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Question
Had pain with biting and temp sensitivity re: tooth #2 fall of 2011. This tooth has multiple fillings.  Dentist said pain may go away with time- no xrays taken. June 2012, continued with same symptoms- no x-rays taken b/c I was pregnant (even though my OB said it was ok). Oct 2012, the tooth broke- no x-rays taken (OB said ok).  Told I would need a crown, but not while pregnant (OB said local anesthetic was ok, even with epinephrine) and to schedule crown for a few weeks after baby's birth.  Temporary crown placed late December without x-ray.  Throbbing pain started next day, saw dentist 3 days after temp.  X-ray taken- said it was fine, adjusted bite.  2 weeks later pain had calmed.  Permanent crown placed.  Ok at first, then temp sensitivity and pain with biting began, but unable to localize exact area of pain. Saw dentist 2 weeks later, took x-rays, said it was fine and was due to grinding teeth or my sinuses.  2 days later, throbbing escalating pain localized to tooth #2.  Was told to call an endodontist for root canal.  Endodontist saw small abscess at nerve root base and told me I tested positive with symptoms and I am now scheduled for root canal.
Is it customary to place a temporary crown without checking an x-ray?  Is it typical for the endodontist to see an abscess but the dentist not to see it?  Could something preventative be considered prior to a tooth breaking?

Answer
Dear Kristen,

Many dentists are reticent about taking X-rays of pregnant women as well as performing non emergency treatment. Of course there are times when we have to perform dentistry on women while they are pregnant. If possible I try to plan my treatment for the beginning of the third trimester.

As to taking X-rays when crowning a tooth. I personally take a pre-operative radiagraph and often take a bite-wing X-ray when fitting the permanent crown. It is possible that endodontists are more likely to notice an endodontic area at the apex of a tooth. Often dentists will send X-rays to an endodontists to evaluate.

As to what might have been done to prevent your tooth from breaking? Possibly if you were wearing a night guard it might have made the breakage of #2 less likely.

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Lawrence Spindel DDS, www.lspindeldds.com

Expertise

Cosmetic Dentistry, Endodontics, General Dentistry, Preventive Dentistry, Comprehensive Dental Care

Experience

Former Clinical Instructor of Comprehensive Dentistry, and Prosthodontic Department New York University School of Dentistry. Also former instructor of Preventive Dentistry Columbia University School of Dentistry.

Publications
Ask Dr Spindel Dental Blog also numerous articles on http://www.lspindeldds.com (over 100 pages of original content)

Education/Credentials
1980 DDS New York University College of Dentistry 1981 GPR Manhattan VA Hospital

Awards and Honors
OKU 1980 Honor Society 1980 Long Island Academy of Odontology award for highest combined Academic and Clinical Achievement.
In 1997 he was elected to Fellowship into the International Academy for Dental Facial Esthetics

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