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Medical Forum / General / Dentistry / July 2005Re: Dentist wants to replace all my fillings (follow-up #2)
Well, I finally got to see the endodontist about two weeks ago. I meant to reply sooner but just kept putting it off. The endodontist doesn't think I need a root canal. Which was good news. But the tooth is still bothering me, so the situation is still unresolved. I suspect that there is some decay under the filling, and would like to have it replaced. If that is successful, then I will have a full crown (preferably CEREC) put on the tooth. If it's not successful, then RCT followed by a crown. The tooth that is bothering me is a molar (#30). That tooth and #19 have a vertical fracture line on the buccal surface. The cracks probably don't go very far in, as the endodontist ruled out cracked tooth syndrome. To reinforce those teeth and help prevent the cracks from worsening, I want to have both teeth crowned. But I am concerned that #30 is still bothering me a little, and feel that it may be getting close to needing RCT. If RCT is needed, I'd prefer that it be done before the tooth is crowned. But I'd also like to avoid RCT, if possible. So my idea is to have the fillings in both teeth (or maybe just #30) replaced, and the cracks sealed. Then wait a month or two to see if the tooth stabilizes and improves. If it does, then have #19 and #30 crowned. If not, then RCT for #30 followed by crowns for both #19 and #30. Does my strategy seem reasonable? And is there an alternate restoration for #30 that I should be considering instead of filling replacement? The reason I ask is that I've run across the term "temporary restoration" when reading old posts on sci.med.dentistry, and I don't know what that is referring to. One post mentioned something about using zinc oxide and eugenol. I can't imagine how something like that would be very durable, but I can see how it would be very soothing to the nerve. Oh, and the endodontist did have one suggestion (though it wasn't really his idea). I mentioned to him that at least one dentist recommended that I wear a splint to stop me from grinding my teeth while sleeping. He said he thought that it's a good idea because clenching could be a large part of my problem. So I also need to find a good local dentist who is experienced with fitting patients with the NTI. Harry W_B wrote: > Good report Harry. > > Sounds like you found one of us good guys. > > Let us know what the endodontist says. > > On 2 Jun 2005 14:56:23 -0700, harry_lewis@yahoo.com wrote: > > >Well, I got that second opinion that several people on here > >recommended... > > > >I just got back from seeing Dr. X. He's a dentist that several of my > >neighbors use, and they really like him. So I figured I'd give him a > >try. He seems like a nice, quiet, soft-spoken guy. > > > >Regarding that tooth (#30) that's bothering me, he said that I should > >see an endodontist and have the tooth tested so we can figure out if a > >root canal is needed. I am going to have the endodontist test the > >corresponding molar (#19) on the left side while I am there. And maybe > >also a third tooth that has a suspicious radioleucency on the x-ray. > >Since the tooth is asymptomatic, I think I'll let the endodontist look > >at the x-rays and see if he thinks it really needs testing. > > > >I also asked him a few questions while I was in there having that > >problem tooth checked out. He doesn't think fixing my overbite will > >necessarily reduce the trauma to my teeth. He said that he has seen > >cases where teeth grinding got worse after orthodontics. He also > >doesn't agree that all of my amalgam fillings should be immediately > >replaced. And I specifically asked him about the back molar on the > >lower right side that doesn't even have a filling in it. That's one of > >the teeth that my other dentist wants to put a full crown on. Dr. X > >said that he could see why someone might recommend a crown-- there are > >some wear facets where the tooth has been worn down to dentin, and some > >other issues. But it's not something he would have recommended. He > >even said, "I wouldn't want it in my mouth." > > > >Dr. X said that one can certainly fix things to "a level of > >perfection," but that's not the way he does things. I have a good > >feeling about this new (to me) dentist. Compared to the other dentist, > >his approach is much closer to what one might call "minimally-invasive > >dentistry." > > > >Harry >Well, I finally got to see the endodontist about two weeks ago. I >meant to reply sooner but just kept putting it off. [quoted text clipped - 5 lines] >have a full crown (preferably CEREC) put on the tooth. If it's not >successful, then