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Medical Forum / General / Dentistry / April 2007Root canal - another followup
Well, three weeks after a difficult RC on a lower second premolar, and it still hurts more than ever. I'm 4 days into taking penicillin to stave off any infection, and all its doing is making me nauseous (don't think I'm allergic, but I often have problems with antibiotics). I see my endo again on Monday. I think I see a crack in the top inner side of the tooth, but I can't be sure. Of course, looking at my molars as well, I seem to see cracks down the sides of most of them, so I may not know what I'm looking at :-) So, my choices would seem to be these: - redo the root canal - apicoectomy to remove root tip - temp crown and hope it gets better - extraction followed by one of: - bridge - denture - implant I get the impression that an extraction followed by an implant will be the least troublesome option, though it will probably also be the most costly and have the longest recovery time. Any comments? >Well, three weeks after a difficult RC on a lower second premolar, and >it still hurts more than ever. I'm 4 days into taking penicillin to [quoted text clipped - 22 lines] > >Any comments? At this stage, hmm am just speculating but... May be a fractured root, if so then extraction is the only choice. Apico on either the first or second lower bicuspids is a rather complicated procedure and may be impossible. There is a neuro-vascular bundle that exits the mental foramen right near the apices of these teeth. See what the endo says, and then choose your path. Best wishes, > Well, three weeks after a difficult RC on a lower second premolar, and > it still hurts more than ever. I'm 4 days into taking penicillin to [quoted text clipped - 22 lines] > > Any comments? John: I agree with the above post. If the tooth is indeed fractured........Extraction will be the choice for my teeth. Implant is always better than a bridge for tooth replacement. Bridge is taking a one tooth problem and make it into a three teeth problem. Best wishes.........I hope you feel better soon......... how long after the root canal did the pain start? hard to give you advice without seeing anything. you need to discuss this with your dentist who can diagnose you and has your x-rays and other pertinent information not us. > Well, three weeks after a difficult RC on a lower second premolar, and > it still hurts more than ever. I'm 4 days into taking penicillin to [quoted text clipped - 22 lines] > > Any comments? If the patient can see cracks and crazing line, he/she is probably clenching with great force during sleep. Time for an NTI before 4-5 teeth fracture bad enough to be extracted.  Signature/ Amatus / > how long after the root canal did the pain start? > hard to give you advice without seeing anything. [quoted text clipped - 27 lines] >> >> Any comments? > If the patient can see cracks and crazing line, he/she is probably clenching > with great force during sleep. Time for an NTI before 4-5 teeth fracture > bad enough to be extracted. It is my understanding that crazing of the enamel is simply the harmless consequence of hot/cold food temperature differences and doesn't affect the underlying dentin. Nor is it a sure sign of bruxism. Now, the cracks I think I'm seeing may not in fact be cracks at all, especially because the endo didn't think they were. But I suppose I'll have my dentist check them too. If the patient can see them with a hand mirror, the crazing has opened up. Normal crazing lines are not visible from 2 feet away. Signature/ Amatus / >> If the patient can see cracks and crazing line, he/she is probably >> clenching [quoted text clipped - 9 lines] > especially because the endo didn't think they were. But I suppose > I'll have my dentist check them too. > If the patient can see cracks and crazing line, he/she is probably clenching > with great force during sleep. Time for an NTI before 4-5 teeth fracture > bad enough to be extracted. It's my understanding that craze lines may only indicate heating and cooling of the enamel relative to the dentin, and are usually nothing to be concerned about. The endo BTW did not see the cracks I said I saw, so either he's a moron, or I don't know what I'm looking at. Crazing lines have no color to them, so are only visible under magnification. If the lines have color to them, they are open cracks. Signature/ Amatus / >> If the patient can see cracks and crazing line, he/she is probably >> clenching [quoted text clipped - 7 lines] > The endo BTW did not see the cracks I said I saw, so either he's a > moron, or I don't know what I'm looking at. > Crazing lines have no color to them, so are only visible under > magnification. If the lines have color to them, they are open cracks. True that. Steve > > Crazing lines have no color to them, so are only visible under > > magnification. If the lines have color to them, they are open cracks. > > True that. > > Steve So, this dentist claims these are craze lines in the lower front teeth here, about 1/3 of the way down the page: http://www.doctorspiller.com/Cracked_Teeth.htm Is he crazed? (sorry, couldn't resist :-) (BTW, sorry for my multiple similar postings above, but google groups seemed to be eating them...) The crazing lines that are white, are still closed. Those which have darkened, have opened up and are developing into cracks. Not a typical picture, since most crazing lines are tougher to see. Signature/ Amatus / >> > Crazing lines have no color to them, so are only visible under >> > magnification. If the lines have color to them, they are open cracks. [quoted text clipped - 11 lines] > (BTW, sorry for my multiple similar postings above, but google groups > seemed to be eating them...) See that presentation fairly often in seasoned citizens. >The crazing lines that are