Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

February 2, 2016

Do I really need this crown on a root canal tooth?

Filed under: Dental crowns — Tags: , , — mesasmiles @ 7:38 am

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Hi, Dr. Hall,

I had a root canal done on a molar almost 5 years ago. After the dentist did the canal he put in a filling which has recently come out. I went back and he has told me I need a crown put in with posts, I was wondering if this is necessary rather than just getting another filling? What are the pros and cons of crowns? and is it strange that he didn’t originally put in a crown as there’s not much of the tooth left and I think he probably would’ve known the filling wouldn’t last. Any help would be great as I really don’t know what to do.
Thanks,
Melissa from Ireland

Melissa,
The only puzzling part of your situation is why the dentist didn’t recommend a crown when the root canal was first done. Now you’re in Ireland where much of the dental care is publicly funded. I’m wondering if that has something to do with this.

Not every tooth that has a root canal treatment needs a crown. I’ve written before on this blog about the need to be careful in doing crowns on front teeth that have root canal treatments, as a crown will weaken a tooth against lateral stresses. But practically every molar with a root canal treatment does need a crown. The reason is that once a tooth has a root canal treatment it tends to become more brittle over time and more susceptible to breaking. Molar teeth in particular are the most susceptible of breaking in this circumstance for two reasons. They are the teeth furthest back in the mouth, so they receive the greatest chewing pressure. Furthermore, because of their cusps, the stresses on them tend to separate the cusps, which subjects them to a high risk of cracking in two. A crown will protect the tooth against cracking in two.

So yes, I would do the crown.

And a post or posts would be needed if there isn’t much of the tooth left to hold the crown on—if the tooth is mostly filling. Otherwise you wouldn’t need a post.

– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

October 21, 2015

My new crown doesn’t feel quite right

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Dr. Hall,
I just got a new crown on an upper molar, and it does not feel like it meshes with the tooth below it. I think it needs a deeper indentation to accomodate the tooth below. Is there a risk of damaging the tooth in drilling away more of the surface of the crown? My dentist says to give it time to get used to it. It’s been two weeks and still is uncomfortable.
– Criss from New York

Criss,
I smile thinking about your dentist’s response, “Give it time to get used to it.” That’s a classic “I don’t know what to do” response. Now this could be a particularly difficult situation, or this could reveal a lack of knowledge of your dentist.

A new crown or onlay should not be noticeable when you bite or chew. It should be so perfectly comfortable that you don’t even know it’s there. But the occlusion between your upper and lower teeth is very complicated with all the various motions that are involved in chewing, and many dentists are simply not experts in that. There are post-graduate institutes dentists can attend such as the Texas Center for Occlusal Studies, the Pankey Institute, the Las Vegas Institute for Advanced Dental Studies, the Dawson Academy, and others. These institutes train dentists in the science of occlusion–how the upper and lower teeth mesh and are supposed to function together. Many dentists attend these institutes, or will attend other solitary courses where the same principles are taught. But many don’t feel that they need this training, that their basic dental school education was enough, and they go through their careers with a fairly rudimentary understanding of occlusion. Without this training, they may not be qualified to do a full-mouth reconstruction, but they can do single crowns or onlays. They may have some patients who experience what you are experiencing–the teeth don’t feel quite right, but for the most part they get by. Yes, in time, over a period of months, you will probably get used to it, and it may cause no further complications. But an occlusal problem like this can in some cases lead to unnatural stresses on the teeth which can contribute to bone loss around the affected teeth. Or in some cases it can be a precipitating factor to TMJ disorder.

Many dentists will simply adjust a new crown or onlay so that it isn’t high. They will ask you to bite on what it called bite registration paper, and that paper will leave marks where the crown or onlay hits prematurely and then will grind down those places. I’m assuming that your dentist has done that basic step and that this onlay isn’t “high”–you can clench together without discomfort–and what is wrong with your bite is more subtle.

What should you do? The best thing would be to get the tooth adjusted so that it is comfortable. No, that shouldn’t damage your new onlay. Such adjustments are fairly common with new dental work, and there should be plenty of thickness in the new onlay to accommodate any necessary adjustments. But if your dentist doesn’t know what the problem is, then I wouldn’t ask him or her to do that, as they could do more harm than good. But then going to another dentist to have this adjusted could be awkward and would involve extra fees.

Here’s what I would recommend. If you’re generally pretty happy with this dentist, then I would let this go and wait a few months to see if this tooth begins to feel like it fits better into your bite. However, I would be leery about having this dentist do another crown or onlay on one of your back teeth.

