Archives for December 2020

A couple years ago, I had to get a root canal treatment done on my front tooth. All went well with my regular dentist. It didn’t hurt and I felt great afterwards. He offered to put a porcelain veneer on top of it for a low price. But, for some reason I was hesitant since everything felt fine. I didn’t want to mess with the tooth anymore than I had to.

However, as time passed the tooth started to change color. In hindsight, I suppose this is why he wanted to do the porcelain veneer right away. Apparently, the lack of blood flow to the tooth will cause it to change color. After some time, I decided to get a porcelain crown done on the front tooth. She shaved the tooth down big time into a little stub and it really bugged me. It was pretty sensitive too. Anyway, the crown seems OK. But, I know it won’t last forever. So, I just wanted to know why the second dentist chose a crown instead of a veneer. Did I get one pulled over on me? I generally trust dentists to make the right recommendations. But, I’m feeling unsure for some reason.

Any information you have to help give me peace of mind would be wonderful.

Thank you in advance.

-Timothy in Tennessee

Timothy,

Thank you for your question. It sounds like we need to make a couple clarifications based on the questions you area asking.

For example, in regard to your question about the choice between a porcelain crown and a porcelain veneer. The straightforward answer is yes. In dental school, the typical treatment after a root canal is a porcelain crown. Typically, porcelain veneers are not taught in dental school as the standard treatment after a crown. So, the second dentist didn’t dupe you or anything. They did what they were trained to do after a root canal. But you are correct in that it can be unsettling to go through the preparation for a crown. I can empathize with you. It probably felt like your natural tooth was ground down to nothing. But, that is how a tooth is prepared properly so the crown is bonded over it to cover and protect the tooth.

Most times, when a tooth requires a root canal, there is an extensive amount of tooth already decayed or missing so usually a crown is the obvious choice. But, from what you have explained, it is possible that is not what happened with your case. Since you didn’t elect to have a restoration done after the initial root canal, you probably didn’t have a tooth that was in that bad of shape. It’s possible you bumped it in an accident or had another trauma which caused you to require a root canal because the inside of the tooth was dying. After a root canal is done, the tooth is also more susceptible to becoming brittle or getting damaged more easily.

The recommendations differ from a front tooth to a back tooth. Since back teeth are used much more for chewing, there is a lot more pressure and force placed upon them. So when you have a back tooth that requires treatment, a crown will help protect the cusps from breaking.

A front teeth endures different contact because there is no chewing surface, so there is less force from eating. However, a front tooth still endures lateral stress, like when you bite together. The lower and upper front teeth make contact. The upper front teeth push back on the lower. Hopefully, that make sense. So, if you get hit in the face or suffer a fall or something, the upper front teeth take the lateral impact. Therefore, it is more common for a front tooth to require treatment. A front tooth is also in danger of snapping off at the gums. So for a crown preparation on a front tooth, it will involve shaving the tooth down to about a millimeter of natural tooth structure all the way around.

Depending on the dentist’s approach, whether they are conservative or aggressive, a dentist will prepare the tooth so it is resistant against breaking. It depends on the particular dentist’s philosophy how short they will prepare the tooth for the crown. If the tooth is thicker, it will be more resistant to future traumas.

If a front tooth hasn’t suffered too much decay, a porcelain veneer would make the natural tooth stronger. In order to prepare the tooth for a porcelain veneer, a dentist will remove a tiny portion on the front surface of the tooth. The amount of tooth removed is about a half of a millimeter of the enamel. This is to ensure a seamless fit between your natural tooth and veneer. This cosmetic dentistry treatment leaves a lot more of the tooth’s structure in tact.

If you are wondering why more dentists don’t recommend porcelain veneers after a root canal treatment on a front tooth, it is likely due to the fact that it requires a much higher skill level to do it well. The coloration and natural translucency takes a lot of extra training and practice to get right. Not every general dentist has the ability to do beautiful cosmetic dentistry.

The last part of your post to address is your comment about how the tooth became discolored. Most people assume that the discoloration takes place from the tooth drying out over time. However, the source is due to the root canal filling materials that are used to treat the inside of the tooth. An excellent cosmetic dentist may elect to clean out the root canal filling materials inside the crown of the tooth. Then, a white fiberglass post can be placed into the tooth. This not only strengthens the tooth, it also seals the opening made inside the tooth when a natural composite filling material is used. This approach will likely last five or in some cases 10 years, with little to no discoloration.

Thank you for your questions. Hopefully, this helps clarify what was done and why, as well as explaining various dentist’s approaches in treating diagnostic and cosmetic dentistry problems.

This post is sponsored by York PA dentist Donald H. Currie, DMD.