Student can finally eat but can no longer afford food.

November 23, 2008 4:52 PM

Is a crown necessary after having a root canal?

I had a root canal a few days ago and the total cost is about 1500 (originally 1700 but I get 10% if I pay with cash) dollars. This includes the crown and if I don't need one I'd rather not pay for it.

I'm a student and while I COULD pay this entire bill (have about $1600 in savings/checking) I would be left with nothing for the next semester. I probably shouldn't have stupidly said yes to the root canal without waiting for my parents to come with me to the office but I was really shocked and the dentist said it was urgent and I need to have the root canal (not to mention they (parents) were yelling at me and just hung up when I called them back after they told me they'd call me back)...So is a root canal necessary and if it isn't can I tell them I'm choosing not to have the crown??? Its a bicuspid #13 and the crown they want to put in is porcelain. Right now I have a temporary crown.

posted by guniang to health & fitness (17 answers total)

After root canal treatment, the tooth is weak and brittle. It is weak because the center of the tooth was removed to get at the infected nerve; only the sides of the tooth are left for support. And it is more brittle because the nerve and blood supply are gone.

This tooth was not crowned after root canal treatment. There is a tremendous amount of force on the edges of the teeth when they bite together, so it's likely that this tooth will break.

After a tooth breaks, it is much more difficult to repair. Our Houston dentist, Dr. Minh Nguyen, typically recommends a crown to cover and protect a root canaled tooth. The crown helps to prevent it from breaking.

I read this after doing a google search.
posted by JayRwv at 5:05 PM on November 23, 2008

I have a root canal without a crown, but the treatment was conservative enough that composite was enough to rebuild the tooth. If you have a temporary crown, then your dentist has probably removed so much of the tooth that a porcelain crown is necessary.

IANAD, but I've spent a couple hundred hours in dental chairs.
posted by bunnytricks at 5:13 PM on November 23, 2008

can you maybe work out a payment plan with your dentist?
posted by 5_13_23_42_69_666 at 5:23 PM on November 23, 2008

No, they actually wanted the money before I even left the office (why? I dunno I guess they think college kids walk around with 1700/1500 dollars) so I have to go pay them tomorrow.
posted by guniang at 5:26 PM on November 23, 2008

You don't want a partially hollowed out tooth in your head. One, it will get full of food debris. That's what causes cavities. Two, it cannot withstand the pressure of your bite, chewing food, etc. You really need a cover shaped like a tooth--a crown--over it. Get the crown.
posted by FergieBelle at 5:33 PM on November 23, 2008

Temporary crowns are typically made of plastic, and held in place by a temporary cement. They are like spare tires, appropriate for short-term use only. (Note: metal temporaries are hardier and longer-lasting, but still held in place with temporary cement).

As for whether your root canal was necessary, only a dentist or endodontist can make that assessment. Indications for root canal include necrotic or dead nerves, exposed nerves, infections, and traumatized teeth due to accident or injury.

After a root canal, your tooth is "dead." It has been reduced in size and, over time, becomes brittle. Without protection of a permanent crown, it can crack, chip, or break. Worst case scenario: after investing in the root canal, you'd have to get the tooth extracted. And if you later desired to replace it, you'd likely need an implant or bridge, which are more expensive than a crown.
posted by terranova at 5:40 PM on November 23, 2008

This is a sad lesson I recently learned: yes. yes it is necessary. The deal is, when they fill your tooth, they fill it with whatever it is-substance X-and the problem is that when the opposing teeth hit the substance, they jam it slightly inward each time you bite (especially combined with substance Y-- whatever you're eating)--so you're creating pressure laterally, against the sides of the tooth. Combined with the brittleness created by the fact that the tooth is dead, you're creating a circumstance where they might have to yank your tooth if it cracks, and it stands a good chance of doing so.