RCT followed by a crown. Good. >The tooth that is bothering me is a molar (#30). That tooth and #19 >have a vertical fracture line on the buccal surface. The cracks [quoted text clipped - 11 lines] > >Does my strategy seem reasonable? Very ! >And is there an alternate >restoration for #30 that I should be considering instead of filling [quoted text clipped - 4 lines] >something like that would be very durable, but I can see how it would >be very soothing to the nerve. I would use fuji 9 Eugenol can inhibit the bonding of resin. >Oh, and the endodontist did have one suggestion (though it wasn't >really his idea). I mentioned to him that at least one dentist [quoted text clipped - 3 lines] >a good local dentist who is experienced with fitting patients with the >NTI. Check the NTI site to help find a practitioner in your area. headachehope.com or headacheprevention.com >Harry > [quoted text clipped - 40 lines] >> > >> >Harry -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Oh, and the endodontist did have one suggestion (though it wasn't > really his idea). I mentioned to him that at least one dentist [quoted text clipped - 5 lines] > > Harry Excellent idea to get an NTI (and even more important if you are considering porcelain restorations for the molars). As far as filling replacement followed at a later time with crowns, that could be argued either way. Certainly, it is possible to have leaking, defective amalgams. However, subjecting the teeth to added trauma may tip them into the root canal camp. My approach would be to use the NTI for a while and see if the symptoms subside. If they do, then I would make a decision about either leaving the teeth alone, replacing the amalgams, or crowns/onlays. I wouldn't be wild about replacing the amalgams, waiting a few weeks/months, and then going to the crowns/onlays. IMO, that would increase the odds of needing endo. JMO, Fawks >> Oh, and the endodontist did have one suggestion (though it wasn't >> really his idea). I mentioned to him that at least one dentist [quoted text clipped - 13 lines] >defective amalgams. However, subjecting the teeth to added trauma may >tip them into the root canal camp. Agreed. >My approach would be to use the NTI for a while and see if the symptoms >subside. If they do, then I would make a decision about either leaving [quoted text clipped - 3 lines] >weeks/months, and then going to the crowns/onlays. IMO, that would >increase the odds of needing endo. Absolutely. >JMO, >Fawks I'm with Fawks. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com Who else keeps reminding us about multiple traumas and endo? <G> Fawks >>I wouldn't be wild about replacing the amalgams, waiting a few >>weeks/months, and then going to the crowns/onlays. IMO, that would [quoted text clipped - 9 lines] > > W_B Yeah you got me. >Who else keeps reminding us about multiple traumas and endo? > [quoted text clipped - 14 lines] >> >> W_B -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com I am definitely going to get an NTI or something like it. I've read that the NTI is a good device, but the differences of opinion about it make me wonder if it's really the best thing to use in my case. Since the amalgam in #30 has deficient margins, I believe there is very good reason to suspect that there is decay under it. I guess I should have mentioned that before. If I am right about this, then I am guessing that it would *not* be a good idea to put a crown on the tooth without first dealing with the decay. I am assuming, of course, that fillings are not usually removed when a tooth is crowned. Is that correct? BTW, I also suspect that the tooth probably *does* need RCT, but the problem is still in its early stages and therefore a definitive diagnosis is not yet possible. I am hope I am wrong, though, and that there's a good chance the pulp can recover if the situation is not allowed to continue to get worse. Phil > Excellent idea to get an NTI (and even more important if you are > considering porcelain restorations for the molars). [quoted text clipped - 14 lines] > JMO, > Fawks >I am definitely going to get an NTI or something like it. I've read >that the NTI is a good device, but the differences of opinion about it >make me wonder if it's really the best thing to use in my case. Most of the practitioners in SMD believe the NTI to be the best device to treat parafunction. >Since the amalgam in #30 has deficient margins, I believe there is very >good reason to suspect that there is decay under it. I guess I should >have mentioned that before. If I am right about this, then I am >guessing that it would *not* be a good idea to put a crown on the tooth >without first dealing with the decay. > I am assuming, of course, that >fillings are not usually removed when a tooth is crowned. Is that >correct? No. All decay and old restorations should be removed from a tooth prior to crown preparation. >BTW, I also suspect that the tooth probably *does* need RCT, but the >problem is still in its early stages and therefore a definitive >diagnosis is not yet possible. I am hope I am wrong, though, and that >there's a good chance the pulp can recover if the situation is not >allowed to continue to get worse. As Fawks so eloquently stated, just the trauma to the pulp of more operations increases the likelyhood of the need for endodontic treatment, especially in a partially compromised pulp. Progression from reversible pulpitis --> irreversible pulpitis. Any chance that you can post a radiograph to SMD ? You can email it to me and I will post it for you if you wish. >Phil > [quoted text clipped - 16 lines] >> JMO, >> Fawks -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE [clip] > Any chance that you can post a radiograph to SMD ? > You can email it to me and I will post it for you if you wish. Hi W_B, How does a person post radiographs to smd? Webby [clip] >[clip] >> [quoted text clipped - 8 lines] >> >[clip] Don't know what prog you are using for newsgroups but... Add the file as an attachment. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > >[clip] > >> [quoted text clipped - 18 lines] > wubbabubbazG@RBAGEyahoo.com > Take out the G'RBAGE Well I'm using NewsWatcher. But my question is how does a person (a patient) obtain that sort of file in the first place? TW >Well I'm using NewsWatcher. But my question is how does a person (a >patient) obtain that sort of file in the first place? > >TW Umm, well, they ask the dentist for a digital copy. --or-- They take their digital camera to the dentists office and take a picture of the radiograph. --or-- The Eichen method of scanning with a backlit scanner. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > >Well I'm using NewsWatcher. But my question is how does a person (a > >patient) obtain that sort of file in the first place? [quoted text clipped - 16 lines] > wubbabubbazG@RBAGEyahoo.com > Take out the G'RBAGE Thanks. TW > Any chance that you can post a radiograph to SMD ? > You can email it to me and I will post it for you if you wish. Yes, I believe that there is a chance. At first I didn't think that it was likely that I would be able to get the dentist to make me a digital copy of the x-rays. But then I remembered that the endodontist used a digital x-ray machine to take x-rays of the teeth he was examining. So the x-ray that he has of the tooth is already in the form of an image file. I will contact the endodontist's office on Monday and see if they will email me a copy of the x-rays. >I am definitely going to get an NTI or something like it. I've read >that the NTI is a good device, but the differences of opinion about it [quoted text clipped - 15 lines] > >Phil Unless, I personally placed the filling less than 2 years ago, all the pre-existing filling would come out before dong a crowm. .. Stephen Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. >Unless, I personally placed the filling less than 2 years ago, all >the pre-existing filling would come out before dong a crowm. > >.. >Stephen Troy Even if personally placed the restoratin ["filling"], no matter the time frame, I still remove it entirely. As you well know, much can happen even within 3 months. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >>Unless, I personally placed the filling less than 2 years ago, all >>the pre-existing filling would come out before dong a crowm. [quoted text clipped - 6 lines] > >As you well know, much can happen even within 3 months. In the CEREC world, all previous filling comes out to give maximum surface area for bonding. .. Stephen Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. >>>Unless, I personally placed the filling less than 2 years ago, all >>>the pre-existing filling would come out before dong a crowm. [quoted text clipped - 11 lines] >.. >Stephen Troy Same is true in the real world <VBG> -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE I suggest you get an NTI right away, Then,,,,,, have an orthodontic band placed around the suspect teeth and see what happens. If the pain stops, you know a crown will solve your problems. A temporary filling (ZOE) will not help.  Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. 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. ...................... > Well, I finally got to see the endodontist about two weeks ago. I > meant to reply sooner but just kept putting it off. [quoted text clipped - 81 lines] >> > >> >Harry |
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