Getting a crown or pulling a tooth are two common treatments for a compromised tooth. Both options have pros and cons to consider when deciding which is right for your specific situation. Key factors include the condition of the tooth, cost, recovery time, and long-term outlook. Careful evaluation of these aspects with your dentist can help determine if a crown or extraction is the better choice.
What is a dental crown?
A crown is a tooth-shaped “cap” that is placed over a damaged tooth to protect and restore it. Crowns can be made from various materials like porcelain, ceramic, metal, or a combination. The crown covers the entire visible portion of the natural tooth above the gum line.
Crowns have several benefits:
- Restore the shape, size, strength, and appearance of a broken down tooth
- Prevent a weak tooth from fracturing
- Hold together parts of a cracked or broken tooth
- Anchor a dental bridge in place
- Cover a dental implant
- Prevent further decay of a tooth with a large filling
Crowns protect damaged teeth from further breakdown and restore proper chewing function. They are a common restorative solution that can last many years with proper care.
Crown procedure
Getting a crown involves two visits to the dentist:
Appointment 1
The tooth is numbed and filed down to prepare it for the crown. An impression is taken to create a mold of the tooth. A temporary crown is placed to protect the tooth while the permanent crown is being made.
Appointment 2
The temporary crown is removed and the permanent crown is checked for fit and appearance. It is then cemented into place.
Patients are given local anesthesia during the procedure so it is not painful. Some sensitivity or discomfort may occur afterward as the tooth adjusts. With proper oral hygiene, a crown can last 5-15 years or longer before needing to be replaced.
What is tooth extraction?
Extraction is the complete removal of a tooth from the gum socket. This is done when a tooth is too damaged or diseased to have other treatments.
Reasons for tooth extraction include:
- Severe tooth decay
- Advanced periodontal disease
- Fractured teeth
- Impacted wisdom teeth
- Needed orthodontic work
- Teeth blocking other teeth from coming in
- Extra teeth from overcrowding
- Infection or abscess
Extractions are also done to prepare for dentures, bridges, implants, or braces. Removing unusable teeth provides relief from pain and allows surrounding teeth to shift naturally or makes room for restorations.
Extraction procedure
The steps involved in extracting a tooth include:
Numbing – Local anesthesia is given to numb the area around the tooth.
Removal – The tooth is loosened from the socket and bone using dental tools. Then it is removed.
Cleaning – The socket is cleaned of any debris and rinsed. Stitches may be placed to close the extraction site.
Recovery – Aftercare instructions are provided to control bleeding and promote healing. Antibiotics and pain medication may also be prescribed. Healing typically takes 1-2 weeks.
Tooth extraction is a routine procedure. With proper post-op care, there are usually no complications and minimal discomfort. The space left behind will heal and fill in over time.
When should I get a crown vs extraction?
Choosing between a crown and extraction depends on several factors:
Condition of the tooth
Crowns can repair teeth that are cracked, fractured, extensively decayed, or have a failed root canal. If enough natural tooth remains, it can be anchored, restored and retained with a crown.
However, if the damage is too severe and the tooth cannot be restored, extraction is the only option. This includes teeth with advanced decay, periodontal disease, infections, or vertical/horizontal fractures below the gum line.
Location and function
Teeth that are necessary for chewing or support of facial structure and jaws are best treated with crowns if possible. Front teeth that are visible and back teeth needed for biting and grinding food should be crowned to maintain proper form and function.
Wisdom teeth that do not fully emerge or impacted teeth can only be removed through extraction.
Cost comparison
While cheaper up front, extraction requires costly follow-up treatment like bridges, implants or dentures to replace the lost tooth. This can cost $3,000-$4,500 per tooth or more. In contrast, a crown averages $900-$1500 per tooth.
However, if the tooth requires other work prior to the crown such as a root canal or build-up, the total costs may be comparable or more than extraction and replacement.
Recovery time
Crowns involve minimal discomfort and take 1-2 visits. Teeth can be used normally right away. Healing from extractions takes several days to weeks. The site is tender and eating or chewing requires some adjustments.
Long-term outlook
Well-made crowns can last 10-15 years or longer if properly cared for. Extracted teeth are permanent, requiring artificial tooth replacements for life. With good dental hygiene, crowned teeth have excellent long-term prognosis.
Evaluating when a crown or extraction is best
Assessing the following factors can indicate if a crown or extraction is the optimal solution:
| Considerations for Crown | Considerations for Extraction |
|---|---|
| Amount of natural tooth remaining | Vertical root fracture below gum line |
| Strong tooth structure | Advanced decay, infection, or periodontal disease |
| Front teeth or needed for chewing | Non-functional wisdom teeth |
| Enough bone to support a crown | Teeth blocking other teeth from coming in |
| Failed root canal but no infection | Overcrowded teeth needing removal for braces |
| Cracked tooth with healthy root | Severe gum disease with extensive bone loss |
Key takeaways
Crowns are ideal if:
- Enough tooth structure remains for a crown to adhere to
- The tooth root and bone are healthy
- Chewing function needs to be maintained
- The tooth is located where a missing tooth would be noticeable
Extraction is preferred when:
- The tooth is not restorable due to extensive decay or fractures
- There is a vertical root fracture below the bone
- An impacted or problematic wisdom tooth needs to be removed
- Teeth are overcrowded and need to be removed for orthodontic treatment
What are the risks of a crown vs extraction?
