Expert: Gary Backlund, DMD, MSD - 11/1/2008

Question
My husband is very traumatized by having to go to the dentist. Unfortunately though, he grinds his teeth and one of them broke apart last December. Our first dentist, who is a very good dentist, put a large filling in it, but did not drill as much as he could have so that hopefully my husband wouldn't have to have a root canal. Unfortunately though, the tooth broke even more - while we were under different insurance, and thus using a different dentist. He says my husband needs a crown (which we agree with). However, he drilled out the entire filling of the first dentist saying that there was more decay under the filling. Now my husband has the temporary crown on but is very, very, very nervous because he feels sensitivity to cold and some pain to pressure (4 days later). He's worried that the second dentist drilled out more than he needed to (the reason the first dentist was conservative in his drilling to begin with) and now he's going to need a root canal. So my questions are: how MUCH pain is reasonable with a temporary crown? How do we know if the pain he is feeling justifies a root canal instead of a crown? The second dentist told him to "pay attention to the sensitivity so that we know if we need to do a root canal before we cement in the crown." But what does that mean? How long are temp. crowns sensitive? I also saw that you told someone else that they could have a root canal done through a new crown-how does that work? Would we not have to pay for a new crown if that happened? I think my husband would rather get hit by lightning than have a root canal. But we also don't want to have to pay for a crown now and then a root canal and another crown in a few months. (That would be like lightning twice). We're going back to our good dentist in January, but the work costs a lot more and his tooth can't wait that long anyway. Thank you very much!

Answer
Hi Megan,

I'm sorry to hear your husband is going through all this, especially when he hates going to the dentist. You raise a number of issues here. Let me try to help.

First, when a temporary crown is done and the filling underneath is large, the tooth can be tender for sometime afterwards. The fact that it feels cold is actually a good sign at this point because it means the nerve is still alive. The important thing here is whether, with time, the sensitivity decreases or increases. If it gets worse, it would be wise to get the root canal before the new crown. The temporary can last for sometime, so I would hold off on anymore treatment until you are able to tell which direction the tooth is going. It could take 2-4 weeks to know for sure, but things should slowly be feeling better...if they are feeling worse, he needs the root canal.

As for doing the root canal through a new crown, that is certainly an option should your husband have problems in the future. However, it can sometimes ruin the new crown causing you to need a new one again, so the best option is to make the call prior to the crown. The way it works is the dentist drill a hole through the crown into the tooth, does the root canal, and then puts a filling in the hole in the crown. hat would certainly save you from paying for another crown.

In a situation like this, you might want to consider asking for a referral to an endodontist. He/she could help your husband interpret his symptoms and, if the root canal is necessary, could make the experience much easier for your husband since all we do everyday is root canals and we see a LOT of fearful patients.

Hope this helps.

Gary Backlund DMD, MSD