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Medical Forum / General / Dentistry / December 2005crown replacement - (UPDATE)
I want to thank everyone again for their comments on my previous thread - very eye opening for me in regards to the "dental plan" issues and whether that has factored into what my current experience is or not. Putting aside the dental plan issues, here's an update of where I am now. Any comments/opinions appreciated on the dentistry aspect itself. I understand that it is not possible to give a real diagnosis, but I'll consider any opinions with a grain of salt & try to use them to help me balance out in my mind & decide what to do (depending on how my tooth feels over the next couple of days). I am in now a similar situation to what JimSocal was asking about in his thread regarding possibly needing root canal before getting a crown. I went back to the dentist today, to ask about getting a temp crown, to mention how my tooth has had constant "pressure feeling" in it ever since he filled it in with "cement", to tell him how temperature sensitivity has gotten worse after being drilled on, in addition to also hurting if it gets hit by food the "wrong" way while chewing, that i think getting a temp crown will help me eat easier etc. He first told me that he could not put in a temp crown because there was not enough tooth there to attach it to, that the temp crown would probably just come off (which made me wonder why a perm would be any different?). Then he asked me about the pressue I'm feeling, and the temperature sensitivity, and he said that I probably needed a root canal for that. That the root may be "dying". He said he may have to send me to an endodontist for that before putting the perm crown in. He decided to remove the existing cement and put some "medicine" on the tooth, and for me to then see how that feels over the next 24 hours or so, and if it feels better, then I should just wait till next week for the permanent crown to come in. Out of curiousity I asked what the "medicine" was he was going to put in there, he said it was medicine to "calm down" the nerve, seemed slightly surprised that I would even ask, said it was "medicine we always use", think he called it "an anodyne" or something like that??? Anyways he explained that this medicine *might* help calm the nerve, make me feel better, and with the cement out of there if that was pressing on something then that pressure would be relieved, and if I felt better then that means I won't need root canal. Which made sense to me. BUT if the discomfort persists or gets worse, including the sensitivity to hot/cold, that I would need to see an endodontist. And he would NOT be putting on a temp crown because of the reason he already stated, plus he wanted to do things logically (just remove the possible pressure on the tooth plus put some medicine in and see how it feels from there). So he drilled out the cement (and my tooth was so sensitive it was hurting even from just getting hit by the air from the drill, so he gave me novocaine). He packed in some "medicine". And I thought I was done at that point but then he said he would put a temp crown on, totally reversing his earlier position. Since I've been suffering trying to eat this way for the past 13 days I welcomed getting a temp crown, give me something to chew against, hopefully protect things, thinking maybe even THAT might help the tooth/nerve feel better period. So he put on a temp crown (piece of metal), on top of the medicine stuff etc and now I'm supposed to give it 24 hours or so and see how things feel, but if it gets worse (or not better?) then call him, which would lead me to seeing an endodontist b4 getting the permanent crown put in next week. Now despite my earlier misgivings about him not putting on a temp crown (which still doesn't make sense to me), for all I know he is a great dentist and this is the way it is. Maybe I do need root canal now (or not depending on how things develop). But I didn't have any of the pressure feelings UNTIL i had the cement in. And couldn't it be normal for my tooth to be sensitive to temperature with the nerve so "exposed"? It was "naked" with no crown or filling for 4 days, then had some cement in it, then got drilled down and left mostly naked again with no crown, only cement in it for yet another week. And over that period the temperature sensitivity has increased. Doesn't my nerve have a right to be complaining after all that? Or is this indicative of it "dying" and needing root canal? Or maybe even it got drilled down too much and that is why it's more sensitive now? Is there even any chance that the nerve might "calm down" or am I kidding myself hoping that could happen? And, I just thought of this, if my nerve is dying, what if it dies today/tonight/tomorrow, then wouldn't I not feel the discomfort after that? But if I were to go by that lack of feeling wouldn't I be erroneously thinking that things are better? Can't you tell if root canal is needed from an x-ray or something like that? Not being a dentist I obviously have no idea of what I am talking about.... Thanks for any thoughts. > He first told me that he could not put in a temp crown because there > was not enough tooth there to attach it to, that