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Medical Forum / General / Dentistry / August 2005

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Crowned tooth needs root canal?

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Blocks To Books - 15 Jul 2005 00:24 GMT
Three years ago I had a cracked upper molar repaired with a crown.  The
crack had formed between two old fillings that were on the molar since I was
a teenager.  Since the crown was placed, the tooth has been symptom free and
great until a few weeks ago when I began to get intermittent pain when I
would chew hard foods such as raw carrots.  That is the only symptom I am
having.  I went to my dentist who x-rayed the tooth and found no sign of
infection.  The occlusion was checked and some minor high spots were found
and they were buzzed off.  Unfortunately the pain is still there, but it
happens only when I chew really hard foods like a raw carrot or tough apple
skin.  I've been referred to an endodontist.

Will the endodontist be able to diagnose if the tooth could benefit from a
root canal if there is no infection showing up on the x-ray?  This tooth
feels so much like another cracked molar I had that ended up needing a root
canal.  The differences are that the other molar didn't have a crown on it
and it was never diagnosed as being cracked until it was already diagnosed
as being abscessed.  By the time I was referred to an endodontist an abscess
could be seen on x-ray.

Thank you for any input you can give me on this situation.
Steven Bornfeld - 15 Jul 2005 15:35 GMT
> Three years ago I had a cracked upper molar repaired with a crown.  The
> crack had formed between two old fillings that were on the molar since I was
[quoted text clipped - 16 lines]
>
> Thank you for any input you can give me on this situation.

    This is sometimes a difficult situation and sometimes takes a while to
get to the bottom of what's going on with a tooth like this.
    For one thing, if the pain is intermittent I find that it's often far
from certain which tooth is actually responsible for the pain.  Your
symptoms sound more to me like those of a crack somewhere than of an
abscess.  Obviously the two are not mutually exclusive, though a crowned
tooth without a prior root canal is not terribly subject to cracking.
So I'd have to have a good look at the other teeth in the area as well.
    It does take a while for an abscess to show up on x-ray, so in the
absence of definitive findings it may be necessary to defer treatment
and follow periodically, as things frequently become clearer over time.
    The endodontist will probably test for tenderness to tapping,
sensitivity to hot and cold.  In urgent cases it may be necessary to
drill through the crown in an inconspicuous spot to judge if the tooth
has any vitality, though obviously this is not desireable if it can be
avoided.  Sometimes the crown may be tapped off the tooth, and this
makes evaluating the tooth far easier.
    How aggressive a dentist is in an uncertain case such as this is often
dictated by the severity of pain.  In the end, if the findings are
uncertain I will ask the patient whether they are willing to wait until
the cause of the pain becomes clearer.

Steve

Signature

Cut the nonsense to reply

Blocks To Books - 15 Jul 2005 18:07 GMT
>> Three years ago I had a cracked upper molar repaired with a crown.  The
>> crack had formed between two old fillings that were on the molar since I
[quoted text clipped - 40 lines]
>
> Steve

Thank you very much for your input.  The tooth was crowned orginally due to
the fact that it had a symptomatic crack, which the crown fixed for three
years.  Is is possible that the crack is beginning to progress despite the
crown?  It feels exactly like a cracked tooth to me - pain only to biting
and worse when biting on certain parts of the tooth than other parts (front
tongue side part).  Pain can sometimes be avoided by chewing "just right" -
more to the back of the tooth.  I forgot to mention it but I also get pain
most times when I go through the front, tongue side contacts of that molar
when I'm flossing.  I wear an NTI at night and I have almost no pain in the
morning but as the day progresses and my teeth contact each other throughout
the day the pain only when biting hard or chewy foods is there by the
afternoon and evening when I eat and floss.

I can understand about the need to wait.  I was hoping I didn't have to wait
until an infection takes over to the point where it shows up on an x-ray. I
was hoping there was some kind of test that could be done to determine the
status of the tooth before that happens.  It seems to affect my overall
energy and health to have an abscessed tooth.  I have a fairly rigorous
fitness routine and lifestyle and I was hoping the need for a root canal
could be diagnosed before it got to the point of abscess.
Steven Bornfeld - 15 Jul 2005 20:55 GMT
> Thank you very much for your input.  The tooth was crowned orginally due to
> the fact that it had a symptomatic crack, which the crown fixed for three
[quoted text clipped - 16 lines]
> fitness routine and lifestyle and I was hoping the need for a root canal
> could be diagnosed before it got to the point of abscess.

    It is certainly possible that a crack can progress despite the presence
of a crown.  In this case however it's unlikely that a root canal is
going to be able to save the tooth.  In a situation like this there is
often a vertical root fracture, and if a crown does not prevent its
spread the tooth will sometimes be lost.
    The first thing to do is to confirm that the crowned tooth is actually
the tooth responsible for your pain.  If it is (and before progressing
to root canal treatment) I would remove the crown and any underlying
restorative material if at all possible and examine the tooth
carefully--preferably with magnification.

Steve

Signature

Cut the nonsense to reply

W_B - 15 Jul 2005 21:57 GMT
>I have a fairly rigorous
>> fitness routine and lifestyle and I was hoping the need for a root canal
[quoted text clipped - 12 lines]
>
>Steve

Also there is the distinct possiblility that preparing the tooth for
the crown was enough trauma to lead to slow pulpal death.
Yes, even three years later. Bet the pulp is calcified and possibly
has pulp stones.

