unusual dental prep with pain

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The first of December I had an upper right molar break off on the back side. I wanted to save the molar because it is one of the only ones I have left for grinding my food.  The dentist put some composite in the broken area  to see if it would hold because he said the cavity that caused it to break was close to the root canal.  The dentist had me wait 2 weeks to see how the tooth would do to rule out root canal.  After 2 weeks, I went back and he pricked on the tooth for any pain even before numbing my mouth.  There was no pain at all with the composite, so he said he'd have to mold the tooth for holding a crown because he was afraid that if I didn't crown the tooth that the composite would not hold.  The tooth was 95% there before the dental prep.  Before the mold was taken the dentist said he had to grind my tooth off down to where the crown would fit.  During the procedure I could rub my tongue over that tooth and feel the tooth had been drilled down to within 1/8  to 1/4 inch of my gums.  Why would the dentist have removed the good side that could help support the crown?  After he drilled and shaped my tooth, then they did the mold for the crown. How would they know what my original tooth was like after whittling it away?   I had never had a crown procedure done like this before.  The prep felt like it was volcano shaped and recessed up under the gum.  They then put on an acrylic temporary crown as I am allergic to the metal ones.  I am also allergic to 99% of pain meds, so the procedure had to be done with lidocaine only.  I was given a few lortab for pain after the procedure which I reluctantly take because it depresses my breathing somewhat due to asthma.  I can not take aspirin, NSAIDS, morphine, dilaudid, codine, etc due to true allergies.  Since the prep was done and all the feeling returned to my mouth, I have had a contant pressure feeling on the tooth. I have not eatten on this side and avoid even drinking on that side due to pain.  I thought at first the pain was from the gums being inflamed due to the injections.  By the time I realized the pain was more than inflammation from the injections, the holidays hit and I haven't been able to see the dentist.  I think what happened was that the dentist over-shaped my tooth and got down into the root because there was absolutely no pain with the composite before he starting prepping for the crown.  The only reason I was going to have the crown was because he recommended it due to fear of the tooth breaking off if I didn't. I noticed after the prep that the acrylic temporary crown did not cover 100% of my tooth and I thought the temporary crowns were supposed to cover the whole tooth.  There is a sharp bony ridge vertical along the tooth that is almost cutting my tongue and the pain continually got worse until two nights ago. At that time, I was just taking a drink of water and felt something start choking me in the throat.  I then coughed up a chunk of the composite that was from that tooth on the back side and now when I breathe I can feel air hitting the root in the tooth and I'm sore from my jaws up to my eyeballs with pain and my neck also hurts.  I've had a migraine ever since the procedure and directly after the procedure I almost passed out from dizziness after having waited five minutes before standing up. I've continued to have dizzy spells and am taking meclazine for the dizziness which helps some and have taken the other antibiotics that were originally given me for the next dental visit which I have to take due to heart condition in order to reduce the inflammation because I've been running a low grade fever since the procedure.  The dizziness continues and I feel like I also have pressure on my eardrum now on that side.  I've never felt this way before even before I developed allergies to medications after having my teeth worked on.  What would cause the dizziness and back pain and why do my sinus cavities on that side still feel congested like they are swollen.  I had to have an injection in the roof of my mouth which during the procedure numbed my sinuses to the point I felt I could't breathe. Shots were also place in the saddle block between the upper and lower jaw joint, an injection in front and back of the tooth,  and several around the tooth.  The lidocaine was wearing off before the procedure was completed.  I'm very hard to numb and so the dentists now know this and try to compensate for it.  I just don't understand why would a dentist fill a tooth and wait 2 weeks to see if it would hold and no root pain, then grind the tooth off to about 1/8 inch and  then part of the tooth ended up flaking out after it was supposed to be prepped for the permanent crown? Now I have root pain so severe it is covering half my face and making the nerves hurt even under the other teeth next to it?  The other crowns I've ever had done, the dentist took a mold of the tooth before the procedure, then once the crown was ready, I went in and they shaped the tooth and put the crown on immediately ruling out the extra fillings. One tooth had to have a temporary crown, but it was molded to fit over the tooth that was left. Isn't a temporary crown supposed to cover the whole tooth?  With this acrylic crown, I could feel a gap between my gums and the tooth when I came home that night which has closed slightly, but one side of the tooth has been completely open since the prep.  Is this standard procedure or have I got a quack for a dentist?  It's been 6 going on 7 days now since the procedure and first thing in the morning I'm calling to see the dentist.  I feel like I shouldn't have to pay for a root canal since the tooth wasnt' hurting before he shaped it.  What do you think about the procedure he is taking to do a crown (first fill it, then drill the filling and tooth away, then mold it, and then tell me to return in 2 weeks for the permanent?)  This seems like an awful lot of office visits that could have been done by just shaping the tooth the first visit with a temp to see if it would work and then putting on the permanent tooth.  I'm losing faith in my dentist.  Can you shed some light on this as I feel like when I go back he's going to tell me I now need a root canal.  I really don't understand so much difference in the way he is performing this procedure compared to other crowns I've had in the past. I'm sure the pain I'm feeling is from the root exposure and personally feel it is his fault for exposing the root after fixing the tooth where it wasn't hurting.  Should I be responsible financially for extra work like this when the tooth didn't hurt at all before he shaped the tooth?  Need some quick advice as my tooth is killing me.  --TNX

