Fixing a cracked tooth can be like figuring out the damage after a car accident. If you don’t have a professional check things out, what looks like a surface dent can actually turn out to be really serious. Since dental bone does not behave like other types of bone and cannot knit itself back together, a chip or a crack to the tooth is likely to get worse over time.

In the case of a cracked tooth, your repair expert is an endodontist. Endodontists are experts in saving natural teeth. They frequently see clients with a cracked tooth, and can use their dental specialty training to determine if additional intervention such as a root canal is needed before placing a crown on the tooth.

When Does A Cracked Tooth Need A Root Canal Before A Crown?

The main job of a dental crown is to provide structural support by acting as the new outer surface of a tooth. Before a crown is cemented into place, your endodontist will want to make sure the natural tooth underneath the crown is as healthy as possible. If there is any injury or infection in a tooth’s nerve pulp, a root canal can provide a healthy tooth underneath.

With a crack deep enough to damage the root pulp, a root canal will be needed to prevent further difficulty, possibly extraction. It can be difficult to tell from symptoms alone if you need a root canal before you get a crown placed on your cracked tooth. Some cracked teeth that need a root canal before the crown hurt a lot; some do not. Some teeth with large cracks do not have root/nerve damage, but some teeth with much smaller cracks may have infected nerve pulp that must be removed via a root canal.

It’s important to see your endodontist right away because there are some types of cracked tooth injuries that cannot be remedied with a root canal and a crown. If the crack in the tooth extends below the gum line, it’s highly likely that the tooth will need to be extracted.

“It’s vital to have an endodontist perform a careful evaluation of a cracked tooth – what you can see on the surface may not be an accurate picture of the entire situation,” says Dr. Susan L. Wood, who practices with the Phoenix Endodontic Group. “Our office can perform the diagnostic procedures needed to determine if a root canal is called for before a crown is placed on the tooth.”

Although advancements in technology and microsurgical techniques have made root canals more comfortable and less stressful, the procedure still requires significant investment of time, money, and care. Root canals aren’t inevitable, though – you can reduce your risk of needing one with targeted, proactive self-care.

The tips below can help you prevent a root canal. They focus on managing your risk of falling prey to the three major causes of root canals: tooth decay, infection, and injury. By diligently following these tips, you can greatly lower your chance of needing a root canal, or developing serious oral health problems.

Keeping Teeth Strong And Healthy: 5 Tips For Avoiding A Root Canal

1. Brush your teeth twice a day. A twice-daily toothbrushing routine is the first line of defense against tooth decay, a major contributor to the type of dental pulp infections that require a root canal to resolve. Use an American Dental Association (ADA) approved fluoride toothpaste on a soft-bristled toothbrush.
2. Floss your teeth once a day. This will amplify the effectiveness of brushing your teeth. Flossing cleans the 40 percent of tooth surfaces that cannot be reached by brushing.
3. Strengthen your teeth with calcium-rich foods. Dairy products such as milk, yogurt, and cheese provide calcium to protect and build tooth enamel. You can also get calcium by eating green leafy vegetables, including bok choy, Brussels sprouts, and kale.
4. Use care when you bite down. This tip applies any time you apply force with your teeth. Be careful eating foods like nuts or peanut brittle or hard pretzels. And if you use your “teeth as tools” to rip, tear, or clamp down on things – stop it!
5. Wear a mouthguard for sports or workouts. Use a mouthguard when playing ANY sport where a collision or fall is possible. Mouthguards should also be worn during fitness activities such as rock climbing, hiking, or even cycling. To best avoid dental injury that could lead to a root canal, get your mouthguard professionally fitted.

“Chances of needing a root canal can be minimized with proper planning and the right habits,” says Dr. Susan L. Wood, an endodontist at Phoenix Endodontic Group. “Visit your dentist for regular checkups and cleanings, and always let them know if you experience any discomfort or symptoms indicating you need a root canal.”