The endodontist should be able to make an accurate diagnosis.

--
W_B

wubbabubbazG@RBAGEyahoo.com
Take out the G'RBAGE
Blocks To Books - 15 Jul 2005 22:48 GMT
> Also there is the distinct possiblility that preparing the tooth for
> the crown was enough trauma to lead to slow pulpal death.
[quoted text clipped - 8 lines]
> wubbabubbazG@RBAGEyahoo.com
> Take out the G'RBAGE

Thank you so much.  I am hopeful to think there might be a possibility to
save this tooth because of its close proximity to my sinus cavity and having
two teeth with no restorations on either side of it.  The x-ray has appeared
clear to two different dentists who each took their own PA x-rays.  There is
no hot or cold sensitivity - just pain to biting - biting only hard or
excessively chewy foods.  Could the pulp still be dying without giving other
symptoms or without any sign of problems at the root tips on a PA x-ray?  I
really hope the answer is yes.  Thank you very much for responding and for
your hopeful input.  I would like to be able to save this tooth if at all
possible.  That's why I'm being so proactive at this early stage rather than
putting it off until I can't stand it anymore like I have in the past with
other teeth.
W_B - 15 Jul 2005 23:16 GMT
>> Also there is the distinct possiblility that preparing the tooth for
>> the crown was enough trauma to lead to slow pulpal death.
[quoted text clipped - 16 lines]
>excessively chewy foods.  Could the pulp still be dying without giving other
>symptoms or without any sign of problems at the root tips on a PA x-ray?

Yes very possible.

> I really hope the answer is yes.  

It is.

>Thank you very much for responding and for
>your hopeful input.  I would like to be able to save this tooth if at all
>possible.  That's why I'm being so proactive at this early stage rather than
>putting it off until I can't stand it anymore like I have in the past with
>other teeth.

Putting off dental treatment only costs you more in the long run;
wether the currency is teeth or money.

I am a bit perplexed that you have no hot or cold sensitivity.
Didn't you say that this tooth already has a crown ?

--
W_B

wubbabubbazG@RBAGEyahoo.com
Take out the G'RBAGE
Blocks To Books - 15 Jul 2005 23:35 GMT
>>> Also there is the distinct possiblility that preparing the tooth for
>>> the crown was enough trauma to lead to slow pulpal death.
[quoted text clipped - 45 lines]
> wubbabubbazG@RBAGEyahoo.com
> Take out the G'RBAGE

Yes, this tooth has a crown on it.  Should I have hot or cold sensitivity
with a crown?  I had some for a few weeks after the crown was initially
placed but once the tooth settled down it felt like all the others pain and
symptom free.  It had remained symptom free until a few weeks ago when it
began to exhibit pain to biting hard foods.  That is still its only symptom.

Thank you for giving me some hope that the tooth can be saved.  I hope that
your opinion turns out to be the one that my endodontist and dentist agree
with.  I do not want to lose the tooth - especially because of its upper
location so close to my sinus.

I put off the previous cracked tooth because I bought into the theory I was
told that it was simply a sprained tooth and I let it go on in pain for over
a year and a half.  It turned out to be multiply fractured and badly cracked
by the time I realized that I needed dental help.  Even then it was hard to
convince my then dentist that I needed more help than a crown.  He had me
wait in a temporary for over 6 months for it to settle down and it never
did.

As a result of input I received from kind dentists on smd years ago, I
finally went to another dentist for a second opinion and he took a PA X-ray
and found a big abscess on the root of the tooth and I was immediately
referred to the endodontist.   I'm very glad that the tooth was able to be
saved and has a good root canal in it.

If it hadn't been for the valuable input I received on this newsgroup I
don't know if I would have ever have gotten the courage to go to another
dentist for a second opinion who found the abscess.  I am still very
grateful for the help that was given on that tooth.  Unfortunately this
tooth feels the same as the other one and I am beginning to show some minor
signs of difficulty completing my workouts - which hasn't happened to me
since the other tooth that was abscessed.  I hope whatever is wrong with the
tooth will be obvious to someone.  In the meantime, I deeply appreciate any
input and information.
W_B - 16 Jul 2005 00:00 GMT
Comments interspersed below.

>>>> Also there is the distinct possiblility that preparing the tooth for
>>>> the crown was enough trauma to lead to slow pulpal death.
[quoted text clipped - 51 lines]
>symptom free.  It had remained symptom free until a few weeks ago when it
>began to exhibit pain to biting hard foods.  That is still its only symptom.

Well, maybe not, what kind of crown is it ?
This crown has been in place for ~3 yrs ?
Sometimes pain to biting pressure is the only symptom.

>Thank you for giving me some hope that the tooth can be saved.  I hope that
>your opinion turns out to be the one that my endodontist and dentist agree
>with.  I do not want to lose the tooth - especially because of its upper
>location so close to my sinus.

Hope so too for your sake.
Don't worry too much about the proximity to the sinus,
this is rarely a problem except in the case of endosseous implants.

