Got a crown, but upset I may not have needed it

[wowzers]

I have 2 amalgrams in a back molar that are about 20 years old, maybe a little older (I’m 30 but had them when I was really young). That molar started to hurt one day when I chewed or drank liquid. I looked at the tooth and it appeared to have a horizontal dark line near the base. I went to the dentist and he put a cold instrument on the line and it was very sensitive. He believed it was a cusp fracture, although it didn’t show up in an X-ray. He said if I drink ice water and hold it on that tooth and it causes lingering pain, it’s probably a fracture to the pulp and I need a crown. So I got the crown. He didn't rush me into it, but I thought since I was there I may as well get it. After all he is an expert, and at this point all of the things he said seemed legitimate.

Well having said that, about a week later I noticed the only other amalgram I have on the same molar other side of the mouth had similar sensitivity to cold water, but not as bad. I looked at that tooth and saw a similar line. I went to the dentist again and he said that tooth was fine, but he could definitely feel a cut in the one he crowned. He said I have natural ridges on my teeth.

Well now I’m really worried that if I have similar sensitivity, amalgrams, and lines on two teeth, but only one was treated for a crown, then there are two possible scenarios: 1. I didn’t need the crown at all, or 2. I probably need a crown on the other tooth. What does it sound like to you guys? Maybe I just had a toothache that I should have let sit for a few days to see if it would go away? I guess I feel like you don’t have many teeth, so it’s kind of a hit on the pride to get half of your tooth sawed off only to learn it may have been in vain.

 

[Steve In Cleveland]

I don't hear anything here that raises concerns. I don't know anything about the dark lines, but sudden sensitivity to cold or pressure is (in my experience) almost always a sign of trouble. Toothaches do sometimes "go away on their own" but usually come back, because the underlying cause is usually some kind of damage to the tooth structure.

As for the other tooth, it may just be a little sensitive, or it may need a crown some day, but I'd trust your dentist's assessment that it looks fine for now. (After all, if your dentist were trying to rip you off, he'd be happy to sell you another crown for that one too!)

It's tempting to "play dentist" and self-diagnose your teeth, but in my experience the dentist's evaluation of a tooth is based on a much better view of the tooth (both visually and via x-rays) and a much more acutely trained eye than any of us have. I've had teeth that look perfectly fine to me and the dentist says, "look at this big cavity here!" and I never have been able to see a thing. Or I'll look at the x-ray and just see a blur, but it somehow makes sense to the dentist. So it's even possible that what looks like the same line to you looks entirely different to the dentist, but it's also very likely that the symptoms also contributed to the diagnosis too.

All in all, it sounds like you got a good assessment and the right treatment, and that your other tooth is perfectly fine. (It's really not unusual to be a little sensitive to cold...) I'd also encourage you to think of the crown as not "losing" half a tooth, but instead as proper care and preventative treatment. The bulk of the tooth structure is "underground" and broken cusp can be a real threat to the integrity of the rest of the tooth. So a new crown is a very responsible, sensible measure to take to protect and save your tooth long term.

 

[Dr. Daniel]

Hi wowzers

The two teeth are not the same, in the first you had more pain than the other, that makes a big difference when diagnosing and when planning a treatment. If you observe one's mouth with good illumination and magnification you will find mini cracks and lines in almost every tooth. The question whether to treat a line/crack/fracture mainly depends on the patient's degree of discomfort.

It sounds like your dentist has treated you well. To begin with, your dental problem was treated well by your dentist (with a crown), and the current tooth is not a real dental problem (correct me if I'm wrong) and your dentist decided not to treat it.

 

[wowzers]

Hi wowzers

The two teeth are not the same, in the first you had more pain than the other, that makes a big difference when diagnosing and when planning a treatment. If you observe one's mouth with good illumination and magnification you will find mini cracks and lines in almost every tooth. The question whether to treat a line/crack/fracture mainly depends on the patient's degree of discomfort.

It sounds like your dentist has treated you well. To begin with, your dental problem was treated well by your dentist (with a crown), and the current tooth is not a real dental problem (correct me if I'm wrong) and your dentist decided not to treat it.

Just a quick update, but I finally got my permanent crown, yet I still feel anxious about the treatment and that it was unnecessary. Whoever built the crown told the dentist to lightly sand down a sharp part of another molar (actual tooth), which I thought was very weird. I'm anxious about that too. I'm really kicking myself for not getting a second opinion in general from the start, and now everything I do dentistry-wise feels like a mistake. I don't really know how to get over it.

