Wednesday, January 22, 2014

What is a Dental Crown and Why Are We Getting One ?

(Photo:   Dr. Jeffrey Krantz )

       I have been fairly lucky in my life from a dental standpoint.   I did have braces when a young teen. I had all of my wisdom teeth surgically extracted when fairly young.  I had the extraction of four secondary teeth and two baby teeth as a teen, because my orthodontist assured me that I had a very small mouth, and inadequate space for so many fairly large teeth.  I have had my share of dental fillings, particularly in back teeth.

              A dental filling, whether amalgam (the ones which are silver in appearance) or polymer (the ones that appear white after the filling) are still a time limited proposition.   A filling is a repair, and some of them last a great many years, but generally from the time a tooth is filled, there is an incomplete barrier, and decay can form in and around the filling itself and necessitate a periodic drilling and removal of that filling, or cause the need for a more drastic and expensive intervention. This is why we are told to report every six months, so that more conservative interventions can be taken before restoration becomes a more expensive and a more arduous task for all of us.

              I have always had a pretty strong gag reflex and I don't much enjoy anyone poking around in my mouth.  In my twenties,  I had three of my four biological children and therefore I spent 36 months or so, pregnant with them.  While I was pregnant, my gag reflex and salivation were in absolute overdrive.  In the second pregnancy I simply decided that dental care would have to wait until afterward.   This fact and the hyperemesis gravidarum I endured during the first pregnancy resulted in some damage and decay to my top molars closest to the back of my mouth. I remember the dentist saying, as if it were yesterday, "I have filled both of these with a deep sedative filling and I lined them with calcium hydroxide.  It will either work, or you will lose both of those teeth."   I was quite pleased when those teeth did not bother me, and successive dentists simply ignored them.  Twenty-five years later, one of them began to ache. It ultimately split and the only reasonable alternative became extraction.  The following Spring, the identical thing happened to the one on the other side. 

            Now, thirty years after those initial fillings, I am losing back teeth to extraction.   This week, one of my filled molars broke a small bit, and so I made an immediate dental appointment.  My dentist saw me Saturday.  I had hoped that she could simply fill the broken region as the original filling was still intact.  She told me that in order to save this tooth, she needed to place a crown over the tooth.  I remember paying for crowns for two of my sons, and the process didn't seem too bad.  Their molars seem perfect now.   My dentist now takes days off during the week when the fewest people turn up, but she comes in for four hours or so, on Saturdays and on Sundays if someone needs something.

          So I saw the dentist yesterday, and today I was the first patient as we began the process of my molar getting a crown.

This is an inside view of two crowns.  This photo came from  This is an excellent website for information on the types of crown available today.

         What is a Crown ?        A crown is exactly as it sounds.  The damage or decay from a tooth is drilled away, and the surface is readied for a tooth to be fitted and "glued" over the peg which remains.   Usually, the initial crown is a temporary one while the permanent one is constructed using a dental impression which the dentist obtained during the initial crowning visit.  After the crown is intact, ALL of the tooth concerned is covered.   This is also done sometimes in order to preserve a tooth which has a large filling.   This is a fairly expensive procedure, and this might be why this was not offered to me when I started to have quite a few back teeth with larger and larger fillings, as the initial fillings aged and required drilling out and replacement.

What Material Is Used to Make a Crown ?      A crown can be made from a number of substances.  Sometimes a white polymer is used, particularly on a temporary crown.    Sometimes ceramic is used to formulate a permanent crown.   Sometimes gold is used.   Silver and palladium are also used.  Often, a dental crown consists of ceramic AND a precious metal of some kind.

How Long Does a Crown Last ?     Dentists quote that a crown will last ten years.  In reality, crowns can last as many as fifty years, or the remainder of the patient's lifespan.  Most dental insurances, if you have this, will pay for crown replacement after only five years. Of course, I have never had dental insurance, and so I pay for all of it.

       Things to remember about a crown.

1. They ARE costly, but they can result in a long term fix for the tooth in question.
2. Typically, there are at least two dental visits for such a procedure.
3. A fair amount of the tooth is removed in order to use dental cement to bond the crown to the remaining tooth.  Of course such removal is permanent.

Rendering from:

                 The above rendering demonstrates that the original tooth is amended to a peg of a variety of shapes, and a customized tooth crown which today, normally covers the entire remaining peg is cemented in place.   In order to get a customized tooth, during the first visit and impression of your tooth, that side of your mouth or your entire mouth is taken.  Often a dental lab off premises constructs the customized crown for your dentist to affix later.


BBC said...

I always hated my teeth and they always hated me, spent tons of money on them over the years but ended up making them pull all of them about five years ago, and I damn sure don't miss them.

But before that, back in the 80's I chipped a front tooth on a cat track when a wrench slipped. No dentist in town wanted to fix it on a state industrial claim, except an old drunk that had managed to get his licence back, he said he figured it would last me about ten years.

That was the only damn tooth in my mouth that didn't give me any trouble over the years after that, it was still in good shape when I made them pull it, go figure.

lotta joy said...

