How Can Decay Be Prevented Under a Crown?

Question

What are dentists' most common treatment options for removing tooth decay under dental crowns? What procedures are the most involved? What do they require?

Scott Young, DDS · Answer

Once you have decay that starts under a dental crown the best long term solution is usually to replace the crown. If the decay present is VERY small and at the margin a composite material can be used to fill the area after the decay is removed. Keep in mind that many times this is a short term approach. I would say to replace the crown with a new all porcelain crown that can be bonded to your tooth. These crowns are less likely to get recurrent decay.

Victor Terranova, DMD · Answer

Hello,

To prevent decay under existing crowns, both dental cleanings and home care are super important. Once decay is detected under an existing crow, the usual procedure is to replace the crown, if possible. Sometimes the decay can be so extensive that restore the tooth is questionable. Your best bet would be to get to your dentist at your earliest convenience if you suspect decay.

Martin Gorman, DDS · Answer

If the decay is small it could be managed with flossing and proper hygiene visit and if it's bigger replacing the crown is probably the best solution.

Arthur Kezian, DDS · Answer

Recurrent decay can occur under fillings as well as crowns if the margins of the restoration are not sealed well and proper oral hygiene and home care is not being practiced by the patient. If recurrent decay has already occurred under a crown, it is best to remove the crown, clean out the decay and make a new crown that seals the tooth perfectly to prevent further tooth decay. An accurate final impression and a crown that seals the margins after having examined under a microscope by the laboratory technician can assure a more successful outcome and longer lasting restoration.

Martin Frankel, DDS · Answer

When we look at crowns with recurrent decay, we must take a number of factors into consideration.

	*  Is the decay extensive (deep) or shallow?

	*  Is the area of decay easily accessible to dental instruments?

	*  Can the dentist be sure to remove all the decay without removing the crown?

	The simplest solution is to place a small filling at the crown margin where the tooth and the crown meet to eliminate the decay and seal the crown, in order to prevent the decay from getting worse.  If the decay is too deep, or inaccessible it is best, although more complicated to remove the crown and place a new one after the decay is removed. 

	It's important to remember that when a tooth has a crown placed on it, it is because that tooth already has a history of being filled and refilled.  The reason to place the crown is to protect and fortify an already structurally compromised tooth.  If the decay under the crown is not treated properly and is allowed to progress, by the time it is properly dealt with, there may not be enough healthy tooth structure left to work with.

	Prevention is the best approach.  Brush your crown well, floss around it daily, and use a toothpaste that contains fluoride.  Be sure to visit your dentist for your regular active maintenance visits so that if a problem arises, it can be caught while it is a small problem and dealt with in a timely manner.

Elizabeth Jahanian, DDS · Answer

A crown that's cemented over a tooth should have good marginal seal to prevent bacteria from leaking in. Once bacteria are able to leak in, they will metabolize the sucrose from your diet and release an acid that will break down your tooth and cause decay. Therefore, the two factors to prevent decay underneath a crown are (1) closed margins around the crown, and (2) excellent oral hygiene. In many cases, the crown had good marginal seal, but due to poor oral hygiene decay developed. To treat this, the crown will be removed, the decay cleaned off, and a new impression will be taken to make a new crown. Be sure to brush and floss twice a day and use Listerine mouthwash which will kill the bacteria. Best, Dr. Elizabeth Jahanian

Dan Hagi, DDS · Answer

Once the decay process commences under a crown there are really only two options: 1) remove crown clean and disinfect the tooth and prepare tooth for new crown 2) if decay is in very accessible area, clean decay and restore tooth with a bonded filling. This option is very seldomly used as decay usually forms under margins between teeth which are not very accessible. The best ways to prevent decay under crowns: 1) have well fitting crowns with tightly sealed margins preformed by a well trained dentist 2) practice great oral hygiene by brushing and flossing between teeth and under bridges 3) attend regular professional cleanings and checkups 4) use toothpaste and mouth rinses that contain fluoride, this may help in strengthening tooth enamle and preventing decay.

Keith Blankenship, DDS · Answer

Believe it or not, decay can easily be prevented. Make sure you are seeing your hygienist on a regular basis first of all. Next, you need to make sure that when you are brushing (twice a day atleast), you need to brush at the edge of your gum tissue where it meets the tooth in order to clean the margin of the crown. This is the area where cavities begin with crowns. Also, use a fluoride tooth paste. If you are "prone" to getting cavities, use a prescription toothpaste which has 5 times the level of fluoride.

James Merrett, DDS · Answer

The best way to prevent decay under a crown is proper oral hygiene. Most people are great brushers, but not great flossers. Many times people get decay under a crown due to food not being removed from around the crown, giving the bacteria a perfect breeding ground. If you have an area that is trapping food, it is best to see your dentist to get that area evaluated. I would go over oral hygiene instruction with your hygienist or dentist to protect your investment of your crown, and the rest of your teeth. I believe that is the best way to prevent decay underneath a crown.

Michael Ayzin, DDS · Answer

First of all, I want to thank you for asking great questions. One needs to understand that normally there is a lot of bacteria, which can cause decay, in the mouth at any present time. By following very simple, and extremely important directions of: proper home care AND seeing a hygienist on regularly scheduled cleaning appointments, amount of bacteria can be minimized and decay can be prevented.

	In case decay has already started, unfortunately, the crown probably needs to be changed. There is no sure way for a Dentist to know if ALL the decay is being removed without direct vision under the crown.

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