Possible consequences of not having a dental crown placed on a tooth.

Fragile, cracked and broken teeth often need the protection of a crown.

A dentist will sometimes recommend placing a dental crown on a tooth because they feel that doing so will help to strengthen it (make it less prone to fracture).

This type of recommendation is common for teeth that have cracked, broken or have large portions missing. It is also sometimes made for teeth that, at least to the patient, seem to be just fine but have a large dental filling that places them at risk for problems in the future.

Often, the alternative to placing a crown is a dental filling, or, if the tooth is not currently displaying any symptoms, no treatment at all. And while these alternatives may seem like viable options, choosing them does come with potential consequences. This page discusses some possible scenarios that might come into play if a tooth that is a candidate for a dental crown doesn't receive one.

Possible outcomes for teeth that aren't protected with a dental crown.

A) The tooth will crack - (with pain / no pain).

B) The tooth will fracture (a piece comes off or is loose).

A cracked tooth.

[ A red asterisk (*) in our discussion indicates a potentially significant problem that the placement of a dental crown could have prevented.]

A) The tooth will crack (no piece breaks off or becomes mobile).

One possible outcome for a tooth that doesn't receive the protection of a dental crown is that it will crack. And unlike bones, cracks in teeth don't heal. In fact, once a crack has formed, it may increase in size over time due to its repeated exposure to heavy biting forces (placing a crown can prevent this outcome).

1) * Teeth that crack - Some pain or discomfort is involved.

Cracked teeth can be sensitive. When biting pressure is applied, the portions of the tooth on each side of the crack can shift, thus triggering a painful response.

The classic sign of a cracked tooth is this. It gives you a sudden, sharp pain when you bite down. And the pain subsides immediately once the biting pressure has been released.

You may not feel the pain every time you close. Sometimes it takes biting or biting on something, at just the right angle, to trigger the response.

A dental crown placed over a cracked tooth.

What treatment remedies exist for cracked teeth?

If you have a cracked tooth, there can be a range of solutions. With the most minor of cases, your dentist may determine that your tooth requires little or no treatment (sometimes just buffing the tooth so it's a tiny bit shorter provides a lasting solution).

In other instances, they may feel that a dental crown should be placed (so to splint the tooth together so to prevent further cracking). In the most extreme cases, they may determine that the crack reaches deep into the interior of the tooth and that root canal treatment is required before a dental crown can be placed.

2) Teeth that crack - Little or no pain is involved.

Not all cracked teeth produce significant, or consistent, symptoms. In fact, it can be very difficult for a dentist to diagnose exactly which tooth lies at fault. It may take some period of time, including investigation on your own while at home, to identify which tooth is the damaged one.

Tooth cracks can be exceedingly difficult, if not possible, to see. Dentists sometimes locate them by applying a dye that seeps into the crack. Obvious "cracks" that produce no symptoms are often just tooth enamel craze lines that require no attention.

It's rare that a crack will show up on a dental x-ray. To be visible, the crack would have lie in perfect alignment with the x-ray machine's rays. While possible, this alignment rarely occurs.

B) The tooth fractures (a portion comes off or becomes mobile).

Some tooth cracks result in outright fracture (a portion physically separates). The piece that comes loose may break away cleanly or, if it is still attached to its gum tissue, remain relatively in place.

1) Reasons why a fractured tooth might (or might not) hurt.

The amount of pain or discomfort caused by a tooth that has broken will vary depending on the specifics of the situation. Here are some possible scenarios.

A) The tooth may not be painful at all.
Not all teeth that break hurt. The broken fragment might be small, or relatively far from the tooth's nerve (pulp tissue). In yet other cases, the tooth's pulp tissue may already have died or been removed (root canal treatment).
B) The tooth may have sensitivity to thermal stimuli.
Some fractured teeth hurt, hurt more so, or only hurt when exposed to hot and cold temperature extremes (foods and beverages). For the most part, the tooth's response simply has to with how close the surface of the fracture is to its pulp tissue.
     The situation where a tooth is bothered somewhat by a thermal stimulus but then immediately settles back down may indicate that the nerve is normal and healthy and once a repair is made, everything will be fine. At the other extreme, a painful response to heat that lingers may indicate that the tooth will first require root canal treatment.
C) Broken tooth edges can irritate a person's tongue or cheek.
Sometimes the pain associated with a broken tooth comes from the soft tissues (cheek, tongue) that rub against its sharp edges.
D) The tooth may be painful to biting pressure.
Sensitivity to biting pressure can be an indication of a number of different conditions. It may suggest that, beyond fracture, the tooth is cracked too. In this case, when pressure is applied, the cracked portions shift, thus causing pain.
     Another explanation could be that the tooth has fractured but the loose portion is still attached to gum tissue (and therefore hasn't fallen off yet). When pressure is applied, the loose fragment shifts position, thus cause gum-tissue pain. In yet other cases, the tooth may have broken coincident with its need for root canal treatment and the pain is a sign of that.
E) Some broken teeth are spontaneously painful.
A tooth that is spontaneously painful (it hurts on its own, without any provocation) suggests that its pulp tissue has been significantly traumatized by the tooth's fracture. It's possible that the tooth will require root canal treatment before the tooth can be rebuilt.
A broken tooth.

2) Most teeth break in a way that is easily repaired.

It's not always a catastrophic event when a tooth breaks. And, in fact, in most cases it usually it isn't. Any tooth, however, that has broken should always be inspected by your dentist so they can make a treatment recommendation.

A stitch in time really can save nine when it comes to broken teeth. Broken teeth that are left untreated may fracture further (possibly catastrophically) or, since they now trap dental plaque and debris more easily, develop tooth decay.

In regards to treatment, it's conceivable that such a small portion of the tooth has fractured off that it only requires some minor smoothing with the dentist's drill. At the other extreme, you may find that your dentist recommends the placement of a dental crown. Especially in those cases where a large portion of your tooth is missing, take the obvious hint that your tooth is trying to give you. It needs protection. Let your dentist make a crown for your tooth.

3) * Some teeth break in a way that cannot be repaired.

Surprisingly, even teeth that have broken off flat with the gum line can usually be rebuilt. However, if a crack or break involves a large portion of the root portion of the tooth (the portion way down underneath the gum line), a repair may not be possible and instead the tooth will have to be extracted.

4) * Sometimes, other types of dental work will be required before a dental crown can be placed.

More serious tooth fractures will require a more involved treatment plans.

A broken tooth which has nerve damage.

a) Cases where periodontal surgery (gum surgery) is required.

If that segment of the tooth that has broken off comprises a portion of the tooth's root, a type of gum surgery termed "crown lengthening" may be needed before a dental crown can be placed. This is because the edge of a crown cannot lie too far underneath the gum line, or else it will affect the health of the tooth's gum tissue.

b) Cases where root canal treatment is required.

A tooth with root canal treatment and a dental crown.

Deep cracks or extensive breakage can result in nerve (pulp tissue) damage. And in these cases, a dentist cannot simply place a crown on the tooth. Instead, they must first perform root canal treatment so to remedy the problem with the nerve. Once this has been completed, a dental crown can be placed.

Some teeth, despite never receiving a crown, never experience a problem.

Of course, there is always the possibility that despite an apparent need, a tooth that receives some type of alternative instead of a crown never experiences any problems at all.

Clearly, no dentist can know precisely what set of circumstances will transpire with a tooth. When they make a recommendation for a crown, they are simply advising you as to what they consider (based on their years of dental training and clinical experience) to be the most predictable treatment in regards to the long-term health of your tooth.

 All FYI's ► 
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