>I put off the previous cracked tooth because I bought into the theory I was
>told that it was simply a sprained tooth and I let it go on in pain for over
[quoted text clipped - 3 lines]
>wait in a temporary for over 6 months for it to settle down and it never
>did.

A 'sprained' tooth eh ? 6 months ? Damn !
7 -10 days, maybe 14, then I do something.

>As a result of input I received from kind dentists on smd years ago, I
>finally went to another dentist for a second opinion and he took a PA X-ray
>and found a big abscess on the root of the tooth and I was immediately
>referred to the endodontist.   I'm very glad that the tooth was able to be
>saved and has a good root canal in it.

Score one for the good guys.

>If it hadn't been for the valuable input I received on this newsgroup I
>don't know if I would have ever have gotten the courage to go to another
>dentist for a second opinion who found the abscess.  I am still very
>grateful for the help that was given on that tooth.  

We are glad to serve, though I probably wasn't here then.

>Unfortunately this
>tooth feels the same as the other one and I am beginning to show some minor
>signs of difficulty completing my workouts - which hasn't happened to me
>since the other tooth that was abscessed.  I hope whatever is wrong with the
>tooth will be obvious to someone.  In the meantime, I deeply appreciate any
>input and information.

The endodontist should be able to make an accurate diagnosis.
After all they are *the* experts in pulpal pathology.

--
W_B

wubbabubbazG@RBAGEyahoo.com
Take out the G'RBAGE
Blocks To Books - 16 Jul 2005 00:22 GMT
> Comments interspersed below.
>
[quoted text clipped - 123 lines]
> wubbabubbazG@RBAGEyahoo.com
> Take out the G'RBAGE

I believe the crown is porcelain over either high noble metal or gold.  It
has porcelain up to the gumline on the cheek side of the tooth and a big
band that looks like gold on the tongue side of the tooth.  It was placed
three years ago to treat a symptomatic crack on the tooth that opened up
from one old filling on front end of the tooth to an old filling on the back
end of the tooth.  The crack went right down the middle of the molar.

What is an endosseous implant?  If it's a regular upper tooth implant, then
I am very worried from what I've read about low sinuses like mine.  I don't
want to lose this tooth if there is any human or divine way to keep it
because of the naturally low sinus position and the virgin teeth on either
side of it.

I don't think you were on smd when I posted about my other tooth.  It was
years ago. The tooth I got help for is still doing well and I'm so thankful
for the courage and help I received from the dentists on smd.

What goes around comes around so I hope you all will always get good help in
your lives when you really need it like I need it now.  I can't tell you how
much I appreciate the information.
Blocks To Books - 15 Jul 2005 22:29 GMT
----- Original Message -----
From: "Steven Bornfeld" <dentaltwinnonsense@earthlink.net>
Newsgroups: sci.med.dentistry
Sent: Friday, July 15, 2005 12:55 PM
Subject: Re: Crowned tooth needs root canal?

> It is certainly possible that a crack can progress despite the presence of
> a crown.  In this case however it's unlikely that a root canal is going to
[quoted text clipped - 8 lines]
>
> Steve

Thanks again.   I was just now able to determine the crowned tooth is for
sure the one that is the source of the pain by biting on a q-tip - using it
almost like a home-made tooth sleuth - which I learned from an original
cracked molar where a dentist used a tooth sleuth to diagnose it.  I learned
about using a q-tip as a type of tooth sleuth from lurking on smd on and off
over the years.  I tried biting on all the upper molars with the q-tip and
the only one that hurt when I bit on the q-tip was the crowned molar but it
hurt on the cheek side instead of the tongue side where I thought the pain
was originating from.  Don't now if a sprained tooth can cause this same
type of pain.  The bite has been adjusted because it was high in places.  I
rested the tooth from all chewing for a week but as soon as I began chewing
hard foods on that side again, the pain resumed as it was before the bite
adjustment on the crown.

My dentist - who is a second opinion dentist - thinks there is a possibility
the crown might be loose or leaking and the pain could be caused by decay
getting inside.  I didn't want to destroy the crown or damage my tooth
further drilling the crown off only to learn the tooth was actually cracked
into the nerve and could be fixed by a root canal and then have to buy a
second crown.  I thought if it needed a root canal - then I should do that
first and then, if the crown survived, see if that solved the problem.  If
not, get the old crown drilled off the root canalled tooth and replace the
crown and pay the big bucks in that order.

Unfortunately the crown is fairly new - only three years old.  I don't know
if that might make it harder to get off without destroying it.  It was
placed by a prosthodontist who is retired.  It's actually the nicest and
appears to be the most high quality restoration I have in my mouth.  It has
a composite build up underneath the crown.  I wonder if my endodontist could
drill into the biting surface of the crown like he was preparing to do a
root canal, remove the build up and get a look at the tooth that way with
his microscope.

