Right Decision?
 

My number 15 tooth is cracked and has started to hurt. It is a pinching, mild hurt which is managed with motrin. I thought it was infected as well. My Doc understands that I refuse all root canals going forward, even if it means losing the tooth. He supports my decision to let nature take it's course with my teeth at this point. I have had some horrible dental issues in the last three years--from teeth that have cracked from huge metal fillings post orthodontics almost 40 years ago and become infected--followed by failed root canals and finally: extractions.

He also offered me the opportunity to have him put a crown on the tooth--temporary crown, no charge to see if it would stabilize the tooth. I asked if it would stop the pain. He said, that's what we would try to find out. I hesitated. Then, all I could think of was more infection down the road...or worse yet, more pain after he put the temporary crown on...and not being able to get the tooth extracted immediately and being in pain.

In the end, I opted for the extraction and it is scheduled. I am now wondering if I should have tried the crown...and if I made the right decision.

Thoughts?

Hi Carmellaann,

I'm sorry you are having yet another tooth problem :/

Is the tooth infected? Did the dentist take an xray of it?
Can the dentist see where the crack is or is the crack below the gum line?

Bryanna

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Hi Bryanna,
Nice to hear from you again (even with dental issues!) I thought the tooth was infected because it was hurting. However, no fistula or anything like that. You can visualize the crack on the tooth--and right where the tooth is cracked and meets the gum you can see this reddish brown...looks to me like decay spot. There are other cracks and crazes I am also aware of as is the dentist. I don't have any sensitivity to hot or cold, and barely to pressure with a bite stick. The pain is like a toothpick in the center of the tooth...it's a pricking pain and then like a low level ache. Motrin helps. The metal filling is rather large and deep and has been in for 30 years. The pain is minimal. He did take an xray and he said the tooth looked ok and that it wasn't abscessed. Normally, in patients with this level of an issue he would recommend crown, he said. However, when I pressed him about the relatively constant low level pain--he said, then most likely a RC and then crown. But, he said, since we have come to an understanding about no more RCs he wanted to give me every opportunity to keep the tooth--therefor trying the temp crown. In the end, I just could see no point at all since the tooth was already hurting. He said the crown may or may not stop the pain. The crack(s) are not new...I knew it was borrowed time with this tooth and I also understand it is borrowed time on two last teeth (last upper right and last lower left) with the same problems. After those go, the teeth I have left are not in the kind of bad shape as were all of those premolars. This dentist I like because--well like today, we talked this through for almost an hour, and mapped out a plan going forward as we look at these other teeth going bad
with the huge old fillings. He was there when I was having all the problems with my last RC ever and the facial pain and nerve issues...so he understands the NO RC rule. I guess I just wanted to run it by you. I have an excellent oral surgeon...and am at peace about the no RC rule...I feel bad about losing these teeth. It's almost like a shameful feeling. My dentist said I am kind of a victim of good intentions of dental history. The braces I wore for almost five years...they pulled two good eye teeth for those, which to this day I do not understand, but I was only 12 when this started. I had 10 horrible cavities after the braces and none going in...huge metal fillings...and I still had an overbite AND my arch was narrowed...add to that immunosuppressing drugs since I was 25 for Rheumatoid Arthritis and here we are...I know you asked three questions and now I am rambling! I'll stop now! Thanks for responding!

Hi carmelaann,

You are not rambling.... it's all good :))

My concern about this tooth is that the cracks you speak of may be crazing lines which is a common thing for many people. The pain that you feel may be due to decay underneath the old filling which is a typical find underneath old metal fillings. But the decay may or may not be into the pulp. If he were to remove the filling, he would then have a better idea of the health of this tooth. If the decay is deep and he cannot remove it without injuring the pulp then have the tooth removed. If it's not that deep then have him remove the decay and place a temp crown on it for several weeks and see how it goes.

I think that may be a viable option based on what you have described here.