the temp crown would > probably just come off (which made me wonder why a perm would be any > different?). I like a person who can think on their own. Congratulations. > Anyways he explained that this medicine *might* help calm the nerve, > make me feel better, and with the cement out of there if that was > pressing on something then that pressure would be relieved, and if I > felt better then that means I won't need root canal. Which made sense > to me. I used to think the same way, until I saw enough consistent research demonstrating that the medicine made no difference in the long term health of the tooth's pulp. > So he put on a temp crown (piece of metal), The old cheapo tin can ! > And couldn't it be normal for my tooth to be sensitive to > temperature with the nerve so "exposed"? Pain is never normal, but it is expected under certain circumstances. Leaving the dentin of a tooth exposed is one situation where I would EXPECT it to hurt. > Is there even any chance that the nerve might "calm down" or am I > kidding myself hoping that could happen? IF the temporary crown solved ALL your pain issues, the tooth _might_ be ok. > And, I just thought of this, if my nerve is dying, what if it dies > today/tonight/tomorrow, then wouldn't I not feel the discomfort after > that? But if I were to go by that lack of feeling wouldn't I be > erroneously thinking that things are better? Can't you tell if root > canal is needed from an x-ray or something like that? Not being a > dentist I obviously have no idea of what I am talking about.... If the tooth completely dies, all pain stops until it begins to push into the bone, then pain stops again once the face swells out to the size of a golf ball. We can tell if RCT is needed by listening to the patient's complaints, looking at the tooth, looking at the x-ray image, tapping the tooth, testing it with temperature, testing it with tiny electrical stimulus, etc. And, yet there are still times when we are surprised.  Signature/ Amatus / >I want to thank everyone again for their comments on my previous thread > - very eye opening for me in regards to the "dental plan" issues and [quoted text clipped - 91 lines] > > Thanks for any thoughts. > I want to thank everyone again for their comments on my previous thread > - very eye opening for me in regards to the "dental plan" issues and [quoted text clipped - 22 lines] > probably just come off (which made me wonder why a perm would be any > different?). Good question. Then he asked me about the pressue I'm feeling, and the > temperature sensitivity, and he said that I probably needed a root > canal for that. That the root may be "dying". He said he may have to [quoted text clipped - 9 lines] > slightly surprised that I would even ask, said it was "medicine we > always use", think he called it "an anodyne" or something like that??? Right. Generally this will be some kind of zinc oxide and eugenol (oil of cloves) preparation. > Anyways he explained that this medicine *might* help calm the nerve, > make me feel better, and with the cement out of there if that was [quoted text clipped - 23 lines] > would lead me to seeing an endodontist b4 getting the permanent crown > put in next week. Well, since he apparently placed an aluminum shell (what we sometimes pejoritively refer to as a "tin can"), you must probably now distinguish nerve pain from soreness of the gums you doubtless feel from the temporary. > Now despite my earlier misgivings about him not putting on a temp crown > (which still doesn't make sense to me), for all I know he is a great [quoted text clipped - 14 lines] > Is there even any chance that the nerve might "calm down" or am I > kidding myself hoping that could happen? It is POSSIBLE, but I wouldn't bet the farm. Steve > And, I just thought of this, if my nerve is dying, what if it dies > today/tonight/tomorrow, then wouldn't I not feel the discomfort after [quoted text clipped - 4 lines] > > Thanks for any thoughts. SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 steve wrote: >>>> Well, since he apparently placed an aluminum shell (what we sometimes pejoritively refer to as a "tin can"), you must probably now distinguish nerve pain from soreness of the gums you doubtless feel from the temporary. <<<<< yeah, it is not very comfortable i put the "piece of metal" comment in there for you guys to see, i was wondering if that was something "normal" for dentists to use, because the 2 crowns that i have had b4 i was always given a temporary crown which was some sort of white material, carefully shaped/fitted for my tooth, whereas this was just a piece of metal that he jammed on there and it sticks out on the sides, even catches on my cheek still it feels better than having nothing there - for the first time in 2 weeks i was able to eat a meal tonight almost normally, no pains from hot/cold things touching the tooth & i had a surface to chew against thanks amatus & steve for your comments > still it feels better than having nothing there - for the first time in > 2 weeks i was able to eat a meal tonight almost normally, no pains from > hot/cold things touching the tooth & i had a surface to chew against I have always called it a "miniature beer can" and I have had several of them used on me over the