Expert: Gary Backlund, DMD, MSD - 12/17/2009

Question
Dr. Backlund,

Thank you in advance for taking the time to address my COMPLICATED situation in my time of extreme frustration.  I'm only 25 years old with healthy adult teeth but when I was little I was irresponsible about brushing and ate lots of sweets.  One of my permanent teeth (tooth 19) needed a root canal when I was only 10.  After the procedure I received a metal crown and as I got older I decided to replace it with a prettier porcelain crown. Every dentist I ever went to said to go to an endodontist to double check this root canal as x-rays showed I may need re-treatment  before I place on an expensive new crown.  I found a dentist with high user reviews in regards to aesthetic dental work who also can apparently perform root canal treatments.  He looked at my x-rays and said the tooth didn't need re-treatment and proceeded to do what was necessary for my porcelain crown.  Three weeks after getting my crown I was eating mac and cheese and the new crown CHIPPED! I ran back to him and he ordered me a new crown to be placed within 2 weeks.  During this waiting period the crown continued chipping away to the point where my tooth was exposed.  When I went back to get my replacement crown I mentioned pain under the tooth (it was my gums, but only if I pressed on it) and expressed my concern that it might be infected.  He said its unlikely and placed the crown on, THEN took x-rays because I asked him again and put me on amoxicillin for a week.  I took it every 6 hours religiously, still it gets worse so he decides to put me on Clindamycin HCL 300mg/4x a day and drill through my expensive crown to retreat the root canal after all (it took all this for him to hear me?). Some of the infection "bubbled" out but he never attempted to remove all the infection other than what came out during his poking around. When he finished, I asked if the infection is gone and he said "Well some of it came out, keep taking the antibiotics and we'll see Jan. 4th (next appt.)".  Shouldn't he have made it a priority to remove the infection "fluids"? The next morning (today) I felt swelling where my infection is/was.  As the day progressed the swelling got worse and now it looks like I have a golf ball attached to my left lower cheek/jaw. I called him and he said this shouldn't be happening and to come see him tomorrow.

What is going on?! The crowned tooth feels loose (I can slightly move it w.my fingers) and if I push it down I feel dull pain.  FIFTEEN years after first root canal treatment and just now it gets infected I THINK due to crown breakage (but he denies that's the cause) then when I go back to him it gets even worse.  I feel like he only listens to me when "poo" hits the fan! I'd be better off never having gone to him.  Please shed some insight for me! What is happening? And should I be paying for all this?!  I feel powerless and truly stuck...    Thanks so much for your patient reading.

Answer
Hi Meri,

I'm sorry you're going through all this, especially with a new crown. From what you describe, it certainly sounds like what you are dealing with is a failing root canal. It seems like the other dentists you saw suspected this. The gum boil and looseness of the tooth are symptoms of this problem. The infection can be controlled by antibiotic, but they won't heal the problem. You most likely need the root canal redone. I would doubt that this anything to do with your crown except that the dentist maybe should have seen a problem before placing your crown. It would not be caused by any crown leakage as it would take a long time for decay or saliva to reach the inside of the tooth and wash out the cement in the root canal filling. Most likely this was all just waiting to be a problem.

At this point, I would ask for a referral to an endodontist to find out what your options are to fix the problem and what it will cost. Retreatment is beyond the ability of most general dentists. As for paying for all this, you'll need to discuss that with your dentist, however, the only question in my mind is why this wasn't diagnosed prior to the new crown.

Hope this helps. Good luck!

Gary Backlund DMD, MSD