A crown or cap is an artificial tooth made of porcelain or metal and porcelain placed over an tooth to increase its strength and improve appearance.

It is done in two appointments. In the first appointment, the tooth is reduced by one to two millimeters on all sides and an impression is taken. A temporary crown is then made to protect the area between the first and second appointment. The impression is sent to a lab which will fabricate the final crown.

At the second appointment, which is usually around 2 weeks after the first appointment, the temporary crown is removed and the permanent crown is cemented. Some adjustment to the height of the crown may be necessary.

Teeth are crowned most often because there is little natural tooth structure remaining. A crown helps prevent this remaining tooth structure from fracturing. This is common in teeth that have had root canal treatments because they often have large fillings.

What are crowns made of?

Crowns can be made of gold, porcelain, or porcelain fused to metal (gold and other metals).

Gold crowns are an excellent choice because they are very close in hardness to teeth. They also require less reduction of tooth structure then other crowns. The problems with them include the esthetics and cost (due to the high cost of gold!)

Porcelain crowns are great for esthetics because they look very natural. They require more reduction because of the need for more porcelain to resist fracture. The problems with them are that they do tend to fracture. They are not generally good in areas where there is high stress such as molars.

Porcelain fused to metal crowns are often the best choice because they have the strength of the gold crowns but are covered with porcelain to provide better esthetics. The esthetics are not quite as good as porcelain crowns but close.

Do crowns fail?

There are some issues that can occur after a crown is placed.

The most common problems would include cavities around the margins. While the crown cannot get a cavity there is natural tooth structure around the edges of your gums that can decay. This may often lead to the crown needing to be redone.

Another major problem can be the fracture of porcelain on both porcelain crowns and porcelain fused to metal crowns. Unfortunately it is not easy to bond materials back to porcelain so depending on the esthetic concerns, crowns may need to be redone.

How do we replace missing teeth?

There are three main ways to replace missing teeth.

1. Full or partial dentures
2. Fixed bridges
3. Implants

The simplest option is usually a denture. This involves taking impressions of the mouth and the fabrication of either a full or partial denture. Partial dentures can generally be made of acrylic or metal and acrylic. The acrylic or plastic dentures are less expensive (about half the cost) but do not function well. They usually look good but do not stay in very well when the patient is trying to eat. A partial denture with a metal framework, which is not visible, is thinner (and more comfortable) and is easier to eat with. These are always the best option cost wise because they can replace a lot of teeth for almost the same price. They are not usually a good option when only one tooth is missing because the patient will usually not bother with it. Of the three options, this is also the least comfortable option.

The next option is a fixed bridge. Bridges are when missing teeth are replaced between two existing teeth to fill in the space. The most common bridge would be a conventional bridge which has a crown on the tooth in front of the space and a crown on the tooth behind the missing tooth. These usually will look almost exactly like real teeth and function like them also. The difficulty with this type of restoration is that they require you to clean underneath the bridge because they need to be slightly away from the gum tissue. The other disadvantage can be if the teeth supporting the missing tooth are in good condition because it involves reducing these teeth for the supporting crowns. In some cases, a Maryland bridge can be done which involves much less reduction of tooth structure and is also less expensive.

The best option (and most expensive) is dental implants. They function almost identically to natural teeth. The implant is usually done in two steps. The first step, a screw is placed into the bone and allowed time to heal into the bone (osseointegration). After that a crown is attached to the screw. These are the easiest two clean because they function just like real teeth. The success rate on implants is also the highest of any procedure in dentistry. The problem is the cost. A single implant can cost around $3500-$4000.

Yes! The teeth we have are for a lifetime. The longer that we can hold on to our own teeth, the better it is for our nutrition, appearance and general health. Besides regular check ups are much less expensive than extractions and dentures.

Dentures

If you have a partial denture, then you should try to hold onto your existing teeth that help “anchor” the denture in place so that you can avoid a complete denture.

If you have complete dentures, you want to keep them in good repair. Proper eating habits are essential to maintain a good diet and good nutrition. In addition, advances in implant therapy are available to improve the fit of your exisiting dentures. However, in most cases we would generally try to repair or reline existing denture then replace them. However, discussing options with a dentist may give you a range of options.

What are things that you should look out for?

Teeth that are sensitive to temperature changes or biting. If a tooth is sensitive to hot or cold or it is sensitive when you bite into your food then you should see a dentist.

Gums that are red or bleed when you are brushing. This is likely a sign of periodontal disease. Maintaining your gums for a lifetime is important so that you don’t lose perfectly good teeth to gum disease.

