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Medical Forum / General / Dentistry / October 2008possible root fracture; what are my options?
A few months ago I mentioned to my dentist that I had some minor pain in one tooth once in a while (it is #19) but he looked at the x-rays and said he didn't see any problems. A few days ago I woke up with a dull ache in that tooth and tried to get in to see the dentist, but since he was on vacation and this is a tooth with a root canal, I was sent to the endodontist who did the root canal 13 years ago. The endodontist was in a rush because it was the end of the day but he said he didn't see anything on the x-ray (new x-ray). By then my tooth wasn't hurting any more, but he did some tapping around to see if there was more sensation in one area than the other. There might have been a little more in one side than the other although I was not sure. A puff of air on my teeth actually caused them all to hurt, not just that one. He used a probe and there was one area of the inner gum that hurt a little. He said it might be a root fracture in which case the tooth has to be extracted. He took another look at the x-ray, and said that now that he suspected a root fracture he thought he might be seeing some bone loss. In any case he prescribed an antibiotic and had me make an appt. for the following week to do a root canal re-treatment. He said he would drill through the crown and "clean things out." He said hopefully all that had happened was that some bacteria had gotten under the crown but he did suspect a root fracture in which case the tooth should be extracted and he recommended an implant. I was in a bit of shock because I wasn't expecting this to be such a major thing and since I have never lost a tooth before I sure hate to lose this one. Now that my tooth has quit hurting I am thinking of putting off the appt. until I get a second opinion. Is there any point in doing another root canal if the tooth probably can't be saved? My insurance maxes at $2000 a year and if I spend of that on a root canal that doesn't leave a lot for an implant. Would this re-treatment destroy the crown? If my tooth no longer hurts and I can chew just fine on that side, is there any risk in putting off this root canal for a few more weeks? If I have this done and the endodontist sees a root fracture, would he just pull the tooth right then or would it be better to see whoever would do the implant (or bridge) first? I also wonder if this molar is mult-rooted and if so, could root amputation be done instead of extraction? Thanks for any info. -yngver > A few months ago I mentioned to my dentist that I had some minor pain > in one tooth once in a while (it is #19) but he looked at the x-rays [quoted text clipped - 39 lines] > info. > -yngver Lots of good questions. Unfortunately, most of them can't be answered without examining you directly. Of course there is no point in re-treating the tooth if there is an untreatable root fracture. The advantage the endodontist has is that most work with operating microscopes, and may be able to visualize the fracture better. Some of the fractures are better visualized surgically too, but that doesn't mean a surgeon should open this area without a good reason. Fractures don't go away, and in the absence of definite evidence either clinically or on x-ray, I'd probably hold off if the pain is gone. But realistically if there is a fracture you should eventually have solid evidence. If you have no swelling, drainage or pain, you can afford to wait a bit. Obviously if you're in pain, something should be done, and if the endodontist is ethical he's not going to do a root canal that he can't reasonably expect will address the problem. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 One other issue that might need to be addressed is night time clenching. If this is a porcelain crown on #19, they often wear slower than the neighboring dentition and can end up having premature contacts. This results in 'extra' forces being placed on that one tooth during the parafunctional activities. An occlusal adjustment and an NTI can often eliminate pain in such a case. Without clear evidence of failure with the endo, I would certainly try the most conservative approach before retreatment or extraction. JMO, D Obviously if you're in pain, something should be > done, and if the endodontist is ethical he's not going to do a root > canal that he can't reasonably expect will address the problem. > > Steve > One other issue that might need to be addressed is night time > clenching. If this is a porcelain crown on #19, they often wear [quoted text clipped - 10 lines] > JMO, > D This is a good, no-risk approach. But the fact that the deep filling was so recent of course casts suspicion on that tooth. Steve > Obviously if you're in pain, something should be >> done, and if the endodontist is ethical he's not going to do a root >> canal that he can't reasonably expect will address the problem. >> >> Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Thought he said the endo was done 13 years ago by the same dude checking him now. Steve >> Without clear evidence of failure with the endo, I would certainly >> try the most conservative approach before retreatment