[sandy60]

Hi Bryanna, you helped me through an ordeal last year and hoping you can answer a question. I had tooth 29 and 30 extracted several years ago due to bone loss, they were loose. Now 31 has become sensitive to cold and it has a large old amalgam filling. I see a crack but the dentist wasn't concerned as it doesn't seem to go down far. He told me to use Gel-Kam and Sensodyne but it is not helping.

I know that you are not an advocate of root canals but he says he can't use a sealant because he doesn't so them on the part near the gum (just on the top of the tooth). If I have the tooth extracted, there will be nothing there to oppose the upper teeth. He hasn't offered me a solution and I am getting really angry about this. I hit the ceiling with even a piece of cheese from the refrigerator, but it's only for a second so I am not sure if it warrants a root canal.

Would crowning the tooth ever help? It seems that they'd have to drill more away and I don't know if this will worsen the sensitivity. I am also afraid of extracting because I have a horizontally impacted wisdom tooth so close to it and I wonder if this can mess that up. They don't want to ever touch that as long as it never gave me a problem. I am in my sixties and it's been ok...and I know that it should have been removed when I was young.

Is there any treatment that can make this sensitivity go away? I can't see spending the rest of my life like this. I know I asked a lot of questions but would so appreciate your advice on each one. I'm a nervous wreck over this. Also, if I DID get a root canal and ever decide to get a fixed bridge, tooth 28 is also root canaled so with 2 root canaled teeth as an anchor...just doesn't sound strong enough. I can't get implants, neurologist doesn't want me to, so not an option. Thanks.

[Bryanna]

Hi Sandy!

You have described your dental situation....perfectly! My opinion based on what you have written is that tooth 31 may also have some bone loss issues just like 29 and 30 did and this tooth is also taking a beating when chewing because it is all by itself. The bone loss causes portions of the root to be exposed... and the exposed portion can be extremely tiny but it can still be enough to make the tooth very cold sensitive. The crack in the amalgam will also cause cold sensitivity as well. Either of these conditions (the crack in the filling and/or the root exposure) make this tooth more prone to decay because the open filling allows bacteria to get in underneath and the exposed root now has no enamel to protect it. GelKam and sensodyne are not going to cure this problem, you are right.

The impacted wisdom tooth may or may not be an issue if you were to remove #31. It all depends on how close they are to each other and if there is any bone dividing them. However, an experienced oral surgeon would be the one to take it out. Having a root canal on #31 may take away your cold sensitivity but you then risk getting an infection in the bone at the site of the wisdom tooth because all root canaled teeth have some degree of bacterial infection. Your wisdom tooth is in a vulnerable place and it wouldn't take much bacteria to cause a problem there. If that were to happen, then you would have no choice but to remove 31 and 32.

Cold sensitivity indicates an open contact as in a filling or crack in the tooth or root exposure in a "live" tooth. Heat sensitivity indicates the nerve in the tooth is dying and infection is brewing. With that said, you may consider having a crown put on #31 and see if that takes care of the cold sensitivity.

If you were to root canal #31, you run the risk of infection spreading as I mentioned before. Putting a bridge from #28 to 31 with 29 and 30 as fake teeth will not be stable irrelevant of whether the anchor teeth are root canaled or not. Because of the bone loss in 29 and 30 area, the bone level is very low making the dynamics or design of the bridge nearly impossible or at best very compromised. There would be alot of pressure on #31 when chewing which in of itself could cause the tooth to dye and/or become infected.

What about..... crowning #31 and wearing a removable partial denture to replace 29 and 30? Are you missing any other teeth in your lower jaw that could be replaced with a lower partial?

Bryanna

Originally Posted by sandy60

Hi Bryanna, you helped me through an ordeal last year and hoping you can answer a question. I had tooth 29 and 30 extracted several years ago due to bone loss, they were loose. Now 31 has become sensitive to cold and it has a large old amalgam filling. I see a crack but the dentist wasn't concerned as it doesn't seem to go down far. He told me to use Gel-Kam and Sensodyne but it is not helping.

I know that you are not an advocate of root canals but he says he can't use a sealant because he doesn't so them on the part near the gum (just on the top of the tooth). If I have the tooth extracted, there will be nothing there to oppose the upper teeth. He hasn't offered me a solution and I am getting really angry about this. I hit the ceiling with even a piece of cheese from the refrigerator, but it's only for a second so I am not sure if it warrants a root canal.

Would crowning the tooth ever help? It seems that they'd have to drill more away and I don't know if this will worsen the sensitivity. I am also afraid of extracting because I have a horizontally impacted wisdom tooth so close to it and I wonder if this can mess that up. They don't want to ever touch that as long as it never gave me a problem. I am in my sixties and it's been ok...and I know that it should have been removed when I was young.