The benefits of a root canal treatment when you have a tooth that is infected or injured are significant. First and foremost, you keep your tooth. Root canals also effectively reduce tooth pain, decrease the chance that serious dental infection will spread to adjacent teeth, and prevent the loss of bone density in the jaw, a common after-effect of tooth loss.

With all these advantages, the longer a root canal treatment can contribute to preserving a natural tooth, the better. The lifespan of a root canal treatment can vary considerably, depending on the circumstances. Here are several important factors that can play a role in how long your root canal treatment may last.

Factors Impacting Root Canal Success

1. Which tooth needs the root canal? The position of the compromised natural tooth will influence how complex the root canal procedure will be. Front teeth typically have only a single tooth root. Your molars, on the other hand, have two or even three root canals to be cleaned and filled, and will require a crown to protect the natural tooth afterward.

2. How bad is the damage to the tooth? Severe tooth decay or a crack or chip in a tooth can lead to inflammation or infection so bad that an abscess forms. If the outer structure of the tooth is still intact, there is a better chance that a root canal will last longer.

3. Who will perform the root canal? Endodontists are specialists in saving natural teeth. Surveys indicate that endodontists perform, on average, 25 root canals a week; general dentists average far fewer. One study found that 98 percent of root canals done by endodontists are successful, along with 90 percent done by general practitioners.

4. Will additional treatment be needed? The overall health of the tooth impacts whether a root canal is the best treatment. If the structure of the tooth itself is weak, a post and core procedure may be performed after the root canal to help anchor the crown and hold the natural tooth together.

5. Are you motivated to take care of your natural teeth? Patient involvement in the root canal process is critical to ensuring its long-term success. Contact your practitioner if you have unusual postoperative pain or if your temporary crown falls out; get the crown for the treated tooth promptly; and contact your dentist or endodontist if you have symptoms indicating tooth root infection at any point.

Dr. Susan L. Wood, who practices with the Phoenix Endodontic Group, says, “Root canals can preserve natural teeth for years or even decades – and for some, they can last a lifetime. Our practice can instruct you in all the ways you can ensure your root-canal treated tooth stays healthy for as long as possible.” 

It seems that our schedules continue to get busier these days and are full of activities that need to be accomplished, particularly this time of year. If you are dealing with the challenge of an infected or injured tooth, you may wonder if you really have to schedule a dental appointment to place a permanent crown over a tooth that’s been treated with a root canal. There’s so much else to do!

You may ask,“Can’t I wait until early next year to schedule my crown appointment?” The short answer to that question is NO. Here are a few reasons why you should schedule your follow up appointment to receive your crown within one to three weeks after your root canal.

Reasons Why You Should Not Delay Getting A Crown After Root Canal Treatment

1. A longer wait means a longer period of being extra careful. Many of the instructions you receive after your root canal – especially the ones related to eating soft, bland foods – are designed to protect the temporary crown. If you wait longer to get a crown, you will have to continue that regimen.
2. Until a final restoration (crown) is placed, your tooth remains at risk of further damage. A root canal-treated tooth can be more brittle after the procedure, and a permanent crown is needed to prevent future damage.
3. Your tooth may suffer extra sensitivity without a crown. Some teeth treated by root canals can become more sensitive to heat or cold. Permanent crowns reduce this effect.
4. The longer you wait, the more likely you are to have the temporary crown fall out. Your temporary crown is not secured to your tooth in the same way a permanent crown is. If it falls off, the chances that you will experience increased pain or reinfection can skyrocket, as can cost. Such situations often result in unplanned emergency trips to the dentist.
5. A permanent crown gives your natural tooth the best shot at long-term survival. A study published in the May 2020 Journal of Endodontics reported that natural teeth treated with a permanent crown restoration have a survival rate of more than 90 percent over nine years. The extra layer of outer protection provided by the crown safeguards the interior protection offered by the root canal.

“Having a root canal is the first step to rescuing a compromised natural tooth,” says Dr. Susan L. Wood, who practices with the Phoenix Endodontic Group. “Having a permanent crown placed over that tooth within one to three weeks ensures a much higher level of certainty that your tooth repair will last a lifetime.”