Dr. Michelle Jorgensen

July 13, 2026

Are Crowns Necessary? What About Root Canals?

X-ray of a molar that has had a root canal, showing the filled canals

If your dentist has ever said you need a crown or a root canal, it is normal to pause and wonder whether it is truly necessary. Maybe you have had a crown that felt sensitive afterward, or a root canal that had to be redone, and you are simply asking a fair question: is there another option?

The honest answer is that sometimes a crown really is the right call, and sometimes a more conservative choice fits just as well. Both things are true. In this article we will walk through when a crown is genuinely needed, when there may be alternatives worth discussing, and how a more conservative philosophy called biomimetic dentistry approaches the same problem. The goal is not to talk you out of care you need, it is to help you ask better questions.

Are Crowns Necessary? The Honest Answer

A dental crown is a cap that covers the whole visible part of a tooth. It is a genuinely useful, well proven restoration, and in the right situation it can save a tooth that would otherwise be lost. Crowns are not a scam, and refusing a crown that a tooth truly needs can lead to a fracture or an extraction later.

At the same time, crowns are common enough that it is always worth a conversation. A crown removes a meaningful amount of healthy tooth structure, so before you commit, it is reasonable to ask whether your particular tooth needs full coverage or whether something smaller would hold. The graphic below shows the situations where a crown is most often the appropriate choice.

When a tooth may need a crown: large filling, cracked tooth, or heavily worn tooth

When Is a Crown Necessary?

A crown is usually the right choice when there is not enough healthy tooth left to reliably hold a smaller repair. Here are the most common situations where a crown is genuinely necessary:

A very large filling. When a filling would take up most of the tooth, the remaining walls can flex and crack. A crown wraps and supports what is left.
A cracked or fractured tooth. A crown holds a cracked tooth together and helps it handle the force of chewing again.
A heavily worn tooth. Years of grinding or erosion can wear a tooth down to the point where a crown restores its shape and function.

People often ask how much tooth is needed for a crown, and the practical answer is that it depends on how much solid, healthy structure remains around the edges. When enough sound tooth is left, a smaller repair may hold. When the walls are thin or missing, a crown is the more predictable and lasting choice. This is exactly the kind of judgment call worth talking through with your dentist.

Dental Crown Alternatives Worth Discussing

When a good amount of healthy tooth still remains, there are often more conservative options that fall between a simple filling and a full crown. These are not right for every tooth, but they are worth asking about:

Fillings. For smaller areas of damage, a well placed filling can restore the tooth without full coverage. This is the crown versus filling question, and the answer comes down to how much healthy structure is left.
Inlays and onlays. These are custom restorations that cover only the damaged part of the tooth instead of the whole thing. Reviews of clinical studies show inlays and onlays hold up well over the long term, with survival rates reported around 85 to 91 percent after a decade.
Bonded restorations. Modern adhesive materials can bond strongly to enamel, which lets a dentist repair a tooth while keeping more of the natural structure intact.

The theme here is simple. The more healthy tooth you keep, the better. A conservative option is not always possible, but it is always a fair thing to ask about.

Biomimetic dentistry mimics the natural tooth, a conservative approach to restoring teeth

What About Root Canals?

A root canal removes the living nerve and blood vessels from inside a tooth and then seals the space, leaving the tooth in place but no longer vital. It is one of the most common ways dentists try to save a tooth that is infected or badly damaged, and for many people it does relieve pain and keep a tooth that would otherwise be lost.

My own approach leans more conservative. Whenever it is possible, I would rather help protect and preserve a living tooth than remove its nerve. A tooth whose nerve is only irritated, not truly infected, is often worth a careful second look before moving straight to a root canal, because a deep cavity or a crack can inflame a nerve without killing it. In those cases a more conservative dentist may first try to calm and protect the nerve.

When a tooth is truly non-vital or abscessed, that is a different situation, and it does deserve prompt attention rather than a wait-and-see approach. This is exactly the kind of decision worth talking through with a dentist who looks at your specific tooth, your symptoms, and your images together, and it is a very reasonable time to seek a second opinion from a holistic or biological dentist.

Biomimetic Dentistry: A More Conservative Philosophy

Biomimetic dentistry is an approach that tries to mimic the natural structure of a tooth and preserve as much healthy tissue as possible. Instead of automatically moving to full coverage, biomimetic and minimally invasive dentists lean on strong adhesive materials, onlays, and careful repairs that keep more of your natural tooth.

This is not a fringe idea. It is a recognized part of the broader movement toward minimally invasive dentistry, and it shows up in the research. In one study, dentists trained in biomimetic dentistry were more likely to choose a direct restoration or an inlay or onlay instead of a full coverage crown when a tooth had only moderate structure loss.

The takeaway is not that crowns are wrong. It is that the amount of tooth a dentist removes can depend partly on their training and philosophy, so a second opinion from a more conservative dentist is reasonable when the situation is not urgent.

