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Medical Forum / General / Dentistry / April 2006Cap/crown keeps cracking
I cracked a front upper tooth several years ago. I cracked it while playing ball hockey. Ball hit the tooth straight on. So I had a plastic cap put on by DentistABC. I don't play road hockey now, this was 11-13 years ago as a teen. The plastic one DentistABC put on was fine for about 11-13 years. (it was not an expensive permanent crown/cap, just a temporary plastic one that was supposed to last 3-5 years or longer). After about 12 years I had the plastic one removed and it was replaced with a more expensive one. The only reason I replaced it was because the other one that lasted for 12 years was the wrong color mixture (way too yellow, my other teeth didn't match it.) The temporary plastic/non-permanent tooth that lasted for 12 years was replaced with an crown/cap by a new dentist, DentistXYZ. The new replacement tooth was a more expensive permanent tooth because it contained porcelain, whereas my old one was a plastic one. The new cap I had put on cracked about 8 months later! I just noticed it in the mirror one day. Cracked on a diagonal line at the front of the tooth. Big diagonal crack down the entire tooth. About me: currently I sit in an office most of the day. I don't play football or any sports that involve roughage. I just walk, do office work, program computers, hike, things like that. Haven't ever been in any car accidents. Went back to dentist: got it replaced. They hit the tooth very hard (his dental assistant) instead of pulling it off or grinding at it. I was leery of what they were doing, because I wish he could have just pulled it off gradually or ground it off, instead of whacking it so hard. His dental assistant didn't seem too bright, and was talking about her latest pair of jeans and how much they cost (or something along those lines - and of course the dentist drives a Mercedes). I asked the dentist why it would crack? His excuse was that I must have done something to it, and that was the most likely cause. Anyway, he put on a temporary tooth because he had to have a new tooth made in the mean time. While at home the temporary glued tooth fell off. I noticed a piece of my real tooth underneath was broken off along with the temporary tooth. I made the assumption that the reason the real tooth was broken off underneath was because of them hitting it so hard (but forget that, for now). Anyway, went back to the dentist to get the new replacement tooth. They put it on. Wrong color. Replaced it again. 3 months later: it cracked. On a diagonal. Today I'm sitting here with a cracked tooth and wondering what to do. So a summary: - two porcelain teeth have cracked coming from the same dentist - never had issues with the plastic one, but was put on by a different dentist. - Functionally, plastic one worked fine for 12 years. Only reason it was replaced was aesthetics. - second dentist has cracked my tooth underneath while hammering off old caps that need to come off. - When I broke the tooth as a teen the first time, there was 1/2 of the tooth left. Now there is only about 1/4 of a tooth left because the second dentist keeps breaking pieces off each time. What do I do? Why would it crack two times? I don't play football or drive cars often. I've never been in an accident. I do not wish to go to the same dentist again. Should I ask for money back politely and try another dentist? How would I do this without hurting his feelings? If the expensive porcelain ones keep cracking, and my original plastic/cheap on lasted me 12 years, should I go back to a plastic one? Has anyone ever noticed problems with porcelain teeth breaking? I live in a cold climate - would temperature changes crack a porcelain tooth? The plastic one never had any issues. I've not moved to new locations. I'm looking for advice on: 1. why it is cracking every few months, and if anyone else has had or seen similar problems. 2. what I should do to tell the dentist politely that I don't want him to try again, I am scared of what will happen. Other reasons why I don't want him to do more work? When he put my expensive cap on the first time: - they got the color wrong several times. I had to go back twice - Temporary glued tooth fell off while they were making the porcelain one. When he put my expensive cap on the second time (after first one cracked): - coloring was wrong, had to go back several times AGAIN. - Temporary tooth fell off AGAIN. > I cracked a front upper tooth several years ago. I cracked it while playing ball > hockey. Ball hit the tooth straight on. So I had a plastic cap put on by [quoted text clipped - 83 lines] > - coloring was wrong, had to go back several times AGAIN. > - Temporary tooth fell off AGAIN. There are a number of reasons a crown may fracture. It may be due to problems with tooth preparation, porcelain firing, wrong cement, patient habits, etc. I doubt very much you can blame cold or hot climate. I should say that a plastic crown lasting 12 years is extraordinary. It would seem to indicate you have no grossly damaging habits. If the dentist has made an honest attempt at remedying the situation, he may well decline to refund your money. However, if you have lost confidence in him, you should go elsewhere, and you would seem to have little to lose in asking for at least a partial refund. OTOH, if you talk honestly about your concerns, he may be able to explain (if he knows) what he feels the problem may be; his answers may be as telling as anything he has done so far. If you were my patient and this crown is all-ceramic, I would probably opt for a ceramo-metal crown instead, which generally is slightly less cosmetic but less likely to fracture. Steve > There are a number of reasons a crown