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Sorry to hear about your problems too. You'd better what that fracture.  A friend of mine had that happen and a systemic infection set up in the bone. Before all said and done it cost her major surgery to scrape the bone then eventually have to have a partial jaw replacement where the bone had gotten so infected that it caused staff to set up in the bone area of the fracture.  I had one wisdom tooth pulled one time and it fractured the jaw causing a fragment to work upward through the pulled tooth area.  I thought I would abosolutely die with pain before switching to a good doctor because the one I had been using wouldn't put his surgical patients before the ones sitting in his waiting room that day!  That's when I found the good dentist and found out the tooth couldn't heal because of the fragment constantly cutting the skin over it. I'm proud to say that today I am feeling some better just getting rid of the infection and can breathe through my sinus cavities on that side today because some of the infection swelling has gone away!  Will take a few days, though. I happened to have an earlier prescription for an antibiotic that was refillable, so I had it refilled and it sure is helping!   I don't know that our rates are any cheaper here per income ratio.  My husband just got through with one molar that cost us about $1800.  Guess it depends on the extent they have to go to in order to fix it or if there are any other complications.  I know that any field of medicine is risky.  That is why they call it "practicing" medicine.  But, a simple extraction for most teeth in this area runs $100 up depending on how much they have to sedate you and how difficult a time they have removing it.  That's the cheapest I've found.  Most are $175 up.  I know they have to have assistants, etc, but just seems rediculous to me to have to pay such prices for a job that takes the dentist less than ten minutes to do.  One day I went to the dentist (the day he botched my crown prep) and he told me he had already seen 60 patients that morning!  Well, if they had to pay  what I did, just think what they are making!  We figured even at the base rate that day he grossed over $30K that morning and you can't tell me it cost him that much on supplies and assistants' salaries or overhead costs!  The dentist is very nice otherwise.  Just wish he knew what he was doing.  I just haven't been that pleased with his work.  He had to put a layer of thin vaneer on the upper part of a sensitive tooth a while back because my gum had receded some.  If I remember correctly, that cost over $300 and I still feel sweet/hot & cold sensations sometimes in that area. Also, seems like he didn't smooth it off well as I can feel the ridge with my teeth.  Stuff like that bothers me and if I had more money right now I'd have sought out my old dentist who I've since found out moved to another location in the same city into a partnership with another well known doctor here  (both famous for their high prices).  But, this time I wish I had followed my instincts and gotten the good one to work on my mouth-- (Since I last saw the good doctor, though, I have become disabled. Used to be an RN making good money. What idiot would want to give up a good job to draw disability when you don't get but about $800 to $1100 per month depending on your prior income. Quite a change for me after working in medicine myself. Disability doesn't go far and that is why I tried to find a cheaper dentist because dental isn't covered under medicare as of yet. I think they are planning a dental option in the future, but I probably won't be able to afford the insurance on what little income I have to live on. You'd think Medicare would see the preventative importance of dental upkeep in their plans to prevent hospitalization down the road due to infections from not being able to eat properly, etc). I'd love to be able to say I could side with the dentists/docs, but I've seen things from the inside out and know things that make me hate going for "any" medical treatment at all!  In spite of my disability, I miss the few and spaced out rewarding outcomes, but absolutely have no desire to ever go back into the occupation due to politics and red tape paper work **** that keeps you from giving more attention to the patients' needs. Believe me, if you find a compassionate caregiver these days it is rare because it is mostly about the almightly dollar now!   Hope all goes well for you.  Guess I'm going to sign off this forum since my mouth is doing better.  Best of luck to you with the implant.  I've always dreaded the thought of having them done especially due to my intolerance to pain meds. Be sure to get them to do a root canal first!  My husband tried one once and they drove the post in to hold the implant without checking the for extra roots.  Needless to say, he ended up forfeitting. Oh yeah--that was yet another "cheap" dentist in costs that cost him a tooth as well. Guess you get what you pay for, huh?  However,I'd probably consider an implant before dentures as I don't think I could ever get used to wearing dentures due to my gag reflex and with my luck I'd probably be allergic to the adhesive which holds them in place! hahaha   Anyway, regards and been nice chatting with you.  Hope all goes well in the future for both of us!

