Everybody should be asking the same question. If a crown or cap (they are same thing) is not my real tooth, how could I get a cavity? This is really a good question as the term “decay” in the biological world refers to living tissue. By the way the words “decay” and “cavity” have the same meaning in dentistry. So, if a dental cavity can only happen on living tissue, how can my artificial tooth develop a cavity? It sounds impossible and actually it is.
What typically happens is that due to years of chewing on a crown, some materials, usually metal, can get so thin that they actually develop a hole. Once the artificial tooth, the crown or cap, develops a hole, bacteria can invade the actual living tooth underneath it and create a cavity on the living tooth. In fact decay on the underneath tooth is most common reason that we replace crowns or bridges (made up of multiple crowns). Bacteria attack and wreak havoc on the tooth tissue, not on artificial metal or porcelain.
So let’s get back to our story. What happened with this patient was such extensive decay that when the dentist tried to simply fill the hole, discomfort developed and the tooth then needed a root canal. The root canal was done right through the crown. Now when a replacement filling was done after the root canal into the crown, the bite was no longer even and caused issues with the patient.
What should have happened is the following. Whenever a hole is found on a crown, the entire crown should be removed and the underlying tooth checked and evaluated. If the decay is minimal, then cleaning it up and making a new crown is all that is needed. If the decay is extensive, then the possibility exists for a root canal procedure to be performed. This needs to be done before the crown is redone. That’s exactly what I did. I removed his crown and the rest of the bridge that was attached to it. I then balanced the bite and made him a provisional bridge to evaluate our progress and technique.
We call crowns “permanent”, because you can’t take them off and we have no intention of removing them. Permanent does mean forever. It is used to convey the idea of firmly attaching or gluing it to the tooth underneath. Crowns will last for many years and even a decade or two, but if you are blessed sufficiently to live long enough, you probably need your crown replaced due to a cavity or glue washing out due to acid and enzymes in your mouth.
This thought underscores the need for a periodic checkup and cleaning. During this time we look at the condition of your existing fillings, crowns, bridges, partial dentures or even full dentures. We can spot signs of wear or breakdown and advise replacement while it is still an easy procedure. If you have any questions about any of your existing work, please feel free to call me at 440.951.7856 and allow me to advise you on the correct approach for your situation.
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