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Dentistry/loose tooth


I have always had very healthy teeth and gums.  Brush twice daily and floss almost every day.  Average depth of tooth gap is 3mm with several at 4mm.  Love my teeth and have them all.  

After noticing mild tooth pain, dentist examined right rear lower tooth, found crack in upper tooth. On 9/5/2014 I went back to dentist to have a crown put on. Dentist ground tooth, placed temp. crown.  No pain. No white blister or infection and no loose tooth.

Approximately 9/23/2014 (three weeks later), still no pain, I revisited dentist to have permanent crown put on.  Dentist first placed new crown over tooth without cement to evaluate crown fit. Dentist then attempted to remove new crown to cement on permanently.  New crown was EXTREEMLY tight and could not pull off with fingers.  Dentist used forceps and pulled, twisted, rocked and finally pulled off new crown, added cement and cemented crown on.  I now experienced jaw pain, more so when biting down, but not sensitive to hot or cold.  Dentist told me pain should subside and sent me home.

Approximately 10/7/2014, (two weeks later), still medium pain and noticed that tooth was loose.  I revisited dentist to check bite and find cause of pain and looseness.  Dentist made several small adjustments to crown bite and sent me home.  Could not explain pain or looseness.

Approximately 10/22/2014 (three weeks after that visit), still in some pain although definitely hurt less, still loose tooth, revisited dentist.  Dentist probed gap depth between tooth and gum and reported one place along tooth with depth of 18mm.  Dentist x-rayed tooth, claimed he could see beginning of jaw bone deterioration, found evidence of gum/tooth root infection and concluded that tooth root was cracked and the tooth was doomed.  I asked him to point out the root crack and he was not able to see crack on x-ray, as they are "too small to see".  I asked why with infection, was the pain diminishing instead of growing worse?  He explained that the infection had created it's own drainage path and the puss was able to drain and relieve any pressure, hence, no pressure no pain build up.  He went on to explain that I needed to have the tooth extracted and could have the oral surgeon perform bone graft at time of extraction if I wanted to later have an implant for a replacement tooth, but needed to do that "soon" to minimize bone loss.

I asked, since there was an infection, why the pain was lessening and he had no explanation.  I asked if he was positive that the root was cracked and he said that the conditions of the gum and infection would indicate that was the case.

I next visited the oral surgeon on 12/10/2014.  He found the same infection and drainage situation and we set an appointment for 1/8/2015 (this week) for the tooth extraction and bone graft.  

The problem that I am facing is that the pain is gone.  There is faint tingling when brushing the gum and no other sensation.  I have even forgotten about the tooth and found myself chewing nuts and steak on the tooth with absolutely no sensation what so ever.  The infection symptoms on the outer gum, the drainage and the gum pain are all gone and the tooth is now FIRMLY set in the jaw.  It appears that all is healed and the issues are gone.  IS THIS POSSIBLE?  

Is it possible that the tooth root IS NOT CRACKED?  That all the looseness, the infection and drainage were the result of the trauma from the dentist prying the crown off? The prying was brutal.  I had two extra molars extracted when I was young and I know how hard it is to pull teeth.  However, I would not have been surprised if my tooth would have come out when the dentist was trying to get that crown off.  Now, things have settled down and I have some grave doubts that I need to have the tooth extracted.  Your comments will be GREATLY APPRECIATED.


Hi John and thanks for your question.

Firstly, please accept for apologies for the late delay to my response.

Your issue is somewhat complicated and very difficult for me to give you any definitive answers, diagnosis and treatment outcomes on, without having the benefit of the examining you personally and without the aid of any diagnostic tools at my disposal.

However, my feelings are this...  Any tooth which is diagnosed with a crack, like in your case, is generally doomed, depending on the depth and position of the crack - ie.  whether or not the crack involves the nerve and blood supply within the deeper tooth, in the pulp cavity of the tooth. Such a crack or tooth fracture has a poor prognosis and even crowning such a tooth gives no certainty that the tooth will be asymptomatic post-operatively, because very often, one still finds some degree of communication between the crack and the oral cavity which results in re-infection. In my opinion, such a tooth is better off being extracted in the long term. In such a case, the crack should always be evaluated more closely and possibly repaired prior to considering any crowning, possibly with the completion of a root canal on the tooth if indicated to prevent any re-infection. If the crack is superficial and only affects one part of the tooth, not involving the pulp of the tooth, then a crown could seal up the crack and prevent it from extending further. If the crack is situated in the floor of the tooth, where the roots meets, the prognosis is very poor and a crown would have no benefit in resolving any problems, because communication with the mouth cannot be prevented.

