Expert: Mark Bornfeld DDS - 10/3/2008

Question

I am a 66 years old female.  My teeth #31 and #18 had been extracted a quite long ago, which caused shifting of opposing teeth #2 and #15.(super eruption)

When I had a consultation with my dentist, his suggestion was that first, have them shortened and second, have them crowned, so that my bottom gum would have enough clearance for the upcoming dental implants of #31 and #18.  It sounded very good to me, and I agreed to have them done

As soon as the work for shortening of the teeth and crowns were completed which was about two month ago, I started having a pain in the both shortened teeth #2 and #15.  My dentist assumed that the cause of pain must be from the nerve of those 2 teeth. In hope for alleviating this pain, the root canals were conducted by an endodontist. However, the same dull pain is still there after the root canal treatments.  The pain is very dull which seems to be coming from somewhere deep down in the gum. There is no sensitivity to hot or cold on neither teeth.

What do you think the cause of this pain?  Do you think it will go away eventually? Was it a bad idea to have these teeth shortened? Is this the correct way to rectify the problems caused by super eruption? Would the extraction be the only solution for getting rid of the pain? Actually, my endodontist can’t figure out the source of this pain either? Your input would be greatly appreciated.


Answer
Dear Danna,

Pain is a non-specific symptom, and could reflect a wide variety of different problems. The fact that the pain onset coincided with the placement of the crowns strongly suggests that the pain is associated with the crowned teeth (although there is always a small possibility that the pain is originating somewhere else-- I will disregard this possibility for the purpose of my answer). Other than that, I will give you my speculative answer:

1. The root canal treatments are deficient in some subtle way that your endodontist either cannot or will not disclose. I would prefer to discount this possibility.
2. Your teeth are still recovering from the root canal treatments and/or the recent crown placements. In fact, this is not uncommon, and any improvement in the symptoms since treatment was completed should be viewed as a favorable sign, even if they haven't yet resolved completely.
3. Something about the way the crowns were constructed either created or exacerbated a periodontal (gum) inflammation around the involved teeth. This might be due to excessively prominent crown contour, or building the bite of the crowns too "high" so that they sustain excessive amounts of chewing force, or leaving space between the crowns, leading to food impaction, or positioning the crown margins too far under the gums, or use of a non-precious alloy in the crowns to which you are allergic.

So, I would recommend continued watchful waiting if you have experienced any improving trend in the symptoms. Otherwise, the periodontal health of the teeth should be explored-- if necessary, by a periodontal specialist.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY