Cerec crown appt tomorrow, feeling very nervous, one last question

[sharon]

I've taken one valium to help me relax and will take one in the morning. The one I have taken hasn't done a thing to help, just makes me feel slightly loopy. Oh dear, in just a little over 24 hours I will be seated in the dreaded chair.

Here is one last question I have - can anyone help? From previous crowns I know there comes a point where the dentist wraps something around the tooth, I think to pull the gum back. Does anyone know what this is called and do you recall it tasting terrible? From other crowns I remember this so well, and the taste of whatever is on the cord is vile. I tried explaining this to one dentist and he didn't know what I was talking about. Is anyone who is reading this familiar with what I am talking about and any suggestions on how to get through it or what I can tell the dentist about this?

My fears for tomorrow - gagging/vomiting, lying too horizontal, being told the tooth is too far gone to save, too many things in my mouth, the above terrible taste, removing the crown and having a terrible odor/taste from the decay underneath (this has happened to me before), valium not working and entire body shaking from fear and anxiety, finding out I need a full mouth impression.

Thanks for listening!

 

[Steve In Cleveland]

From previous crowns I know there comes a point where the dentist wraps something around the tooth, I think to pull the gum back. Does anyone know what this is called and do you recall it tasting terrible? From other crowns I remember this so well, and the taste of whatever is on the cord is vile.

I think that's hemodent or epinephrine. It's not always necessary depending on where the tooth margin is, but if the margin is below the gumline, I think it's pretty standard.

If you think of a crown for your tooth as kind of like a hat for your head. The edge of the hat that meets your head is called the margin. With a hat, your head is still head-shaped, so the hat needs to be a little larger than your head (so it can fit over!), and consequently the margin isn't smooth: there's a ridge or rim where the hat meets the head.

With a tooth, the dentist shapes the tooth down a little, and the crown is created to be exactly the same size and shape as the rest of the tooth. So when it fits, there's no lip. This allows the tooth to look and feel smooth, but more importantly provides a smooth surface that won't attract germs and bacteria. In order to do this, the dentist needs to be able to expose the entire margin (you might hear the dentist talking about a "clean margin")-- either to the CEREC camera, or to the impression material. Without a clean margin, it's like trying to fit you for a hat without knowing what the size of your head is!

When the margin is above the gumline, the margin is pretty easy to see. But when the margin is below the gumline, it's often necessary to wrap the tooth in "packing cord", which is basically a little piece of string inserted between the tooth and gum, to hold the gum back for long enough to get the impression or picture. The packing cord is soaked in hemodent or ephinephrine, which controls bleeding and also causes the gums to retract a tiny bit temporarily. But it does taste pretty vile.

Whether this is necessary depends on the location of the margin, which depends on a) how much decay needs to be removed to find healthy tooth, and b) the visibility of the crown. For front teeth, the dentist will usually "bury the margin" so that there's no visible line. Or, if the decay is near or below the gumline, same thing.

I think CEREC makes it a little easier to get a good margin compared to traditional impressions, but it's still critical to see the entire margin, so packing cord is still pretty common. Mention your concern to the dentist beforehand. Like a lot of things, if the dentist knows it's a concern, maybe he can use something different, or at the very least, he can move quickly or make sure you have good suction while he's packing the cord, to minimize the amount that gets on your tongue.

Good luck with your appointment. Some of your fears you're unfortunately just going to have to wait and see, but it's always good to communicate these things to your dentist ahead of time, because some of them, like chair position, can sometimes be adjusted to help.

Hang in there!

 

[sharon]

Thank you Steve. And I'm so glad you know what I meant. Whenever I mention this to other people they have no idea what I am talking about and look at me like I'm looney. They have never heard of this vile tasting thing.

My appointment was fine, I didn't need to have that vile cord tasting stuff. All together I was there almost 3 hours. He had to way more pictures of my tooth than I expected. I thought he would take one. He kept taking them over and over, about 5 minutes worth. The worst part really was at the very end after he put the crown in, there was a lot of drilling and filing and whatever else he does to make a perfect fit.

In the end none of my fears came to be, no gagging or vomiting, though I did a little nervous about the gagging when he had so much stuff in my mouth. I ws able to sit in a fairly comfortable position, no terrible odor from decay when he removed the crown, didn't lose the tooth, I did have to have a couple of impressions but they were small and doable.

Next tooth is #10. He already has told me he may not be able to save it and will need an implant. I'm not going to worry about that tonight.

I am beat, Probably took more valium and meclizine than I needed, didn't feel it hit me until after the appt. Off to bed.

Sharon

 

[Steve In Cleveland]

So glad your appointment went well!

CEREC really is a wonderful thing. Definitely no need to think about the next appointment tonight-- get some rest and enjoy your new restored tooth!