Archives for April 2021

My dentist doesn’t know what to do for my cracked tooth

Posted on April 30, 2021 by AllSmiles.

One of my right lower molars has a filling in it. The tooth cracked last Friday, but my dentist’s office is closed on Friday. I found an appointment with another dentist to look at it and see if anything needed to be done to save it. The dentist said it didn’t look like I would lose it, so I followed up with my dentist on Monday. My dentist then referred me to an endodontist who suggested that I get the filling replaced with a crown. My dentist wanted the endodontist to remove the filling to see the depth of the crack. When I returned to my dentist, he tried to mend the crack. Now the tooth is very sensitive. My dentist does not want to put a crown over the tooth. I suggested that he refer me to another endodontist. My dentist seems a little clueless, but maybe because he is young and in a big practice. Anyway, should I go with a crown or see another specialist? – Thank you. Clay from MS

Clay,

Dr. Perry would need to examine and x-ray your tooth for an accurate diagnosis. Cracks in teeth can be tricky, but we will provide some insight. You were wise to see a dentist right away to ensure your tooth was stable enough to see your regular dentist.

Types of Cracks in Teeth

Cracks in teeth have varying degrees of severity. But cracks differ from fractures. When tooth pieces move independently, the tooth is fractured.

Types of tooth cracks

Superficial crack in the enamel
Deep crack beneath the enamel
Crack into the tooth pulp
And tooth cracks can vary in location and can be vertical or horizontal.

Restoring a Cracked Tooth

There are different ways to protect your tooth depending on the extent of the crack. But if your tooth is sensitive, it may be infected. Your dentist or an endodontist will need to determine if root canal treatment is required.

Porcelain onlay – An onlay is a custom-made restoration that covers a portion of a tooth. If you have a horizontal crack on just one cusp, or peak, of your tooth, an onlay can cover it. But an onlay is not strong enough to stabilize a vertical crack.
Gold onlay – Gold is durable, and a gold onlay can cover the entire chewing surface of a tooth to protect it.
Dental crown – It will cover and protect the entire tooth.

Consider Getting a Second Opinion

Your dentist and the endodontist disagree on which treatment is best for your tooth. Consider getting a second opinion from another dentist. You can also ask your dentist for a referral to another endodontist for a second opinion.

Ryan Perry, DDS of Baton Rouge, sponsors this post.

Does a root canal tooth always need a crown?

Posted on April 14, 2021 by AllSmiles.

I had an emergency dental appointment for a toothache on my top right first molar. The dentist scheduled a root canal for me. But he also looked at my left incisor and noticed that the tooth was a little dark. I told him that I had a root canal on that tooth in 1986. The only reason I remember the year is because it was a month before I got married. The dentist recommended doing a dental crown on that tooth to prevent it from breaking. I do not feel any tooth pain. Is a dental crown necessary? – Karson from GA

Karson,

Thank you for submitting your question to our office.

Whenever you have a lingering toothache, it is wise to see a dentist promptly. But do not agree to let the dentist complete cosmetic work without verifying if he or she has advanced cosmetic dentistry training.

Although root canal treatment can make a tooth weak and at risk for breaking, not every dentist automatically places a crown over the tooth. But the condition and location of a tooth can determine if it is wise to get a crown.

Stress on Molar Teeth

The stress on molar pushes the four cusps—or peaks in the biting surface—apart. Premolars have two cusps. And stress can cause them to split also.

Stress on Front Teeth

Front teeth are subject to horizontal stress. Canine teeth have long roots to absorb some of the lateral pressure on back teeth. When you chew and grind food with your back teeth, the canine tooth forces the back teeth apart to relieve stress.

Protecting a Root Canal Tooth

Back tooth – A dentist can protect a back root canal tooth from fracture by covering it with a dental crown or an onlay. An onlay covers a tooth’s chewing surface and at least one cusp, or tooth point.
Front tooth – Although root canal treatment weakens a front tooth, preparing it for a dental crown will further weaken it. A dentist prepares a tooth for a crown by removing about one millimeter of tooth structure on every side of the crown. A tooth can be left with 50% or less of its initial fracture resistance.

When little healthy tooth structure is left, a dentist may use a crown to protect a front tooth. Otherwise, a crown will only weaken the tooth.

Some advanced cosmetic dentists use this technique:

Clean out the crown of the tooth, removing root canal filler material and cement
Insert a flexible fiberglass post deep into the tooth
Cement the post
Fill the tooth with durable composite
Bond a custom porcelain veneer to the front of the tooth

We recommend scheduling a consultation with a cosmetic dentist to examine your tooth and explain your options.

Ryan Perry, DDS of Baton Rouge, sponsors this post.