I wrote a post yesterday regarding having a cracked crown replaced and having issues with pain in the tooth next to it:
"I was wondering if anyone could help me out with an issue I'm having with my teeth. It regards the last two teeth on the upper left side of my mouth. The crown cracked on the last tooth and I had it replaced recently. While I had the temporary on I was feeling extreme sensitivity with hot, cold and sharp pain when biting down on something like a cracker. I had no previous pain. I thought it was just sensitive because I had a temporary on, but after I had the permanent crown put on I had the same pain and sensitivity, but not as extreme.
When the permanent crown was put on it was done quickly and there was no adjustment(drilling) of the new crown. I had told the dentist about the sensitivity and he said the tooth is probably sensitive from having work done on it and give it a week to calm down, if I still had an issue, call him in a week. After a little more than two weeks I still had the same issue so I went back to the dentist and pinpointed exactly where the pain was(back right corner of the tooth), it turned out to be the tooth next to the last(newly crowned)tooth. The dentist said because of the fit of the new crown my bite was putting pressure on the second tooth.
Now, this second tooth is a double root canal tooth and I was not having any pain prior to this procedure. The dentist then used the drill to reshape the root canal tooth and it seemed to feel a little better. He also took an X-ray and said the root canal tooth might be infected but he had to compare the X-ray to one taken over a year ago to be sure. Anyway, after I left I could now bite down on food(like crackers) and not feel the sharp pain, so the tooth felt better. But it still had some sensitivity and a little aching. I grind my teeth at night(I wear mouth guard) and sometimes during the day under stress I clench my teeth together and it is during these times, when I wake in the morning, and throughout the day under stress where I'm feeling pain in the tooth.
So, I'm wondering if I'm feeling this pain because my bite is still not correct? From what I understand root canals are often infected but not sure this pain is because of infection since I didn't have pain before this new crown."
-------------------------------------------------------------

I called the dentist to tell him I was still having pain in the tooth with the new crown and he told me I should see an endodontist because "when you have work done on the tooth, the nerve gets inflamed and usually the inflammation goes down but sometimes it does not and because I'm still feeling pain, maybe the nerve in my tooth has not settled down and I'll need a root canal". Does this sound possible?
I do remember when I went in to have my permanent crown put on and I told him I was having sensitivity, when I was leaving he told me something similar about the nerve getting inflamed because of being worked on and to come and see him if it didn't get better. How does one go from having a crown put on to possibly needing a root canal? Btw, the tooth was not infected in any way.

Hi Nell,

I am in the dental profession and can try to help you. Without an xray I can only go by what you have described here.

I will answer your questions in bold type to make it easier to follow.

<<So, I'm wondering if I'm feeling this pain because my bite is still not correct?>>>

IT IT POSSIBLE THAT YOUR PAIN HAS MANY REASONS.
1) THE BITE MAY STILL BE OFF
2) THE NERVE IN THE TOOTH MAY BE DYING
3) YOUR GRINDING HABIT CAN BE IRRITATING THIS TOOTH.
4) THE RC TOOTH BEHIND IT MAY BE FINALLY SHOWING SYMPTOMS OF AN INFECTION.

<<<From what I understand root canals are often infected but not sure this pain is because of infection since I didn't have pain before this new crown.">>>

ROOT CANALED TEETH ARE ALWAYS INFECTED BECAUSE THERE IS NO ACCESS TO THE TINY CANALS THAT CONTAIN NECROTIC NERVE TISSUE. SO IRRELEVANT OF HOW MANY TIMES THE TOOTH IS ROOT CANALED, THESE TINY CANALS REMAIN INFECTED. EVENTUALLY THE INFECTION SPREADS FURTHER INTO THE TOOTH, THEN INTO THE PERIODONTAL LIGAMENT, AND THEN THE JAW BONE.
PREPARING THE TOOTH FOR A CROWN DID NOT CAUSE THE RC TOOTH TO BECOME INFECTED. IT WAS ALREADY INFECTED FOR THE REASONS THAT I STATED ABOVE. HOWEVER, YOU MAY BE HITTING THE RC TOOTH DIFFERENTLY NOW SINCE GETTING THIS OTHER TOOTH CROWNED WHICH WOULD CAUSE SYMPTOMS OF THE INFECTION IN THE RC TOOTH TO SURFACE. IT IS IMPORTANT TO KNOW THAT MOST DENTAL PROBLEMS HAVE NO SYMPTOMS UNTIL THE AREA HAS BEEN IRRITATED OR THE PROBLEM HAS PROGRESSED. PAIN IS OFTEN A LATE STAGE SYMPTOM.
-------------------------------------------------------------

<<<I called the dentist to tell him I was still having pain in the tooth with the new crown and he told me I should see an endodontist because "when you have work done on the tooth, the nerve gets inflamed and usually the inflammation goes down but sometimes it does not and because I'm still feeling pain, maybe the nerve in my tooth has not settled down and I'll need a root canal". Does this sound possible?>>>

