[gdmcor]

Hi everyone,

My latest dental work includes an extraction of upper very back molar on the left, which healed nicely after slight sinus communication. I was pain free when I went in to get two temp crowns. One went without any problems. Then....

I got prepped for a crown on the molar next to the extraction on the upper left side. This was 8 days ago, and ever since then I've had off and on pain in the area and teeth on the bottom as well. Plus my jaw hurts in a spot as well as my left ear. Cold sensitivity also.

I went to the dentist yesterday and told him all of this. His assistant did adjust my bite, which seemed to help. The dentist told me not to chew on the side for four days and then see how it felt. He told me if it was not any better by then, I'd need a root canal most likely. He wants to have that done before the perm. crown is put on.

Now my dilemma. First, my teeth were feeling pretty good yesterday, but today they are all hurting again.
The real question is: Do I get the root canal and hope for the best? Or, get it extracted and have to look into getting partial dentures. If it's removed, I will have three missing upper molars and one on the bottom. I will have none that meet, so chewing in the back on either side will be pretty much impossible.

I hope I will hear from Bryanna and anyone else who has had this experience with suggestions. Thank you so much, in advance. Oh, I am taking ibuprofen for swelling and pain.

Hope everyone is doing better! Gretchen

[ginnie]

Hello, and welcome. Bryanna is the best about dental issues. However I can state positively, that a root Canal, is not the best choice. Most dentists do not inform their patients correctly about this proceedure to " Retain" a tooth.
This is an expensive temporary solution, that will NOT last. If you are in pain now, that will not stop the pain. The infection cannot be entirely gotten rid of with a root canal no matter what your dentist tells you. It will eventually cause you more harm than good. I speak from experinece with my own RC'd teeth. Yes I had them extracted and I am glad I did it. End of the money pit, end of the pain, end of the trouble. I have a partial called a nesbit. Inexpensive, comfortable, and most dentists want you to have more expensive devices. Bryanna can tell you if the location in your mouth would be suitable. These infections get into the tiny spaces inside the tooth, where no dentists probing can eradicate is the problem. That small bit of infection stays there, and does cause trouble down the line. Please read some of the earlier posts from Bryanna on the dental forum here. You will find alot of information, and people that have gone through much of what you are experiencing. Have heart, loosing a tooth is not so bad. I felt awful about me losing mine, but in the long run, it was the wisest of choices. You will get other information right here. I wish you all the best, ginnie

[gdmcor]

Thank you ginnie, for your response and story. I did have two root canalled teeth that got infected and had to be pulled. So I'm not a fan of root canals, but I also don't like losing the last tooth that helps me chew food properly. So, I'm in a difficult position. I still have two other root canalled teeth and I'm not happy about that, but they seem okay for now.

Anyway, I need to decide rather soon, so I hope to hear from others who might have different experiences. I wouldn't opt for implants either, too intrusive. If I get a tooth extracted, I don't want to put something else in there!

Thanks, Gretchen

[ginnie]

I hope for the best for you, no matter what your decision is. It is always such a hard decision when it comes to your teeth. Let me know what you decide on. Best of wishes. ginnie

[Bryanna]

Hi gretchen,

I am going to re post some of your post and answer in bold.

<<<I got prepped for a crown on the molar next to the extraction on the upper left side. This was 8 days ago, and ever since then I've had off and on pain in the area and teeth on the bottom as well. Plus my jaw hurts in a spot as well as my left ear. Cold sensitivity also. >>>

WAS THIS MOLAR SENSITIVE TO COLD AFTER THE TOOTH NEXT TO IT WAS EXTRACTED AND/OR ANYTIME PRIOR TO THE PREPARATION FOR THE CROWN?

YOUR DESCRIPTION OF SYMPTOMS MAY INDICATE THAT THE TEMP CROWN IS NOT COVERING YOUR TOOTH COMPLETELY (CREATING COLD SENS) AND THAT IT MAY ALSO NOT BE FITTING PROPERLY INTO YOUR BITE. THIS ILL FIT WOULD CAUSE ALL OF THE SYMPTOMS THAT YOU HAVE DESCRIBED.

