Re: Crowned tooth needs root canal?


----- Original Message -----
From: "Steven Bornfeld" <dentaltwinnonsense@xxxxxxxxxxxxx>
Newsgroups: sci.med.dentistry
Sent: Friday, July 15, 2005 12:55 PM
Subject: Re: Crowned tooth needs root canal?


> It is certainly possible that a crack can progress despite the presence of
> a crown. In this case however it's unlikely that a root canal is going to
> be able to save the tooth. In a situation like this there is often a
> vertical root fracture, and if a crown does not prevent its spread the
> tooth will sometimes be lost.
> The first thing to do is to confirm that the crowned tooth is actually the
> tooth responsible for your pain. If it is (and before progressing to root
> canal treatment) I would remove the crown and any underlying restorative
> material if at all possible and examine the tooth carefully--preferably
> with magnification.
>
> Steve

Thanks again. I was just now able to determine the crowned tooth is for
sure the one that is the source of the pain by biting on a q-tip - using it
almost like a home-made tooth sleuth - which I learned from an original
cracked molar where a dentist used a tooth sleuth to diagnose it. I learned
about using a q-tip as a type of tooth sleuth from lurking on smd on and off
over the years. I tried biting on all the upper molars with the q-tip and
the only one that hurt when I bit on the q-tip was the crowned molar but it
hurt on the cheek side instead of the tongue side where I thought the pain
was originating from. Don't now if a sprained tooth can cause this same
type of pain. The bite has been adjusted because it was high in places. I
rested the tooth from all chewing for a week but as soon as I began chewing
hard foods on that side again, the pain resumed as it was before the bite
adjustment on the crown.

My dentist - who is a second opinion dentist - thinks there is a possibility
the crown might be loose or leaking and the pain could be caused by decay
getting inside. I didn't want to destroy the crown or damage my tooth
further drilling the crown off only to learn the tooth was actually cracked
into the nerve and could be fixed by a root canal and then have to buy a
second crown. I thought if it needed a root canal - then I should do that
first and then, if the crown survived, see if that solved the problem. If
not, get the old crown drilled off the root canalled tooth and replace the
crown and pay the big bucks in that order.

Unfortunately the crown is fairly new - only three years old. I don't know
if that might make it harder to get off without destroying it. It was
placed by a prosthodontist who is retired. It's actually the nicest and
appears to be the most high quality restoration I have in my mouth. It has
a composite build up underneath the crown. I wonder if my endodontist could
drill into the biting surface of the crown like he was preparing to do a
root canal, remove the build up and get a look at the tooth that way with
his microscope.

Another thing that really concerns me is that this tooth is an upper first
molar with roots almost inside my sinus. The roots have always been that
way. I've been told that about the closeness of the roots my entire life
when I get x-rays but it's never caused me any pain problems the tooth in
the past. Because of the close proximity to the sinus cavity, I don't know
if I could have an extraction without causing damage to my sinus bones and I
don't think there is even enough bone and space for a replacement tooth
implant to ever be screwed in. As far as a sinus lift goes; I don't know if
everyone is a candidate or only those people whose sinuses have sagged. I
have very small bones and I think the closeness is just part of my body make
up. It's compact and everything is close together. Unfortunately the teeth
on either side of my molar have no restorations; which makes a bridge a more
invasive situation. I've been concerned about anything happening to this
particular tooth for all those reasons.

I was/am a heavy clencher and they didn't know how to prevent the damage
like they do now with NTI's. Because of that, over the years, my teeth have
been damaged by abfraction lesions, cracked molars, and gum recession even
though I have almost perfect home care and am in good health. I will talk
to the endodontist about what you suggested when I go in on Tuesday for his
evaluation. Unfortunately from having more than one cracked molar, I pretty
much remember what the feelings are with a cracked tooth and that is what
this feels like. I truly hope and pray I'm wrong on this. I didn't know it
could be a hopeless case that couldn't be salvaged by a root canal. I
thought only teeth with root canals were subject to root fracture and
couldn't be saved.

Thank you very much for responding. The help and education people can get
here is vital. Thank you again for trying to help me understand my options
and what might be possibly going on. If you get any more ideas on my
situation, I would appreciate it. The help you have already given is
appreciated very much.

> --
> Cut the nonsense to reply

>


.

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