Dental Crowns: Do You Need a Root Canal First?

Braces? Nerves?

I had a silver filling in my molar when I was a child, and I don't remember it being painful.
It lasted for over 20 years, but the filling has fallen out twice.
The dentist replaced it with resin for aesthetic reasons, but it seems like the cavity keeps getting larger.
After the filling, my tooth felt sensitive for a few days.
One day, while eating, a piece broke off, and the sound was unforgettable! The dentist repaired it with resin, but after a few years, I noticed a dark line around it.
I'm not sure if it's the old silver filling coming out or a new cavity.
When I went back to the dentist, they didn't say much and just refilled it again.
I'm worried that this tooth might break, so I've been chewing on one side only, avoiding the missing tooth area.
Eventually, I developed noticeable tartar in that area, and the dentist suggested using a crown to protect the tooth.
I also have a small cavity from childhood that seems to have a missing silver filling, but it hasn't fallen out yet.
The dentist recommended re-filling it, and I asked if that would also lead to a larger cavity.
The dentist confirmed that it would, so I decided to go for a crown instead.
If I get a crown, will I need to extract the healthy teeth on either side? Will I need a root canal? In the past, I let the dentist handle everything, but now that I'm experiencing sensitivity, I realize the nerve might still be alive.
How long does it typically take to get a crown, and will I be able to eat normally afterward? I want to ask more detailed questions, but I don't know how.
The dentist seems to rush after each appointment to see the next patient, so I can't ask for clarification.
I searched online, but most articles are about crowns after a root canal, which is why I stopped looking.
Consulting here seems more appropriate.
Thank you.

Niming, 30~39 year old female. Ask Date: 2017/08/16

Dr. Zeng Guanghui reply Dentistry

1.
If the extent of tooth decay is too severe to be filled, a dental crown should be considered to restore the tooth's shape and occlusal function.
When placing a crown, the tooth must be prepared, and if the remaining tooth structure is inadequate, there is a risk of exposing the dental pulp.
In such cases, it is recommended to perform root canal treatment before placing the crown.

2.
When placing a crown, it is not necessary to extract the adjacent healthy teeth.

Reply Date: 2017/08/16

More Info

When it comes to dental crowns, especially following a root canal treatment, there are several important considerations to keep in mind. Your concerns about the integrity of your teeth, the potential need for crowns, and the implications of previous dental work are valid and common among patients.

First, let's clarify what a dental crown is. A dental crown is a cap placed over a tooth to restore its shape, size, strength, and appearance. Crowns are often necessary after a root canal because the procedure can leave the tooth more fragile and susceptible to fractures. The tooth structure is significantly reduced during a root canal, and without adequate protection, it can easily break under normal chewing forces.

In your case, since you have experienced multiple fillings and concerns about the structural integrity of your teeth, it is wise to consider a crown. If a tooth has been filled multiple times, especially with materials like silver amalgam or resin, it can weaken over time. The fact that you have noticed black lines or gaps could indicate either recurrent decay or the breakdown of the filling material. This is a common scenario where a crown may be beneficial to provide additional support and prevent further damage.

Regarding your question about whether you need to extract adjacent healthy teeth to place a crown, the answer is no. Crowns are designed to fit over the existing tooth structure without the need to disturb neighboring teeth. However, if the tooth requiring the crown has significant decay or structural loss, it may be necessary to perform a root canal first, especially if the nerve is still alive and causing pain. If the tooth has already undergone a root canal, the crown can be placed directly over it.

As for the timeline, the process of getting a crown typically involves two visits to the dentist. During the first visit, the dentist will prepare the tooth, take impressions, and place a temporary crown. The permanent crown is usually ready within a couple of weeks, at which point you will return to have it fitted and cemented in place. After the crown is placed, you should be able to eat normally without issues, as long as the crown is properly fitted.

If you are experiencing sensitivity or pain, it is crucial to communicate this with your dentist. Sensitivity can sometimes indicate that the nerve is still alive or that there is an underlying issue that needs to be addressed before proceeding with a crown.
In summary, if you are concerned about the structural integrity of your teeth, especially after multiple fillings, discussing the option of crowns with your dentist is a prudent choice. You do not need to extract adjacent healthy teeth, and the process typically involves two visits. Make sure to express all your concerns to your dentist, as they can provide tailored advice based on your specific dental health situation. If you feel rushed during appointments, consider scheduling a longer consultation to ensure all your questions are answered thoroughly.

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