Is there any treatment that can make this sensitivity go away? I can't see spending the rest of my life like this. I know I asked a lot of questions but would so appreciate your advice on each one. I'm a nervous wreck over this. Also, if I DID get a root canal and ever decide to get a fixed bridge, tooth 28 is also root canaled so with 2 root canaled teeth as an anchor...just doesn't sound strong enough. I can't get implants, neurologist doesn't want me to, so not an option. Thanks.

[sandy60]

Originally Posted by Bryanna

Hi Sandy!

You have described your dental situation....perfectly! My opinion based on what you have written is that tooth 31 may also have some bone loss issues just like 29 and 30 did and this tooth is also taking a beating when chewing because it is all by itself. The bone loss causes portions of the root to be exposed... and the exposed portion can be extremely tiny but it can still be enough to make the tooth very cold sensitive. The crack in the amalgam will also cause cold sensitivity as well. Either of these conditions (the crack in the filling and/or the root exposure) make this tooth more prone to decay because the open filling allows bacteria to get in underneath and the exposed root now has no enamel to protect it. GelKam and sensodyne are not going to cure this problem, you are right.

The impacted wisdom tooth may or may not be an issue if you were to remove #31. It all depends on how close they are to each other and if there is any bone dividing them. However, an experienced oral surgeon would be the one to take it out. Having a root canal on #31 may take away your cold sensitivity but you then risk getting an infection in the bone at the site of the wisdom tooth because all root canaled teeth have some degree of bacterial infection. Your wisdom tooth is in a vulnerable place and it wouldn't take much bacteria to cause a problem there. If that were to happen, then you would have no choice but to remove 31 and 32.

Cold sensitivity indicates an open contact as in a filling or crack in the tooth or root exposure in a "live" tooth. Heat sensitivity indicates the nerve in the tooth is dying and infection is brewing. With that said, you may consider having a crown put on #31 and see if that takes care of the cold sensitivity.

If you were to root canal #31, you run the risk of infection spreading as I mentioned before. Putting a bridge from #28 to 31 with 29 and 30 as fake teeth will not be stable irrelevant of whether the anchor teeth are root canaled or not. Because of the bone loss in 29 and 30 area, the bone level is very low making the dynamics or design of the bridge nearly impossible or at best very compromised. There would be alot of pressure on #31 when chewing which in of itself could cause the tooth to dye and/or become infected.

What about..... crowning #31 and wearing a removable partial denture to replace 29 and 30? Are you missing any other teeth in your lower jaw that could be replaced with a lower partial?

Bryanna

I am not missing any other lower teeth. I don't really want a partial because nobody can see the two teeth missing. I am going to get a second opinion but wonder if by drilling more tooth away to get a crown, can that increase the sensitivity or do they put something inside the crown to prevent this? One more question...the opposing tooth, #3, may eventually have to come out...I am having this evaluated but would it make sense to crown 32 if it has no opposing tooth? I mean, what purpose would it then serve? Thanks so much once again.

[Bryanna]

Ok, so no other missing teeth on the bottom. Are there any teeth in the mandible that are not in good health and bordering on removal? I ask this because sometimes it's best to re-evaluate the entire mouth before doing any dental work that will be costly as there may be another option that will cost less in the long run if everything is taken care of at the same time. Do you know what I mean?

Drilling away more of #31 will not increase the sensitivity so long as the fabricated crown fits properly. There is a base/liner that can be applied to the filed down tooth called Vitrebond that can be applied which can help reduce or eliminate sensitivity. Covering an exposed root surface can be difficult depending on where it is. Sometimes the gum needs to be lowered.... this is called a crown lengthening procedure. It allows more tooth structure to be exposed so the crown can cover it better. However, sometimes this procedure alone can cause root sensitivity. I know... oy vey... what's the best solution here!!!

You make a good point about the removal of #3... see that's why I say, it's best to re-evaluate the entire mouth before undergoing any expensive, time consuming dental work. Generally #3 lines up with #30 but since your #30 is gone, there may have been some shifting in the lower jaw and it may be lining up somewhat with #31. Do you still have #1 and 2 on the upper right?
If tooth #31 is not lining up with anything or let's say with any tooth that has a long term healthy prognosis, then you do not need to go to any extremes to keep #31 because you wouldn't be using it for any chewing purposes. However, you would need to have that area evaluated for extraction by an oral surgeon because of the impacted wisdom tooth #32. If you do have healthy opposing teeth to chew against in the right upper quadrant, then either a crown on #31 or perhaps a large composite filling could be done. That depends on how much tooth structure is actually left and how much is already amalgam filling because you need adequate tooth structure to put any filling (other than a crown) on the tooth.