<<<I went to the dentist yesterday and told him all of this. His assistant did adjust my bite, which seemed to help.>>>

SOME ASSISTANTS ARE TRAINED AND PRETTY GOOD AT WHAT THEY DO... BUT THEY ARE NOT DENTISTS AND THEY SHOULD NOT BE ADJUSTING THE BITE ON A PATIENT WHO COMPLAINS ABOUT PAIN AS YOU HAVE. I AM A WELL TRAINED AND VERY EXPERIENCED CHAIR SIDE ASSISTANT AND I WOULD NOT ADJUST YOUR TEMP CROWN WITH YOUR SYMPTOMS. HE ALSO NEEDS TO DETERMINE IF THERE IS AN OPENING ALONG THE GINGIVAL MARGIN OF THE CROWN THAT COULD BE CAUSING YOUR COLD SENSITIVITY. FYI... COLD SENS USUALLY INDICATES EXPOSED DENTIN OR DECAY. HOT SENSITIVITY USUALLY INDICATES A PROBLEM WITH THE NERVES.

<<< The dentist told me not to chew on the side for four days and then see how it felt. He told me if it was not any better by then, I'd need a root canal most likely.>>>

THIS DENTIST NEEDS TO PERSONALLY CHECK YOUR BITE AND ADJUST IT PROPERLY. "THEN" YOU WOULD NOT CHEW ON IT FOR A FEW DAYS TO ALLOW THE NERVE TO CALM DOWN AS IT IS PRETTY IRRITATED FROM NOT FITTING PROPERLY IN YOUR BITE. TELLING YOU TO HAVE THIS TOOTH ROOT CANALED WITHOUT THE PROPER ADJUSTMENT IS COMPLETELY IRRATIONAL AND IRRESPONSIBLE ON HIS PART. MANY DENTISTS WILL TELL THEIR PATIENTS TO HAVE A ROOT CANAL JUST TO MAKE THEM STOP COMPLAINING ABOUT THE PAIN FROM AN ILL FITTING TEMP OR PERM CROWN. CRAZY!

<<< He wants to have that done before the perm. crown is put on.>>>

OF COURSE HE DOES! HE WANTS TO BE ABLE TO BLAME THE ENDODONTIST FOR YOUR FUTURE PROBLEMS ON THIS TOOTH WHEN ALL THE TOOTH MIGHT NEED IS A PROPER ADJUSTMENT. THIS WAY HE CAN GET PAID IN FULL FOR THE PERMANENT CROWN WHILE YOU DUKE IT OUT WITH THE ENDODONTIST WHEN YOUR TOOTH BECOMES INFECTED.

<<<Now my dilemma. First, my teeth were feeling pretty good yesterday, but today they are all hurting again. >>>

CHANCES ARE THE TOOTH NEEDS TO BE ADJUSTED PROPERLY. THAT SHOULD BE THE FIRST STEP AND YOUR DENTIST SHOULD BE THE ONE TO DO THAT.

<<<The real question is: Do I get the root canal and hope for the best?>>>

IF THERE IS NO INDICATION THAT YOU HAVE AN INFECTED OR FRACTURED TOOTH... IF THE TOOTH WAS RADIOGRAPHICALLY HEALTHY AND HAD NO CLINICAL SIGNS OF DISEASE PRIOR TO THE PREP FOR THE CROWN THEN THERE IS NO REASON TO JUST GO AHEAD AND GET IT ROOT CANALED. WHAT HE IS NOT TELLING YOU IS THAT ALL ROOT CANALED TEETH ARE UNHEALTHY IRRELEVANT OF WHETHER THEY HAVE SYMPTOMS OR NOT. WHY RUIN A HEALTHY TOOTH BECAUSE YOUR DENTIST WAS LAX IN YOUR POST OP CARE?

<<< Or, get it extracted and have to look into getting partial dentures. If it's removed, I will have three missing upper molars and one on the bottom. I will have none that meet, so chewing in the back on either side will be pretty much impossible. >>>

IF THE TOOTH IS INFECTED OR FRACTURED... THEN THE HEALTHIEST OPTION WOULD BE TO HAVE IT REMOVED. IF NOT, THEN YOU CAN REST ASSURE THAT YOU WILL BE ADDRESSING THIS TOOTH AGAIN AT ANOTHER TIME. AT WHICH POINT YOU MAY NOT BE A GOOD CANDIDATE FOR REPLACEMENT DUE TO BONE LOSS. YOU CAN ONLY DECIDE WHAT IS IN YOUR BEST INTEREST REGARDING YOUR OVERALL HEALTH. LOSING TEETH AND WEARING PARTIAL DENTURES IS TRULY SECONDARY TO YOUR HEALTH... AT LEAST IT IS IN MY OPINION. BUT OF COURSE YOU HAVE TO DECIDE THAT FOR YOURSELF.

