Expert: Frederick R. Liewehr DDS, MS, FICD - 9/21/2006

Question
Hello,

I am 24years old in good overall health.  I recently changed dentists because of a relocation and I am having trouble trusting this new dentist (I guess with any new doctor, I am overly cautious).

I complained about a pain in my upper right, farthest in the back tooth.  I was told that my previous filling was damaged, and there was decay.  The x-ray couldn't reveal whether the decay reached the nerve, so we'd have to drill and explore and then go from there to determine if I needed a root canal.

So on appointment #2 he drills out my filling.  Says that I am safe from a root canal (for now) and he's going to put in a temporary filling.  Because the filling is so big he tells me he is scheduling me for a crown to support the tooth.  He also adds that we're going to wait and see if my tooth acts up which I don't really understand.

I googled for info on temporary fillings ( I have the white colored kind) and its highly breakable and weak.  I've also noticed my pain is worse and I am highly sensative to cold foods and liquids.  I feel cornered because after looking at the estimate for a crown ($770, my portion after insurance would be $350ish) I just don't know about paying that much for something.  But then again I have this highly breakable 'temporary' solution in my mouth.

Is this standard to not give patients options as far as how they want to fill in their tooth?   Is this dentist just trying to make more money off of me?  Hello,

I am 24years old in good overall health.  I recently changed dentists because of a relocation and I am having trouble trusting this new dentist (I guess with any new doctor, I am overly cautious).

I complained about a pain in my upper right, farthest in the back tooth.  I was told that my previous filling was damaged, and there was decay.  The x-ray couldn't reveal whether the decay reached the nerve, so we'd have to drill and explore and then go from there to determine if I needed a root canal.

So on appointment #2 he drills out my filling.  Says that I am safe from a root canal (for now) and he's going to put in a temporary filling.  Because the filling is so big he tells me he is scheduling me for a crown to support the tooth.  He also adds that we're going to wait and see if my tooth acts up which I don't really understand.

I googled for info on temporary fillings ( I have the white colored kind) and its highly breakable and weak.  I've also noticed my pain is worse and I am highly sensative to cold foods and liquids.  I feel cornered because after looking at the estimate for a crown ($770, my portion after insurance would be $350ish) I just don't know about paying that much for something.  But then again I have this highly breakable 'temporary' solution in my mouth.

Is this standard to not give patients options as far as how they want to fill in their tooth?   Is this dentist just trying to make more money off of me?  

Answer
Everything your dentist did sounds fine to me, Alan. You had what we call recurrent decay on your tooth. That means a tooth that had a filling in it now has new caries, for the same reason it got caries in the first place. Now, however, you have (or had in this case) a filling in the tooth, which does not decay, just the tooth under it. So, the new decay can hide under this filling and not be detected clinically until it gets pretty big and the tooth starts breaking due to being undermined inside. You often cannot see this happening on a radiograph because that big filling hides the decay because the x-rays cannot penetrate the filling material, just as it does clinically. You also cannot see how deep, or close to the nerve, it is for the same reason.
    So, when your dentist took out that old filling, he found a lot of decay beneath. The tooth was undermined so that is was weak. Although we call what we put in the tooth a "restoration", I like the term "filling", because that is what we do, we put in something to fill a hole. That is all it can do. When the tooth gets severely broken down, however, it cannot support a filling. Rather, it needs something to support and strengthen it, and that is a crown.
    The problem is that nobody can predict how a tooth is going to react when it has that much deep decay. It may do fine, or it may give you a toothache, in which case you need a root canal. In order to do the root canal, you need to drill out the filling. Your dentist was saving you money by just putting in a temporary filling that is cheap in case the tooth acted up and required root canal treatment, which in turn would ruin the new filling.
    It is normal to have some increased sensitivity to cold and so forth following what you have had. The temporary actually is a sedative and insulative filling material, so it makes your tooth feel better during this period than it would if he had put in the permanent filling. If everything calms down in a couple weeks or so, then go ahead with a permanent restoration and crown. If it remains sensitive, I would seriously consider having a root canal done before the crown is placed. If anything, after the tooth is prepared for the crown (which involves a lot more drilling) it will be considerably more sensitive than now, so you should seriously consider having it done before your dentist would have to make a big hole in your $700 crown to do the root canal.
   At any rate, sounds like you found a pretty good dentist to me!

Dr. Liewehr