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Medical Forum / General / Dentistry / October 2004Abscess after a new crown
Hi About 3 months ago, after a routine check-up, my wife's dentist suggested she renewed two crowns on adjacent teeth. One of the teeth had an old (10 years) root canal performed. Soon after the procedure she started complaining that one of the newly crowned teeth (not the root canal) has become very sensitive - sharp pain only when biting. During the next 4-5 visits to the dentist he performed several re-adjustments to the crown with no improvement. Finally the crown was removed and replaced with a temp just to see if this was the reason for the biting pain. The pain remained but soon after the adjacent tooth (also recently crowned) developed an abscess. Apparently this tooth had been the source of pain all along. Today the dentist had a look at it and said he didn't pay sufficient attention to the old root canal before installing the crown. He looked quite unhappy with himself and suggested we wait with no intervention or medication for a week to see if the abscess breaks through the gum. Any opinions if this course of action seems safe and sensible? Should we get a second opinion? We both have the nagging feeling that if she never went ahead with the new crown her tooth would have been fine. NO way to know from a monitor, but generally, if a tooth is going to behave this way, it will do regardless of whether or not it is treated. The end effect simply appears sooner when treated. It would have occurred no matter what. Sometimes, the treatment is the extra trauma which pushes it over the edge, but rarely (if ever) does this happen on a "healthy" tooth. Waiting for the abscess to perforate the tissues does no good. Either the RCT is bad, or the root is fractured.  Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > Hi > [quoted text clipped - 18 lines] > we get a second opinion? We both have the nagging feeling that if she > never went ahead with the new crown her tooth would have been fine. > Sometimes, the treatment is the extra trauma which pushes it over the > edge, but rarely (if ever) does this happen on a "healthy" tooth. > > Waiting for the abscess to perforate the tissues does no good. Either the > RCT is bad, or the root is fractured. .... Ach laddy.... therrre's the rrrub... How many 'healthy' teeth do you crown? I try not to crown any unless they've had root canals for just this reason. (Yes, if I was a CEREC user, it'd be diffrent..). That said, I know a lotta dentists here who crown as soon as they see a three-surface carious lesion. The hick is differentiating the healthy teeth from the traumatized ones. As W_B has said, pulp stones can be the indicator, but most teeth I see already have squashed down pulp chambers (calcifications). I wouldn't dream of crowning them in that state. Any thoughts on how you decide this are welcome. SP SignatureNot a real Addy, yet >Any opinions if this course of action seems safe and sensible? Sure, why not. >Should we get a second opinion? Always a good idea. >We both have the nagging feeling that if she >never went ahead with the new crown her tooth would have been fine. Doubtful. But, I repeat for the umpteenth time, fellow practitioners: Carefully evaluate the pulpal health of any tooth that is scheduled for a crown. The final pulpal insult may be the unintended consequence of preparation. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > >We both have the nagging feeling that if she > >never went ahead with the new crown her tooth would have been fine. [quoted text clipped - 8 lines] > > W_B OK,but just how to do that? Pulp stones, yes; calcifications and extensive fillings, yes; but apart from that, like I said to DrS in the same thread: how to decide the health in a multi-radicular tooth is not trivial. Two procedures? IME, most patients have no idea how many procedures their teeth have had. Those in the practice b/4 I acquired it have also had multiple patch-ups as well as the major fillings. This is why I try like hell NOT to crown any non- RCT'd tooth. The price I pay is a compromise on resistance form and ease of maintenence and a low-income practice. As soon as I tell them that we are risking the health of the tooth in redoing this decayed filling, they scream for a patch. I counter that we are risking that very health as well if we don't know what is what under the hood, but that arguemt hold no real weight with most of them. Put-off-as-long-as-I-can mentality. Any more thoughts on this appreciated. SP SignatureNot a real Addy, yet >> >We both have the nagging feeling that if she >> >never went ahead with the new crown her tooth would have been fine. [quoted