Archive for June, 2009

Do I need a crown if my front tooth has a root canal?

Saturday, June 27th, 2009

I broke my left front tooth. My dentist did a root canal and a post. After 6 months, the tooth has discolored already. My dentist advised that I get a porcelain crown. Is there a better option in my case because I don’t really like the crown.
- Christina from New York

Christina,
I can’t tell for sure if you need a crown on your tooth or not without an examination, but let me give you some guidelines and principles.

On a back tooth, when you have a root canal treatment, it’s especially important to get a crown, because the tooth otherwise is very susceptible to vertical fracture, and if that happens, you could lose the tooth.

On a front tooth, there isn’t so much risk of vertical fracture, but we still often will do a porcelain crown. It doesn’t always need a crown. Sometimes, the right kind of post will strengthen the tooth enough. But then you have the problem of discoloration. Although it should take several years before a root canal treated front tooth will discolor, if the dentist doesn’t seal off certain root canal filling materials and confine them just to the root of the tooth, it will discolor sooner.

And there are other ways to treat a discolored root canal tooth. It can be whitened from the inside. Or a porcelain veneer can correct the color. But if a large portion of your tooth has broken off, I would probably lean toward having the crown.

A problem with the crowns most dentists do for front teeth is that they have metal in them, which makes them opaque and will cause them to eventually get a dark line at the gumline. We do all-porcelain crowns on front teeth, and they look beautiful and perfectly natural, so that you can’t tell them from a natural tooth. But I wouldn’t advise asking your dentist to do this type of crown for you unless he or she suggests it, because many dentists aren’t trained in the highly specialized techniques required to place these but may be tempted to try it by your encouragement.

I hope this helps sort things out for you.

Monday, June 15th, 2009

For a few years now I have had a lot of toothache around one of my bottom front teeth. The gum beneath it feels swollen. There is also a deep pocket that goes quite deep into my gum and when I press on it white stuff comes out of the pocket. The dentist I have just seen said no I definitely don’t need a root canal. Could you please let me know if this is anything to worry about because I’m getting to the point where I just feel like pulling it out when it is aching.

Thank you,
Belinda from New Zealand

Belinda,
I can’t tell for sure what is wrong without seeing you, but I can tell you that something is wrong. When you can express pus from around a tooth, that means there is infection.

I would suspect gum disease, because of the pocket around the tooth that you speak of. And, when you start seeing pus, it could be at a fairly serious advanced stage. I don’t know much about your dental care system there in New Zealand. I would have thought your general dentist should know enough about gum disease to recognize that. We treat gum disease in our office all the time. But since you’re not getting a good answer from your general dentist, I would seek out a periodontist or gum specialist for an evaluation.