Gordon - how can a root canaled tooth have pain?

[leela]

Gordon - hoping you can once again explain something to me. I actually have 3 questions:

1. As I posted before, there is a suspicion of a fracture that has not been confirmed or seen, but I still don't understand how a tooth that has had a root canal can feel pain - even if there is a fracture. Can you explain?
2. After the root canal the tooth felt fine with the temp filling. It was only after the temp filling came out and the perm filling was done that this pain started. It's making me lose faith in my dentist - did she do something wrong with the filling? Could she have made the fracture worse??
3. If there is a fracture, could the crown prep make it worse? I understand the tooth has to be "made smaller" in order to fit the crown on it. Couldn't all of this drilling and/or filing of the tooth damage the tooth and make the fracture worse. If the tooth is already in a compromised/weakened state it would seem to me that blasting away at it can't be a good thing.

Thanks.

 

[Gordon]

1) It's not the tooth feeling the pain, it's the nerves to the jaw bone and the ligament that holds the tooth in place. They feel the movement of the fractured pieces and trigger off as pain.

2) Maybe the permanent filling was a bit high in the bite, the temp ones are very soft and soon deform if they're too high, the permanent one wouldn't and it could have made things worse, it's difficult to get the bite exactly right when you're working on a root treated tooth, the patient's perceptions are a wee bit skewed.

3) Yes, but the benefit that the crown will bring by reinforcing the tooth is greater than the risk of making it worse by doing the crown prep.

 

[leela]

Gordon, many thanks again. You are always such a wonderful source of information for me. You may wonder why I am asking you instead of my dentist - partially because I sort of "freeze up" a bit when I'm there and always think of the questions after I leave; and I trust you, you always give sensible, practical and informative answers that make me feel better.

Thank you again.

 

[Gordon]

Gordon blushes furiously

It's also much easier for me to give these answers than your dentist because I have the time to sit and think about it, it's hard to do it on the hoof so to speak!

 

[leela]

Hi Gordon,

I was away for what was supposed to be a long holiday weekend, and I spent all of it thinking about this stupid tooth - not much of a holiday weekend.

1. When this whole process started one of the major symptoms was that when water hit that tooth I felt searing momentary pain. Before the root canal, my dentist tried a filling - and that did the trick for that particular symptom - the filling seemed to cover the crack. I am hoping that this means that if the filling helped "cover" the crack, the crown will do the same - what do you think?
2. My next thought is that all the work on this tooth has clearly made the crack worse. It was fine BEFORE the root canal, but since the permanent filling it's gotten progressively worse. I now understand why there is pain in this dead, but cracked tooth, but what I still don't understand is how it can feel pain ALL THE TIME. If I was chewing on it and biting down with it, I can see that causing pain because of the shift, but why is it always hurting now?
3. Before the first filling and root canal I could bite down on it and had no pain - and the nerve was still alive then! I only felt pain with the water. If I had a crack like this before the root canal and could bite down with no pain, why is there pain now all the time?
4. My final thought is that I think a lot of damage has been done to that tooth by the dentist and the endo, and it kind of makes me angry. I know they are doing what they think is best, but I can't help but feel that even though their intentions are honorable, they are making the crack worse with all this work. Every time that tooth is worked on, it's in worse shape than before. That just doesn't seem right and makes me sad, angry and frustrated. Does my dentist realize what is happening, and I wonder if a different dentist would have opted for a different course of action, although I don't know what. It just seems weird to me that all this work is supposed to help save the tooth, but may actually be causing so much damage to it that it may end up needing to be pulled. What a tragic shame that would be!!

Anyway, I know this is super long and I apologize. I've had ALLLLL weekend to keep going over this in my brain. But any feedback from you would be really super appreciated.