<<<I hope I will hear from Bryanna and anyone else who has had this experience with suggestions. Thank you so much, in advance. Oh, I am taking ibuprofen for swelling and pain.>>>

WELL YOU'VE HEARD FROM ME.... :/ NO SURPRISE TO MY ANSWER I'M SURE.
GRETCHEN... WHAT IS SWOLLEN??

Bryanna

[gdmcor]

Hi Bryanna, Thank you for always being so honest!

This tooth did have a fracture and deep, old mercury filling. It did not bother me before being prepped for the crown, however. I did know it was a ticking time bomb and needed to be taken care of. I don't think it was sensitive to cold though.

The one I had extracted next to it was hurting and had the same problems as this one basically. It was sensitive to cold and causing headaches and sinus pain. A week or so after removal, I felt 100% better.

Now I feel pretty much the same as I did before the last extraction, very unwell. I almost had this one taken out at the same time as the other one, but I wanted to see if a crown would be okay, plus it wasn't hurting at the time.

I will say that the assistant did an excellent job of adjusting the crown, I no longer am hitting an area that I previously was. She told me to take ibuprofen because of sore and swollen gums. The dentist had actually prescribed Vicodin after the initial prep, telling me that my gums would be painful.

I do not want anymore root canals either, so my decision is going to be to have it pulled if it doesn't improve. At this point, I don't think it's going to, but I'll give it a couple more days.

Thanks for all your answers to my questions!
Tomorrow I get the perm. crown on my other tooth. Is there anything you think I should tell or ask this dentist about my bad tooth?

[Bryanna]

Hi Gretchen,

You are welcome Thanks for being so receptive to my... honesty ~)

Okay so this tooth has a fracture and had a deep mercury filling. Depending on where and how big the fracture is, it could cause a vulnerability in the structure of the tooth which may not be able to be remedied with a crown. If that is the case, then the tooth would remain cold sensitive and bacteria would continue to seep in resulting in recurrent decay and infection. Mercury fillings expand and contract with temperature changes which causes cracks and fissures to occur within the tooth. The deeper the filling the deeper the cracks will be within the tooth. Over time this causes irritation to the pulp area and nerves of the tooth. Sometimes a tooth like this will be symptomatic on and off, other times it's relatively quiet. It may shows signs of a problem as you found out on the tooth next to it that was extracted. The tooth becomes additionally irritated from the drill prepping the tooth for a new filling or crown. However, sometimes it does calm down.. again depending on the circumstances. What you need to know most importantly just in case this tooth does not calm down is that a root canal will not "favorably" alter the condition of this tooth. In fact it will cause it to become more fragile because the blood supply will be cut off and the tooth will become non vital.

I'm sure the assistant did the best job she could in adjusting it. But when a patient presents with several symptoms as you did with a temp crown and the history of this tooth is what it is.... the dentist should be the one to adjust the bite because it could make a huge difference in the final outcome.

For you to be prescribed vicodin for the post op of a crown prep may indicate an anticipated problem........

**The dentist may have had to prep a lot below the gum line to obtain enough tooth structure to hold the permanent crown on. He also may have had to do this to bypass the fracture in the tooth. This means that the crown margins would sit sub gingival... below the gum line... which is not ideal because the gum tissue may then be chronically irritated. SO ASK THE DENTIST IF THE CROWN MARGINS ARE GOING TO BE BELOW THE GUM LINE (SUB GINGIVAL) AS OPPOSED TO AT THE GUM (SUPRA GINGIVAL).?? IF HE SAYS YES, ASK WHY?? BY THE WAY.. MANY YEARS AGO MOST CROWNS WERE MADE TO SIT BELOW THE GUM TISSUE BUT FOR THE LAST 15 YRS OR SO THAT WAY OF THINKING HAS CHANGED TO AT THE GUM LINE TO LESSEN THE IRRITATION TO THE TISSUE.

***The dentist may have suspected that this tooth would act up after being prepped and is leaning towards the possibility that you will have it root canaled and wanted to minimize your pain. You need to make your decision about root canals clear to him at this point. This way the two of you can come up with a plan in case this tooth acts up.

If the gums are actually swollen, they you may be sensitive to the temp material. Please have the dentist evaluate that possibility.

When was the most recent xray taken of this tooth? If it was more than 3 months ago, ask the dentist to take a new one. This will show if there are any changes that have occurred, it will show the depth of the crown prep and it will show if there are any open margins in the temp along the gum line that is causing exposure of some dentin.

I really hope things start to improve for you!
Please let us know how it goes tomorrow

Bryanna

Originally Posted by gdmcor

Hi Bryanna, Thank you for always being so honest!

