stisso:
I cracked my tooth this weekend, Saturday night. Had to abandon my Sunday dives after renting my gear (if only I had the cash to buy the stuff!!!)
Anyway, I'm getting a crown put on it. Half the tooth is gone now (they yanked it), but the other half will remain under the crown.
Will I be okay to dive after I have a crown? I had previously had a root canal done on that tooth, and I swear I felt pressure in it (and then a release of pressure) a few dives ago...very suddenly. It hadn't happened before, or since. Then, after a bad peanut, it cracked.
Advice? Do I just ask them to make sure that there's no air in there? Or, should I just pull the sucker and get an implant, so I can still dive? Yes, I would do this so I could dive.
Hi Stisso,
The question is not whether you can or cannot dive with a crown...you can. The potential problem is whether the remaining tooth that was prepared for that crown is in a good enough condition to retain that crown during scuba diving.
It sounds like your root canal was completed a while ago and then the tooth was filled. Typically, it is recommended that most (but not all) teeth which have had a root canal procedure completed then be restored with a crown or some other type of cast metal restoration. The restoration should in effect "surround" the remaining tooth to reinforce it. A core or an endo-post and core is inserted into the space created by the access hole created to allow the root canal procedure to be performed. If the entire top of the natural tooth is missing, the post and core is the only thing that is actually holding the crown onto the tooth once it is cemented.
While a filling can be used to permanently block the opening created by the procedure, it affords NO reinforcement and support of the remaining tooth. That is why the crown is recommended.
Once the nerve in a tooth dies, or the nerve is removed, the remaining tooth and root is more brittle. Forces that would not normally break a healthy tooth may break the root canaled tooth. There may already be fractures within the tooth prior to needing the root canal procedure and bacterial migrating into such fractures can contaminate and then cause the abscessing of the nerve.
Bonded fillings...either composite or amalgam are not infinitely strong and will not support the exterior of a dead or root canaled tooth.
While it is a generalization to say that the longer you go with a filled root canal tooth the weaker it gets and the more subject to breakage it becomes, for the most part it is accurate.
You discribe a tooth with a root canal, and a filling. Now that tooth has broken and you had no other choice but to cap the remaining tooth to salvage the tooth. What you discribe is a common occurence and typically it is done because a patient could not afford to do the crown following the root canal procedure OR they didn't really think that they needed to spend the money to completely restore the tooth. Either way, once it breaks there is only really two treatments...extraction or try to rebuild it with a cap (crown). Only once you get to the "rebuilding as a last resort to save the tooth", the tooth that gets rebuilt is substantially weaker then it would have been had it been done in the "normal" progression of treatment.
With no disrespect intended nor any meaning to preach or lecture you, now you found the means to restore this tooth with a crown...it should have been done immediately following the root canal procedure.
So back to the original question...Can you dive with a crown on this tooth? Probably yes but don't be surprised if some underlying, undetected problem like a fracture causes problems in the future...diving or not. Diving however, subjects the tooth to even greater stresses than usual.
Finally, how long before a problem occurs? Nobody knows. Most fractures DO NOT show up on x-rays. So, usually you find out about them just a short time before we find them on the emergency visit. Your tooth could last for years or it could break tomorrow...and it is no indication that anything was done "wrong" by your dentist.
If this tooth persists in feeling strange, uncomfortable, or painful during dives then it probably going to fail and an extraction may be in your near future. If it occurs, replace the tooth as soon as you can so the remaining teeth don't start to shift. As long as this tooth seems to be a viable solution keep on using it. HOWEVER, if you experience problems or pain then an implant or a fixed bridge may be the best treatment.
In the last few years, implants have become very predictable and should be considered as a good solution to a missing tooth. IMHO it should always be offered as one of the good treatment alternatives...just the same as a fixed (permanent, cemented) bridge. In fact, if your choice is to retreat an old previously root canal to salvage the roots for a new crown and this same tooth is darkly discolored OR you're told that you need to do surgery to remove part of a reinfected root tip on this tooth, get the darned thing out and put in an implant. The prognosis is actually better for the implant than messing with the tooth. The up front cost for the implant plus restoration is considerably more but when you factor in the cost of redoing a root canal, a post and core a new crown AND THEN the poor prognosis, long term, which is a learned way of saying that you may very well lose all the treatment you just did and, in fact, if you underwent surgery to remove a root tip with sacrificed bone that would have supported an implant and must then be grafted back to place an implant in future, the implant is actually better treatment and you DON'T pay for all the potentially useless previous treatment....Talk about run-on sentences!!!!! For the record, this is MY OPINION and reflects my TREATMENT PHILOSOPHY. This is not meant to undermine the opinion and treatment philosophy of you own dentist if different than my own. Discuss the options with him.
Hey, get out there and try the little bugger out on a dive...what have you got to lose...er...maybe we shouldn't go there!
Good luck...keep us informed.
Regards,
Laurence Stein, DDS