years. Some of them felt better than the permanent crowns. That said, I have never been totally happy with having aluminum in my mouth. Too many alt.stories about how it causes Alzheimer's. Now where was I? Vaughn > steve wrote: > [quoted text clipped - 14 lines] > tooth, whereas this was just a piece of metal that he jammed on there > and it sticks out on the sides, even catches on my cheek I used to use aluminum shells, but I don't remember the last time I did. It only takes a few minutes to make one out of cold cure acrylic. For front teeth and premolars they make polycarbonate crowns that can be relined and adjusted. For back teeth I just put a glob of self-cure acrylic around the prepared tooth, have the patient bite in place, then hand-carve the mass to the shape of the tooth. It only takes a few minutes more, and it is much more comfortable. This however doesn't sound like the kind of dental practice that has that extra few minutes. Steve > still it feels better than having nothing there - for the first time in > 2 weeks i was able to eat a meal tonight almost normally, no pains from > hot/cold things touching the tooth & i had a surface to chew against > > thanks amatus & steve for your comments SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 sounds like you are the kind of dentist worth seeing steve, i commend you on the way that you operate! there were some things that happened in this dentist's office the other day that quite frankly i was amazed at how "slipshod" he operated....maybe i will post about that later > there were some things that happened in this dentist's office the other > day that quite frankly I was amazed at how "slipshod" he > operated....maybe I will post about that later Please elaborate. We can, probably, tell you if your perception of the situation is right or not. Signature/ Amatus / > sounds like you are the kind of dentist worth seeing steve, i commend > you on the way that you operate! > > there were some things that happened in this dentist's office the other > day that quite frankly i was amazed at how "slipshod" he > operated....maybe i will post about that later amatus wrote: Please elaborate. We can, probably, tell you if your perception of the situation is right or not. <<<<< Ok, here goes If i'm wrong to think that either of these 2 examples were less than stellar working techniques please tell me! Just as a simple patient i was a bit perplexed/aghast at some of this, but i could certainly be wrong to think this. (1) To rewind a bit - I told him how sensitive my crownless stub of a tooth was to temp & pressure if something hit it right. Also about the general uncomfortable pressurized feeling that I was having all the time possibly being related to the cement he put in the stub the week before. We discussed some things. He decided to take out the cement, put in the "medicine", see if things calm down. He picks up the drill, puts it in my mouth, and starts to drill out the cement. As soon as he starts doing this I feel a stab of pain and I reacted inadvertantly to this, picking up my foot, groaning, but taking care not to move my mouth or anything like that. He sees my reaction and stops and says that he hasn't done anything yet! That there was nothing for me to feel! Which made no sense to me. I said that if he hadn't touched the tooth yet, then what was I feeling? He again says that there was nothing to feel. I tell him that my tooth is very sensitive to cold for example, so much so that I get pain if i breathe through my mouth if air hits the tooth "right". So perhaps what I felt was a rush of air on the tooth from the drill? That would hurt! That actually was when the whole root canal discussion started, him saying that if my tooth was that sensitive then the root must be dying & i must need root canal. Regardless of whether that is true or not (needing root canal), he said he wanted to continue, to get the cement out, get the medicine in there, see if it calms down. I told him to just go ahead & if it hurts it hurts, I can take it as long as it a quick thing. To his credit though he says no, he will give me novocaine first. And here is where I noticed something perhaps "shoddy". I have never gotten a novacaine shot b4 without first the dentist applying some kind of topical thing first to the gum area. I don't know exactly what the purpose of that is, but assumed that was for both disinfecting and slight anesthetic reasons. He did that when he gave me novacaine for the crown work last week so this isn't something he doesn't know about. But not this time. He just got his novacaine thing out and stuck me a couple times. No topical anything first. Is that kosher? Note that at that time in the room it was just me and him, no assistants to remind him of anything or hand him this or that. Which may have had something to do with it, I dunno. (2) This one really had me wondering. After the novocaine shot(s) he had to run out to see another patient, then come back to me. When he came back he starts drilling then stops and mutters to himself something like "where's the water?". I 4get if there was an assistant already in there or not or he yelled to get one. Anyways, he and an assistant have a discussion. Something about him not having water in his