Another thing that really concerns me is that this tooth is an upper first
molar with roots almost inside my sinus.  The roots have always been that
way.  I've been told that about the closeness of the roots my entire life
when I get x-rays but it's never caused me any pain problems the tooth in
the past.  Because of the close proximity to the sinus cavity, I don't know
if I could have an extraction without causing damage to my sinus bones and I
don't think there is even enough bone and space for a replacement tooth
implant to ever be screwed in.  As far as a sinus lift goes; I don't know if
everyone is a candidate or only those people whose sinuses have sagged.  I
have very small bones and I think the closeness is just part of my body make
up.  It's compact and everything is close together.  Unfortunately the teeth
on either side of my molar have no restorations; which makes a bridge a more
invasive situation.  I've been concerned about anything happening to this
particular tooth for all those reasons.

I was/am a heavy clencher and they didn't know how to prevent the damage
like they do now with NTI's.  Because of that, over the years, my teeth have
been damaged by abfraction lesions, cracked molars, and gum recession even
though I have almost perfect home care and am in good health.  I will talk
to the endodontist about what you suggested when I go in on Tuesday for his
evaluation.  Unfortunately from having more than one cracked molar, I pretty
much remember what the feelings are with a cracked tooth and that is what
this feels like.  I truly hope and pray I'm wrong on this.  I didn't know it
could be a hopeless case that couldn't be salvaged by a root canal. I
thought only teeth with root canals were subject to root fracture and
couldn't be saved.

Thank you very much for responding.  The help and education people can get
here is vital.  Thank you again for trying to help me understand my options
and what might be possibly going on.  If you get any more ideas on my
situation, I would appreciate it.  The help you have already given is
appreciated very much.
W_B - 15 Jul 2005 22:44 GMT
>----- Original Message -----
>From: "Steven Bornfeld" <dentaltwinnonsense@earthlink.net>
[quoted text clipped - 80 lines]
>situation, I would appreciate it.  The help you have already given is
>appreciated very much.

IMO the only way to safely remove a crown is by cutting it off.
Sometimes a 'Richwill crown remover' can be used sucessfully.
Those reverse dent puller thingies should remain in the auto
body shop.

If the crown cannot be removed safely, then have the RCT done
through the crown and have Fuji 9 placed in the access.

You can get a new crown later after your symptoms subside.

You do have an appointment with the endodontist right ?

--
W_B

wubbabubbazG@RBAGEyahoo.com
Take out the G'RBAGE
Blocks To Books - 15 Jul 2005 22:56 GMT
> IMO the only way to safely remove a crown is by cutting it off.
> Sometimes a 'Richwill crown remover' can be used sucessfully.
[quoted text clipped - 7 lines]
>
> You do have an appointment with the endodontist right ?

> --
> W_B
> wubbabubbazG@RBAGEyahoo.com
> Take out the G'RBAGE

Yes I have an appointment with an endodontist on Tuesday.  He has done root
canal work for me before and I trust him.  He has a good microscope also.
W_B - 15 Jul 2005 23:20 GMT
>> IMO the only way to safely remove a crown is by cutting it off.
>> Sometimes a 'Richwill crown remover' can be used sucessfully.
[quoted text clipped - 15 lines]
>Yes I have an appointment with an endodontist on Tuesday.  He has done root
>canal work for me before and I trust him.  He has a good microscope also.

Excellent, am curious as to what he will find.

Best wishes,

--
W_B

wubbabubbazG@RBAGEyahoo.com
Take out the G'RBAGE
Dr. Steve - 15 Jul 2005 23:52 GMT
>>----- Original Message -----
>>From: "Steven Bornfeld" <dentaltwinnonsense@earthlink.net>
[quoted text clipped - 92 lines]
>
>You do have an appointment with the endodontist right ?

The slide hammer is good for tapping off an NTI which became too tight
during adjustment phase.
..
Stephen
Troy, Michigan, USA

I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting.
W_B - 16 Jul 2005 00:51 GMT
>>Those reverse dent puller thingies should remain in the auto
>>body shop.

>The slide hammer is good for tapping off an NTI which became too tight
>during adjustment phase.
>..
>Stephen
>Troy,

A cutting wheel is just as effective and less dangerous.

Don't give Jocken Ze Itchen any more ideas, OK ?

--
W_B

wubbabubbazG@RBAGEyahoo.com
Take out the G'RBAGE
Dr. Steve - 16 Jul 2005 18:08 GMT
>>>Those reverse dent puller thingies should remain in the auto
>>>body shop.
[quoted text clipped - 8 lines]
>
>Don't give Jocken Ze Itchen any more ideas, OK ?

When Hans was at my office he showed me his technique.  He lets it set
up on the teeth (after initial removal at 2 minutes).

He drops it in hot water at 2 minutes, waits a few seconds, then
re-inserts it.  He lets it set hard on the teeth, then taps if off
with the crown puller.  Trims the undercut, tests the fit ad shapes
the DE.
..
Stephen
Troy, Michigan, USA

I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting.
W_B - 16 Jul 2005 21:38 GMT
>>>>Those reverse dent puller thingies should remain in the auto
>>>>body shop.
[quoted text clipped - 18 lines]
>..
>Stephen Troy

I still think that it is a brutal device.

Have never owned one and never will.
Yes, have used one back in the days.

Just wait until the day that you fracture a virgin
# 8 or 9.... or both...
Can you say 'malpractice' ?

If I would not tolerate the use of the device on myself,
I am damned sure not going to use it on another human being.

