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

Gregg L wrote:
"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




The signs aren't too subjective--our judgment is! ;-)

Steve
.

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