Category Archives: Crowns

Using porcelain fused to metal crowns

When is it OK to use porcelain fused to metal crowns?  My dentist wants to put one on my molar, but I thought that all-porcelain crowns were better.

Brady C.- Washington


All-porcelain crowns are generally best because of appearance issues. Porcelain-fused-to-metal crowns are made more opaque in order to cover the metal base.  They also tend to develop a dark line at your gumline.  That being said, there are two reasons to use porcelain-fused-to-metal crowns.

1. Porcelain-fused-to-metal crowns are stronger than all-porcelain crowns. The pure porcelain crowns are strong enough for your visible, front teeth. Though they can still hold up well on your first molar, the biting pressure is stronger there, so some dentists prefer to use a metal base.

2. The appearance issues generally disappear on your first molar. Unless you have a really wide smile, the issues with the metal based crowns will not be an issue.

This blog is brought to you by Cleveland Dentist Dr. Jay Goldstein.

Do I need a root canal?

I had a  crown fall off and I didn’t replace it right away. My  dentist says I have an infection now and he needs to pull the tooth. I’m a little concerned about the infection part. Shouldn’t I get a root canal treatment?

Alan L.- Benton, AR


I recommend you get a second opinion. If the tooth couldn’t be saved, your dentist should have told you why. It’s possible he or she is right and the tooth must be extracted, but maybe you could save the tooth by doing a root canal treatment and placing a new porcelain crown.

I don’t know how long you were without a crown. If it were a significant amount of time then your teeth could have drifted and a crown would not fit in the space any longer.

This blog is brought to you by Cleveland Cosmetic dentist Dr. Jay Goldstein.

My tooth chipped all the way through, do I need a crown?

I broke my tooth down to the gum line and it had a root canal last year. I have no pain with the tooth but did go to the dentist and he told me I needed a crown. I have a tight budget and really don’t want to spend the money. Is it really necessary to have the crown done?

Thanks Greg,

Dear Greg,

Having a root canal completed on a tooth without having the crown placed soon after is one of the reasons for the tooth breaking. When a root canal is done on a tooth the blood supply to the tooth is no longer present making the tooth brittle. For this reason, a dental crown is standard procedure after a root canal to preserve the tooth. Another reason to put a crown on the tooth is because you are leaving the tooth exposed and making it more at risk for a root fracture or reinfection. A fracture in the root leads to an extraction because the tooth cannot be saved at that point. If the tooth becomes reinfected your looking at another root canal. We advise you to have the crown completed to save your tooth from further damage and to save you more money in the future if the tooth becomes not savable.  If the tooth breaks further past the gum line you may not be able to have a crown at that point and the only option would be an extraction.

 Post courtesy of Dr. Goldstein, Cleveland Cosmetic Dentist


Dental crown pain with any pressure?

I had a dental crown fitted on a bottom back molar around a year ago and haven’t had any problems with it until now. I ate some ice cream last night and since then my tooth has been very painful when putting any pressure on the tooth like brushing and trying to eat. What’s going on with the tooth?

Thanks, Neal

Dear Neal,

Sorry to hear about your tooth pain. Due to the fact that your tooth has not caused any problem in the past until now there could be a possibility that the nerve of the tooth has an infection. However, it could also be referred pain from another tooth next to the one with the dental crown. Whenever tooth pain is experienced with pressure while eating it’s a sign that the nerve in the tooth is dying or that the bite may need adjusting. If the nerve of the tooth is dying and infected it would require a root canal to stop the infection and tooth pain. We recommend you see your dentist as soon as possible to have the tooth looked at and determine what the cause of your tooth pain is.

Post courtesy of Dr. Goldstein, Cleveland Cosmetic Dentist

Getting a crown on a root canal?

I got a root canal because my tooth was infected and a small portion of my tooth broke. Four months have passed and I’m supposed to get a crown but have not yet. Is it really necessary for me to put a crown on it even though it feels fine now?

