Disadvantages of Dental Crowns


Disadvantages of Dental Crowns

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Dental crowns are a common restorative treatment used to cap and protect damaged teeth. While they offer many benefits in terms of restoring a tooth’s shape, size, strength and appearance, there are also some potential disadvantages to consider before getting a dental crown. This comprehensive guide will explore the main drawbacks of dental crowns, including cost, the need for tooth reduction, risks of nerve damage and decay, and more. By understanding both the pros and cons, you can make an informed decision with your dentist about whether a dental crown is right for your dental needs.

High Cost of Dental Crowns

One of the primary disadvantages of dental crowns is their high cost compared to other restorative options like fillings. On average, a dental crown costs between $800 and $1,500 per tooth in the USA as of 2024. The price varies based on factors like:

  • Crown material (porcelain, ceramic, metal, etc.)
  • Dental insurance coverage
  • Geographic location
  • Dentist’s expertise and reputation

For perspective, a dental filling typically costs between $50 to $450 for one or two surfaces, making crowns significantly more expensive upfront. Dental insurance plans often categorize crowns as a major procedure and cover only 50% of the cost. Patients with no insurance coverage must pay the full cost out-of-pocket.

The high price tag can deter some patients from getting a crown even if it’s the recommended treatment. However, it’s important to consider the long-term value. Crowns generally last 5-15 years, so the cost averages out to a lower annual amount over time. Delaying or avoiding a needed crown due to cost concerns can lead to worsening dental problems that are more expensive to treat later on.

Significant Tooth Reduction

Another drawback of dental crowns is the significant reduction of the natural tooth structure required for placement. In order for the crown to fit over the tooth and restore it to appropriate size and shape, the tooth must be filed down considerably, removing much of the outer enamel and dentin. The amount of reduction depends on factors like:

  • Crown material thickness
  • Extent of damage or decay
  • Tooth location and position

Removing healthy tooth structure weakens the remaining tooth and makes it more vulnerable to fracturing, especially if the crown is very thick or the tooth is small. Dentists must carefully assess how much reduction is truly necessary to avoid over-preparing the tooth.

Tooth reduction is an irreversible process. Unlike veneers, which require only minimal enamel removal, crowns involve significant reshaping of the underlying tooth. If the tooth is later damaged or the crown needs replacement, even more of the natural tooth structure may need to be removed. Teeth with prior crowns are at higher risk of eventually needing a root canal or extraction.

Potential Nerve Damage

The process of preparing a tooth for a crown can potentially lead to nerve damage in some cases. Each tooth contains pulp tissue in the center, including blood vessels and nerves. During crown preparation, the drilling and heat generated can irritate the nerve, causing temporary or lasting inflammation (pulpitis). Symptoms of reversible pulpitis include:

  • Sensitivity to hot and cold
  • Pain when biting
  • Lingering discomfort after the crown is placed

Most mild pulpitis resolves on its own within a few days or weeks. However, if the nerve is significantly damaged during the crown preparation process, it can lead to irreversible pulpitis and nerve death. Signs include:

  • Persistent, severe pain
  • Sensitivity to pressure
  • Swelling and tenderness
  • Tooth discoloration

If irreversible nerve damage occurs, root canal treatment is necessary to remove the dying pulp tissue and prevent infection. This involves additional cost, time, and potential discomfort for the patient. Although relatively uncommon, the risk of nerve damage is a disadvantage to consider with dental crowns, particularly for teeth with large fillings or prior trauma that makes the nerve more vulnerable.

Increased Temperature Sensitivity

Many patients report experiencing new or increased temperature sensitivity after getting a dental crown. Hot and cold foods and beverages can cause sharp, shooting pains or a dull ache in the crowned tooth. This occurs due to fluid movement within the dentin tubules, which are tiny channels that transmit sensations to the nerve.

During crown preparation, some dentin is left exposed, making it more sensitive to temperature changes until the permanent crown is placed. The dental cement used to fill the space between the crown and tooth can also cause short-term sensitivity if it transmits temperature more readily than the natural tooth material.

In most cases, mild temperature sensitivity is temporary and subsides within a few days to a couple weeks. However, some patients have lingering sensitivity that persists for months or even years in rare cases. Desensitizing toothpaste and avoiding extreme temperatures can help manage discomfort. Persistent sensitivity may indicate an ill-fitting crown or underlying nerve damage.

Risk of New Decay

Although a crown itself cannot develop decay, the underlying tooth is still vulnerable to cavities at the margin where the crown meets the tooth. This area creates a small gap that can accumulate plaque, bacteria, and food debris over time. Inadequate oral hygiene makes it easy for new decay to develop in this space and progress under the crown.

Decay around or under a crown can be difficult to detect, often showing no visible signs or symptoms until it’s advanced. Regular dental x-rays are important to monitor for cavities under crowns. If decay spreads considerably under the crown and damages the underlying tooth structure, the crown may need to be removed and replaced after the cavity is treated.