Crown and extraction procedures share some general risks like infection, bleeding, nerve damage, and complications from anesthesia. More specific risks include:
Crown risks
- Tooth or nerve sensitivity to hot/cold temperatures
- Damage to adjacent teeth during preparation
- Crown does not fit properly and falls off
- Fracture of remaining natural tooth
- Nerve inflammation or injury from procedure
- Chipped or cracked porcelain crowns
- Loose crowns over time requiring replacement
- Tooth decay under defective margin between crown and tooth
Extraction risks
- Dry socket – when blood clot is lost from socket
- Sinus infection from upper tooth removal
- Air trapped under skin resulting in swelling or bruising
- Accidental removal of adjacent teeth
- Root tips inadvertently left in the socket
- Damage to nerves resulting in numbness
- Hole or tear in the sinus membrane
- Oral antral fistula – abnormal opening from mouth to sinus
- Fracture of jaw bone
Proper technique and experience by the dentist can reduce the chances of risks or complications from crowns and extractions. Patients should discuss their medical history including allergies, medications, and pre-existing conditions.
What is the recovery like after a crown vs extraction?
Crown recovery
Getting a crown requires only routine recovery time. After the procedure, patients can expect:
- Mild to moderate tooth sensitivity and gum soreness for several days
- Avoiding very hot or cold foods and beverages until sensitivity resolves
- Slight discomfort from the crown feeling different than the natural tooth
- Temporary crowns may come off easily so care is needed when brushing and eating
- Applying ice packs to reduce facial swelling from anesthetic injections
- Taking OTC pain relievers as directed for discomfort
- Using mild saltwater rinses to keep the area clean
Within 7-10 days, any swelling, soreness, or sensitivity should be greatly improved. Normal brushing and eating can usually be resumed right away.
Extraction recovery
Healing after a tooth extraction takes longer, around 1-2 weeks. Typical post-op care involves:
- Biting on gauze pads to stop bleeding and encourage clotting
- Avoiding spit, rinsing, and sucking actions for 24 hours
- Applying ice packs to reduce facial swelling
- Eating soft foods for several days until soreness subsides
- Rinsing gently with saltwater after 24 hours
- Taking antibiotics or pain relievers per dentist’s orders
- Returning for follow-up visit to check healing
Swelling and bruising of the cheek can last for up to 2 weeks. Moderate pain is normal for 3-5 days. Strenuous activity should be avoided during the first several days. Full healing can take 4-6 weeks.
What are the costs of a crown vs extraction?
Crown and extraction costs can vary based on insurance coverage, dentist fees, and location. General price ranges include:
Crown cost
The typical total fee for a crown is $900-$1500 or more per tooth. This includes:
- Crown preparation appointment – $200-$500
- Lab fees for crown fabrication – $500-$900
- Crown placement appointment – $200-$500
Additional costs may be required if the tooth needs a root canal, core build-up, or post and core foundation before the crown. These can range from $300-$1500 or more per tooth.
Extraction cost
Simple extractions usually cost $75-$300 per tooth. Surgical extractions are more complex and expensive:
- Wisdom tooth removal – $150-$400 per tooth
- Surgical extraction – $225-$600 per tooth
Multiple teeth removed in the same visit can reduce the per tooth cost. Follow-up costs for bridges, implants or dentures to replace extracted teeth start at $1500-$4000 per tooth.
Many dentists offer financing options like dental savings plans and payment plans to offset treatment costs. Getting an estimate ahead of time is recommended.
Does insurance cover crowns or extractions?
Dental insurance can lower out-of-pocket expenses for crowns and extractions. Coverage varies based on the individual policy. Some general guidelines include:
Crown coverage
- Diagnostic and preventive services – typically 100% covered
- Basic services like fillings – often 80% covered
- Major services like crowns – 50% coverage or less
- Annual maximum benefit – $1000-$1500 is common
This means you would pay the remaining 20-50% of the crown cost up to your annual limit. Higher level plans may offer 60-80% crown coverage.
Extraction coverage
- Non-surgical extractions – often 80% covered
- Surgical extractions – 50% or less covered
- Subject to annual limit if extractions are done along with other work
Similar to crowns, you pay the remaining percentage after insurance. Be sure to get pre-treatment estimates of benefits. Procedures not fully covered by insurance require out-of-pocket payment.
Conclusion
Deciding between a crown and tooth extraction depends on several important factors – the restorability of the tooth, location in the mouth, cost comparison of treatments and replacement, recovery time, and long-term prognosis.
Crowns attempt to save and restore damaged teeth, while extractions remove non-restorable teeth. A crown is the preferable choice if the tooth meets the requirements for being crowned. However, if the tooth cannot be restored or the extraction site can be left open, removal may be the only realistic option.
Careful evaluation with your dentist will determine if your particular situation is better treated with a crown or extraction. They can discuss the risks, benefits, and alternatives in detail so you can make the most informed decision. While crowns cost more initially, they provide long-lasting tooth replacement and can prevent the need for bridges, implants or dentures in the future.