My 2¢

--
W_B

wubbabubbazG@RBAGEyahoo.com
Take out the G'RBAGE
Dr. Steve - 17 Jul 2005 02:12 GMT
>>>>>Those reverse dent puller thingies should remain in the auto
>>>>>body shop.
[quoted text clipped - 32 lines]
>
>My 2¢

I find that if I do a lot of these, my thumbnails et soft from pulling
them out the first time after shrinkage. About once a year, I will
gently use the slide hammer to get it stated. You really only use very
light taps.
..
Stephen
Troy, Michigan, USA

I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting.
W_B - 17 Jul 2005 17:44 GMT
>>If I would not tolerate the use of the device on myself,
>>I am damned sure not going to use it on another human being.
[quoted text clipped - 8 lines]
>Stephen
>Troy

I suppose that is one of my short comings.
Am not experienced in the use of the device.

--
W_B

wubbabubbazG@RBAGEyahoo.com
Take out the G'RBAGE
Blocks To Books - 19 Jul 2005 19:58 GMT
I went in for the endodontist to evaluate my painful crowned molar.  The
endodontist found nothing bad on the x-ray and the cold test came back
indicating no pulpal involvement at this point.  The tooth sleuth test was
extremely painful and my tooth is still hurting after having it done.  He
diagnosed cracked tooth syndrome.  He said I had three choices:

do nothing - which he didn't recommend.

Go back to referring dentist to see if crown could be re-cemented or removed
and a new crown placed.  (Said this might resolve problem if crown is simply
loose. He did comment on what an exceptionally good crown and what a good
job the existing crown appeared to be - which I agree so I don't want to
lose this crown if possible.)

Get a root canal.  He said the permanent filling my dentist would do to the
hole they drilled into the crown would make the crown secure and tight once
again if being loose was its original problem.  He also said the root canal
would not guarantee to fix the problem as the tooth is too fractured - which
he said he may or may not be able to tell for sure once he gets inside the
tooth with the microscope.  Unfortunately I'm feeling time pressured as I
have an upcoming trip I've planned with my adult son coming up in a few
weeks and I need to try to get something resolved on this tooth before then
so every day counts.

I tried to call the second opinion dentist who referred me to the
endodontist to get more info on what his treatment plan would be if I went
to him to deal with the molar as if it had a loose crown, but he had a
sports injury and won't be back in until next week!  I want to know if he
would first try to get the crown off and be willing to re-cement it - even
though it wasn't his work - or if his plan was to give me a new crown.
Crowns aren't cheap so I need to know what's at stake to help me make my
decision.

I also feel that I would like to say something about this to my original
dentist who I really like and respect.  We just had a difference of opinion
on this one issue.  Do dentist/patient relationships often end if, for
example, the patient gets a second opinion and the patient chooses to follow
through with the second opinion dentist's recommendation to get an
endodontic evaluation?  Should I just consider that I burned my bridges with
my original dentist because of going to a second dentist and then going to
the endodontist?

I wish there were more definitive tests for teeth such as mine.  There is
still a risk that I might loose the tooth no matter what. Unless it's
possible to get crowns off and re-cemented fairly easily; it seems my best
option seems to go ahead with the root canal and hope that it solves the
problem.  Then I'm only out 1,400 rather than 2,000 or more.
Dr Steve - 19 Jul 2005 20:07 GMT
You might try the RCT then return to Dentist #1 for further treatment.

I cannot imagine a scenario where the crown was loose and creating your
symptoms.

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.
......................

>I went in for the endodontist to evaluate my painful crowned molar.  The
>endodontist found nothing bad on the x-ray and the cold test came back
[quoted text clipped - 43 lines]
> option seems to go ahead with the root canal and hope that it solves the
> problem.  Then I'm only out 1,400 rather than 2,000 or more.
W_B - 19 Jul 2005 21:06 GMT
>Do dentist/patient relationships often end if, for
>example, the patient gets a second opinion and the patient chooses to follow
>through with the second opinion dentist's recommendation to get an
>endodontic evaluation?

Nope

> Should I just consider that I burned my bridges with
>my original dentist because of going to a second dentist and then going to
>the endodontist?

Nope, not for my patients.
--

W_B
Take out the G'RBAGE
wubbabubbazG@RBAGEyahoo.com
Blocks To Books - 17 Aug 2005 22:37 GMT
I decided to have the root canal.  I had it two weeks ago and things are
going well with my molar.  I can chew on that side with only very minimal
tenderness but nothing like the cracked tooth symptoms I was having before
rct.  This is more like a slight bruised feeling that I know from past
experience will get better with time.  I believe I did the right thing for
my tooth by getting the root canal.

A new situation that has arisen as a result of my second opinion dentist
taking the crowned tooth out of occlusion before the endodontic referral.  I
believe what he did was a necessary part of the diagnostic procedure to try
to see if a root canal could be prevented.  Apparently that first molar was
carrying the majority of my bite on the left side and when it was taken out
of occlusion the bite on my right side changed very much.  I fractured a
filling on the first molar on the other side and my other root canalled
tooth (lower first molar) that is below the upper first molar that had the
fractured filling is now hurting whenever I do anything that causes my teeth
hit together such as talking when saying certain words that cause my teeth
to come together in a certain way.  The root canalled molar doesn't hurt
when I chew food, but only when talking or when my jaws come together
rapidly like if I'm jogging and my mouth relaxes and my teeth bang together
slightly.  My dentist had to do a lot of work to try to get the occlusion
more even and marginally comfortable on the right side after the other side
tooth was taken out of occlusion.  She also did quite a bit of re-contouring
of the crown on this symptomatic root canalled tooth during this time.

