Expert: Gary Backlund, DMD, MSD - 12/21/2009

Question
Hi Dr. Backlund,

I have some questions that I'm sure lots of people are wondering and yet I cannot find the info I need online.

First a little background:  In 2006 I had a crown placed on tooth number 31.  The tooth had a large filling in it, but didn't require a root canal.  This year in October, I went to a new dentist as we had moved out of state, and discovered that the crown that had been placed on 31 was way to big for the tooth on the cheek side and developed a large cavity.  It had to come off and be replaced.  I contacted my old dentist to let him know (and complain) that the crown was not a proper fit and had leaked.  He actually refunded my money back!  So...I had the old crown removed, the cavity drilled and filled and a new porcelin crown fitted.  My out of pocket was still nearly $600.  For the past month, I have now had a dull aching toothache along with an earache on my right side.  I went back to my dentist to see if there was a problem with 31.  He took an x-ray and honestly, the tooth looked amazing.  No infection, no nothing.  So I went to my doctor to see if maybe I had an ear infection--but nope...no infection there either.  Still convinced that it was my tooth, I went back to my dentist.  He didn't take an xray, but looked at it and says it looks good.  He checked my bite as well, and the bite is fine, no contact with my upper teeth.  I'm confused.  I know my mouth very well.  I've had lots of problems in the past (abscesses, failed root canals, apico's... the whole thing!).  I know my pain is coming from 31.  So...here are my questions.  Is is possible to have reversible pulpitis, despite having had mild toothache for a month?  Would an infection show up by this point (ie. an abscess?), Now that this tooth has a brand new crown on it and possibly needs a root canal, who pays for the new crown?  My insurance is NOT going to pay thier share for another crown 3 months after they just paid.  Am I going to be out around $1000 again plus the out of pocket for the root canal?  I feel like we're bleeding money at the dentists office.  Every time I go, I have to pay out hundreds of dollars, and I'm just getting to a point of not being able to afford it anymore.  I just had number 13 pulled last month after a failed root canal and apico on that tooth and am trying to save up for an implant.  I'm just very disappointed that despite regular dental visits, consistent and time consuming home care, I just cannot keep my mouth healthy.

Thanks for your time in reading and answering, I really appreciate it!

-Tanya

Answer
Hi Tanya,

I'm sorry your going through all this. It must be VERY frustrating for you. When a tooth has been sensitive for awhile, only two things can happen..it will either get better or worse. Even if the sensitivity decreases, that does not mean it is healing.....it can mean it is progressing on from a pulpitis to a full blown abscess and eventually a dead tooth. The problem is knowing and diagnosing the difference. Until the tooth has been abscessed long enough to cause breakdown in the bone, the Xray will appear normal, so in the early stages of an abscessed tooth, X-rays really are not much help.

At this point, you need a good examination with tests to try to determine if the tooth is alive or dead and what your options are for treatment. If a root canal is really needed, it can usually be done through your crown and then a small filing placed in the biting surface, so a new crown would not be necessary. You may want to consider asking for a referral to an endodontist for all this to make sure your diagnosis and treatment is correct and goes smoothly.

Hope this helps.

Gary Backlund DMD, MSD