[Judith C]

Hi Bryanna:
First a quick update the implants seem fine (so far) and gum work settled down and comfortable but very thick, the dentist says it looks fine. Early days but nice to have it all done.
However, I broke a crowned far right back molar in June and had it restored Oct 9th with new crown which was left rather high. The tooth was aggravated and sensitive and was not able to get it adjusted until Oct 20th. It is much less sensitive now but still irritated somewhat by hot, cold and when touched by opposing tooth. The dentist suggested IB Profin when it was still sensitive took dexamethasone for 4 days but even so the tooth is still sensitive. I am recommended to get a root canal done. Is it likely this tooth could still settle or best to do the root canal? Do you have any recommendations as to the best treatment to sterilize the tooth. I have read Dr Miichael Goldman's web site recommendedCalcuim Hydroxide to kill any bacteria not Biocalex or Endo-Cal with time between treatment and closing off the tooth.
The dentist does not recommend this says not finalizing the procedure at once leaves more chance of infection. I would value your opinion on this, actually as I am writing the dentist called to say they can take me on Fri whereas the previous first appointment was Dec 15th.
I did hope not to have any more root canals but this seems the only option for a back tooth.
Thanks you for your thoughts.
Judith C.

[Bryanna]

Hi Judith,

Glad to hear the implants are doing well!!

The newly crowned tooth....... it sounds to me like the nerve has been traumatized. This could have happened as a result of the grinding down of the tooth for the crown and/or biting on it when the bite was high.

It is important that the bite has been adjusted properly and you are not hitting this tooth harder than the others...... and the margins of the crown need to fit properly along the gumline. If those issues are correct and you are still having discomfort, then chances are the tooth is not going to get better. IF the bite is not right and/or the margins of the crown are not precisely where they should be, then either or both of those things will cause the discomfort that you are describing and eventually the nerve in the tooth will die from the repeated trauma.

I think you know my stand on root canal therapy........ I wish there was a way to sterilize a tooth and make it healthy, but there just isn't. It doesn't matter what instruments or medicaments are used to perform the procedure or what material is used to fill the large canals ..... the microscopic canals will continue to have nerve tissue inside of them but without blood flow to provide them with nutrition. During all root canal procedures, the large nerves and vessels are severed which instantly stops all blood flow to that tooth. No blood flow to anyplace in the body means no circulation......the end result of this is necrosis. A necrotic tooth is another term for an infected tooth. One of the problems with an infected tooth is that the infection eventually spreads from the inside of the tooth to the surrounding area. In some people this happens within a short amount of time and others it can take longer.

These dentists that promote various alternative medicaments (calcium hydroxide, etc) to fill the large canals are leaving out very important information. Firstly, the microscopic canals are not able to be cleaned out and secondly NONE of these materials can enter these tiny curvy canals in which there are millions of them in every tooth.

Our body's are amazing in that they can live without certain organs, heal burns, etc....... but give our body a chronic infection and our immune system eventually becomes overwhelmed.

I know this is not what you wanted to hear......... I really wish I had a better answer for you. Make sure the bite and margins of the crown are good before you consider doing anything else.

Bryanna

Originally Posted by Judith C

Hi Bryanna:
First a quick update the implants seem fine (so far) and gum work settled down and comfortable but very thick, the dentist says it looks fine. Early days but nice to have it all done.
However, I broke a crowned far right back molar in June and had it restored Oct 9th with new crown which was left rather high. The tooth was aggravated and sensitive and was not able to get it adjusted until Oct 20th. It is much less sensitive now but still irritated somewhat by hot, cold and when touched by opposing tooth. The dentist suggested IB Profin when it was still sensitive took dexamethasone for 4 days but even so the tooth is still sensitive. I am recommended to get a root canal done. Is it likely this tooth could still settle or best to do the root canal? Do you have any recommendations as to the best treatment to sterilize the tooth. I have read Dr Miichael Goldman's web site recommendedCalcuim Hydroxide to kill any bacteria not Biocalex or Endo-Cal with time between treatment and closing off the tooth.
The dentist does not recommend this says not finalizing the procedure at once leaves more chance of infection. I would value your opinion on this, actually as I am writing the dentist called to say they can take me on Fri whereas the previous first appointment was Dec 15th.
I did hope not to have any more root canals but this seems the only option for a back tooth.
Thanks you for your thoughts.
Judith C.

[Judith C]

Dec 3 2009
Dear Bryanna
Thank you for your quick response and I do appreciate your comments about root canals. Looks like this tooth is on it's way out and I will have to decide whether to do without it or have one more root canal - neither being obviously a particularly good choice.
As always you have excellent sensible advice to share and I am sure I echo others when I say how useful and educational your comments are.
Sincerely,
Judith C.

[Bryanna]

Hey Judith...

Thank you so much for your kind words. I have these very same conversations with patients every day and it never gets any easier to deliver the facts. There are choices to be made, but it is important to be well informed prior to making the best choice for ourselves.

If you were to have this tooth removed, could an implant be placed in that spot to replace it?

Bryanna

Originally Posted by Judith C

Dec 3 2009
Dear Bryanna
Thank you for your quick response and I do appreciate your comments about root canals. Looks like this tooth is on it's way out and I will have to decide whether to do without it or have one more root canal - neither being obviously a particularly good choice.
As always you have excellent sensible advice to share and I am sure I echo others when I say how useful and educational your comments are.
Sincerely,
Judith C.