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Avatar universal

Abscess Complications?

About six months ago, I had two teeth (18 and 19) prepped for crowns. One of the teeth (19) had deep decay. No pain prior to procedure and no sensitivity to hot/cold. After the crown prep, had periodic pain in both so asked dentist to place crowns with temp cement in case root canal became necessary. Experienced severe galvanic shock. Removed temps and had root canals on both teeth. Continued to have severe pressure sensitivity on 19 and some on 18. Dentist insisted on placing perm crowns - different crown materials (about six weeks ago.) Afterwards, pressure sensitivity improved but gum swelled on the linqual side. Dentist treated with Cavitron and said tooth would need to be extracted if swelling continued. Four days ago, had tooth 14 prepped for crown. All okay first day, then cheek and jaw started swelling and have not improved.  No pain in tooth 14. Made an independent appt with Oral Surgeon but can't get in for three weeks. Any ideas/suggestions? And, why would tooth 14 exacerbate 29? Or, is it a separate problem? Thanks so much for any help/advice!  
13 Responses
540545 tn?1377626518
MEDICAL PROFESSIONAL
What type of crowns are they using?  Perhaps you have an allergic reaction to the metal that may be possibly inside the crown.  So 14 was done and now 19 is bothering you more?  I thought that 19 was bothering you first.  They probably touch each other when you bite down.  
Avatar universal
I meant, "Why would tooth 14 exacerbate 19, not 29?" Thanks!
Avatar universal
Thank you SO much for responding! What a great service you provide by giving of your time and expertise. Thank you! Originally, 19 was a PFM and 18 was Zirconia. We thought 19 (the PFM) was causing the galvanic shock symptoms so it was removed. But the symptoms continued for two days (and 6 dental visits!) until 18 (the Zirconia) was removed and then the shock symptoms stopped immediately. I know this makes absolutely no sense. I've researched it extensively and cannot find another single case of galvanic shock with Zirconia. I realize it is usually the other way around. When the permanents were eventually seated, they were both PFMS. I have had several other PFMs in the past and never had a problem. Yes, 19 was bothering me first and the recent crown prep of 14 with the initial temp (no metal) is what exacerbated 19.  Thank you again for sharing your expertise!
540545 tn?1377626518
MEDICAL PROFESSIONAL
If the bite was off on the temporary, it could potentially be putting extra pressure on the #19 and causing some pain or discomfort.  Otherwise, the only other possibility I can think of is referred pain in which the pain is coming from one particular area that feels like its coming from somewhere else
Avatar universal
Thank you again for responding. My perception is that there's an infection under 18 and 19. When the crowns were permanently cemented, the Dentist had to do considerable bite adjustments to both crowns (the metal is even exposed on the top of 18). It felt like they were sitting high because of the inflammation (infection?) underneath the two teeth - mainly on 19. As a result of the adjustments, the teeth barely touch so I really don't feel like it's a bite problem, because I do know how that feels.  I think that when they were permanently seated, it caused the infection/inflammation to push out to the lingual side. What I can't understand is how the prep on 14 caused the physical swelling of the jaw and cheek which seems related to 18 and 19. So, I don't understand how that could be referred pain. There is no pain per se, just the swelling and inflammation. Any other ideas given this information? Thanks again for your thoughts on this matter!  
540545 tn?1377626518
MEDICAL PROFESSIONAL
Could be some trauma or injury from the injection possibly?  Sometimes you can get some trauma from an injection, especially if you needed a few "shots."  But the swelling seemed to go down to the gums of #18, 19 or did it just swell in the cheek area?  
Avatar universal
Thanks Dr Tsang. This kind of makes sense to me. Reason being, the area just underneath the cheekbone is still tender - almost a week later. The Dentist had to provide additional numbing medication during the crown prep and she also did a filling on #12 during the same visit. There is an area near #12 that feels really strange when I lightly press on the cheek. But, to answer your question, most of the cheek swelling was toward the lower jaw and there is a knot along the jawline that has been present since the 18/19 crown work and it became enlarged after the #14 crown prep. That's why I felt the #14 crown prep exacerbated the #18 and #19 infection. But, the gum itself did not swell anymore than it already is. Given what I've told you so far, do you have an opinion about an apicoectomy for #18 and 19? I've spent almost $5000 just on these two teeth and hate the idea of extracting them and spending another $3 to $6K for implants. I have several other dental priorities and just can't afford to invest anymore on a losing proposition. Thank you again for all of the time you've given to my case.
540545 tn?1377626518
MEDICAL PROFESSIONAL
I can't really help you with that.  I don't know your case well enough to know what the best treatment is.  I would guess that if a cleaning of that area doesn't help, I would go over the option of an apicoectomy on the tooth.  Sometimes residual cement can cause pain and swelling in the area.  
Avatar universal
I did meet with the Oral Surgeon who is not a fan of apicoectomies. He said he believed there was an infection in #18 (based on the pano), but did not see any problems with #19. He was very reluctant to do an apicoectomy on #18 because of the location of the tooth. So, I suppose my only real alternative is extraction.

