What causes a crown on a molar to fail shortly after it is done?

[Hoppi]

I had a crown fitted on a molar that had damage to the top and decay that had not quite reached the pulp/nerve. The drilling for the crown did seem quite intensive.

Shortly after the temporary crown was put in, I noticed sensitivity to cold drinks and a bit to pressure also.

Fast forward a few months and I have quite severe toothache in that tooth.

So... what's going on? Did an infection get in there somehow or why is there an issue?

Did the trauma of the drilling for the crown cause the nerve to... be distressed? I mean, it can't be dead because if it was dead it wouldn't be hurting.

I'm confused ._.

Thanks all

 

[MountainMama]

I had a nerve go bad after a crown prep. I still had the temp crown. The tooth had been tested prior to the crown prep, and the pulp was vital and reacted normally to the ending ice. I was told the trauma of prepping the tooth could have caused irreversible pulpitis. Another molar had irreversible pulpitis after a deep filling (that wasn’t to the pulp). So in my experience the trauma of the drill or grinder caused irreversible pulpitis.

 

[Hoppi]

Oh... so it's chronic inflammation of the pulp of the tooth but not caused by bacteria?


EDIT -- I've been having a think. Am I right in saying that all I can do then is use Sensodyne, use numbing agents (clove, benzocaine, etc), be patient and hope it either calms down or dies? And if it doesn't calm down I'll need a root canal and if it dies then I may need one?

Also it's really confusing isn't it because if indeed it's not a worsening infection and merely difficulty recovering after trauma, then why is it worsening so dramatically over time? >.<

 

[MountainMama]

Oh... so it's chronic inflammation of the pulp of the tooth but not caused by bacteria?


EDIT -- I've been having a think. Am I right in saying that all I can do then is use Sensodyne, use numbing agents (clove, benzocaine, etc), be patient and hope it either calms down or dies? And if it doesn't calm down I'll need a root canal and if it dies then I may need one?

Also it's really confusing isn't it because if indeed it's not a worsening infection and merely difficulty recovering after trauma, then why is it worsening so dramatically over time? >.<

With both of mine, no infection was ever present. I don’t know if it is chronic inflammation or just irritation caused by the crown prep. I was told that it could take a few weeks to settle. Mine actually started a week or two after the initial crown prep, before I had the permanent crown. I had mine tested at an endodontist and it came up with lingering pain after the endo ice test, so the endodontist said it would not recover.
Yours may just be irritated. Do you have lingering pain after heat or cold? Lingering as in more than a second or two.

 

[Hoppi]

It's been I think 3 and a half months now since the drilling was done. For a long time it was just sensitivity to cold (which resulted in fairly intense pain but it didn't last long) and some mild sensitivity to pressure. Now it's full-on toothache and it's coming and going but often very painful indeed

 

[MountainMama]

It's been I think 3 and a half months now since the drilling was done. For a long time it was just sensitivity to cold (which resulted in fairly intense pain but it didn't last long) and some mild sensitivity to pressure. Now it's full-on toothache and it's coming and going but often very painful indeed

If it were me, I would see an endodontist (or ask your dentist if they can do it) and get the tooth tested. If it has been that long and it is very painful, then it may well be irreversible pulpitis. If so, you want to get it treated before it gets infected.

 

[Hoppi]

Oh... does this make it more prone to infection?

 

[Dr. Daniel]

Hi,

the name of the game is inflammation that is taking place in the pulp tissue. If the inflammation is low we call reversible pulpitis, thenthe tooth is sensitive to cold and maybe other extreme things and gradually the sensitivity is getting reduced.
If the inflammation is too high, irreversible pulpitis, then the sensitivity to cold continues for more than a month and even gets worse: stronger pain for lighter stimuli and even spontaneous pain. This requires a root canal treatment (or an extraction).
The factors that cause the inflammation are:
1) bacteria, or should should I say: the bacterial toxins
The closer the bacteria is to the pulp, the more it is causing inflammation
2) mechanical irritation. Drilling and such.
3) chemical irritation. Like the chemicals we use for a filling.
4) heat during drilling

hope it clarifies.

 

[Hoppi]

Ah I see thank you. It's strange isn't it that it worsens for no reason! Like after 3 months I have severe toothache out of the blue!

Then again I suppose it's also a bit odd that the pulp can stay inflamed with no remaining cause without simply calming down / healing.

The body does all kinds of strange things I guess ._.

Apparently the decay was almost at the pulp when they were working on the tooth. Also I didn't really like the dentist I had at the time. I felt that he was too heavy-handed and also not very understanding/patient about how nervous I was!

So I switched to someone else at the same practice.

