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Crown procedure questions

S

silvercat

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HI I'm due to get a crown soon but I'm very very nervous about the whole thing as my previous posts show. The tooth in question has a large filling taking up the rear third of the tooth it has also been filled on both sides.

1. I'm just teriffied that as soon as the tooth is touched with the drill its just going to fall apart. Ok I'm no dentist but I don't see how the tooth shaving reshaping can be done and enough tooth left for a crown to sit on, my dentist has noted on my plan that a post is to be used if required what does that mean?

2. I'm also very nervous about the possibility of a root canal needing done, this was not mentioned by my dentist but there is so much info online about root canals being needed on teeth with crowns. Should a root canal be done before placing the crown? and will the crown procedure cause trauma to the tooth leading to the need for a root canal at some point?

3. I'm also very scared of the possibility of the temporary crown that will be placed coming loose and falling out while im sleeping and going down my throat. I also have the same fear about the possibility of the permanent crown falling out and doing the same.

I'm just so stressed can't sleep properly for two weeks now (I suffer from extreme health anxiety) and I can't get in touch with my dentist as he is so busy then going on holiday. I just feel trapped in an imposible situation and am really struggling to deal with the prospect of this work being done. I don't want it done but it needs done and I'm really am not in a good place cause of the stress. I've managed to build this up in my head to being the biggest and most traumatic procedure anyone can undergo to the point it is having an extreme detrimental effect to my quality of life at the moment.

Any advice, info explanations will be appreciated very much thanks Owain
 
Gordon

Gordon

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1. I'm just teriffied that as soon as the tooth is touched with the drill its just going to fall apart. Ok I'm no dentist but I don't see how the tooth shaving reshaping can be done and enough tooth left for a crown to sit on, my dentist has noted on my plan that a post is to be used if required what does that mean?
It's very unlikely teeth are extremely strong structures and don't just crumble like that.
A post is a metal or plastic preformed structure that can be bonded into the tooth to give a bit more structure for the crown to hold onto.


2. I'm also very nervous about the possibility of a root canal needing done, this was not mentioned by my dentist but there is so much info online about root canals being needed on teeth with crowns. Should a root canal be done before placing the crown? and will the crown procedure cause trauma to the tooth leading to the need for a root canal at some point?
Kind of backwards, crowns are nearly always needed on teeth which have had root canal treatment, (RCT) but the reverse doesn't apply.
The crown prep isn't particularly traumatic to the tooth, no worse than a filling really. Having said that, to need a crown in the first place the tooth has always been compromised a bit so sometimes they will go on to need an RCT, but it isn't automatic.


3. I'm also very scared of the possibility of the temporary crown that will be placed coming loose and falling out while im sleeping and going down my throat. I also have the same fear about the possibility of the permanent crown falling out and doing the same.
Your body has an excellent automatic defence mechanism for your airway. It's pretty unlikely for a crown to come out in your sleep to begin with (usually happens when chewing) but your automatic airway defence will kick in and you'll probably either unconsciously spit it out (with a nice surprise on your pillow in the morning) or you'll swallow it.
It's one of the things that makes a general anaesthetic a bit risky, we are switching off all those automatic airway defence mechanisms :(
 
S

silvercat

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Gordon thanks again for you replies. I'm just wondering if you have any other advice for me I know for 100% that my fear around this issue is getting the local and the fear of having a panic attack on the chair as well as any side effects that may occur as I have said in my previous posts. I read other posts on folk who have dental phobia and I don't really fit that (or do I) I have no problem phoning or going to the dentist no probs with the cleaning have had fillings done with zero local. My single fear is the local.

The new dentist's I have selected have the 2nd highest number of positive online reviews of any dentists in Edinburgh Slateford Dental Care. The particular Dentist I saw has treated my Wife, Son and Daughter who all switched to him from their old dentist last year and they all found him excellent. But Im still terrified I just cannot rationalise the proceedure in my head. Ive also looked at online videos of the procedure and it looks horrendous. I feel completely trapped I know it needs done but am in such a state of fear about it I can't sleep properly. It's having a huge impact on my daily life. Thanks
 
S

silvercat

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Hi I have another question I wanted to ask you. I lost a front tooth aged 19 and had a maryland bridge fitted. The original bridge lasted 30 years but did fall out several times and had to be recemented. The 2nd time it came out the tooth it was attached to must have suffered some trauma as it ached for months afterwards a weird sort of pain not excruciating pain but just a sort of sensation and sensitivity in the tooth noticable during the day but not enough to stop me sleeping. This pain subsided over the next few months but ever since then (that was 2004) it has contiuned to come and go (more noticable in very cold weather).

