Expert: Mark Bornfeld DDS - 1/10/2007

Question
I'm in Asia and need some advise; I'm unfortunately not in Singapore or HK and locally there isn't much good advise.

I had a root canal on the upper central incisor about 3 weeks ago here. I was getting a crown and the root was dead, at least at the tooth there was no feeling. Without anesthetic he filed and cleaned it that day (something like bleach) and filled it temporarily and nothing hurt at all unless he reached the top with the file, though I think he said this was the boundary, not more root. To me it did feel like touching something very sensitive and my head would rise up, but not the SHOCK of touching a root, though I wouldn't know. When I came back he checked it and when touching at the top it hurt as before so he did another x-ray with a file in the tooth and then did a bit more work at the top of the canal, then filled it. He commented that the length was a bit longer than with Asians (I'm Caucasian).

I don't feel any pain now but I noticed when I rub my nose at the bottom left right above where this was done, it feels a little odd. Doesn't hurt per se, but more like there is a  slight uncomfortable pressure, much like when you bend an arm in the wrong direction, and when pressed more that pressure extends slightly down into the gum. The same effect if I reach up under my lip to the same spot. The other side of my mouth doesn't feel that way, just feels solid.

No pain or anything else.

Is this something to worry about? Has he pushed the canal filling up too high or dug into something beyond the canal? Is this where my sinus is and a problem? If I need to get it checked, I'd have to fly somewhere else, so wondering how serious. Or could I get an x-ray here that someone overseas could examine?

Or am I just paranoid and it is slightly sensitive still and will go away?

By the way, how dangerous is it to have a crown cut and taken off? I have cercon zirconia crowns on the front teeth recently and the margins when checked overseas were not well done. One crown fell off which was why it was all checked and they thought they should be redone as not a great fit. Back in Asia now, he's going to redo them for me but I have little confidence now. I'm worried it can damage the teeth, and if this root is a problem - there is no post if that makes a difference - I don't want to redo it twice and risk damage. He suggested I wait until a crown falls off because safer but I'm worried about decay and figure I have to redo them anyway so might as well do them now and let him cover the cost as it was his mistake. On the other hand...

Any advise appreciated.

Thank you.

Answer
Dear John,

There is not much reliable information that can be inferred from your symptoms. While I cannot assess the quality of the root canal therapy you received, you should know that it is common to have some postoperative soreness even when services are skilfully rendered. This is especially true in the case of root canal that is implemented after the pulp has already lost vitality, which appears to be your situation. Mild tenderness to palpation (finger pressure) may persist for several months, so it is premature to judge the quality of your result so soon after completion.

If a crown needs to be removed, cutting it off is the safest way-- there will be far less risk of injury this way than using a brute force technique, such as a pneumatic crown remover. Granted, every dental intervention carries with it some risk, but the removal of a crown is relatively safe procedure for the average dentist with a modicum of skill.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY