Replacement of Dental Crowns?

[SunnyOne]

I had a dental exam this morning with a new dentist who appears conservative and not overly aggressive with suggested work needed.

At the conclusion of the exam, she gave me a run down of the issues she found in my mouth (and some of these are obvious and not a surprise) and ranked them in order of priority.

At the bottom of the list, lower priority, she mentioned two older crowns (both are at least 20 years old, probably older) that should be replaced since the gums have receded around these teeth and now the underlying natural tooth portion that still remains is now above the gum line - she says that this makes these teeth now susceptible to decay - but she did not find any decay yet.
To my mind - this sounds like a nice to have - but then maybe the decay could lead to me needing a root canal somewhere down the road?
Nevertheless, I plan to have fixed the other more pressing issues - but I was curious if any um...other middled aged people here - have experienced gum recession around a crown and their dentist recommended pre-emptively replacing it?
The good news is that my periodontal health is good.

 

[Dash man]

Yes, I had two replaced this year. They were my two upper front teeth and it was pretty obvious, so I chose to have them done,

 

[Mark1]

For what it worth, I have ~ 4 crowns (maybe 3 more that are inlays so the number is unclear to me) that are now maybe 20-30 years old and I have never gotten advice to replace. I doubt mine all go down below the gum line, as well.

I agree that decay is possible, but isn't it also possible on your uncrowned teeth near the gum line

 

[braumeister]

"susceptible to decay"?
Well, aren't all your teeth in that category?

In this case, I think "If it ain't broke, don't fix it."

You have no way of knowing what might be found when that old crown is taken off. It's entirely possible that it could lead to some very expensive work that could be avoided by simply waiting until it really becomes necessary to replace it.

 

[razztazz]

Keep brushing properly and often and don't eat too many sweets and it will avoid decay. At least for a long long time just like all your other teeth.

 

[Freedom56]

I had one replaced this year that was over 25 years old. It is probably a good idea to so so. If it start decaying under your crown you can risk fracturing your tooth to the point where they have to do an extraction and your option at that point is a dental implant which is far more expensive.

 

[OldShooter]

No reason to not get a competent second opinion. Do you have a university dental school within range? Maybe they can give you an appointment or a referral.

 

[zinger1457]

At the bottom of the list, lower priority, she mentioned two older crowns (both are at least 20 years old, probably older) that should be replaced since the gums have receded around these teeth and now the underlying natural tooth portion that still remains is now above the gum line - she says that this makes these teeth now susceptible to decay - but she did not find any decay yet.

I have a similar problem with two molars and my dentist recommended against replacing the crown unless it becomes an issue. They aren't visible so not a cosmetic issue.

 

[SecondAttempt]

I have a similar problem with two molars and my dentist recommended against replacing the crown unless it becomes an issue. They aren't visible so not a cosmetic issue.

My insurance company will pay to replace a crown after 5 years so I understand they do have a lifetime. I have one that is about 20 years old. My previous dentist who just retired suggested replacing it but low priority. I have no other work scheduled and he did not suggest actually scheduling the replacement, just suggested keeping an eye on it. His reason was similar to what you were told, the gum is not against the crown. He says he can't tell if it was a poor fit originally or gums have receeded. But it is only that one.

New dentist who took over, who I posted elsewhere I don't really like, said it should be scheduled but not urgent.

Seems like I got advice consistent with what you were told for a similar issue.

 

[SecondAttempt]

I agree that decay is possible, but isn't it also possible on your uncrowned teeth near the gum line

I am not a dentist but as it was explained to me, when the gum is not covering the base of the crown it can leak and decay can start on the part of the tooth left to create the post for the crown and can proceed rapidly.

 

[Luvtoride]

I am not a dentist but as it was explained to me, when the gum is not covering the base of the crown it can leak and decay can start on the part of the tooth left to create the post for the crown and can proceed rapidly.

Exactly right. At least OP dentist pointed this exposed tooth issue out.
I had to have a root canal this year on a tooth that had an old crown on it. The root canal is done right thru the existing crown leaving a HOLE in the crown and tooth which can bring decay and requires a new crown anyway.
When I went back to my dentist for the crown a few months later (I waited because I had another more pressing crown done earlier this year) and she removed the old crown, she found addl decay on the tooth. She removed this decay before taking the impression for the new crown.

I guess it’s a gamble…”either pay me now or pay me later” including the cost of a root canal.
Good luck.

 

[Sunset]

I had a tooth where the gum had receded, the dentist just filled in the area of the exposed tooth with the white filling material.

Why couldn't the dentist fill in the exposed area ?

 

[Irishgirlyc58]

Not only a gamble on the cost of additional treatments but I’d be concerned about being in pain from a potential infection, or whatever.
Prevention is cheaper in many different ways.

