Dental crown complications: The unexpected need for root canal treatment.

When a dentist places a dental crown on a tooth it is no doubt their hope that doing so will be the last treatment that the tooth will need for a very long time. But since dental crowns are not placed on pristine, intact teeth but instead those that have been seriously compromised by fracture, breakage or the presence of tooth decay, complications can and do occur. It is possible that the very same traumatic event that has caused the need for the placement of a dental crown has also damaged or compromised the tooth's nerve (pulp tissue). If this has occurred, root canal treatment will be required.

The statistics: Dental crown placement and a tooth's potential need for root canal treatment.

Researchers have identified a statistical relationship that exists between those teeth that have had a dental crown placed and those teeth that subsequently require root canal treatment. (This need for root canal treatment can either be immediate, in relationship to when the crown has been placed, or some point in the distant future.) Here are the statistics that dental researchers have been reported.

Bergenholtz et al. (1991) reported that over the long-term 9% of crowned teeth as opposed to 2% of uncrowned teeth required root canal treatment. Felton et al. (1989) reported that 13% of crowned teeth developed a need for root canal treatment, over the long-term, as opposed to just one-half of a percent of unrestored teeth. Whitworth et al. (2002) performed a review of the available dental literature. They suggested that a reasonable estimate is that 4 to 8%of teeth that have had dental crowns placed will require root canal treatment within the ten years that follow the crown's placement.

Why might a tooth that has had a dental crown placed end up needing root canal treatment?

You may wonder why a dental crown - root canal treatment relationship exists. The answer lies in a status that a tooth's nerve tissue can have that could be referred to as "stressed dental pulp syndrome."

What can cause "stressed dental pulp syndrome"?

Any type of trauma that a tooth might experience can have a detrimental affect on the health of its nerve tissue (dental pulp). The reason for this is as follows. When a tooth receives insult its nerve tissue (just like any other type of soft body tissue) responds with what is called an inflammation reaction. A part of this reaction includes tissue swelling. In the case of teeth, when this swelling occurs the pulp tissue is compressed (the nerve tissue expands but is limited by the hard confines of the tooth). And as these compressive forces build up, the blood vessels that supply the nerve tissue become restricted.

Of course, it is the blood vessels that perform vital functions that help the tooth's nerve tissue to recover from the insult it has received. So, when blood flow becomes restricted activities such as the oxygen and nutrient delivery as well as the ability to carrying away the excess fluids associated with swelling are inhibited. The net effect is that the normal course of events that should take place so the tooth's nerve tissue can recover are instead stifled. In severe cases of trauma, the dental pulp will die and root canal treatment will be required. In other cases the nerve tissue may survive but linger on in a debilitated state (stressed dental pulp syndrome).

In those cases where the tooth's pulp tissue is still alive but debilitated (stressed dental pulp syndrome), its ability to healthily rebound from future trauma is compromised. Each new traumatic episode will cause the same scenario as described above to repeat. And each time this cycle reoccurs, the nerve tissue can become more and more debilitated. At some point in time it is possible that enough dental pulp degeneration has taken place that root canal treatment is required.

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