Since 2018 the bridge came out and was recemented a further 2 times then it fell out for a third time and my Dentist said I needed a new one in Jan 2021. It has be fine since then but this weird sort of pain/sensation is still present not all the time but it comes and go's. The tooth the bridge is attached to is also slightly loose I can move it back and forth a tiny bit. Anyway Ill get to the point would the tooth my bridge is attached to have died by now if it was going to die. With all my current worries this has now crept into my head and Im worried about the nerve dying in this tooth. Before the new bridge was fitted xrays showed the tooth taking it had adequate bone/strength to take it but this weird minor pain sensation continues to this day. My dentist had to drill a lot of old cement of the back of the tooth in order to fit the new bridge could this have caused enough trauma to cause the nerve to start to die? Thanks again Owain
 
Gordon

Gordon

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Hi I have another question I wanted to ask you. I lost a front tooth aged 19 and had a maryland bridge fitted. The original bridge lasted 30 years but did fall out several times and had to be recemented. The 2nd time it came out the tooth it was attached to must have suffered some trauma as it ached for months afterwards a weird sort of pain not excruciating pain but just a sort of sensation and sensitivity in the tooth noticable during the day but not enough to stop me sleeping. This pain subsided over the next few months but ever since then (that was 2004) it has contiuned to come and go (more noticable in very cold weather).

Since 2018 the bridge came out and was recemented a further 2 times then it fell out for a third time and my Dentist said I needed a new one in Jan 2021. It has be fine since then but this weird sort of pain/sensation is still present not all the time but it comes and go's. The tooth the bridge is attached to is also slightly loose I can move it back and forth a tiny bit. Anyway Ill get to the point would the tooth my bridge is attached to have died by now if it was going to die. With all my current worries this has now crept into my head and Im worried about the nerve dying in this tooth. Before the new bridge was fitted xrays showed the tooth taking it had adequate bone/strength to take it but this weird minor pain sensation continues to this day. My dentist had to drill a lot of old cement of the back of the tooth in order to fit the new bridge could this have caused enough trauma to cause the nerve to start to die? Thanks again Owain
Can we do this one first, it's much easier to answer for my age addled brain :)
It would be worth getting the bite checked on the Maryland, sometimes teeth can drift a bit over time, especially with a missing tooth beside them, slight biting force trauma would match your symptoms.
No, drilling some cement off would not cause enough trauma to kill off a nerve.
 
Gordon

Gordon

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Gordon thanks again for you replies. I'm just wondering if you have any other advice for me I know for 100% that my fear around this issue is getting the local and the fear of having a panic attack on the chair as well as any side effects that may occur as I have said in my previous posts. I read other posts on folk who have dental phobia and I don't really fit that (or do I) I have no problem phoning or going to the dentist no probs with the cleaning have had fillings done with zero local. My single fear is the local.

The new dentist's I have selected have the 2nd highest number of positive online reviews of any dentists in Edinburgh Slateford Dental Care. The particular Dentist I saw has treated my Wife, Son and Daughter who all switched to him from their old dentist last year and they all found him excellent. But Im still terrified I just cannot rationalise the proceedure in my head. Ive also looked at online videos of the procedure and it looks horrendous. I feel completely trapped I know it needs done but am in such a state of fear about it I can't sleep properly. It's having a huge impact on my daily life. Thanks
Fear of local is probably the No 1 reason people are scared of dentists, since it's pretty irrational then I'd call it a phobia :)

Helping you through this is probably outside the scope for a dentist, you'd be better seeking some help from a hypnotherapist, NLP practitioner or similar.
 
S

silvercat

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@Gordon thanks it strange as is said it is totally fine today but yesterday it had the weird sensation to it. Ive been told I grind my teeth would this be a possible factor in agravating it? possibly some nights I hit the tooth when grinding and some nights I don't grind. As I said the original bridge came out in 2004 due to another trauma which then caused the pain and sensitivity in the tooth it was fixed to.

If the nerve was going to die would it have done so by now?

Is the fact that the tooth also moves very very slightly ok? It has for the last 20 years and never got any looser just a very slight 0.5-1mm approx movement but enough that I can see it move in a mirror.

Can I also ask if I had a tooth abscess would I know about it just worried this nerve might die and form an abscess.

I had a one hour new paitient appointment last week with a new dentist and he never raised any concerns about the bridge or tooth it was fixed too. He also took x rays but only on either side of the mouth not directly of the front would these still show any issues with the front teeth?

Thanks Owain
 
Gordon

Gordon

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Oh yes, grinding/clenching at night would absolutely do this. In addition, most folks do it when they're stressed and you're stressed at the moment over this whole dentistry business.

Maybe can't see any reason why the nerve would die in the first place though.

Yes, all teeth move slightly, if this one is getting battered by grinding then a bit more movement would be reasonable.

