Is a root canal necessary before a crown?
February 5, 2013 6:41 PM   Subscribe

So, I cracked one of my lower molars and it now needs to be crowned. My dentist is planning to perform a root canal on the tooth before crowning it, but I'm not sure if it is necessary.

At my last visit, the old filling was removed to assess the damage and a temporary filling was put in place. She told me that I could decide whether or not to do the root canal based on the level of sensitivity I felt with the temporary filling. The tooth doesn't seem to be sensitive to temperature, but there is a tiny bit of dull pain if I bite down fairly hard on the affected tooth. There wasn't much if any pain before the filling was removed, so I am tempted to attribute this new pain to the temporary filling. I'm willing to accept a small amount of permanent pain if necessary.

My only goal is to maximize the longevity of this tooth, and I am not concerned with costs, i.e. I would be willing to pay for a new crown and root canal if this tooth took a turn for the worse at a later date. I guess my two main concerns are:
1. A root canal will shorten the lifespan of the tooth.
2. Having to perform a root canal at a later date, either through the crown or by removing the crown, may increase the likelihood of breaking and therefore losing the tooth. I know that root canal can be performed through the crown, but my experience with fillings is that they tend to leak after several years and the roots would be susceptible to decay.

Super thanks!
posted by defreckled to Health & Fitness (12 answers total)
I had a few crowns with no root canal. I had one tooth that was still sensitive (only upon biting) after my dentist prepared the crown, and we waited several months to see if the sensitivity would subside (put the crown on temporarily in the meantime) - it didn't and in fact got worse. I finally got a root canal and the problem was solved! Get the root canal now while it's easier.
posted by analog at 7:10 PM on February 5, 2013

I am not a dentist. I can only give you my experience. I have three crowns, all on molars and all three had root canal before putting on the crown. They have lasted at least 25 years each.

Prior to getting the root canals, I asked a relative who is a dentist the same question, is it necessary or appropriate to get the root canal when putting on a crown and his answer was, "I would view that on a tooth by tooth basis. No general rule, but more often than not yes." This was between 25 and 30 years ago.
posted by JohnnyGunn at 7:16 PM on February 5, 2013

Yea, I just had a crown put in for a broken mollar (pretty big break too), and I didn't get a root canal. My dentist wasn't sure if I'd need one or not while we waited for my braces to come off, but he said "most likely". When it was finally time to prep the tooth for the crown he said there was no need for a root canal after all. Probably a tooth by tooth case. Get a second opinion?
posted by carmel at 7:17 PM on February 5, 2013

I have had a crown without a root canal, with no further problems.

Given the $$ involved, I'd get a second opinion if I were you.
posted by Salamander at 7:31 PM on February 5, 2013

Even if you get a crown and later need a root canal, all is not lost. Often they can drill a hole in the top of the crown, do the root canal, and then fill it back up, saving the crown.
posted by JackFlash at 7:50 PM on February 5, 2013 [1 favorite]

My prediction is that if you are experiencing spontaneous pain for more than 15-20 seconds at a time then you should plan on having a RCT done before the crown. That said its impossible to give meaningful advice over the internet.

Seek a referral to an endodontist for the second opinion on the RCT.
posted by Under the Sea at 7:56 PM on February 5, 2013

I have two crowns. One was done on a severely damaged tooth that required a root canal, and the other was done on a tooth that did not need a root canal. Would definitely see an endodontist to make sure (because they have all sorts of nifty ways to see what that tooth really needs). Your dentist is probably right about the root canal (and in my experience, it was the easiest dental procedure I've been through, very comfortable), but I saw an endodontist before my last scheduled root canal, and discovered it wasn't necessary.
posted by Happydaz at 8:26 PM on February 5, 2013

My experience has been two crowns, both of which needed root canals afterwards. Of course, YMMV. Also, the root canal thing is actually not a horrible experience (and if you're in pain it can actually be quite a relief.) If you have the root canal, have it done at an endodontist. That's pretty much all they do, and they try to make it as easy as possible.
posted by azpenguin at 9:14 PM on February 5, 2013

I have several crowns, and root canals. My dentist and I have come to an agreement whereby I will get the crown, and then he affixes it using "temporary cement". This way if it turns out after a few weeks that I do need a root canal, its easy to remove the crown prior to the root canal and save it. Note that the temporary cement is amazingly strong. I have one crown that is still affixed with temporary cement 2.5 years later. And yes, I do need a root canal on that tooth, but I am a total dental chicken of the procrastinating kind. Root canals are not that bad though.
posted by Joh at 9:18 PM on February 5, 2013

Yeah, you do not need a root canal with every crown. You only need one if the root pulp has been compromised. Get a second opinion, and get it at a dentist in a neighborhood that's lower income. You'll usually get better quotes, and better service, in my experience, at a place that's not in an upper/upper middle class area.

And dont equate price/nice office with service. I had a dentist in a good area here in Atlanta botch a root canal on me, and then botch the crown after the fact. I went to a dentist further away from home, and had infinitely better service even if the walls were that frightening color that white paint turns after 20 years.
posted by strixus at 11:24 PM on February 5, 2013 [1 favorite]

Best answer: What Joh has described is the most common way I deal with a tooth that doesn't have the clinical signs necessary to warrant an endo (root canal). Preparing the tooth for the crown and ruling out a crack or decay that exposes the pulp (nerve, blood vessels etc) and placing a temporary crown with a medicated cement gives the first idea of whether the tooth will recover.

Sometimes all symptoms disappear, sometimes they fade but plateau, sometimes they persist or worsen. the next step might be dictated by this, or we might place the permanent crown on temporarily and see what happens then.

I try not to put the final crown on permanently if there are symptoms, but sometimes, even when the tooth is calm and fine for a time, root canal is necessary later down the road.

the pulp of the tooth is a strange beast that way, but its presence or absence should not greatly alter the longevity of your tooth.

have a conversation with your dentist, and if you understand what she is trying to accomplish and why, then proceed, if not a second opinion wouldn't hurt.
posted by OHenryPacey at 12:13 AM on February 6, 2013

Get a second opinion. I was once told I needed a root canal and a crown, but after seeking a second opinion, I ended up with a filling instead---the second dentist felt there was just enough living tooth left to put in a filling, and five years later that filling is doing fine.
posted by qxntpqbbbqxl at 7:37 AM on February 6, 2013

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