 

[FLSUnFIRE]

Did the dentist recommend replacing all your teeth with crowns as the tooth becomes more exposed as your gums recede? If the margin is good between the tooth and crown I see no reason. Maintain good hygene and keep an eye on the crowned teeth as you would all your teeth. If the dentist replaces the crown they'll grind down the non decayed portion of your teeth. Conservative is best IMO. For my molars that need crowns I got/get (hopefully done!) gold and plan on them lasting longer than me (47 now but no reason they cannot last 50+ years).



I get a cleaning and fluoride treatment 2x/yr, exam once a year, daily flossing and brush 2-3x day and use a fluoride rinse. After dealing with pathology due to teenage/young adult bad habits (little flossing, lots of soda), I have had few problems in the last 10 years. I'm conservative on surgery but relentless in prophylaxis.... at least I learned from my youthful mistakes.

 

[troutnut1]

You’re lucky so far. My wife’s dentist sent her to an oral surgeon who eventually performed 2 implant surgeries. One required a sinus floor lift surgery first. Both required bone graft surgeries prior to implants. Finally the surgeon installed two titanium posts. Then covered them over while they healed. Eventually he uncovered them. Then back to the dentist to have crowns made for the posts. All done now. Total cost was about $15,000 and about a year. This is becoming so common that ads showed up for it here while I was typing this.

 

[SecondAttempt]

You’re lucky so far. My wife’s dentist sent her to an oral surgeon who eventually performed 2 implant surgeries. One required a sinus floor lift surgery first. Both required bone graft surgeries prior to implants. Finally the surgeon installed two titanium posts. Then covered them over while they healed. Eventually he uncovered them. Then back to the dentist to have crowns made for the posts. All done now. Total cost was about $15,000 and about a year. This is becoming so common that ads showed up for it here while I was typing this.

I got an implant, needed a bone graft. Total time was about a year. But total cost all in was about $5000. Seems like there is a huge variation in cost of implants out there!

 

[Alan]

At the bottom of the list, lower priority, she mentioned two older crowns (both are at least 20 years old, probably older) that should be replaced since the gums have receded around these teeth and now the underlying natural tooth portion that still remains is now above the gum line - she says that this makes these teeth now susceptible to decay - but she did not find any decay yet.
To my mind - this sounds like a nice to have - but then maybe the decay could lead to me needing a root canal somewhere down the road?
Nevertheless, I plan to have fixed the other more pressing issues - but I was curious if any um...other middled aged people here - have experienced gum recession around a crown and their dentist recommended pre-emptively replacing it?
The good news is that my periodontal health is good.

I’m in the same position. An old crown of 30+ years and I had a dentist over 10 years ago who was keen on replacing it but I refused as it was causing no issues. My latest dentist of 5 years ago also commented on it but said that if it ain’t a problem to me then he would just monitor it.

 

[Koolau]

Yep, just had an old crown replaced this summer. Same issue of receding gum line exposing the tooth. I probably could have said "no" but I tend to trust my dentist as I've been seeing him for 40 years. YMMV

 

[RetireBy90]

I had one replaced this year that was over 25 years old. It is probably a good idea to so so. If it start decaying under your crown you can risk fracturing your tooth to the point where they have to do an extraction and your option at that point is a dental implant which is far more expensive.

This happened to me, old crown and decay was not found but the underlying tooth broke and had to be removed.

 

[athena53]

I got an implant, needed a bone graft. Total time was about a year. But total cost all in was about $5000. Seems like there is a huge variation in cost of implants out there!

Yes, but Troutnut's wife needed a sinus lift surgery first. My implants have been running about $5K each, with bone grafts, too,

A few of my implants have been due to decay under a crown that wasn't detected till it was too late- harder to see on X-rays.

 

[pacergal]

I had a tooth where the gum had receded, the dentist just filled in the area of the exposed tooth with the white filling material.

Why couldn't the dentist fill in the exposed area ?

Same thing with me, had a small receded area filled, actually, more than once, as it fell out after a few years. The filled in area allowed me to go several years before I needed a replacement crown.

 

[accountingsucks]

Not sure if this is the spot for dental queries but here goes. Nearly 50, teeth are in good shape, cleanings and checkup every six months. At cleanup last time six months ago dentist noted possible signs of clenching which I've never had before. We agreed to keep an eye on it and that mouth guard probably not needed. Fast forward to I guess 2-3 months ago and something felt off on one of my bottom right molars. No pain, no soreness perse...almost like my bite shifted. Only lasted two days didn't think of it again.