ANYTIME A TOOTH IS DRILLED INTO, THE NERVE IS TRAUMATIZED AND INFLAMED. IF THE PREPARATION OF THE TOOTH WAS NOT SEVERE AND IF THE TOOTH WAS HEALTHY TO BEGIN WITH, THEN IN MOST CASES THE NERVE WILL CALM DOWN. DENTISTS TYPICALLY TELL THEIR PATIENTS TO SEE THE ENDODONTIST WHEN THE PATIENT COMPLAINS ABOUT PAIN WITH A NEW CROWN AND/OR WHEN THEY SUSPECT THE NEWLY CROWNED TOOTH WAS NOT HEALTHY TO BEGIN WITH.
KEEP IN MIND THAT RC TEETH ARE NEVER HEALTHY AND THERE ARE SYSTEMIC RISKS ASSOCIATED WITH CHRONICALLY INFECTED TEETH. SO YOU MAY WANT TO DO SOME RESEARCH ON THOSE HEALTH RISKS AND RECONSIDER GETTING ANOTHER ROOT CANAL DONE FOR THAT REASON.

<<I do remember when I went in to have my permanent crown put on and I told him I was having sensitivity, when I was leaving he told me something similar about the nerve getting inflamed because of being worked on and to come and see him if it didn't get better. How does one go from having a crown put on to possibly needing a root canal? Btw, the tooth was not infected in any way.>>>

PLEASE READ ABOVE ABOUT THE TOOTH BEING DRILLED INTO.

Bryanna

Thank you for answering my questions. I really appreciate it. The pain is definitely coming from the newly re-crowned tooth, not the root canal tooth which is in front of the crowned tooth. There was no decay in the tooth so I think it's the nerve. I've been back to the dentist and he said x-rays show nothing so I should go to the endodontist. I'm not sure what my options are but I really don't want another root canal. Is it possible that the nerve can heal over time if it is the nerve? I'm really upset over the whole thing because if I had known there was a chance that by replacing a cracked crown I would have to have a root canal, I wouldn't have replaced the crown at this time. Shouldn't patients be told this is a possibility beforehand by the dentist? I really never knew it was possible. Thanks again.

Hi Nell Bowen,

You're welcome.

If you go to an endodontist, of course he will root canal that newly crowned tooth because that is the only type of dentistry that he does. So you have to decide whether or not you want to have it root canaled.

The tooth could be hurting if it is not fitting properly into your bite. You could be clenching against it or grinding into it which is making it sore. You said that you noticed the pain more when you did either of those things. If it is a bite problem and it is not corrected, then the nerve will become irritated and it will die.

So your dentist should really be looking at this more closely than he is. He should also see how your night guard is fitting with this new crown to make sure that is not causing a problem. The night guard may need to be adjusted to accommodate the new crown.

Bryanna

Thanks again for your response. I've been back to the dentist twice and the first time he adjusted the bite by drilling down the tooth next to it and a good portion of the pain disappeared but the second time I went back he just took an x-ray(said he saw nothing) and had me bite on the paper and said go see the endodontist. I do not want a root canal but am not sure what to do because I'm still having pain and the dentist just keeps telling me to go to the endodontist. My night guard is an over the counter Sleep Right guard which does not have to be melted it is just adjustable to the size of one's mouth. Do you have a suggestion what I should do? Thank you.

Hi Nell Bowen,

Yes, seek a new dentist. This guy is not willing to listen to your complaints. He has not addressed them all either. Adjusting the one tooth was obviously not enough as you may be hitting the newly crowned one when you grind your teeth. The paper to test the bite is not 100% accurate when the patient is lying down in the chair. The patient needs to be in an upright position to check the bite properly because as we lay back.. .our jaw moves backwards... as we sit up our jaw aligns more forward. Did he have you lying back in the chair when he did the adjustment? Most dentists do and this is one huge reason why people are then referred to the endodontist :/

Regarding your night guard. The OTC guards are not adequate for someone who has a bruxing habit. They can actually do more harm than good because they do not fit the individual bite.... they are a one size fits nobody. ALL night guards need to be adjusted any time there is new dentistry done in the mouth.

Your problem could very well be as simple as a bite adjustment and getting a new night guard fabricated for you. If it is that and it is not taken care of, the nerve will become irritated and it will die.

The other thing that can be going on is the tooth may be fractured. It is not always able to be picked up on an xray... so diagnosing it can be difficult. One way to try to diagnose it is to have the patient bite down on a bite stick as it is placed on various areas of the biting surface. The patient would be uncomfortable if they bit down where the fracture was leading to. Did he do that?

It is typical for dentists to become impatient with common issue like yours. It is easier for them to just send you off to the endodontist and wash his hands of the problem. I'm sorry to even tell you that.... but it is so unfortunately true.

My suggestion would be to either go back to this guy and tell him you are not going to the endodontist... have him check the bite more thoroughly for high spots and fractures and let him made you a better fitting night guard. Or seek the same work up from a different dentist.

Bryanna

Thank you so much for taking the time to answer my questions and offer advice. It is much appreciated.
No, he did not have me sitting up when testing my bite, nor did he have me bite down on a stick. When he put the new crown on he didn't do any adjustments and just asked me how my bite felt. The new crown he put on looks like a stump in comparison to the same crowned tooth on the other side. If I go to a new dentist do I tell them I would like my bite tested and a night guard? I hope I can find someone decent. Thank you.