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Should I get a crown after Root Canal front tooth after some decay?

K

Kilaya

Junior member
Joined
Jan 11, 2016
Messages
4
Hey there everyone. First post here in the forum, mostly because I am completely torn as to whether I should do this or not! It's been a crazy journey for me, which I might elaborate more on in another subforum later... but today I have this question in mind. Sorry for the long post in advance, I hope you'll all still read it.

A bit of a back story.... Years ago (Nov 2011 in California) I had a cavity in a front upper incisor, the one next to the front ones, on the side closest to the canine which was definitely noticeable. At the time I had no money, no coverage, no cheap way to get it done. So I had to wait... Eventually I got into a government program (Job Corps) which helped me to take care of some issues. Unfortunately, being a government program I had to wait a while longer than I really needed to! Eventually I got a filling for it... looking good, so I thought.... But then, something happened. Somehow the filling was so close to the root that it got infected around December (filling was placed in Sept/Oct) and so I had to have a root canal preformed on it. After that, I really felt nothing, but then I started to feel occasional weird throbbing.

I transfer to a different Job Corps location in central Cal, and I've already become familiar with checking in with a dentist when I move because hell if I want more worse to happen to me. She xrays me and tells me that my root is reinfected because they used an archaic filling for a RCT which was a metal pin, instead of the more common rubber root filling. (Really a great dentist which I could've kept her)
She recommended that I get a crown for it, and I'm thinking "I guess later, when I get a FT job and can afford it" (Really subconsciously putting it off.....)

I graduate from the program and find a new place to live in Oct 2014. And I put off visiting a dentist for a long time, because I only have one option I know of that Denti-Cal (The free CA insurance) accepts, and that's Western Dental.
Previous dentist recommended to stay away from Western Dental, but it's been a YEAR (and a few months) and I need a checkup. As a PT worker, FT college student NOW, I don't have any other insurance. I need to check these things bi-yearly, srsly, or else I'm worried because I have had a lot of work done and don't want to screw it up.

I just had my first exam there last Tuesday.... and it was a bit odd. They took xrays, but didn't show them to me (Gonna ask them to do that this Tuesday), and took pictures of my teeth with a little camera. A bit different than I'm used to, with a normal human to human face to face exam to check for anything missed.
To my surprise, I was told I only needed 3 fillings which were all inbetween teeth (Not too surprising, I still forget to floss Dammit! >.> ((Some people would say to their surprise because they never get cavities, for me it's because I have a bunch lol)) And also a crown on my front incisor, which, well, I knew.

This is where it gets me questioning.... I'm feeling I'm just a part of some protocol. "If a tooth has a RCT, cap it" seems to be peoples mantras. But the dentist I went to *previously* did a really awesome job on just the permanent filling. I never bite with it, because I do have an overbite which allow my front incisors to do their job while ignoring the little ones. The tooth has not lost any color, (Funny enough, the canine to my right looks more dull with white calcium flecks than the RCT one does), and does not have pain. The only thing the slightest confusing is that sometimes I can feel a "pulse" sporadically through it, but no infection was found on the Xrays from Western Dental, or they'd have told me, right? (Is it possible they missed it? If they missed that, could they have missed other things too, like my dull canine, even though the dentist himself scaled it?)

I've been doing a lot of googling lately regarding this topic... As I think I might want to get the cap put on it, but then I think I might *not* want to do that.
I have about 2/3 - 3/5 of natural tooth structure left of this restoration I think. I'm going to double check with them on Tuesday. I'm not sure if that's too little to be left without a crown, or if it's fine that way.
In all honesty, after all the effort I've gone through to keep my front teeth in tact and pretty by brushing/flossing/having composite, I feel like putting a crown on my little tooth there is just like getting an implant, only it's my tooth acting as the post, instead of a screw.
It's like, why even bother with a crown, if it's basically a fake tooth that I'm showing everyone? Seriously. I'd be showing everyone the same thing if I had an implant.

Not to mention, with Western Dental being a brand new place I've gone to, and their reputation on Yelp being less than favorable, I honestly do not have the trust instilled yet to trust them with such an important decision as to
1. Make the tooth look like the original
2. Not cause it to fracture/break while doing the procedure (I read some stories where crowns just cause unneeded pressure on the root canal, along with being filed down already, that they just "snap" off at the base. Needless to say, it terrifies me.)
3. Doing it *right* (keeping all bacteria out with the cement and good fit crown)

Still, I don't want it to break or get reinfected due to *not* having the crown, causing even more issue, because I heard that's common too with large fillings... but is mine large enough to warrant that?

It's all so confusing for a person who just wants to do what's best in her individual circumstance, where I feel like many dentists just see people as another number in a line, a protocol to be followed... So For right now, I'm going to put it off. I'll either tell them I don't have the money for it or that in all honesty I don't trust them with such a delicate procedure due to just meeting last week and having low Yelp reviews.
(Though in all honesty, most of those reviews are based on poor front customer service, long wait times, collections calls to customers needing to pay, and the limited time you see the dentist because they're so busy. Not one was about the quality of work, except one that claimed they found cavities where they later were told by a second opinion that they didn't.... but really, who lies about that about just 3 teeth which are paid by gov insurance, when they could lie about a bunch more or other procedures? )

Anyway, thank you for reading this long winded, scattered post. I hope you all (or maybe even some dentists) could give me some advice with this before I make a commitment to anything. Right now I'm leaning towards keeping my filling, but I'm still worried it might crack too that way, somehow by accident. I'm not sure what other second opinion I *could* see with a higher rating that would be decent and accommodating to one with Denti-cal/Low Income in a city filled with rich people. (I'm living in San Francisco ATM)
It's definitely scary, and that's why I'm here.
So please try to convince me to do the right thing, because I'm lost. Haha.
 
