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QUESTION: I had a filling on tooth 31 two weeks ago.  The tooth already had a deep filling which was removed and replaced along with filling the newly decayed area between 30 and 31.  Amalgam was the material used. I did not experience any pain after the procedure. A week later tooth #30 which was a previous failed root canal that I have lived with for 12 years started hurting a lot.  Tooth #2 which had a crown placed 6 weeks prior, my jaw in general and my right ear also had pain. After a few days of this and a course of antibiotics (in case of infection), the pain settled well but I had extreme cold sensitivity in the area of tooth 30 and 31. I went to an endodontist yesterday and after several xrays, bite tests and cold tests, determined that 31 is the culprit.  Since the xray indicated that the root was healthy, he determined that I had a crack somewhere and he wanted to open up the tooth to either do a root canal, or if the crack is extensive, recommend I have the tooth extracted. The xray did not show a crack (which I understand may not happen).  

So after all of this, my question is this: tooth 31 reacted very strongly to the cold test and I have some discomfort with the bite test.  Is it possible that the tooth has simply not recovered from the trauma it experienced during the extensive drilling process and simply needs more time to settle down?  Or does the bite test confirm a crack?  I am not in a lot of pain and can wait to see what happens so I'm tempted to put off this procedure which is scheduled for next week.

ANSWER: Hi Darlene,

I'm sorry all this is going on...pain isn't too much fun ever! It's hard for me to give you good advice without examining you, but you seem to report the facts very well. Based on that I can make a few comments. It is not unusual for a tooth to be sensitive for awhile after a filling, especially a large one. It seems that things are pretty well narrowed down to tooth #31. If the bite test showed that you had pain when you released the bite rather than when you bit down, that pretty much ensures you have a crack. You would then have 2 options..extract the tooth or prepare it for a well fitting temporary crown that would "splint" the tooth together and stabilize the crack. If you choose that option, I would leave the crown on for 3 months before getting the permanent crown to make sure the tooth is comfortable and the crack stabilized.

Now to the root canal. A root canal will immediately stop the cold sensation, but not the biting tenderness if there is a crack. We only suggest root canals when a patient is having severe pain, which doesn't seem to be your situation. In cases of a suspected crack, we always suggest the temporary crown route first because even with a microscope, it's hard to be sure the crack is not severe and stabilization of the crack is critical.

So, here would be my treatment plan for you....

1. Well fitting temporary crown...leave on for 3 months. If the tooth stops hurting, place the permanent crown.

2. If the tooth really becomes cold sensitive, which it might after the crown preparation, I would open into the tooth to BEGIN a root canal. Leave it like this for 1 month to see how the biting goes.

3. If the tooth is comfortable, complete the root canal. Leave for another month. If all is well, place the final crown.

4. If the tooth continues to be biting tender, extract the tooth.

These situations can be very complicated, and in our office, we have found taking small steps is the best way to ensure a correct long term decision. The last thing you want is to go for the root canal, have the endodontist say the crack is small, get a crown and THEN have continued problems. I know this is a lot of waiting and watching, but we have found this to be the best path for the most people over the long haul.

Hope this helps. Good luck!

Gary Backlund DMD, MSD  

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

QUESTION: Thanks so much for your speedy reply. I have been trying my own bite test and although I can't repeat it too often, I do get pain biting down which worsens with release.  Unfortunately, I get the same response from my new crown on tooth 2.  Tooth 2 has also given me grief with sensitivity because of gaps around the crown so it doesn't fit well. (It is a permanent crown but fixed temporarily for now because of the extreme pain I suffered after prep. We were waiting to see what the endodontist thought my issues were before fixing the crown problem. This particular pain is gone and I am left with sensitivity because of the gaps. It also hurts in general when everything else id hurting.  So my question is: since I am finding it reacts in the bite test, could this also suggest a crack even though it didn't react in the cold test?

ANSWER: I'm confused...are you referring to tooth #2 or #31 with this question?

Gary Backlund DMD, MSD

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

QUESTION: Sorry if I was confusing.  Except for the first sentence, all of the above is referring to tooth #2.  (You answered tooth #31 very well for me).  So when I was testing tooth #31 myself, I noticed that tooth #2 also has pain with release.  So my question is, does this mean this tooth (#2) may also have a crack, even though it didn't react to having cold placed on top of the tooth?

Answer
No Problem Darlene....just wanted to make sure I was answering the right question. Cold is our best measure of whether a tooth is alive or dead. If you didn't feel cold at all in tooth #2, that could mean that the nerve and blood supply, the pulp, are dead. If that's the case, it could also account for your biting sensitivity and you may also need a root canal on that tooth. You should pursue that with your endodontist and/or general dentist. Since #2 already has a permanent crown, it is probably not cracked. However, there is a chance it is, based on the same info I gave you about #31, and would sort of depend on why a crown was needed on that tooth to begin with.

I know this is confusing, but cracks are difficult things to diagnosis as well as treat. That's why we take small steps through treatment. You really need someone who can evaluate both these teeth and sort through your symptoms and use your dental history of those teeth and what they have been through to help get you out of pain.

Gary Backlund DMD, MSD

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Gary Backlund, DMD, MSD

Expertise

I am an Endodontist ( root canal specialist ) and can answer questions about root canals and their treatment. I cannot diagnose or treat online, but can answer general questions. I have been a specialist for 25 years and am Past President of the Washington State Association of Endodontists.

Experience

25 years practicing as a specialist

Organizations
American Association of Endodonists, Past President Washington State Association of Endodontists.

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