Why Is Plaque Building Up on My Dental Crown?
When dental crowns are placed correctly, they should feel seamless. In fact, a well-crafted crown should be so comfortable that you forget it’s even there. But when something isn’t done quite right, patients can be left with discomfort, frustration, and concerns about their oral health.
This patient wrote to our Naperville cosmetic dentist with concerns about her new dental restoration. Read her story below:
The Patient’s Experience
As soon as the crown was cemented onto this patient’s back tooth, she noticed that something didn’t feel right. The crown didn’t match the shape of her natural tooth, and when she flossed, the string would catch between her teeth instead of gliding smoothly. She also felt what seemed to be a gap in the back of the tooth near her gums, and the area became tender.
Concerned about these issues, the patient returned to her dentist for a follow-up visit and was assured that the crown was cemented perfectly. The dentist told her that her discomfort was simply due to plaque buildup, and sent her home with a rubber-tipped cleaning tool and small brush.
As the days went on, she couldn’t shake her concerns. How could so much plaque build up in just three weeks, especially if her tooth had been thoroughly cleaned before the crown was cemented? She began to wonder whether it was unreasonable to ask for the crown to be redone.
Dr. Newkirk’s Advice
Our cosmetic dentist explained to the patient that the way a crown is designed and fitted is one of the clearest indicators of a dentist’s skill. With quality work, a crown should look, feel, and function like a natural tooth; with mediocre work, however, a number of small but significant problems can arise.
In this case, Dr. Newkirk identified a few potential issues:
- Poor contact with the neighboring tooth: If the shape of the crown where it touches the adjacent tooth isn’t correct, it can create a small gap. This gap acts as a trap for food and plaque. Over time, it can irritate the gums and even contribute to tooth decay.
- An open margin: The margin is the edge where the crown meets the natural tooth. If this margin doesn’t fit properly, it can leave a rough edge. In some cases, the crown may create an overhang, or a small ledge that snags floss and accumulates plaque, often increasing the risk of gum disease.
- Subgingival decay or preparation issues: Sometimes decay extends deep along the root of a tooth, making it challenging to achieve a perfect margin even for skilled dentists. In these situations, the margin may not be ideal, though the dentist should still do everything possible to minimize risks.
Any of these factors could explain why the patient’s floss was catching, why she felt tenderness near her gumline, and why plaque seemed to be building up so quickly.
Next Steps
Dr. Newkirk discussed the following options with this patient:
- Discuss the margin and contacts directly: The patient could return to her dentist and explain that she believes there may be an open margin, an overhang, or poor contact between the crown and adjacent tooth.
- Request a simple adjustment: If the problem is a minor rough edge, the dentist may be able to smooth it down quickly, eliminating the floss-catching and irritation.
- Seek a second opinion: If her current dentist dismisses her concerns or cannot provide a satisfactory explanation, a second opinion from a dentist with advanced restorative training could help confirm whether the crown needs to be redone.
- Redo the crown if necessary: If the issues are significant enough, replacing the crown may be the only way to truly resolve the problem. Ideally, this would give the patient a properly fitting restoration that supports her oral health rather than compromising it.
The Takeaway
This story highlights an important truth: dental crowns should not cause discomfort, trap floss, or make you feel like you need an arsenal of tools just to keep the area clean. If you notice plaque buildup, tenderness, or irregularities in the way your crown fits, these are red flags that something may not have been done correctly.
For patients like this one, the key is not to accept “plaque buildup” as the final answer. Asking questions, requesting clarification, and seeking a second opinion when necessary are all reasonable steps to protect your investment and your oral health. Be sure to choose a cosmetic dentist who values open communication and answers any and all questions.
Editor’s note: This blog was originally posted on June 19th, 2010.