Crowned tooth decay

[WonkyToothy]

Had a dental check up/clean this week and all was deemed well by dentist whom I've been attending for almost 2 years. However after I went home I noticed that eating felt strange around the area of a molar which has had crown for over 12 years. No pain but just felt like food was getting caught in that area.

A few days later I went back to the dentist who took a look and quite easily was able to pull the crown off.

On inspection he said that the tooth, which had had root canal treatment many years ago, was decaying. He cleaned it up and replaced the crown, which he says was originally poorly done, and advising that we should see how it holds up but may need to consider removing the tooth and an implant.

I presume that at my check up he should have seen evidence of a deteriorating/cracked crown requiring further investigation? His suggestion that diet/sugar etc is responsible for the decay doesn't quite hold up - is decay possible unless the crown is breached? Also, my general dental health is good - good diet, brushing, dental sticks etc, and I don't have decay elsewhere so it sounds as if the decay is due to a breach in the crown?

It feels as if a sticking plaster has been applied to the problem and I'm wondering how to go forward with this. Do dentists routinely check crowns at check up and do X-rays reveal issues? How will I know if there is not further decay happening in future? (since it seems to have been missed on this occasion). Will a quietly decaying tooth cause any bone issues, issues for surrounding teeth? Is it better to be just done with the tooth and go for an implant?

The dentist seemed to take a very casual approach to these questions when raised and said there was no point in worrying about it and that I had been dealt a poor hand with a badly done crown😒

It sounds like you are not happy/confident with your dentist and don't trust them, so probably better to move to another one.

I've been happy up until now but this incident has made me question his judgment.

Decay gets in when you haven’t been cleaning very well round the edge of where the tooth meets the crown or under the gum. It is actually very unlikely that the crown is cracked.
X-rays can help to spot decay

@RobinHumphries - I had X-rays just over a year ago, presuming they didn't reveal any issues. Dentist said next X-rays would be in 6 months.

Would evidence of decay not be present at my check up earlier this week? inflamed gums, any discolouration, nothing? I had the hygienist right after the check up and she did a clean and said gums and everything looked well.

I expect that sometimes things will be missed but it is unsettling that at my revisit the dentist immediately assessed that the crown was loose, pulled it off and could see the decay. Yet no tell tale signs to him or the hygienist a few days earlier?

What was the tooth like originally under the crown? The difficulty with a root canal and then crown is you’re unlikely to feel any problems as the nerves have been removed. An X-ray will definitely show bone loss if any has occurred. Have another X-ray and see what he says.

As I said decay gets in in that small gap. It then can spread underneath the crown so it’s not easily visible. No it would not necessarily cause inflammation of the gum and and discolouration would be under the crown where it is not possible to see it.

@RudsyFarmer - I think it would have been reasonable for him to suggest having x rays now rather than wait 6 months as originally planned just to see what's happening underneath, any bone loss etc. Of course, you expect to rely on professional judgment but he could see that I was unnerved by his findings and wasn't offering much other than cementing the crown back on and adopting a wait and see approach - apparently it could last another 5 years!

Second opinion sounds like a good idea.

Well the dentist has seen what the tooth is actually like now under the crown. An X-ray wouldn’t necessarily provide any new information.

@RobinHumphries - any possible issue of bone loss?

Not from tooth decay no. Bone loss is from gum disease

Decay under a crown is not always visible without xray, sometimes even just the cement loosens and the crown debonds

Xrays are indicated every 2 yrs, so you weren't at

Decay under a crown happens because of sugar in your diet. Bacteria can work their way under a crown and you therefore can get decay, lifespan is about 10yrs so the fact yours lasted 12 is fairly standard

You had xrays a year ago, bone loss is unlikely to have significantly worsened. The dentist will have checked for pocketing at youe check up. Bone loss and decay are not related, bone loss is related to your periodontal health

The dentist has acted appropriately and done the steps any dentist would do if presented with a debonded crown.

Bone loss may prevent you from having an implant.

My oh had a crown over a back tooth that had a root canal. The crown fell off so he superglued back on (yes really)

there was a bit of funky smell for a while but and we suspected a bad tooth we couldn’t see any decay (the crown was hiding it) . Then the crown fell off again with half the tooth stuck to it —- the superglue had held up but it turns out the tooth was decaying anyway and that’s why the crown had failed in the first place and it ended up rotting right through. No pain due to the root canal. Whole tooth ended up being pulled and it was hard and painful because half the tooth was missing so not sure why your dentist is waiting and seeing?

This had been missed on on X-rays and dentals but had clearly been going on for some time so I guess it may not have been visible on said X-rays.

i only suspected it cos of the smell and I don’t think I’d have smelt it if the crown had a tight seal (ie not superglued on)

The dentist has 1 Yr old xrays and will have checked OPS perio health, so know if she is at risk for bone loss. She's had perio treatment with the hygienist so is unlikely to have any calculus in that area

Decay does not cause bone loss. Its unlikely OPS perio health has worsenes significantly over the last year that doing an xray 6 months sooner will change. If she does have bone loss she's already had the appropriate treatment (hygenist), she's got good oral hygeine. She's not having an implant right now. An xray is not going to change the treatment plan and would be unnecessary exposure to radiation.

The dentist is waiting and seeing because it is the best option. The other option would be extraction and it’s not going to be pain free when ever that happens.

this is all very enlightening!

so essentially, not always obvious to the eye if decay is happening under the crown but x ray should pick it up.

hopefully he will have picked up if I had significant bone loss at last X-ray. Think I'm likely to go for implant if sufficient bone exists - can't be dealing with this uncertainty of what's happening underneath.

I have very good dental hygiene - electric toothbrush at least twice a day focusing on the gum line, tepee sticks, usually don't allow food to settle without a a quick run through with the sticks. It's hard to say about sugar in its very guises though...

The thread was moving on while I was posting!

@RobinHumphries "would be extraction and it’s not going to be pain free when ever that happens" 😓

@CarPoor yes.
Regardless of what you say, bone loss can prevent the use of implants. Yes?

"Whole tooth ended up being pulled and it was hard and painful because half the tooth was missing so not sure why your dentist is waiting and seeing?" Oh dear oh dear!!

Why are you so convinced there is bone loss when people have said that’s related to gum disease (not tooth decay)

Have you had radiation therapy on the head or neck area?

Yes. But there's nothing to indicate OP has bone loss and there's no reason to xray OP at this stage

So can bone loss prevent implants yes (although grafts exist). But given that OP is clearly anxious is that really relevant? No.

Yes. But there's nothing to indicate OP has bone loss and there's no reason to xray OP at this stage

So can bone loss prevent implants yes (although grafts exist). But given that OP is clearly anxious is that really relevant? No.

The dentist is waiting and seeing because they've removed the decay and recemented the crown. A treatment that will likely work but not necessarily, so you wait and see.

By nature most teeth are heavily broken down when extracted because you don't extract healthy teeth. Root canalled teeth are more brittle, extracting the tooth before the crown comes off won't make the extraction easier if the crown has failed.

She mentioned bone issues in her OP, hence my comment regarding bone loss and implants.