Questions to Ask Before a Crown or Root Canal

You do not have to be a dentist to be an informed patient. If a crown or root canal is recommended and the situation is not an emergency, these questions can help you understand your options:

How much healthy tooth structure is left, and is there enough for a smaller repair?
Would an onlay, inlay, or bonded restoration work here instead of a full crown?
Is the nerve actually infected, or is it irritated but still healthy?
What happens if we watch it closely for a while before deciding?
Would you recommend the same treatment for your own tooth?

If you are unsure, it is always reasonable to seek a second opinion, ideally from a holistic or biological dentist who will review your full health history. A good dentist welcomes these questions.

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Prevention: Keeping Teeth Strong Enough to Skip the Crown

The best way to avoid a crown is to keep a tooth healthy long before it ever gets to that point. Most teeth that end up needing a crown started with a small problem that grew, so the everyday basics matter more than almost anything a dentist does later.

That means brushing twice a day, flossing, scraping your tongue, and giving your enamel what it needs to stay strong. One simple upgrade is brushing with a hydroxyapatite tooth powder. Hydroxyapatite is the mineral your tooth enamel is naturally made of, and research on hydroxyapatite based products shows they can support enamel and help keep it strong. If you want the deeper science, see our guide on what hydroxyapatite tooth powder is.

From there, a few of our most useful reads can help you keep more of your natural teeth: how to build cavity resistant teeth, a guide to supporting tooth remineralization naturally, and the secrets of effective teeth cleaning. Strong enamel and good home care mean fewer teeth ever reach the crown conversation in the first place.

Regular checkups matter too. Catching a small issue early is what keeps it small, and a conservative dentist can often repair a little problem with a little restoration instead of a big one.

References

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So, are crowns necessary? Sometimes, yes, and in the right situation a crown or a root canal can be exactly what saves your tooth. Other times a more conservative option fits just as well. The point is not to fear these procedures or to refuse care you truly need. It is to understand your choices, ask good questions, and work with a dentist who wants to keep as much of your natural tooth as possible.

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Dr. Michelle Jorgensen, DDS

Dr. Michelle Jorgensen, DDS, is a biologic and holistic dentist, naturopath, author, and the founder and formulator behind Living Well with Dr. Michelle. After her own health journey through gut and digestive struggles, she built a clean, science-backed line to support the body at the root — for her own family and patients. More than one million bottles of her tooth powder have been sold.

Frequently asked questions

Are crowns necessary?

Sometimes, yes. A crown is genuinely needed when there is not enough healthy tooth left to hold a smaller repair, such as after a large filling, a fracture, or a root canal. In other cases, when more healthy structure remains, a more conservative option like an onlay or filling may work instead. It is worth discussing both with your dentist.

When is a crown necessary?

A crown is usually necessary when a tooth is cracked, has a very large filling, is heavily worn, or has had a root canal, because in those cases the remaining tooth walls need full coverage to stay strong. When enough solid tooth remains, a smaller restoration may hold instead.

How much tooth is needed for a crown?

It depends on how much solid, healthy structure is left around the edges of the tooth. When enough sound tooth remains, a smaller repair such as an onlay or filling may be possible. When the walls are thin or missing, a crown becomes the more predictable, lasting choice.

What are the alternatives to a dental crown?

Depending on how much healthy tooth is left, alternatives can include a filling, an inlay, an onlay, or a bonded restoration. These more conservative options cover only the damaged part of the tooth and keep more of the natural structure. They are not right for every tooth, but they are always worth asking about.

Is a crown better than a filling?

Neither is universally better. It comes down to how much healthy tooth remains. A filling works well for smaller areas of damage, while a crown is the stronger choice when most of the tooth is gone or the walls are at risk of cracking. Your dentist can help you weigh the crown versus filling decision for your specific tooth.

Are root canals necessary?

Often, yes. When the nerve inside a tooth is truly infected or dead, a root canal can relieve pain and save the tooth from extraction. If the nerve is only irritated but still healthy, a more conservative dentist may first try to protect it. An active infection or abscess should always be seen promptly.

What is biomimetic dentistry?

Biomimetic dentistry is a conservative approach that tries to mimic a tooth's natural structure and preserve as much healthy tissue as possible, using strong adhesive materials and restorations like onlays instead of automatically placing a full crown. It is part of the broader movement toward minimally invasive dentistry.

Can I avoid needing a crown?

You cannot always avoid a crown once a tooth is badly damaged, but good daily care goes a long way. Brushing with a hydroxyapatite tooth powder, flossing, and regular checkups help keep enamel strong and catch small problems early, so fewer teeth ever reach the point of needing a crown.

How much does a dental crown cost?

Costs vary widely depending on the material, your location, and your insurance, so ask your own dental office for a written estimate. If you are weighing the cost, it is also worth asking whether a more conservative and often less expensive option, like an onlay or filling, would work for your tooth.