What Problems Could Develop with a Dental Crown?
What do I need to look out for after getting a dental crown?
Table of Contents
Written by NoFrills Dental
This dental article has been curated by the clinical team @ NoFrills Dental 🙂
September 16, 2021
Understanding: Dental Crowns
Having broken down and fragmented teeth can look unsightly, feel unpleasant and severely impact your functional capacity to chew food and speak. Dental crowns and bridges are treatment options used to restore single or multiple teeth that are damaged or lost and are recommended by all dentists in the hope of increasing the tooth’s longevity and optimizing patient’s oral health.
Let’s Save Your Teeth!
One huge advantage of fixed prosthodontics (i.e. dental crowns and bridges) is its high tensile strength. This is the ‘maximum load that a material can support without fracture when a force is exerted’ [1]. It has the potential to transform an unattractive, non-harmonious occlusion into a comfortable, attractive and ideal occlusion.
What is a Dental Crown?
Crowns are fixed restorations placed on all surfaces of the ‘head’ of the tooth. They replace the outer part of the tooth and are primarily used to preserve the integrity of an extensively restored or broken-down tooth.
Crowns are essentially like ‘caps’ placed over your teeth like a helmet. The decision to provide a crown for a patient very much depends on his/her oral and general health, motivations, periodontal conditions, and oral hygiene. It is important for the dentist to assist the patient in evaluating whether the long-term benefits and clinical advantages of crowns should justify such treatment and outweigh their disadvantages. If the patient does not have the right oral environment or the self-motivation to maintain his/her crowns, problems can arise.
In this article we outline 5 big potential issues that can develop if you fail to look after your dental crown.
Postoperative Tooth Sensitivity
The two types of postoperative tooth sensitivity patients’ experience after crown cementation are hypersensitivity to hot and cold foods or drinks and a mild dull intermittent pain especially when biting down. The sensitivity does not linger and dissipates after removal of the stimuli.
Factors associated with the occurrence of sensitivity include the type of cement, aggressive tooth preparation, inadequate provisional (temporary) restorations and patient’s age [2] [3].
The reason for sensitivity immediately after cementation of crowns for cements made of zinc polycarboxylate, zinc phosphate and glass ionomer is attributed to its initial acidity in the setting reaction, which leads to irritation of the pulp where the nerves of the tooth are located [3].
If the tooth requires extensive drilling for a dental crown to be placed, it increases the number and area of exposed dentine tubules per unit area. This poses a significant effect on postoperative sensitivity.
Our Recommendations: You can rest assured that postoperative sensitivity is short lived and will last for a maximum of 1-2 weeks. We recommend that you stay away from chewing hard foods which can contribute to further discomfort and consume cold or hot beverages with a straw, making it less likely for it to come into contact with the dental crown.
Accumulation of Plaque around Gum Margins
The ideal position of a dental crown should be above the gum line to facilitate monitoring and maintenance. Plaque can form on natural tooth and artificial surfaces and adheres better to restorations than enamel [4].
The junction between the crown and gum is a common place for the accumulation of plaque. This can induce inflammation around the gums as well as adjacent tissues. Signs of gingivitis include red and puffy gums that bleed on brushing. Untreated gingivitis can progress on to periodontitis (gum disease), which can lead to receding gums, jawbone shrinkage and eventually, tooth loss.
Our Recommendations: The progression of gingivitis can be prevented if patients maintain adequate oral hygiene and home care. During your daily brushing routine, be sure to not miss out on your gums! Use a soft-bristled toothbrush to brush gently at a 45-degree angle towards the gums. Don’t forget to floss at least once a day as well!
Secondary Dental Caries
Secondary (or recurrent) dental caries refers to a carious lesion associated with restorations (fillings) or sealants. The main culprit that causes decay underneath crowns is plaque and bacteria.
After the consumption of food, debris that is left on the tooth becomes a reservoir for harmful bacteria. Bacteria metabolizes the food in our teeth and converts them to acid which attacks and damages the enamel. Decay starts at the edges of the natural tooth under the crown and progresses very quickly towards dentine.
Your dentist can spot decay underneath crowns through an X-ray. The crown will need to be debonded using high speed rotary instruments to access and remove all the decay. Deep carious lesions can lead to severe destruction of hard tissues and loss of even more tooth structure.
Our Recommendation: It is so important to brush twice a day for two minutes and floss every day to remove as much plaque as possible. Good oral hygiene habits go a long way!
Problems with your Bite
Adjustment of your bite is a very important part of the crown cementation process. An abnormal bite can put you at a high risk of jaw and temporomandibular joint (TMJ) disorders. If your bite is too heavy on one side of your mouth, it can cause stress on all the teeth and crowns on that arch, making them extremely sore.
Our Recommendations: If you feel that your bite feels a bit ‘off’ during your crown fit appointment, don’t be shy and speak to your dentist about it. They will be able to make a few quick adjustments to the crown and/or its opposing tooth in the arch.
Crown Debonding (‘My Crown Fell Out!’)
Dislodgement of crowns from your tooth is not an uncommon problem. Why would a dental crown fall out in the first place? I thought it was held firmly in place by a special dental cement!
Here are some reasons why crowns are likely to dislodge:
- Improper fit of the crown – this is the most common cause of your dental crown falling out if it is relatively new. If it was ill-fitting at the start, the accumulated pressure and force of biting and chewing over the course of a couple of months can cause it to become loose.
- Tooth grinding – Do you grind your teeth at night? Tooth grinding puts a lot of pressure on your posterior premolars and molars. This can wear down the material of your crown and cause the cement to lose its integrity. It is important to wear a nightguard to protect your teeth and crowns.
- Secondary tooth decay – dental decay can weaken and compromise the tooth structure that is holding the crown together. This is not very common, but it can happen.
Our Recommendations: The most important thing to do is to retrieve the crown. Be careful not to swallow it! Next, call your dentist and book the soonest available appointment. During the appointment, they will be able to advise whether the crown will need to be replaced or recemented.
Conclusion
Dental crowns are an amazing treatment option to restore broken down and fragmented teeth. We hope this article gives you a better picture of the risks involved with getting a crown and how you can avoid them. Good oral hygiene goes a long way in ensuring that your crown stays intact in your mouth for as long as possible.
References
- Wang L, D’Alpino P, Lopes L, Pereira J. Mechanical properties of dental restorative materials: relative contribution of laboratory tests. Journal of Applied Oral Science. 2003;11(3):162-167. doi:10.1590/s1678-77572003000300002
- Farias D, Walter R, Swift E. Postoperative Sensitivity with Indirect Restorations. Journal of Esthetic and Restorative Dentistry. 2014;26(3):208-213. doi:10.1111/jerd.12103
- Chandrasekhar V. Post cementation sensitivity evaluation of glass Ionomer, zinc phosphate and resin-modified glass Ionomer luting cements under class II inlays: Anin vivocomparative study. Journal of Conservative Dentistry. 2010;13(1):23. doi:10.4103/0972-0707.62638
- Litonjua LA, Cabanilla LL, Abbott LJ. Plaque formation and marginal gingivitis associated with restorative materials. Compend Contin Educ Dent. 2011;32(4):e69-e72.
- Dental decay. Oral Health Foundation. https://www.dentalhealth.org/dental-decay. Accessed September 4, 2021.
- Dental M. Why Do Dental Crowns Fall Out? The Most Common Reasons -. Miamisburgfamilydental.com. https://www.miamisburgfamilydental.com/blog/post/why-do-dental-crowns-fall-out-the-most-common-reasons.html. Published 2020. Accessed September 4, 2021.
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