I hope this is not too difficult to follow... let me know if you need any clarification :-))

Bryanna

Originally Posted by sandy60

I am not missing any other lower teeth. I don't really want a partial because nobody can see the two teeth missing. I am going to get a second opinion but wonder if by drilling more tooth away to get a crown, can that increase the sensitivity or do they put something inside the crown to prevent this? One more question...the opposing tooth, #3, may eventually have to come out...I am having this evaluated but would it make sense to crown 32 if it has no opposing tooth? I mean, what purpose would it then serve? Thanks so much once again.

[sandy60]

No clarification...you explained it really well. Nope, I don't have 1 or 2 anymore. 2 was taken out last year and 3, 4 and 5 are covered by one long crown (looks like 3 but all attached for stability about 25 years ago). I am going to an ENT tomorrow to see why I have pain in those teeth, if it is sinus related or if 4 and 5 are just old root canals that are not serving me well anymore, which dentist says leave alone....but I know your thoughts on that. In other words, my teeth are a mess.

You made an interesting point about 31 taking a lot of stress...I do clench, I wake up feeling this so this may account for the soreness on top when I wake up...because it isn't just on tooth 5, but 3, 4 and 5. And the clenching could be what all of a sudden is making 31 so sensitive to cold. Thanks for the info on how they do a crown to prevent sensitivity. It's VERY scary for me to think of anything happening to the wisdom teeth on the bottom as they have explained this to me so many times, paresthesia and everything else that can go wrong. Is there no sealant they can use rather than having a crown for 31? I went through so much in my 30s, crowns, root canals but at this "older" age, I am terrified.

[Bryanna]

Hi Sandy,

There really isn't any type of sealant that can be used to cure your type of cold sensitivity. If the problem was occuring from slight recession, then a desensitizing material could be applied. However, from all that you have shared here, I think your temperature sensitivity is caused by several factors.

Since you are missing the top opposing teeth #'s 1 and 2, then #31 is taking a beating when you are chewing because it doesn't have any direct support to chew against. The fact that #'s 3,4 and 5 are splinted together indicates that there is some moderate degree of periodontal disease and bone loss. If any of those upper teeth are also root canaled, then the long term prognosis for these teeth is not so good.

I'm curious to see what the ENT has to say about your pain in the upper right area. Hopefully you will remember to tell him about their dental history, especially the root canals. ENT drs very often see the complications that occur in the sinus cavity from teeth that have periodontal disease and/or have been root canaled. So hopefully your ENT dr is familiar with these issues and can give you some definitive answers.

Please let me know what the dr says..... ;-)

Bryanna

Originally Posted by sandy60

No clarification...you explained it really well. Nope, I don't have 1 or 2 anymore. 2 was taken out last year and 3, 4 and 5 are covered by one long crown (looks like 3 but all attached for stability about 25 years ago). I am going to an ENT tomorrow to see why I have pain in those teeth, if it is sinus related or if 4 and 5 are just old root canals that are not serving me well anymore, which dentist says leave alone....but I know your thoughts on that. In other words, my teeth are a mess.

You made an interesting point about 31 taking a lot of stress...I do clench, I wake up feeling this so this may account for the soreness on top when I wake up...because it isn't just on tooth 5, but 3, 4 and 5. And the clenching could be what all of a sudden is making 31 so sensitive to cold. Thanks for the info on how they do a crown to prevent sensitivity. It's VERY scary for me to think of anything happening to the wisdom teeth on the bottom as they have explained this to me so many times, paresthesia and everything else that can go wrong. Is there no sealant they can use rather than having a crown for 31? I went through so much in my 30s, crowns, root canals but at this "older" age, I am terrified.

[sandy60]

Tooth 3 and 4 are root canaled but have been for years with no change on the x-ray. The ENT only saw a problem in my nose, a pocket of air that I can have surgery on, but elective. It's very common. He could find no reason for the tooth pain. I was hoping that between him and a neurologist, they'd come to some conclusion. I had tooth 11 removed over a year ago and when I flare my nostrils, it hurts right next to my nose. This is on the left side. I would like an implant but I can't see putting a screw in a place that already hurts. So, as you can see, my whole mouth is a mess. Have a flipper but can't speak, eat with it so never wore it (I did try). I am more concerned right now with the fate of 31 though and thanks for the sealant answer. I do clench and wake up with the three top teeth sore. I sometimes wish they could just pull 3 and 4...in which case would it even pay to keep 31? It would have nothing opposing it so what would be the point? I am just mentally drained from all of this worry and even though 3 and 4 might be ok now, I'd rather get them out now than later when I'm old (and worry about one of them abscessing). I do have a root canal for 46 years that has been fine and my best friend has had one for 52 years, another friend for 50 years with no problems. So my oral surgeon says leave them alone...but I worry.