Anyway erm, thank you again for your reply and I hope you both have (or are having!) a nice Christmas

 

[Hoppi]

Unfortunately this pain is becoming absolutely excruciating at times. To the point that I was thinking that if they said they could just extract it there and then I'd have probably said yes, even though a root canal would be far better in the long-term I think. But here and now I just want the pain to end.

Ugh, this is unreal. It's kind of OK until I eat (even if it's not hot or cold and it's simply just my mouth moving) or even do things like talk or brush my teeth. Everything upsets it.

I'm going to try to get some kind of emergency dental care I suppose. I just don't know what I should do or even what options I'll be offered but I do know that a root canal at my normal dentist will be about a month's wait and although the pain comes and goes depending on what I do, when it's bad it's REALLY bad. Plus I've got 2 co-codamol and 2 ibuprofen in me now that I took when I was at my most desperate a couple of hours ago, so I don't know how much of it settling down is due to that. It's hard to say.

What an unpleasant situation to be in

 

[Hoppi]

Just woke up after a sleep. It was just about OK when I was lying in bed to sleep (maybe at least partly because I took those painkillers) but upon waking up it was pretty painful, which is unusual because in the past with this tooth it would always feel fine when I woke up and then become more painful as I ate things, etc (even if I chewed on the other side of my mouth).

It's just getting worse and worse. I will see an emergency dentist tonight. A woman I spoke to at an emergency dentist line just then said that she thought the only thing that could explain this level of pain is an infection underneath the crown.

I don't care what it is or what is done - I just want the pain to stop really so I can go back to living my life (instead of often just pacing back and forth in my room waiting for the pain to calm down)

 

[Enarete]

So sorry to read about the pain you're going through, Hoppi. It must be upsetting that the tooth worked itself up to such severe pain during few months, after having just some sensitivity. Glad you are getting help at an emergency dentist today and keeping my fingers crossed for you to be painfree soon. Hope they treat you kindly there as well. Hang on there and keep us updated

 

[MountainMama]

Oh no, pain over the holidays is awful! I am glad you have an emergency dentist available. I hope they can get you sorted out and stop the pain.

 

[Hoppi]

Huh, turns out it had an abscess. Wow.

I got given metronidazole by the emergency dentist which I've been on now for about 18 hours and it's working wonders.

I have no idea how it got infected like this but I'll go back to my regular dentist asap. I'm also not 100% confident about that dental surgery so I might look again into other options.

Either way I'm SO, SO glad to be out of pain because that was horrible

Thank you for your concern both of you - I was truly desperate yesterday and it was one of the most painful things I have ever experienced.

Thanks all

 

[krlovesherkids777]

Hoppi,

So glad you were able to get in and get those meds and that pain reduced.. absesses are awful!! HOpe your reg dentist can get you in soon to finish the work !

 

[Enarete]

You poor thing. So glad you're out of pain now! Hope you can enjoy the rest of the year now

 

[Hoppi]

Thanks both of you!

Yeah that really wasn't nice. I'll see what my regular dentist says when I go back.

I'm still on the antibiotics of course and the pain is still decreasing.

Anyway erm, I hope you both have a great new year's celebration and a great 2020 too!

 

[MountainMama]

I am glad you got antibiotics! My husband had an abscess and said it was the most painful thing he ever experienced. He has a very high pain tolerance, so I know it must have been bad. He once shot a nail through his hand with a nail gun, pulled out the nail and wrapped his hand, and went back to work!
For me, I had an undetected abscess on my front tooth that didn’t hurt until it was huge! I would have rather had pain early so it could have been treated before it destroyed so much bone.
Hopefully you can get it fixed up and be pain free soon!

 

[Hoppi]

Hm. I am wondering if I should try to get some kind of compensation for this? Is that possible?

I do think that particular dentist is incompetent.

The tooth also might have darkened, I can't really tell.

So... what now

Is the nerve dead? But if it's dead then why is it still able to hurt? It doesn't seem dead.

And can I get compensation? I'm so tired of that dentist screwing up and this time he's really done me harm I think.

 

[Gordon]

1) Doubt it, you'd need to prove the dentist was negligent in some way, it doesn't sound like it from your posts, but obviously I've not examined you.

2) Why? Doing a crown on a seriously compromised tooth can go wrong, it's unfortunate that it has but it doesn't sound like they've done anything which a reasonably competent dentist would not have done.

3) It may well have done, the dying nerve can release some chemicals as it decays which cause some slight discolouration

4) Yes, it's dead. It's not the nerve that's causing the pain

5) I doubt it. You could ask them to write off the bill for the crown though or discount the root canal that you're going to need to fix the tooth.