Crown placed on an infected post. Is this okay? Dentist replies greatly apprec

[MikeOverseas]

Hi,

I would greatly appreciate it if a dentist could comment.

I made the mistake of walking around for two years with a "permanent" crown which was attached only with temporary seal. (Due to frequent travel and change of continents, just never made it back to California for the follow up). Number 14 tooth, I believe, upper left hand side.

Anyway, the crown fell out two weeks ago. A dentist put it back in today. But before placement, she observed (without taking any x-rays) a cary (around the top of the root canal). Drilled into it (I could smell bacteria). Then, place some white material in there for a few minutes, then glued the old crown back in. The crown immediately felt wrong, and she did not believe me that my bite does not feel right, and said to come back in a few weeks -- if "I don't get used to it."

My bite is definitely off. She did not use carbon paper or anything like that to assess the bite. When I close my upper and lower jaws, the predominant feeling is pressure from the area of crown against the lower tooth (even though I can sort of clench down on the right side of the mouth if I try).

My concerns are the following:

1. Did she really take care of the infection that was in there? The root canal was complex and took a long time on this. (I have an excellent endodontist back in Maryland who has an excellent regional reputation (dentist's dentist; professor; etc.) and he said that my long roots / curves made for a very difficult root canal.

Since there was a nasty smell when she applied the drill, was this more than just a little pocket of bacteria? Could this be in the root? How could she know if she did not take an x-ray?

2. Is there something wrong with putting an old, dirty crown (which I brought in a plastic bag) back onto the stump without cleaning it (she used some swab/solution right at the chair-side)? I would have expected a cleaning machine, autoclave, or something like that.

3. Is there something wrong with covering an infected tooth with a crown right away? My common sense tells me that things should be allowed to drain or dry out or something like that. Maybe she put in a filling, but it was not clear to me what the steps were during the procedure.

4. As far as the fitting goes, I almost would prefer that some other dentist remove this "porcelain on metal" crown and take a proper look / start over again. I feel that this was a botched job.

I have a set another appointment with a very expensive clinic in the major city near here, and I'm hoping to get better service.

Any thoughts by professionals on the above will be GREATLY appreciated.

Thank you!

[mike1105]

of course it can. your new dentist will drill a slice in it and pop it off.

[mike1105]

yes a film should have been taken
yes the crown should have been placed in a steri-solution in an ultrasonic machine before being re-cemented.
you are correct- it is not seated correctly if yor bite is off.
the odor is probably more likely from the drilling on the old dental materials than from the decay, but it is impossible to say. If the decay was very extensive, it should have been removed, a new post placed, a new buildup done ,and a new crown made.
i'd see another dentist, have the crown removed, the tooth evalated, and the case redone. there is no good reason in my opinion not to have your new crown permanently cememted at this point. temporary cement leaks. hope this helps

[mike1105]

if there was decay around one of the canals, and the dentist saw it and removed it, then you have to assume it was removed. while technically decay is "infection" becasue it is bacteria, it is not thae same as an infection that requires antibiotics. when the decay is removed, so is the bacteria. do not be swayed by odor. dental materials that have been in the mouth for a long time smell bad when they are being drilled out.  A patient can not usually smell decay unless it is very very extensive and is causing a secondary infection in the surrounding tissues.
I personally do not like to re-seat crowns after I have in any way altered the "stump". common sense should tell you that when the tooth is drilled upon (altered) the fit can no longer be perfect (which it should have been if it was originally done right). the fact that your bite feels different tells me it is not fitting the same way. if it were me I'd have it redone. when it is removed, your new dentist can evaluate the "stump" to be as sure as possible there is no more decay. and yes, when your crown was removed it should have been placed in an ultrasonic machine with some strong anti-bacterial agents. hope this helps.

[MikeOverseas]

Yes, thank you.

Unfortunately, the crown was place permanently.  Can it still be removed?

[Jerome Bogin, D.D.S.]

From what youy tell me I would have the crown taken off and remade. The fact that the bite was "high" after the cementation tells me that it was not seated correctly, therefore it is not fitting correctly. The odor from the tooth is probably from the cement washing out and does not necessarily mean that you have an infected tooth. Do youself a favor and get it redone.