I have a burning sensation still when a cold liquid is held in that corner of the mouth, so I have deduced that pain may be sensitive gums and not a tooth. That was only one symptom at the time of the dentist visit however. I also had pain chewing and drinking water off/on for a few days preceding the visit, however I really wish I had given the pain a few more days or even weeks to decide and settle. As Dr. Daniel mentioned, fractured teeth may only need to be treated based on severity of pain. I didn't really consider that option because I was scared it would fracture more (if indeed it was fractured) and cause me to need a root canal down the road.

I've been consoled by a few dentists/orthodontists that I know, and they assured me with two fillings already in the crowned tooth, it was a good idea to get the crown if there may have been a fracture, for I would have possibly needed it down the road anyway. But I just feel immature for giving in so easily. I didn't know the procedure for a crown was so serious (drilling away so much of the tooth just irritates the crud out of me!) and it's my own fault for not having the doubts I am now having about the procedure before I even went in the first time.

Am I overreacting or do I have good reason to feel like this was unnecessary treatment?

 

[Suzie]

Hi, I'm sorry you are feeling so anxious about whether or not you made good choices about your teeth. I think it is a problem that many of us share when getting dental care, I for one certainly become anxious when having to make choices about dental treatment. particularly if it is what I consider invasive which is probably any kind of dental treatment.

I use to be very trusting of the dental profession and went along with any and all treatments that were suggested to me because the dentist knows best after all, well, that's what I believed.

I have learnt that questioning dentists about their knowledge and reasoning for suggesting a treatment plan should be backed up with evidence that can reassure you that their practice is sound. I feel it's the same for medical doctors as well. In my recent experience with the medical profession, patients are pushed down 'pathways' that are suppose to provide the best options for treatment, but little consideration is taken into account that not all will fit comfortably into a target set system of health care.

My point being that one should question, question, question until you are satisfied that the choices made about you health are yours.

Your crown may have been the best thing for your tooth, I'm not a dentist so can't advise one way or another and I too have agreed to treatment in the past thinking, well, the tooth feels fine and then ended up with a root filling which fractured and failed and wondered how I got to that point when the tooth was painless to start with. I have lost a few teeth that way. I'm very cautious about my remaining teeth, they are very precious and it would take a lot of discomfort to convince me there was a problem.

I am due for a check up very soon and dreading it. Last time the dentist looked in my mouth he started poking about at an upper back tooth asking me if I had any pain. "NO", I replied and after taking a X-ray told me there was an abscess at the end of the root, my question is, should I have this tooth treated if it is painless. He tells me he can replace the existing 20 year old porcelain crown with a nice shiny gold one. Hmmm!

I don't think you are over reacting. Trust in your feeling about this and ask a few questions and learn from the experience for next time. That's how I would approach this. I feel less anxious because I seek out the information and challenge the options.

If your dentist is reluctant or unable to help alleviate your anxiety then there are professional. ethical dentists that will, i'm told, although I haven't really found one yet (except Gordon and the other dentists on here who are all marvelous)

Good luck

 

[Gordon]

Whoever built the crown told the dentist to lightly sand down a sharp part of another molar (actual tooth), which I thought was very weird. I'm anxious about that too. I'm really kicking myself for not getting a second opinion in general from the start, and now everything I do dentistry-wise feels like a mistake. I don't really know how to get over it.

I've been consoled by a few dentists/orthodontists that I know, and they assured me with two fillings already in the crowned tooth, it was a good idea to get the crown if there may have been a fracture, for I would have possibly needed it down the road anyway. But I just feel immature for giving in so easily. I didn't know the procedure for a crown was so serious (drilling away so much of the tooth just irritates the crud out of me!) and it's my own fault for not having the doubts I am now having about the procedure before I even went in the first time.

Am I overreacting or do I have good reason to feel like this was unnecessary treatment?

That's not unusual, sometimes you just need a bit more space for the crown than is available, it gives you a more ideal thickness for the crown without having to compromise the prep.

Cracked teeth a really grey area, the all need to be assessed individually, so I don't think it's fair to start second guessing your dentist on this one. He was the one with the best information available, so I think it's fair to give him/her the benefit of the doubt.