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Old 11-16-2020, 09:54 AM
 
3 posts, read 1,221 times
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Quote:
Originally Posted by stresslessdds View Post
Hello. I'm sorry for your situation. Sounds tough. Great questions though. In regards to the pain after 2 weeks being due to malocclusion, it is possible that it would take that long. Typically, with pain from a filling that is too high, the patient feels a sharp, electrifying pain when biting on that tooth. It can take 2 weeks because the "shock absorbers" of your teeth that we call the periodontal ligament can get inflamed over a period of time and cause that pain. If that was the cause of the pain, then filing it down should essentially get rid of the pain in couple of days after filing down the filling. If you are still sensitive, there is a possibility that it could be something else. Your dentist can check to see how sensitive your tooth is to something cold to determine the need for a root canal. We call this the endo ice test and it is a very helpful tool to determine if a root canal is needed. Your dentist can also use a probe and check around this tooth to see if there is a sudden drop. This is a bit complex to explain but it lets the dentist know if there is a possible fracture of the tooth.

As far as the lifetime of a tooth goes I have some general advice that I've come up with during my own time a dentist. Don't replace amalgam fillings unless there is a clinical problem with them. In other words, don't fix something that isn't broken. Sometimes patient's want to replace amalgam fillings because they read somewhere that the mercury is bad for you. That's very misleading and unfounded information. Others want to replace amalgam fillings because they don't want silver colored fillings. I understand this more, but I still don't recommend replacing them unless the filling is visible during smiling or the patient is extremely unhappy with the look of them.

The lifespan of a tooth that I personally think of is this. Filling -> Inlay/Onlay -> Crown -> Root canal -> Extraction. This means, for example, if a cavity is small, you can do a filling. If a cavity is everywhere around a tooth you may need a crown, but you cannot go back to a filling afterwards. If you get a root canal and the root canal fails, yes you can get another root canal. If it fails too many times, then there is no other thing to do than to have it extracted. It's mostly a one-way path. So if you want to extend the life of a tooth when you have a filling that hurts, then maybe another filling may do the trick, but it may not work. This assumes you have the money, time, and patience for this.


-Dr. S
Firstly, thanks Dr. S for taking the time to explain. 12 days since I had the malocclusion corrected. The premolar is not sensitive to hot or cold temperature, only pressure when biting down on non-soft foods. The pain doesn't linger, it goes as soon as I remove pressure from eating. Yet when I push on the premolar with my finger I'm not getting the pain. I'm so confused. I'm going to see a dentist on Thursday for a second opinion and ask if they could do an x-ray too.

Thanks for the example lifespan, how might an inlay or onlay act differently to a filling? The amalgam filling was already deep before so drilling out the composite bonded filling and putting in another filling seems risky. I will see what the dentist suggests but I really don't want to have to resort to a root canal or crown for a tooth that was perfectly fine before this filling.

I was self-conscious about the amalgam filling for years and had reservations about changing it, unfortunately for the reasons I'm experiencing now. This is a nightmare scenario and I don't yet know how potentially serious this issue is, fingers crossed things change for the better after I see the dentist.
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Old 11-16-2020, 12:02 PM
 
Location: SW US
2,553 posts, read 2,401,413 times
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I have a crown that was put on the early 90's. The gum has now receded around it and it is sensitive to foods getting on that exposed part. When the hygienist tried to scrape that area for cleaning I about jumped out of the chair.
Should the crown be replaced? Or would the gum recede again?
What else might be done?
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Old 11-18-2020, 09:41 PM
 
44 posts, read 33,871 times
Reputation: 126
Quote:
Originally Posted by Starry_eyed View Post
Firstly, thanks Dr. S for taking the time to explain. 12 days since I had the malocclusion corrected. The premolar is not sensitive to hot or cold temperature, only pressure when biting down on non-soft foods. The pain doesn't linger, it goes as soon as I remove pressure from eating. Yet when I push on the premolar with my finger I'm not getting the pain. I'm so confused. I'm going to see a dentist on Thursday for a second opinion and ask if they could do an x-ray too.

Thanks for the example lifespan, how might an inlay or onlay act differently to a filling? The amalgam filling was already deep before so drilling out the composite bonded filling and putting in another filling seems risky. I will see what the dentist suggests but I really don't want to have to resort to a root canal or crown for a tooth that was perfectly fine before this filling.

I was self-conscious about the amalgam filling for years and had reservations about changing it, unfortunately for the reasons I'm experiencing now. This is a nightmare scenario and I don't yet know how potentially serious this issue is, fingers crossed things change for the better after I see the dentist.
Another possibility is composite sensitivity which can happen. One difference between amalgam and composite is that amalgam expands over a long period of time whereas composite shrinks as soon as we cure it with the blue light. Due to the shrinkage of the composite, the walls of the cavity bend towards the center of the filling and can cause sensitivity when biting down. In cases like this, redoing the filling often helps. It is definitely more difficult to remove composite vs amalgam but the dentist doesn't have to remove every last bit of composite if the composite is in good shape.