white, are still closed. Those which have >darkened, have opened up and are developing into cracks. Not a typical [quoted text clipped - 15 lines] >> (BTW, sorry for my multiple similar postings above, but google groups >> seemed to be eating them...) >> > Crazing lines have no color to them, so are only visible under >> > magnification. If the lines have color to them, they are open cracks. [quoted text clipped - 10 lines] >(BTW, sorry for my multiple similar postings above, but google groups >seemed to be eating them...) The fourth picture down shows lower anterior teeth with multiple craze lines and some frank cracks. Craze lines are not stained while open cracks are. This page has some good examples of the types of fractures that occur in teeth The last 2 picture sets are prime examples of how posts can fracture teeth. On Apr 22, 1:34 am, Alexander Vasserman DDS <purple543...@yahoo.ca> wrote: > how long after the root canal did the pain start? About a week. It seemed to be getting less painful until then. After seeing what I thought were cracks, I was worried that I bit too hard on something and ruined an otherwise perfectly fine RC. I saw the endo again yesterday, but he didn't think there were any visible cracks. Plus he did various pressure, release, tapping and pulling tests and couldn't elicit pain. Which is true, but my plaints of it still aching basically all the time, and feeling best during the hour or two between waking and breakfast and worse after chwewing, only made him think it wasn't the tooth at all, but something else: he suggested I wait a week and get a crown put on it, and/or see a neurologist. I am still tempted to just have the tooth pulled, but the endo warned about what if it still hurts after that? I suspect it wouldn't (after suitable healing time of course), but what do I know... > hard to give you advice without seeing anything. > you need to discuss this with your dentist who can diagnose you and > has your x-rays and other pertinent information not us. Yeah, well, so far, neither the dentist nor the endo is doing a very good job of that. Which is why I'm here soliciting further ideas. > > Well, three weeks after a difficult RC on a lower second premolar, and > > it still hurts more than ever. I'm 4 days into taking penicillin to [quoted text clipped - 22 lines] > > > Any comments? On Apr 22, 1:34 am, Alexander Vasserman DDS <purple543...@yahoo.ca> wrote: > how long after the root canal did the pain start? About a week. I saw the endo again yesterday, and try as he might, he could not elicit pain via various tapping, pressure/release, biting and pulling tests. I still made it clear to him that it basically aches all the time, feels best in the morning for an hour or two between waking up and breakfast. And feels worse after eating and chewing on it. He basically concluded that it can't be a problem with the RC because he couldn't elicit pain at his office. Is that conclusion valid? I have my doubts. All I know is that it still hurts all the time. He said it might be a nerve problem and to perhaps see a neurologist. Either that or get a crown put on it, which may stabilize things. But since a crown is going to be $600 - $1000, I risk throwing that money away if it doesn't help any. I'm sorely tempted (pun intended) to get the tooth pulled, but with the endo's warning that if the problem is not the tooth, I'll be in the same boat I am now - but with one less tooth - I'm doubting if even that's a good idea. > hard to give you advice without seeing anything. > you need to discuss this with your dentist who can diagnose you and > has your x-rays and other pertinent information not us. Well, yeah, but so far the dentist and endo haven't been too successful. Which is why I'm posting here - to try to get some other ideas. Maybe if we saw you in person, we would come up with more ideas. I have seen people who were severe clenchers with your complaints. A few had multiple RCT and some extractions prior to seeing me. Ended up needing some muscle therapy. Signature/ Amatus / > On Apr 22, 1:34 am, Alexander Vasserman DDS <purple543...@yahoo.ca> > wrote: [quoted text clipped - 27 lines] > successful. Which is why I'm posting here - to try to get some other > ideas. On Apr 22, 1:34 am, Alexander Vasserman DDS <purple543...@yahoo.ca> wrote: > how long after the root canal did the pain start? About a week. It's now 3 weeks after that. I saw the endo yesterday, and he could not elicit any significant pain through various tapping, pulling/releasing, biting, and temperature tests. Nevertheless, I made it clear that it basically aches all the time, less first thing in the morning before breakfast, and more after chewing. There are never really any sharp pains. He basically said that it was not the tooth causing the pain, and suggested I get a crown put on it in a week to stabilize it, and/or see a neurologist. But spending $600 - $1000 on a crown only to find that it still hurts is not my idea of money well spent. I'm sorely tempted to get the tooth pulled despite his warning that if it still hurts after that, I've pulled the tooth for nothing. > hard to give you advice without seeing anything. > you need to discuss this with your dentist who can diagnose you and > has your x-rays and other pertinent information not us. Yeah, well, my endo and dentist are not doing a very good job of that so far, which is why I am posting here for some more ideas after all... Do not put a final crown on until the tooth is comfortable. However,,,,, you could opt for a temporary crown to see if the tooth will settle down. Signature/ Amatus / > On Apr 22, 1:34 am, Alexander Vasserman DDS <purple543...@yahoo.ca> > wrote: [quoted text clipped - 22 lines] > so far, which is why I am posting here for some more ideas after > all... |
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