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Medical Forum / General / Dentistry / August 2005Crown, not placed properly
I need some advice, please. Last year I had a crown and root canal done on an upper molar. After the work was done I noticed that food was getting caught in between my teeth and that it was causing some pain. The dentist told me that happens to him and to just knot the floss when I flossed to get the food out. So that's what I did. Within this past year, the tooth has bothered me off and on, to the point where I would take mild pain pills. Just last week, the tooth got really bad so I went in to have it checked. I ended up having gum surgery because apparently the crown was not placed properly and food and bacteria were building up around and in a pocket around the tooth. This is neglect as far as I'm concerned and would like to know how to approach this situation to make the dental office responsible? I don't believe that I should have to pay for the gum surgery, or a replacement crown (if necessary), not to mention the pain and inconvenience of it all. Any suggestions? Thank you, Susan Was it immediately in front of the very last tooth in the upper arch (ie--between the last two teeth)? >I need some advice, please. Last year I had a crown and root canal done on >an upper molar. After the work was done I noticed that food was getting [quoted text clipped - 14 lines] > > Susan It's actually the very last tooth on the right upper side of my mouth. So it's the area between the last and 2nd last tooth. >Was it immediately in front of the very last tooth in the upper arch >(ie--between the last two teeth)? [quoted text clipped - 22 lines] > > Typical location for a contact to open up with a patient who is a night-time parafunctional clencher.  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. ...................... It's actually the very last tooth on the right upper side of my mouth. So it's the area between the last and 2nd last tooth. NOYB wrote: Was it immediately in front of the very last tooth in the upper arch (ie--between the last two teeth)? "Susan (Schwarzkopf) Burkard" <burkard@buffalo.edu> wrote in message news:dcllt6$l42$1@prometheus.acsu.buffalo.edu... I need some advice, please. Last year I had a crown and root canal done on an upper molar. After the work was done I noticed that food was getting caught in between my teeth and that it was causing some pain. The dentist told me that happens to him and to just knot the floss when I flossed to get the food out. So that's what I did. Within this past year, the tooth has bothered me off and on, to the point where I would take mild pain pills. Just last week, the tooth got really bad so I went in to have it checked. I ended up having gum surgery because apparently the crown was not placed properly and food and bacteria were building up around and in a pocket around the tooth. This is neglect as far as I'm concerned and would like to know how to approach this situation to make the dental office responsible? I don't believe that I should have to pay for the gum surgery, or a replacement crown (if necessary), not to mention the pain and inconvenience of it all. Any suggestions? Thank you, Susan >It's actually the very last tooth on the right upper side of my >mouth. So >it's the area between the last and 2nd last tooth. Just as I thought. Those teeth have a propensity to drift after crowns are placed, and sometimes a space (food-trap) opens up. If it happens within 6 months of my placing a crown up there, I either redo it at no-charge, or I replace the filling on the tooth in front of it to re-establish contact. If it happens outside of 6 months, I charge half-price to redo it. If it happens again after I've already redone it once, then I tell the patient that there's nothing I can do other than crowning the tooth in front of it and splinting both teeth together. P A R A F U N C T I O N 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. ...................... > >>It's actually the very last tooth on the right upper side of my >mouth. [quoted text clipped - 8 lines] > once, then I tell the patient that there's nothing I can do other than > crowning the tooth in front of it and splinting both teeth together. > P > A [quoted text clipped - 8 lines] > O > N Perhaps. But these folks seldom have spacing back there prior to crowning the tooth. What accounts for that? The dentist has changed the occlusal morphology of the tooth. You (or the treating DDS) added or removed a sloped surface. If the lower tooth impacts on the mesial slope of a cusp, but never did before, parafunctional activity will work to push the tooth distally. I have not had much success with adding contour to redirect forces mesially, but it is always a thought. Predictability says you need to either use elastics to close the gap, then reshape the occlusal anatomy, or re-make the occlusion (new crown) paying close attention to all sloped surfaces. In the absence of parafunctional activity, the tooth does not drift distally. You need constant application of a distalizing force to achieve that. The act of making a crown does not create a *constant* force. 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. ...................... > >> P [quoted text clipped - 12 lines] > Perhaps. But these folks seldom have spacing back there prior to crowning > the tooth. What accounts for that? > The dentist has changed the occlusal morphology of the tooth. You (or the > treating DDS) added or removed a sloped surface. If the lower tooth [quoted text clipped - 8 lines] > distally. You need constant application of a distalizing force to achieve > that. The act of making a crown does not create a *constant* force. I must say that since I've been paying close attention to the force vectors on the most distal crowns when I cement them, I get a lot less drifting than I used to. Thanks for the heads up. Wow I didn't think I'd create such a flurry regarding this issue! I went yesterday for my checkup and they took out the stitches. They said the pain should subside more now after removing the stitches. The peridontist said he moved the gum up around the crowned tooth to prevent the buildup of food and bacteria from happening again. I hope he's right. It is still very difficult for me to chew on that side of my mouth. > > [quoted text clipped - 18 lines] > > >> The dentist has changed the occlusal morphology of the tooth. You (or >> the treating DDS) added or removed a sloped surface. If the lower tooth [quoted text clipped - 13 lines] > vectors on the most distal crowns when I cement them, I get a lot less > drifting than I used to. Thanks for the heads up. Susan, Unless there's a tight contact between the two teeth now (ie--floss "snaps" when you insert it), you'll continue to have the problem. "Moving the gum around" will only close what's called the embrasure space...which is a gap below the contact point of the two teeth. Get a temporary crown with a tight contact on there ASAP. |
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