Probably. Nerves can die off quietly and a "silent" abscess can form but it's very rare and to be honest, it isn't that serious.

No they wouldn't show any issues with that tooth.
 
S

silvercat

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Thanks I was just concerned that when the bridge was knocked out in 2004 that the force of it happening might have been enough of a trauma to cause damage to the nerve of the tooth it was fixed on perhaps via slight rotational forces. Also worried that the constant movement of the tooth due to chewing and grinding might cause nerve damage but again would that not have happened by now? The tooth has never discoloured in any way so is that good. Ive read online that dead or dying teeth change colour.
Ive also noticed a stange thing I get sensitivity from the false tooth area well actually the gum above the top of the false tooth is still sensitive to hot/cold is that normal. It's like I have a ghost tooth that is still sensitive its weird.

Thank you again your info is fantastic
 
Gordon

Gordon

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Thanks I was just concerned that when the bridge was knocked out in 2004 that the force of it happening might have been enough of a trauma to cause damage to the nerve of the tooth it was fixed on perhaps via slight rotational forces.
Yes, but not 20 years later. It either happens immediately or not at all.

Also worried that the constant movement of the tooth due to chewing and grinding might cause nerve damage but again would that not have happened by now?

Nope, doesn't work like that. It could conceivably cause some damage to the ligament that holds the tooth in place, but not the nerve in the tooth.

The tooth has never discoloured in any way so is that good. Ive read online that dead or dying teeth change colour.
Colour change is not a reliable sign of nerve damage.

Ive also noticed a stange thing I get sensitivity from the false tooth area well actually the gum above the top of the false tooth is still sensitive to hot/cold is that normal. It's like I have a ghost tooth that is still sensitive its weird.
No idea about that one, sorry.
 
S

silvercat

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Thanks again Gordon I notice from your profile that you were a special needs dentist I have a severely non verbal autisitc son whom we find it very difficult to brush his teeth for the recommneded time. He will let us brush them but only a few seconds for top/bottom both sides. Unlike a lot of autistic kids he eats virtually anything which is good so nutirtion wise he is fine. I have looked in his mouth and his teeth don't appear to have any visable signs of decay. He is constantly chewing and biting things so will his saliva be helping keep his teeth ok? The provision of special needs dentists here in Edinburgh is very poor he's only seen a dentist a few times but quite often just refuses point blank to open his mouth so I understand it can't be easy for them. They are also prone to cancelling appointments out of the blue which is very frustrating. I just wondered if you had any pointers or tips for me to help us look after his teeth as best we can. Thanks
 
Gordon

Gordon

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You just have to get in and brush his teeth as best you can, if he won't let you do more than a few seconds at a time then that's fine. Have you tried experimenting with different toothpastes? Sometimes the different flavours can help.
Saliva generally helps maintain teeth, it's one of the things it's made for. If you can try to prevent him from snacking on food all day long and keep things to 3-4 eating sessions a day then decay will be less of a problem.
Lothian used to have a superb Special Care Team, that's a shame that it's been allowed to deteriorate to that extent.
 
S

silvercat

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Hi just wondering if you can give me your opinion on my recent x rays and photos. As I mentioned before there are six fillings being recommended first two are the ones in pic number 9 that have been filled 3 times (the last two times by my old dentist which fell out twice) she now says they are fine but new dentisit says nope they need filled also the teeth in pics number 7 and 8 are recommended my old dentist has never even mentioned these to me. Pics 4,5 and 6 show the tooth that needs a crown. Pic 6 also shows a filling that fell out in the root area again old dentist said no need to fill new dentist says it needs done. Im not sure which is the 6th filling. Also how do my x rays appear to you many thanks Owain
 

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Gordon

Gordon

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What do you want to know? There are some obviously defective fillings there, a dentist who is fairly conservative and has watched you for years might be inclined to leave some of them, a new dentist who has no idea what your disease rates are like would want to replace them immediately. Looking at them I'd be tending towards the latter viewpoint.
 
S

silvercat

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Hi just if I should get them filled or not the two side fillings fell out over 4 years ago and my old dentist says they are fine she has been watching them. She says that each time they are filled it takes a part of the tooth and makes the tooth weaker. She had fillled them twice and the fillings just fell out. Then she said to just leave them but as you can see from the pics there are deep curved pockets in both the teeth. I also have a concern that if they are filled again will it not take the tooth surface to near the nerve and perhaps cause the need for root canal in the future or cause immidiate damage.

My head is scrambled my old dentist has now been phoning me as she is adamant that the new dentist is trying to do treatment that does not need done but we have both seen the pics. As I said she does not have the intraoral camera that the new dentist has.

