What Does a Cavity Under a Crown Look Like?

As this blog approaches nearly 3 years of age and well over 150,000 views, I am able to see what the more popular dental topics are out there. Currently, the fourth most popular post on this site, clocking in with a little more than 19,000 views (as of July 2015), is Dental MythBuster #9: You can’t get a cavity under a crown.

In analyzing what people search for online, many readers – hundreds that is – searched for some variation of: what does a cavity under a dental crown look like?

I had just finished compiling this information when a long time patient of mine – one who I had been telling for several months now about decay under one of her crowns – called to finally schedule her extraction.

Photos and X-rays of Cavities Under a Crown

In this particular case, the decay was so deep that her only option was extraction (see below for why extraction was her only options). Below is a bitewing x-ray:

dental bitewing x-ray showing decay under a crown

The x-ray shows the definite shadow of decay underneath a crown.

I had first diagnosed this nearly a year ago primarily based on the x-ray. In this area of the mouth – the last tooth on the lower left – the cheek drapes up against the tooth – making it very difficult to see – and very difficult to brush!.

I then removed the tooth. And no, I did not put my knee on her chest! The decay was unmistakable. Upon completing the procedure and having the patient go home, the first thing I thought was: “this will make a great photo for my blog!” So here it is:

high quality detailed photo of extracted tooth with decayed cavity under a dental crown

The extracted tooth in all its glory. If you dare, you can click on it to see a larger version!

You can clearly see the decay on this crown when it is out of the mouth. However, when it was in her mouth, it was nearly impossible to see. It could only be “felt” with a dental instrument. But the x-ray showed it.

Why was the tooth extracted?

If you get decay underneath a crown, it doesn’t always mean that the tooth has to be extracted. Before I explain why this was extracted, let’s look at one where the tooth was able to be fixed:

high quality photo of a cavity under an incisor crown

The decay underneath this crown was predictably fixed with a new crown.

The tooth directly above could be saved because the decay was easily accessible and only extended slightly underneath the gum tissue. The tooth had already had a root canal.

For the first tooth, the decay extended deep underneath the gum tissue and went into the furcation (the furcation is where the two roots of two-rooted tooth meet). No amount of modern dental procedures could have saved the tooth. So we extracted it and placed a dental implant.

Please note that I have greatly simplified the criteria for when a tooth can be saved vs. extracted. There are dozens of other factors – all beyond the scope of this post.

So, to summarize:

  • You can get decay or cavities underneath a crown.
  • The extent and location of the decay as well as other factors will dictate the treatment needed to correct the problem.

As always, your dentist should answer all your questions. If he/she doesn’t, it’s time to look for a new one.

Dentistry and Art: The Dentist by Pietro Longhi

Pietro Longhi was a Venetian painter who lived from 1702 – 1785. He primarily painted contemporary scenes and daily life of residents of Venice in the mid 1700s.

Pietro Longhi the Dentist oil Painting showing a tooth extraction in the 1700s in Venice

The Dentist, sometimes also referred to as The Tooth Puller or Il Cavadenti, painted approximately 1750. Clicking on the image will show a larger version

This painting does not include the gory scenes as depicted in works by Caravaggio or Gerard van Honthorst. Rather, it elevates the “dentist” into somewhat of a magician-like figure. But, similar to other works, it shows the dentist having just pulled a tooth. Other procedures (root canals, crowns, etc) that we associated with modern dentistry have not yet been invented.

There are several masked individuals and a person of small stature is at the foreground. All of this suggests some type of Venetian Carnival type atmosphere.

On a lighter note, there are three individuals, probably early teens, looking up and admiring the dentist. Based on this viewpoint, doesn’t it appear that they are holding smartphones and taking pictures?

Pulling Your Own Tooth?

Basketball star Reggie Evans photo loose tooth that he pulls

Basketball Star Reggie Evans after he pulled his own tooth.

As a dentist, I’ve heard lots of stories from patients. And I’ve seen lots of YouTube videos where people perform dentistry on themselves. And I have, on occasion, had to treat a patient in pain in my practice in Orange, CT after they attempted dentistry on themselves. So this incident piqued my interest when one of my patients told me about it.

On April 6, 2013, Brooklyn Nets player Reggie Evans was setting up for a rebound and was headbutted by an opponent. The headbutt significantly loosened one of his front teeth. Then several seconds later, he pulled his own tooth, and placed it on the coaches table. The photo above shows Reggie shortly after he pulled the tooth when he began to bleed from the extraction site.

Within one minute of the incident, he fists bumps another player, and then jumps back in the game. Below is the YouTube video from the incident:


Athletes Behaving Badly?

No one can dispute that Reggie was demonstrating a 100% commitment to his team and to his sport (at least in this instance). But does he set a precedent that pulling a tooth or doing dentistry on yourself is “cool” given the way many look up to and emulate professional athletes?

vice grips used to pull teeth if you do it yourself

Unsterilized vice grips from my basement.

As I mentioned before, on multiple occasions, I have treated patients who thought it would be either “funny” or “cool” to pull their own teeth or do other dental procedures. They’ve told me about the vice grips or pliers they used.

In all of those instances, the patients ended up in severe pain and suffered significant complications. One patient even pushed a piece of his tooth into his sinus and required invasive sinus surgery to have it removed!

Reggie most likely sought professional dental care after this incident. We’ll never know what complications he suffered. So, in spite of the fact that Reggie looked cool pulling his own tooth, it is not recommended!

What will Reggie do next? He will most likely need a dental implant at some point to replace his missing tooth. But we also recommend that he not “behave badly” and set a dangerous example for NBA fans.

Dentistry and Art: Lambert Doomer The Dentist

I’ve featured baroque dental paintings in the past, including masterpieces from Caravaggio and Gerard Van Honthorst. This is another baroque piece but it is a pen and ink drawing as opposed to oil on canvas. This is from the Dutch painter Lambert Doomer (1623 – 1700).

Lambert Doomer painting drawing of dentist from baroque era

High quality electronic reproduction of this drawing. Clicking on the image will yield a much larger version.

There are several interesting observations about this piece. First, we notice that the “dentist” is seated behind the patient with his assistant to his right. The assistant is ready to hand the “dentist” a vial and ensures that the three of them are underneath the umbrella. The ergonomics of this scene are very similar to the way dentistry is practiced now.

Secondly, the “dentist” also has a sword on his belt! I can only hope for the patient’s sake that the “dentist” isn’t planning on using it! I can assure you that if I wore a sword on my belt while practicing dentistry, I wouldn’t be in business for too much longer.

Lastly, we see the basket of eggs at the feet of the patient. This is typical for this era, as eggs were frequently used as payment for services of this kind back then.

This artwork, along with many of the other pieces I’ve posted in my Dentistry and Art series, should make us glad we live in 2013!