Now for the latest "complication".........I went back after two weeks to have the permanent crown seated on #14. The crown did not fit and the dentist did additional drilling on the tooth. They made new impressions for the permanent and I also asked them to remake the temporary since I didn't feel like it was a good fit around the gums. The next day, I began experiencing sensitivity to cold. Reading that this was somewhat common, I assumed it would settle down once the permanent was placed. So, I went back two weeks later (last Tuesday) and had the permanent cemented. I was told that it fit perfectly, the margins looked great, and the xray looked great. Next day, tooth was also sensitive to hot and even room temperature liquids. Went back to dentist Thursday and she applied desensitizing gel and referred me for root canal. What is going on??? I'm afraid we're missing some big picture problem!!

The pain is short, sharp, and severe. NOT lingering, but severe enough to avoid it at ALL costs. There is no other pain with the tooth. It does not ache or throb at all. After doing more research, I realized the symptoms I'm having are more consistent with a problem with the gums than with the tooth. To test this, I took a q-tip and placed it in ice water and applied it to the bottom side of the tooth and I felt absolutely nothing.

What is the remedy for this type of situation other than a root canal. Please help me. I am devastated at this point at the series of events I've experienced in the last six months.

Any inofrmation you can provide is greatly appreciated. Thank you again for your time.
540545 tn?1377626518
MEDICAL PROFESSIONAL
You may want to have the endodontist (root canal specialist) take a look at the tooth and see if it needs a root canal.  Sometimes excess cement can cause tooth pain in the area as well.  Sometimes if the cavity is deep, it can take some time before the teeth develop symptoms and its unpredictable when that'll happen.  Another issue may be pulpal degeneration, in which the nerve will begin to die and develop problems due to its long history of fillings, cavities, crowns, etc.  Each time something happens to the tooth (trauma, etc) it damages it and eventually it can't heal itself anymore and the nerve begins to die.
Avatar universal
Thanks Dr Tsang.  Went to a new dentist. Good news is tooth doesn't need a root canal. Gums receded badly around this crown possibly because of poor fitting temporary. Nerve roots exposed causing the severe sensitivity. Dentist applied topical to tooth and cured with light but I haven't noticed any improvement. I'm using GelKam (bid), Sensodyne (am), Prevident (pm), and Oral B Rx mouthwash (bid) and flossing of course.

I am trying to give the tooth time to heal and lay down new dentin, and the sensitivity to abate. Since I can't even tolerate room temperature water, it is very difficult but I'm taking it day by day. Do you have an opinion as to how long it might possibly take before I could see some improvement in the sensitivity? At some point, I may have to have the root canal if I can no longer wait for the symptoms to subside. Any encouraging words??

Thanks again for your time.
540545 tn?1377626518
MEDICAL PROFESSIONAL
My guess would be that it may take a few weeks.  Keep using all the recommended treatment regimen at home and hopefully it'll gradually go away.  

You may need a root canal if the symptoms don't stop after about 4-6 weeks I would guess.
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