Preparing a tooth for a crown usually requires two visits to the dentist – the first step involves examining and preparing the tooth, the second visit involves placement of the permanent crown.

First visit: Examining and preparing the tooth

At the first visit in preparation for a crown, your dentist the conditions of your tooth involved. If the tooth has extensive decay or if there is a risk of infection or injury to the tooth’s pulp, a root canal treatment may first be performed.

Before the process of making a crown begins, your dentist will anesthetize (numb) the tooth and the gum tissue around the tooth. Next, the tooth receiving the crown is filed down along the chewing surface and sides to make room for the crown. The amount removed depends on the type of crown used. If, on the other hand, a large area of the tooth is missing (due to decay or damage), your dentist will use filling material to “build up” the tooth to support the crown.

After reshaping the tooth, your dentist will make an impression or take a scan of the tooth to receive the crown. Impressions or scans of the teeth above and below the tooth to receive the dental crown will also be made to make sure that the crown will not affect your bite.

The impressions are sent to a dental lab where the crown will be manufactured. The crown is usually returned to your dentist’s office in two to three weeks. If the crown is made of porcelain, your dentist will also select the shade that most closely matches the colour of the neighbouring teeth. During this first visit your dentist will make a temporary crown to cover and protect the prepared tooth while the crown is being made. Temporary crowns usually are made of acrylic and are held in place using temporary cement.

Second visit: Receiving the permanent dental crown

At the second visit, your dentist will remove the temporary crown and check the fit and colour of the permanent crown. If everything is acceptable, a local anaesthetic will be used to numb the tooth and the new crown is permanently cemented in place. When the procedure is over, you will receive further care instructions.

• Discomfort or sensitivity. Your newly crowned tooth may be sensitive immediately after the procedure as the anaesthesia begins to wear off. If the tooth that has been crowned still has a nerve in it, you may experience some heat and cold sensitivity. Your dentist may recommend that you brush teeth with toothpaste designed for sensitive teeth. Pain or sensitivity that occurs when you bite down usually means that the crown is too high on the tooth. If this is the case, call your dentist. He or she can easily fix the problem.

• Chipped crown. Crowns made of all porcelain can sometimes chip. If the chip is small, a composite resin can be used to repair the chip with the crown remaining in your mouth. If the chipping is extensive, the crown may need to be replaced.

• Loose crown. Sometimes the cement washes out from under the crown. Not only does this allow the crown to become loose, it allows bacteria to leak in and cause decay to the tooth that remains. If a crown feels loose, contact your dentist’s office.

• Crown falls off. Sometimes crowns fall off. Usually this is due to an improper fit, a lack of cement, or a very small amount of tooth structure remaining that the crown can hold on to. If this happens, clean the crown and the front of the tooth. You can replace the crown temporarily using dental adhesive or temporary tooth cement that is sold in stores for this purpose. Contact your dentist’s office immediately. He or she will give you specific instructions on how to care for the tooth and crown for the day or so until you can be seen for an evaluation. Your dentist may be able to re-cement the crown in place; if not, a new crown will need to be made.

• Allergic reaction. Because the metals used to make crowns are usually a mixture of metals, an allergic reaction to the metals or porcelain used in crowns can occur, but this is extremely rare.

On average, dental crowns last between five and 15 years. The life span of a crown depends on the amount of “wear and tear” the crown is exposed to, how well you follow good oral hygiene practices, and your personal mouth-related habits (you should avoid such habits as grinding or clenching your teeth, chewing ice, biting fingernails, and using your teeth to open packaging).

While a crowned tooth does not require any special care, remember that simply because a tooth is crowned does not mean the tooth is protected from decay or gum disease. Therefore, continue to follow good oral hygiene practices, including brushing your teeth at least twice a day, flossing daily — especially around the crown area where the gum meets the tooth — and rinsing with an antibacterial mouthwash at least once a day.