For my vicarious sanity, please crown your tooth. I haven't, and if you want to mail me, I'll tell you all kinds of horrors about it, but for now, I can't say this strongly enough: SUCK IT UP AND PAY THE MONEY.
posted by A Terrible Llama at 5:42 PM on November 23, 2008

Also, sweetie, I promise you, 1600 dollars is horrifiying right now, but ten years' from now, you'll be so glad you shelled it out. I promise. I promise. I promise.
posted by A Terrible Llama at 5:45 PM on November 23, 2008

Yes, you will need the crown. Will you need it immediately? Depends on how lucky you feel. I've gone for a year or two without a crown over a root-canalled tooth, but on any given day I was one stray nutshell or cherry pit away from losing the tooth entirely.

So yeah, you could do without the crown short-term, but it's risky, and I personally wouldn't feel comfortable recommending it to anyone else. Ultimately, it's your decision.
posted by gimonca at 5:47 PM on November 23, 2008

One other minor aspect: sometimes uncrowned root-canalled teeth can look awful.
posted by gimonca at 5:53 PM on November 23, 2008

What they said: you're in far enough that you can't stop now. You already have a crown, and if you have a temporary I assume that the permanent crown is already being made at the lab.

(They want you to pay before you leave for the same reason a car garage or Wal-Mart wants you to pay before you leave.)
posted by mendel at 6:14 PM on November 23, 2008

I'd suggest really trying to get them to agree to a payment plan. If the temp is metal, you could leave it on for a while, but they're called temporaries for a reason. If you decide to keep the temporary on and wait to get the crown, which is done fairly often, just make sure you do it ASAP and that you don't start thinking, "Eh, this is fine. I'll just leave this on". That would be a mistake. You'd end up with bigger and more expensive problems in the long run.
posted by FlyByDay at 6:28 PM on November 23, 2008

Is a crown necessary after having a root canal?

It depends on the tooth.

There are many who will say "yes" blindly to this question, but it just ain't so. While the odds are higher than not, it's not a 100% all-the-way yes. Further, you don't always need a crown right away. I had a root canal and my dentist advised not having a canal in order to see how the tooth shifted around. A year later, I got the crown with no rush necessary.

It's worth noting that there are a lot of different filling materials used nowadays as well as slightly different techniques in doing root canals. Only a fully trained dentist can make the call. Some fillings will provide enough strength that a crown would add very little benefit. After all, the tooth has to be shaped down in order to fit a crown on top, which could ultimately weaken the underlying tooth further.
posted by wackybrit at 6:50 PM on November 23, 2008

Mendel, I told them I didn't have the the 1500 BEFORE the procedure, and after the procedure we talked more about the payment when the secretary brought up the fact that a payment plan wasn't even possible because I'm actually supposed to pay rightatthisminute instead of letting me go and get my money and pay the next day.

Thanks everyone, my teeth and I are forever grateful.
posted by guniang at 6:53 PM on November 23, 2008

I have two crowns and both have come off several times over the past 10 years. One of the crowns was poorly made and the porcelain has cracked and chipped away. The dentist who put it in told me there is a 5-year maximum warranty on crowns from the lab she gets them from. Since it's been more than five years since I had the root canal and crown put in, if I want this crown replaced then I must fork over the money again.

You may be able to find a dentist who can mold and order a crown for you for less than what your dentist is asking. Check around for local dental schools and see if they'd be willing to help out a poor student.
posted by camworld at 7:45 PM on November 23, 2008 [1 favorite]

I had to get a lot of dental work done over the summer, and I financed it through capital one (which was recommended by my dentist). They were able to approve me over the phone at the dentist's office. I'm surprised your dentist doesn't offer anything like that.

For what it's worth, I was pleased with the Capital One loan. I opted for the no-interest-but-if-you-miss-a-payment-we'll-screw-you-with-back-interest loans, but they offered some standard loans with rates as low as 2%. Here's a link

I have no affiliation with CapitalOne other than being a happy customer
posted by chndrcks at 7:46 PM on November 23, 2008 [1 favorite]

Whatever you decide to do about the crown, I think you should find a new dentist. Those people sound like jerks.
posted by ottereroticist at 8:33 PM on November 23, 2008 [1 favorite]