Expert: Tony Appleton BDS DPDS - 2/3/2009

Question
QUESTION: Five months after getting a new crown my tooth #19 developed a fistula. I had a root canal done (four canals) and took antibiotics for a week. Four weeks later I got the tooth prepared for a new crown and an aluminum temporary was placed on it. This was two days ago. It has now started aching. Since it's uncomfortable I don't chew on that side at all. If I wiggle the temporary with my fingers it feels slightly loose and it causes me discomfort. My question is: How can it be determined whether this aching is just because the temporary is ill fitting vs. that perhaps there is still infection in the tooth or jaw?


ANSWER: Hi Gail

Your dentist needs to look at this as you are right, it needs to be diagnosed.  It may just be because the temp is loose, or it may be infection/inflammation.

Regards

Tony Appleton

---------- FOLLOW-UP ----------

QUESTION: I see that I wasn't sufficiently clear with my question. What I wanted to know was by what *means* such a determination is typically made.

The reason I'm asking is because I anticipate that the dentist will blame the endodontist and the endodontist will blame the dentist. I want to be prepared with some degree of understanding of how the determination is made so as to help avoid a potential standoff or wasted time in a situation where diagnosis is perhaps actually quite difficult. I do have a certain advantage in being the person experiencing the actual symptoms. Add to that the fact that I am so fascinated with teeth that I would probably become a dentist if I were thirty years younger.

As an example of what I'm looking for, here are my guesses on what reasonable diagnostic procedures might be:
a. Wait a while to see if it gets worse or better
b. Take another round of antibiotics to rule out infection

Actually, I can't think of anything else either the dentist or the endodontist might do to make the determination of whether the aching is due to the ill-fitting temporary (dentist's fault) or infection in the tooth (endodontist's fault). I would greatly appreciate a few hints hints on what the standard diagnostic tactics are in a situation like this.

Thanks,

Gail

Answer
Diagnosis involves weighing up the symptoms and signs along with the results of any special tests. So they will listen to how you describe the trouble, look at the tooth and assess the mobility (is it the whole tooth that is loose or just the temporary crown), is there any redness/swelling, tenderness in the gum, and may take x-rays and may use a stimulus such as heat/cold or electrical, are you biting correctly onto the temporary.

Considering all of this information then hopefully leads to a diagnosis, or a list of possible diagnoses.  You are then given appropriate treatment options.

Regards

Tony Appleton