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Medical Forum / General / Dentistry / November 2004WORRIED: Severe tooth pain after getting crown
A week ago I chipped my tooth on some hard candy. I went into the dentist a few days later and they told me I needed a crown. They had some high-tech stuff that made the crown right then, and they drilled out my old filling, and had it on within a few hours. Since then my tooth has been in a ton of pain. It is off and on for the last few days, usually hours at a time, but when the pain is present, it is severe. Today, the pain subsided for most of the day, however before going to bed, I flossed and brushed my teeth, and that has caused the tooth to really start hurting. Some of the worst pain I have ever felt. I guess my question is, is this at all normal after a crown, or should I be concerned? Can I expect it to go away, or is it a sign that I may need more work, or a root canal? Any advice you can give would be greatly appreciated as I am quite worried. Any ideas on what to do for the pain? I usually take advil or some otc pain killers, which seems to work some of the time, but it's not working tonight. I've soaked it in alcohol, which also sometimes work, but again, not tonight. Again, any advice would be great. >A week ago I chipped my tooth on some hard candy. I went into the >dentist a few days later and they told me I needed a crown. They had [quoted text clipped - 4 lines] >the last few days, usually hours at a time, but when the pain is >present, it is severe. Pulpitis or "inflammed pulp." > Today, the pain subsided for most of the day, >however before going to bed, I flossed and brushed my teeth, and that >has caused the tooth to really start hurting. Some of the worst pain >I have ever felt. Known as the "Swan Song," according to Louis I. Grossman DDS, the father of modern endodontics. >I guess my question is, is this at all normal after a crown, or should >I be concerned? Can I expect it to go away, or is it a sign that I >may need more work, or a root canal? I believe you will require root canal therapy. >Any advice you can give would be >greatly appreciated as I am quite worried. [quoted text clipped - 3 lines] >working tonight. I've soaked it in alcohol, which also sometimes >work, but again, not tonight. Again, any advice would be great. It may stop hurting very suddenly. But all may not be well afterwards. You are describing a classic case of what leads to root canal therapy. Joel M. Eichen DDS >It may stop hurting very suddenly. But all may not be well afterwards. > >You are describing a classic case of what leads to root canal therapy. > >Joel M. Eichen DDS Agree. Probably will progress to irreversible pulpitis, crown prep --> final pulpal insult --> RCT -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > >It may stop hurting very suddenly. But all may not be well afterwards. > > [quoted text clipped - 7 lines] > -- > W_B ....... Does no one think that perhaps the cement has caused contraction stress in the tooth, and that cutting a buccal-lingual and a mesio-distal score in it to relieve the stress might just save it? IOW, contraction of the cement (if it is Composite) may just be the problem... ? .... Just an Idea... SP  SignatureNot a real Addy, yet Shoot. Well that's obviously not what you want to hear. So it's not really normal to have pain after a crown? The pain has gone away today... at least so far. But you think it is likely to come back? If not tonight, then soon? If I do have to get a root canal, should I be looking for a new dentist? Only a little piece of my tooth came off during the break, and I wasn't in any pain beforehand. Would a better dentist have been able to perform the crown without all this added misery? It's just so frusterating to spend all that money, and go through all that pain, only to have to spend more money, and go through more pain... all because he didn't do it right the first time. Or was this inevitable? >Shoot. Well that's obviously not what you want to hear. So it's not >really normal to have pain after a crown? > >The pain has gone away today... at least so far. But you think it is >likely to come back? If not tonight, then soon? Well, either it calmed down, or it died. Your dentist will be able to tell you which one. >If I do have to get a root canal, should I be looking for a new >dentist? Only a little piece of my tooth came off during the break, >and I wasn't in any pain beforehand. Would a better dentist have been >able to perform the crown without all this added misery? Unfortunately, no. Sometimes crowns will cause the tooth to need a root canal. The