Dentists, like many other people in specialized occupations, need to realize that their routine lingo and descriptors for what they do often sound like parts for a Mustang, not a mouth.
I will attempt to dispel some of the myths and misunderstandings surrounding one of the most common dental procedures I do on a daily basis – a crown, sometimes called a cap.
A “crown” and a “cap” are actually the same thing, although dental professionals typically use “crown”. Sometimes they are made entirely of a metal alloy like gold. In other cases, they are made from a thin metal alloy “coping” that has a layer of esthetic porcelain applied over the metal.
Recently, other variations have been appearing. Crowns made entirely out of super strong, tooth-colored materials like lithium disilicate and zirconia are being used more each year. There are even crowns that can be made on a milling machine that uses computerized optical scans of the tooth.
“Which one is the best?” is a logical question. The most honest answer is “it depends.” Most dentists are capable of doing all of the types listed above.
Each tooth is different and is exposed to different stresses. Some people grind their teeth at night or chew their nails. Others clench their jaw muscles when they are stressed or angry. Some teeth have had root canals or previous large fillings, and are particularly weak.
Your dentist should evaluate your tooth in light of all of the above factors, as well as ask questions like, “Are you more concerned about esthetics and beauty or strength and longevity?” In my own mouth, I have had my dentist place the oldest technology we have available on my back molars … gold alloy. Why? Because nothing has withstood the test of time longer, nothing fits better or is more compatible with your mouth tissues than gold. Gold can’t crack like porcelain, and it wears out at almost exactly the same rate as your own enamel does. That means it won’t wear out the tooth it is chewing against.
I still chew ice on occasion, even though I know it’s hard on my teeth, so gold makes sense for my second molars. They are so far back there that the only people who see them are my dentist and hygienist. I still recommend gold to a lot of patients who are more concerned about durability than the way things look, especially on back teeth.
That being said, I provide all of the other types of crowns mentioned above far more often than I do gold. Why? Because many crowns that are necessary are in areas that show when you smile or laugh. Some patients definitely want a tooth-colored restoration, even if it is more fragile. Still others are concerned about having any metals at all in their mouth because of allergy concerns.
As a dentist, I want to be proficient in many different ways of accomplishing what my patients need so I can best address their concerns. A dentist should involve you in choosing which option is best for you. There are some types that balance the need for beauty and strength quite well. You are entitled to a logical, easily to understand review of available treatments. After al , it’s your mouth … and your money.
So what is a core? Is that when you exchange your old car battery for a new one? No, actually a core, or buildup, is often needed underneath a new crown for proper strength and protection of the tooth. Teeth that need crowns usually have had very large fillings. Many times a large portion of what you think of as your tooth is actually old filling material. While it may do a good job of filling in the hole, it doesn’t add much strength to the tooth.
In fact, in some cases, an old amalgam filling may actually be acting as a wedge that can crack your tooth unexpectedly when you bite down. Usually, when preparing a tooth for a crown, it’s best to completely take out the old filling, in order to make sure all the decay has been completely removed. The tooth is then reinforced internally with a bonded composite material before being trimmed down between 1-2 millimeters in all dimensions so that it can be covered and strengthened by the crown.
A buildup is not always necessary, depending on how much healthy tooth structure remains after all the decay and old filling is removed. The final decision can only be made once that step has been completed. Often I will include the cost of a buildup in our fee estimate for a crown. If it ultimately isn’t needed, I am able to give my patient the good news that today’s appointment will cost less than we estimated.
So, to conclude this car analogy … what exactly is a “grill?” Like the flashy chrome front end of a car, a grill is an accessory that some people in the hip hop music scene have made for their front six teeth. Perfectly healthy tooth enamel is ground down in order to install a gold framework, sometimes festooned with diamonds. There is no purpose for the procedure other than to add some “bling” and attract attention to the person wearing it.
The teeth are left much more sensitive and prone to decay. They eventually will need real crowns because of the damage done by the unnecessary procedure. Although I offer my patients a variety of options to restore or improve their smile, that’s one you won’t find on my list of available treatments.
Stuart Rich is a dentist in Auburn, and a frequent contributor to the Auburn Reporter on dental health topics. You can learn more about this and other dental topics by going to www.StuartRichDDS.com.
