Re: My left tooth... again

John wrote:
On Nov 1, 11:12 am, Mark & Steven Bornfeld
<bornfeldm...@xxxxxxxxxxxxxxx> wrote:
John wrote:
Some things I wanted to try to better understand further before I opt
to get the tooth pulled:
- How can a successfully RCT-ed tooth still cause pain? I've been
told if it has a crack in it, but what is the mechanism? The only
living thing the crack could be touching is the periodontal ligament.
Can that really cause significant pain?
Yes.

Can you elaborate a little? Are we talking pinching? Bacteria
getting in the crack and irritating the periodontal ligament?
Something else?

If the crack extends to the periodontal membrane a periodontal abscess will almost certainly result. The degree of pain is variable, depending upon how acute the abscess is and whether drainage is occurring.

- Can gutta percha overfill that is visible on an x-ray and seems to
be coming out of the tooth root apex be the cause of pain? I would
think so, especially if it is impinging on the nerve in the jaw. Is
that actually a possibility? Seehttp://geocities.com/dtminer40/tooth.jpg
for the xray, which I've linked to before on a file sharing site, but
this one is easier to get to.
That doesn't look like a gutta percha overfill, it looks like a puff of
sealer there. Either way, these rarely if ever cause pain. The sealer
is gradually resorbed by the body (gutta percha won't be).

A related question: how close is the nerve in the jaw to the tooth
apex usually? Any way to see the nerve via some contrast imaging
method?

Not close enough for the overfill of the canal to be a factor.

I remember this x-ray. The most likely causes of pain are fracture or
a missed canal, leaning toward fracture. However, I cannot see it. If
the tooth is re-x-rayed, there may be more evidence if there is a fracture.

I've been told by an oral surgeon that because of the orientation of
the tooth, it would be difficult if not impossible to locate the
crack. Does this make any sense? What method could he have been
talking about? (Yeah, I know, why didn't I just ask him? Well, I was
taken aback by his condescending attitude and curt responses, so I got
derailed...)

John.

It's usually difficult to directly see a fracture on x-ray unless it separates or is directly perpendicular to the plane of the film. If it's separating you usually can be pretty certain of fracture based solely on mobility of the tooth. Also, an area of bone destruction on x-ray at the side of the root is often suggestive of fracture. But the statement of the oral surgeon as you put it is pretty meaningless--he's probably not a great communicator.

Steve


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Relevant Pages

  • Variable percussion tenderness on RCT and crowned tooth after 5 weeks?
    ... Pre-RCT pain was exquisite when trying to sleep, ... Tooth was sensitive ... Post-RCT pain was minimal except for tenderness to contact ... the hallmark of a fracture.) ...
    (sci.med.dentistry)
  • Re: Metallic taste in mouth and pain after filling replacement
    ... second amalgam filling. ... regular dentist drill out the old filling where the pain was ... I had the tooth refilled yesterday. ... Considering the dentist was able to visualize a crack, ...
    (sci.med.dentistry)
  • pain from cracked tooth after onlay
    ... left jaw) treated for a crack which ran right through the rear inner ... The dentist gave it a Cerec onlay (which reaches down ... stretching in a curve from the cusp across the centre on the tooth. ... began to notice quite a lot of pain on biting. ...
    (sci.med.dentistry)
  • Re: pain from cracked tooth after onlay
    ... left jaw) treated for a crack which ran right through the rear inner ... The dentist gave it a Cerec onlay (which reaches down ... stretching in a curve from the cusp across the centre on the tooth. ... began to notice quite a lot of pain on biting. ...
    (sci.med.dentistry)
  • Re: pain from cracked tooth after onlay
    ... Cracks in teeth are NOT due to chewing. ... extends into a tooth without extracting the tooth and sectioning it. ... the crack can act like a "wick". ... will infect the pulp of the tooth and cause pain. ...
    (sci.med.dentistry)