Dental crowns

What it is

A crown covers the whole visible part of a tooth, down to the gumline. It holds a weak tooth together the way hoops hold a barrel together, so the tooth is less likely to crack further when you bite.

Crowns can be made of porcelain, zirconia (a very strong ceramic), metal, or porcelain fused to metal. Your dentist will suggest a material based on where the tooth is, how hard you bite, and how much it shows. Ceramic crowns are shaded to match your other teeth.

Who it helps

A crown may help if a tooth:

• is cracked, or has a large piece broken off
• has a filling so big that little natural tooth is left around it
• has had a root canal (treatment for the inside of the tooth), especially a back tooth
• is badly worn down from grinding
• needs to hold a bridge, or sits on a dental implant

A cracked tooth can look fine but hurt sharply when you bite down or let go. Your dentist can test for this kind of crack.

What happens

A crown usually takes two visits, a few weeks apart.

1. Numbing. We numb the tooth and the gum around it. You’ll feel a small pinch, then your lip, cheek, or tongue will feel thick and heavy for a few hours.
2. Shaping the tooth. Your dentist removes any decay and trims a thin layer from the top and sides so the crown has room to fit. If a lot of the tooth is missing, it’s first rebuilt with filling material. Most people feel vibration and pressure, but not pain.
3. Impressions. We take an impression (a mold or a scan) of the shaped tooth and the teeth around it, and match the shade. A dental lab uses it to make your crown.
4. A temporary crown. You’ll leave with a plastic crown that protects the tooth while the lab works. Its cement is weak on purpose, so it can come off easily later. Avoid sticky foods, and chew on the other side.
5. Fitting the new crown. At the second visit, your dentist removes the temporary, checks the fit and color of the new crown, and adjusts your bite. Then the crown is cemented in place. Some people need numbing for this visit; others don’t.

Recovery and aftercare

Wait until the numbness wears off before you eat. Your gum may be sore and the tooth sensitive to cold for a few days. Call the office if your bite still feels high after that, or if the ache grows instead of fading.

Care for a crown the way you care for your other teeth: brush twice a day and clean between your teeth once a day. The crown can’t decay, but the tooth under its edge still can. If you grind your teeth, a night guard can protect your crown.

Cost and insurance

The cost of a crown depends on the material, which tooth it’s on, and whether the tooth needs other work first, such as a build-up or a root canal.

Many dental plans treat crowns as major care and pay a smaller share than they do for fillings. Most plans also have a yearly maximum, and many won’t pay for a new crown until the old one reaches a certain age. A pre-treatment estimate from your plan can tell you what to expect. To spread out what’s left, see insurance and financing.

Alternatives

• A large filling or an onlay. These keep more of your natural tooth but protect it less, so they suit teeth with less damage. An onlay covers part of the chewing surface.
• Removing the tooth. If a tooth can’t be saved, it can be taken out and replaced with an implant, a bridge, or a partial denture. Replacing a tooth is usually a bigger job than crowning it.
• Waiting and watching. If a crack is small and causes no symptoms, your dentist may suggest keeping an eye on it. The risk is that the crack grows, and a tooth that splits below the gumline often can’t be saved.