may fracture. It may be due to > problems with tooth preparation, porcelain firing, wrong cement, patient > habits, etc. I doubt very much you can blame cold or hot climate. > I should say that a plastic crown lasting 12 years is extraordinary. The dentist that put on that one (first dentist, DentistABC) did ask quite often "is it still holding up"? As if it wasn't really supposed to be holding up that long :) How long do they usually last? Do they break off/rot away in 5 years usually? > It would seem to indicate you have no grossly damaging habits. > If the dentist has made an honest attempt at remedying the situation, > he may well decline to refund your money. However, if you have lost > confidence in him, you should go elsewhere, and you would seem to have > little to lose in asking for at least a partial refund. I wish to have a peaceful conversation first. I decided since it has cracked twice, even after a peaceful conversation I would definitely not go back into the dental chair. I will visit the office and phone them to talk, but will not sit in a chair because I fear being controlled in the chair. Problem is, when they were hammering the other ones off and breaking peices I couldn't really say anything - they have your mouth opened up and you just can't speak, not to mention you might choke on a tooth if you try :) If after a peaceful conversation, he does not offer any refund so I can spend it at another dentist, is there some sort of complaint system or dental association to contact? I'm actually worried about his other patients too. I would like to prevent future patients from having similar problems - it's not just about my $1000 dollars that I might lose here, but about other patients I'm worried about. I.e. I'm worried about the community here more than my own self. Normally I'm not one to rad on someone. The funny thing is, while I was sitting getting my tooth done, I heard two other patients come in who sat beside me with teeth that had fallen off or cracked. > OTOH, if you talk honestly about your concerns, he may be able to > explain (if he knows) what he feels the problem may be; his answers may > be as telling as anything he has done so far. > If you were my patient and this crown is all-ceramic, I would probably > opt for a ceramo-metal crown instead, which generally is slightly less > cosmetic but less likely to fracture. The tooth is the very front top one so I'd hope for something pleasant looking - but I'm a practical guy, so I'll go for what works. The plastic one had a yellow stain on it the day they put it on, but at least it worked. They tried to make it look more real by putting a stain on it - don't know why I would WANT a stain on my tooth. That was the first plastic one. I'm not 100 percent sure it was pure plastic, will have to check. But they said it was a temporary one that should last a few years. Thanks for tips.. >>There are a number of reasons a crown may fracture. It may be due to >>problems with tooth preparation, porcelain firing, wrong cement, patient [quoted text clipped - 6 lines] > > How long do they usually last? Do they break off/rot away in 5 years usually? I try not to push the envelope here. Generally I use plastic crowns only temporarily; I ordinarily use a temporary cement for easy removal. Plastic crowns generally don't fit as well as metal or ceramic; cement can wash out, predisposing to decay. More often they wear or crack eventually or fall out. They also stain--as you found out. >>It would seem to indicate you have no grossly damaging habits. >>If the dentist has made an honest attempt at remedying the situation, [quoted text clipped - 19 lines] > my tooth done, I heard two other patients come in who sat beside me with teeth > that had fallen off or cracked. It depends upon where you live. In most areas of the U.S., there is a mechanism called "peer review" run by the dental society. If you truly feel there is something wrong with the dentist's competence, this is an avenue you may wish to explore. One word of caution--even if there is a problem here, it may well be with the lab. Of course the dentist is responsible for using a competent lab. However, it sometimes happens that a lab that has been doing perfectly good work for years may suddenly start having problems--due to personnel changes, or even quality control issues in their raw materials. The dentist should be willing to stand behind his treatment (by this I do not mean any express or implied warranty; just that the patient will be taken care of and care taken that mistakes be put right); but you have to be careful about assumptions about just where the problem is. I have had problems with labs and can tell you that it can be very, very frustrating for everyone concerned. For this reason, being non-judgemental in your approach to the dentist can be very helpful in trying to reach a resolution satisfactory to both you and the dentist. Steve >>OTOH, if you talk honestly about your concerns, he may be able to >>explain (if he knows) what he feels the problem may be; his answers may [quoted text clipped - 12 lines] > > Thanks for tips..  