Re: OT - Dental question - Painful Crown...

sheetsofsound wrote:
On Apr 30, 4:40 pm, Mark & Steven Bornfeld
<bornfeldm...@xxxxxxxxxxxxxxx> wrote:
sheetsofsound wrote:
Had a new crown installed a month ago. Tooth under the crown is still
painful. Dentist is now saying I may to have a root canal. Is this
SOP? Wouldn't they want to make that diagnosis *BEFORE* installing a
new crown? They want me to undergo *MORE* xrays on monday (at my
expense) to re-diagnose.
Thoughts?
I can't answer for other dentists. When a tooth is prepared for a
crown, and esp. if there is decay present at the time, you've got to
look very carefully for visible evidence that the pulp may have been
damaged--esp. if the tooth has symptoms before beginning work.
Sometimes the tooth doesn't begin to hurt until after the tooth is
ground down and impressioned for the crown. If the tooth has
significant symptoms at the time I'm ready to insert the crown, I will
usually put it in with temporary cement and let it go for a while and
see what happens. If the pain disappears I cement the crown. If the
pain gets worse, well you know what has to be done.
The problem is when the tooth has symptoms but they aren't getting
significantly better or worse. Then I'll send a patient to the root
canal specialist, unless there's clear evidence on the x-ray that
there's a problem. So it's not always so cut and dried.
Even if the tooth feels fine, sometimes you find out even years later
that there is a problem with the pulp, and root canal is necessary.

Thanks Mark. In my case the tooth was assymptomatic until he worked on
it. The reason it was replaced was because of a cavity so I'm
wondering if something went awry. I did have a temporary crown for 3
weeks and pain wasn't an issue there but they did do quite a bit of
scraping of the temporary cement before putting the permanent one in.
It was very painful. I remember my wife telling me that taking her
temp crown out and putting the permanent one in was pain-free...


There's a great deal of variation in sensitivity in a tooth that has been prepared for a crown, but usually there is some sensitivity. I've often had patients that I have to numb to try in a crown or to cement it--and often it works out just fine. But the tooth shouldn't have significant pain after a month--doesn't sound right. If the tooth has a sharp pain to cold and it remits in a few seconds the pulp is probably OK. If it throbs for several minutes, that's not so OK. If it wakes you up in the middle of the night, or you get spontaneous pain, there's probably a problem.
Incidentally, this problem usually doesn't show up on x-ray in your situation, so it's usually a professional judgment based on the severity of symptoms and your tolerance for waiting that makes the decision. I only have one crown in my mouth--Mark did it for me a few years ago (I'm Steve BTW, but I answer to anything). The tooth cracked almost in half on New Year's eve. I know where my dentist lives, but I didn't have it treated for a few days. Even now I see stars if I happen to touch the crown with a fork (the crown is gold--the conductivity is one of the disadvantages of gold), but otherwise the tooth feels fine.
There is usually a lot of grinding going on when a tooth is prepared for a crown. If the tooth has been filled repeatedly, then prepped for a crown, well there's only so many times the pulp can be insulted before it has problems. There's really no way to know if there wasn't enough water spray, or too much drilling, or the pulp had just had enough--it's just one of those things. But I doubt very much that picking off the temp. cement is what did it--the damage had probably already been done.

Sorry,
Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001
.

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