I have a problem being told my tooth must be ground away, in order to "save" the tooth. But I've had it three times. Once in Indiana, where I paid $1,080 for a gold back tooth. Last year the price of gold went up, and a gold crown in Florida is now over $3,000. I have huge mercury fillings that my Indiana dentist used to patch up for me since he knew I wasn't rich. Down here, two crowns went in before I could yelp. Now I've cracked two back teeth because they're mostly mercury fillings, but I'm staying away from the dentist.

Linda said...

I am afraid I am heading toward crowns. I suppose that getting to 67 without crowns is a feat since my daughter has several.

JaneofVirginia said...

Interesting that all the literature says we need our teeth to eat properly and retain our health. However, anecdotally, I have met a number of people who are toothless and who eat quite well and are actually in better shape than they were with constant infections from decayed teeth.

JaneofVirginia said...

The problem with leaving them is that molars especially become a breeding ground for bacterial infection which migrates to the heart. A friend lost her son in his thirties about five years ago to a cardiac infection from an abscessed tooth. There are silver and palladium lined ceramic crowns which are cheaper than gold. Also, gold has come DOWN now. It's a good time to buy all of these precious metals in one way or another.

JaneofVirginia said...

Yes, it is, Linda. I probably should have had a few, but I spent it on my kid's dental instead.

BBC said...

We don't eat raw meat anymore, dentists just want us to keep our teeth so they can make big bucks for nice homes and toys and vacations. If they really cared about your teeth they wouldn't charge so much to fix them.

JaneofVirginia said...

Some of them do the job for a very modest profit. It takes time to look for a good dentist who isn't part of a "horse and pony show". Of course, the fewer dentists there are in a region, the harder it is to find one who is satisfied with a modest profit or who doesn't have a couple of hundred thousand in dental school debt and debts to start a practice.
My original dentist in Virginia worked on oil wells in Texas to finance his dental school expenses. He came to practice with less debt and with more of an understanding of the common man. He could be counted upon to tell the truth even when others didn't want to hear it. He is a dental school professor now.

BBC said...

I have an old hand grinder with a 'butter' attachment. So I can still enjoy nuts and such, and I just grind up tough meats to make sandwich spreads with. I have fewer health problems since getting rid of my teeth. I have dentures but I don't like them.

WordsPoeticallyWorth said...

I hate a visit to the dentist! Gives me shivers. A nice article well written. Good luck to you and your teeth!

Thank you. Love love, Andrew. Bye.

JaneofVirginia said...

Thank you Andrew, Today in the extreme cold while spending three hours changing and then rechanging horse, alpaca, chicken and ducks waters, the subject tooth aches !
I don't like dental visits either !

JaneofVirginia said...

I hear this more and more. My father would not allow the dentist to make him implants, so he had a bridge. He couldn't stand to wear it, and so he simply maintained his front teeth and ground things that were difficult to chew in order to be sure to receive all the vitamins and minerals he needed. This strategy lasted him the rest of his life.

BBC said...

What did you think of Obama’s speech? I think that monkey is a fine speaker, and a fine dreamer, and a fine bullshitter.

JaneofVirginia said...

I tried to watch it, and I found it difficult to allow him the respect due the office of the POTUS demands. Then, I changed the channel and watched MHz network and watched an Italian TV series. Anything was better than listening to the delusions of an administration that has failed in everything it has tried to do while digging us deeper into debt.

Jennifer Frank said...

Thank you for giving a detailed explanation about dental crowns. My dentist in Chandler that I should get a dental crown, but I told him I'd give it more thought. I'm not a big fan of dental check-up, hence the infected tooth, but reading your experience made me realize that there's nothing to be scared of dental procedures. It's different when a doctor explains a procedure; you can't help but think irrationally. Yikes. Anyway, thank you.

JaneofVirginia said...

Anytime, Jennifer. I am not fond of the dentist's chair myself. However I have found someone gentle who keeps the pearlies white, clean and chomping on apples, lettuce, and veggies !

Dorothy Gonzalez said...

I had my dental crown treatment because I lose a tooth and I hate it. Missing tooth gives me shyness in facing anyone. I can’t smile freely because of it. I thought dental crown is expensive but I’m shocked when offers me a dental crown package that is very affordable of my budget. I get it and now I boost again my self confidence. Smiling is my asset now hahahaha I think. Anyway, you have a very nice blog, informative! Keep on blogging Jane.

JaneofVirginia said...

Thanks for posting, Dorothy. I do not normally include ads for anything I have not personally used, but I am including this in the event that this helps someone. Glad you found a solution. Keep smiling.

Stacey Beck said...

I was just told that I am most likely going to have to get a crown so of course I'm going to run home and start doing research on it. I have heard the term before but didn't know what it was exactly. Hopefully it won't be too painful!

JaneofVirginia said...

I have only ever had one, but although it was time consuming, and I don't think having dental work is ever enjoyable, it did not involve discomfort on the order of an extraction. Best wishes.

Rcik Soordhar said...

Key Benefits of Dental Crowns:
*Replaces missing teeth
*Offers support to misshapen teeth or badly broken teeth
*Looks completely natural
Fixes “smile” and functional chewing problems