How Long Do Dental Crowns And Bridges Last?

How Long Do Dental Crowns And Bridges Last?

by | Dec 2, 2015 | Bridge, Dentistry, Prevention, Tooth Replacements

How long do dental crowns and bridges last? 

I haven’t written anything to the blog for some time now.  Like so many people I know, I have been busy with other projects.  Every now and then, though, something will come up and I find I tell myself, “I need to write about that”.   Recently, an exchange with a patient prompted me to write on the subject of how much time a patient might expect from a crown or a bridge. 

What I found interesting was this patient’s viewpoint about something that was happening with her relative. It seems that this relative was experiencing a problem that required she/he have a crown re-made.  My patient, made an off-hand comment to me along the lines that her relative’s dentist might not have been so great because the crown was having to be redone.   

I’m thinking: Oh, it must have just been placed recently. 

She’s thinking:  After about twenty years. 

Granted.  My patient has not (yet) had to replace any of her dental work and she has been with me nearly twenty-five years.   

But here’s the thing: as a dentist when I hear that a crown lasted twenty years, I think – “Sounds like that dentist did a pretty good job.”  It seemed to me, my patient had an entirely different impression. 

I asked her: “Did you realize that the average life for a crown or bridge is only between 5 and 15 years?”  My patient seemed a little alarmed by that, but acknowledged she did not realize it. 

There are so many factors that can go into how long a crown or bridge may last, that this can be really difficult to predict.  The five- to fifteen-year figure often cited by dentists is based upon university studies and insurance company estimates of how frequently they need to be replaced.  Most insurance companies will pay for a new crown after five years, although, a number of them have recently extended that replacement date to 7 or even 8 years.  

In all fairness, sometimes crowns can fail due to manufacturing errors.  But the reality is that this is very seldom the case.  More often it is the patient that fails the crown.   

How so?  There are two main reasons:  decay under a poorly maintained crown and tooth clenching and grinding. 

But here are a few other ways a crown can break – 

  • Removing bottle caps 
  • Biting fingernails 
  • Cracking crab claws 
  • Holding roofing nails 
  • Tearing open cellophane packages 

Inappropriate use can cause porcelain that is veneered onto a metal base to break off.  Using common sense is important.   

 

Provided a crown is manufactured to high standards, after choosing the right material for you, and having it fitted correctly to your bite it has the potential to last a lifetime. 

 

Home care has something to do with it too. 

In my twenty-five years of practice, I have seen this repeatedly.  For me, two cases have illustrated it best: 

Earlier in my career, I had a patient who needed a lot of dental work.  He already had a lot done, but much of it was pretty old and, frankly, it didn’t look very good.  It’s actually uncommon for me to see work that I believe wasn’t done carefully, but if any situation fit that bill, this was it.  His crowns fit like “socks on a goose.”  I don’t know where he had it done and, at this point, it really isn’t the moral of this story.  The important thing is that this work was, apparently, what he could afford at the time.  What amazed me was that these crowns were still functioning after more than twenty years.  There was no reason they should have.  They fit that badly. So, why were they working?  This patient’s home care was excellent.  He brushed and flossed after every meal.  He knew that getting new dental work was going to be costly for him, so Mr. Flosser he made sure that what he had lasted him.  I was impressed. 

 

Not too many years thereafter, I saw a different patient for a new patient exam. This man had bridgework from ear to ear.  Honestly, it looked great.  Pretty much everything about his crown and bridge work was technically correct.  The bite was good, they were esthetic, and when I took his diagnostic x-rays, I noticed that the critical areas fit perfectly.  Someone obviously took a great deal of care to make sure that they delivered a great product to this patient.  I would have gone to that dentist. 

 

But another thing that I observed when I reviewed the films was that there was decay all over the place.  So much, in fact, that the only way to correct it would have been to remove the bridges, clean out the decay and replace everything. 

 

The likelihood that his dentist would have left behind that much decay is nearly zero.  No one who took that much care into crafting his work would have allowed it.  But the real reason I know that is this:  during the course of my exam, I observed that this patient has so much plaque and garbage in his mouth, I doubt he ever brushed his teeth.  It looked like he had just finished eating cottage cheese before he came in.  The plaque was that heavy. 

