Should I Have a Crown? What are the Advantages and Disadvantages of Having a Crown?

The advantages and disadvantages of having a crown depend on what we are comparing the choice of a crown to… be it tooth bonding, an inlay/onlay, a filling or doing nothing. It also depends on the purpose of the crown- is it for protection or aesthetics for example.

In general, the main advantages of having a crown are:

• Looks (aesthetics). You can improve the colour and the shape of the tooth or teeth with crowns. Porcelain has a more natural appearance and is much more resistant to stains than white fillingmaterial (composite).

• Protection. They provide the best possible protection to a heavily broken down tooth.

• Long lasting. Studies have shown that crowns last longer than any other type of dental restoration including all types of filling and implants. That said, they aren’t as good as natural teeth and once prepared for a crown, a tooth will always need a crown- there’s no going back.

The main disadvantages of having a crown are:

• Destructive. If the tooth is completely natural, the preparation is quite damaging to the tooth as it involves grinding part of it away. Where the tooth has already been heavily damaged or has multiple or large fillings it can have actually have a protective role. Careful consideration of this is needed in treatment planning.

• Damaged Nerves. 1-15% loose vitality and will require root canal treatment. For a number of reasons it is difficult to be any more accurate than this.

• Expensive. It may be 5-10 times the cost of a filling. See ‘crown costs‘.

• Long and multiple appointments.

Can I Have a Crown?

There are circumstances in which a crown may not be possible or a sensible decision:

• Inadequate access. Preparing a tooth for a crown is a delicate/ fine procedure and even though a dental crown may seem to be the right treatment, if you cannot open more than two centimeters or the tooth is very far back or on an angle- it may not be possible to get the drill in to prepare the tooth.

• The tooth itself. It is very important that the dentist considers the biological effect on the tooth, not just how it will look and it is important that you understand this. It is well known that a number of teeth that have crowns lose vitality (the nerve dies)- see above.

• Maintenance and aftercare. It is important that you have good oral hygiene and are able to keep the crown margins clean.

• Plaque build-up around the crown can only ever shorten the life of it, and so it is important that you and your dentist take steps toward preventing decay and gum disease.It is the duty of the dentist to provide the best technical work they can and to make sure that you understand how to look after your mouth; keep good oral hygiene and convey what maintenance procedures are needed. IT IS YOUR JOB TO MAKE SURE YOU CARRY OUT THESE ACTIONS! The success of everything your dentist carries out, relies greatly on you doing your part, or things won’t last as long as they should.

• General medical conditions. If a patient is not physically or mentally able to understand and accept treatment or cannot remain still for extended periods then having a crown may not be appropriate.I

• Poor prognosis- unrestorable tooth. If the tooth cannot be restored properly and predictably to health and function, for example, if the decay extends below the crest of the bone supporting the tooth, then an extraction may be a better choice.

• Poor periodontal support. If the tooth has very little bone holding it in place and has mobility that suggests that the prognosis is not good and it may be lost shortly anyway, then extraction should be considered. Given that the tooth may soon need to be removed, the cost of a crown may not be justified. Just for the record, mobile teeth do not necessarily need to be removed. In fact many people have mobile teeth in their mouths that allow them to chew without pain and discomfort for many years before they become troublesome. If the tooth has healthy periodontal tissues this is not an issue.

• Unopposed teeth. If the tooth doesn’t have another tooth opposite it to chew on and is of little functional use, i.e. it doesn’t support a partial denture or provide any value to the mouth, then extraction may be considered. If it is opposite a space that is in a useful position, it would be far better to keep the tooth and fill the space to provide extra surface for chewing, thus preventing the effects of missing teeth such as tilting and movement of other teeth.