Papa Needs a Brand New Crown

May 6, 2009 9:39 AM

Dental filter: I just visited a dentist who told me that I chipped one of my molars and that I'd need a crown for it. He said that since I'm not really having pain associated with it (it's a little sensitive, but that's it) I don't need to have a root canal. Is getting a crown instead of a root canal wise?

He said that it's possible I may need to get a root canal down the line, but after looking at my x-ray and talking to me about pain, that it wasn't necessary at this point. He said if I had come in complaining about pain that he would have recommended the root canal first. Of course, now the affected molar is piping up with a song that sounds suspiciously like pain.

I don't have dental insurance, and while paying for crown and root canal (both ~ $1,200 each) over an extended period would be possible, it would also be painful (I'm moving in a month and a half to a place where I currently have no prospect of getting a job with any dental benefits).

Is this a common procedure, the crown without the canal? I know you are not dentists, not my dentist, etc., but I'm searching for similar stories and helpful wisdom. I thank you, my molar thanks you, my softly aching jaw thanks you.

posted by theefixedstars to health & fitness (11 answers total)

I had a crown in a similar situation. Three years later the pulp died, and I had to have a root canal. This was done by drilling a hole through the crown, which my dentist later fixed.

I have had another crown for about 10 years. It has never required any additional work. And, no, I didn't get a root canal.
posted by Midnight Skulker at 9:45 AM on May 6, 2009

I have a couple of teeth with crowns but without a root canal, they were mostly done for structural reasons (e.g. cracks). Root canals are done because of infection or other internal damage to the tooth that could result in the tooth being lost from the jaw. Although it's common for a tooth that requires a root canal to be in such bad shape that a crown is also necessary, it's not a given.
posted by tommasz at 9:49 AM on May 6, 2009

A root canal removes the nerve from the tooth. The open space then gets filled with something permanent. The crown just replaces missing tooth matter that covers the root. It is what you get when the damage is bigger than what a filling can cover. If you root is not damaged or infected, maybe you can get away with just a crown. If you have to get a root canal later, you'll probably end up with a new crown.

You might want to get a second opinion on the root canal issue and determine if it really is necessary or not.

If you ever get a root canal, get it from someone who does these all the time. I have had two root canals. One was done by a regular dentist. It was two hours of suck followed by an infection and repeat performance. The second was done by a specialist. It was 15 minutes of suck. No infection followed. No need to do more than to fill the root area in. YMMV.

Anticipate multiple visits before all the work is done.
posted by onhazier at 9:51 AM on May 6, 2009

I've got two crowns that I've had for more than 20 years. No problems. (And no root canal.)
posted by Chocolate Pickle at 9:57 AM on May 6, 2009

I'd go get a second opinion. The same thing happened to my partner and she paid for a nice crown. About 8 months later, she needed a root canal and a new crown. Who knows if your crack is small enough for just a crown or if the root canal is imminent. Depending on your financial position and insurance, if the root canal and crown is going to be needed sooner rather than later, you might just go for that option now.
posted by barnone at 10:03 AM on May 6, 2009

BTW, a root canal does not hurt during the procedure, nor should it hurt when all is said and done.
posted by cahlers at 10:06 AM on May 6, 2009

Crowns without root canals are common. I have several crowns and no root canal. Don't ask for a root canal if you don't need one.
posted by Ery at 10:38 AM on May 6, 2009

IAAD. There are several factors to consider in deciding whether or not you need a root canal. One factor is whether your tooth is sensitive to cold only and the pain does not linger. In this case you have what is called a reversible pulpitis (inflammation of the pulp) and you may be able to get away with not having root canal therapy as the pulpitis can subside after the decay is removed. If the tooth is sensitive to heat and the pain lingers after the heat source is removed, then you have an irreversible pulpitis and root canal therapy (RCT) would be indicated. If the pain only occurs while eating, then the pulp is probably normal and just responding to the stimulation of chewing. Other factors that are looked at are, do you have a periapical radiolucency at the tip of one of your roots? Is there an abscess on the gum?

Of course, IANYD and I can't see your X-rays (radiographs). My recommendation would be that you get a 2nd opinion from an endodontist (a root canal specialist); they can perform certain tests on your tooth to determine whether the pulpitis is reversible or whether the pulp is indeed necrotic (dead, thus needing RCT).

As to whether you need a crown, yes, if there is a large enough decay where the hole that is left after removal of decay is too large to hold a filling, then a crown is indicated. Needing a crown doesn't necessarily mean you need RCT. But your complaint of pain raises concerns that RCT may be indicated, thus the recommendation to get a 2nd opinion.

As to whether a root canal hurts, frequently the procedure is painless minus the injection of local anesthesia (I've had RCT without pain) but IF there has been an ongoing infection then it can sometimes be difficult to numb the tooth sufficiently, and afterward, the tissue around the tooth may be sensitive as well.

Hope it helps.
posted by choochoo at 10:40 AM on May 6, 2009 [1 favorite]

Yes, crowns without a root canal are common. Occasionally you may find that you later need a root canal. In that case they drill a hole in the crown to do the root canal and then fill it back up. You usually don't need a new crown. So it isn't mandatory to do a root canal first.

Teeth are not inanimate objects. They have micropores which are nourished by the nerve and blood vessels. If you have a root canal, that nourishment is stopped and the tooth becomes more brittle over time. It is best not to have a root canal if it is not necessary.

If you do need to have a root canal, I second the recommendation that you get a referral from your regular dentist to go to an endodontist who specializes in root canals. You want someone who does root canals all day long, not just an occasional procedure.
posted by JackFlash at 1:11 PM on May 6, 2009

Same here, have both RC and non RC crowns.

You did not ask, but $1,200 each sounds like too much. I had a root canal + crown three months ago, the root canal done by an endodontist with very good reputation, and it cost $800 each. This is in San Francisco. This would be another reason to get a second opinion.
posted by dirty lies at 2:08 PM on May 6, 2009

I just want to point out one thing: if you are moving in a month and a half and losing your insurance, you need to start the process ASAP. It took me a month and a half to get all of the crap done for my root canal + crown, especially since they want to have a week or two or more "off" in between each step. Maybe if you're only getting the crown it won't take so long, but you're really going to need to hurry this up at any rate.
posted by jenfullmoon at 4:08 PM on May 6, 2009