Is it possible that this tooth is painful simply due to the bite still being
slightly off?  Can a root canalled tooth's ligament still cause tooth pain
if the occlusion is off or is the pain a sign of something else?  (This
tooth in question was also a cracked tooth syndrome tooth.  The root canal
was done 6 years ago and it took almost a year for it to settle down but
it's been fine since then.)

I'd appreciate any input. Thank you very much.
Mark & Steven Bornfeld - 17 Aug 2005 22:42 GMT
> I decided to have the root canal.  I had it two weeks ago and things are
> going well with my molar.  I can chew on that side with only very minimal
[quoted text clipped - 24 lines]
> slightly off?  Can a root canalled tooth's ligament still cause tooth pain
> if the occlusion is off

Yes.

Steve

 or is the pain a sign of something else?  (This
> tooth in question was also a cracked tooth syndrome tooth.  The root canal
> was done 6 years ago and it took almost a year for it to settle down but
> it's been fine since then.)
>
> I'd appreciate any input. Thank you very much.

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

W_B - 17 Aug 2005 23:21 GMT
>Is it possible that this tooth is painful simply due to the bite still being
>slightly off?  

Yes

>Can a root canalled tooth's ligament still cause tooth pain
>if the occlusion is off or is the pain a sign of something else?

Yes

> (This
>tooth in question was also a cracked tooth syndrome tooth.  The root canal
>was done 6 years ago and it took almost a year for it to settle down but
>it's been fine since then.)
>
>I'd appreciate any input. Thank you very much.

I suspect that you are a clencher.
An NTI may be in order.

headacheprevention.com
--

W_B
Take out the G'RBAGE
wubbabubbazG@RBAGEyahoo.com
Blocks To Books - 18 Aug 2005 01:32 GMT
I am a long time NTI wearer.  I wear it when I sleep.  My
clenching has improved somewhat during the day as a result.  I still catch
myself clenching at times during the day and I try to stop it when I notice
it.  I am a heavy hitter on my teeth even when simply chewing or talking
etc.  Thanks for the input.

>>Is it possible that this tooth is painful simply due to the bite still
>>being
[quoted text clipped - 23 lines]
> Take out the G'RBAGE
> wubbabubbazG@RBAGEyahoo.com
Amatus Cremona - 18 Aug 2005 14:31 GMT
>I am a long time NTI wearer.  I wear it when I sleep.  My
> clenching has improved somewhat during the day as a result.  I still catch
> myself clenching at times during the day and I try to stop it when I
> notice it.  I am a heavy hitter on my teeth even when simply chewing or
> talking etc.  Thanks for the input.

You may have already cracked and damaged many teeth from the forceful
clenching of previous years.  The NTI will at least prevent things from
getting worse while you are wearing it.  You might gain advantage from an
occlusal equilibration (maybe not).  You might want to wear a day time NTI.

Signature

/

Amatus

/

>I am a long time NTI wearer.  I wear it when I sleep.  My
> clenching has improved somewhat during the day as a result.  I still catch
[quoted text clipped - 30 lines]
>> Take out the G'RBAGE
>> wubbabubbazG@RBAGEyahoo.com
Blocks To Books - 18 Aug 2005 20:00 GMT
I do think that my bite could possibly be helped by doing an equilibrium but
I don't think my dentist would want to risk it because she's seen firsthand
how changing one thing can cause an entire cascade of events that are
unforeseen and very difficult to undo.  I'm too afraid to seek out a dentist
who does these adjustments for fear of possibly worse problems happening to
me such things I've read about with people developing painful TMJ jaw issues
after an occlusal adjustment.  I admit I'm very scared to make any changes
that aren't absolutely necessary at this point.

I believe the reason the molar that cracked and was crowned and symptom free
for three years under the crown cracked again was because I learned that
crown was only occluding on the outside cusp and nobody knew about it until
after the tooth cracked.  (It was that cusp that cracked.)  My dentist
discovered it was only occluding on that one cusp when I went in with my
cracked tooth symptoms on that crowned and previously cracked tooth.

The crown was placed three years ago to repair another crack in that molar
by a prosthodontist who is not my dentist anymore.  I thought it was weird
that he said the bite didn't need to be adjusted when the crown was
cemented.  I didn't have any pain afterwards, so I let it go.  Now I learn
that crowned tooth was carrying the brunt of almost my entire bite on the
left side just on its one cusp because, once it was taken out of occlusion,
almost all my teeth on my left side are now out of occlusion.  Now my right
side is taking the majority of the force of my bite.

