Jaw/Ear/Face Pain After Crown: How to prove it needs replaced?

[hyperphonics]

Back molar lower left #18 had decay or a break so it was repaired/built up or filled (the dentist didn't make it clear what he did). No root canal or post needed, healthy root. He fabricated a temp and the temp was fine. It fit nice and snug on the tooth, no pain in that tooth, and I was able to eat on it like a normal tooth.

Two weeks later, I went back to get the permanent crown, metal covered with porcelain. The crown wouldn't fit on my tooth. It was like it was too wide or shallow, like a hat sitting on a hat rack basically, or like there wasn't enough tooth for it to grip to so it kept falling off.

Even after biting down hard on it on the foam thing to get it to stay, it would just fly back off the second I released my bite. I told my dentist I was worried that the crown was a poor fit and needed to be remade. He kept insisting that the crown's fit was fine and they weren't going to redo it even though it wouldn't fit on my tooth. He had me bite down on it to hold it in place while they took an xray and still said the fit was perfect, nothing needed to be redone and he was just going to cement it in and then worry about trying to adjust it afterward since he couldn't work on it with it falling off.

Immediately there were two distinct problems. One, the bite was way too high to the point where none of my teeth were even touching anymore . Two, the crown didn't feel like it was seated properly, it was as if it was sitting high up ABOVE my tooth rather than ON it and it felt tilted. He said he'd adjust the bite a little and he did but it was still terrible. He said it was fine to him and the paper agreed with him so he wouldn't adjust it anymore and to just let it go down on its own for a few days or a week or so. This was a Friday.

I went home and looked in my mouth and saw that the porcelain was off where he adjusted and was angry about that because I paid for this out of pocket but mostly, I didn't understand how the crown could be so high that he already wore away porcelain and it still wasn't anywhere close to being a proper bite or fit. I've never had that problem with any other crown and didn't have it with the temp.

Later that night when I tried to eat dinner (fish), the poor fit of the crown was more obvious. The bad height made the crown smash into my upper teeth whenever I tried to chew causing pain and touch sensitivity to the tooth. When I tried to eat on the side with the crown, the crown felt like it would go down and then come back up when I released and that made pain.

My dentist isn't available weekends and I had to go out of town that next week so I gave it a week like he said and nothing got better, as I suspected, it just got worse to the point where I was now getting pain in the bone underneath the tooth as well as the nerve. I was afraid the nerve was being killed and my jaw and bone was being damaged. I called when I got back in town that following Monday and they made me an appointment for Friday.

I told him about all the problems and again that the crown wasn't sitting right and was too high and he argued that it wasn't, then said he'd adjust the bite a little again, which helped a little with the bite but it was still clearly wrong and it still didn't address the seating of the crown. I told him again I was concerned that it needed to be redone and he said no and he wouldn't adjust it anymore, wait again a few days to a week and come back again.

The problem continued to get worse to the point where I was now having pain in the whole jaw underneath the tooth, in the joint, and in my ear. I made a third and final appointment and he kept making any excuse to not consider the crown was done wrong like that I might just have sensitive gums (I don't). He wouldn't redo it and he said he'd adjust it a little again but the bite still wasn't right.

I was done with him so I went to a new dentist for a second opinion. She said the bite was clearly not right but when I asked her about how it was seated, she took an xray and just said that the cement was sealed all around. I wasn't concerned about the cement not being sealed, I was concerned about the fact that the crown doesn't feel like it's seated properly but she didn't say anything about that or all of the pain I was having and just adjusted the bite and said to let me know how it feels in a week.

It'll be a week in two days and nothing is better so it's now been a month that I've been dealing with all this pain and the sensation of the crown not being on right and even the side of my face hurting when touched now so I can't even sleep on the left side or rest my head on my hand Before calling my new dentist to follow up, I wrote to a dentist who specializes in occlusion and also TMJ and has thirty years of experience for a third opinion explaining everything that went on including what the second dentist said.

He said that even though he hasn't examined me, it's clear to him that one or more of the following happened: 1) The impression was done wrong and therefore the crown was a poor fit but the dentist ignored it 2) the impression was done right but the crown was poorly fabricated 3) the dentist prepared the tooth wrong to the point where he removed too much of it for the crown to have a proper fit and mechanical retention 4) he over cemented the crown to compensate for it which resulted in it being bonded while poorly seated.

He said no amount of adjusting the bite on the top of the crown is going to do anything to fix these issues, especially if the crown is even slightly tilted, and that the poor fit alone can cause not only misalignment in the jaw but muscles spasms that can contribute to the pain in the bone, ear, and joint and that the crown definitely needs to be redone and that the fact that the crown wouldn't even fit on my tooth in the first place would have been a red flag to any good dentist.

He said it's possible the second dentist doesn't want to get in the middle of it so she didn't say that and was hoping that continuing to adjust the bite would be enough. She did seem more thorough than my dentist but I can still believe her being hesitant because she looks very young (maybe 20s) and I can't help but lean towards the opinion of someone with more experience and who specializes in occlusion and this kind of problem.

But obviously he didn't examine me, so I can't use his word as proof. He just went out of town so my question for the dentists on this board is what kind of questions I should ask this new dentist when I go back so that she can verify that the crown needs to be replaced and why? If it's over cemented, how can my dentist tell that from the xray or would she not be able to?

Also, if they do decide to remove it, are there any methods I should ask about or request that would be less likely to damage the tooth underneath? Thank you!

 

[rob wain]

You can't neccessarily tell if the crown has a poor internal fit from the xray.
You can tell if the bite is wrong.
You can record the damage done to the crown in attempting to correct the bite (photos)
You can request the models on which the crown was made which may demonstrate good or bad design.

I can understand your new dentist not wanting to get involved but you are entitled to a full and truthful assessment of the crown.

 

[hyperphonics]

Thank you! That's what I was worried about as far as not being able to tell from the xray. I don't think my old dentist keeps models of anything since it's a dental clinic. That's another reason why I suspect he put a poorly fitting crown in my mouth instead of having it remade. To save money.

He even tried to reuse the temp from that tooth on my other one even though the teeth are very differently sized and shaped, which I only found out thankfully because I asked him for the temp to keep (in case I needed to have the permanent taken off) right before he did it. There's been a history of that there, them cutting corners sometimes (like trying to reuse old posts instead of placing a new one and then being shocked that the post and crown fell out an hour later).

I think at this point I just need to find a dentist willing to take the crown off because I can't deal with this pain anymore and everything about how it feels is telling me that it's not right and if one of them doesn't, I will. I don't want to let people keep adjusting it to fix a problem that can't fix until I've finally done permanent damage to the bone or my jaw or the root and have to get it taken off anyway to have a root canal.