Crowns on front teeth

My 15 year old son had a bicycle accident, which chipped his front two teeth. I was thinking about getting veneers put on his teeth, but when I took him to the dentist today, he said it was better to place crowns on the teeth. I thought it best to get a sort of second opinion, so I’m writing your blog.

Pauline- Texas

Pauline,

My opinion is to not put crowns on his front teeth. Crowns will require his teeth be filed down to stubs. On a 15-year old, the teeth are very young with a large pulp inside. Since crowns require the removal of a considerable amount of tooth structure, there is a very real risk that the dentist would run into the pulp, which would kill the pulp and mean that the tooth would also need a root canal.

For something like chipped front teeth there are two more conservative options: The most conservative is dental bonding. Though if you have this done, you need to be sure that your dentist is artistic enough to do this work, because it involves shaping and tinting the restoration freehand. The advantage is that it wouldn’t require the removal of any additional tooth structure.

Another option would be porcelain veneers placed on his two front teeth. The dentist would shave off about half a millimeter of the enamel on the front of the each of these two front teeth and place porcelain veneers.

I suspect that your dentist recommended crowns because he is not comfortable with doing either direct dental bonding or porcelain veneers. They require specialized cosmetic dentistry techniques that most dentists aren’t familiar with. But I would definitely discourage doing the crowns on a fifteen-year old.

This blog is brought to you by Boston Cosmetic dentist Dr. Randall Burba.

 

Discolored Root Canal Tooth

I had to get a root canal about two years ago because of an inflamed nerve. The tooth has turned an ugly yellow color, which is making me very self conscious. My dentist told me that whitening it will weaken the tooth. What are my options?

Nancy G.- Alabama

Nancy,

Ideally, it would have been best to prevent the discoloration to begin with, though this is not your fault. Many dentists aren’t aware that if you carefully remove all root canal filling materials and cements from the inside of the crown of the tooth, the tooth won’t discolor for maybe ten years. We are seeing cases, where the dentists didn’t do this and discoloration is starting even within the first year.

However, now you’re stuck with this discolored tooth, so let’s figure out your options. Your first option is teeth whitening. If you bleach only the crown of the tooth, and prevent it from getting to the root, then your teeth will not be weakened, but you’ll have to make sure ahead of time your dentist knows how to accomplish that.

Your next options are to either get a porcelain crown or a porcelain veneer. I am guessing you’d want the more conservative treatment. In this case, as long as there are no large fillings in the tooth, that would be porcelain veneers. They will actually leave the tooth stronger. You would only need one veneer, unless there are other things you want to change about your smile. A dentist may try to suggest there really needs to be two of them, but that is not the case and reflects a lack of confidence on  the dentists part of how to match the color and translucency.

If there are other issues with the tooth, such as fillings, then it might be preferable to do a crown. With porcelain crowns, you have to shave the tooth down quite a bit, so if the tooth is otherwise healthy, this would be my last choice.

With either of the last two options, you’ll want to make sure to go to an expert cosmetic dentist. Matching another front tooth, and making it look natural takes a lot of artistic talent and technical expertise. Don’t just entrust this to your average family dentist.

This blog is sponsored by Boston Cosmetic Dentist, Dr. Randall Burba.