When a new restoration is completed they have me bite on the paper or film
and pronounce my bite as fine.  Unfortunately I sometimes still have pain
and develop symptoms over time such as abfraction lesion notches, gum
recession, and changes of tooth positions in other areas of my mouth.  I
went to three different dentists asking to have the bite adjusted on my
lower crowned root canalled tooth after the crown was cemented and the bite
felt "off" and they all worked on it with bite paper and film and pronounced
my bite as good.  It didn't feel right to me and I had pain in the tooth for
a year.  Within three months of the crown being placed I developed for the
first time, abfraction lesions on all my molars and my upper front teeth
that were straight and normal went into a completely open bite with flared
and crossed and twisted incisors.  I also developed very severe gum
recession but the pockets remained at 2mm or less because of my excellent
home care.

Because of my experiences in the past such as the one listed above, I have a
lot of fear of letting anyone do anything to me anymore and I especially
fear getting new restorations such as crowns and bridges.  I take excellent
care of my teeth by flossing and brushing and I get them cleaned every four
months by a periodontist.  I'm guess I should be extremely grateful I don't
have the problems of jaw joint issues and headaches, etc. with all the
problems I do have and have had all my life.  I am very grateful to have
been spared that.

The dentist I have now knows that I do have bite issues and she tries very
hard to adjust things properly after restorations and she's done a great job
for the most part.  However, once that paper says it's perfect, she is
inclined to want to believe it over me saying I still feel like there might
be a problem.  She does try to help but then I eventually just try to make
the best of it and hope it will be OK.  Over time, my teeth begin to adjust
in any way they can and it usually causes some kind of changes for the
worst.   Just in the month that my bite was way off on the right side after
my crown was taken out of occlusion on the left side by a second opinion
dentist, I have gotten very deep gum recession on the lower right crowned
root canalled first molar on the cheek side of the molar.  You can actually
see the orangeish pink gutta percha beginning to show through the root below
where the crown margin and the gums are because maybe that part of the root
bone has thinned due to the stresses placed on it for only one month even
though I was wearing my NTI almost 24/7 during that time.   I also cracked a
composite filling in the molar above the root canalled tooth during that
time.  I think the stresses I place on my teeth with eating might be enough
to do damage.  If I hadn't had my NTI in who knows what would have happened.

I'd give anything if they could come up with a cure for parafunction. I know
lately they are saying orthodontia is the answer.  Maybe if I had a spare
ten or twenty thousand dollars and the years of time to risk trying it,
maybe it would help but I know for a fact that I was clenching even when I
had perfectly straight teeth with no open bite and my canines were touching
each other.  I have big wear facets on them to prove it!  I recently learned
on a dental website that people like me can't tolerate implants or dentures
very well either!  I have faith dental science or God helping a scientist
will cause a solution to be discovered that will actually cure this problem
once and for all.

I was glad to recently learn on the headachehelp website that Dr. Boyd
developed an NTI for denture wearers.  I hope he will develop all kinds of
NTI's for people with implants, crowns, partials, bridges in the front, etc.
People like me need help badly and there will be plenty of them as the baby
boomers age and their teeth begin to crack.

The minute I learned about NTIs a few months after my root canal - but after
the damage was already done,  I went online and found a dentist who made
them in my town and had one made.  I doubt I would have any teeth left at
all if I hadn't gotten an NTI back then.  I think I would have snapped them
off at the abfraction lesions.  I since have had to go to two NTIs because
one of my lower front teeth that was previously cracked before the NTI
became more damaged as time went on, so I now need the protection of a lower
NTI to balance the load over more teeth.  I hope they someday will come up
with an NTI for people who might have bridges for their upper and/or lower
front teeth because I'm afraid that could happen to me if I get any more gum
recession in my front teeth.

Dr. Boyd is a true national treasure for what he has done to help people
like me.  I hope he will continue to expand on his work and provide help or
special NTI's for all those who have parafunction no matter what the state
of their teeth or restorations or lack of teeth thereof.

Thank you for understanding the severity and ramifications of occlusion
problems.

>>I am a long time NTI wearer.  I wear it when I sleep.  My
>> clenching has improved somewhat during the day as a result.  I still
[quoted text clipped - 44 lines]
>>> Take out the G'RBAGE
>>> wubbabubbazG@RBAGEyahoo.com
Amatus Cremona - 18 Aug 2005 14:29 GMT
> Is it possible that this tooth is painful simply due to the bite still
> being slightly off?  Can a root canalled tooth's ligament still cause
> tooth pain if the occlusion is off or is the pain a sign of something
> else?  (This tooth in question was also a cracked tooth syndrome tooth.
> The root canal was done 6 years ago and it took almost a year for it to
> settle down but it's been fine since then.)

You have severe parafunction, probably very severe during sleep.  You and
your dentist need to understand clenching with attempted grinding while
clenched and the harm it does to teeth.  You are breaking teeth from this
and will continue to do so until you get it under control.

www.headacheprevention.com

Signature

/

Amatus

/

>I decided to have the root canal.  I had it two weeks ago and things are
>going well with my molar.  I can chew on that side with only very minimal
[quoted text clipped - 30 lines]
>
> I'd appreciate any input. Thank you very much.
Blocks To Books - 16 Jul 2005 00:34 GMT
> IMO the only way to safely remove a crown is by cutting it off.
> Sometimes a 'Richwill crown remover' can be used sucessfully.
[quoted text clipped - 9 lines]
> wubbabubbazG@RBAGEyahoo.com
> Take out the G'RBAGE

Forgot to ask - what is a Fuji 9?  I'm sure my dentist would know, but I'd
like to know if you have the time to tell me.  Thanks so much for all the
time and input you have already given to me to me.
W_B - 16 Jul 2005 00:57 GMT
>> IMO the only way to safely remove a crown is by cutting it off.
>> Sometimes a 'Richwill crown remover' can be used sucessfully.
[quoted text clipped - 13 lines]
>like to know if you have the time to tell me.  Thanks so much for all the
>time and input you have already given to me to me.

