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


"Mark & Steven Bornfeld" <bornfeldmung@xxxxxxxxxxxxxxx> wrote in message
news:n1oKl.3740$b11.2722@xxxxxxxxxxxxxxxxxxxxxxx
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.

Steve

What Steve said pretty much covers it. Dental pulps can only put up with so
much trauma over the years before they give up the ghost and you need to
choose to lose the tooth, or attempt to retain it via root canal treatment.
Trauma includes our decades of tooth grinding, orthodontic treatment,
cavities, fillings, filling replacement, replacing the filling with a crown,
etc. It's actually a pretty vulnerable bit of tissue deep within the tooth
and it's odd that there aren't more problems that develop like yours. Just
went thru your scenario myself, Jack. Tooth (filled as a kid, then 35 yrs
ago new cavity led to a crown, then recently having worn a small hole thru
the gold over that time, it had to be replaced) gave me warning before final
crown went in, though. So before it did I was able to have the root canal
done. But had the cementation appointment been a week earlier, woulda been
in line with you.

Your symptoms <could> represent something as simple as a minor bite
interference that's irritating the tooth. The brevity of the pain you
experience, and that it seems not to be spontaneous, are good things. Be
sure to let your dentist know, as you've done here, what level of discomfort
you're experiencing. Ice testing is a standard way to evaluate a
problematic tooth, and (s)he may do that. A response lasting a few secs, as
Steve said, is often an indication of a reversible problem.

Sounds pretty "normal", altho inconveniently on the negative side of that.
No reason to think anything went awry. We do what we can to assess the
health of a pulp before starting a crown, but nothing, unfortunately, can
give us 100% accuracy in that assessment. It's pretty subjective, as
opposed to a scan showing coronary arteries blocked.
Gregg


.

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