[lynn117]

wow. i really feel bad for your horrible ordeal. i hope you and your husband find another dentist if you cant find you previous one. sometimes its better to spend a little more to save in the long run! my last crown and root canal suffered a root fracture and is considered fatal. the bone is good and it only hurts off and on so i am keeping it till i can afford an implant. the whole thing runs around 5000 for a molar so it will take a while. you have cheaper dental rates where you live! here (ct) molar extraction runs 500+ and a crowned molar last year was 1300. i side with the dentists a lot because there is no guaranties when it comes to various procedures but i have to say your dentist seem incompetent at best. i hope you get this all cleared up soon.

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Update on my tooth:  Went to the dentist this a.m.  He said he was sorry "I" had made the decision to have the crown because he had warned me I might need a root canal.  I agreed with him that he had told me that, but I also pointed out that my decision to have the crown was based on what he had told me that the tooth would probably not hold up if I didn't have one.  The nurse then started explaining that it is quite common for the fillings to burst out when they start shaping the tooth and it isn't something the dentist can help (none of this was explained or discussed with me before my decision to have the crown and the dentist was all gung-ho to prep the tooth for the crown once he saw the temporary filling was causing no pain).  To make a long story shorter, after examining my tooth,  he then decided I needed a root canal if I had that much pain and wanted to send me to an endologist to do the root canal or I had the option to live with the pain until the permanent crown was ready and just wait to see if it was just the temporary crown causing the pain. I told him I knew it "wasn't just the temporary crown because I could feel the exposed root and could fill part of the tooth that "had not been covered well" by the temporary crown --(this being where the tooth broke off exposing the root). He said it looked pretty well covered to him.  I then asked him why could I feel composite with my tongue and why was there a ridge of bone on the tooth that was almost cutting my tongue that I had felt from day one since they covered it with the temporary crown (or should I say, "half covered it".) Also, the dentist had just done a root canal on my husband 3 weeks ago but all of a sudden doesn't want to do mine because it is a back molar.  Then the nurse tells me he only does root canals on the frontal teeth because the back ones were too hard for him to do.  None of this was discussed with me prior my decision to have the crown "based on his recommendation that if I didn't it could break away and the crown would prevent the tooth from breaking away".  Well, the tooth broke away anyhow and then he wanted to send me out of town to have the root canal done elsewhere instead of doing it himself.  His endologist that normally did the harder to get to teeth had quit and moved away so they claimed since out last visit.  The closest endologist was over an hour drive away (50 to 75 miles from here).  Basically, the dentist implied the failure of the tooth was my choice and would he would not own up to the fact that the filling burst out exposing the root due to his over-drilling but informed me I would have to still pay for the crown.  So here I am with $855.00 in a tooth that had been temporarily filled to see if it would hold (which it did until he overdrilled it), then had to have a mold and crown prep to drill it all out (which caused the filling to weaken and burst) and then this dentist wanted to send me to someone else to do his root canal for him!  That would have been another $700 or $800 dollars plus the cost of driving and time.  I felt so bad I finally told him to just lpull it because I couldn't stand the pain of waiting to see another dentist, nor driving that far to see another dentist. He kept trying to tell me I'd have to pay for the crown anyway and he really felt the tooth was worth saving. I asked his staff to check to see if the crown had even been started since I saw them the last day of the year prior New Year holidays and that all the offices had been closed up until yesterday. I told them I'd be willing to pay for the filling part, but didn't feel like I owed for a crown that he recommended that caused me to loose a tooth that I could have lived with for several more years with only composite in it.  Normally it takes 2 to 4 weeks to build a crown, but they said they'd have to get the dentist's approval to do that. Chances were the place they sent the mold to hadn't even received it yet.  The dentist finally decided to "not charge me" for today's extraction.  I would think not after paying him $855 for a filling that didn't work because he decided to grind it down too much and had already prepaid for the crown.  So, I lost the tooth, was out $855 for a pulling and didn't get the crown I paid for.  If I had figured a basic filling and extraction, the total would only have been $180 for the filling and $100 to pull it.  Quite an expensive extraction today, huh?  When the tooth was removed, I wanted to examine it and it was so darkened it looked rotten through and through and I could see a black spot on the underside between the tooth and root area. He denied seeing anything wrong and started scraping around on the extracted tooth trying to tell me it didn't matter what color the tooth was as long as it was hard and firm. The base of the tooth was the color of a popped popcorn kernel!!   I then looked at the root ends of the tooth and all the bulbs were swollen and inflammed.  I'm glad I got it out because not all root canals work the first time and the instruments they use for extraction I found out are made of nickel.  WEll, I'm allergic to nickel.  So, I'd have been in a mess if this dentist had broken off one of his drill bits like he did while doing my husbands root canal a few weeks back.  Of course, they said that wasn't uncommon either. Also, just because you have a root canal, that doesn't mean it will work either.  Sometimes there are canals they miss and they have to re-do the tooth.  And, just because you crown a tooth doesnt' mean you won't get cavities under it.  From the looks of the tooth he extracted, I would have never recommend trying to save it in the first place.  The doctor then gave me some lortab for pain and no antibiotics.  My gosh!  I nearly hit the ceiling when he had to inject medication to numb my mouth and tooth into those inflamed roots!!  I had had so much swelling from this incident that my whole right side of my face was hurting with shooting pain all the way to my eyeballs, jaw joints and every tooth from the back to the center front on the upper and lower sides were sore along the gum line (felt like deep root irritation)  from the infection.  I asked, "What about an antibiotic  to go with the pain meds?"  Their reply was that now that the tooth was gone then so was the infection!  That is a bunch of bull!  I nearly lost another tooth one time due to a systemic infection because another dentist had not given me antibiotics for infection after pulling an infected tooth. Needless to say, I was very disappointed with my care and today's outcome.  Not only did I loose a tooth because of his recommendation, but was out tons of money for an extraction, but as the old saying goes:  Screw me once and shame on you. Screw me twice and shame on me.  He wants me to return in a week to see how it is feeling. To top it off, the tooth broke into and he had to extract a second piece while pulling!   Well, I got news for him--if my tooth isn't infected or hurting I won't be back.  I'm going to try and locate my old dentist I used to use.  My old dentist may have been a little more expensive, but he knew what the heck he was doing!!!  I'm just praying now that I don't get a dry socket in this tooth or infection because I had to wait almost a week to see this dentist because he wouldn't work me in the first day his clinic re-opened because he was still on vacation and didn't want to do come in for an emergency check-up on my tooth.    