Patients can reduce the risk of new decay by:

  • Brushing twice daily with fluoride toothpaste
  • Flossing daily, especially around the crown margins
  • Getting regular dental cleanings and checkups
  • Limiting sugary and acidic foods/beverages
  • Using antibacterial mouthwash

Maintaining excellent oral hygiene and being diligent about professional dental care is crucial to preventing new cavities from forming at the vulnerable crown margins. Catching and treating decay early can prevent more extensive and expensive damage.

Cosmetic Imperfections

While dental crowns are designed to look like natural teeth, they may have some cosmetic imperfections compared to your original tooth. Factors like the crown material, lab technician’s skill, and color matching process can affect the final appearance of the crown.

Potential cosmetic disadvantages of crowns include:

  • Slight color mismatch with adjacent teeth
  • Less translucency than natural enamel
  • Visible metal margin at the gumline
  • Asymmetry in shape and size
  • Rougher surface texture than natural teeth

All-porcelain and ceramic crowns typically offer the best aesthetics, mimicking the translucency and luster of real enamel. However, they are also the most expensive. Porcelain-fused-to-metal crowns have a metal substructure that can create a visible line at the gumline, especially if the gums recede over time. Gold and metal crowns are the least natural-looking.

Skilled cosmetic dentists and dental labs utilize high-quality materials, detailed shade-matching, and precision crafting to create crowns that blend in with your natural smile. Digital scanning and milling also allows for more accurate manufacturing than traditional impressions. Discussing your aesthetic goals and preferences with your dentist is important to get a crown that looks and feels as natural as possible.

Possibility of Chipping or Breaking

Dental crowns are very strong and durable, but they are not indestructible. Like natural teeth, crowns can still chip, crack, or break due to various factors, including:

  • Biting down on hard objects
  • Trauma to the face or mouth
  • Teeth grinding and clenching
  • Misaligned bite putting extra force on the crown
  • Weakened underlying tooth structure

Porcelain crowns are particularly prone to chipping or shattering compared to metal crowns. Small chips may be repairable with dental bonding, but significant cracks often require complete replacement of the crown. Breakage that extends into the underlying tooth may need more extensive restoration like a root canal or extraction.

The risk of crown damage is highest for patients who grind their teeth at night (bruxism). The repeated clenching and grinding motions can put immense pressure on the crown, causing it to crack, chip, or completely break off over time.

Some signs you may be grinding your teeth at night include:

  • Waking up with jaw pain, facial soreness, or headaches
  • Excessively worn tooth surfaces
  • Chipped or cracked teeth and crowns
  • Tooth sensitivity

If you suspect you grind your teeth, talk to your dentist. They can examine your mouth for signs of bruxism and recommend treatment options. Common approaches include:

Wearing a Night Guard

A custom-fitted night guard or occlusal splint can protect your teeth and crowns from the forces of grinding. Made of durable plastic, the guard fits over your upper or lower teeth to provide a barrier that distributes the clenching pressure.

Stress Reduction Techniques

Since stress is a common cause of teeth grinding, finding ways to relax and reduce tension can help. Techniques may include exercise, meditation, yoga, therapy, or other stress-relief methods.

Dental Correction

In some cases, teeth grinding is worsened by an uneven bite or missing teeth. Correcting misaligned teeth with orthodontics or replacing missing teeth with bridges or implants can help stabilize your bite and reduce grinding.

Botox Injections

Botox injections into the masseter muscles can temporarily weaken them, reducing the intensity of grinding and clenching. The effects typically last 3-4 months before retreatment is needed.

If you already have damaged crowns due to grinding, your dentist will need to assess the extent of the damage to determine the best course of action. Small chips can sometimes be repaired with dental bonding, while cracks may require crown replacement. In severe cases involving damage to the underlying tooth, more extensive treatment like a root canal may be necessary.

The key is to address teeth grinding as soon as possible to prevent additional damage to your crowns and natural teeth. Ignoring the issue will only lead to more problems and expenses down the road. Work with your dentist to find the best combination of treatments to manage your bruxism and protect your dental work.

What is the average lifespan of a dental crown?

The average lifespan of a dental crown varies depending on the material used. Metal crowns can last 20-30 years, while porcelain or ceramic crowns typically last 10-15 years. The longevity also depends on oral hygiene and lifestyle factors.

Can dental crowns lead to tooth sensitivity?

Yes, some patients may experience increased tooth sensitivity after getting a crown, especially if the crown is not properly fitted, leaving part of the tooth or dentin exposed.

Are there any risks associated with the procedure for fitting dental crowns?

The process of fitting a crown involves reshaping the natural tooth, which can weaken it and expose sensitive dentin. Additionally, an improperly fitted crown can cause discomfort and bite misalignment.

How does the cost of a dental crown vary?

The cost of a dental crown varies based on the material (e.g., gold, porcelain, ceramic) and the location of the dental practice. Additional costs may include preparatory dental work and long-term maintenance.

What should I do if my dental crown doesn’t feel right?

If your dental crown feels uncomfortable or causes bite issues, it’s important to consult your dentist immediately. An improperly fitted crown needs adjustment to prevent further oral health complications.