Fugi 9 is a glass ionomer cement/build up material.
Hard as rock, bonds to tooth structure, gives off fluoride
that inhibits recurrent decay.

You are welcomed sir, endodontics is a special interest for me.

--
W_B

wubbabubbazG@RBAGEyahoo.com
Take out the G'RBAGE
Dr. Steve - 16 Jul 2005 18:08 GMT
>> Thank you very much for your input.  The tooth was crowned orginally due to
>> the fact that it had a symptomatic crack, which the crown fixed for three
[quoted text clipped - 29 lines]
>
>Steve

Also, possible that the crack just barely involved the pulp
originally aud it took this long to become necrotic.
..
Stephen
Troy, Michigan, USA

I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting.
Blocks To Books - 16 Jul 2005 20:03 GMT
> Also, possible that the crack just barely involved the pulp
> originally aud it took this long to become necrotic.
[quoted text clipped - 4 lines]
> I am writing on a Tablet-PC,so forgive me if the PC misreads my
> handwriting.

I hope that is what has happened.  Thanks for your input.
Dr. Steve - 15 Jul 2005 23:23 GMT
NTI

NTI_

NTI

Try an NTI first, if pain persists RCT

>> Three years ago I had a cracked upper molar repaired with a crown.  The
>> crack had formed between two old fillings that were on the molar since I was
[quoted text clipped - 40 lines]
>
>Steve

..
Stephen
Troy, Michigan, USA

I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting.
Blocks To Books - 15 Jul 2005 23:58 GMT
> NTI
>
[quoted text clipped - 3 lines]
>
> Try an NTI first, if pain persists RCT

I have worn an NTI from the time I first learned of them on smd and found a
dentist in my area who could make one for me.  I think that's why my
symptoms have been as mild as they are and possibly why they are worse later
in the day after my teeth have been clenching on each other all day.  I
don't know what I would do without my NTI.
W_B - 16 Jul 2005 00:54 GMT
>> NTI
>>
[quoted text clipped - 9 lines]
>in the day after my teeth have been clenching on each other all day.  I
>don't know what I would do without my NTI.

You may need a daytime device.
Otherwise you can wear your nite-time during the day.

--
W_B

wubbabubbazG@RBAGEyahoo.com
Take out the G'RBAGE
Dr. Steve - 16 Jul 2005 01:00 GMT
>> NTI
>>
[quoted text clipped - 9 lines]
>in the day after my teeth have been clenching on each other all day.  I
>don't know what I would do without my NTI.

I could be wrong, but it sounds like time for a RCT
..
Stephen
Troy, Michigan, USA

I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting.
Blocks To Books - 16 Jul 2005 01:18 GMT
> On Fri, 15 Jul 2005 15:58:11 -0700, "Blocks To Books"
> I could be wrong, but it sounds like time for a RCT
[quoted text clipped - 4 lines]
> I am writing on a Tablet-PC,so forgive me if the PC misreads my
> handwriting.

I hope all who say the tooth isn't irretrievably fractured and can be saved
with a root canal are correct.  I appreciate Dr. Bornfield's observations
and concerns because I know how eerily similar the symptoms are to my other
tooth that was fractured.  I hope the fracture has not progressed beyond the
hope of root canal.  My desire is that this tooth can be saved.  I don't
fear a root canal. I would welcome it to save the tooth.  I fear only
extraction due to my low sinus cavity.  Thanks again.  I will post once this
is all over if not sooner.
W_B - 16 Jul 2005 01:34 GMT
>> On Fri, 15 Jul 2005 15:58:11 -0700, "Blocks To Books"
>> I could be wrong, but it sounds like time for a RCT
[quoted text clipped - 7 lines]
>I hope all who say the tooth isn't irretrievably fractured and can be saved
>with a root canal are correct.
Very likely, try not to worry so much.

> I appreciate Dr. Bornfield's observations
>and concerns because I know how eerily similar the symptoms are to my other
>tooth that was fractured.

Bornfeld is master dentist, I often find myself agreeing with his
opinions.  Am just to lazy to make such complete answers.

> I hope the fracture has not progressed beyond the
>hope of root canal.  My desire is that this tooth can be saved.  I don't
>fear a root canal. I would welcome it to save the tooth. I fear only
>extraction due to my low sinus cavity.  Thanks again.  I will post once this
>is all over if not sooner.

I don't think that your fears are unfounded but... at this point
why worry until you know what is wrong and what steps can
be taken ?

Chill dude, Tuesday isn't that far away.

--
W_B

wubbabubbazG@RBAGEyahoo.com
Take out the G'RBAGE
 
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