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Saturday, August 25, 2012

I had a root canal many years ago and since the crown falls out all the time and it bleeds and smells really bad.

Sometimes you get a letter with questions that touch on numerous issues.  I received one such letter this past week and I would like to share it with you.

Hello Dr Barzilay,
I had a root canal many years ago and since the crown falls out all the time and it bleeds and smells really bad. After telling my dentist over and over again they referred me to a specialist who just found out that the dentist who did the first root canal missed a canal and it got infected that's why i was having so much pain. My question is if i get a crown on it again will it keep falling out? Or did it fall out because it was infected. Also my appointment to get my crown on isnt until 2 weeks from now how do I keep this clean from getting infected again I have a huge hole there it is my number 3 tooth. Thanks

Wow, these are great questions I thought I would put up this letter on the blog for discussion.  There are a lot of important issues that have been brought up here that deserve discussion and many things that I have seen throughout my years of practise.

1)  Why has this crown been falling off since it was placed.  A properly place crown does not fall off.  If this  crown has been falling off since it was placed we can only assume that it was not placed properly.  Meaning that perhaps the underlying tooth is too short to give retention to the crown and if so it may be necessary to lengthen the underling tooth or find retention by another method.  Another reason the crown could come off would be if the tooth was rotten underneath but we will assume that this was not the case since it was coming off from the beginning and a new crown would not have decay underneath.  My question here to the writer would be, how many years ago was the crown done? and what does falls out all the time mean?

2)  Bleeding gums and a bad smell around a crown can mean that the crown is loose and bacteria is getting in around the crown causing inflammation of the gums. ( when you touch inflammed gums they bleed).  Also, if the crown is loose and bacteria and debris are getting between the tooth and the crown you can get decay of the tooth and supporation of the debris leading to bad odour.

3)  Is the crown falling off related to the missed canal and pain you were having?  No.  The missed canal will not cause the crown to come off.  It most definetly may be the cause of your pain among other possible reasons (such as a moving crown or a cracked tooth).

4)  If you get a new crown on the tooth, will it keeping falling out?  You must get a new crown on the tooth and if it is done properly should not fall out as the original should not have fallen out.  Remember, the crown holding onto a tooth is just related to the physical properties of the tooth.  In other words, if the crown has what to hold it will hold.  If it doesn't have what to hold we have to start thinking about either making the tooth longer so there is more of what to hold or perhaps extracting the tooth and placing an implant as a regular crown will not hold.  You have to ask your dentist flat out "will this crown hold?"

5)  Now this last question is really important.  The patient say she has a huge hole there and wants to know how to keep it clean so it won't get infected.  Her appointment for the new crown is in two weeks.  Sometimes a hole is a result of the temporary filling being compressed into the crown space, in which case you may be getting bacterial leakage and you should go back to the dentist to top up the temporary filling.  This is simple and not a problem.  If for some reason there is no temporary crown or filling then that is a problem as bacteria can percolate through exposed root canals and cause reinfection of the canals.  Speak to your dentist regarding this.  The last issue here is also, as I have mentioned in point 1,  if  you are going to be having a new crown done in two weeks, ask your dentist what is different that now that will make the new crown stay on.

All the best

Dr. Ron Barzilay

Enjoying dentistry in Hamilton Ontario

Feel free to post your comments and follow my blog.


  1. My dentist says that she will have to pull tooth because crown is so loose, that there is no tooth anymore for it to stay attached to. Well, crown and post fell out. Do I still need to go back to have something else done? I put it back on, but know it's not going to stay. There is nothing left except a hole!

  2. Of course you do and you know it!

    You need to go back and have the tooth extracted. It sounds like it is rotten underneath and it is just a question of time before nothing will hold it. If you wait you risk inflammation of the gums in the area, a possible abscess in the area with resultant bone loss and of course the associated pain. Why wait?
    You should get the tooth extracted and discuss with your dentist what are your options for replacement.

    Good Luck

    Dr. Ron Barzilay