 

[Gordon]

1) I hope so. That's certainly the plan behind doing crowns on cracked teeth. Not just to cover up the crack but to reinforce the tooth and hold the bits together.
2) I'd really need to see the tooth and some x-rays to comment
3) As above
4) What's been done is kind of the standard thing to do for a cracked tooth, it's hard to criticise somebody for doing exactly what I would have done

 

[leela]

Gordon thanks again. I feel better that she is doing what is considered the standard procedure, even if it does seem a bit barbaric. I just wasn't sure that a cracked tooth should get different treatment than a non-cracked tooth, but it doesn't look that way.

I dropped in to see her today and she is fitting me in on Friday for the temporary crown, and we are hoping that this will solve all the problems, and if it does she will then order the permanent crown.

God I hope so, I want this behind me and "cured" more than you can possibly imagine.

Thanks again for the feedback.

Oh and just FYI - I've been told that the crack is neither visible on xrays nor under examination by the dentist.

 

[Gordon]

Not that unusual. Sometimes you only find the buggers when you take the tooth out

Hope the temp crown fixes things, keep us informed.

 

[leela]

Gordon, need you opinion again. I just found out from my dentist that the procedure tomorrow with the temp crown is not preparation for the permanent crown at all. Her thinking was to try the temp crown just to see if that got rid of the pain, and then proceed with the proper crown fitting if it did.

But this means an extra step. Tomorrow she would fit me for a temp crown only - no impressions or anything. If it worked and got rid of the pain, then I would have to go back in - have that temp crown removed, take impressions, put a temp crown back on and then wait for the perm crown.

This scares me to death because every time that tooth is worked on, it gets more painful, leaving me to believe each time it's worked on it's receiving more trauma.

I'm wondering if I shouldn't just put up with the pain until she can fit me in to do the "real" temp and perm crown prep.

What do you think - is that extra step of putting on and removing the first temp crown only going to cause more damage to an already weakened tooth? My thought is minimize the amount of work being done, not create more.

Your thoughts would be appreciated. I'm going to try to get her on the phone to ask her these questions before my appt tomorrow.

Sorry again for the long email.

 

[leela]

Hi Gordon,

Just wanted to update you. I talked to my dentist earlier, and she assured me that the extra step really isn't much of an extra step. She said the process of popping the temp crown off to take the impressions and then put it back on again isn't going to cause the tooth any more trauma. She explained to me that the reason she wants to do this step is because she wants to save the cost of taking impressions and doing lab work when we don't know yet if the crown is going to solve the problem.

She is not charging me for tomorrow's appt to put the temp crown on, she just wants to see if this works, and hopefully to relieve the pain. She said if it does work, then we can start the preparation for the perm crown, but she didn't want me to go through any additional expense in the event the crown doesn't work.

So, I'll let you know how this turns out. Maybe it's one for the dental books, it seems like this whole process was out of the ordinary, or so it seems to me.

 

[Gordon]

Hi Gordon,
She is not charging me for tomorrow's appt to put the temp crown on, she just wants to see if this works, and hopefully to relieve the pain. She said if it does work, then we can start the preparation for the perm crown, but she didn't want me to go through any additional expense in the event the crown doesn't work.

Again, can't possibly criticise your dentist for doing exactly what I would do in the same situation. If it's any consolation she probably feels nearly as frustrated with the whole deal as I do.
Oh, and would you ask her if she fancies a job in Scotland? I have this vacancy in my department I can't fill...

 

[leela]

Hi Gordon, I'm back, albeit a little groggy from the drugs (Ativan and Gravol).

I just wanted to tell you that she saw the crack this time. When she drilled down the tooth she was able to see it. Most of it seems to be above the gum line, with a little hidden. She said it didn't look too bad to her. She asked me if I wanted to see it, but I declined. Blech.

I have the temp crown on, she wants me to monitor this for a week or so and let her know how it goes. I'm not convinced yet, I'll wait and see how it goes over the weekend.

Anyway, thanks again for being my "virtual dentist" and I'll let you know how it goes. You've been a great help.

Here's hoping this does the trick.