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    Thread: Is extraction logical after a failed root canal w/ cracked tooth, in my early 20s?

    1. #1
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      Default Is extraction logical after a failed root canal w/ cracked tooth, in my early 20s?

      For the past three months I have been undergoing assorted horrors with an upper left molar. A dentist put a filling in about six months ago for a 'small cavity', but apparently had not fully cleaned out the tooth or the infection had spread, as a very painful abcess developed a few months later. A root canal was performed in early July. Pain and swelling remained; the dentist re-did two of the canals and said to let it settle down. Pain subsided but did not disappear; after three weeks a post was put in. Pain continued, I was put on more antibiotics and a round of steroids to calm down residual swelling. Pain is now mild, but the tooth (which currently has a root canal and a post but no crown) has a fracture in it -- no serious crack or chip but a visible line of fracture along the back. It is still painful to bite on that side and some days I have residual throbbing pain in the area. The dentist is having me wait a MONTH for the pain/swelling to subside as she thinks it is still just residual swelling, and then intends to crown the tooth. She is worried about the crack and is unsure of whether or not I will lose the tooth but thinks that a crown will take care of it.

      I am very concerned about this -- what is the logical prognosis at this point? I have spent nearly $12,000 so far on this tooth alone but worry that having it pulled would also be quite expensive, but don't know if there is any other option at this point. I have been in pain for over three months and every single treatment on the tooth in this time has failed or somehow gone wrong. Nothing has made me feel better. I am even more terrified of the dentist than I was to begin with.

      The teeth on either side of the problem tooth have also recently had root canals (within the past year), and have crowns on them -- does this mean a bridge would not be an option? What if I am not a candidate for or (more likely) cannot afford implants? Will I need to get a partial denture as a healthy 24 year old woman?

    2. #2
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      Default Re: Is extraction logical after a failed root canal w/ cracked tooth, in my early 20s?

      Hi there
      What was the story with the other teeth on that side having root treatment?
      Do you have root treated teeth elsewhere?
      Do you have many fillings etc elsewhere in your mouth, - do you have many on the lower teeth?
      Do you grind or clench your teeth when you sleep or while awake as far as you know?
      Do you have worn teeth anywhere?
      Does it feel like your teeth meet/bite properly?
      Have you ever cracked fillings or teeth?
      Do you have sinus pain or problems?
      Do you have any pain in your jaw joint- or suffer from migraine, tension headaches- neck/shoulder pain etc?

      The reason why I ask is that there is a small chance (and please remember that without a consultation- any advice is just guesswork)- that there could be something else going on such as a sinus problem, or perhaps a clenching/grinding or TMJ (Jaw joint) issue.

      Bridgework and implant may be an option eventually if you lose the tooth- but I would be more concerned with finding out why you are suddenly needing root canal work at 24.
      Having a bridge or implant if there are other problems such as grinding, may mean that there could be problems also with those treatments ultimately.

      As I said- I may be barking up the wrong tree here- but I think that anyone who is following a pattern of numerous root canal work in one region of the mouth, and that pain persists after the root canal work- may have other issues. Also- the crack in the tooth- I wonder if that is just through it being weakednd and undermined- or if it could be to do with clenching/grinding?

      An anterior discluding splint (eg NTI or Lucia jig etc) worn for a week or two may help diagnose if there is an issue with the jaw joint/grinding etc if it relieves the pain, as it would allow the tooth to settle down as any excessive force that it was being subjected to at night would be relieved.

      I'll be interested to hear your answers to the above and hope that some of this may help get to the bottom of things for you. It may just be bad luck with decay/caries- but as I said- at 24, and with the description you have given- I'm a bit suspicious that there is more to this than meets the eye.

      Regards
      Dr Mike
      Last edited by DrMike; 12th September 2009 at 00:13.
      Dr Mike Gow BDS (Gla) MFDS RCPS (Gla) MSc Hyp (Lon) PGCert (Edin)
      The Berkeley Clinic, Glasgow
      www.WhatFear.Com

    3. #3
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      Default Re: Is extraction logical after a failed root canal w/ cracked tooth, in my early 20s?

      hi dr mike -- Thank you for the thorough reply! this will be a long explanation but any further advice you could offer would be so helpful... this whole experience has been so traumatizing and i feel like i have 'no faith' in my dentists and that nobody knows what the problem is.

      I have had issues with these teeth for my whole life -- the upper left quadrant of my mouth had developmental issues (there is genetic history of "weird molars" or missing molars.) Two of the three (the premolar and the molar next to it) were impacted baby teeth on which i had surgery when I was 12. They were pulled down with some sort of chain and were never fully developed teeth -- my dentist called them 'dinky teeth' as they were more like stubs and had very poor enamel. The roots were normal but the part of the tooth that shows was always misshapen. One of them (premolar) broke in November 2008 which was the first root canal; the back molar was the next one due to a cavity underneath a massive filling (which had been done as a teenager when I got my braces off and they found half my tooth rotted underneath the back band.) The current tooth -- the one in between those two and by far the most troublesome -- started out of nowhere in early July .

      The rest of my teeth do not have many cavities -- I have maybe 4 or 5 total in the rest of my mouth ever? Only one on lower teeth, a bottom right molar. My teeth are greyed from tetracycline and stained from drinking a lot of tea, but otherwise very 'good' and straight/strong. I floss obsessively and use a fluoride mouthwash.

      I DO grind my teeth, and have started wearing a store-bought mouthguard and am looking into getting a 'real' one once the work here finishes. The grinding occurs largely when I am anxious, and being in therapy for anxiety has helped for sure. There were also issues with my bite being off thanks to an ill-fitting crown put on by my old/cheaper/insurance-recc'd-but-terrible dentist in NJ; my dentist here in NYC has filed it down and I think this has also helped.

      Additionally I struggled with bulimia for around 4 years as a teenager and I am sure that did not exactly do wonders for my teeth. ((I am better now.)) My dentist suspects that the developmental issues (as the rest of my teeth are essentially perfect) + bulimia + grinding are probably much of the problem; I also do have minor sinus issues but not nearly as badly as I did as a child.

      My dentist also commented on this tooth having an abnormal amount of nerve tissue which she had trouble removing; it was very difficult to get me numb and she commented on the tooth itself being somewhat 'strange' inside. (This was one of the half-developed molars.)

      I figure I will eventually need implants in that quadrant of my mouth -- but I don't have the money for it right now, and I think if there was a way to fix the problem for now until a.) I am more financially stable in my life (24 is NOT a great time to have $12k of dental bills) and b.) technology has advanced.

      I'm at a loss really for 'what to do now' -- my dentist is having me wait a month to see if pain subsides but meanwhile the tooth is still painful and I am very worried about the crack and cannot stop thinking about it. Any advice would help a lot

      thank you so much!

      - meghan

    4. #4
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      Default Re: Is extraction logical after a failed root canal w/ cracked tooth, in my early 20s?

      hi there
      thanks for such a detailed reply!
      it does certainly sound quite complex.
      i take it your dentists know all of this info- as it is all relevant.
      i think that if the pain continues or gets worse you should contact them again.
      The cack itself hopefully isn't a big issue- your dentist will be able to reassure you when they have a look at what is going on.
      cheers
      Dr Mike
      Dr Mike Gow BDS (Gla) MFDS RCPS (Gla) MSc Hyp (Lon) PGCert (Edin)
      The Berkeley Clinic, Glasgow
      www.WhatFear.Com

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