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 One more thing I forgot to mention: When the second tooth arrived (after they sorted out all the color issues) it was quite big. They put it on and ground down my other teeth in order to make it fit. Is this right? Shouldn't they have gotten the porcelain tooth the right size instead? Is this normal practice to grind down real teeth in order to make a porcelain tooth fit? I never had any issues with the plastic tooth that was originally on for 11-13 years. What they did: - ground down bottom teeth, I can see a ridge in the mirror where it is ground down (about a 1-3 millimeter ski jump now on my bottom teeth) - used a sand paper like dental floss on all the teeth around porcelain replacement. The first porcelain replacement was a bit big but not big enough to warrant grinding and sanding of my other good teeth. The second tooth was big enough and they went ahead. I was unable to stop them because my mouth was open, couldn't speak and did not know if it was normal practice. > One more thing I forgot to mention: And an important thing you forgot to mention. While there may be more important things, this is a pet peeve. I do not think a dentist has the right to grind down natural teeth to adjust the bite to the false tooth without first asking the patient if that is allright with him. The crown can be adjusted, even if it can't be smoothed afterwards. The patient may accept that. Since they seem to be producing mass crowns, perhaps the patient would have preferred foregoing this crown and get another made with a better fit. And part of a tooth breaking off? This dentist seems to have more nerve than skill. I feel sorry for this patient I hope the final outcome with or without another dentist is somewhat satisfactory, if that is possible. Even a full refund would not suffice for this person. Irreversible unexpected procedures on natural teeth should be the patients option. Gail Not a dentist, and perhaps doesn't think like one. > When the second tooth arrived (after they sorted out all the color issues) it > was quite big. They put it on and ground down my other teeth in order to make it [quoted text clipped - 17 lines] > they went ahead. I was unable to stop them because my mouth was open, couldn't > speak and did not know if it was normal practice. >>One more thing I forgot to mention: > [quoted text clipped - 15 lines] > Gail > Not a dentist, and perhaps doesn't think like one. Whether justified or not, this certainly doesn't look good, and if the need arises (it does occasionally), it should be explained to the patient. Steve >>When the second tooth arrived (after they sorted out all the color issues) > [quoted text clipped - 44 lines] > >>speak and did not know if it was normal practice. SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > One more thing I forgot to mention: > [quoted text clipped - 19 lines] > they went ahead. I was unable to stop them because my mouth was open, couldn't > speak and did not know if it was normal practice. You deserve an explanation for this. One more thing--to play devil's advocate. Let's say this dentist IS grossly incompetent. Would you let him continue to grind your teeth indefinitely? If you think something MIGHT be wrong, you MUST, MUST, MUST stop treatment IMMEDIATELY!! This is your body you're talking about. You have a right to be informed BEFOREHAND of any treatment, and why things are being done. Your questions here art totally reasonable; there may be a perfectly valid reason for grinding the other teeth (I sometimes find it necessary to do this in my office), but you have the absolute right to stop work at any point. Any dentist who reacts to a reasonable interruption in treatment for a totally understandable question like this is to be avoided. Poor behavior in this situation IMO is sufficient reason to run, not walk out of the office!!! This may well be a more important issue IMO than you concern about the crowns cracking. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > You deserve an explanation for this. > One more thing--to play devil's advocate. Let's say this dentist IS > grossly incompetent. Would you let him continue to grind your teeth > indefinitely? If you think something MIGHT be wrong, you MUST, MUST, > MUST stop treatment IMMEDIATELY!! This is your body you're talking > about. One other thing I forgot to mention: I had a cavity that I found in my mirror at home about 5 years ago. I was sure it was a cavity. Other people in my family were telling me "oh it must be a grinder mark, can't be a cavity, you aren't a dentist". Went to see dentist, didn't find any cavities. Did not tell him about the cavity I found. I wanted to test him to see if he could find it. Left the cavity for a few years. Went back each year for a check up. No cavities, says the dentist. even with x-rays. I wanted to see how long it would take before he found it. About 5 years later, he still didn't find it. It was my prediction all along that the dentist was not skillful/cometent, but I'm not one to make assumptions or negative quick judgements. I'm not a professional dentist or an expert, so maybe I was wrong about this cavity? Maybe I was just seeing things? I tried to give the dentist "a chance". So I went to another dentist for a second opinion. Didn't see any cavities upon first look over. Didn't see it upon cleaning checkup either (two visits). I pointed out the cavity - he x-rayed that area where I pointed out. Yes, it was a cavity. I had it filled. It was a cavity. It wasn't just my imagination. If I could spot it, and I'm not a dentist, they should be able to. This scared me, that I had to point out the cavity to not one, but two dentists. Remember, this second dentist I'm talking about was just a second opinion person. He was not the person who originally put on my capped tooth 11-13 years ago. That was another dentist. At this point, I'm going to try a fourth dentist (pick one randomly out of the phone book) because I've really lost trust in all dentists. The worst dentists I've had are ones that have been recommended by "family" because "family" seems to be pretty gullible, and pretty "sucker" like. If the third one is OKAY, and I don't have to point out cavities and keep getting cracked crowns replaced, then I will regain some trust in the dental industry. Could it be the dental schools are slipping a bit, where I live? I'm not sure. I'm trying to keep calm here, but believe