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#18
#18  
QUESTION: Hi there!

My number 18 tooth..bottom left molar in the far back has a crack on the distal part of the tooth. Since the tooth has a filling my dentist is thinking that I need a crown to protect the tooth from fraturing (hopefully it hasn't). Can you tell me what your opinion is of my #18 and if you think it may need a crown. My tooth has had the distal crack for 10+ years but I'm wooried about it now bc it is a little sensitive. :-(( I really don't want a crown. If it was your tooth what would do you with it?

ANSWER: Dear Susan,

If your tooth is cracked, then it needs a crown.  From the xray, #18 does not appear to have a crack.  But I have seen cracks in teeth that cannot be seen on an xray.  I would have to see the tooth and test the tooth to know more.

I'm sorry.  I wish I could, but I can't really help you much with the information you have provided.  There are many reasons that a tooth can become sensitive:  Gum recession, decay, fracture, leaky filling, trauma, and more.  Maybe if you gave me more info, I could help more

You may want to visit an endodontist and have this specialist test your tooth.  Or just put yourself on a soft diet for a few days and see if the sensitivity goes away.  

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

QUESTION: I saw my dentist and he tested my four cusps to see if any were sensitive. My cusp closest to my cheek in the case back is more sensitive when tapped on than the others. He also tested it with cold and it reacted very quickly to pain. Yeah, he suggested that if I wanted to do a crown it would be for preventative reasons. My root looked fine amend there is no infection. I am going to go have my endodontist but what's other kind of testing could he do? I am 34 with 3 crowns and impeckable hygiene...just bad genetics. I wish I didn't have to get another crown. There is nothing better than your own REAL teeth. So sad. :-(

Answer
So far, by your dentist's testing, it seems like you don't need a crown.  Elevated sensitivity to tapping or to cold does not necessarily mean you need a crown.  The same reasons that I stated before could be the cause.  Sometimes just waiting and not chewing on the tooth helps.  Do you chew gum?  Stop.  Do you clench your teeth?  Stop, or get a biteguard that might distribute the clenching stress away from this tooth.  Have you given it enough time to see if the sensitivity will just go away?  Give it time.  Have you tried a soft diet for several days?  Anti-inflammatory medications?  Applying desensitizing medications to the tooth?  Adjusting the sensitive cusp out of occlusion?  Adjusting the tooth out of occlusion?  Replacing the filling?

You see, there are a lot of things you might try before committing this tooth to a crown.  The endodontist should have several additional tests for your tooth. One of these may be a 3-D CT scanner.  Another a microscope.  Both of these will provide clearer pictures which will provide more information to determine if there are cracks that might be worth treating, or might give any treatment for this tooth a poor prognosis.

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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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