 

This man’s dental work was only between two and three years old. He probably paid a small fortune for it.  It was that extensive. 

 

Now, I had the unpleasant task of telling him my findings.  To make a long story short, I never saw him again.  Mr. Cottage Cheese probably thought I was trying to put one over on him.  Nothing bothered him (yet!), and it was most likely inconceivable to him that he should have anything wrong in so short a time.  And yet, it was not a promising scenario. 

 

Today, however, an equally common cause of crown or bridge failure is tooth clenching and grinding.  I have written about this epidemic elsewhere.  But, if you grind or clench your teeth, things are just going to wear out a lot faster.  It’s just common sense.  If you had a choice of parking your car in the middle of a golf driving range or outside of the driving range, under which conditions is your car likely to end up with the better paint job? 

 

Some people can place amazing forces on their teeth.  When they do, if a tooth was in really bad shape before it was restored, the crown probably won’t survive the weak tooth.  You need something of a substrate to support and retain the crown.  The cement can’t be relied upon to do the entire job.   

 

Also, to put things into perspective, the average force on a back tooth is typically around 75 pounds per square inch.  When we chew, that goes up a little – maybe, to 80 or 90 pounds per square inch.  Remarkably, some people have been recorded as having applied as much as 3,000 pounds per square inch on their teeth while sleeping. That can crack a virgin tooth, let alone one that has had any work done to it. 

 

In the end, there really isn’t a simple answer as to how long a crown should last. It can vary.  With all other factors being equal, I would hope for no less than seven years and consider anything beyond fifteen years “good.”   

 

Many of my patients who are still with the practice after 25 years and that I still have the opportunity to examine, continue to have their original crown and bridge-work.  But some have moved to other states, and others have passed away in their older years.  Yet, much of what I can see looks pretty good.  Some old crowns and bridges could use a face-lift. That usually means replacing it. 

 

Every now and then, I wonder about those two patients I mentioned above:  Mr. Flosser and Mr. Cottage Cheese. 

 

Mr. Flosser may still be running around with those old crowns. 

Mr. Cottage Cheese is probably wearing dentures by now. . . . 

 

 

 

http://www.realself.com/question/dental-crowns-last 

It’s More Than Just a “Cleaning”

It’s More Than Just a “Cleaning”

by | May 1, 2015 | Dentistry, Medical Issues, Periodontal Disease, Prevention

It is not without purpose that dentists repeatedly herald the fact that your mouth tells us a great deal. Yes, it will communicate — and without words — whether you have been brushing or flossing. But it will also tell us a story of your overall health.

For centuries, even the physician began his examination of the patient with a look at the head, ears, eyes, nose and throat. He would ask you to “Say aah.”

Ever wonder why?

The specific reason is that the sound you make elev

ates the soft palate and allows for a clearer view of the back of the throat, but it also tests the function of the vagus and glossopharyngeal nerves. Doctors have an abbreviation they use to describe this evaluation: HEENT (head, ears, eyes, nose, throat). More recently, health professionals have been pushing for a modification to that standard evaluation, changing it to “HEENOT” instead (head, ears, eyes, nose, oral cavity, and throat).

Thus, health professionals can work together in the best interest of their patients. By performing a thorough oral exam, the dentist will often spot systemic problems and refer their patient to a physician for further evaluation. The family doctor can, in turn, evaluate oral health and alert the patient to the fact that it is time to see a dentist in order to get better.

Anyone following our blog or newsletter for any length of time has already been acquainted with the fact that what goes on in our mouths can affect the health of the rest of our bodies. Studies continue to show the links between oral and general health. By way of review – periodontal disease has been linked to complications with diabetes and pre-term labor in pregnancy. There is also a strong connection between poor oral health and rheumatoid arthritis, cardiovascular disease, strokes, and Alzheimer’s.

The fact that we perform an oral (and oral cancer) examination during your bi-annual checkups and “cleaning visits” does not excuse you from seeing your doctor for general health problems, and vice-versa. We are professionals in oral health and regular maintenance in our office helps you to stay healthy. So you want to be certain that each time your family doctor ask you to “say aah,” they then say “good job – everything looks great!”

