My Crown Fell Off
Instead of being concerned with why their crown came off patients are often more concerned about whether i can glue it back on. This puts me in a tough spot when patients don’t want to address “why” because often there is a bigger issue going on and ignoring it nearly guarantees future problems. Decay under the crown or improper fit are two possible reasons but there are others. If the decay is addressed you need a new crown and possibly a root canal. If the decay is not addressed and the crown is cemented back into your mouth the likelihood of pain, more expensive procedures or loss of the tooth are more than likely and can almost be guaranteed. Moisture contamination can cause new crowns to come off and your dental professional should take a close look the cementation procedure and assure a dry field for success.
At some point in time most dental patients are asked to address teeth that are not aligned properly. It usually comes up around the age of twelve but is a very useful conversation to have at any age. The benefits are undeniable and are a major pert of preventative dentistry. Cost is a major concern of patients and so is the time and energy it will take to re position the teeth. The older you get the less predictable the movements can be and the length of time to move the teeth increases. But the benefits are numerous. Temporomandibular joint health, wear on teeth, fractures, abfraction lesions are all great google searches if you are interested in these benefits. Invisalign and other clear aligner companies have made this service more acceptable and relatively easy to achieve great success while making the process a lot more comfortable for the patient in my opinion. No brackets and wires is attractive to most people. The process might be longer in some cases but overall my patients love this option.
When I sit down with a patient for the first time my first question is always the same. “What can I do for you”? As I listen to the patient describe their current problem, or their dental history I am always shocked at how confident they are in their understanding of the situation. I always listen very carefully, because I feel it is extremely important to know where you are coming from and where you are at if I am going to help. I try to express to patients that where they are does not dictate where they can be. The vast majority of patients are unsatisfied with their previous dental experience (thus their attendance in a new office) and do not (always) acknowledge their own part in this frustrating circumstance.
I get told all the time (by my staff) I can’t spend all day talking with the patient but I am eager to address and discover what they want and how others have failed to meet their expectations. I firmly believe there is no way to meet a patient’s expectations if you do not spend some time finding out what they are. Teeth problems can happen in an instant via trauma but the problems that most people face are avoidable. In the business we call it preventative dentistry. I think it is less expensive to live “preventative dentistry” then to go through life patching problems like pain, decay or esthetic concerns. These problems are best addressed first in childhood. Teaching great hygiene habits to children and watching and mentoring them daily and nightly (brush 2x floss once/day and see your dentist every 6 months. On top of this positioning the teeth (braces, Invisalign) and correcting any positional problems as early as possible can save crucial tooth structure throughout life and has been shown to cut down on decay and periodontal disease (bone loss around teeth).
So when the 30, 50 or even 90 year old who never got a good start on things regarding their teeth presents to me with a number of frustrations, the bigger picture must be addressed. No it is not as simple as just gluing your crown back on, or bonding your tooth again. Can I glue your crown back on? Yes I can, but when it comes off next time I don’t want my name added to anyone’s dental disappointment, so please just let me tell you what you can expect if the bigger problem is not addressed and choose a more comprehensive solution to your problem.
So my dream of helping you with your teeth is complicated. We both need to listen to each other.
Fillings: I don’t use amalgam and haven’t since I left school and the HMO offices I worked in right out of school but I have replaced a lot of them for people concerned with esthetics. I have also crowned many teeth that had huge amalgams done a long time ago and the giant filling worked for many years (25-30 sometimes more) but over time becomes a wedge between cusps at some point and there is a break. A cusp breaks off. If the filling is bigger than the remaining tooth structure then a filling is not a good idea. Even in the patient does not clench or grind their teeth and all of their teeth have perfect position this filling will break and when it does you will question why I charged you several hundred dollars for something I knew would not last. Well most likely you said “can you just do a filling?” and technically I can but it will not last and your money spent on the filling will be wasted.
I want to say here that I am a consumer as well. I don’t know much about how cars work so when mine does I have to take it in. I had an experience about 2 years ago where I went to have my oil changed and the technician was like “your belts look really worn” I was like “can you glue my crown back on?” just kidding I was like “im here for an oil change ill deal with the belt later.” About a week later I was driving south on the 99 returning home to LA when my car just stopped accelerating and died on the freeway. All I wanted to do was get home and guess what I couldn’t because that belt that was recommended it be changed did not get changed. I waited until it broke. I called aaa and I had not renewed my membership so I had to buy one. I was grateful they let me purchase one beings I was stranded on the side of the road in need. They were great. They towed me to Bakersfield and I left my car at pep boys for the night. It was dark when i had an uber take me to the train station so I could ride a bus back to la so I could work again at 7am. Moral of the story: Don’t wait for your shit to break. I went back to jiffy lube and told the same technician my story and asked him to look at my car top to bottom and let me know what he thought. He recommended some other things and I may have spent 500 bucks but I had learned my lesson.
