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Abused Dental Procedures Part 2: Crowns, Fillings & Root Canals

This is the second of two articles discussing common ways less than honest dentists can take advantage of patients. In the prior post, we discussed in some detail periodontal scalings which is commonly over-prescribed by dental practitioners. We have also discussed the importance of your right as a patient to get a second opinion or even a third opinion. While there is much in dentistry that is subjective, the reason for treatment must make sense to you as a patient and should be backed with objective research. I will follow up today with the remaining procedures that we see diagnosed by others but in truth, do not really need to get done.

Crowns:

Crowns (aka caps) are done very often in dentistry and for good reason. When older white or silver fillings begin to show signs of leakage, often times, the next progression for the restoration of the tooth is to do a crown. But not every restoration replacement requires a crown. Criteria for a crown include:

  1. The existing restoration shows signs of breakdown, leakage and recurrent decay under the filling. If your dentist has an intra-oral camera, have them take a photo so that you can see the breakdown of the restoration. You will see cracks, brown and black outlines around the tooth and sometimes a dark “halo” around the restoration. These are the signs of recurrent decay. If your dentist doesn't have an intra-oral camera, it’s time to change dentists.
  2. On the x-ray, the existing restoration should be large taking up over 60% of the tooth above the gum line. If it’s not a large restoration, chances are you don’t need a crown.
  3. A crown may be necessary if there is a pain when you bite into certain foods. This is a sign that your tooth may be cracking and propagating down to the nerve of the tooth. Placing a crown acts to keep the parts of the tooth together and evenly distributes the load forces associated with chewing preventing the tooth from splitting further.

Be wary about doing a crown if the existing filling is small or if you simply see cracks in a tooth without pain or existing restorations. Sensitivity to sweets can be a symptom to leaking restorations and/or decay but just because you don’t have sweet sensitivity, doesn’t mean you don’t have leaking fillings.

Fillings:

Fillings are done when there are areas of decay in the tooth. Basically, decay is a bacterial invasion of the tooth which continues to get larger unless the affected tooth structure is completely removed then sealed with a dental restorative material.

  1. Fillings usually need to be done if you feel sensitivity to sweets.
  2. They are done when there is less than 60% of the tooth surface is affected.
  3. On dental x-rays, you can see a triangular dark area in between the teeth which are not viewable during your clinical exam.
  4. If on the top of the tooth, a dental explorer may “stick” into the tooth, indicating a soft spot that decay has penetrated through.

The biggest misconception is that if the groves on the top of the teeth are brown or stained, that this a cavity which needs to be filled. The tops of teeth are naturally stained and this usually does not mean that they have cavities. If there is a “stick” with the explorer or radiographic evidence of decay, then these stains are probably decay which need to get treated and restored.

Root Canals

Intentional misdiagnosis of root canals is not nearly as common as the aforementioned diagnosis, but we see this from time to time so I thought I would quickly mention it here. Usually, a root canal needs to be done if you are in dental pain which can be attributed to a specific tooth. However, that is not always the case. There are times when a root canal needs to be done because there simply is not enough tooth structure above the gum line. You may have had pain on a tooth and suddenly it doesn't bother you anymore. This is often a sign of necrosis. The tooth can be saved, but a root canal must be done to remove the dead material inside the tooth. If you have doubts if your tooth needs a root canal, you should seek an opinion from a root canal specialist or endodontist.

Most dentists are honest professionals who really have the best interest of their patients at heart. However, it is always ok to get a second opinion and most dentists who are trustworthy welcome second opinions. Always follow your intuition and if something doesn't make sense to you, don’t move forward with the procedure. Getting dental work done is time-consuming and expensive. Make certain that it is something you need done before moving ahead with the treatment.

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