or extraction. [quoted text clipped - 6 lines] > > Steve That's right, the root canal was done in 1995 by this same endodontist. My general dentist made the porcelain crown. Since then I've not needed any further treatment on this tooth, until now. -yngver > Thought he said the endo was done 13 years ago by the same dude > checking him now. [quoted text clipped - 11 lines] > > > Steve > One other issue that might need to be addressed is night time > clenching. If this is a porcelain crown on #19, they often wear [quoted text clipped - 17 lines] > > > Steve Thank you, this is helpful to know. Yes, it is a porcelain crown on #19 and it is 13 years old. None of my upper teeth have crowns-- actually I have no other crowns but an onlay on #18. I thought that I might be clenching my teeth at night because I woke during the night with soreness in that tooth, and your explanation makes a lot of sense. Once in a while I have awakened at night aware that my teeth were clenched, but I have assumed that if I were grinding or damaging my teeth at night my dentist would see evidence of that, right? I last saw this endodontist 13 years ago and I assume he did a good job with the root canal but I was there with an infected tooth that was causing me so much pain I didn't pay much attention to the procedure. For occlusion adjustment or an NTI I would go back to my general dentist, correct? There is a center for endodontic microsurgery at the university near me so I was wondering if they would have better equipment to detect a root fracture. The endodontist I saw last week only looked at the x-ray my general dentist's office sent with me. I have nothing against him and I think he is probably a good endodontist but from what I saw his office hasn't changed much since 1995 and I don't think he has newer equipment. -yngver > Thank you, this is helpful to know. Yes, it is a porcelain crown on > #19 and it is 13 years old. None of my upper teeth have crowns-- [quoted text clipped - 4 lines] > were clenched, but I have assumed that if I were grinding or damaging > my teeth at night my dentist would see evidence of that, right? > -yngver Not saying anything about your dentist (good or bad), but not everyone knows about, or has seriously tried the NTI. Also, not every dentist pays a lot of attention to some of the signs of clenching. Sounds like you need to find someone who does. JMO, Steve > > Thank you, this is helpful to know. Yes, it is a porcelain crown on > > #19 and it is 13 years old. None of my upper teeth have crowns-- [quoted text clipped - 14 lines] > JMO, > Steve Thanks, that is a good point. Now that I am thinking more about it, I have been aware for a while that all my teeth ache are sore and then, not just that one. I've been thinking it might be due to using a whitening mouthwash and toothpaste, so I have switched to ACT enamel restoring mouthwash. I know I clench my teeth at night sometimes but never made the connection before with sensitive teeth. I have been seeing my dentist for about 20 years but I think in this case I will consult someone else about this particular problem. This is is a very helpful board. -yngver You might want to find one experienced with NTI-TSS. JMO, D >>>Thank you, this is helpful to know. Yes, it is a porcelain crown on >>>#19 and it is 13 years old. None of my upper teeth have crowns-- [quoted text clipped - 25 lines] > helpful board. > -yngver > yng...@aol.com wrote: > > A few months ago I mentioned to my dentist that I had some minor pain [quoted text clipped - 63 lines] > Brooklyn, NY > 718-258-5001 Thank you. I understand that if there is a root fracture eventually the tooth has to come out although I have read that root amputation may be possible on a multi-rooted tooth. As far as I know there is no swelling or drainage, or the endodontist didn't mention seeing any of this. I have been on amoxicillin since Friday but the tooth had already begun to feel normal (no discomfort) before I even started the amoxicillin. I am taking it easy with that tooth but just as an experiment chewed a bit of hard candy on that side and it didn't hurt at all. I may have jumped the gun a bit in going to see the endodontist because I remember how much pain I was in 13 years ago when this tooth was infected and needed a root canal, and I was afraid if the tooth got worse, I'd be stuck over the weekend with no help. Looking back, if I had waited the weekend I probably wouldn't have gone. -yngver >> A few months ago I mentioned to my dentist that I had some minor pain >> in one tooth once in a while (it is #19) but he looked at the x-rays [quoted text clipped - 57 lines] > >Steve Agree with Steve for the most part. <as usual> There is no harm in seeking a third or even fouth opinion. Endodontist recommended. Root fractures often present with a variety of symptoms, and diagnosis can be difficult. Would not hold off further evaluation but *would* delay treatment until a definitive diagnosis <if possible> can be made. Eventually root fractures will give clinical and radiographic evidence. On another note, you said all your teeth were sensitive to the cold air. Suggests parafunction to me. You may need a 'bite guard', recommend the NTI. |
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