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Medical Forum / General / Dentistry / November 2005

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crown complication part deux

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tdonline - 03 Nov 2005 02:59 GMT
Had a crown replaced 6 months ago and off and on it hurts when I floss.
Otherwise no pain and no blood.  With the old crown there was a bad
smell in the area as there was bacteria in the tooth.  Dentist said to
wait and see if the pain would go away.

Went back this week for a cleaning and mentioned that nothing had
changed.  Again, the dentist sloughed it off and said that over time,
the problem would resolve itself.  Is this guy shirking me off?  I'm a
student, do not have insurance and pay cash for all dental work.  The
pain isn't chronic, but I just want to make sure I'm not letting a
problem fester and then the ensuing pain...I have had  unusually bad
breath the last 3 months and wonder if it's related.
Steven Bornfeld - 03 Nov 2005 04:39 GMT
> Had a crown replaced 6 months ago and off and on it hurts when I floss.
>  Otherwise no pain and no blood.  With the old crown there was a bad
[quoted text clipped - 8 lines]
> problem fester and then the ensuing pain...I have had  unusually bad
> breath the last 3 months and wonder if it's related.

Question: does floss slip without resistance between the crown and the
adjacent tooth?  There should be some resistance.  If not, food will
pack in between the teeth just as easily.  If this was so from the time
the crown was inserted, this IMO was an oversight of the dentist, and
the crown should be replaced.

Steve

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tdonline - 03 Nov 2005 23:07 GMT
> Question: does floss slip without resistance between the crown and the
> adjacent tooth?  There should be some resistance.  If not, food will
[quoted text clipped - 3 lines]
>
> Steve

He actually brought this up when he put the crown in 6 months ago.
There is a fair amount of resistance at the bottom but there is a
plenty of room once it gets closer to the gum line.  He said that food
may get stuck in there and to let him know if there was a problem.
Well, I went back two weeks later and again last week, and he doesn't
seem too interested.

I get the feeling that's he's not kosher with redoing this.  I thought
we had a good relationship, I'm not sure how I can put my feet down on
this matter without burning any bridges.
Mark & Steven Bornfeld - 03 Nov 2005 23:35 GMT
>>Question: does floss slip without resistance between the crown and the
>>adjacent tooth?  There should be some resistance.  If not, food will
[quoted text clipped - 14 lines]
> we had a good relationship, I'm not sure how I can put my feet down on
> this matter without burning any bridges.

    You bring up a good point.  The contact between molar teeth is nearer
the chewing surface than the gumline.  Esp. if there is gum recession,
it's not unusual at all to have some space between the teeth near the
gumline but a decent contact near the chewing surface.  Food impaction
from the side (horizontal food impaction) is generally less damaging to
the gums than vertical food impaction (through a weak contact).  So
there may well be nothing wrong with the crown.
    Even so, I would check for what we call "plunger cusps" from the
opposing tooth contacting near the space.  Sometimes I'll see
improvement by just taking an abrasive stone and rounding the contours
of any opposing cusps.
    As far as re-doing the crown for horizontal food impaction, it could be
done--by overcontouring the crown where it faces the adjacent tooth in
the food impaction area.  This would decrease the area available to pack
food in.  However, this could solve one problem and create another, as
overcontoured crowns tend to be irritating to the gums themselves.  If
your dentist is diligent and honest, he should be able to speak to you
in terms you can understand as to what might be causing this problem,
and what might be done to improve the situation.  If there are no good
options, he preferably should be able to explain why, esp. in view of
the fact that this problem did not exist before placing the crown.

Steve

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

W_B - 04 Nov 2005 16:31 GMT
>>>Question: does floss slip without resistance between the crown and the
>>>adjacent tooth?  There should be some resistance.  If not, food will
[quoted text clipped - 38 lines]
>
>Steve

If the proximal contact is good and no plunger cusp...

    ...what's wrong with a nice proxabrush ?
--

W_B
Take out the G'RBAGE
wubbabubbazG@RBAGEyahoo.com
Steven Bornfeld - 04 Nov 2005 22:54 GMT
> If the proximal contact is good and no plunger cusp...
>
>     ...what's wrong with a nice proxabrush ?

    I agree.  Of course, I have no idea just how annoying the food
impaction is.
    Because of a miscalculation with interproximal reduction Mark did on my
Invisalign, I now have a small diastema mesial to my UL lateral incisor.
 It's pretty annoying, but not a perio issue.

Steve

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

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Tony Bad - 05 Nov 2005 01:30 GMT
> Because of a miscalculation with interproximal reduction Mark did on my
> Invisalign, I now have a small diastema mesial to my UL lateral incisor.
>   It's pretty annoying, but not a perio issue.
>
> Steve

Miscalculation!! My brother in law is a lawyer...let me know if you want his
number.

T
Steven Bornfeld - 05 Nov 2005 04:19 GMT
>>Because of a miscalculation with interproximal reduction Mark did on my
>>Invisalign, I now have a small diastema mesial to my UL lateral incisor.
[quoted text clipped - 6 lines]
>
> T

    Thanks, Tony.

Steve (the evil twin)
W_B - 07 Nov 2005 16:10 GMT
>> If the proximal contact is good and no plunger cusp...
>>
[quoted text clipped - 7 lines]
>
>Steve

Hw about a little composite bonding ?
--

W_B
Take out the G'RBAGE
wubbabubbazG@RBAGEyahoo.com
Mark & Steven Bornfeld - 07 Nov 2005 19:52 GMT
> Hw about a little composite bonding ?

Maybe.  I might be too lazy even for that.

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

Signature

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

W_B - 07 Nov 2005 20:52 GMT
>> Hw about a little composite bonding ?
>
[quoted text clipped - 4 lines]
>>
>> W_B

C'mon over, I'll do it for you.
--

W_B
Take out the G'RBAGE
wubbabubbazG@RBAGEyahoo.com
tdonline - 03 Nov 2005 23:35 GMT
Lost in cyberspace...again

There is resistance btw the teeth at the bottom but once it goes up to
the gumline, there is plenty of space.  The dentist said something
about they couldn't get a tighter fit without damaging or doing
something to the neigboring tooth.  He actually did point out that food
may get stuck and that if it bothered me, I should let him know.  Two
weeks later I did.  Did it again 6 months later and he doesn't seem too
interested.

Thought I had a good relationship with him, so how did I put my foot
down without burning any bridges?  A few years back, a dentist put me
through hell with a bad crown, but when he saw the blood and damage,
agreed to replace at no cost.  This new guy is "nice"...but is smiling
and shirking me off at the same time.
USC95 - 04 Nov 2005 08:43 GMT
sounds like maybe you have gum disease...maybe some bone loss
 
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