What are your thoughts on that?

Bryanna

You know, my old dentist would do just that--the first time, I went for about a week after he opened the deep cavity, cleaned out, and refilled. He even filled and closed with the cerac stuff...one week. That lead to my first ever root canal. The second time, it lasted about two years and resulted in an abscess with fistula, agonizing pain and extraction. My new dentist did not even offer to do this. He just offered a temp crown. Honestly, I have been through so much with dental pain from abscess...had he offered it, I would have probably just turned it down. The fillings are wide and deep...just awful. I would be afraid of bothering the nerve even more...and then having to live through a week of let's see if it calms down and then triggering facial nerve pain...gah. I guess I answered my own question(s). Thank you for the suggestion, though. I think I am beyond trying to save teeth that are beyond saving by buying a year or two. I'm 51 years old...never thought in a million years I would be staring down partials and dentures--but here I am.

I was thinking...just two years after my braces were off and that summer my general dentist filled ten deep and wide cavities with metal fillings--when I turned 19 was the onset of my Rheumatoid Arthritis. I do have a genetic predisposition--my dad had what they called polyarthritis back in the day...but I can't help but wonder if the metal fillings and all the mercury may have been a trigger. I know some schools of thought would say yes to that.

As an aside, my doc wants to make me a night guard to maybe stave off worsening off the crazing and cracks. They are quoting a price of $510. He says he thinks this might buy me 5 years before partials. I do grind at night all the most of the teeth I used to grind are gone now. He said this would protect me from grinding on what is left...thoughts? I have no idea the price of these things. I would spend the money to protect what I have left if that's what a custom night guard costs.

Thank you for your considered opinion on tooth 15. It goes on Oct. 8. I am praying it is as easy and pretty much pain free as my last two extractions!

Hi carmellaann,

Okay well you know best. Trust your instincts and your own judgement.

I think a night guard may be very helpful for you. Yes, I would give that a try and yes that cost is within the usual cost for one.

Regarding the correlation between mercury dental fillings and arthritis.... I think there are more arguments for that correlation than against it. :(

Bryanna

Extraction #15 Update
 

Hi Brianna,
I am home now from the extraction of #15. All went well. My oral surgeon is most excellent with the novacaine. I felt nothing going in with the needles and only a slight pressure and pinch for the one into the root, I guess? Not sure where it goes, actually. He said when he looked at it prior, that most teeth don't crack like that. It was a big visible crack with decay right in the front of the tooth when looking straight at it. The doc had to section out the tooth with drill action because the roots were long and splayed. I felt the slightest of tugs as he brought out each piece. Of course,the drill was loud and rumbly. It took a little longer as he was working to get the tooth out, but this was also the case when he removed number 14. I feel a huge sense of relief...I can't tell you. Feeling pretty good so far, hungry of course... :o)

As always, thanks for being there for those of us with tooth issues of all sorts!

Carla

Hi Carla,

Thanks for checking in with us:)

So the tooth did have a large crack in it?! Good thing you had it removed!

Hope you feel well and everything heals perfectly.

Bryanna

Cracked
 

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B~
Yes, he said tooth was cracked and had never seen one "cracked that way". I don't know what that means...you could see the crack or at least a very obvious craze line in the tooth straight down the front of it and decay along the gum line and in the crack...the OS did not elaborate. I did look at the tooth once it was out (in pieces)...morbid fascination, I guess. So weird, teeth. For a cracked tooth with decay, it wasn't all that painful...it was a constant dull ache...and only the slightest pain on bite--on only one of the cusps. I am just thankful it is out. Two more with big metal fillings, but they seem to be dormant (as it were) for the time being. I keep hoping my RA will subside as these fillings go one by one. And perhaps once the metal fillings are out--who knows, a remission? I have had RA since I was 19 and rarely a day goes by that I am not in some kind of pain.

Thanks again for running this form--you do a great service to humanity! :o)