Is this really just a totally routine and normal procedure I am overthinking?

November 6, 2012 6:40 PM

Trying to figure out if/when I should get a dental crown replaced.

As a child I fell off my bike and one of my top front teeth broke. I had a dental crown which has felt fine/no problems for over 10 years. Today, I had a lengthy diagnostic appointment at a school of dental medicine, as I have insurance through the affiliated university. They told me that the top of the crown was separating slightly and was getting soft and that I needed to get it replaced. They proceeded with setting up appointments and I sort of went along with it, but am now having second thoughts.

I have never had any kind of pain or infection near the crown, and I have good oral hygiene. I don't have a good sense of how long a crown is supposed to last. My insurance covers 100% of all preventative and minor restorative procedures (like fillings), and 60% of major procedures like this crown. My dentist was also pushing for me to get the crown done in Nov/Dec, because I have a certain maximum amount of benefits each calendar year.

I feel like this is happening very fast - my next appointment is on Friday, which I am supposed to confirm tomorrow. I thought about getting a second opinion as to whether this procedure was necessary, but I don't know if that is kosher at a school of dental medicine. I sort of feel like waiting a while to get the crown done because I feel unsure about things, but of course understand the benefits of getting it done this year in case something catastrophic happens next year. So, any thoughts about whether this is something I should just proceed with? Or information on the longevity of dental crowns?

posted by leedly to health & fitness (5 answers total)

Not a dentist. Crowns last 10-15 years or so from what I've been told, and from my own experience. Cleveland Clinic says 5-15 years.

20 years ago I got crowns on 4 teeth (bad dental hygiene as a kid) and they are being replaced one by one over time as they wear out, or fall off, or fail in some other way. The first replacement was around the 12 year mark, then one at around 17 years, and now I am getting the third replaced because it fell off and I have extra FSA money to use anyway. That said, if I didn't want to do it now my dentist would have just cemented it back on.

If there is a gap at the gumline now where there wasn't before (which can happen with age, even with great dental hygiene) then the danger is that decay will form and the tooth could eventually fail.

All of this is to say, if it were me I would replace it because I wouldn't want to run the chance of the tooth breaking off or needing a root canal (if your tooth is still "live"). However, you shouldn't let them pressure you into it. Get the second opinion.
posted by cabingirl at 7:10 PM on November 6, 2012

I would ask the dentist to explain to you exactly what is going on. The dentists at a dental school? They're nerdy! They like to tell people how things work!

What's supposed to happen at the next appointment, do you know? You might be able to get a quick second opinion consult from another dentist at the dental school, if that would make you feel better (I understand if you want to go outside the school, too, but in my experience the dental school dentists were, if anything, more conservative about recommending interventions than private dentists).

(Also, is this BU Dental? If so, seriously, ask, everyone was always super nice about explaining everything to me when I used to go there.)
posted by mskyle at 7:35 PM on November 6, 2012

Your crown is probably 'past its pull date'. Under your crown is the remnant of your natural tooth. If the adhesive holding the crown on fails, the tooth will be unprotected and virtually un-cleanable. It may get infected and abscess. This is not something you want to happen.
posted by Cranberry at 11:20 PM on November 6, 2012 [1 favorite]

I had 4 crowns done about 10 years ago. I just got one replaced a few weeks ago, because it had started failing at the top, and some decay had crept in around the side - then made its way inside. The other 3 crowns looks fine, so it can happen. Replacing a crown is no big deal. In my case, because there was decay underneath, my dentist did need to do some minimal drilling (very minimal), then took an imprint of my tooth stub to get the new crown made, then made a temporary crown out of that gooey white stuff. Done in about an hour, back a week later to get the final crown fitted.

That said, why not get a second opinion? Crowns are expensive.
posted by Joh at 10:00 AM on November 7, 2012

*I am not a dentist but I play one on TV.
First of all, your question is completely legitimate because people get railroaded into unnecessary dental treatments all the time.

Assuming that you already had the root canal when the crown was originally done, you're not going to feel any pain from that tooth, nor would you have an infection necessarily.

Can you clarify what you mean by "getting soft"? That verbiage instantly makes me think that they were finding decay under the crown. Replacement of the crown in that circumstance would also mean cleaning out the decay.

If you don't replace the crown and you've got the decay under there, the decay will progress until either a carious pulp exposure (which wouldn't be an issue for you if you had a root canal when the crown was originally done), or the whole crown just breaking off completely.

The added risk of this latter scenario is that if the decay has been very extensive underneath the crown, it might reduce the available tooth structure for the new crown prep -- i.e., they clean out the decay, and find so much of the tooth is gone that there's nothing left for the new crown to grab onto. Sometimes the decay can be so extensive that the tooth just isn't salvageable and must be extracted. Or, the treatment option can be crown lengthening, a periodontal surgical procedure which involves pushing back a section of the gum in order to expose subgingival tooth structure, and use that for the crown prep. You could be looking at thousands of dollars between the crown lengthening and new crown, which would definitely max out your insurance and leave you with a huge copayment.
posted by overeducated_alligator at 12:26 PM on November 7, 2012