Dentistry/sensitivity in crowned tooth
QUESTION: Dear Dr. Spindel,
Hello. I am having a problem that I wondering if it is safe to wait a few days to see what happens (as today as Saturday) or if it is something that I need to take care of immediately. I had a crown placed on a tooth two months ago. This molar did not have a root canal. It did not have any sensitivity. It just had a very old large silver filling from when I was a kid that my dentist felt really needed to be replaced with a crown. (I am now 42.) Everything was fine (no pain or sensitivity) for the two months since I got this crown. About a week ago I got something (probably food of some kind) stuck between the crowned tooth and the molar next to it, and I had to do a lot of digging to get it out and finally got it out with floss and a waterpik. Anyway, I do not know if this is related to that incident or is just a coincidence in timing, but since a day or two after that I have had a lot of sensitivity (sometimes very painful) in the crowned tooth to cold beverages. The sensitivity lingers and lasts a few minutes afterward.It is also sensitive to hot beverages, but it is much worse with cold. I was trying to give it time thinking maybe I just inflamed something but it is getting worse this weekend.(The sensitivity has been going on about 4 days now I estimate.) Do you think this means I will need a root canal or that it might be something minor or even something that will calm down and go away on its own? Is it OK to wait or could this turn into an abscess?
Thank you so much in advance for any advice you can share with me. I am very nervous!! (And a very nervous dental patient in general.)
ANSWER: Although it probably isn't a super emergency, you should schedule an appointment with your dentist to see what is happening. He should be able to diagnose the exact cause.
---------- FOLLOW-UP ----------
QUESTION: Thank you so much for the response. I saw my dentist, and am now more confused (and of course now panicking even more)!! I am a very nervous person in general, but for some reason it kicks into high gear when it comes to dental work.
So anyway, I visited my dentists office on Thursday morning (it is now Sunday). They x-rayed the tooth and poked around, etc. The dentist said he did not see anything wrong with the tooth and that I should relax and give it another week and baby the tooth and see how things went. However, he said the only thing that concerned him is that the margins on the crown may not be perfect, and that if the margins were not good, that could be causing the symptoms I am having. However, he said that usually those symptoms would happen right away, and I've had this crown for two months and the symptoms only just started now so that confused him a little. He left a note for the other dentist in the office, since he was the one who did the crown and he said he wanted him to look at the x-ray since it was his work. The next day, on Friday, the nurse called. She said the dentist who did the crown looked at my x-ray and did not see any issues with the tooth or the crown, and that the margins were fine. But she said he wanted to see me sometime next week because he wanted to do a clinical exam because sometimes something is wrong you cannot see on the xray. So since the other dentist to give it a week I made the appointment for next Friday (Feb. 27). She said that if I didn't have anymore symptoms by next Friday I could cancel the appointment. This weekend I think my tooth is doing a little better. It is not tender to chew on, the cold sensitivity is sooo much better that it is only there slightly. However, my concern is that my heat sensitivity has seemed to have gotten worse. (I actually swished a very hot drink in that area myself to test it, and it was painful, and the pain lingered for a while. Maybe I shouldn't have done that.) Since then, I have not had anything hot and I haven't had any pain. I did some research online about this (which I know can be dangerous) and I read in several places that lingering pain to heat is a definite sign that the nerve is dying and I need to a root canal or can get an abscess that can get into my bloodstream and can be very dangerous. So of course now I am very scared.
Again, I have no pain from chewing, my gum is not swollen, I have slight sensitivity to cold, and sensitivity to heat that lingers. I do not have spontaneous pain that wakes me or anything. Do you think this can still be from inflammation from the minor trauma I had to the area, or does that heat issue mean without-a-doubt that the nerve is dying? Also is it true that if the nerve does die, even heat wont seem to hurt it anymore, giving me the false sense of security that everything is now fine, when it fact a dangerous infection is actually brewing? Is this OK to wait and see what happens? I am very nervous now about the infection information I keep reading about. (I probably should be staying away from the Internet.:) ) I am considering skipping going back to my dentist for now, and just going to the endodontist for an opinion. Any advice you can share with me would be GREATLY appreciated! (sorry this was so long).
Waiting to see if your symptoms get better sounds like a good idea. It seems the two dentists have a difference of opinion about the x-ray of your crown. If the symptoms do not subside, It may be in your interest to go to a different office and get an independent opinion.