Introduction

Being told “you need a root canal” is never a pleasant feeling. Root canals invoke many negative associations, including pain, lost time, and, most certainly, a significant expenditure. The cost of a root canal can be prohibitive and sometimes pushes patients to seek alternative, less desirable solutions, such as extractions. (In my mind, an extraction should always be a last resort, as natural teeth are invariably preferred over any type of replacement, assuming they can be saved with a decent chance of success.) The financial investment in a tooth goes far beyond the root canal itself. Many times, patients are told that their tooth must be treated not just with a root canal, but also with a buildup (or a post) and a crown. This could double the cost of the investment in the tooth. Are crowns really necessary after root canals?

Root Canals

A crucial detail to address is: Why is a root canal being recommended in the first place? What is a root canal anyway?

As an aside, in my practice, I try to avoid using the terminology “you need” when advising my patients. I prefer to inform a patient of the diagnosis, present the necessary risks and benefits, and subsequently recommend or advise treatment if indicated. Sometimes monitoring will be suggested, especially if someone prefers to defer treatment. I trust people to use their own intelligence to decide what they need.

Root canals remove the pulp (nerve and blood tissue) from inside a tooth, disinfect the spaces where it used to reside, and seal that space with a body-friendly material that will, usually, prevent bacteria from re-entering. Root canals are used to treat a sick or dead tooth pulp. If left untreated, a bacteria-ridden pulp can worsen into an infection in the bone around the root of a tooth.

Pulp and root problems are separate from issues relating to the structural integrity of the tooth. These concerns should always be evaluated independently.

Structural Integrity of a Tooth

Teeth are very strong. Just take a moment to think about how many times we pound on our teeth from the time they enter our mouth, as early as six years old—and they last exceptionally well! A major weakening force against our teeth is, believe it or not, dental work! That is correct, you just heard that from a dentist. Every time our teeth are drilled to treat a cavity, they weaken and are more prone to fracturing under our chewing force in the future. Root canal treatment does the same. It weakens our teeth from the inside by reaming out the infected structure that is causing us problems. Even though it may be necessary, it has its drawbacks. That being said, root canal treatment can be performed in a minimally invasive manner by a skilled clinician.

Crowns

Simplistically, crowns are made of a strong material that surrounds a tooth and prevents it from breaking during regular chewing forces. Crowns are able to direct the chewing forces in a way that will not wedge the tooth apart and cause it to fracture. Crowns also seal a tooth circumferentially, which is helpful when a tooth has many areas where cavities have penetrated.

Why is it not beneficial to place a crown on all our teeth? After all, it can seal them and prevent them from breaking! The answer is simple. Teeth are strong. When they have not been compromised, they do not need extra fortification.

Crowns After Root Canal Treatment

Does a tooth “need” a crown after a root canal? I hope our discussion is making the answer to this question clearer. It depends. If a tooth has already undergone significant treatment over the course of its life (i.e., many fillings), and now the pulp is sick and treated with a root canal, it is likely that a crown will be helpful in mitigating its fracture risk. It has been highly compromised. However, if a tooth has been generally healthy, and, for whatever reason, the pulp must be treated, a conservative, minimally invasive root canal and a filling will certainly leave the tooth better off than removing significant tooth structure to place a crown. The tooth itself is strong enough when it has not become compromised. A mindful dentist will assess these issues and provide the best recommendation.

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