Dental Crowns & Bridges

"My tooth hurts when I bite! What is a cracked tooth?"

Unfortunately, it is not simple to say what is making a tooth hurt when you bite down or chew with it.

Possibly, you have a cracked tooth. These teeth have hurt to bite on for at least 2 weeks, and the pain is described as a brief sharp, shooting, electrical shock-type pain.   In this case, the crack extends into to the deeper, sensitive part of your tooth, and the crack flexes ever so slightly when you bite down on that part of your tooth.  And because the pulp is involved, the pain is more significant.  Occasionally these teeth may become sensitive to hot or cold things.

If has been painful to biting for a while, I try to determine the part of the tooth that is flexing.  If the whole tooth hurts, then I may have to consider if the pulp is dying or dead.  But if only one, possibly two cusps are painful, that indicates the cracked tooth.

The best treatment for a cracked tooth is to cover the tooth with a crown (same thing as a cap).  This prevents the crack from flexing, so it stops the pain, and prevents the tooth from breaking.

 If a cracked tooth isn't treated, sooner or later the cracked part will break off, and then it becomes a bit of an emergency, because now there is usually a sharp edge, and tooth is sensitive to hot and cold because the inside part of the tooth is exposed.

Also, if treatment is delayed too long, the tooth may become sensitive to hot and cold, which indicates the pulp is inflamed.  It has been shown that 20% of teeth that were diagnosed with a cracked tooth AND had temperature sensitivity will need a root canal in 6 months.  Now, the tooth should still have the crown placed even if it is sensitive because 80% of the time it will be fine, but know if you wait too long, it might become sensitive and then may need a root canal.

So to make things really simple, if it is a sharp pain when you bite, you should have it checked out at the office.  If it is a dull, achy pain when you bite; try not to eat hard things in that area, take some ibuprofen, and make sure you're muscles are not over working.  If this self-management doesn't take care of the discomfort, we should check it at the office. 

Three Common Situations Where We Recommend A Crown For Your Tooth

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There's only half of your tooth left

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If it is a back tooth and it has a root canal

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If the tooth consistently hurts to bite

  • There's only half of your tooth left.This could be because it broke, or there's decay and you already have a big filling in the tooth.  A filling is a good name for what we put in your tooth.  It just 'fills'; it doesn't help the tooth stay together and truth is it weakens the tooth.  I recommend covering the rest of your tooth with a crown at this point because if more of your tooth is lost due to breaking or decay, the amount of tooth left is pretty weak.  I have had patients come in saying their crown came off and when I look at the crown, all tooth that was holding crown is broke off inside the crown.  Then the only way to save the tooth is $$$; a root canal, building the tooth back up and a new crown.  So I don't want you to wait until that point.  On the other hand, if you have a small filling and one of your cusps break off, I usually just suggest a new filling.

  • If it is a back tooth and it has had a root canal, the tooth becomes considerably more brittle.  Because it is so much more susceptible to breaking, a crown is best.  If it is a front tooth with medium size filling in it and has a root canal, then I would recommend a crown at that point.

  • If the tooth consistently hurts to biting for more than 10-14 days it might have what is called cracked tooth syndrome.  It is cracked, but just hasn't broken off.  We will make sure that this is the problem, and if it is, a crown is the best way to keep it from breaking.

As we get older we accumulate cracks in our teeth.  These cracks often will be visible as a dark line on the tooth.  Everyone over the age of 40 has numerous cracks in their teeth.  But if there isn't any discomfort when biting, there is no reason to crown the tooth.  Is it a weak point in the tooth?  Somewhat. But the vast majority of these will not break, so suggesting a crown would be unnecessary.

What is the procedure for getting a dental crown?

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  • If the tooth has been fractured or had a root canal treatment, it will first need to have a buildup -- a filling that restores enough of the tooth for the crown to hold onto.
  • Then the tooth is reduced down to make room for the crown; the crown has to have the same shape and size as the tooth it will replace.
  • An impression is made of the prepared tooth with a material that has the consistency of peanut butter. This impression is sent to the dental lab and they will make a model of that area of your mouth.
  • A temporary crown is made from a resin or acrylic material using a molding or stentof the original tooth. This temporary crown is cemented with temporary cement so that it can come off easily once the permanent crown is ready.
  • Usually two weeks after that appointment, you will return for a second visit. During this visit, the tooth will most likely need to be numbed again and the temporary crown is removed. The permanent crown is placed on the tooth and inspected for acceptable fit, bite, and smooth margins. After any necessary adjustments have been performed, the crown is cemented with a permanent cement or dental glue.
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Dental Crowns in West Des Moines, Iowa

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