What are the disadvantages of dental crowns?

Jonathan B. Levine, DMD
There is a disadvantage to getting dental crowns. Any time a tooth gets prepared for a crown, there is always the possibility of unnerving it, which means causing severe damage to its nerve, which usually requires a root canal.
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Dental crowns, also called “caps,” may have several disadvantages:
  • Crowns, which are used to cover damaged or decayed teeth, will not protect you from developing gum disease (gingivitis or periodontitis). Crowns can only protect the teeth that they cover from further damage or tooth decay.
  • Crowns may become chipped, especially the ones that are made of porcelain. If there is a lot of chipping, or if you have to keep coming back for many chip repairs, your dentist may suggest a replacement crown.
  • A crown that doesn't fit correctly over your tooth can lead to tooth decay, if the cement that attaches the crown to your tooth washes away and bacteria invade the space between the crown and your tooth.
  • Sometimes crowns can fall out, either because the cement has washed away over time or because the crown does not fit correctly and is too loose. In these cases, you should put the crown in a plastic bag and see your dentist. In most cases, your dentist will probably suggest making a new crown instead of re-using an old or poorly fitting crown.

Crowns involve the removal of tooth structure. The removal of tooth structure is traumatic to the tooth, and the nerve inside of the tooth needs time to heal after teeth are prepared for crowns. Sometimes, the nerves of the tooth do not heal, and the tooth abscesses. If there are more conservative treatments such as bonding and fillings, these should be considered before deciding on crowns. Younger patients have larger pulps inside the teeth, and these pulps contain the nerves. It is generally recommended that crowns not be placed on younger patients until they are 18 years old because of this. Your dentist can advise you on what treatment would be best for your teeth.

If a crown is indicated the advantages certainly outweigh the disadvantages in that a crown provides a more secure restoration than a direct filling, and it thereby helps to prevent fracture of a tooth with extensive fillings and weak cusps.

Disadvantages include:
  • cost
  • preparation of the crown portion of the tooth
  • potential sensitivity and/or need for root canal treatment
  • potential for recurrent decay
  • potential for crown remake at some time in future
  • gum recession from crown margin
  • change in color of natural teeth which will then not "match" color of crown
  • fracture of porcelain
These are some of the risks that must be accepted prior to having crown services performed. Some of these risks, such as 2, 3 and 4, may occur even if a crown is not placed.
The fact that the tooth needed one in the first place. It is better to not need get into the situation where you need a crown. (Mother nature's original product is usually better than the man-made ones.)

While crowns can save teeth, it does mean more effort from the patient in maintaining them. The crown circumscribes the tooth -- anywhere along the circumference where the crown meets the tooth (called the margin) is a possible entry point for decay. If the margin isn't sealed well or the patient doesn't/can't keep it clean, you risk getting a cavity under that crown.

Crowns are usually an investment of time and money from both the patient and the doctor. It is important to evaluate the prognosis of the tooth before putting a crown on it.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.