drill. The assistant tells him that this exam room drill is broken, the water in the drill doesn't work, and they put me in this room because they didn't think he would be doing any drilling on me. He says something about not being to drill without the water. They start to discuss stuff like what patient is already in what room etc. He says something to the assistant like, "you just stand on that side and spray his mouth while i drill". As the drillee, I'm not that thrilled with someone going to be drilling on me using equipment which is not working right, having someone standing on one side of my mouth shooting water into me and a dentist on the other side reaching over and drilling, and i have no idea how safe this arrangement is. I try to interrupt and say something like, "hey no hurry, just put me in one of the working rooms as soon as it's free, don't go to all this trouble....".....but he goes ahead and does it anyways. As far as I know it worked fine but - ??????? Didn't seem like necessarily the best thing for a dentist to be doing. Am I wrong to think that? > And here is where I noticed something perhaps "shoddy". I have never > gotten a novacaine shot b4 without first the dentist applying some kind [quoted text clipped - 7 lines] > remind him of anything or hand him this or that. Which may have had > something to do with it, I dunno. No big deal. The topical is just to make the "prick" of the needle less noticable. No other purpose. > (2) This one really had me wondering. After the novocaine shot(s) he > had to run out to see another patient, then come back to me. When he [quoted text clipped - 17 lines] > trouble....".....but he goes ahead and does it anyways. As far as I > know it worked fine but - ??????? That is not comfortable for the dental team, but just fine for the patient. Lots of surgeons operate this way so they can spray ony sterile water on the area. Amatus Thanks for your response about the stuff that seemed odd to me. I feel less uncomfortable about this dentist now. I don't think he's great, but at least I don't think he's "shoddy"! >steve wrote: > [quoted text clipped - 19 lines] > >thanks amatus & steve for your comments bytor, I share your pain. In my case, the dentist DID put the right type of temp. crown on, as described by Dr. Bornfeld. Yet, still I am experiencing pain when I eat sometimes, or when I drink hot tea with sugar. (not sure if it's the hotness or the sugar or both) However it does not seem to bother me when I eat things like pasta or cooked veges, or even crackers. My advice is to do what I'm going to try to do, which is avoid chewing on that tooth, at all. Wish I could put some sort of invisible force field around it so it could not be chewed upon! Why aren't scientists working on this technology?? (-; I could need a root canal, but for now I'm operating with the assumption that I do not. I hate that there is no way to really KNOW, it seems, other than that sudden sharp unyielding pain that might attack me in the middle of the night. Hope you get your permanent crown soon and that it solves all these problems. Wish I could put some sort of invisible force field around it so it could not be chewed upon! Why aren't scientists working on this technology?? (-; <<<<< i heard that that has been perfected but insurance plans won't cover it (sorry, bad joke) I could need a root canal, but for now I'm operating with the assumption that I do not. I hate that there is no way to really KNOW, it seems, other than that sudden sharp unyielding pain that might attack me in the middle of the night. <<<<<<<< i confess to being confused on the whole picture of knowing when you "need" root canal or not surely the big pain that you describe is one of the things can't at least part of this question be answered via an x-ray? (we may have discussed this in a previous thread but i 4get) in my own situation, things feel better today so maybe i don't need root canal - or maybe i do - i don't want to get a new perm crown put in then find out i need root canal & have the new crown destroyed for that Hope you get your permanent crown soon and that it solves all these problems <<<<<< thanks very much; at this point, pending what else develops, i think i'd like to get the new crown put in next week with "temporary cement", so i can have it removed if need be for a root canal, give it some time to see how the tooth feels in the meantime (does that make any sense to the peanut gallery?) good luck with your situation as well, and thx for all the threads you've posted up here >Wish I could put some sort of invisible force >field around it so it could not be chewed upon! Why aren't scientists [quoted text clipped - 3 lines] >i heard that that has been perfected but insurance plans won't cover it >(sorry, bad joke) You're right. It would not be included, it would be an extra cost! >thanks very much; at this point, pending what else develops, i think >i'd like to get the new crown put in next week with "temporary cement", >so i can have it removed if need be for a root canal, give it some time >to see how the tooth feels in the meantime (does that make any sense to >the peanut gallery?) I did not know of that option. Maybe that's what I could do as well...? >good luck with your situation