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Dentistry/periodic pain question

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x-ray
x-ray  

Segment of orthopantomogram
Segment of orthopantom  
Hi,
I've got this vital molar under a gold crown. Lately I feel pain periodically, maybe around 2-3 on a scale of 10. I sense pain on hot food/drink. There is no pain on percussion or pressure.
The crown is there for just little over a year. The process of preparing the tooth and installing a crown apparently didn't cause any harm to the tooth at that time.
I made an x-ray today, which I attached (image file "number2"). There doesn't appear to be an obvious sign around the root apexes that would indicate pulpitis. But that is to me, I'm not a dentist. I'd like to ask you to take a look at the image.
I attached also a segment of this same tooth from an orthopantomogram that is about 5 years old (image file "number1"). Thought the quality may be not so good.
I understand that pulpitis can take time (weeks?) to develop.
Please review the images and provide your opinion on my periodic pain complaints. Thank you.

Answer
HI Pavel,

First, I noticed you're from St. Petersburg. What a beautiful city! We were there this past Fall and just loved to walk around town and appreciate all the history. Very friendly and helpful people as well!

Now to your problem. The one x-ray, you're right. Quality is not good, however the other one is very good and there does not seem to be any "issues" around the apex that would be consistent with an abscessed tooth. However, it can take some time for bone to break down enough to be obvious on an x-ray.

The best test for an tooth that may be dying is cold. Take a sliver of ice and place it near the gum on the metal of the crown. Be careful to not touch other teeth. If you feel cold in the tooth, that means the nerve(pulp)is still alive. If you don't feel cold, you may be in the early stages of an abscess. Hot sensitivity is often an early indicator of an abscess too.

If cold really irritates the tooth when you test, that can mean the tooth is inflamed and unless there is decay or your bite is off, it can mean the pulp is inflamed and may end up with an abscess later on if you can stand the discomfort. Many times when a tooth is sensitive to both hot & cold and there is no other reason that can be found, it is prudent to just get the root canal done before you become a real emergency.

Hope this helps explain things. If you have other questions, please write back.

Gary Backlund DMD, MSD  

Dentistry

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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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