dental crown after a root canal?

100% of the time, if it's your chewing tooth, just get a crown. Here's what I see a lot of patients do. These patients usually come from the former Soviet bloc countries. They used to do root canals and put a big old filling on top of there, and those teeth functioned for a number of years. However, they start to decay, those fillings start to leak, the root canals start to get infected, and patients don't really know about this until the tooth completely breaks down, and then there's no way to fix that tooth. I'm forced to tell the patient, "Hey, listen, this was going to be this much money, but now it's five times more because you know we didn't crown this." Of course, I don't make my patients feel bad about it, but the honest truth of the situation is that if only they would have crowned it maybe five years ago, they wouldn't need to worry about that problem in the future. So what I do is I tell all my patients, "Hey, listen, if it's a chewing tooth, don't even bother thinking about it, just crown it because it'll save you so much time, money, and headache in the future." Because face it, things are getting more expensive, so whatever procedure you're going to do right now, it's going to be cheaper today than it will ever be in the future. Just get it out of the way, and now you know that you have a 30-year result; you don't have to worry about anything else, you're good to go.

What is the procedure associated with getting a tooth crowned?

As I talked about before, in sort of loose terms, here's exactly what happens. Let's say you have a tooth like this. What I do is once I get you numb, I whittle down the tooth with the burs to be a little bit smaller. How much smaller are we talking about? Oh man, maybe a 16th of an inch, very tiny adjustments. So I make the tooth smaller, and this new dimension allows a crown, or like a helmet, to be put on the tooth in order to protect the underlying structure. So the crown acts like a barrel hoop, sort of hugging the remaining tooth structure and giving it strength. So when you're biting on that crown, it distributes the entire force across the whole tooth structure and the root evenly. Without a crown, let's say you could be biting on this side of a tooth, and if you have an underlying fracture, the fracture would be absorbing a lot of that force and increasing, so the fracture would be growing. But with the crown, it binds that whole tooth structure and distributes the forces evenly onto the root structure itself, so you don't have that continual widening of the fracture in the tooth anymore. So that's how a crown really functions and helps to prevent further fracturing or breaking down of the tooth.

Can kids have dental crowns?

Yes, kids can get dental crowns, and the procedure is a little bit different. We don't do the whole aesthetic thing. Kids get metal crowns all the time, and the reason they're metal is because those teeth are going to go missing in a few years, so we really don't care about how pretty they look. They just need to be functional. That's why they're quite a bit cheaper, and they don't need to go to the lab to be created. A dentist picks out pre-formed crowns and just sticks it on the tooth, and that's it, day is done. Fun fact: previously, from the Soviet Union countries, they used to do these prefabricated crowns for adult teeth, and some of them hold up really well. I have patients who are 50, 60, 70 years old, and they are still wearing these crowns, and they're holding up fantastically well. However, there are quite a bit more problems regarding the gum because the flange of the crown is not exactly flush with the tooth, so here's the root, and then the edge of the crown kind of sticks out a little bit and packs a lot of food. Even though sometimes it doesn't lead to a cavity, it always leads to periodontal disease. So a lot of people from Soviet bloc countries have periodontal disease, and I keep telling everybody, "Hey, you need to get cleanings, and you need to get good crowns because there can be problems, so take care of yourself, please."

How long does a dental crown last?

A dental crown can last anywhere from 5 to 10 years, all the way up to 30, 40, and 50 years. I have patients who are still wearing crowns from when they got them placed at 18 or 20, and they're now 75 or 80. These things last, provided you take care of them. A well-done crown can be a lifetime before you have to do anything about it, so really take care of it. It's there for life.

What causes pain under a crown?

