Tooth/Teeth - Crowns, Fillings, Bridges, Artificial Teeth, Dentures and False Teeth

When a tooth or teeth become significantly compromised, dental work may be required to repair the damage, infection or cavity. Further dental work may then be needed to strengthen the tooth or teeth, as well as provide a better cosmetic appearance.

Crowns, fillings, bridges, implants and false teeth all have important roles to play in dental restoration of teeth and or the better cosmetic appearance of teeth.

CONTENTS: Why are Crowns, Fillings, Bridges and Artificial Teeth needed? What are Crowns? What are Fillings? What are Bridges? What are Artificial Teeth? Life Spans of Crowns, Fillings and Bridges. Failure Rates with Crowns, Fillings and Bridges. Problems with Crowns, Fillings and Bridges. Saving a Crown or Bridge Dentures and False Teeth.

Why are Crowns, Fillings, Bridges and Artificial Teeth needed?

Crowns, Fillings, Bridges and Artificial Teeth may be needed when a tooth has become compromised by decay, as through a cavity, or by trauma, such as being cracked when biting on a hard seed or bone. To do nothing would normally mean excruciating pain - toothache - and eventually the loss of the tooth, or loss of a portion of the tooth.

What are Crowns?

A crown is a hard protective covering that is placed over a tooth to hold the tooth together and prevent further damage occurring to the weakened tooth. The crown can be made of a variety of substances, typically plastic or metallic in nature. The plastic ones are generally cheaper, but don't tend to last as long as a metal based crown.

The procedure of fitting a crown is somewhat time consuming and is generally NOT an enjoyable experience. The fitting typically occurs over several dental visits. The first dental visit involves a lengthy procedure, in which the tooth is cut down appreciably in width and height, with a cast of the tooth stub and surrounding teeth being taken. The color of the teeth around the tooth is also determined. Often a temporary crown or band is fitted to protect the tooth stub from damage.

The mould and desired color are then sent to a lab that makes crowns and the crown is made to specifically fit over the tooth stub and blend into the rest of the teeth in height, color etc.

The next visit involves the crown being fitted to the tooth. This can also take some time, as the crown may not fit perfectly. If it sits to high, some of the crown may need to be ground down - if the dentist gets the height to high, expect the tooth above or below it to crack as well, as the crown is much harder than tooth, so when you bite, the crown will pound into the opposing tooth, thereby cracking it. If it cracks, you will then need to have that cracked tooth crowned as well - that is what happened to me.

One thing I have found, is that if the tooth is subject to root abscess, getting the tooth crowned may be a pretty dodgy idea.  It may be hard to consider, but having a tooth subject to root abscess removed, is possibly the more practical way to go. To do the root canal work to remove the pulp and clean out the germ and then crown the tooth, could easily cost you about $3,000 - It may sound OK, but there is no guarantee the germ will be gotten rid of, which means that if the root abscess recurs, you will likely loose the tooth anyway.

What are Fillings?

A filling is used when the damage to the tooth, normally through tooth decay, does NOT compromise the structural integrity of the tooth. The filling is a plug, to prevent germs and debris from entering the tooth. Fillings use to be made with mercury and other bits thrown in, but owing to the health risks associated with mercury based fillings, they are no longer used. The typically filling is now a form of plastic like resin. Once the damaged area of the tooth is removed, the filling is inserted. Fillings are relatively inexpensive, being about $100.

The larger the filling involved, the more likely will be the loss of structural integrity of the tooth and you may be advised to look at having a crown fitted to the tooth.

What are Bridges?

Bridges are actually three crowns that made as one crown. They are sometimes used when a tooth is lost. The middle crown replaces the lost tooth and the other two crowns straddle the teeth on either side of the gap. To do this, the procedure is very similar to fitting a single crown, but the procedure much more lengthy, as two teeth have to be prepared for the crowning. A bridge requires the presence of two teeth, one on either side of the gap. A missing end tooth cannot be replaced by a bridge. A bridge normally costs about double the price of a crown.