me, it is stressful to know that my teeth have not been in good dentists hands for several years. When the dentist tells me "you have no cavities, good job" I will always be leery. Because for 5 years, a cavity slipped through the eyes of a dentist. I could always go back to my very first dentist, the one who put the original plastic cap on. The only reason we left him was because he was a bit aggressive, and my family didn't like him much. Maybe my family is out of their mind - because the dentist they recommended, couldn't even find a cavity, and keeps cracking crowns. Hope I haven't confused you with all the dentists I've had. > I cracked a front upper tooth several years ago. I cracked it whil playing bal > hockey. Ball hit the tooth straight on. So I had a plastic cap pu on b > DentistABC. I don't play road hockey now, this was 11-13 years ag as a teen > Th > plastic one DentistABC put on was fine for about 11-13 years. (i was not a > expensive permanent crown/cap, just a temporary plastic one that wa supposed t > last 3-5 years or longer) > > After about 12 years I had the plastic one removed and it wa replaced with > more expensive one. The only reason I replaced it was because th other one tha > lasted for 12 years was the wrong color mixture (way too yellow, m other teet > didn't match it. > > The temporary plastic/non-permanent tooth that lasted for 12 year was replace > with an crown/cap by a new dentist, DentistXYZ. The new replacemen tooth was > more expensive permanent tooth because it contained porcelain whereas my ol > one was a plastic one > > The new cap I had put on cracked about 8 months later! I jus noticed it in th > mirror one day. Cracked on a diagonal line at the front of th tooth. Bi > diagonal crack down the entire tooth > > About me: currently I sit in an office most of the day. I don't pla football o > any sports that involve roughage. I just walk, do office work progra > computers, hike, things like that. Haven't ever been in any ca accidents > Went back to dentist: got it replaced. They hit the tooth very har (his denta > assistant) instead of pulling it off or grinding at it. I was leer of what the > were doing, because I wish he could have just pulled it of gradually or groun > it off, instead of whacking it so hard. His dental assistant didn' seem to > bright, and was talking about her latest pair of jeans and how muc they cos > (or something along those lines - and of course the dentist drives Mercedes) > I asked the dentist why it would crack? His excuse was that I mus have don > something to it, and that was the most likely cause. Anyway, he pu on > temporary tooth because he had to have a new tooth made in the mea time. Whil > at home the temporary glued tooth fell off. I noticed a piece of m real toot > underneath was broken off along with the temporary tooth. I made th assumptio > that the reason the real tooth was broken off underneath was becaus of the > hitting it so hard (but forget that, for now) > > Anyway, went back to the dentist to get the new replacement tooth They put i > on. Wrong color. Replaced it again > > 3 months later: it cracked. On a diagonal. Today I'm sitting her with a cracke > tooth and wondering what to do > > So a summary > - two porcelain teeth have cracked coming from the same dentis > - never had issues with the plastic one, but was put on by different dentist > - Functionally, plastic one worked fine for 12 years. Only reason i wa > replaced was aesthetics > - second dentist has cracked my tooth underneath while hammering of old cap > that need to come off > - When I broke the tooth as a teen the first time, there was 1/2 o the toot > left. Now there is only about 1/4 of a tooth left because the secon dentis > keeps breaking pieces off each time > > What do I do? Why would it crack two times? I don't play football o drive car > often. I've never been in an accident > > I do not wish to go to the same dentist again. Should I ask fo money bac > politely and try another dentist? How would I do this withou hurting hi > feelings > > If the expensive porcelain ones keep cracking, and my origina plastic/cheap o > lasted me 12 years, should I go back to a plastic one > > Has anyone ever noticed problems with porcelain teeth breaking? live in a col > climate - would temperature changes crack a porcelain tooth? Th plastic on > never had any issues. I've not moved to new locations > > I'm looking for advice on > 1. why it is cracking every few months, and if anyone else has ha or see > similar problems > 2. what I should do to tell the dentist politely that I don't wan him to try > again, I am scared of what will happen. > [quoted text clipped - 7 lines] > - coloring was wrong, had to go back several times AGAIN. > - Temporary tooth fell off AGAIN. There are a number of reasons a crown may fracture. It may be due to problems with tooth preparation, porcelain firing, wrong cement, patient habits, etc. I doubt very much you can blame cold or hot climate. I should say that a plastic crown lasting 12 years is extraordinary. It would seem to indicate you have no grossly damaging habits. If the dentist has made an honest attempt at remedying the situation, he may well decline to refund your money. However, if you have lost confidence in him, you should go elsewhere, and you would seem to have little to lose in asking for at least a partial refund. OTOH, if you talk honestly about your concerns, he may be able to explain (if he knows) what he feels the problem may be; his answers may be as telling as anything he has done so far. If you were my patient and this crown is all-ceramic, I would probably opt for a ceramo-metal crown instead, which generally is slightly less cosmetic but less likely to fracture |
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