Tartar – Why Should You Care?

Tartar – Why Should You Care?

by | Feb 23, 2015 | Dentistry, Periodontal Disease

You go to the dentist every six months to have your teeth cleaned. Well, hopefully you are getting regular dental visits. Right? But, just what is the dentist doing when he cleans them anyway?

We’ll get into that shortly. And maybe you can even recall the dentist pointing out places where you had some tartar. But if you are like many patients, you nodded your head and he went on cleaning.

On the other hand, possibly you were thinking: “Just what the heck is tartar anyway? Isn’t that a Russian thing? Or, maybe, it has something to do with that white sauce. No, that doesn’t make any sense. Oh well, I don’t want to embarrass myself by asking.”

And it went in one ear and out the other.

Let’s try to clear it up a little. Tartar is basically hardened plaque. And plaque is the sticky mix of bacteria, food particles and proteins that forms in your mouth — pretty much every day. It sticks to your teeth, it gets under your gums, and it builds up on your dental work. The trouble is that when plaque hardens, it builds up – actually, very much like a coral reef.

And like a coral reef it can spread out over a broad area. But the damage it causes hits you in two ways. Firstly, the bacteria that cover the tartar damage your gums from the toxins they secrete. This can cause the gums to become inflamed and to bleed. In its mildest form, this is called gingivitis. But secondly, the tartar acts as a foreign body. Get the idea of having something stuck in your teeth – say, a shell of popcorn. It won’t take long before the gums get puffy, red, and irritated.
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The thing is, if it’s popcorn, you notice it pretty much immediately. After all, one moment everything is fine, and the next you’ve got this thing stuck in your gums. And until you pick it out, your gum stays puffy and protests its presence with bleeding and, sometimes, pain.

The difference with tartar is that it generally forms more slowly. So, in most cases, people don’t even notice it growing. Nor do they notice what it is doing to their gums and the surrounding bone. Because when gingivitis is not gotten under control, it gets worse. Pockets form between your teeth and gums and get filled with more bacteria and more tartar. This leads to an infection called periodontitis.

Over time, your immune system kicks in, trying to use stronger methods to fight this problem that just isn’t going away. The result: it starts to work against you and breaks down your own bone. What’s more it usually does it painlessly. So many people don’t even realize they are losing bone until their teeth get loose. That’s why this is the number one cause of tooth loss worldwide.

So what is the dentist doing when he cleans your teeth? He’s removing the foreign body (the tartar) and what is basically a condominium for your harmful bacteria. But don’t feel too bad for your evicted bacteria. They will try squatting in a new home under your gums in less than twenty-four hours. And they are associated with such nasty effects as heart attacks, strokes, Alzheimer’s, pancreatic cancer, and more.

For the sake of your health, when it comes to tartar, you should care. Steps you can take to get matters under control include brushing after meals, daily flossing, and eating a healthy diet. Oh, and if you smoke, chances are you will build more tartar as well. There’s one more reason to quit.

Once tartar has formed on your teeth, only your dentist or hygienist can remove it.
So, be sure to visit your dentist at least twice a year to remove any plaque and tartar that has built up and to prevent more serious, and costly, health problems.

Is Having Straight Teeth Important?

Is Having Straight Teeth Important?

by | Apr 6, 2013 | Dentistry

When we are young our teeth make their way into our mouths through a process known as tooth eruption. How do they know when to stop erupting? Basically, they keep going until they find the opposing tooth. But what if we lose a tooth? Much like a computer program, the tooth opposite the missing one starts looking for the tooth that it is supposed to chew against. If it can’t find i

t, it may erupt all the way to the opposing gum. It’s not that the tooth is growing. The bone below (or above it) moves it into position. Of course, at this point, it’s in the wrong position, and entirely new problems often start to appear.Tooth Eruption Chart

If this were all that happened, we would have enough to worry about in terms of our ability to chew our food well. This is important for good digestion and nutrition. Unfortunately, when teeth border an empty space they also have a tendency to try to drift into it. This means that teeth may drift forward or backward toward the spaces. Perhaps this is nature’s way of distributing the load now that one of the soldiers has fallen. It is an engineering marvel, but it can become a chewing nightmare.