Hopefully, it's nothing too problematic. Best of luck.

- Dr. S
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Old 11-18-2020, 09:45 PM
 
44 posts, read 33,871 times
Reputation: 126
Quote:
Originally Posted by Windwalker2 View Post
I have a crown that was put on the early 90's. The gum has now receded around it and it is sensitive to foods getting on that exposed part. When the hygienist tried to scrape that area for cleaning I about jumped out of the chair.
Should the crown be replaced? Or would the gum recede again?
What else might be done?

You need to see the dentist regarding this. If you have gum recession, part of your tooth may be exposed that is often more sensitive to cold and other items. It's not unheard of for dentists to place a filling over there and fix the issue. The other potential issue it could be is a cavity underneath the crown. Since we don't have x-ray vision through crowns, the dentist may have to remove the crown to determine what exactly you need. It could also be other issues besides these two. Your questions demand a visit to the dentist because they are too specific to your situation, and it requires visualizing the issue. Good luck.

- Dr. S
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Old 11-19-2020, 04:46 AM
 
Location: USA
3 posts, read 1,418 times
Reputation: 10
Well, there have been some new developments recently. Earlier this month things got worse. I developed an infection in my wisdom teeth, the broken one on the bottom left is really badly infected.

I don't think I realized that my wisdom teeth were at the heart of it all. Not when I was experiencing such severe nausea and stomach pain on top of everything else. A stomach flu, I told myself. Until it got so bad that I was having a hard time breathing, my chest hurt and I was out of it mentally.

After a trip to the doctor I was put on antibiotics for the infection. I did go to the dentist and they told me to have my wisdom teeth removed. But I have such severe dental phobia, anxiety and panic attacks that I'm now facing the possibility of surgery under general anesthesia. And the only place that will use general anesthesia doesn't take my insurance. Which is lovely.

I am unemployed, fighting with delays to get my unemployment payments months after I signed up for unemployment, and have limited funds to pay for this. I think I can pay for this, but out of curiosity, how much does it usually cost to remove the roots of two badly damaged wisdom teeth under general anesthesia? Because that's all I really have left at this point is roots. The dentist even wrote on his paper "removal of root tips."

They won't give me an estimate until I go in for the consultation, and I'd like an idea of how much this will cost before I get into this. If it helps, I live in the state of California, because I know costs can vary from one place to the next.

Last edited by Rosepetals95; 11-19-2020 at 04:56 AM..
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Old 11-19-2020, 09:11 AM
 
Location: Florida
13,720 posts, read 6,814,093 times
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Quote:
Originally Posted by chiluvr1228 View Post
I broke off part of a tooth - had to have a crown and a root canal. Now I am having discomfort in that same tooth. The endodontist said I may need to have that tooth removed! What is up with that? I thought a root canal meant I would not have any pain in the tooth ever again.

My regular dentist said it's possible the endo didn't remove all the "canals". I spent $3K between the root canal and the crown and I'm not removing the tooth.

Should I get a second opinion from a different endodontist in the original guy's office or a different practice entirely?
I posted this a few weeks ago but have not seen an answer yet. I hate to have the tooth removed after spending over $3K between the root canal and the crown. Called the endodontist this week and he said that he could "re-treat" the tooth but that it would be an additional $1,400 and there was no guarantee. The tooth has been bothering me more and more but I hate to remove a tooth and worry about the rest of my teeth shifting. It's a top molar and wouldn't be noticeable but is having an empty space there going to cause discomfort? I'm 65 btw.
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Old 11-19-2020, 10:39 AM
 
4,347 posts, read 1,810,974 times
Reputation: 10067
Quote:
Originally Posted by chiluvr1228 View Post
I posted this a few weeks ago but have not seen an answer yet. I hate to have the tooth removed after spending over $3K between the root canal and the crown. Called the endodontist this week and he said that he could "re-treat" the tooth but that it would be an additional $1,400 and there was no guarantee. The tooth has been bothering me more and more but I hate to remove a tooth and worry about the rest of my teeth shifting. It's a top molar and wouldn't be noticeable but is having an empty space there going to cause discomfort? I'm 65 btw.
Sometimes removal is the best way.I'm 74. I've had three molars removed in the past several years. I got used to the empty spaces. One of the molars is a bottom tooth and the top tooth hasn't shifted. If the crown didn't work out I would get a dental surgeon to just pull it. Should just be a few hundred dollars. My wife has several missing teeth where they could be seen and has 2 partial bridges.
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Old 11-19-2020, 12:04 PM
 
Location: SW US
2,553 posts, read 2,401,413 times
Reputation: 4586
Quote:
Originally Posted by stresslessdds View Post
You need to see the dentist regarding this. If you have gum recession, part of your tooth may be exposed that is often more sensitive to cold and other items. It's not unheard of for dentists to place a filling over there and fix the issue. The other potential issue it could be is a cavity underneath the crown. Since we don't have x-ray vision through crowns, the dentist may have to remove the crown to determine what exactly you need. It could also be other issues besides these two. Your questions demand a visit to the dentist because they are too specific to your situation, and it requires visualizing the issue. Good luck.