Dentures that don’t fit well or are sore after eating. The bone under your denture will change in time. In most cases, over a period of years the dentures should be relined or refitted to maximize there use. This will also improve the comfort of the dentures.

Simple Dental Tips for Seniors

1. Use a soft toothbrush and replace it regularly (every 3 or 4 months).
2. If you have difficulty holding a regular toothbrush then consider an electric toothbrush.
3. Keep your dentures out at night. Dentures are not meant to be worn 24 hours a day. This allows the gums to breathe which prevents infection and allows them to heal.
4. If you have a dry mouth then keep a glass of water handy, suck on sugarless (diabetic) candies or a sugarless chewing gum. These will all help promote increased saliva flow.
5. If you have pain or concerns then see a dentist in the early stages before things progress.

Cavities (or caries) is one of the most common disease in the world. It is directly related to the presence of both the correct bacteria and sugar produce acid which leads to the breakdown of the enamel surface.

Does Everyone Get Cavities

Not all people will have a high concentration of the correct bacteria so some people are naturally more resistant to decay or cavities. Conversely, some people with high levels of the caries causing bacteria will be much more susceptible to caries despite maintaining good oral hygiene.

How Do I Know if I Have a Cavity

Decay or cavities can be identified by a dentist either visually or sometimes with x-ray radiographs. Radiographs are essential for detecting caries between the teeth. We try not to take x-rays often but regular radiographs will allow us to diagnose cavities while they are small versus when they have done extensive damage.

What are the Symptoms of a Cavity

Common symptoms may include sensitivity to sweet things or cold sensitivity of a short duration. When you have these early symptoms it is a good idea to check with your dentist to make sure that things are caught early.

What is Periodontics?

Periodontal disease or gum disease is often not something that you will not feel in the early stages but can be very serious leading to a loss of teeth in middle age. Most periodontal disease in adult periodontitis and is common in patients over the age of 35.

Is Periodontics Preventable?

It is very preventable as it is caused by plaque and calculus which is built up by bacteria in your mouth leading to the breakdown of the bone that supports your teeth.

Can Periodontics Damage Be Reversed?

Once periodontal disease has occurred it is not reversible but it can be stopped so more damage does not occur. If it is caught in early stages it is highly treatable with a combination of increased home care and professional cleanings. Depending on the severity of the disease, this may require you to see the dentist more often then normal. Possibly as often as every 3 or 6 months.

Do I Need Surgery for Periodontics Damage?

Periodontal surgery is sometimes required in more severe cases but most often it can be controlled with deep cleaning of your teeth possibly with a local anesthetic if things are bad enough. In some cases, patients may need to be referred to a periodontist (a gum disease specialist) for more treatment.

There are many options in making your teeth whiter. The preferred method is whatever is the least invasive procedure!

The best choice is often bleaching of the teeth. The best option is almost always a take home kit that you do at home. The bottom line is that the longest and best results are a result of the greatest time and concentration of bleach. Therefore, a home kit done over 1 to 2 weeks will provide better results then one hour in office treatments.

However, these procedures are not effective on existing dental work so if you have other fillings in the anterior region these areas will not bleach so other procedures maybe required. This can involve replacing these anterior restorations with either new restorations or possible something more permanent like veneers or crowns depending on the extent of the restoration.

Root canal treatment is done on teeth when the nerve is permanently damaged or infected. In this procedure, we drill into the inside of the tooth or the canal where the blood vessels and nerves of the tooth were found. We then clean and shape the inside canals of the tooth. We also rinse the inside of these canals with medicine to further clean the inside of the tooth. At the end, the tooth is filled with a material which fills and seals the inside of the tooth from further infection.

When do they Need Them?

Root canal treatment is done to eliminate pain and in most cases should not hurt during the procedure. In some cases, if the tooth is severely infected it may make it difficult to freeze the tooth which may lead to pain.

How Many Appointments Will a Root Canal Take?

Root canal treatment may take 1 or 2 appointments depending on the number of canals that are present in the tooth and usually one further appointment for a final filling.

Will the Tooth Hurt After a Root Canal?

After the root canal treatment, the tooth may be mildly sore but rarely as bad as before and should improve in a few days to a week.

Do Root Canals Ever Fail?

Root canals can fail because of difficulties in treatment, root fractures in the future, or accessory canals. However, in almost all cases this procedure will prolong the life of the tooth.

How Will my Tooth Function After a Root Canal?

After the procedure, the tooth will feel normal and should function as it did before. Your dentist may suggest a crown in the future to prevent further fracture of the tooth especially in back molars.