Thanks, Ken

Dear Ken,

When we get a root canal the nerve is removed from the tooth, therefore cutting off all blood supply making the tooth very brittle. For this reason, crowning the tooth is the standard of care in dentistry to prevent the tooth from breaking or getting another infection. If the tooth breaks below the gum line or you fracture the root of the tooth it will most likely have to be extracted. Leaving the tooth unprotected can also cause another infection within the tooth if it wasn’t sealed properly and will need to be retreated with another root canal. We highly recommend you make an appointment with your dentist to have a crown put on the tooth to prevent you from losing it in the future.

Post courtesy of Dr. Goldstein, Cleveland Cosmetic Dentist

What can I do to fix my gray tooth from a root canal?

I cracked my front tooth and had to have a root canal to avoid infection. The tooth is now gray and my dentist never told me this would happen. Will internal bleach help me and is there anything else I can do to make my gray tooth match my white ones?

Thanks, Ben

Dear Ben,

A tooth that is not vital or has a root canal as in your case, are the hardest to whiten. Internal bleaching can still be done, but the end color is not predictable and probably won’t be as light as your other teeth. Ideal treatment would to do internal bleaching  first, fill the inside of the tooth with composite, then place a lumineer, porcelain veneer, or porcelain crown over the tooth. If you want your teeth even whiter, its  strongly recommended you whiten your teeth first before following through with any of this treatment mentioned below.

Depending on where the tooth is and its positioning you may be a candidate for a lumineer, porcelain veneer, or a porcelain crown. A lumineer is a type of dental veneer made from ceramic called Cerinate. These usually require no grinding on the tooth surface and are the least invasive of the three treatment options mentioned. A porcelain veneer involves shaving a small amount of the tooth structure  in order to make room for the veneer. These are very strong and look and feel very much like a natural tooth. Porcelain crowns are the least conservative because more shaving of the tooth is required and it covers the entire tooth whereas the other two options just cover the front surface of the tooth.

We would recommend you to schedule a consultation with a cosmetic dentist to see which treatment is more appropriate for you. It would be wise to make sure the dentist of your liking has the skills, extra training, and experience in cosmetic dentistry as well as lumineers. Cosmetic dentistry is a skillful art so do your research and choose wisely.

Post courtesy of Dr. Goldstein, Cleveland Cosmetic Dentist

Can a tooth infection be dangerous?

I heard the craziest thing today, and have to ask someone about it.

I broke one of my molars off a little while ago, maybe 10 days or so. After a day or two, I started having pretty bad pain in my face and jaw. It has been getting worse, and now it seems like I feel pain in my nose and behind my eyes. I was talking to one of my co-workers about it, and he said that you can get an infection inside the bone of your tooth, and it can be dangerous!

Seriously? Dangerous? That seems pretty dramatic. Anyway, my face hurts. I don’t have dental insurance. Can I just go to the emergency room and have them take care of it, or do I have to go to a dentist? This might sound bad, but I can get seen at the ER, for sure, but I doubt any dentists will take an appointment with me when they find out I am uninsured and a broke student. I’ve been taking some old antibiotics from when I had strep earlier this year – will that help?

Angie in Big Rapids

Dear Angie,

Yes, a tooth infection can be dangerous. You have an infected tooth, and that infection is spreading. If left unchecked, the infection could spread to your brain. This is very serious, and you must address it.

It would be best if you could be seen by a dentist. Check with the university to see if they have the names of dentists who will work with you to get this procedure done. If that is not successful, follow your plan to go in to the emergency room. Whatever you decide, do it quickly.

If the tooth can be salvaged, a dentist will perform a root canal treatment to remove the source of the infection, and the “cap” the damaged tooth with a porcelain crown. If the tooth cannot be salvaged, the dentist will extract it. In that case, you may want to consider a dental implant or dental bridge to replace the missing tooth. If you just leave the socket empty, your remaining teeth will shift, and you could develop problems with your jaw alignment, or experience pain in your temporomandibular joints.

This post was completed courtesy of Cleveland Cosmetic dentist Dr. Goldstein.

What should I do about old, ugly crowns?

I have some pretty old crowns on my teeth. They were put in place more than 20 years ago, and they are looking pretty awful. There is a very obvious black line where my gums meet my teeth, and they have always looked very “fake”.