While all of our teeth are important, structurally, the loss of certain teeth will bring about more change than the loss of others. Think of this in terms of the walls of your house. If you take down a non-supporting wall, the house will still stand. Take out a supporting wall, however, and you have a bigger problem. Teeth are constructed much like an arch, though. If you have ever seen a stone arch, you know it has a keystone at the top that keeps the arch together. Remove that one stone, and the whole thing collapses. In your dental arch, you can think of your canines as a keystone. Lose them, and the ensuing change is rapid. If your teeth were straight, they often won’t be for too much longer.

So, why then, do people lose teeth? The most common reasons that I see are:

  1. Periodontal disease – this is sometimes also referred to as “gum disease” but is really a condition more directly affecting the bone. This is the result of a bacterial infection leading to the permanent breakdown of the bone surrounding the teeth. It is actually the most common form of tooth loss world-wide. Because it is generally not painful, often people have no idea that they have periodontal disease until their teeth start to get loose and fall out.
  2. Tooth decay – this is what many people think is the main cause of tooth loss. And while it is true that tooth decay often does lead to tooth loss, it follows periodontal disease in terms of frequency.
  3. Habits – this is the type of tooth loss that results from such things as tooth grinding or clenching. This area is one in which we often see a “domino-effect” of problems. Sometimes clenching or grinding starts with the loss of a single tooth or an accident resulting in a spinal misalignment. At other times, it may be due to stress, a deficiency, or genetic structural anomaly. In any of these cases, if the grinding or clenching results in the wear of your canines (those “key-stones” again), you may find yourself wearing down ALL of your teeth more rapidly. They are pointy for a reason. When you slide your teeth to the side, they are supposed to keep the back teeth from touching. If they wear down to the point where all of your teeth touch in all directions it is possible to wear them all down. Over the years I have had cases where what brought the patient in to see me in the first place was that they wore down their teeth to the point where they exposed their nerves. (Ouch!)
  4. Accidents – this speaks for itself. And it happens. It may be a sports injury, car accident, a fight, or biting into something hard – but if it breaks off enough of the tooth, it can need to be extracted.

Straight TeethWhatever the cause, if you lose a tooth, you should speak with your dentist about replacement options. Together you can discuss the choices that are best for your circumstance. Where possible, try not to delay correcting your bite for too long. The additional changes that may occur with your bite over time can limit your choices or cost you more to correct. While a nice, straight smile may be desirable cosmetically, a good bite is also important for health and function.

The Most Affordable Dental Insurance

The Most Affordable Dental Insurance

by | Mar 24, 2013 | Cavity, Dentistry, Periodontal Disease, Prevention, Tooth Decay

Recently, a great deal of attention has been placed on economizing in all different aspects of life. Some people have even considered cutting back in the area of health care by putting off routine maintenance care. While this is a little like playing Russian roulette when it comes to dental health — for reasons I’ll explain shortly — there may be a better way to dodge the financial bullet. And it may be a much simpler one.

After more than twenty years of practice I have seen people consider all sorts of ideas to deal with rising dental costs. Often, people become fixated upon dental insurance as the primary solution to the majority of their dental needs. Because dental insurance generally tends to be pretty expensive relative to what it pays out, especially if you are buying it yourself, patients that rely on it exclusively often end up worse than when they started. Dental insurance typically has waiting periods before it can be used, during which time existing conditions advance, becoming more expensive.

In these cases, you have to wonder – if the premiums are costing you more than what the company pays you back – what’s the point? Obviously, this arrangement is a much better deal for the insurance company than for the patient. Let’s also consider that when I first started practice, dental insurance maximums averaged $1,000 to $2,000 annually. Twenty years later, they average . . . $1,000 to $2,000 annually. If insurance kept up with inflation alone, the annual maximum should easily be over $5,000. Don’t hold your breath for that one though. Patients would be better off just setting aside the amount they pay for premiums. They usually come out better in the end.