L

littlething

Well-known member
Joined
Jul 28, 2015
Messages
129
Location
California
Hi,

NOT a dentist...but I think in general, they recommend crowning a tooth with a RCT because when you remove the nerve, it cuts off the blood supply and the tooth can become brittle. But with anything like that, your dentist should present you with pros/cons/risks/benefits so you can make an educated decision for yourself.

I'm in SF as well, and certainly get it about the astronomical costs...but maybe you can get a second opinion at a dental school? UCSF and UOP (Pacific) are out here, and they both have good reputations as high-ranked schools. Treatment is carried out by a dental student, but under supervision, and I hear you get good, high-quality care there. They also have payment plans are treatment is much cheaper than in a private office (I looked into this at one time, but decided to go with a private office).

Hope this helps :)
 
D

Deck2015

Well-known member
Joined
Jun 24, 2015
Messages
188
Hi Kilaya --

So, you had a cavity in a front top tooth that was filled and then a few months later, that same tooth became infected and required RCT which was performed with inferior material(s). You followed up with a private dentist (when?) who advised that tooth was re-infected and recommended just a crown (?? Am I understanding this part correctly??). You didn't have the funds for the recommended crown so you held off on doing anything. A few years later, the tooth is still occasionally throbbing and you consult with a chain, store front dentistry business who diagnosed you w/o you in the room and said the front tooth was NOT re-infected but does require a crown.

I'm lost here...how did you have re-infection but not require a repeat RCT or Apico to address the re-infection? Were you prescribed antibiotics? And the dentist who diagnosed re-infection said you only needed a crown?

Geez, a lot happening here. Some admittedly amateur (not a dentist) advice:

1. Don't rely on chain, store front dental clinics. They get terrible reviews for very solid reasons. This does not imply that all chain dental clinics do shoddy work, but the majority of reviews I've read about several of these practices indicate they hire dentists straight out of school with limited experience and ZERO supervision of their work once they're in practice. Some of these places have been accused of insurance fraud, and it's strongly implied that they diagnose conditions that are not supported by exam and imaging. Better to spend a few bucks having QUALITY dental work that'll save you loads more in the long run...Remember that ANY time you have work done on a tooth, you're compromising the tooth structure and teeth can only withstand so much drilling. A quality crown crafted by a skilled, respected Dentist will save you money because it's much more likely to last much longer than a cheaply crafted crown. Just food for thought.

2. Address the Re-Infection. As soon as you can. Strongly recommend seeking a 3rd opinion from a private dentist that reviews well online and doesn't treat his/her patients like an assembly line. Or, the dental college (see below).

3. I would second the option of having treatment performed at your local dental college...yes, they're students, but they are supervised every step of treatment and they're under pressure to perform the procedure as perfectly as possible for grading purposes. Plus, I've heard that they're eager to please and are generally very gentle with their techniques. Treatment can be completed for substantially less than market value and many people have excellent experiences. Keep in mind the wait times for appointments can be much longer than private practice and any procedure takes a great deal longer to complete...

4. I've had several RCT teeth crowned - not one of them have snapped off. You've had one professional and the dental chain recommend a crown on that tooth - sounds to me like you need a crown.

I realize that finances are a concern, but again, I can't stress enough how much more it will cost you in the long run if you don't get quality dental care. I would really stress that the dental college is a much better option that the run of the mill dental chain clinic...and you'll probably pay less at the college than your co-pays are at the chain. Ask the college if they accept Denti-Cal or if they can help you submit claim forms (if they won't process claims) - you may be able to get some reimbursement for treatment even at the college...but check with them about this to find out for sure.

So, overall, I'd recommend a 3rd opinion and treatment plan - dental college is probably your best bet. If they also recommend crown, I'd have the crown done there. And have them address the cavities, too. I'd request the xrays from the chain dental clinic as well as the xrays taken by the private practice on that front tooth so the college has historical data to compare to current images...it will help their diagnosis. Best of luck.
 
K

Kilaya

Junior member
Joined
Jan 11, 2016
Messages
4
Basically, what I meant was... First dentist didn't do it right, second dentist did it very very well, and got rid of infection, but I still have some kind of "feeling" that's not pain, pers'e, but *something*

Anyway I went back to get two in between teeth fillings and basically the dentist I talked to was super awesome, seemed to have experience and a sense of humor/personality, as opposed to the last one I saw there.
I asked him why I felt *something*, if he could double check the xrays, and he said there's a clinically allowed amount of bacteria and that that doesn't necessarily mean it's infected to the point re treatment is necessary, but so long as it's not painful, get worse, or get abscessed that it's not a bad thing. Also showed me pictures of where exactly the RCT tooth was likely to fracture even though under the guise of a tooth-colored filling, it doesn't seem so bad. (Xrays show a lot of proof in the pudding) He basically admitted that the dentist who did the RCT and filling did an amazing job on making it look real. Part of the reason I'm apprehensive of covering up that person's work for something "permanent". (The filling is permanent, but old dentist recommended it...)
I decided to reschedule an appointment with him for the 21st to do it, as despite being apprehensive, I feel like I can trust the person doing it. I just hate how my subconscious emotional logic thinks that I'll hate it because it's technically fake, covering up "real tooth", when in reality the filling isn't really real tooth, and would look much worse if done with amalgam. *rolls eyes* I was told I get to pick the shading, but still. =/
 
T

tc2016

Junior member
Joined
Nov 19, 2016
Messages
18
I know it had been a while. Just wondering if there have been any updates? I got a root canal without a crown on one of my front teeth. It has been fine for 16 months and I don't anticipate any problems anytime soon. But I do anticipate someday either having to cap it or extract which both scare the you know what out of me since it is a front tooth. Just curious what eventually took place in your situation.
 
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