[Bryanna]

Hi Sandy,

One of the major issues with root canaled teeth is they can be symptom free for many years but that does not mean they are healthy. For example, heart disease, diabetes, high blood pressure...... can be symptom free for years too but that does not mean that something is not going on. People don't have spontaneous heart attacks from coronary artery disease.... it's a progressive disorder that can go on for many years without a single symptom. Abcesses in the mouth are not spontaneous either.. they are a progressive infection that originates from an unhealthy tooth.

Up until about 10 years ago, during every root canal procedure formaldehyde was injected into the canals of the tooth as a disinfectant. Keep in mind that formaldehyde is a poisonous irritating gas often referred to as embalming fluid. Cotton pellets were soaked in formaldehyde and placed inside the tooth as a preservative prior to placing the root canal filling material. Formaldehyde lasts indefinitely. So when someone says they have a root canaled tooth more than 10 years old.... they most likely have formaldehyde inside their tooth. Perhaps people should have been told that this poison was being used....? I certainly think so. Unfortunately there are still some dentists who continue to use it.

There are many reasons why some dentists tell their patients to hold onto unhealthy teeth. One main reason is... trying to convince the patient that although they may be symptom free, there is a problem. Many people do not have the finances or won't spend their money to replace the teeth that they have removed, so they hold onto their teeth until the problem becomes very severe. Eventually, a bad tooth shows signs of infection..... those signs can be subtle like temperature or pressure sensitive... bad taste or odor... on/off swelling... bleeding from the gum.... bone loss... mobility. Or a person can wake up one morning with severe pain and swelling.

I'm sharing all of this with you.... and whomever.... because these are things that people have a right to know about. The decision to be proactive or wait and see is completely up to the individual. However, you and so many others might not be in this predicament today, if you had been better informed years ago.

Sandy, I know you are mentally shot from all of this and rightfully so because now you have a menagerie of dental problems that are becoming more evident and it's very worrisome. Perhaps your intuition, more than anything else is telling you something has to change?

I share this information with the best of intentions and I know it is disturbing to say the least..... I'm sorry, I wish people were better informed right from the get go.

Would you consider consulting with a new dentist... someone who is not associated with your current one?

Bryanna

Originally Posted by sandy60

Tooth 3 and 4 are root canaled but have been for years with no change on the x-ray. The ENT only saw a problem in my nose, a pocket of air that I can have surgery on, but elective. It's very common. He could find no reason for the tooth pain. I was hoping that between him and a neurologist, they'd come to some conclusion. I had tooth 11 removed over a year ago and when I flare my nostrils, it hurts right next to my nose. This is on the left side. I would like an implant but I can't see putting a screw in a place that already hurts. So, as you can see, my whole mouth is a mess. Have a flipper but can't speak, eat with it so never wore it (I did try). I am more concerned right now with the fate of 31 though and thanks for the sealant answer. I do clench and wake up with the three top teeth sore. I sometimes wish they could just pull 3 and 4...in which case would it even pay to keep 31? It would have nothing opposing it so what would be the point? I am just mentally drained from all of this worry and even though 3 and 4 might be ok now, I'd rather get them out now than later when I'm old (and worry about one of them abscessing). I do have a root canal for 46 years that has been fine and my best friend has had one for 52 years, another friend for 50 years with no problems. So my oral surgeon says leave them alone...but I worry.

[sandy60]

Yes, I am definitely going to get another opinion, someone who will look at the whole picture. I don't want to hold on to teeth that are unnecessary and doomed but the prospect of a partial is upsetting and I can't get implants. Losing an anchor tooth in the back for a partial is upsetting but 31 is probably doomed.

As far as the root canals, I'm not so sure at this point it's helpful for me to hear this stuff as I have many and don't want to pull them and be toothless. My Mom has many and she is 100 years old and very healthy. Some were done 60 years ago, same with many of my friends. I have one that's 46 years old and no problem (I was a kid and broke my tooth on a cherry pit). I am not opposed to getting a root canal, especially if it's in a visible tooth. If I were to extract all of my root canaled teeth, I'd look like a jack-o-lantern! The alternative to a root canal on one tooth is an extraction and interfering with two adjacent teeth and sometimes they have to go further for a fixed bridge. Some people can't tolerate an implant, like myself.

Are there no circumstances where you think a root canal is ok and justified? Even with a good endodontist or do you believe there is no such thing as good endodontics? I do hear your message but I am open to both sides.