This tooth did have a fracture and deep, old mercury filling. It did not bother me before being prepped for the crown, however. I did know it was a ticking time bomb and needed to be taken care of. I don't think it was sensitive to cold though.

The one I had extracted next to it was hurting and had the same problems as this one basically. It was sensitive to cold and causing headaches and sinus pain. A week or so after removal, I felt 100% better.

Now I feel pretty much the same as I did before the last extraction, very unwell. I almost had this one taken out at the same time as the other one, but I wanted to see if a crown would be okay, plus it wasn't hurting at the time.

I will say that the assistant did an excellent job of adjusting the crown, I no longer am hitting an area that I previously was. She told me to take ibuprofen because of sore and swollen gums. The dentist had actually prescribed Vicodin after the initial prep, telling me that my gums would be painful.

I do not want anymore root canals either, so my decision is going to be to have it pulled if it doesn't improve. At this point, I don't think it's going to, but I'll give it a couple more days.

Thanks for all your answers to my questions!
Tomorrow I get the perm. crown on my other tooth. Is there anything you think I should tell or ask this dentist about my bad tooth?

[gdmcor]

I think my appointment went really well. Armed with the question about the margin of the crown on the gums, I proceeded to tell the dentist that I didn't want to have anymore root canals. I told him that if I keep having pain, I would opt for extraction and partials on my upper molars. When I asked him where the margin of the crown would be, he said they always try to get it at the gumline, but that sometimes it will hit a little below. I didn't press any further on that.

I did tell him that I have MS and seem to get infections quicker than others, esp. sinus and tooth. He agreed that harboring infection is not good and extraction would be better for me if I don't start feeling better. I asked him about the process for the upper molar partials and he explained that in pretty good detail.

So, we have a plan, and he knows what I will be doing. They placed my other crown and it feels fine. I feel I will be taken better care of now that I've explained what I expect. I hope I can keep this other tooth, the pain seems to come and go, but I can't live on ibuprofen forever. I will give it until mid next week, then make the decision.

Thank you so much Bryanna and ginnie!

[Bryanna]

Gretchen,

So glad to hear you had a good dental visit! Without a doubt in my mind, the patients who gently but assertively let their concerns and decisions be known to their dentist get the best dental care.... by far! Your dentist did not feel threatened by your questions or that you were second guessing him because you presented yourself simply and decidedly. You do know what is best for you and now he does too

So hope this tooth calms down and behaves itself!! There is no harm in waiting a few weeks if you think you have to. So long as the pain does not increase or you do not develop additional symptoms.

Keeping my fingers and toes crossed for you :>

Thanks for keeping us posted!
Bryanna

Originally Posted by gdmcor

I think my appointment went really well. Armed with the question about the margin of the crown on the gums, I proceeded to tell the dentist that I didn't want to have anymore root canals. I told him that if I keep having pain, I would opt for extraction and partials on my upper molars. When I asked him where the margin of the crown would be, he said they always try to get it at the gumline, but that sometimes it will hit a little below. I didn't press any further on that.

I did tell him that I have MS and seem to get infections quicker than others, esp. sinus and tooth. He agreed that harboring infection is not good and extraction would be better for me if I don't start feeling better. I asked him about the process for the upper molar partials and he explained that in pretty good detail.

So, we have a plan, and he knows what I will be doing. They placed my other crown and it feels fine. I feel I will be taken better care of now that I've explained what I expect. I hope I can keep this other tooth, the pain seems to come and go, but I can't live on ibuprofen forever. I will give it until mid next week, then make the decision.

Thank you so much Bryanna and ginnie!

[gdmcor]

I did have to get the extraction on #14 and I got it done today. The OS said everything went well and that the tooth under the temp crown had a crack in it, which he thought was the reason it hurt. Funny, because my dentist had told me that he had drilled out the fracture. I also did not have any sinus exposure with this tooth - another plus.

Another bad thing - last Wednesday I had the perm crown put on my other tooth, the next day it chipped when eating beans, a large chip, exposing part of my back tooth. Friday they were not in and I also couldn't see him, the dentist, today because of the extraction appointment.

So, I have an appointment to have the dentist look at the chipped crown next Wednesday. I'm beginning to think I will have to look for yet another dentist. It's so hard to find a good one as well as an honest one. In fact, I haven't found one yet!

I'm presuming I will be reimbursed for the crown I've already paid for on #14, which is now extracted. I also assume I will have this other crown replaced at no extra charge. Do you know anything about that, Bryanna?

Some luck I have, huh? Gretchen - Thanks!