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Dentistry/Crown failure?

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Question
Hello,

Thanks in advance for your advice.

I am wondering about crown failures/problems. I had my first crown put on about a month ago. After the dentist removed the old (broken) filling, she had to do some build-up on the tooth before the crown would fit.

The crown felt fine for 8 days and then on the 9th day, suddenly I had pain shooting down from the tooth (it's a bottom tooth) whenever I bit down on anything. It was also suddenly very sensitive to cold and hot. I couldn't even bite into a piece of soft bread without the pain. I couldn't see the dentist for about 5 days so I just chewed on the other side of my mouth for a while. When I did see her, she did an x-ray and examined everything and said that everything LOOKED just fine and that the seals looked tight (or something like that) on the x-rays. She blew air onto the tooth and it didn't hurt, but biting down on the little metal tool was quite painful. Anyway, she shaved a tiny bit of the crown down (my bite feels pretty good though) and told me to take some ibuprofin for a few days and try to not chew on that side for a few days because she said maybe I had bitten something wrong and things were inflamed.

It's been two weeks since I saw her, but the pain hasn't lessened very much. I CAN eat soft things fine now, but anything with any resistance is very painful to chew. The sensitivity to heat has declined a lot and the cold sensitivity is still there but not quite as shocking. Anyway, I will go back to the dentist in a few days and let her know that things still aren't good, but I was wondering if you had a second opinion about what might cause that kind of pain but not be visible on an x-ray or a visual exam.  Is there something else I should do before asking for a new crown? How often do crowns "fail"?

Thank you!
Megan

Answer
Dear Megan,

Here's the secret that only I know.  Now you will know the secret.  Only the two of us now will know it.  And the secret is....

Every time we cut into a tooth to do something good (remove decay; prepare for a crown, etc) we are cutting into the tiny nerve fibers that run through your dentin (the bone-like substance that lies under your enamel).  This dentin contains thousands of tiny nerve fibers that connect to the nerve deep inside your tooth.

Now let's imagine that, instead of cutting your tooth, I am removing a mole from your skin.  From the skin on your foot.  From the skin on the bottom of your foot.     I make you numb so you don't feel it, then I remove the mole by cutting your skin, then I put on some disinfectant and a bandaid.  I don't think I would have to tell you to leave it alone.  Tell you not to walk on it for a while.  Certainly don't go running a marathon tomorrow.  Just protect it for a few days and let it heal.  You just would know not to do these things.  But when it's your tooth, we tell you "wait until the numbness is gone before your eat."  So after a couple of hours, you will want to have some food.  Maybe test the new tooth.  This is the equivalent of walking on your foot that has just been cut.  If you clench your teeth (a habit that about 50% of Americans have), this is the equivalent of running a marathon on that foot.

When we cut into a tooth, especially to make a crown, we are cutting away the enamel and a portion of the dentin (nerve fibers).   So your tooth nerve will become irritated for a while.  Sometimes inflamed (like a cut that is healing).  Sometimes infected (about 5% of the time).  What happens after we place your filling, or cement your crown, is that all this tinkering will cause the nerve to swell inside your tooth.  Often this swelling will cause the tooth to elevate very slightly in the socket in the first few days after the procedure.  Because we dentists are trained to make your new tooth chew against your natural teeth just the same as it used to, if there is any swelling, combined with eating and clenching, your tooth will get worse rather than better over time.  This is why (shhhhhh....)  I will make my crowns very slightly OUT of your bite.  This allows for swelling to occur without placing your new tooth into a HIGH bite, which will begin a cycle of inflammation and pain that you experienced.

When you go back to your dentist, ask if she will adjust it slightly out of your bite.  Then baby this tooth for about a week, chewing on the opposite side.  Give that nerve some time to heal.  And remember that no matter how good is the work that we do, about 4% of all tooth treatments will end up needing a root canal.  So do everything you can to avoid this tooth and reduce the inflammation in its nerve (ibuprofen, 2 every 4 hours for 4 days).  

Let me know how this works out.

Dentistry

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Howard Finnk, D.D.S., P.A., CEO

Expertise

I am a Family, Implant and Cosmetic dentist. I will answer questions on any aspect of dentistry and matters relating to the smile, gums, jaws and lower face. Member American Dental Association, Florida Dental Association, Broward County Dental Association, and Atlantic Coast District Dental Association. I have served as District Council Member of Alpha Omega, as well as serving for one term as its President. I am also a member of The Vedder Honors Society, Broward Dental Research Clinic, and Mount Sinai Hospital Guild. I have served as a Volunteer for Project Dental Health and The Tri-County Dental Health Council.

Experience

Having attained over 30 years of clinical experience in private practice in Michigan, in 2001 I was re-certified by taking and passing the Florida State Dental Board Examination. After moving to Florida, I spent nearly 10 years re-honing my skills while working as an Associate Dentist for several large dental groups. In September, 2004, I was appointed Adjunct Clinical Professor at Nova University's College of Dental Medicine. I am certified in placement of Mini Dental Implants, and I am Director of The Florida Implant Center (floridaimplantcenter.com). On March 1, 2010, at the age of 62, I began all over again by buying a dental practice near my home in the Fort Lauderdale area. As sole owner and Chief Dental Officer of the new Nob Hill Dental Center (nobhilldentalcenter.com), I can now carefully provide dental care to patients who care, all within a caring, joyful environment. Over my career lifetime, I have provided thousands of diagnoses, fillings, crowns, bridges, root canals, periodontal treatments, TMJ therapies, partials, dentures and extractions, and dozens of implants for my patients. The only aspect of dentistry with which I have very little experience is orthodontics.

Organizations
American Dental Association, Florida Dental Association, Broward County Dental Association, Atlantic Coast District Dental Society, Vedder Honors Society, Broward Dental Research Clinic, Alpha Omega Alumni Association, and American Association of Dental Implantologists. Formerly, American Academy of General Dentistry, Michigan Dental Association, Macomb Dental Society, Detroit District Dental Society, Tri-County Dental Health Council (a charitable dental care organization)

Publications
"How To Save Money At The Dentist" Going to press soon.

Education/Credentials
Bachelor of Arts and Sciences in Psychology from Wayne State University Doctor of Dental Surgery from University of Detroit College of Dentistry Adjunct Clinical Professor, Special Needs Department, Nova Southeastern University College of Dental Medicine, Fort Lauderdale, Florida

Awards and Honors
Membership in The Vedder Honors Society

Past/Present Clients
HIPAA rules do not allow me to post this information.

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