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Medical Forum / General / Dentistry / August 2006Can't tell what's wrong with my tooth
Hi all, I'm 23 years old and recently had a lower 2nd molar extracted and replaced with an implant due to a severe crack that dentists didn't notice until it was far too late to save the tooth. It all started when I broke off a cusp when I was a kid. It was progressively replaced and replaced until the replacement went so deep that it split the tooth. I had a root canal and crown, after which the dentist told me it was cracked so badly it probably wouldn't last. After six months of heat pain and tenderness, I finally got them to remove it and do an implant. About a month after having the bottom tooth removed, I noticed tenderness in the molar directly above the empty space. It would hurt to press on it. I went back to the dentist, who couldn't find anything wrong via xray. He sent me to two endodontists, both of whom did pulp tests (vital and normal) and xrays and checked my gums and used a bright light and microscope. They both couldn't find anything wrong but one said I could have a hairline crack that just wasn't showing up somehow. After this, the dentist sent me to an ENT doctor, who couldn't find any inflammation in my sinuses, although my sinuses do come down very low into my teeth area. I got the crown part of the implant done last week and this tooth is still tender. It is tender to biting on things like cereal, but not as much on things like toast or other soft foods. It is sore to push on with my finger, almost like a bruise. There is no abnormal response to cold or hot. Sometimes it hurts to push it from the side or to push my fingernail into the crevice between this tooth and the next. And when it's really acting up, it hurts to tap on it with my fingernail. Often when I wake up it doesn't hurt one bit, but then later in the day it hurts more. Some days pressure hurts and some days it feels just like any other tooth. I'm not sure what to do--there are no explicit signs of yet another cracked tooth, but if it is a crack I don't want it to become thousands more dollars in extractions and bone grafts and replacements. I don't understand how I could have cracked it without a tooth beneath it. I have no signs of grinding and no deep filling or anything like that that would provoke a crack. Can anyone offer any advice? Thank you! Have your gums been checked thoroughly? No inflammation, or pocketing in this tooth? What about the adjacent teeth? Have you had a bite test done? This is where the dentist will use an implement called a "Tooth Slooth" or "Frac Finder" (really just a piece of plastic) and get you to bite down on it, isolating individual parts of the tooth. This is one test for cracked teeth. What about your muscles? Did the dentist(s) palpate your cheek and biting muscles? It seems strange to me that you are still getting tenderness when you bite down on this tooth, even when you didn't have an opposing tooth to bite against. Are you sure it's not coming from another tooth? If not, how are you biting down on this tooth to get the pain? > Hi all, > I'm 23 years old and recently had a lower 2nd molar extracted and [quoted text clipped - 34 lines] > > Thank you! Thanks for replying! Yes, my gums were checked for pocketing or any other abnormalities, as were the teeth around it. I have had a bite test done. Strangely enough, sometimes the bite test revealed soreness, and sometimes it was 100% completely fine. My muscles (I think the lateral pterygoids, the dentist said) *are* inflamed on that side of my face, but I would have thought this would affect several teeth up top and not just the furthest back molar. Is it possible that it would only irritate one? Apparently when I only chewed on one side for a year, it threw off my muscle balance. I had some radiating ear pain from this for awhile but it's subsided mostly. I'm positive it's not coming from another tooth. I can easily replicate the pain (that is, when it's symptomatic, which isn't always). When I didn't have another tooth below it, I would press hard with my thumb or (more rarely, out of caution for my remaining teeth!) wedge something plastic that I could reach that tooth with. I notice it more in the region abutting the next molar. Those two teeth are kind of pressed together--not enough to be considered impaction, from what I understand. They're just close. I appreciate your help! :) >Have your gums been checked thoroughly? No inflammation, or pocketing >in this tooth? What about the adjacent teeth? Have you had a bite test [quoted text clipped - 14 lines] >> >> Thank you! Oh and I just wanted to clarify--when I said that sometimes the bite test hurt and sometimes it didn't, I mean on separate days and not separate biting instances on the stick during an evaluation. It's amazing how it can start out nearly normal, become sore at midday, and then resolve again at night. And not to keep posting to my own thread, but I've noticed it seems to flare up more if I've been smiling a lot (after my wedding it hurt badly) or in the winter when I chatter my teeth outside. Sounds like you have either a slowly developing abcess or a hairline crack somewhere in the tooth. At any rate, these can be extremely difficult to elucidate, and I'd hate to do something just to "do something." Ultimately, it will either get better [then you are lucky] or get worse -- and then you've got more to go on in a diagnosis. Good luck. > Hi all, > I'm 23 years old and recently had a lower 2nd molar extracted and [quoted text clipped - 51 lines] > > Thank you! Do you know what would have caused an abscess or crack in what the dentists have called a "virgin tooth"? (If it really is a crack or infection, I just have to deal with it of course, but it kills me that it would just come on spontaneously). I thought these things were caused by grinding or by decay, neither of which I have. I'd like to prevent these things in the future! Thank you! >Sounds like you have either a slowly developing abcess or a hairline crack >somewhere in the tooth. At any rate, these can be extremely difficult to [quoted text clipped - 7 lines] >> >> Thank you! > Do you know what would have caused an abscess or crack in what the dentists > have called a "virgin tooth"? (If it really is a crack or infection, I just [quoted text clipped - 3 lines] > > Thank you! I have seen this only a few times in 30 years. More frequently we see cracks leading to tooth loss in teeth that have been filled heavily, but a surprising number have smallish fillings. More frequently (at least in vital teeth) these fractures are down and away from the center of the tooth, and the tooth can be saved by a crown. Why a virgin tooth would crack vertically I can only speculate. On these very occasional circumstances the patient usually cannot relate a history of trauma. One woman who cracked an intact upper premolar certainly looked like a grinder. Most of the time I suspect an errant olive pit, possibly years ago, long forgotten... Steve >>Sounds like you have either a slowly developing abcess or a hairline crack >>somewhere in the tooth. At any rate, these can be extremely difficult to [quoted text clipped - 8 lines] >> >>>Thank you!  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 If you don't mind, I have a few more questions: Is the phenomenon where the tooth is sore to pressing on it one day and completely normal the next, on and off for over 6 months with no consistency, in line with a vertical fracture? (I would have thought it would get worse, or at least be sore every day). What would cause a vertical fracture to hurt more when I smile a lot or otherwise strain the muscles in my face? Lastly, how does a fracture occur without an opposing tooth on the bottom to even do the fracturing? I'm starting to panic now because I certainly can't afford another extraction, bone graft, sinus lift (which I'd probably need) and implant, so I'd just have to deal with all the negative effects of a missing tooth. I'm too young to have these sort of problems without gross negligence. Personally, I'm still hoping it's not a fracture, particularly because the tooth seems to be feeling *better* rather than worse now that I have a tooth to oppose it. I asked the dentist if I could have a vertical fracture back when I first saw him for this, and he pretty much ruled it out. However, if it's extremely rare, I can understand why he'd do so. Thank you!! >> Do you know what would have caused an abscess or crack in what the dentists >> have called a "virgin tooth"? (If it really is a crack or infection, I just [quoted text clipped - 20 lines] >>> >>>>Thank you! > If you don't mind, I have a few more questions: I'll supply some possibly speculative answers. ;-) > Is the phenomenon where the tooth is sore to pressing on it one day and > completely normal the next, on and off for over 6 months with no consistency, > in line with a vertical fracture? (I would have thought it would get worse, > or at least be sore every day). Cracks don't go away. Any infection associated with the fracture might wax and wane--but I'd guess there would always be some discomfort. With a fracture, characteristically the pain isn't described as "sore", but as a sharp sometimes stabbing pain. Abscess pain is consistent with soreness to biting pressure. Note that both of these may exist at the same time. > What would cause a vertical fracture to hurt more when I smile a lot or > otherwise strain the muscles in my face? This is more likely when the tooth is infected and esp. when the infection has already extended into the soft tissues, as the muscles pull over the swollen area. It is possible that facial muscles might put enough stress on a fractured tooth to elicit pain, but this sounds a little far-fetched to me. > Lastly, how does a fracture occur without an opposing tooth on the bottom to > even do the fracturing? That's a good question. Sounds unlikely. > I'm starting to panic now because I certainly can't afford another extraction, > bone graft, sinus lift (which I'd probably need) and implant, so I'd just [quoted text clipped - 6 lines] > when I first saw him for this, and he pretty much ruled it out. However, if > it's extremely rare, I can understand why he'd do so. Based on what you're saying, I'd say the chances of a vertical fracture are slim. But this doesn't mean there might not be something else going on. I hadn't realized this was an upper back tooth--soreness may not even be dental in origin. You mention sinus lift--you know the roots of some of the upper rear teeth are sometimes in very close contact with the maxillary sinus lining. A sinusitis can be responsible for what feels like dental pain in this area. Steve > Thank you!! > [quoted text clipped - 24 lines] >> >>>>>Thank you! SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Thank you so much for your time and consideration, Dr. Bornfeld! I sincerely appreciate it! >> If you don't mind, I have a few more questions: > [quoted text clipped - 47 lines] >>> >>>>>>Thank you! |
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