Crown prep now more pain

[KevinMc]

Hi

I began the crown procedure for one of two crowns, (last two molars on upper left).  Been having MINOR discomfort and cold sensitivity, but then I started experiencing some odd headaches on just the left side and after a CAT scan, they recommended I deal with the dental to rule it out.  There are a couple of hairline cracks I'm told.  The Dr did the second to last tooth first and put on a temp crown.  The next day I had some pretty significant pain, but thought it was typical from all the work done.  The next two days it just got worse and I developed a serious heat sensitivity issue and a tenderness above the tooth he didn't work on.  I called the Dr and he gave me an RX for a antibiotic.  He said he is going to go and prep the other tooth for a crown and if the pain doesn't go away he recommends an extraction!  Why wouldn't they try a root canal first?  Is it possible the work on the adjacent tooth made this obvious infection worse?  Could I have become infected by the procedure?

thanks
Kevin

[KevinMc]

The endodontist began the root canal but determined once he looked under the microscope that there were too many cracks and the only option was to pull it.   A whole new adventure.

thanks for all the advice!

Kevin

[KevinMc]

Saw the dentist on Friday and he began the crown prep for the back upper back left molar and said for sure I needed the root canal. Having it done on Tuesday morning.  I go back to the dentist a week from Monday.  Will this be enough time to make sure we got the right tooth before they cement these two crown in?

[StratRebel]

Swelling and pain that goes away after 4-5 days of antibiotics is due to an infection for sure. Do finish off your antibiotics though, don't want the bacteria coming back.  Yes, eventually it will come back because antibiotics really have no effect inside a tooth (low blood supply).  This is why root canals are necessary, to eliminate the source.  Enough bacteria in the tooth to cause an infection and swelling means that nerve is dead or dieing, so yes, its a greater indication for a root canal.  The way to test for this is with cold testing (this allows the dentist to narrow down which tooth is the problem).

Good luck with everything.  Let me know how things work out.

[KevinMc]

thanks for all your advice.

The antibiotics seem to have worked.  The swelling, pain and heat sensitivity have abated after 5 days of them.  Does this mean it was (is) an infection for sure?  I imagine these can come back?  Can the root canal be avoided or is this an even greater indication that I should get it done (once they narrow down which tooth it is for sure?  Seeing the Dentist tomorrow morning.

Kevin

[StratRebel]

Sounds good.  I would keep that dentist, he seems like he is covering all the angles and looking to save you time and money by not doing unnecessary treatment.

I would like to know how things turn out.  Good luck!

[KevinMc]

thanks for the responses. Pain is a little better today.  Maybe the antibiotics are working   I spoke with the Dentist this morning and we are going to go ahead with the crown prep on the tooth that I believe is causing the issue,  He said if he pain is not better, I'll go to the root canal guy and if the tooth is too cracked - an extraction.  He is also not going to put the permanent crown on the other tooth until we can pinpoint this pain.  Sound about right?

Kevin  

[scottma]

Seeing an endodontist to have a thorough evaluation is advised.  Occlusal interference is a common culprit of thermal sensitivity after restoration.

[StratRebel]

Vitality testing also includes putting cold on the tooth and gauging the reaction of the nerve.

A crown prep only takes away the outside surface of the tooth.  A root canal involves removing the inside core of the tooth, which can make the tooth very fragile (hence the need for a crown after a root canal).  During a root canal procedure, a lot of pressure is used to clean out the canals and place the sealant material (this part will crack the tooth if it already has hairline fractures).

Antibiotics take up to 4-5 days before you will notice a difference.  Two days is not long enough to see a result.

If you don't want him putting on the crown yet, tell your dentist that.  Your teeth need to be in good health before putting on any final restoration.

[KevinMc]

Thanks for your response.

The dentist spent some time probing and tapping if that's what you mean about a vitality test.

So, the prep for a root canal is different than for a regular crown?  I thought they had to get the tooth down to a similar size to crown the tooth after a root canal.  If the tooth was ok for a crown would it not be a good candidate for a root canal?

I've had two full days of antibiotics, very little relief - esp to heat.

What I don't want them doing is putting the final crown on next Friday when this pain is still not pin pointed.

[StratRebel]

Did your dentist do a vitality test on the teeth you were having sensitivity on?

If you have fractures in your tooth, the pressure from a root canal procedure would crack the fracture in two, making things worse.  

The first thing in any dental procedure is to remove the infected part of the tooth before doing anything else, so its unlikely the work caused an infection.