Two weeks ago that tooth had abscess. Dentist drained it and said would investigate further in two weeks as I was due for another checkup then. During this checkup/cleaning today I heard them saying that gum went from 2mm recession to 10mm in that six months. I do recall at some point biting on a kernel really hard and being abit sore next day. Possible crack? That molar does have 2 or 3 filings as my oral hygiene was not great in my teens

He has referred me to an endo in about four weeks. Best case scenario is root canal needed otherwise extraction. He thinks endo can save tooth but can't say for sure as he does not have I believe Cone Beam xray needed to investigate. My doctor friend told me to insist that the endo has microscope to check for crack and I called them and they do have that tech too. I will be fitted for mouth guard in 2 weeks by dentist as well.

I'm abit bummed out by it as I have good hygene and not really clear what has caused this. As far as I know my gum in that spot will always be receded. Is that correct? Sounds like in a previous reply in this thread they can fill that in?

 

[38Chevy454]

Not sure if this is the spot for dental queries but here goes. Nearly 50, teeth are in good shape, cleanings and checkup every six months. At cleanup last time six months ago dentist noted possible signs of clenching which I've never had before. We agreed to keep an eye on it and that mouth guard probably not needed. Fast forward to I guess 2-3 months ago and something felt off on one of my bottom right molars. No pain, no soreness perse...almost like my bite shifted. Only lasted two days didn't think of it again.

Two weeks ago that tooth had abscess. Dentist drained it and said would investigate further in two weeks as I was due for another checkup then. During this checkup/cleaning today I heard them saying that gum went from 2mm recession to 10mm in that six months. I do recall at some point biting on a kernel really hard and being abit sore next day. Possible crack? That molar does have 2 or 3 filings as my oral hygiene was not great in my teens

He has referred me to an endo in about four weeks. Best case scenario is root canal needed otherwise extraction. He thinks endo can save tooth but can't say for sure as he does not have I believe Cone Beam xray needed to investigate. My doctor friend told me to insist that the endo has microscope to check for crack and I called them and they do have that tech too. I will be fitted for mouth guard in 2 weeks by dentist as well.

I'm abit bummed out by it as I have good hygene and not really clear what has caused this. As far as I know my gum in that spot will always be receded. Is that correct? Sounds like in a previous reply in this thread they can fill that in?

From your description it seems your tooth cracked. The old fillings make this easier for that to happen. Probably too late for a crown on that tooth if cracked down below gum line, and looking at extraction and replacement for long term fix. The cracked tooth will not get better even with root canal.

You can get a DIY night guard kit that will help a lot and way less cost than the dentist one; as in $10-20 max. Search "bruxism mouth guard" and look on ebay or amazon for the DIY kit, it is basically a plastic mold that you put in hot water and then bite down to make impression. Then you trim excess off and it's done. Got that for my DW and it works good for her.

 

[Koolau]

Not sure if this is the spot for dental queries but here goes. Nearly 50, teeth are in good shape, cleanings and checkup every six months. At cleanup last time six months ago dentist noted possible signs of clenching which I've never had before. We agreed to keep an eye on it and that mouth guard probably not needed. Fast forward to I guess 2-3 months ago and something felt off on one of my bottom right molars. No pain, no soreness perse...almost like my bite shifted. Only lasted two days didn't think of it again.

Two weeks ago that tooth had abscess. Dentist drained it and said would investigate further in two weeks as I was due for another checkup then. During this checkup/cleaning today I heard them saying that gum went from 2mm recession to 10mm in that six months. I do recall at some point biting on a kernel really hard and being abit sore next day. Possible crack? That molar does have 2 or 3 filings as my oral hygiene was not great in my teens

He has referred me to an endo in about four weeks. Best case scenario is root canal needed otherwise extraction. He thinks endo can save tooth but can't say for sure as he does not have I believe Cone Beam xray needed to investigate. My doctor friend told me to insist that the endo has microscope to check for crack and I called them and they do have that tech too. I will be fitted for mouth guard in 2 weeks by dentist as well.

I'm abit bummed out by it as I have good hygene and not really clear what has caused this. As far as I know my gum in that spot will always be receded. Is that correct? Sounds like in a previous reply in this thread they can fill that in?

I can't answer your question about the permanence of your recession. But at one time, the dentist (hygienist, actually) noted some general recession - enough so that the dentist wanted to treat it. He had me use a high fluoride tooth paste which reduced the recession. My understanding is that it does not replace lost enamel (when it's gone, it's gone) but it does somehow fill in where enamel has been lost. I have just told you way more than I know, so YMMV.

 

[Koolau]

I have what my dentist (and I) think is a cracked tooth. Most of the time it doesn't bother me. The endo could NOT find anything wrong with it so dentist decided to wait. We've been waiting 5 years. No change. Occasional pain (very mlld) if I over-vigorously use my dental tape during flossing. (Pain scale 1 for an hour.) Dentist is puzzled. Otherwise, YMMV.