Teeth are one part of what I watch, care for, evaluate. They are connected to your bone. So the bone around your teeth is important too. If your teeth are not clean the buildup destroys the bone. The gums become inflamed and the bone runs away and your teeth fall out or have to be extracted when you are 25, 40 or 90 depending on how severe your case is. It doesn’t matter if “you think” your teeth are clean. It doesn’t really even matter if you floss everyday if you are not getting the build up off. If the build up is there the bone will disappear and your teeth will suffer. If you bleed when you brush or floss you need to come see me. If you are flossing then all you need to do is get your teeth cleaned and then have the hygienist or me show you how to floss properly. Water piks do not replace flossing but they help and I recommend them all the time, especially for patients who endure crowding and have fixed bridges. This process is of losing your supporting bone is called periodontal disease. Ignore it at the peril of your teeth. Since your teeth are connected to nerves and blood vessels there are all sorts of systemic complications to not dealing with periodontal disease on a systemic level (but I can’t cover everything right now). Im just trying to let you know where im coming from when you come in and ask me to glue your crown back on.
I have been practicing dentistry for 14 years and in that time I have enjoyed helping patients find solutions to their dental needs.
It is a lot cheaper to prevent then it is to treat. As I have gained experience in dentistry my knowledge of teeth and the body has grown immensely but not remotely close to my understanding of patients and what they want. They want an easy, inexpensive solution to a complex problem. They want this to be accomplished without opening their mouths very wide, without drilling, and no shot. There is no way to accomplish this but the best solution for the disparity is preventative dentistry. Practice great oral hygiene at home. Position the teeth correctly when you are young. Visit your dentist regularly. Sound familiar? These are the easiest simplest ways to avoid the dentist, the drill and the shot.
Abfraction lesions are one of the most common results of not practicing preventative dentistry. Teeth with poor positioning, clenching and grinding will cause the loss of tooth structure where the tooth and gum come together. The damage is a scalloped void of tooth structure that is sensitive to cold water or the bristles of your tooth brush sometimes. The area can also become a resting place for food bacteria, and can lead to infection inside or outside of the tooth on the gums.
You may never develop signs or symptoms, until the damage is irreversible, it could even lead to a catastrophic break when combined with further grinding and clenching. Caries (bacteria) can find a home in the scalloped lesion and begin further breakdown leading to the need for root canal therapy or even extraction.
Sometimes there are multiple contributing factors. Your dentist might have to really look at your clinical findings closely to be able to tell you exactly what is going on. Study models are helpful when mounted on a semi adjustable articulator and can help patient and doctor visualize the extent of wear on your teeth. Abfraction lesions are the result of a very complicated wear process that progresses at a various speeds and severity.
Fixing the dentition that is worn down extensively is difficult and complicated to say the least. Orthodontic positioning should always be a consideration. In most cases re-establishing a healthy vertical dimension to allow replacement of lost tooth structure with modern day restorative materials must be considered as well. You can bond tooth colored restorative materials to these teeth and cover some of the symptoms (like cold sensitivity but if the cause (your bite, clenching poor tooth position) is not fixed the bonding will not last. It makes sense that if your natural healthy tooth could not survive the forces no bonding will either. A comprehensive method to restoring these worn dentitions must be employed. A wax up is critical that considers the patients mouth as a unique entity. By correcting teeth position and restoring areas of lost tooth structure the patient is given a much improved balance of forces. This new balance of force is teamed with beautiful esthetic porcelain to drastically improve the patients smile while also improving function and protecting further loss of valuable tooth structure.
We have an entire checklist of risks we address at the commencement of all complex cases. Temporomandibular joint dysfunction must be ruled out or addressed before full mouth restorative techniques considered. Various Bite splints can be made to stabilize or deprogram muscles of mastication in a repeatable way so as to predict the success of full mouth reconstruction. Once the joint has been addressed a leaf gauge can help your dentist find a reproducible vertical dimension/teeth position that will work predictably and then restore your teeth with strong beautiful porcelain restorations. Crowns, Veneers, onlays, crownlays, I really would not rule anything out. In other cases orthodontics might be enough to prevent future wear and tear that the patient might get away with a few small bondings.
A night guard can be a great intermediary device until the patient is ready to move forward. These full mouth restorative cases although of great value can be very expensive. A night guard if adjusted properly can slow wear and destruction due to clenching and grinding for a while in situations where money needs to saved.