Why use crowns instead of veneers in a smile makeover?

I just had a smile makeover done, and while I am thrilled with the results, I am a little uncertain about some of the choices my dentist apparently made. I thought my dentist said that she was going to use porcelain veneers, but now that I have had a chance to really look at my new teeth, I can see that the porcelain goes all the way around my tooth. Isn’t that a porcelain crown?

Have you heard of using crowns instead of veneers? I had another dentist take a look at the work, and he was quite impressed and said that it was normal to use porcelain crowns instead of veneers. What do you think?

Gloria in South Philadelphia

Dear Gloria,

It is indeed quite common to use porcelain crowns instead of veneers, especially on your highly visible front teeth. In fact, the difference between a porcelain veneer and a porcelain crown is a matter of degree—there is no definitive line between a crown and a veneer.

That being said, I would have expected your dentist to provide you with a detailed treatment plan before treatment. If she did so, and what she did is actually different from what the plan stated, I would ask why. There are several reasons I can think of that would indicate the use of crowns as opposed to veneers, such as existing fillings in the affected teeth or a need to alter your bite.

Most cosmetic dentists will always elect to go with the most conservative treatment in an effort to preserve as much of your natural tooth structure as possible. Crowns require a reduction of the entire tooth, whereas veneers can be placed with only a small amount of shaving. Ask your dentist to explain to you why she chose to go with the more aggressive form of treatment.

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Can a fast diagnosis of a sensitive tooth really be accurate?

One of my molars has recently become really sensitive to everything - heat, cold, even air. The tooth has a large filling, so I started to worry that maybe the filling was thinning or something, or had a hole in it. I went to my dentist, and she blew air on it a couple of times, then put some kind of gel on that was to desensitize my tooth, and that did take care of the pain right away. She said if the pain had stayed, she would have to remove the nerve of my tooth, but I want to know how she could know that with a couple puffs of air? My dentist is always in a really big hurry, so I was too nervous to ask her to explain how she knew what was wrong, or if it could be anything else. I guess I am kind of nervous that she did not really figure out what is wrong.

Oliver in Bostwick

Dear Oliver,

Diagnosing the causes of dental pain issues can be a clear cut process sometimes, and it sounds as if this was the case with you. Different sensitivities tell your dentist fairly specific things about what is wrong with your tooth. Sensitivity to air is an indication of an unprotected spot on the tooth, which can be treated with a desensitizing bonding agent. In your case, the pain was transient, meaning that it went away after the desensitizing agent was applied. That further indicated that the pulp or nerve of your tooth was irritated, but had the potential to heal without interference. If the pain had lingered, your dentist would probably have recommended a root canal treatment, because that lingering pain would have been an indication of irreversible irritation.

You say your tooth has a large filling, and that causes some concern over whether or not that filling could be leaking, or have decay under it. Certainly most competent dentists would check the integrity of the filling first, to make sure that was not the cause of the pain. If the tooth continues to trouble you, it may be time to consider a root canal treatment and porcelain crown.

The greater issue here is your lack of trust in your dentist. Trust is the key to good health care, and dental care is no exception. If you are not comfortable asking your dentist questions, she may not be the right dentist for you.

Posted in Porcelain Crowns, Tooth Decay, White Fillings | No Comments »

Do teeth with crowns also need root canal treatments?

Do people who need a crown aslo need a root canal procedure? What are the differences in dental condition that result in a placement of a crown as distinct from root canal, post and crown. Thank you.
Hilda from Massachusetts

Hilda,
Root canal treatment and dental crowns are both treatments for extensive tooth decay or large old fillings. But they don’t always go together.

If the decay goes deep, then you need a root canal.

If it goes wide, then you need a crown.

With deep decay, bacteria get into the pulp of the tooth, which is the living inside tissue. This pulp tissue gets infected. Because this tissue can’t swell to accommodate antibodies and white blood cells that would come in to fight the infection, that means that the tooth can’t defend itself. A root canal treatment removes this tissue and replaces it with an inert material that also seals the tooth from bacteria getting back into the tooth.

With wide decay, the visible part of the tooth becomes vulnerable to breaking off. A crown covers the entire chewing surface of the tooth and also the sides of the tooth, which strengthens it and prevents it from breaking.

A tooth often needs a crown without needing a root canal treatment. But most teeth with root canal treatments also need crowns, especially if they are back teeth. A tooth with a root canal treatment is usually weak and brittle, but a crown will prevent it from a fatal fracture.

Related links on Dr. McKay’s website:
Read more about porcelain crowns.
Read about Seattle dental implants.

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