- Dr. S

The dentist just told me I need to use fluoride toothpaste or mouthwash. He also said he could replace the crown. He didn't mention the filling part so I will ask about that next time. He's a new dentist for me and I'm not sure how to evaluate his abilities.
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Old 11-19-2020, 04:26 PM
 
3 posts, read 1,221 times
Reputation: 10
Quote:
Originally Posted by stresslessdds View Post
Another possibility is composite sensitivity which can happen. One difference between amalgam and composite is that amalgam expands over a long period of time whereas composite shrinks as soon as we cure it with the blue light. Due to the shrinkage of the composite, the walls of the cavity bend towards the center of the filling and can cause sensitivity when biting down. In cases like this, redoing the filling often helps. It is definitely more difficult to remove composite vs amalgam but the dentist doesn't have to remove every last bit of composite if the composite is in good shape.

Hopefully, it's nothing too problematic. Best of luck.

- Dr. S
Thanks Dr. S, I've seen a 2nd dentist for an opinion, he said as he didn't do the filling he can't say much. He took an x-ray and can't see any issue with the filling from exterior. He mentioned it is close to the nerve which could potentially be what is causing the pain when I bite hard food but he can't be sure.

I went back to the dentist who did this filling today and they took an x-ray too. It looked less close to nerve on x-ray, I guess because of the angle it was taken. He said filling looked good, no sign of infection at the roots. He fixed my bite some more, filing down the filling. When putting a little pressure on the tooth surface with my finger I feel the sensitivity and start of pain. The previous time he fixed malocclusion, I couldn't feel pain when I put pressure on it with my finger. Let's see, it might need time to heal. He said if it doesn't work a replacement filling might be next step. These are the x-ray pics, hope you don't mind me sharing:

https://ibb.co/VxYcvGn
https://ibb.co/NyYwgnb

I've lost almost 3 kilos during this stressful journey so far, hopefully sharing my symptoms clearly helps someone who might be going through something similar.
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Old 11-21-2020, 10:50 PM
 
9,672 posts, read 9,925,210 times
Reputation: 11497
Quote:
Originally Posted by stresslessdds View Post
Hello. It appears that your situation is more on the unique side. I have personally seen many different and unique looking artifacts and lesions near the root tips of some of my patients so it can happen. As I mentioned in earlier comments, antibiotics do not typically get rid of infections but rather make them subside. So if there was an infection before the antiobiotics, there is still going to be an infection now. With that said, I would listen to the the endodontists you spoke with. You seem to be doing a good job getting second opinions which is highly encouraged. Typically, they will tell you exactly what you said that they mentioned...... do another retreatment with no guarantee of long term prognosis vs extracting now. It's really appears to be up to you at this point.

With all of my patients I always think in my head for a second, what would I recommend to my sister in this case assuming my sister was a millionaire. Looking at things like this is not realistic as patient's typically have financial concerns, but it gets me the best treatment option. In your case, if it were my sister, I would say do a root canal retreatment. I wouldn't call it agony, the nerves are already gone from the first root canal anyways. Also, since I'm assuming the whole millionaire thing for a second, cost isn't an issue.
Thank you for your reply. Just an update on my situation. After seeing 2 general dentists, 3 endodentists, and 3 oral surgeons (don't ask; I got so many different opinions), the general consensus is that this molar cannot be saved and a retreatment would only be a temporary fix or wouldn't fix the problem at all. 2 out of the 3 oral surgeons said that there was a cracked root. All of the dentists said that there was an acute infection. One of the dentists suggested an apicoectomy but none of the oral surgeons said that it was feasible since the cracked root was on the side (Palatal?) that was inaccessible. The bottom line is to get the tooth extracted with a bone graft, then a possible sinus lift or just get an implant directly, depending on whether additional bone would need to be added. It's going to be a long process. I also got differing opinions about whether these procedures could be performed after taking oral bisphosphonates, but it seems that I will have to take the risk since this baby has got to come out. Fortunately, cost is not an issue. I just want the procedure performed properly and I do have dental insurance.

It's funny that when I spoke to 2 of my MDs regarding the bisphosphonate issue, they both replied (while holding their cheeks) that dental pain was the worst pain ever and that they were babies when it came to going to their dentists.

Thanks again for reading my post.
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