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Thanks for the info.  Tried to call my dentist today, but my luck he wasn't in today.  Been dealing with this pain for days and it is just getting worse.  I thought that the temporary filling was to make sure that the root would not be affected.  The tooth was 100% feeling ok until I went back for the mold and crown prep.  If there had been trauma to the roots due to the deep cavity, then wouldn't it have shown up after the first drilling and filling with composite?  All I know is I could have lived with the composite like it was until it gave way.  Now my whole jaw aches with pain shooting up to my eyes and back to my ear with a throbbing pressure pain under the temp crown area and sharp very sensitive pain in the area that doesn't feel like it got covered with the acryclic temporary crown.  The part of the tooth that was covered well doesn't bother me at all--it's where the acryclic didn't cover the tooth where some of the composite broke off and I wasn't even eatting anything at all on that side since the procedure.  The dentist told me the first temporary filling was to make sure there was no pain so that I would not need a root canal.  So, I still don't understand how the tooth could be ok with the filling and then all of a sudden after being prepped for the crown drive me up the wall.  I still believe the dentist ground my tooth off too much.  I was always told the more tooth left to help support the crown the better it would hold.  Now I have a short nub just above my gums.  So, looks to me like the dentist would know he'd be getting into the nerve area.  Past procedures I've had done, the dentist filled the tooth and smoothed the composite. .  Then a mold was made for the tooth before ever grinding it down and a temp crown applied to last until the final crown was ready (2 to 4 weeks to make).  Then when the casted crown was finished, the dentist would pop off the temp and had to do very little grinding to cover the tooth.  Never have I ever had a dentist drill my tooth to look like a volcano in the center for a crown.  Of course, the temporary crown he called a plug was a good name for it because a plug goes into a hole.  Just doesnt' make sense to me.  Must be some new dental procedure.  If it is, I much prefer the old method with less dental visits and less pain.  Have an appointment first thing in the a.m. and maybe I'll get to the "root" of this problem.(haha)  --TNX  

[lynn117]

my dentist make a cast, fills the tooth (it isnt regular filling material so it needs to be refilled), whittles the sides all around (even the good part so the crown covers the tooth. its stronger that way), takes another impression, places a temp crown. then i wait a month for the lab to make my new crown. temporary crowns sometimes can be a little irregular but if you are in pain go back now. if you do need a root canal it probably is not your dentists fault. repairs close to the nerve can cause trauma and can not be avoided. you had a deep cavity so its like a **** shoot. the dentist is waiting to see if trauma will calm down on its own or if you need a root canal before attaching the final restoration. this is normal maybe you pain is due to an ill fitting temp so go back and have him look at it.