Expert: Gary Backlund, DMD, MSD - 11/21/2006

Question
Thanks, so much, for your expert advice. Do you think it's odd that the problem has existed, unchanged, for at least 3 or 4 years? As a matter of fact, the tooth had a huge filling prior to being crowned and the problem existed even then. Does that offer any other clues?
Charlie
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The text above is a follow-up to ...

-----Question-----
Hi Dr. Backlund,
I have a crowned molar (gold) that has bothered me for several years. I experience pain upon biting or chewing which varies in degree. Sometimes, biting lightly causes pain whereas biting hard might not...and vice versa. A GP dentist took an x-ray, checked my bite and seemed to doubt I need a root canal. I've noticed that if I put ice on it, I feel pain, whereas I don't on the adjacent teeth. I feel I must do something because it's very irritating and I'm positive something's just not right. By the way, my general medical and dental health is quite good and I have no gum problems. I suspect, in spite of the x-ray not providing a diagnosis, that I need a root canal. Does that sound reasonable or likely, based on my symptoms? Is there any further test I can conduct myself before going to the expense of seeing an endodontist? (I don't mind, at all, if it's necessary...but would rather not if it's not. Thank you very much for any advice!

Charlie
-----Answer-----
Hi Charlie,

Sorry to hear you're having this problem. The fact that you feel cold in the tooth tells me that the tooth is still alive...in fact that is the test we use on crowned teeth to determine whether a tooth is alive or dead. That would explain why nothing shows up on an xray, since the tooth needs to be dead for xray changes to occur.

That said, you could have a tooth in the very early stages of problems, especially if it seems to be MORE sensitive than other teeth to ice. If that's the case, you will probably need a root canal anyway.

Unfortunately, I think it is time to see an endodontist and let him/her help with your decision. If I had to guess, I'd say you will end up with treatment.

Hope this helps.

Gary Backlund DMD, MSD

Answer
Hi Charlie,

When you have a tooth that is NOT dead, but is more sensitive, what that means is that the nerve and blood supply...the pulp....is irritated. This easily could be related to the large filling that is under the crown because when we do those large fillings, we know we cause inflammation in the pulp. This irritation can go on for a long time, but after all this time, it is highly unlikely that it will heal normally. More than likely, it will go on to become more sensitive and at some point the tooth will die....maybe tomorrow, maybe 5 years from now, but at some point I really feel you will be looking at a root canal. If the endodontist finds that this is the situation, I would not wait and become a dental emergency. Get it done when it is convenient for all involved.

Gary Backlund DMD, MSD