text clipped - 13 lines] >same thread: how to decide the health in a multi-radicular tooth is not >trivial. Age of the patient is a deciding factor too. > Two procedures? IME, most patients have no idea how many >procedures their teeth have had. Ahh but you can make an educated guess. >Those in the practice b/4 I acquired it >have also had multiple patch-ups as well as the major fillings. This is [quoted text clipped - 3 lines] >health of the tooth in redoing this decayed filling, they scream for a >patch. OK then start doing your 'patches' with fuji 9. Remove all of the old fills, decay, etc. and build-up with fugi 9 it's a stop gap measure and inform the patient as such. After a reasonable period of time you will know if endo is needed. >I counter that we are risking that very health as well if we >don't know what is what under the hood, but that arguemt hold no real >weight with most of them. Put-off-as-long-as-I-can mentality. Well nothing you can do to change that. Wait till they start hurting, they will be back >Any more thoughts on this appreciated. >SP -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > decide the health in a multi-radicular tooth is not Cool use of words! I use periradicular, but never thought of your use above. Its great. Joel > > decide the health in a multi-radicular tooth is not > [quoted text clipped - 3 lines] > > Joel Let's at least be clear on what I mean: I mean that it is difficult to interpret pulp testing on multi-rooted teeth, as there will often be one canal that is almost sick, one that responds normally, and another might even be asymptomatically necrosis-ed. If you put the 2000 Volt electric pulp tester on that tooth, you can never know what a response means. This is why the Local Endo Guy tells us to put away the 2000 Volt thingie, unless we want to heat up our coffee with it. (joke...) The Endos don't seem to believe in pulp testing for the number of false positives and negatives. They seem to rely on the films, cold and biting responses (Tooth Sleuth) and their well-developed noses more than anything. Our L.E.G. doesn't normall use a heat test either. So your mention of periradicular is not exactly in the same sense as I mean multi-radicular here: I mean complicated root canal system means complicated decision making. Thanks SP on CraPinTosH SignatureNot a real Addy, yet > >OK,but just how to do that? Pulp stones, yes; calcifications and > >extensive fillings, yes; but apart from that, like I said to DrS in the > >same thread: how to decide the health in a multi-radicular tooth is not > >trivial. > > Age of the patient is a deciding factor too. Yes.... so is being able to confidently tell your patient that this can be done well and not turn around and around in bullshit. SP SignatureNot a real Addy, yet > >> But, I repeat for the umpteenth time, fellow practitioners: > >> > >> Carefully evaluate the pulpal health of any tooth that is scheduled for a > >> crown. The final pulpal insult may be the unintended consequence of > >> preparation. > > Two procedures? IME, most patients have no idea how many > >procedures their teeth have had. > > Ahh but you can make an educated guess. Judging from age, I'd say that most of those eldery patients' molars have had at least 2 and maybe 4 procedures already. >>...... As soon as I tell them that we are risking the > >health of the tooth in redoing this decayed filling, they scream for a [quoted text clipped - 5 lines] > fugi 9 it's a stop gap measure and inform the patient as such. > After a reasonable period of time you will know if endo is needed. Just to be clear: are you advocating replacing the TOTAL filling (As in the whole M.O.D.B.L.s.h.i.t. prep with Fuji 9? BTW: remember I said that I had ordered Fuji 9 at the ODQ congress way back in MAY????? Well, the Kaaannnaaadian gov't finally cleared it: it came on WEDNESDAY of this week!!!!!!!! 280$ Kannaadian dollarettes. Haven't even had time to open the box. Do you follow the manufacturer's instructions re: time and force of shake in the Amalgammmmattorrr? Or do you shorten the time of mix? > >I counter that we are risking that very health as well if we > >don't know what is what under the hood, but that arguemt hold no real > >weight with most of them. Put-off-as-long-as-I-can mentality. > > Well nothing you can do to change that. > Wait till they start hurting, they will be back .... and I bounce them to the Endo Guy, as they won't have the patience to let me archeologize (find buried canals)... Thanks and sorry for the bitchy tone, but they PISS me OFF, sometimes... Of course, it's not all of them..... SP on the ol' CRAPINTOSH SignatureNot a real Addy, yet |
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