Crowns and Root Canals:

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Are these two procedures related? Many of you have questions about it. I am frequently asked “Do I need root canal with my crown?”

Unfortunately the answer is not just “yes” or “no. It’s not quite that simple.

You don’t need to have a root canal before a crown just because you are having a crown. There are reasons why you may need it before and reasons why you may need it after the crown.

Crowns are not done on healthy and asymptomatic tooth. They are indicated in the following conditions :

1) Tooth with extensive decay where a good portion of the tooth has rotted away leaving less remaining tooth.

2) Tooth with a moderate to large ‘filling’ has decay around and underneath it.

3) Broken tooth (with or without filling)

4) Tooth with very prominent or extensive fracture lines, especially if sensitive.

5) Very sensitive tooth that cannot be managed by other means.

It become obvious from above that crowns are done to prevent complete breakage or separation at the fracture line or to control sensitivity. Tooth weakened by large decay or large filling and very prominent fracture(s) need crown to reinforce the integrity of the tooth.

Let’s see when root canal is indicated.

1) Extensive decay close to the pulp (nerve) of the tooth.

2) Crack in the tooth extending to the pulp.

3) Broken tooth (depending on the amount and location).

4) Sensitivity that cannot be managed by other means.

5) Teeth with necrotic pulp due to injury/insult. Teeth turn gray/black color over time when hit during accident, fight, contact sports etc.

As you can see the circumstances that prevail requiring crown is very similar to that needing root canal. Fortunately, most of the time crowns don’t require root canal if done in a timely manner.

* 5-10% of cases may require root canal before crown. Even fewer need root canal after the crown is placed. Yes, you read that! After crown is done, either right after or sometimes months after the crown is done.

Root canal is not done because you are about to have a crown or because you just had a crown done. It’s the condition of the tooth before the crown that determines the need for it. Before or After.

Root canal before your crown:

When would you need root canal before your crown? Here’s when…

1. Decay extends in to the pulp/nerve.

2. Tooth broke in to the pulp/nerve.

3. Constant sharp/throbbing pain.

4. Pain on biting down.

5. Tooth that are extremely cold/hot sensitive.

…in other words whenever the integrity of the pulp/nerve has been breached either physically by a broken tooth, fracture or by bacteria.

Root canal after your crown:

When would you need root canal after your crown? Here’s when…

1. Decay that extends very close to pulp but not into it at the time of filling.

2. Tooth broke very close to pulp but not into it.

3. Dull pain which is not constant but intermittent.

4. Pain on biting is present only sometimes.

5. Tooth has been sensitive intermittently to hot/cold.

…in other words the integrity of the pulp/nerve cannot be clinically confirmed to have been breached but is suspected to be compromised or weakened by trauma or bacteria. It is a matter of time when some or all symptoms of pain will return. This could be in weeks, months or even a few years!