Expert: Frederick R. Liewehr DDS, MS, FICD - 11/10/2009

Question
QUESTION: I had an exposed nerve and constant tooth pain and so my dentist recommended a root canal. I had a root canal and the tooth was filled instead of a crown. I began experiencing pain/sensitivity on both sides of the tooth and sometimes on the surface when I chewed. My dentist could not find anything wrong with the tooth and sent me back to the endontist who did the root canal. He found a small crack in the tooth and recommended a crown. I had a crown put on and am still experiencing the same discomfort. It is not necessarily pain but the side of the tooth closest to the cheek is sensitive to the tooth if I touch my cheek. There is also some sensitivity and slight pain when I eat on the tooth as well. Therefore I am very reluctant to eat on the tooth at all. What could this problem be? Is my only other course of action to have the tooth pulled? Could I need another root canal on the same tooth? Any advice you can offer would be greatly appreciated as I am very concerned. Thank you for your time.

ANSWER: I can't give you accurate advice without knowing what your endodontist saw when he treated your tooth. However, putting a crown on after the tooth is cracked is often closing the barn doors after the cows are out. Too late. It prevents further splitting, but obviously cannot repair the damage already done. So, these teeth often never feel right to biting. If the tooth is sore to touch, the crown may be too "high", in hyperocclusion. You can test for this by biting and grinding with nothing in your mouth. If this hurts, your crown needs to be adjusted, and the constant pounding may be making your tooth sore. If it doesn't, and if the tooth is sensitive to cold, the endodontist could have missed a canal, but this is rather unlikely. You shouldn't overlook the possibility that it is another tooth, either. Your endodontist should be able to help you sort this out.

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QUESTION: So if the  tooth was cracked and the crown was put on it what can be done?
Will I cause further damage by eating on this tooth or will it just continue to be sensitive?
I don't believe that the crown is causing the pain as it was this same pain/sensitivity that led me back to the endodonist and his recommendation that a crown be placed on the tooth instead of the filling the dentist had placed after the root canal. There is no sensitvity to either cold or hot.

Answer
Nothing more can be done. If you are not biting prematurely (you passed my biting test), then it is just sensitive due to the crack. It may give many years of service, but always be a bit tender to biting. The alternative is extraction. All this assumes the root canal therapy was well done, which I have no way of evaluating.