Expert: Mark Bornfeld DDS - 11/6/2007

Question
Hi Dr.

I have a tricky situation here.

I had impact trauma on my front teeth while rollerblading when I was 12 years old. I'm currently 23

years old.

Now with wisdom teeth coming in on all four corners of my gum, I feel pressure constantly on my

teeth especially my front teeth.

My right front tooth is pushed upwards...due to the overcrowding.

But on a recent trip to a dentist, she said that my right front tooth seems to be a little discoloured

from the rest of my front teeth... a little darker. Then I told her about my impact trauma when I was

12.

She took an x-ray and the x-ray seems fine, no infections going on but a little bone loss on both right

and left front teeth.  She also says she suspects my right front tooth is dying slowly and thus the tiny

discolour, which is only visible if you look closely enough. WHAT???

I had an x-ray done early this year in January 2007 with another dentist, and I told the dentist about

my trauma, wisdom teeth eruptions, pressure etc.

She checked the x-ray and my front teeth and said the right front tooth is not dying, because

otherwise the colour change would be very significant.  

The x-ray is here http://aycu36.webshots.com/image/31475/2005841764687126955_rs.jpg


So now the two dentists are saying different things...

I just did a check on Abscessed Tooth Symptoms at http://www.webmd.com/oral-

health/tc/abscessed-tooth-symptoms

And I think I might have these symptoms:
"A feeling that the tooth is being raised out of its socket..."

and my two front teeth are a tiny bit shaky... I discovered very tiny movements when i bite my teeth

together and open up my jaws by placing my finger on the front teeth. My left front tooth's

movement is a tiny bit larger than the right front tooth, up (when jaws closed), down (when jaws

open). I think it's due to bone loss, i don't have the habit of drinking milk. what can i do to rectify

this bone loss situation? spinters?

and

Is my right front tooth being raised out of its socket? It seems like it's being pushed upwards

though... possibly by the overcrowding. But i'm not sure what you mean by "raised out of its

socket"... (you can take a look at the photos below).

I think my right front tooth feels a little different. And I just tested putting ice on my front teeth and

see if there's any abscess tooth... yes there is pain when ice gets in contact with my teeth but the

pain goes away after the ice is removed.

Now after scaling done by the dentist yesterday, my gums feel a little sore...all around. is it normal? Hi

Dr. Appleton,

I have a tricky situation here.

I had impact trauma on my front teeth while rollerblading when I was 12 years old. I'm currently 23

years old.

Now with wisdom teeth coming in on all four corners of my gum, I feel pressure constantly on my

teeth especially my front teeth.

My right front tooth is pushed upwards...due to the overcrowding.

But on a recent trip to a dentist, she said that my right front tooth seems to be a little discoloured

from the rest of my front teeth... a little darker. Then I told her about my impact trauma when I was

12.

She took an x-ray and the x-ray seems fine, no infections going on but a little bone loss on both right

and left front teeth.  She also says she suspects my right front tooth is dying slowly and thus the tiny

discolour, which is only visible if you look closely enough. WHAT???

I had an x-ray done early this year in January 2007 with another dentist, and I told the dentist about

my trauma, wisdom teeth eruptions, pressure etc.

She checked the x-ray and my front teeth and said the right front tooth is not dying, because

otherwise the colour change would be very significant.  

The x-ray is here http://aycu36.webshots.com/image/31475/2005841764687126955_rs.jpg


So now the two dentists are saying different things...

I just did a check on Abscessed Tooth Symptoms at http://www.webmd.com/oral-

health/tc/abscessed-tooth-symptoms

And I think I might have these symptoms:
"A feeling that the tooth is being raised out of its socket..."

and my two front teeth are a tiny bit shaky... I discovered very tiny movements when i bite my teeth

together and open up my jaws by placing my finger on the front teeth. My left front tooth's

movement is a tiny bit larger than the right front tooth, up (when jaws closed), down (when jaws

open). I think it's due to bone loss, i don't have the habit of drinking milk. what can i do to rectify

this bone loss situation? spinters?

and

Is my right front tooth being raised out of its socket? It seems like it's being pushed upwards

though... possibly by the overcrowding. But i'm not sure what you mean by "raised out of its

socket"... (you can take a look at the photos below).

I think my right front tooth feels a little different. And I just tested putting ice on my front teeth and

see if there's any abscess tooth... yes there is pain when ice gets in contact with my teeth but the

pain goes away after the ice is removed.

Now after scaling done by the dentist yesterday, my gums feel a little sore...all around. is it normal?

Especially the gum above my right front tooth is really sore... like i am sensitive to the pain around

that area...

is it possible for an traumatised tooth to die slowly over 11 years, showing slight discoloration after

that?

I want to make sure there's no possibility of my right front tooth as being abscessed.

And can you discover an abscessed or dying tooth simply by looking an x-ray?



Pls take a look at the x-ray i had done in Jan 2007.
http://aycu36.webshots.com/image/31475/2005841764687126955_rs.jpg

The rest photos are current close up shots of my front teeth.
http://aycu18.webshots.com/image/31977/2005844069334819457_rs.jpg
http://aycu11.webshots.com/image/34770/2005828334156796328_rs.jpg
http://aycu18.webshots.com/image/32657/2005856633682688944_rs.jpg
http://aycu17.webshots.com/image/32736/2005861970110078809_rs.jpg
http://aycu31.webshots.com/image/32630/2005895040659229727_rs.jpg
http://aycu04.webshots.com/image/32763/2005832687165642987_rs.jpg
http://aycu35.webshots.com/image/34114/2005844422649758976_rs.jpg
http://aycu34.webshots.com/image/34113/2005885145148335384_rs.jpg
http://aycu34.webshots.com/image/34113/2005835560667035549_rs.jpg
http://aycu37.webshots.com/image/34236/2004396600849102894_rs.jpg
http://aycu21.webshots.com/image/31580/2004308366547657937_rs.jpg


Please take a good look at these photos and tell me what I should do now....about my front teeth,

especially the two front teeth in question.

Please answer my doubts Doctor...

Merci Beaucoup!

Yours truly,
C'est Moi

Answer
Dear C'est Moi,

Your upper right central incisor is clearly devitalized, as evidenced by its darkened color, and the fact that the pulp chamber and root canal has calcified, as seen on your x-ray (if you look closely at the image of that tooth in the x-ray, you can see that the vertical dark line that runs down the middle of the other teeth is much less distinct on the tooth in question).

There is a fine point of distinction that I believe is important here-- a devitalized tooth is not necessarily an "infected" or "abscessed" tooth. Granted, a dying nerve is usually accompanied by pain, swelling, and all the other signs of overt infection. However, one does see occasional cases such as yours where the pulp of a tooth dies a quiet death, with no noticeable symptoms.

The question then becomes one of determining the correct course of action. I think most dentists would recommend attempting root canal therapy, because a tooth with a non-vital pulp is at risk for becoming infected at any time. However, there is the very practical consideration of whether root canal therapy is possible if the pulp is calcified, because a mineralized pulp can prevent the passage of root canal instruments.

In these cases, I have sometimes offered my patients the option of NOT treating the tooth, but rather maintaining a posture of vigilance-- periodically taking x-rays to monitor for changes, and asking the patient to be mindful of the development of any symptoms so that prompt treatment can be rendered if necessary.

However, I will admit that the textbook "correct" approach would be to refer the patient to an endodontist (this specialist would bring the greatest resources of skill and experience to a treatment that would be predicted to be quite challenging) to implement a root canal therapy-- even in the absence of symptoms or signs of infection.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY