Your dentist has recommended a dental crown but you don’t know what to do.

Sometimes it’s not as easy as saying OK, let’s go ahead and get this sorted. It can be an expensive treatment and you need to make sure you get it right. Firstly, what actually is a crown and why has your dentist recommended it? It’s then important to understand your options, the procedure and the risks associated with dental crowns to ensure you make a fully informed correct decision.

Once you answer your questions and fully understand the treatment then you can make the decision to go ahead with your dentist’s recommendation.

In this article, you’ll find literally everything you need to know about dental crowns.

What is a crown?

dental crowns

A dental crown is a hollow shell which fits snuggly over your tooth, in the same way as a hat fits over your head.

It’s a bespoke treatment, prepared by your dentist and handmade by a dental technician to restore the shape and size of a tooth or for cosmetic reasons, to improve the appearance.

They are sometimes referred to as dental caps and cover every part of the tooth above the gum line.

Why are dental crowns needed?

Generally, they are placed for two reasons, to improve the structure of your tooth or the appearance.

Cosmetically, they completely mask out what your tooth underneath looks like. If you have large ugly fillings or severely stained teeth a dental crown will block them out and freshen up the appearance. They’re made bespoke, so you can choose the colour and shape to suit your taste.

Structurally, they protect a weakened tooth. For example, teeth with fillings that keep breaking, or root canal treated teeth may be crowned to improve their longevity. They are also used to build back up severely worn teeth from grinding or erosion.

Lastly, dental crowns can be used to hold a bridge in place or sit on a dental implant.

Common types of dental crowns

There are many crown materials for teeth. Here are the most common types of dental crowns available:

Metal Crowns

photo showing appearance of metal dental crowns

Metal crowns are usually an alloy, and either gold or silver coloured. Gold crowns for teeth rarely have much gold these days due to the high price.

Metal crowns are strong and durable, and an ideal dental crown material for back teeth. Because there’s no porcelain, it also means we don’t have to shave away as much natural tooth.

The obvious drawback is the metallic appearance.

Porcelain bonded over a metal core

photo of porcelain bonded over metal crown

These have the same metal layer as above, but with a porcelain coat over the top. They’re great for either front or back teeth, but because of the extra layer, it means losing more of your natural tooth.

They’re still strong but can be prone to chipping. They look better than metal dental crowns, but light can’t pass through them due to the metal core, meaning they can look opaquer than your natural teeth. The biggest drawback is the metal core can cause a grey appearance at your gumline. Gums naturally recede over time, and this will show the metal.

Fully Porcelain Crowns

These provide a beautiful finish in your mouth. Because there’s no metal, light passes through and gives the same translucent appearance as your natural teeth. This makes them the most lifelike.

Zirconium Crowns

These white coloured crowns made from Zirconia, give great aesthetics for cosmetic placement.

It’s actually a white metal, so perfect for strength on front and back teeth, but it doesn’t give the horrible grey line porcelain bonded to metal crowns can.

What’s the procedure

So, it’s been established that your tooth needs a dental crown to prolong its longevity.

Your dentist will do two tests on this tooth. Firstly, they’ll take an x-ray to check the root is healthy and can support the crown. Secondly, they’ll test the tooth to make sure it’s alive and well, usually with a cold substance not unlike when you bite into ice cream.

Tests are positive. Great.

Let’s get the tooth crown procedure started.

The procedure is split over two appointments, the preparation stage and then the fitting stage.

You will likely need local anaesthetic for the preparation unless your tooth has had root canal treatment. After your tooth has gone numb, the dentist will reduce the tooth in size and shape it so it’s fit for the crown. They’ll then take impressions or digital scans, which they’ll send to a lab technician, who will make the crown. Lastly, they’ll fit a temporary crown for the next 10 days or so until your crown fitting appointment. Together, you and your dentist will look at colours and shades and make a joint decision on what matches the surrounding teeth.

At the crown fitting appointment, the temporary crown will be removed and the cement cleaned off. The dentist will then try the permanent crown on your tooth and check it fits well. If the dentist is happy with the fit, they’ll then show you the crown in the mirror to ensure you’re happy with the appearance.

Make sure you are happy before you give the go-ahead to glue it. Once it’s cemented, it’s not coming off again.

What’s a post crown?

