Most people who have an adequate knowledge in the dental arena would be familiar with what a tooth crown is. The phrase is a bit confusing though. For the sake of clarity and delineation, the following will discuss in detail what it is.
In oral anatomy speak; the tooth crown is that portion of the tooth that is exposed. The portion embedded in bone is the tooth root. In the realm of prosthetic dentistry, it is literally a cap that covers the crown of a tooth that could either be restored or endodontically treated.
Endodontic treatment is otherwise known as root canal therapy (RCT). The tooth crown is the end stage procedure of RCT. It is fabricated in the laboratory and could either be made of plastic or porcelain. A tooth that has undergone RCT will eventually be grinded around its perimeter which would make way for the installation of the tooth crown.
Now that we are technically aware of what a tooth crown is, we would get the picture of a perfectly seated prosthetic piece. However, with a cap-like mechanism that covers sound tooth structure, what could possibly occur underneath?
This is where most people are misled. They think that having a tooth crown would guarantee success until the end of time. However, there have been incidences wherein patients come back and complain about pain and sensitivity underneath the crown.
The sensitivity could be explained by the open dentinal tubules that have been brought about by the grinding. Even if the tooth crown is already seated over a well prepared tooth, sensitivity could last for quite some time; hence, the sensation.
But if pain begins to make its presence obvious, this is a different matter. For a tooth treated with RCT, it could be due to an improper approach during the course of treatment. Pain could have been brought about by mutilated pulp tissue that wasn’t thoroughly removed. A more serious consideration is a perforated root, one wherein the root filling material was extruded beyond the apical root foramen and has caused an infection within the bone.
Telltale signs that there is something wrong with a (“painful”) tooth crown:
1. Decayed abutment tooth (involved tooth that has undergone grinding). The tooth preparation was not able to remove all the decayed tooth structure.
2. A subgingival (below the level of the gums) crown border with an equigingival (equal to the gum line) tooth crown neck would result in a space in between. The borders of the crown should seat perfectly on the neck of the prepared natural tooth. A space in between denotes exposed dentin, which, if left exposed, is very susceptible to decay. Dentin is softer than enamel; therefore, bacterial activity will contribute to rapid progression of new dental decay.
3. A highly soluble temporary cement that has been inadvertently used may eventually wear off, thus leaving a hollow space between the crown and the remaining tooth structure.
4. Another factor would be a wrong tooth preparation and an ill fitting crown that has been “forced” onto the preparation. This is like putting a wrong puzzle piece – it will never solve it.
So do not be misled by a perfectly seated tooth crown. What it doesn’t tell you could equate to underlying serious dental problems that would certainly compromise the prosthesis. It conceals a supposedly healthy tooth structure – not decayed. It is not the end of your dental appointment.
Checkups are still necessary even after the tooth crown has been installed. This is essential in examining the condition of the prosthesis and the underlying tooth structure, as well as a routine checkup of one’s oral health status.
Let your tooth crown give glory to your smile. Take care of it. If there’s pain, there is probably something wrong in between. Have it checked once in a while so you won’t have to relinquish the crown to decay.
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