A dental crown is a custom-made cap placed over a damaged tooth, designed to restore its shape, size, strength, and overall appearance. While crowns offer significant protection, the natural tooth structure underneath remains susceptible to decay. This means, despite the protective covering, a tooth can indeed rot under a crown, making ongoing oral care just as important as before.
How Decay Develops Under a Crown
Decay can develop under a crown primarily due to a compromised seal between the crown and the natural tooth. Microscopic gaps can form at the crown’s margin, allowing oral bacteria, along with food particles and sugars, to seep underneath the crown. Once beneath the crown, these bacteria produce acids that erode the tooth enamel and dentin, leading to decay.
Secondary decay forms at the very edge of the crown, often visible near the gum line. This type of decay typically results from inadequate oral hygiene around the crown’s margin, allowing plaque to accumulate and bacteria to flourish. These bacteria then produce acids that break down the tooth structure adjacent to the crown. In some instances, if any decay was not completely removed before the crown was placed, or if microscopic decay existed, it can continue to progress unnoticed.
Recognizing the Signs
Recognizing the signs of decay under a crown can be challenging because it is often hidden from direct view. A person might experience increased sensitivity to hot, cold, or sweet foods and beverages, indicating nerve irritation. Pain when biting or chewing can also signal an issue, suggesting pressure on the underlying tooth or inflammation.
Swelling or tenderness around the gum line of the crowned tooth can indicate an infection or inflammation beneath the crown. While less common for decay under the crown, a visible dark spot or hole near the crown’s margin could be a sign of secondary decay. Persistent bad breath or an unpleasant taste in the mouth may also point to bacterial activity. If the crown begins to feel loose, it could be a sign that decay has compromised the underlying tooth structure.
Preventing Decay Under a Crown
Maintaining excellent oral hygiene is essential for preventing decay under a crown. Brushing twice daily with a fluoride toothpaste helps remove plaque and food debris from all tooth surfaces, including around the crown. Flossing or using interdental brushes around the crown’s margins is equally important to clean areas where plaque can easily accumulate.
Regular dental check-ups are also important, as dentists can conduct professional cleanings and examinations. These visits often include X-rays, which are crucial for detecting decay that might be hidden beneath the crown. Limiting sugary and acidic foods and drinks reduces the fuel for decay-causing bacteria and minimizes acid attacks on tooth structure. Addressing habits like bruxism, or teeth grinding, is also important, as the excessive force can damage the crown’s seal and create pathways for bacteria.
Addressing Decay Under a Crown
When decay is suspected under a crown, dentists use a combination of clinical examination and X-rays for diagnosis. X-rays are effective in revealing decay that has formed beneath the crown or between teeth. Once diagnosed, treatment depends on the extent of the decay.
For smaller areas of decay, the existing crown is removed to access the affected tooth structure. The decay is then excavated, and the tooth is restored, often requiring a new crown. If the decay has advanced significantly and reached the tooth’s pulp, a root canal treatment may be necessary to remove the infected tissue and save the tooth. In severe cases, where the tooth structure is extensively compromised or the infection is untreatable, extraction may be the only option.