Reguarding the dentists qualifications she graduated from dundee with a distinction in 2006 and has an mfds from edinburgh in 2008. The new dentist I saw Graduated from belfst in 2017 and is currently doing a masters in implantology. So as you see there is a huge diff in experience bewteen them. Im just stuck don't know what to do
 
S

silvercat

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Hi again Gordon I have just had a half hour talk with my old dentist. She phoned as she was concerned about me getting what she called overtreatment. I talked about all the fillings the new dentist said I needed and she said she was aware of them all. She has been moinitioring them all for the last 4 years and none of them have got any worse in that period therefore no need to fill as it takes part of the tooth. She says she likes to practise what she called minimal dentistry as to keep filling can lead to further probs later on (like root canals that I mentioned before). So now I'm even more stressed who do I believe? She has been my dentist since 2015 and treats my borther and mother as well.

Up until now I have had no reason to doubt her she has even come out on on sat morning with less than 24 hours noitce to refit my old maryland bridge when it fell out the day before I was due to go to a wedding. As I claimed in my previous post she did not say she would never treat my tooth that needed a crown again she meant she would not give me the next appointment that I had booked to fit the crown. I was so anxious I misunderstood.
 
letsconnect

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Not a dentist, but to me, the fillings don't look great (or "obviously defective", as Gordon put it). Having said that, people may not want to pass judgement on their quality because they were likely placed under less than ideal circumstances (for example, lack of local anaesthesia and not wanting to hurt you).

My gut feeling is that the new dentist may be closer to the truth. But you could always try and get another opinion. You mentioned that Fraser at Craigentinny was booked out for months ahead, but maybe John Booth (who's also been recommended here) has availability? Might be worth checking. Both Fraser and John have a minimally invasive orientation, so that might make for an interesting comparison.
 
S

silvercat

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Im just getting more and more confused by all this. Have you read my other posts re the dentists experience and qualifiactions and about my phone chat with my old dentist yesterday? What she says made sense to me re the minimal tooth removal approach and the fact we have been watching the cavities in the pics for 5 years not 4 with zero derteriation. Also I can actually feel the two buccal cavities are hard and reminerlized when touched scraped with the end of a toothpick and have zero sensitivity. Ive had 3 weeks of dealing with this stress and Im just at my wits end. I also have to decide today if I go to the appointment with the new dentist next tues and get the treatment started on the 6 fillings he says I need at a cost of £1000, which my old dentist says I absolutley do not need as there is a chance this will cause more harm than good in the long term i.e removing the reminerlised areas and disturbing them may cause root canal probs
Thanks Owain
 
Gordon

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You're not going to get an absolutely definitive answer to this, it's a judgement call between whether to replace those fillings or not, as such different dentists will almost certainly have different opinions.

Which one is "correct" will not be obvious for years afterwards at best, possibly never.
 
S

silvercat

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Just a wee update here. I went back to see my old dentist today to discuss the treatment plan propsed by the new dentist. She went over the x rays and photos at great length with me and expalined everything in great detail to me. Re the x rays she says there is absolutley nothing there apart from the small area of decay under the big filling on the tooth that needs the crown. Re the photos the three occlusal fillings the new dentist propsed she has been watching for years (the one with the brown mark on the surface has been there for 15 years it's is listed in my old records she has from my older dentist at the surgery that she took over from. As for the buccal fillings that are being proposed again they she says they are arrested caries and have not progressed at all in 5 years. Thus to remove this remineralised material could poetentialy cause more harm in the long term.

I know the issue here that has been mentioned is the fact that the new dentist has no record or idea of my history or rate of caries. However I did tell him these had been there for years with no deteriation, my old dentist said that being the case he could easily have suggested leaving them all for 3 months then having another look then? rather than just drilling and filling everything he saw. Surely that would have made sense it seems logical to me? Ill point out here that my oral hygenine has changed massively in the last 5 years.

1 I used to rinse after brushing in the evening my old dentist told me to stop this.
2 She got me to start using interdental brushes and floss (I never had before)
3 I have changed my diet to a far less sugar containing one
4 She has told me to rub toothpaste on the areas that have remineralised to help keep them this way.

Again she put huge empahasis on what she was calling over treatment by the new dentist. And again telling me that all the propsed fillings did not need done and all would involved removing healthly or remineralised material. The result being a spiral of possible future work needing done which is what she is trying to avoid by not removing material. She agreed that if any of the areas show any deteriation in the future then yes they may need work but at present and over the last 5 years this has not happenend (hopefully due to my oral hygenine changes)

As a final note she also said that if I was in any way unhappy with her treatment she would happily stand by her observations on the x rays and photos and submit a report to the General Dental Council saying so should I wish to complain.

I would be interseted to hear back from anyone and their thoughts on this

Thanks
 
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