I was offered the idea of a bridge when it was clear my crowned tooth could no longer be salvaged from the ravages of a root abscess.  I though about it, but turned the idea down as it means that two perfectly good teeth are being compromised through the crowning procedure.

The cost of a bridge is about $5,000.

What are Artificial Teeth?

An artificial tooth can be used when a tooth has been extracted or lost. It is typically made of a hard metallic compound and typically inserted on an operating table, using a screw type set up to attach the artificial tooth to the jaw. The use of an artificial tooth is therefore often used when an end tooth is lost. It is much more expensive than a crown, but roughly on a par with a bridge for cost.

In more detail, the operation is performed ideally between the 3 and 6 month mark following the loss of the tooth - any earlier and the body may reject the implant, any later and the jaw wont grow as well onto the implant.  The tooth implant operation requires a general aesthetic, after which a screw on plug is inserted into the jaw.  The tooth part of the artificial tooth (essentially a crown) is then attached to the plug some weeks later, when the area has had a chance to heal.

The cost of an implant tooth is about $6,000.

Life Spans of Crowns, Fillings, Bridges and Artificial Teeth.

The Life Spans of Crowns, Fillings, Bridges and Artificial Teeth is roughly ten years. After ten years they will generally become compromised by decay, gum recession, failed glue contact between tooth and crown, or something else. Some crowns, fillings, bridges and artificial teeth may last longer, some may not last as long - but roughly every ten years each crown, filling, bridge or artificial tooth will need to be replaced. How long a crown or bridge lasts can also depend on choosing the right dentist. I recently met a lady from England and some of her crowns had survived over 25 years - she mentioned that England had the best dentists at the time her crowns and bridge went in and believed having the good dentists attributed much to the life span of her crowns and bridge.

The exception to the above life spans are the plastic based crowns. Plastic based crowns last about 5 years from our personal experience and from what a dentist told us as well.

Failure Rates with Crowns, Fillings and Bridges.

Problems with Crowns, Fillings and Bridges.

Germs getting in as a result of new cavities or fillings becoming cracked - normally the germ gets in through a cavity, then undermines the tooth the filling is sitting on. The filling then cracks. It is rare for a filling to crack if the underlying tooth is sound.

Gum slightly retreating showing a little tooth under the crown or bridge, the tooth cannot be cleaned properly at the tooth / crown interface, so germs set in and decay rots the area, causing a crown to no longer fit right. Crowns are fitted so that the gum covers the bottom of them, forming a complete seal round the tooth. Another problem is when cheaper metallic crowns or bridges are used, in lieu of their more expensive brothers, as sometimes the metals used cause tooth erosion and bad discoloration of surrounding teeth as well.

Also a tooth that has been crowned for decay reasons, may cause problems on a regular basis, due to tooth abscess on the tooth root. When this problem arises, the tooth has to be redone, with root canal work as well.

Another consideration for bridges, is that two perfectly good teeth are being savagely altered. This gives the teeth a long term risk factor for loss, that would not have otherwise been present.

If a crown or bridge is fitted incorrectly and sits too high, it will affect the bite, which may lead to good teeth becoming cracked or Bruxism behavior - teeth grinding.

Saving a Crown or Bridge

First, don't bite down hard on anything that shouldn't be hard!  It may be your crown or (rarely) bridge. When a crown is bitten down on when sideways, it is easily destroyed.  Assuming your crown or bridge has just fallen off - failure of the glue bond between tooth and crown - just wrap the crown in glad wrap or similar sterile packaging, make an emergency appointment with your dentist and have the crown reattached.  While waiting for your dental appointment, avoid eating anything on that side of your mouth that the crown fell out of, as the tooth is very vulnerable.  Also, if the crown has a post attached to it, try not to eat or drink at all until you see the dentist, as that post represents a hole now running down your tooth and into your jaw - not something you want to get germs or food into.

I know of one lady whose crown broke in half and not having a dentist at all handy, she super glued the crown together and super glued the crown to her her tooth.  Five years later it was still there before she had a dentist fix the crown up properly.

Dentures and False Teeth