Tooth ache 20+ years after rct, now what?

[sharon]

20-25 years ago I had a crown and rc on tooth #31. About 4 years ago I had the crown redone (no pain at all but there was decay underneath). About 2-3 years ago I noticed a gross odor coming from underneath the tooth (sorry) and it hurt occassionally. Since the new crown there is a small space between #30 and 31 and food always gets trapped there so I am ocd about cleaning and flossing. The dentist couldn't find anything wrong and said if it still bothers me after the cleaning he'll take another look. A month later still having same problems, he said nothing is wrong. A few months later he again said nothing is wrong.

I switched dentists, this one said there might be decay underneath, he can't tell, eventually he'll redo crown, but no hurry. First he wants me to get my other issues taken care of (2 implants). For the last 6 months I've have an occassional nagging ache and often feels like something is stuck there, nothing that I can't tolerate. My cleaning is in 6 weeks and I was going to wait it out.

In the last week it has turned into a toothache, very sensitive to tapping, no problem with hot or cold though. Last week I had an appt with my oral surgeon so he could check the implant area and he took a ct scan (?) of jaws, teeth, everything. I asked him to see if he could see anything on #31 and he said it looked fine.

Three days ago it started hurting real bad so tomorrow I will call the dentist. Any idea what I can expect at this point? Extraction? another rooth canal? apicoectomy? Nothing of these sound at all pleasant to me. And why would I have a toothache if the root if "dead?" That really confuses me. Could the ct scan have missed something? Could it be referrred pain from a tooth that still has a good root, maybe #30?

 

[leasierra]

20-25 years ago I had a crown and rc on tooth #31. About 4 years ago I had the crown redone (no pain at all but there was decay underneath). About 2-3 years ago I noticed a gross odor coming from underneath the tooth (sorry) and it hurt occassionally. Since the new crown there is a small space between #30 and 31 and food always gets trapped there so I am ocd about cleaning and flossing. The dentist couldn't find anything wrong and said if it still bothers me after the cleaning he'll take another look. A month later still having same problems, he said nothing is wrong. A few months later he again said nothing is wrong.

I switched dentists, this one said there might be decay underneath, he can't tell, eventually he'll redo crown, but no hurry. First he wants me to get my other issues taken care of (2 implants). For the last 6 months I've have an occassional nagging ache and often feels like something is stuck there, nothing that I can't tolerate. My cleaning is in 6 weeks and I was going to wait it out.

In the last week it has turned into a toothache, very sensitive to tapping, no problem with hot or cold though. Last week I had an appt with my oral surgeon so he could check the implant area and he took a ct scan (?) of jaws, teeth, everything. I asked him to see if he could see anything on #31 and he said it looked fine.

Three days ago it started hurting real bad so tomorrow I will call the dentist. Any idea what I can expect at this point? Extraction? another rooth canal? apicoectomy? Nothing of these sound at all pleasant to me. And why would I have a toothache if the root if "dead?" That really confuses me. Could the ct scan have missed something? Could it be referrred pain from a tooth that still has a good root, maybe #30?

Probably referred pain. One time i was sure that the pain came from one tooth (wich had RCT), and it was the antagonist. Fixed by the dentist, no more pain.

 

[sharon]

I went to the dentist, he said most likely it's cracked and he recommends an extraction. He said a root canaled tooth shouldn't hurt and the fact that mine does makes it more likely than not that it's cracked. After having rct and 2 crowns on this tooth there's not a lot of tooth structure left to work with.

So this makes 3 implants I have to deal with. At this point the money I have to put into teeth that I've already spent thousand's is very upsetting. My dentist is going to talk to the surgeon to tell him what he saw at my exam today and the surgeon will take another look at the scan just to make sure they are in agreement about the next step.

When I asked the surgeon to look at the 3D/ct scan he took last week he said "I don't see a crack." Would a crack show on this type of film?

 

[gentledental]

I went to the dentist, he said most likely it's cracked and he recommends an extraction. He said a root canaled tooth shouldn't hurt and the fact that mine does makes it more likely than not that it's cracked. After having rct and 2 crowns on this tooth there's not a lot of tooth structure left to work with.

So this makes 3 implants I have to deal with. At this point the money I have to put into teeth that I've already spent thousand's is very upsetting. My dentist is going to talk to the surgeon to tell him what he saw at my exam today and the surgeon will take another look at the scan just to make sure they are in agreement about the next step.

When I asked the surgeon to look at the 3D/ct scan he took last week he said "I don't see a crack." Would a crack show on this type of film?

How did your dentist decide there was a crack in the tooth? Did he remove the crown first to inspect the inside? Sorry to be sarcastic but unless he has 3D vision, there is no way he could actually see the crack.

The most likely cause of the pain would be if the root canal is starting to fail. I would check the xray to see whether all canals have been filled and whether they were filled all the way to the root end.

 

[sharon]

Hello and thank you so much for you kind response. I believe he determined it was cracked because

1) hurts with tapping/chewing, but no sensitivity to hot or cold

2) he didn't take an xray but talked with oral surgeon who had my panormic from 4 months ago and oral surgeon compared that to the the 3d/ct scan he took of my entire mouth the week before.

3) he took pictures with that fancy camera he has and blew those up. There is a space showing of a millimeter or two of my root between where the crown ends and the gum starts. In that area he could see a crack (so he said, he showed it to me and much as I thought that was rather interesting I'm not sure what I was supposed to see). The root also is "dark."

4) on the xrays the area between the 2 roots was darker on the 3d/ct scan compared to the xray of 4 months ago (though this seems to me to be more rc related rather than crown??)

5) I'm missing a tooth on the other side and have a flipper in the front for extraction done last Nov, so this area of my mouth is getting the brunt of all my chewing, very stressed area.

Having had an rc and 2 crowns on this tooth I think the treatment is the same as this point (extraction) though I don't like to think he may be basing that on a wrong diagnosis.

Now the area under the gum of the neighboring tooth (#30, crowned but no root canal)) is very tender so I'm concerned that tooth is the problem one, but I think if it were I would be having sesitivity to hot and cold wouldn't I?

Meanwhile, it's hurting more and I'm hoping I can make it until Thursday.