I am sure you can appreciate the difficulty for me to make any comment on what loosened up the tooth - whether it was due to the bone loss, in light of an 18mm pocket, due to infection as a result of the crack or due to the actions of your clinician during removing the crown prior to final cementation.

What I will say is that it might be in your best interest to find a clinician whom you have full trust and faith in, as I get the sense that your professional relationship is somewhat bruised as a result of this incident and if this cannot be improved and put right, you owe it to yourself to trust the hands which are healing you. You are also very entitled to get a second opinion of the matter and request a copy of the available X-rays and notes to present to another clinician for their input and advice. I will also stress that, what ever treatment is done in future, that a proper diagnosis of the problem is made first, on which to base a scientific and sound treatment plan, and that you are presented with all the possible options, outcomes and choices at your disposal. The final choice must be yours as educated and properly informed by your clinician. That way, you are aware of all the complications and know what to expect.

I hope this helps ans wish you all the very in resolving the matter speedily and successfully. Take care.

Kind regards
Dr Craig Peck


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Dr Craig W Peck ( B.Med.Sc., B.Ch.D., Clin. Botox, Cosmet. Derm.)


I am a General Dental Practitioner, with special interests in Cosmetic Dentistry & facial aesthetics and Periodontology, placing a strong emphasis on the establishment and maintenance of a healthy periodontium (the support structure of the tooth) before cosmetic options are considered. I uphold all principles of prevention above interventional treatment and try as far as possible, to remain conservative in my approach. I believe in detailed, open and honest patient discussion, establishing what the patients expectations are and what the reality is of achieving this and involving the patient at every level of the treatment. I have strong principles on ethical treatment and appropriate patient management. I have chosen to treat and rehabilitate many nervous and phobic patients, who, for whatever reason, find it impossible to take part in the very important task of even a routine check-up. I will accept questions relating to general and cosmetic dentistry (in conjunction with the use of facial cosmetic procedures) and dental fears/phobias. I will be more than willing to answer any academic questions in dentistry, biology, physiology, psychology and health sciences in general. As most dentists will tell you, there is often not only one way of dealing with a dental issue - so very often, there is no precise right and wrong way of approaching the problem. All clinicians vary when it comes to treatments and what works best in their hands is often the treatment that is advised. Be understanding of this and bear in mind that nothing lasts forever! Patients are happy to accept only a one-years warrantee when buying a new car, but seem to expect that dental work is going to last them their lifetime.


I have worked for many years in the UK and RSA as a general dental practitioner - within the NHS, private practice and the government dental health services. I am certificated for the administration of Botox and Dermal Fillers for facial lines and wrinkles as I have attended further courses in minimally invasive facial cosmetic procedures. I started seeing an increasing number of patients who presented with severe to moderate dental fears, even with full-blown phobias, so I started with the slow and patient task of tackling this problem and have successfully rehabilitated many patients. The key is good, effective, concise and understandable communication, shifting control from the dentist to the patient in order to slowly, but confidently, regain their trust back in dentistry, thereby giving them the feeling of achievement and this self-empowerment which drives them to the next level of treatment.

Academy of General Dentistry. American Dental Education Association. IAPAM (International Association for Physicians in Aesthetic Medicine). Professional Speakers, Writers and Managements Consultants in Dentistry. The British Dental Association. UK Aesthetics Group. ARC - Aesthetic Professionals. Botox. Aesthetics & Beauty. American Association for Dental Research. FDI - World Dental Federation. SOURCE1uk. World Dental Hygiene Forum. ProDentalCPD. Public Health Dentistry. Dentist Network. LinkedIn. Who's Who of South Africa.

B.Med.Sc. Degree (Medical Physiology and Medical Virology; Physiology Cum Laude; Stell 1994). B.Ch.D. Degree (Bachelor of Dental Surgery; Clinical Dentistry Cum Laude; Stell 1997). CPR and CPR-Advanced Courses (2000/2001; UK). Clinical Botox (UK, 2001). Cosmetic Dermatology (Botox and Dermal Fillers; RSA 2011).

Awards and Honors
Placed on the Dean's List at University for academic achievement (1994). Highest achievement in the subject Dental Materials. Medal from 3M and the Radiology Association of South Africa for highest achievement in the subject Dental Radiology and Imaging. Medal from The Periodontal Association of South Africa for highest achievement in the subject Periodontology. Highest achievement for Oral Medicine. Highest achievement in Oral Pathology. Received the DASA (Dental Ass. of South Africa) Gold Medal for highest achieving dental student across the 5 1/2 years of the Degree. Passed the subject, Clinical Dentistry with distinction in final year.

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