Q: Dr. Crapo: I am 56. Ten years ago, a gold crown came loose and fell off one of my right lower molars. The hollow tooth hasn't bothered me since then. Should I worry about getting it repaired or replaced with an implant? Friends and family seem to think so, but I quit chewing on that side and if food particles happen to get stuck in it they come out easily enough with a toothpick; I also brush at least three times a day.
A: Your dilemma is a common one. In the loss or breakdown of fillings, or crowns, or whole teeth for that matter - the cause is always the same. They are the biologic forces brought to bear on a tooth and are greater than that individual biologic resistance to the stress. In other words, teeth just don't break, and fillings don’t just fall out and crowns don’t come off without a force that is causing that action. I hear individuals query “my tooth broke while I was having some pasta, how could something like that break my tooth?” To some, it was a piece of soft bread, or it happened while having a bowl of soup.
To put your mind at rest, the breakdown did not occur with your meal. It was the result of thousands of chewing, clenching and grinding forces on that tooth prior to that event. “But I don't grind my teeth” will be the reply “at least I don't think I do”. In most cases a short clinical exam will reveal clenching, grinding or both. A more careful examination will reveal alignment problems. A detailed clinical and laboratory analysis will reveal exact patterns of force in relation to the individual's tooth structure and the support the teeth have to withstand these forces.
Undermining a tooth's ability to bear up under these stresses is always decay or insufficient tooth support (due to over filling). When imbalances between jaw alignment and tooth position are out of harmony, overwhelming vectors of pressure weaken, crack and then break the tooth.
This may seem a bit technical but in your case leaving a tooth crownless will influence the dynamics of your whole mouth. It's not only decay that will set in, but the forces of the masticatory system trying to reach equilibrium. The tooth above your lost crown has a lifelong eruptive force.
This means it will descend until it touches something to stop its downward “growth”. Teeth migrate to find something to bite against. With this unguided “growth” malalignment occurs. This then causes greater stress on the surrounding teeth and may also affect the overall jaw function. I routinely see teeth severely worn that are remote from the lost filling or crown area because of jaw dynamics.
Take your family's advice, and I would add, make sure you get a detailed exam if it's been more than ten years.