tooth was not in good shape to begin with if it needed a crown, and the pulp doesn't like having the tooth drilled on, no matter how good the dentist is at it. >It's just so frusterating to spend all that money, and go through all >that pain, only to have to spend more money, and go through more >pain... all because he didn't do it right the first time. Or was this >inevitable? Sometimes it gets worse before it gets better. Every temp I've gotten stayed sore until the final crown was delivered. -- Adenosine Semi-informed Dental Consumer ? >Shoot. Well that's obviously not what you want to hear. So it's not >really normal to have pain after a crown? [quoted text clipped - 11 lines] >pain... all because he didn't do it right the first time. Or was this >inevitable? From your description, I bet there have been years of low grade irritation to this tooth from your night-time clenching and other factors. I suspect the tooth had a large filling in it previously. Nation-wide 4% of all teeth which receive crowns will require root canal therapy within the first year. This is simply a fact of life. I suspect this result would have occurred regardless of who the dentist was. .. Stephen Mancuso, D.D.S. Troy, Michigan, USA Writing on a tablet PC,so forgive me if the PC misreads my poor handwriting. >A week ago I chipped my tooth on some hard candy. I went into the >dentist a few days later and they told me I needed a crown. They had >some high-tech stuff that made the crown right then, and they drilled >out my old filling, and had it on within a few hours. OK... >Since then my tooth has been in a ton of pain. It is off and on for >the last few days, usually hours at a time, but when the pain is >present, it is severe. Today, the pain subsided for most of the day, >however before going to bed, I flossed and brushed my teeth, and that >has caused the tooth to really start hurting. Some of the worst pain >I have ever felt. What kind of pain is this? Is it a very painfull dull pain, or the throbbing sort? If you brux (grind your teeth) at night, and the crown is a bit too high, it can make your tooth miserable. >I guess my question is, is this at all normal after a crown, or should >I be concerned? Can I expect it to go away, or is it a sign that I >may need more work, or a root canal? Any advice you can give would be >greatly appreciated as I am quite worried. You could need a root canal.... it happens sometimes after a tooth is prepared for a crown. On the plus side, you can have your dentist cement the crown with a temporary cement to see if it calms down with the final, and you don't end up with a brand new crown with a hole in the top. >Any ideas on what to do for the pain? I usually take advil or some >otc pain killers, which seems to work some of the time, but it's not >working tonight. I've soaked it in alcohol, which also sometimes >work, but again, not tonight. Again, any advice would be great. Soaking the tooth in alcohol, or your liver? I've always found 800mg ibuprofen works for me. Another extremely strong pain killer is tramadol (brand name Ultram), but it's Rx only. -- Adenosine Semi-informed Dental Consumer ? >>A week ago I chipped my tooth on some hard candy. I went into the >>dentist a few days later and they told me I needed a crown. They had >>some high-tech stuff that made the crown right then, and they drilled >>out my old filling, and had it on within a few hours. This might be called a laser ... or something like that. >OK... > [quoted text clipped - 28 lines] >ibuprofen works for me. Another extremely strong pain killer is >tramadol (brand name Ultram), but it's Rx only. >>>A week ago I chipped my tooth on some hard candy. I went into the >>>dentist a few days later and they told me I needed a crown. They had >>>some high-tech stuff that made the crown right then, and they drilled >>>out my old filling, and had it on within a few hours. > >This might be called a laser ... or something like that. Oh, I see. A CEREC crown..... So much for the 'no drilling through your new crown'. On the other side, maybe they'll be inclined to redo the crown for less because it doesn't cost them as much of a lab fee. -- Adenosine Semi-informed Dental Consumer ? >>This might be called a laser ... or something like that. > >Oh, I see. A CEREC crown..... There ya go ,,,, I knew it sounded familiar ....... >>>>A week ago I chipped my tooth on some hard candy. I went into the >>>>dentist a few days later and they told me I needed a crown. They had [quoted text clipped - 8 lines] >side, maybe they'll be inclined to redo the crown for less because it >doesn't cost them as much