Dr. Noah's Dentistry Blog

Questions About Dentistry Answered

Archives for January 2021

Should Porcelain Crowns Be Ground Down?

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Earlier this year, I had porcelain crowns put on my two front teeth, but one of them came loose and fell off. I went to my dentist, and he cemented the porcelain crown back on my tooth and then ground down the porcelain to correct the bite after it was placed. It wasn’t even a week later when the backside of my crown broke off where the dentist had ground down the porcelain. What would your opinion be? Does grinding down the porcelain crowns weaken them?

– Rachel from New Mexico

Rachel,

First, I’m going to assume that you’re talking about an all-porcelain crown. With a porcelain-fused-to-metal crown, the crown wouldn’t break if it was ground too much—it would just be ground down to the metal, which wouldn’t be a problem on the back side of a front tooth.

When a dentist puts on a new porcelain crown, they will sometimes have to adjust the crown to your bite and will sometimes do that by grinding it down a little. That isn’t that uncommon and should be nothing to worry about. With that being said, something isn’t right with your experience. These things bother me:

  • The first thing is that your crown shouldn’t have come loose. Something was done wrong for a new permanently cemented crown to fall off so soon. There are dentists who never have permanent crowns just fall off. If they’re properly prepared and properly cemented, that should be a very rare event.
  • Second, your dentist should’ve adjusted your bite right away after the first placement. It is odd, and something must’ve gone wrong that the bite needed to be adjusted after it was recemented. If your bite felt okay after the first placement, the only explanation I can think of for the adjustment after recementing is that the recemented crown wasn’t put on straight.
  • Third, the only reason that the back of the crown would break off would be if they ground the porcelain so much that it made it too thin. That could happen if the tooth wasn’t prepared properly—not enough space was allowed for the porcelain. Or, as I mentioned above, the crown wasn’t fully seated the second time.

Of course, you’re going to need a new crown, but I would recommend that you go to a different dentist for the procedure. It concerns me that your dentist couldn’t get this right, and I would definitely ask for a refund. Unfortunately, you did not get what you paid for.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Root Canal Gone Wrong!

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My husband coaches my son’s basketball team, and while coaching, he fell, which caused his front two teeth to fracture. He went to the dentist and ER that day, but the dentist wanted to wait for 2 weeks before treating him. Within 2 weeks, his right front tooth was starting to discolor, but no pain. He wasn’t treated, just fitted for temporary crowns that were placed 3 weeks later.

He had an emergency root canal 2 months later because of his severe pain and was given amoxicillin for 5 days. This offered him some pain relief, but after 24 hours, the pain returned up to his nose with a cold sensation.

2 weeks later, he had a root canal on his left front tooth, which caused no pain relief and was most likely an unneeded root canal.

We went to an oral surgeon to get a second opinion, and he recommended Augmentin TID for 7 days with Medrol Dosepak. Within 5 days, the cold sensation had resolved, and he was pain-free for the first time in 3 months! However, within 24 hours, the pain returned at about 50%.

I am a Nurse Practitioner, and my pharmacist friend recommended a 2-week taper of prednisone and my neighbor thought maybe the tooth fractured at the gum line. The dentist did see a black spot on the x-ray but said it was nothing. My husband has been suffering from pain for months; what would be the recommended next step? Do you think it would’ve been better if the root canal had been performed right away? Could the tooth be saved, and should he need an extraction, would you recommend implant next to permanent crown or bridge?

– Jodi in Michigan

An adult male grimacing in pain has he holds his cheek

Jodi,

The nice thing about doing the root canal right away is that there is less chance of post-operative complications because infection wouldn’t have settled in yet. They would just need to clean out the dead tissue and leave the tooth open for a couple of days before sealing to ensure there aren’t any flare-ups. The dried blood would be an indication the tissue inside the tooth was dead.

I’m very confused on why they would prescribe Amoxicillin for only 5 days. Doing things the way you stated would leave a fairly substantial risk of a flare-up. Also, Amoxicillin would not typically be the first choice of antibiotic for this type of tooth infection, and a 5-day course would not be enough to clear up the infection.

My recommendation would be to see a root canal specialist; it is always good to see someone who has the specific training needed. There are many of your dentist’s treatment choices that I disagree with, and it sounds like a lot of his treatments were guesses. It’s important to have an endodontist look at the x-ray and figure out what is really going on.

Your husband shouldn’t need his tooth extracted as there are several options for correcting the root canal if it wasn’t sealed properly. I would also recommend Clindamycin for antibiotic therapy.

I hope your husband’s pain is resolved quickly! Take Care.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.