as well, and thx for all the threads >you've posted up here Thanks. Referring to what i said about getting my perm crown mounted with <<<<<< I did not know of that option. Maybe that's what I could do as well...? <<<<<< A friend of mine suggested that idea to me. She had that done to her at her own dentist's suggestion when she was in a similar situation, when not sure if she needed root canal b4 a crown or not. They did it that way to tide her over until they could decide one way or the other if she needed root canal.. She also works as a dental assistant, so maybe that factored in with him willing to work that way with her, I don't recall the whole story. If this is an idea that could possibly help you (jim) that would really make my day! I'd feel like I was giving something positive back to the forum rather than just asking about my own situation. hey jimsocal, i was just reading new posts in your thread about possibly needing root canal b4 a crown, and in there Steve Bornfeld mentions the temporary cement approach as a possibility for your situation! So this must not be that rare of a thing to do. I think that good dentists are flexible and think of these types of options. Hopefully mine won't give me grief if I suggest this approach. >hey jimsocal, i was just reading new posts in your thread about >possibly needing root canal b4 a crown, and in there Steve Bornfeld >mentions the temporary cement approach as a possibility for your >situation! So this must not be that rare of a thing to do. I think >that good dentists are flexible and think of these types of options. >Hopefully mine won't give me grief if I suggest this approach. Right, I saw Dr. Bornfeld's post about that. It sounds like a great idea. We'll see how my dentist feels about it. Mine does not seem very flexible and kind of arrogant and might not like me making such a suggestion. But I'm going to do it anyway! (-; Thanks for the suggestion. I figure posts like our's may help others in similar situations. They can google the archives at google.groups and if nothing else, at least they can see people with similar problems/questions/comments, and read these dentists' responses. > Right, I saw Dr. Bornfeld's post about that. It sounds like a great > idea. We'll see how my dentist feels about it. Mine does not seem very > flexible and kind of arrogant and might not like me making such a > suggestion. But I'm going to do it anyway! (-; That is the problem with managed care dentistry. The office cannot afford the extra time to bring you back and final cement the crown. Good luck ! I hope this is settled with both of you being very comfortable and happy. Signature/ Amatus / So much nicer not to deal with temporary crowns and just bond the restoration in on the same day. So many fewer RCT as well. Signature/ Amatus / > Referring to what i said about getting my perm crown mounted with > [quoted text clipped - 14 lines] > make my day! I'd feel like I was giving something positive back to > the forum rather than just asking about my own situation. > can't at least part of this question be answered via an x-ray? Most of the time, yes, but very often no. > (we may have discussed this in a previous thread but i 4get) > [quoted text clipped - 3 lines] > a new perm crown put in then find out i need root canal & have the new > crown destroyed for that With the way the tooth was treated, there may be no way to test it before the final crown is on and you have lived with it for a while. You may ask to have the final crown put on with temporary cement for the firs 2-3 weeks to make sure it settles down. > Hope you get your permanent crown soon and that it solves all these > problems Hey what is a temporary crown anyway :-) Hi Steve B ! Amatus >>can't at least part of this question be answered via an x-ray? > [quoted text clipped - 19 lines] > > Amatus Hey AC! Up there in Bangor ME, do you ever use a temporary luting material for your CEREC restorations if you haven't decided if a tooth needs endo? Steve > Hey AC! Up there in Bangor ME, do you ever use a temporary luting > material for your CEREC restorations if you haven't decided if a tooth > needs endo? If I decide it needs endo, I do the endo while the restoration mills. I just get less time to post to SMD. If the prep is close to the pulp with no caries invading the pulp, I bond it on and keep going. About 3 times a year I get bore a hole through the CEREC, do RCT then close with CERANA Signature/ Amatus / > >>>can't at least part of this question be answered via an x-ray? [quoted text clipped - 26 lines] > > Steve Listening to you guys makes me feel pretty good about what I deliver. Things aren't always perfect, but usually a lot smoother than your experiences. Dartos Gazing into my crystal ball, I see a man named Jim. He is walking into an office. He seems to be holding his hand to his face. He looks distressed. I can almost make out the words on the door of the office. It says: "End- - - tist, Ro - t C- - al Speci- - -t" I am sorry that is all I can see. The ball has gone dark again. Signature/ Amatus / > >>steve wrote: [quoted text clipped - 41 lines] > Hope you get your permanent crown soon and that it solves all these > problems. |
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