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cbale718 08-17-2004 10:50 AM

Root Canal Questions - 1st one kind of urgent
 
Any help with these questions would be appreciated, especially with the first one.

1. How long can a back molar go without a crown after a Root canal? I'm going out of town so I'll have to wait for 4 months before I can get my tooth crowned. I'd hate for it to break.
2. My dentist recommends metal crowns (as opposed to porcelain I suppose) for my root canaled molar. But I personally don't like the way it looks. Are there any alternatives or ways to make the crowned tooth look better?
3. In relation to the 2nd question, is a gold crown better than a metal crown? My dentist says the metal crown he's going to give contains a small amount of mercury. Does gold contain mercury too?

Kikki 08-17-2004 03:49 PM

Re: Root Canal Questions - 1st one kind of urgent
 
1) Molars should be crowned rather quickly after a root canal, in my oppinion. I know plenty of people that have had molars that were not crowned at all and have no problem, and I have known people who have tried to wait a few months and have the tooth crack. A couple of things to consider when making this decision:
1) what was the condition of the tooth before the root canal - was it fairly strong with good bone around it; did it have a large filling in it that would cause weakening of the tooth before the root canal?
2) what is the size of the filling in it now - fillings weaken the tooth if they are big, so if a great deal of the crown is filling, it is at risk of chipping.
3) Do you have any oral habits that may stress the tooth a lot and put it at risk - clenching and grinding, crunching ice, biting hard candies, and even chewing gum, as the filling in it is probably just a temporary.

It takes a while for a relatively healthy tooth to become brittle after root canal. Therefore, if the tooth was strong before your root canal and your teeth in general are of relatively good quality (you don't have genetically weak teeth), waiting 4 months should not be a problem, though there is a risk. I think as long as you feel you are a good candidate to wait and you are careful not to stress it way too much, you will be fine.

As for the types of crowns. First, there is a small amount of mercury in metal fillings and crowns. There are a very few people that are mercury sensitive and they have a problem with mercury in dental restorations. These are the cheapest types of crowns and really they are quite good and will probably cause you no trouble what so ever. Gold crowns do not contain mercury, nor do crowns made of all high noble metals. Porcelain and porcelain fused to metal do look better, particularly in the front, but they are not as strong as the different metal types. Personally, I think the metal ones would last you much longer and carry less risk of cracking or breaking. It will not show in the back, so metal really is a good way to go, unless the look really bothers you.

cbale718 08-17-2004 08:58 PM

Re: Root Canal Questions - 1st one kind of urgent
 
kikki, thank you for answering my questions. If cost is not a problem for me, would you prefer a gold crown or a mercury-containing alloy crown? Which one is healthier or just overall better for the teeth?

My dentist tells me that in my situation waiting for a few months before I get my tooth crowned is ok. But I guess I just want to be better safe than sorry. Would it be a good idea for me to just have my tooth crowned with a different dentist near the new place I'm gonna be at for the next 4 months? I heard that sometimes a root canaled tooth can last for months until the day it's crowned only to be fractured during the crowning process because the process places so much force on the tooth. Is this true?

Kikki 08-18-2004 12:21 AM

Re: Root Canal Questions - 1st one kind of urgent
 
If cost were not an issue, I would use the best quality metal I could get - the gold or a gold alloy is a very good crown. Lots of people want porcelain now, but they are just too weak to last any length of time. Maybe 5 years on a molar. The metal is far stronger and really worth it as it may very well last you 15 years or more. When you get in to lower grade metals, they are not quite as strong and they have more of an incidence of causing problems with your gums, which can react negatively to metals. This is greatly reduced with the gold. I think between the two, gold is the way to go.

As for cracking the tooth, I have never heard of a root canaled tooth cracking during the crowning process, though it is a possibility. I would not worry about it though. As long as your dentist is a good restorative dentist, your tooth will not have a great deal of force on it during the process. The tooth will be growned down gently and the a mold taken, and a temp put on. If the dentist and lab do a good job and you do not lose your temp the crown should go on very very easily and that will be the end of it. It takes a long time for a relatively healthy tooth to become brittle enough to break while getting crowned.

And for what dentist, if you like your dentist and plan on continuing using him, I would just wait. You should be fine and your dentist and you have a relationship you can't get with a dentist you just see once or twice to get a crown.

cbale718 08-18-2004 01:04 AM

Re: Root Canal Questions - 1st one kind of urgent
 
kikki, I really appreicate your help. As for my dentist, I actually am not very satisfied with him. He never explains anything to me and never tells me what options I have. I told him my concern about the mercury in the alloy crowns he proposed and he just said mercury is not really bad for me and did not even tell me that gold crowns were another option. I had to do my own research. I've only been with him for 2 years and I'm actually looking for another dentist right now. Anywhoo, thanks for all your help with answering some of my questions.

Kikki 08-18-2004 10:09 PM

Re: Root Canal Questions - 1st one kind of urgent
 
I am sorry that you are not happy with your dentist - that is always hard as your dentist should be someone you have total confidence in. As for the question about the mercury, you are far from the first to come to the boards complaining that their dentist just brushed off their concern about mercury. I have seen several in my short stint here. I just asked a good friend who is a dentist and he said that this happens a lot because dentists are constantly having to defend the mercury in dental restorations. The media has (like lots of things) created a bit of a panic over mercury. The truth is, mercury in dental applications is very rarely a problem for a reasonably healthy adult. There are cases where someone has had problems with mercury and I certainly do not want to belittle them at all as they sometimes suffer severe reactions. But these people are in the minority. The chances of a problem are very low. But this type of paranoia is rampant in our society. If a couple of people have a problem (out of many thousands) we start looking for it to happen to ourselves. That awareness is good, but it should not be used to scare you. So now dentists are constantly having to defend the materials they use. (sorry to get longwinded about this, but I got a long speach when I asked my friend, so I thought I'd pass on the same).

Nonetheless, your dentist fell short when he did not tell you all the options and then the plusses and minuses of each. I think he should have told you about all the different types of crowns and then why he would suggest a particular one. Don't think that your dentist is offering you something that isn't the best, but the best for your situation. Every case requires your dentist to choose the best possible restoration to fit the patient. If there was a one size fits all solution, then there would be only two types of crowns - an expensive one, and a cheap one. Sometimes dentists unfortunately fail to explain WHY a certain type of restoration is being suggested. Dentists just don't just draw one out of a hat. Don't get me wrong, I am not trying to defend your dentist at all, nor am I accusing you of anything. I have no idea the problems you have been having with him, all I am doing is telling you what I know from watching friends who are dentists, and good ones at that. Unfortunately the most qualified are the least personable.

If you are unhappy with your dentist, maybe seek a new one before having the restoration put on - after all the new one will be the one dealing with it once its in! The most important thing is to find a dentist who you have confidence in and are comfortable talking with.

Keep me posted on what happens - I know you are just ready to have it all behind you!


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