Aging and Teeth (Broken Crown)–2: Important Factors in Treating Old/Older People + New Technology

Sr. Advisor R had a problem. The crown on her tooth broke. She didn’t want to sit in a dental chair and experience an “ordeal,” as she put it, which I’m sure it is for a woman who’s 100. While R makes every effort to take good care of herself, deciding about options (extract tooth, make new crown using new technology, or using traditional technology) was causing stress.

A relative living in Washington state, weighed in. She just had the newest technology for crown restoration, using CAD/CAM computer-aided design and computer-aided manufacturing. The new crown was made during the appointment; she went home “all fixed up.” All went well.

NY Times October 8, 2013 column describes the procedure. It requires only one appointment. That is very appealing to an old person. In the end, however, Sr. Advisor R chose to have the traditional “tried and true” method.

I discussed Sr. Advisor R with my dentist, Gary Markovits, DDS. He’s highly experienced, skilled, comes from a dental family, and is sensitive to old people’s needs (his wife’s parents are in their 80’s). I wanted to know if old/older patients need special consideration.

“For our senior patient population,” he says “it’s important to:

1. Keep treatment time as brief as possible.
2. Reduce recurrent and repetitive procedures, such as anesthesia and office visits.
3. Complete treatment quickly and thus, as cost effectively as possible.”

Since he has the CAD/CAM technology, I also asked for a brief explanation.

While CAD/CAM technology clearly provides the potential to achieve the above for elders, there’s a reality that Dr. Markovits reminds us of through an analogy:

“Technological advancements don’t necessarily lead to improvements in quality. When there’s a human operator at some level, “quality” may be enhanced by improved technologies but these tools are only as good as their user.  An average carpenter using state of the art tools will likely continue to produce average work, whereas a master carpenter using basic or even out dated tools will likely still produce high quality work.”

That said, Dr. Markovits explains that there are additional factors to consider when (in this instance) making a crown. “Since each case has its own requirements, one technology can’t necessarily be applied to all situations, he says.”

For example, just-taken X-rays, visual inspection of the tooth (with crown removed if that tooth is causing problems), and a digital laser scanner’s 3-D imaging, may reveal new issues, which make it unwise to put a permanent crown in place that very day. Thus a temporary crown is put on the tooth because the 1-visit CAD/CAM crown replacement isn’t appropriate; and at least one more appointment is necessary before a permanent crown can be put in place.

TEETH. Probably not the first thing we think about when our goal is to help parents age as well as possible. That said, our having the preceding general information –and staying abreast of the new dental technology–will no doubt come in handy for our elders now and as they continue to age.

Check out “Newsworthy” (right sidebar). Links to timely information,  research from top universities, plus some some fun stuff–-to help parents age well.

Aging and Teeth

      Dad taught me how to brush my teeth when–if memory is correct–I was shorter than the sink. I stood on a little stool and each brushed-tooth was dedicated to someone. It was a game. “This tooth is for Aunt Dorothy,” he’d say and then we’d choose another person to brush a tooth for. Being young, I didn’t have that many teeth, but it was fun brushing before bedtime and I realized teeth were important, but doubt I knew why.
     Dad valued his teeth; took good care of them. You can imagine my surprise decades later when Dad’s tooth broke while he was sitting in his favorite chair watching TV. No theatrics–it just broke. He was in his 90’s, wasn’t eating anything at the time. The tooth just–unexpectedly–“broke off.”
     This event replayed itself recently. It happened to another old person. She also took good care of her teeth, was a conscientious dentist-goer and, in her late 90’s, had all her own teeth. She said her “tooth broke.” Turns out it wasn’t really her tooth–it was the crown (very old) on her tooth. But saying her tooth “broke” amounted to the same thing in her mind and no doubt in the minds of many elderly people.

Do teeth just start breaking off  at 90?

Fortunately we have a wonderful retired dentist in the family. A quick call to him provided some answers:


There are three layers to a tooth–the enamel, dentin, and pulp

1. Tooth enamel remains strong in old age, but the pulp naturally slowly shrinks as we age. Unless there’s sufficient blood coming into the pulp the dentin tends to dry out. When this happens, it becomes more brittle. As it becomes more brittle, the teeth are more prone to fracture.

2. A tooth could break by itself, but usually it takes a small amount of pressure for it to fracture.

3. A crown is more likely to “break” or cause problems when it gets old. It’s much faster and easier to remake, with the new technology, than in the “old days.”


1. Extracting the tooth involves anesthesia, presents a small possibility of infection (there are antibiotics) and one wonders if it takes longer for old people to heal.

2. Tooth or root restoration. Regular dentists should be able to do this. There are also specialists who, since they specialize, do many more of these procedures. Endodontists specialize in root restoration (root canal). Prosthodontists specialize in tooth restoration.

These options and their cost can be discussed with a regular dentist.

3.  Common sense is an additional factor. When Dad was 91 0r 2, his dentist recommended root canal on a tooth that wasn’t bothering Dad but looked problematic in an X-ray. Although an appointment was made for the procedure, we decided to wait until it became a bother, rather than have Dad go through the root canal ordeal. Dad died at least a year later. That tooth never caused a problem.

If medical science continues to help people age longer, no doubt “broken teeth” in old age will become more common–even for those who began brushing their teeth while standing on a stool.

*                          *                         *
RELATED: Never been to Fayetteville, but found this site’s information excellent:

From the site’s home page:
Prosthodontics – You may wonder what a prosthodontist does. Prosthodontists are specialists in the restoration and replacement of teeth and related tissues, and the specialty is one of nine that are recognized by the American Dental Association. Extensive post-doctoral training and education provide prosthodontists with the skills for restoring optimum function and esthetics to your smile

Endodontics – Endodontists are Dentists who are root canal specialists, extensively trained to save teeth. One of the main reasons to see a specialist for your root canal therapy is that endodontists are trained to use the latest technology to help patients maintain their natural teeth. Get it done right the first time, and avoid the need for later re-treatment. Endodontists perform routine as well as difficult and very complex endodontic procedures, including retreatment of previously treated teeth that have not healed, as well as endodontic surgery.

Changing often: “Newsworthy”  (right sidebar). Links to timely information and research from top universities, and repected sources–to help parents age well.