Here are the sources of pain that can be associated with the crowning procedure itself. If you just got a crown, let's say two weeks ago, and your tooth is sensitive to air, liquids, maybe a little bit of chewing, yes, your tooth is a little bit angry because somebody drilled on it. Totally normal. Take a little Tylenol, ibuprofen, and within the next couple of weeks to a month, that discomfort will disappear. However, if you're feeling spontaneous pain or you're waking up at night in pain continuously and it's just getting worse, maybe what has happened is the nerve has been irritated beyond repair. How nerve irritation works in human teeth is that, let's say, the first dentist drilled on that tooth a little bit, then the second dentist drilled on that tooth some more, and the third dentist did the same thing, and then the fourth dentist finally decided to put a crown on that tooth. The compounding irritation of those four visits drilling on that tooth is not forgotten; it's compounding, and at some point, the nerve just says, "Okay, I'm done," and it dies. When that happens, yes, you will experience pain, and that will transition into infection. So sometimes that is a possibility, and I do warn patients about that when I see a tooth that has been worked on extensively or if the previous work is quite deep to the nerve. I also tell patients, "Hey, this can be an eventuality, but I'll just be really careful, and we'll see how we can get around it," and 80% of the time, it goes fine.

What can be done about cavities under a dental crown?

I don't like redoing dental crowns. I redo dental crowns only when absolutely necessary. If a patient comes to me and there is a little caries right underneath the margin of the crown, so let's say here's the crown and the tooth structure begins right here, I can feel with my explorer that there's a little bit of soft tooth structure. I won't replace the whole crown. I will actually go in, explore how deep that cavity is, and if I can confine it to a limited space, I will just place a patch on there, like a filling, and call it a day. Usually, that particular fix lasts for years; you don't have to redo the crown and spend more money on it. A filling most likely will do. If a cavity is in a hard-to-reach area or if it just kind of blows up in the tooth, so to speak, like you enter through a small space and then underneath that is just a disaster, yes, of course, we have to redo the crown and maybe possibly even do the root canal. Of course, I have a conversation with patients when I find something. I say, "Hey, listen, this is fine, we're going to fix it, no big deal," or I may say, "Hey, you may want to consider redoing this crown because this is really an issue. I'll still patch it up for now, but we're going to see how it acts and possibly redo a crown, maybe even add a root canal down the road."

Does dental insurance cover crowns?

Depending on what kind of insurance you have, the dental insurance industry is kind of interesting. Think about it as somebody else's wallet, and they may or may not let you use it sometimes, even though you're paying a subscription fee to that wallet, but somebody else tells you when you can draw money from it or not. Is this an elegant system? Sometimes it is, and sometimes it isn't. You just have to see the situation. So what we usually do is check the insurance benefits and let you know beforehand what's covered and what's not. If there's any questions, we submit a pre-authorization just to understand if they will for sure cover something or if there are questions.

When should I schedule a dental crown procedure?

As far as scheduling is concerned, whenever your dentist tells you that you need a crown, just get a crown. This will prevent further problems down the road. If you are definitely feeling some symptoms, yeah, you want it faster rather than later. If you have a big cavity that you know can't be fixed with a filling and requires a crown, of course, we want you to get a crown faster because if you don't, it may require a root canal and then also crowning, so it's just an added expense the longer you wait. In some cases, I do tell patients, "Hey, I am watching this. I think you may need a crown later, but for now, this is okay. How about we just watch it for another year?" Just because the tooth has been there for 20 years like this, and it looks okay, and it's not changing from month to month, from year to year, it remains the same, and I take pictures just to prove that to myself. When I know that this situation is stable, then I say, "Hey, listen, how about we don't do the crown, just let this be." Anything I do, I want to be 100% transparent with my patients, just so they know that I really care about them and I have their best interests at heart. That's what we do at Pacific Park Family Dental: we're absolutely transparent and honest, and I want you to be able to use your teeth, smile, and chew with full confidence without anything falling apart.

I hope that answers some crown questions that you may have had, and if you have any more further questions or you want to come see me in person, please call us at (360) 803-3546. Hope to see you soon. Bye-bye!