of a lab fee. The blank alone costs around the same as the crown from Malaysia ..... >>>>>A week ago I chipped my tooth on some hard candy. I went into the >>>>>dentist a few days later and they told me I needed a crown. They had [quoted text clipped - 10 lines] > >The blank alone costs around the same as the crown from Malaysia ..... And the Malaysian ones come glazed. -- Adenosine Semi-informed Dental Consumer ? >>>>A week ago I chipped my tooth on some hard candy. I went into the >>>>dentist a few days later and they told me I needed a crown. They had [quoted text clipped - 8 lines] >side, maybe they'll be inclined to redo the crown for less because it >doesn't cost them as much of a lab fee. I will perform RCT through a CEREC crown, then seal the hole with a CERANA porcelain inlay. I offer the patient a new crown if the porcelain should break. No big deal. .. Stephen Mancuso, D.D.S. Troy, Michigan, USA Writing on a tablet PC,so forgive me if the PC misreads my poor handwriting. > >>>A week ago I chipped my tooth on some hard candy. I went into the > >>>dentist a few days later and they told me I needed a crown. They had [quoted text clipped - 8 lines] > side, maybe they'll be inclined to redo the crown for less because it > doesn't cost them as much of a lab fee. Not exactly. They still have to cut the old crown off and I doubt it can be done without changing the surface of the margins since cerec is bonded. What that means it is the same amount of work and expense to redo the crown. What probably will happen is an access hole through the crown and then filled after the root canal. This is a major disadvantage to the CEREC you never know whether the tooth will survive. In the traditional approach at least you have 2 weeks to check things out before the crown is bonded in place. I suppose CEREC makes up for this in volume of one visit crowns. A better appoach would be to make the provisional and have the patient come back for the seat not rush things. I'm sure you can even have the CEREC make the provisional by putting a lump of acrylic on that metal piece that goes into the machine. Another point was made that since this was due to trauma and it is possible the crown is high in which case this can resolve on it's own. Provisionals kill pulps. The patient gets to walk around with leaking margins for two weeks. Since CEREC, my post-restoration RCT has dropped to 5% of what it was with conventional C&B. About the only RCT I do now is new patients. You are simply trying to justify not spending the money for new technology, by inventing reasons. You can take a CEREC off by "chattering" it with a bur. The vibration of cutting against it with a fluted carbide bur will shatter the CEREC. You then just gently and carefully remove the adhesive with a fine diamond. Re-mill from machine memory and bond. 95% of the time, we simply bore through the CEREC with a diamond, do the RCT and immediately seal with CERANA pre-formed porcelain inlays. Once in a while, the marginal ridge will come loose (if the isthmus is narrow) and we just make the whole thing over. Not an issue at all. Oh, and I do not charge the patient for the new endo-crown if they recently paid for a large onlay. 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. ...................... >> >> >>>A week ago I chipped my tooth on some hard candy. I went into the [quoted text clipped - 26 lines] > Another point was made that since this was due to trauma and it is > possible the crown is high in which case this can resolve on it's own. >Provisionals kill pulps. Maybe yes, maybe no. Let's say CEREC eliminates the possibility of somethign bad happening fro mthe provisional (temporary). Joel In the touchy feely 70s, we said, Provisionals DO NOT kill pulps ... only PEOPLE kill pulps! JOKE > The patient gets to walk around with leaking >margins for two weeks. [quoted text clipped - 16 lines] >charge the patient for the new endo-crown if they recently paid for a large >onlay. Thanks for all the replies. I'm really hoping that I don't need a root canal. The pain seems to be a very constant, extreme pain, which has now radiated to most of the side of my mouth. Doesn't seem "dull" at all. At times it subsides. Right now I feel like there is sort of a shadow pain, possibly dulled by the ibuprofin. If I do need a root canal... should I be looking for a new dentist? I wasn't very thrilled with the dentist to begin with, and now with all this pain, I'm wondering if he is subpar. Would the outcome have been the same with a different dentist? Or really, is no one to blaim?
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