Dental crowns are custom-made caps placed over a damaged tooth to restore its strength, shape, and appearance. While crowns offer significant protection, decay can still develop beneath them. Understanding how this happens and what to look for can help maintain oral health.
Mechanisms of Decay Under Crowns
Decay can develop underneath a dental crown through several pathways, as the natural tooth structure beneath the crown remains susceptible to bacterial activity. Marginal leakage is a common mechanism, occurring when the seal between the crown and the tooth degrades over time. This creates microscopic gaps, allowing bacteria, food particles, and saliva to seep into the space, fostering an environment where decay can thrive.
An improper crown fit also contributes to decay. If a crown does not perfectly fit the tooth margin, small spaces are left where bacteria can accumulate and initiate decay. Decay can also originate from pre-existing decay not entirely removed during the initial crown preparation, or form at the margins of existing fillings under the crown.
Over time, the materials used for the crown or the bonding agents can degrade, further compromising the protective seal. Inadequate oral hygiene also plays a significant role. Neglecting consistent brushing and flossing, especially around the crown margin, allows plaque and bacteria to build up. These bacteria produce acids that attack the tooth enamel, leading to decay underneath the crown.
Recognizing Signs of Hidden Decay
Identifying decay under a dental crown is challenging as it is often hidden from view. However, several signs may indicate a problem. Increased sensitivity in the affected tooth, particularly to hot, cold, or sweet foods and drinks, is a common indicator, often manifesting as a dull ache or sharp, throbbing pain.
Pain when biting down or a persistent toothache in the crowned tooth can also signal underlying decay. Patients may notice bad breath or an unpleasant taste from the area. Visible changes can also occur, such as darkening or discoloration around the crown margin or the tooth itself.
A crown that feels loose or wobbly is another significant sign, as decay can weaken the underlying tooth structure, causing the crown to lose its secure fit. Food particles or floss getting caught between the crown and the tooth more frequently can also suggest a compromised seal. If any of these symptoms appear, consult a dentist promptly.
Addressing and Preventing Decay Under Crowns
Addressing decay under a dental crown begins with a thorough evaluation by a dental professional, often involving a dental exam and X-rays to assess the extent of the damage. Treatment approaches vary depending on the severity of the decay. For minor decay, the crown might be removed, the decayed area cleaned and filled, and then a new crown placed. If the decay has reached the tooth’s inner pulp, a root canal may be necessary to save the tooth. In severe cases where the tooth is extensively damaged or infected, extraction might be the only option.
Preventing decay under crowns involves diligent oral hygiene and regular professional care. Maintaining excellent oral hygiene includes brushing twice a day with fluoride toothpaste, paying close attention to the area around the crown and gumline. Daily flossing is important to remove plaque and food particles that accumulate between teeth and around the crown margins. Using an antimicrobial or fluoride mouthwash can further reduce bacteria and strengthen enamel.
Regular dental check-ups and professional cleanings are essential for early detection and prevention. Limiting sugary and acidic foods and drinks helps prevent decay, as these contribute to an environment conducive to bacterial growth. Avoiding hard or sticky foods protects the crown from damage. For individuals who grind or clench their teeth (bruxism), wearing a nightguard can protect the crown and underlying tooth from excessive force, preventing seal compromise and loosening.