Sometimes you may not have enough tooth structure left to place a crown. Your tooth may be broken or heavily decayed.

The crown will need extra support, in this case, to stop it breaking. A post is inserted into the root of the tooth to act as a support beam. Then it’s built back up and prepared in the normal way explained above.

Does getting a crown hurt?

After a local anaesthetic, you’ll feel the sensations of water and vibration on your tooth, but no it won’t hurt.

How do you care for a temporary crown?

Temporary dental crowns are rubbish.

And they’re supposed to be because we want them to come off easily when we replace them with the permanent crown. The cement is poor because we need to make sure none of it stays on your prepared tooth. If we used a good cement, the permanent crown wouldn’t fit as well.

For this reason, it’s common for temporary crowns to fall off. This isn’t necessarily a problem so don’t panic. Call the surgery and tell the receptionist. The dentist may want to recement it, but they may just tell you to wait.

If a temporary crown falls off the main issue is sensitivity. This is annoying but it’s not a long term problem and will settle once the permanent crown is cemented.

If you can, it’s best to avoid eating entirely on the temporary crown. Sticky, hard and chewy foods will pull it off, so avoid these if you do have to bite on it. You need to make sure you’re brushing it, but try to be more gentle than normal.

How do you care for a permanent crown?

photo of toothbrush illustrating how to clean dental crowns

Dental crowns can be treated like any other tooth.

Eat and drink as normal and forget they’re there.

Your brushing regime shouldn’t change either. Brush twice daily and ensure you’re cleaning between the crown with either floss or interdental brushes.

How much do crowns cost?

The cost of a tooth crown depends on which type you go for.

If you have a crown on the NHS, it’ll mean providing what’s necessary for dental health and no more. The crown will do the job of stabilising and prolonging the tooth’s life, but won’t be the most attractive work of art you’ve ever seen.

Generally speaking, on the NHS, metal crowns are used for back teeth and porcelain bonded to metal crowns are used for teeth you can see when you smile. NHS dental crowns cost £256.50 at the time of writing this (January 2019).

If you’re after a great looking crown then it’s worth paying for it to be made privately. Dental technicians are highly skilled craftsmen. For private dental crowns, they sit there for hours painting shades and layers on with brushes to make it look incredible. It’s the work of an artist and this incurs the extra cost.

Prices can start from £350 for a privately made porcelain bonded crown, and if you’re after a top-of-the-range all-ceramic crown, expect to be looking in the region of £800.

But it’s like anything in life, you get what you pay for and the difference between standard and premium crowns is significant.

Potential dental crown problems

Gum recession

photo shows grey margin of crown at gum line

Recession happens with age, hence the term long in the tooth. The margins of a crown at your gumline may show over time, which can be a problem for porcelain bonded to metal crowns as they will appear grey in this area.

Galvanic action

This is an issue with metal crowns which touch a different metal. Say a gold crown touched an amalgam filling when you bite, occasionally you may feel a slight current between them.

Loss of tooth life

There’s a small possibility that the preparation of a tooth for a crown can cause it to die off. This process can take years and you may never even know about it.

In the worst case scenario, a dead tooth may need root canal treatment or removal.

Loosening crowns or debonding

Dental crowns can become loose and fall off.

This is more common for post crowns. A trip to the dentist may be needed to stick it back in.

Chipping

Occurs occasionally with porcelain crowns.

The problem is they’re difficult to repair, if not impossible. If it’s not an aesthetic concern then we can smooth them off, otherwise, you’d have to pay for a replacement.

How long do dental crowns last?

photo shows a clock to illustrate the point of how long dental crowns last

Conservatively, we’d say dental crowns will last 10-15 years. In reality, they can last decades or a lifetime with regular check-ups and good oral hygiene.

Finally

Remember every case is unique. What’s right for your friend may not be perfect for you.

If you need further information or have specific questions about dental crowns for yourself, always ask your dentist and they’ll be more than happy to help.


AUTHOR

Dr Gareth Edwards Dentist AuthorDr Gareth Edwards BDS (Hons) MFDS RCPS (Glasg) is a Poole & Bournemouth based dentist who qualified with honours. He has a keen interest in aesthetic dentistry and orthodontics and is a certified Invisalign and Six Month Smiles provider. For more information click here.

 

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