4 months after root canal

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gjedwards@gmail.com - 28 Nov 2006 23:33 GMT

Hi,

I had a root canal on an upper incisor about 4 months ago followed by a
post and permanent crown two weeks later. Ever since the permanent
crown (temporary was fitted between RC and permanent, the tooth has had
a strange sensitivity. It's not really 'pain' as such, and is more or
less unnoticable during the day, but if I run my tongue across the
front or the back of the tooth early in the morning (or sometimes in
the evening) there's a sensensation of 'pressure' I guess, though it's
really hard to describe. I suppose you could just about call it 'pain',
but it's very mild. I've been back to the endontist twice who's xrayed
the area again both times and sees no change. Also there's no
significant pain on percussion (although a slight sensation - more so
than on the other tooth - also RCT'd years ago). He has now referred me
for a 2nd opinion to another endontist. Anyone experienced this, or
have any ideas? My completely naive guess is that maybe the new crown
is 'tight' and is exerting pressure on the gum itself. Possible?

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Steven Bornfeld - 29 Nov 2006 02:33 GMT

> Hi,
>
[quoted text clipped - 13 lines]
> have any ideas? My completely naive guess is that maybe the new crown
> is 'tight' and is exerting pressure on the gum itself. Possible?

    It is possible, but tenderness to percussion makes me think this is
somewhat unlikely. If the crown extends too far under the gumline it
will cause inflammation, but generally this is easy to see and either
you and/or your dentist would see it.
    There may in fact be nothing identifiably wrong. It is thought that
sometimes the cut end of the sensory nerve at the tip of the root may
form a small cluster of nerves that continue to cause sensation. This
is analogous to post-amputation "phantom limb" pain.
    I'm sure this has been checked, but slight discrepencies of the bite of
the crown may also cause discomfort, and if it hasn't been checked yet
it should be looked at.

Steve

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gjedwards@gmail.com - 29 Nov 2006 03:40 GMT

> > Hi,
> >
[quoted text clipped - 27 lines]
>
> Steve

Thank you. I'll be sure to post the results of the 2nd opinion anyway.

Reply to this Message

General Pathology - 29 Nov 2006 03:41 GMT

On Nov 28, 6:33 pm, gjedwa...@gmail.com wrote:

> Hi,
>
[quoted text clipped - 13 lines]
> have any ideas? My completely naive guess is that maybe the new crown
> is 'tight' and is exerting pressure on the gum itself. Possible?

Reply to this Message

General Pathology - 29 Nov 2006 03:51 GMT

BASICS:
In your teeth and supporting structures that hold them in your head
(bone, PDL ligaments, etc.) there are two types of nerves. First, there
are the free nerve endings that sense "ouch" pain. These are what were
treated by your root canal and reside inside the central canal of the
tooth. Second, there are nerve fibers that relay information about
pressure and position and these reside completly outside the tooth in
the connecting tissue that holds the tooth in the bone. RCT will have
no effect on these and they will continue to function.

NEW CROWNS:
First thing is to make sure the crown is "fitting" correctly, but don't
be supprised if your dentist says it looks ok. Without getting into
boring detail...it might take time for the crown to "fit" with the
adjacent teeth, at which point they will self-adjust and the
pressure-pain will go away.

On Nov 28, 6:33 pm, gjedwa...@gmail.com wrote:

> Hi,
>
[quoted text clipped - 13 lines]
> have any ideas? My completely naive guess is that maybe the new crown
> is 'tight' and is exerting pressure on the gum itself. Possible?

Reply to this Message

Steven Bornfeld - 29 Nov 2006 04:10 GMT

> BASICS:
> In your teeth and supporting structures that hold them in your head
[quoted text clipped - 12 lines]
> adjacent teeth, at which point they will self-adjust and the
> pressure-pain will go away.

Personally, I haven't seen crowns "self-adjust". While a crown in
occlusal harmony may feel strange for a day or so at most if the tooth
was in hypo-occlusion with the temporary in place, I see little hope
that occlusal problems will spontaneously disappear after 4 months.

Steve

> On Nov 28, 6:33 pm, gjedwa...@gmail.com wrote:
>> Hi,
[quoted text clipped - 14 lines]
>> have any ideas? My completely naive guess is that maybe the new crown
>> is 'tight' and is exerting pressure on the gum itself. Possible?

Reply to this Message

General Pathology - 30 Nov 2006 05:29 GMT

Yes, you are absolutely right Steve...After more careful reading I
notice now the crown was placed two weeks after RCT. Any tight contacts
should have resolved (if in proper occlusion). Just adding simple
insight into differentiation of pain, which the original author was
vexed to describe.

However, given the description of the pain (running tounge across..ie.
lateral pressure), with lack of acute percussive pain, the problem most
likely resides in the PDL, rather than "phantom-pain," of
endodontically treated nerve fibers. This is best observed in the
percussive "pain or pressure" sensation that is felt after
placement/osteointegration of an implant. Of course, without knowing a
complete history, possible trauma, etc...generalities and background
are all I can offer.

Thanks for the discussion.

On Nov 28, 11:10 pm, Steven Bornfeld <dentaltwinm...@earthlink.net>
wrote:

> > BASICS:
> > In your teeth and supporting structures that hold them in your head
[quoted text clipped - 36 lines]
> >> have any ideas? My completely naive guess is that maybe the new crown
> >> is 'tight' and is exerting pressure on the gum itself. Possible?

Reply to this Message

Mark & Steven Bornfeld - 30 Nov 2006 17:01 GMT

> Yes, you are absolutely right Steve...After more careful reading I
> notice now the crown was placed two weeks after RCT. Any tight contacts
[quoted text clipped - 6 lines]
> likely resides in the PDL, rather than "phantom-pain," of
> endodontically treated nerve fibers.

I'm inclined to agree. Of course, this isn't internet diagnosis.

This is best observed in the

> percussive "pain or pressure" sensation that is felt after
> placement/osteointegration of an implant.

I assume you mean "phantom-pain"? If so, I hadn't heard that. If so,
that would I presume mean if the fixture actually contacted what was
left of the cut afferent nerve bundle from the extracted tooth.

Steve

Of course, without knowing a

> complete history, possible trauma, etc...generalities and background
> are all I can offer.
[quoted text clipped - 46 lines]
>>>>have any ideas? My completely naive guess is that maybe the new crown
>>>>is 'tight' and is exerting pressure on the gum itself. Possible?

Signature

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

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Newbie - 29 Nov 2006 16:09 GMT

>Hi,
>
[quoted text clipped - 13 lines]
>have any ideas? My completely naive guess is that maybe the new crown
>is 'tight' and is exerting pressure on the gum itself. Possible?

Possible but unlikely IMO.

Bet you are a nocturnal clencher/grinder.
You probably just need a nightguard, I prefer
the NTI

headachehope.com

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gjedwards@gmail.com - 15 Dec 2006 17:27 GMT

> >Hi,
> >
[quoted text clipped - 21 lines]
>
> headachehope.com

Well, after further prodding, probing and xrays, my dentist found a
small piece of cement between the crown and the gum, removed it, and
now everything is fine.

Reply to this Message

Newbie - 15 Dec 2006 18:28 GMT

>> >Hi,
>> >
[quoted text clipped - 25 lines]
>small piece of cement between the crown and the gum, removed it, and
>now everything is fine.

Good to know.

That just goes to show that when you hear hoofbeats,
think horses, not zebras...

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