09/12/2026
If you are going to read anything medical today, read this.
I borrowed a couple of these photos from Dr. Donato Napoletano. 
Patient: Why do I need a crown? I have no pain and there is no decay and my tooth is not broken?
Me:
First off, if there is pain, that is a larger problem that involves your nerve. Now you are dealing with getting this tooth extracted or a root canal.
Secondly, you do NOT have to have any of the 3 symptoms described above (pain, decay or a broken piece of tooth) to need a crown or crowns on teeth.
Me:
Your tooth has a crack (fracture line) that runs from the front of your tooth to the back. If you do not crown this tooth now, when this crack finally gives, and it will, you will lose this tooth because it will be non restorable.
Me:
These usually happen on Fridays at 1pm (when we leave for the day) or right before a big event (vacation, wedding, something you have to attend).
When this tooth fractures it will be very painful.
Patient:
Ehhhh, I think I’m going to hold off on that crown for now.
Me:
That is your choice because it is your mouth, however when this fractures, please understand I may not be able to see you immediately. (I may be on vacation, or coaching, or have a slam packed day at my office).
Patient:
Oh I understand.
3 months later, patient calls my office Friday at 12:30pm in excruciating pain. That tooth that needed a crown, fractured in half. I am away for the weekend and I cannot get them into another local dental office. They are stuck, downing ibuprofen, and miserable all weekend until I can get them in on Monday. They have a wedding to attend on Saturday. Folks, this happens all the time.
Tooth is surgically extracted on Monday and now the patient has to make a decision. Do you want me to graft the site and place an implant in the future or not.
Patient:
What happens if I don’t replace this tooth.
Me:
Well you will eventually lose another tooth or two due to supraeruption (when a tooth does not have support and starts drifting out of place). See photo below.
NOTE: I see supraeruption daily and there is nothing that can fix it.
Patient:
Response A: I guess I have no choice, go ahead and graft the site and plan for a future implant.
OR
Response B: Just pull it and I’ll figure something out in the future.
I see more response B than A.
Folks, at a bare minimum we need 1st molar to 1st molar occlusion. When you do not, things eventually crash and burn dentally speaking.
When you pull teeth and do not replace them, you are now putting more stress and pressure on the remaining teeth that they are not supposed to be subject too.
Think of it this way. You start pulling parts off your car, one part at a time and then expect your car to function the same way it did when it was fully equipped. Eventually there is going to be a catastrophic failure, it always happens.
So please do not be mad at your dentist when you choose to not replace missing teeth or your mechanic when you do not maintain your vehicle. Or you have neglected your oral health for years or decades and then get mad or frustrated with Drs like myself when the fix isn’t easy or cheap or quick or what you wanted to hear.
We are healthcare providers and here to help but we also have to do what is right and correct and that sometimes goes against what the patient wants.
Your teeth are just as important as any other organ in your body so take care of them and when your dentist tells you you need a crown or crowns due to wear, fractures, grinding, etc….you have 2 choices. Crown or crowns or highly risk losing a tooth or teeth.
Have a blessed day.
Photo 1: molar with zero symptoms but Dr noted a large crack and informed patient they needed a crown.
Photo 2: patient denied treatment and then showed back up months later with a very painful fractured molar that now had to be surgically extracted.
Photo 3: supraeruption. Lower molars extracted years ago. Upper molar now floating downward into the empty space. This patient will lose this upper molar in the future.