Putting off dental care often becomes more costly to patients for several reasons. Firstly, many dental conditions are actually painless in the early stages. Periodontal disease is a prime example. This is a condition in which the bone surrounding the teeth becomes lost, leading to a variety of circumstances including bleeding gums, loose teeth, bad breath and, eventually, tooth loss. It is the number one reason that people loose teeth world-wide. For the most part, it doesn’t hurt. When it does, if it does, it is usually too late. The tooth or teeth have to come out.

Likewise, dental decay usually doesn’t hurt in the early stage. Actually, I’ve lost count of the number of times it didn’t hurt in the advanced stage either – but this is usually the point at which the patient becomes aware of a problem. A piece of the tooth breaks off, or they actually experience pain. The tragedy of this scenario is that when it reaches this stage teeth often end up requiring more expensive root canal therapy or extraction. Dental costs can very quickly escalate as much as ten times from the cost of a simple filling to what it costs to complete a root canal and crown.

So what do you do? Focus upon prevention.

Here is a true story I hope will leave as big impression upon you as it did me at the time:

When I was a dental student, I recall a lecture give by one of my professors in which he made a powerful point on the subject of prevention. The seminar dealt with the subject of prosthetics – more specifically, the fabrication of crowns and bridges. This professor, however, was one of those rare dentists who actually had two recognized specialties. He was a professor of prosthetics, but he was also a periodontist. While this was a crown and bridge lecture, he taught us a very valuable periodontal lesson.

Here’s what he did. The seminar was pretty informal at this point. The professor told us he was going to put up some slides of patients and have us guess their ages – just by looking at their x-rays and then at pictures of their gums. As a student, I remember thinking this was a refreshing little game and most of the class was doing quite well calling out the ages. Looking at the x-rays, we would evaluate bone levels, tooth eruption patterns, tooth wear, number of restorations and similar factors to make our “guess.” Then we would look at the color and texture of the gums and appearance of the smile and offer up our estimate. The professor would then show us the face of the patient and tell us their age. This went on for a while and we all did pretty well.

He then put up the next slides and guesses rang out: “twenty-five,” “thirty,” “twenty-seven,” went the typical guesses. I don’t think I can remember seeing a single filling on those slides, though there could have been. Nothing changed when he showed us a picture of the gums. They looked like a teen-ager’s. Then he put up a picture of the face. The person pictured was obviously in their late seventies, maybe even early eighties.

Dead silence. Then there was a small commotion and most of the class pointed out that the slides got mixed up.

The professor paused, and said “No. This is correct. Let me tell you how I can be sure. This is a picture of my father. Those are actual x-rays and a recent picture of his gums. How is it that he has such excellent oral health?”

He then went on to tell us how when his father was a younger man, he had a visit with his dentist and he complained to him that whenever he ate, he would get food stuck between his teeth. His father wanted to know if there was anything he could do about it, because it was pretty annoying.

The dad’s dentist thought about it for a second and told him: “Well, I’ll tell you what I do when that happens to me. I go over to my wife’s sewing kit and take out a piece of silk thread and just pass it between my teeth.” As a student, I wondered when floss became invented. Evidently, it just wasn’t popular back in those days.

In any case, our professor went on to explain that his father did exactly that after every meal since he was a young man. His gums, teeth and bone levels were almost unchanged. That’s what he had to show for his efforts.

I filed the image in the back of my mind, but I have to be honest – I didn’t exercise the same level of commitment – just yet.

Oh, sure, I brushed, watched what I ate, and took vitamin and mineral supplements. But my flossing was sporadic. That is, until I really started looking at what happened to my patients and how those who flossed performed against those who didn’t. If you asked me today: do I floss regularly? Absolutely. You can’t buy cheaper dental insurance.

Flossing benefits your gums, your breath, your teeth, your lungs, your heart – in short, you.

Do you know that probably up to a third of the cavities I treat happen between the teeth? This is why regular exams are so important. You simply can’t see this area. For that matter, without x-rays, neither can I in most cases. But my point here is simply this: even if you brush after every meal and snack, without flossing this area never gets cleaned. Why would anyone become surprised that an area that never got cleaned could decay over time?

There are all sorts of reasons people don’t like to floss, but the reasons to do it are actually pretty compelling and very cost-effective. Think it over. Maybe floss is the most affordable dental insurance. . . .

Richard Walicki, EzineArticles Basic PLUS Author