What are my options? What about Lumineers? I’ve seen those on a lot of those makeover shows, and they always seem to look really good.

Hannah in Santa Barbara, CA

Dear Hannah,

Your case is not unusual, and probably quite simple, if you have an expert cosmetic dentist helping you.

You mention Lumineers, which are a brand of porcelain veneers. Porcelain veneers are a possibility, but your dentist will recommend which brand of porcelain veneer will work best for you.

If you currently have crowns, though, you may need to replace them with porcelain crowns. The most important thing to emphasize is that you need to work with an expert cosmetic dentist to get this work done. Anyone can say they do cosmetic dentistry, but you really must work with someone who has the experience, training, and artistry to create a really beautiful smile for you.

This blog posted courtesy of Cleveland cosmetic dentist Dr. Goldstein.

Will any dentist treat a patient in addiction recovery with pain medication?

I hope you can help me. I need some advice, and I would rather ask in a more anonymous way first, because I’ve had just about enough rejection. I am currently in treatment for addiction to opiates. When I told my dentist that I was on methadone, he refused to give me any medication for pain at all. I am not talking about just a filling or two, but major dental work included at least three root canals, an extraction and dental bridge and a porcelain crown on one of my front teeth that is cracked.

I asked my dentist to call the doctor I am working with at the clinic, but he flat out refused. I have known this dentist most of my life, and he wouldn’t even meet my eyes. I left without getting any of the much needed work done, because the thought of enduring all of that without any pain medication makes me break into a cold sweat.

What do I do? Is there some way I can find a dentist that will work with me without going through that kind of humiliation? I know I have not always made the greatest choices, but I don’t need anyone’s judgement. I am getting my life back on track, and getting my serious dental issues addressed is part of that.

Thanks for any help you can offer.

Mario in Indianapolis

Dear Mario,

We are sorry that you had to experience that. You should be supported in your effort to continue your life drug free.

Sadly, many dentists have a fear of the Drug Enforcement Administration. Rather than investigate what they can do to help a patient in your situation, they will just say that they can’t do anything.

We suggest that you find a sedation dentist to help you get this work done with medication that will be appropriate for your situation. Another source for dentists that are more compassionate than paranoid is the doctor you are working with at the clinic.

Best of luck to you.

This blog post was created for Cleveland cosmetic dentist Dr. Goldstein.

Sensitivity and pain in tooth after white filling

Last July I got a filling done on one of my teeth. It was one of those white fillings. A little while after that, the tooth got really sensitive every time I drank or ate something cold. When I went back to the dentist, he said that the cavity had been very deep. He put a temporary dental crown over the tooth and said that if it remained sensitive, we might have to do a root canal treatment. That was quite some time ago, and the tooth remains very sensitive. All this time I have been saving for the portion of the cost of a crown that my dental insurance will not cover, but I read something the other day that made me wonder if this is really the only course of action.

I wonder if just replacing/redoing the white filling would solve the problem? I read where if a dentist doesn’t REALLY know what they are doing when they place white fillings and they do it wrong, it can cause pain really similar to what I’ve been experiencing.

Should I get a second opinion?

Marianna in Orlando, FL

Dear Marianna,

There are nuances to this question, which you will need to talk over with your dentist. Is the sensitivity getting worse? Better? Staying the same? That will matter as to whether or not you need a root canal treatment.

The treatment plan you describe is a little confusing. The assumption would be that there is evidence of a crack or something in your tooth – that is the only thing that would make a temporary crown over a sensitive tooth make sense. Generally speaking, a tooth that is sensitive to cold after a white filling should be left alone. The more that is done to it, the more it can be irritated.

For this reason, I would not recommend replacing the filling at this time. If your sensitivity is remaining the same or slowly improving, your best course of action is just to wait it out.

When your tooth feels fine right after a filling and then develops a sensitivity (whether white or amalgam), it can often mean that there are bacteria left from the original decay. If that is the case and your body does not heal on its own, the only course of action is a root canal treatment. Happily, root canal treatments for all their bad reputation are usually quite painless.

Cleveland cosmetic dentist Dr. Goldstein’s office sponsored this blog post.