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Getting root canal treatment when you have decayed teeth is understandable but what about when you just want to get a crown or replace a missing tooth? We lay out if root canal treatment is actually necessary before getting a crown or a bridge.

One of the problems that patients have with medical and dental treatment is that they get drawn into procedures that they did not want and may not need. This is often a problem of perception and of miscommunication between the doctor and the patient [1].

In dentistry, this is more apparent because the patient might come in for a tangible need and end up hearing that a number of other things are needed before that need can be fulfilled. For example, patients will walk in needing a replacement for a missing tooth or wanting to get a partially fractured tooth covered by a cap.

What they are often told is that they first need to get root canal treatment done before the initial problem can be solved. So what is the actual truth?

Is root canal treatment necessary before getting a crown or bridge?

A crown is a single cap that covers one tooth while a bridge can span multiple teeth in order to replace missing ones [2]. Irrespective of whether a single crown or a dental bridge is being planned, the procedure involves the grinding down of the supporting teeth to fabricate the prosthesis [3].

Our teeth are designed in such a way that the outermost layer is hard enamel which does not have any nerve endings. The layer beneath that is called the dentin which is softer and there are some nerve endings present here. The innermost layer of the tooth is the pulp which contains all the nerve endings and blood supply to the tooth [4].

By removing the outermost layer of the teeth while grinding, the protective layer is actually being lost [5].

Now, in an ideal situation, the crown being placed or the bridge being planned would be on big healthy teeth where the grinding can be limited to the enamel only. The patients would also then be able to keep immaculate oral hygiene and prevent any decay from occurring underneath the crown.

That is not the reality.

Often, a crown is needed to be performed on a fractured tooth and so a portion of the enamel is already missing [6]. This makes it essential to grind down the tooth further and into the dentin where some amount of sensitivity will start to be felt.

A bridge may require the support of some smaller teeth which do not have the amount of enamel that the bigger back teeth have.

All of this is not even taking into account the individual variation between people. What may be bearable sensitivity to one may be uncontrollable pain to another [7]. This is why dentists advise getting root canal treatment done before most crown or bridge procedures to err on the side of caution.  

Can root canal treatment be avoided before getting a crown or bridge?

In some cases, it absolutely can be. If the patient is able to understand the possibility of needing root canal treatment down the line and is fine with it then the dentist can try to avoid one at the time of crown preparation through conservative tooth preparation [8].

The final decision will be with the dentist because it is not possible for the patient to judge how much grinding needs to be done, what is the status of the supporting teeth, or what kind of prosthesis is being planned.

As a patient, you can make your desire to avoid root canal treatment be made clear to the dentist before the procedure is being planned.

Advantages and disadvantages of root canal treatment before a crown

The decision to carry out root canal treatment, in this case, has both pros and cons to consider. The very fact that root canal treatment is debatable is because it is not essential at the moment. Conservative treatment where only the minimal required treatment is provided would dictate trying to avoid the root canal procedure [9].

The cost to the patient decreases when root canal treatment is avoided, the number of visits go down, and the span of total treatment time goes down as well.

Doing root canal treatment for the supporting teeth allows a greater level of certainty in the treatment provided. The patient is not likely to come back with sensitivity or pain a few months or years after the prosthesis has been cemented [10].

If the patient is agreeable to getting root canal treatment done then it allows the dentist to plan crown and bridge treatment in many more clinical situations than would be otherwise possible.

Conclusion

All patients want to minimize the treatment that they get as is understandable. This is why it is very important for clear and honest communications between the dentist and the patient. A clear idea of the advantages, disadvantages, and options in front of the patient should be laid out.

Patients have the right to understand their treatment and take some time before committing to a line of treatment. It is also favorable for the dentist to have informed patients that know they are not being ‘fooled’ or ‘tricked’ into getting root canal treatment done just for monetary gains.  

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