When a tooth needs a crown
A filling works when there is enough healthy tooth around it to hold it in place. Once a filling takes up most of the tooth, the walls that are left start to flex every time you bite, and sooner or later one of them cracks. A crown fits over the whole tooth and holds it together, which makes the next crack far less likely.
Most of the crowns we place are for one of a handful of reasons:
- A large old filling that is breaking down, with too little tooth left to fill again.
- A cracked tooth, especially one that hurts when you bite and let go.
- A back tooth that has had a root canal, which leaves it brittle.
- A tooth worn down by years of grinding.
- The replacement tooth on top of a dental implant.
If a filling will do, we will say so
A crown means shaping the tooth, and tooth that has been cut away does not grow back. So we do not recommend one for a tooth that a tooth-colored filling can repair properly. When it is a close call, we show you the image on the screen and explain what we are weighing, and the decision is yours.
The same goes for timing. A crack that is causing no trouble can sometimes be watched for a while. A crack that hurts on biting usually cannot, because those tend to split further, and a split that reaches the root can cost you the tooth.
What the appointments involve
Most crowns take two visits. At the first, the tooth is numbed, any old filling and decay are cleaned out, and the tooth is shaped so the crown can sit over it. Then we scan it with a small digital wand instead of filling your mouth with impression putty. The scan goes to the lab, and you leave with a temporary crown protecting the tooth.
At the second visit the temporary comes off and the finished crown goes on. We check the fit, the color and the bite before anything is bonded, and we adjust it until your teeth meet the way they did before. A bite that feels high on day one does not settle in by itself, so tell us, and we will fix it.
Choosing the material
Most crowns today are tooth-colored ceramic, strong enough for the back of the mouth and matched to the teeth around them. Where a tooth takes very heavy biting force, or someone grinds hard at night, a stronger material can be the better choice even if it is less invisible. We will explain the trade-off for your tooth rather than default to the most expensive option.
Making a crown last
The crown itself cannot decay, but the tooth underneath can, right at the edge where the two meet. That edge is where brushing and flossing matter most, and it is one of the places we look at every check-up.
Crowns commonly last many years. How long yours lasts depends far more on your gums, your habits and whether you grind than on the crown. If you clench or grind, tell us, because it changes what we recommend.
Cost and insurance
The fee depends on the tooth and the material, so we give you a written estimate before anything is scheduled. Most dental plans treat a crown as a major service and pay part of it when the tooth needs one. For larger treatment we can send the insurer a pre-treatment estimate first, so you know what they will pay before you commit. See insurance for the plans we work with.
No insurance? The Virginia Dental Club is a membership plan built for exactly that, and it is worth a look before you decide.
Questions patients ask
Does getting a crown hurt?
The tooth is fully numb while we work, so most people feel pressure and vibration rather than pain. The gum around the tooth can be tender for a day or two afterward, which ordinary pain relievers handle.
How long does a crown last?
Commonly many years. The biggest factors are the health of the gum and the tooth at the edge of the crown, and whether you grind your teeth, which is why both are checked at every visit.
Can a tooth with a crown still get a cavity?
Yes. The crown cannot decay, but the natural tooth underneath can, starting at the edge where the crown meets the tooth. Brushing and flossing along that line is what protects it.
What if my temporary crown comes off?
Call us and keep the temporary. It can usually be put back quickly. Try not to leave the tooth uncovered for long, because a shaped tooth can shift or become sensitive without its cover.