If you have other points of dissatisfaction with your dentist, this could be a way to find a dentist whom you feel will better meet your needs. Look for a dentist who has publicized his or her training at one of the institutes I mentioned above, ask for a second opinion on this onlay, and if you’re happy with what they do for you, you’ve found a new regular dentist.

– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

October 8, 2015

The main reason your crown probably fell off

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I happened across a website the other day, Oral Answers, that had a post, “Six Reasons Why Your Crown Fell Off.” As I read it, in my mind it highlighted the difference between this website and other dental websites. The dentist writing this gave six “politically correct” possible answers that pretty nearly absolve dentists of any responsibility in this mishap and skirt the main cause.

The author of the website appears to be a nice guy. He is a dentist and identifies himself only as Tom. And it’s not that the information is incorrect, it’s just sanitized. It seems to adhere to the philosophy I’ve had preached at me from other dentists, that we professionals need to stick together and defend each other. And so Tom, rather than frankly explain what he was taught in dental school about crowns falling off, instead tries to portray dentists as nearly infallible.

For me, I can’t bring myself to do that. I need to tell it like it is and let the chips fall where they may. My professional duty, as I see it, isn’t to make other dentists look good but to help the patient.

Here are the six reasons Tom gives, with my comments on each one. Again, they’re all true. It’s just that he leaves off the main reason, which is what he and I were taught in dental school. So after I list his six reasons, I’ll let you in on a dental school lecture about the main reason crowns actually come off.

1 – The tooth underneath the crown got decayed.
This will definitely cause the crown to come off. However, if you are having regular checkups, your dentist will spot this decay well before it is extensive enough to cause the crown to fall off.

2 – The cement holding the crown on wasn’t strong enough. This could be due to contamination of the cement while it was being prepared or any number of other reasons. If this is the case, your dentist can usually re-cement the crown back ont your tooth.
This is the closest he comes to faulting the dentist. But I preserved his solution because he presents this as so easy to fix that it makes the dental mistake easy to forgive. In reality, I would attribute this cause to fewer than 1% of crowns falling off. I don’t think I ever saw a case like this in my practice.

3 – You ate too many chewy foods.
I was never taught in dental school to advise my patients with permanently cemented crowns not to eat chewy or sticky foods, and I never told them that. I will add that in 23 years of practice, I never had a crown that I put on just fall off, and my patients ate jelly bellies, taffy, whatever. I also have eight crowns myself and don’t observe any diet restrictions because of them. But if you do have a borderline crown or a temporary crown, yes, sticky foods will give you problems.

4 – The crown broke.
Again, this will do it, but it rarely happens. I’m trying to remember if I ever saw a broken crown in my practice. I may have seen one or two over my 23 years. In the old days, some pure porcelain crowns would break if they were used too far back in the mouth.

5 – You abused your crown.
He mentions grinding your teeth or using your teeth as tools. Yes, he is correct, this will stress your crown, but if the crown is done well it won’t be enough to loosen it so that it comes off.

6 – There wasn’t enough tooth structure to hold onto the crown.
Here he’s getting close to the main reason that crowns come off. This happens most often with short teeth. However, we dentists are taught how to address short teeth and get a crown to stay on. There are retentive grooves and other preparation features we can put into the crown preparation to deal with a short tooth.

The Main Reason

Keeping a crown from falling out

Now let’s go to our dental school training. Here are a couple of slides from a dental school lecture. Dr. Al Amri is teaching his students crown retention and resistance forms, the two principles involved in crown preparation that keep the crown on the tooth.

He explains to the students that the greater the taper in the crown preparation, the less likely the crown is to stay on. In his graph, which I have enlarged below, he teaches that by tightening up the taper,Taper the prep to keep the crown from falling off the dentist can increase the retention dramatically.

This seems like a simple solution and you may wonder, then, why every dentist doesn’t just prepare the teeth with minimum taper. There are a couple of reasons. First, to prepare a tooth with minimum taper requires a lot of precision. What if the dentist is off just a little bit? He or she could end up with what is called an undercut. I’ve illustrated that in this small diagram below. crown retention graph In an undercut, the tooth preparation is narrower crown-retention-graph-edited at the bottom than at the top. Having even the slightest undercut makes it impossible to make a crown to fit—it simply won’t slide on the tooth. If there is a small undercut in just one small part of the preparation, the crown won’t work. And the less taper there is in the crown, the more time and effort it takes to tell if you have an undercut.

The second reason is that the tighter taper makes it harder to seat the crown. The tighter taper, which makes it hard to dislodge the crown once it’s on, makes it harder to get on during the seating appointment. Any irregularity in the surface of the tooth or the internal surface of the crown needs to be resolved. There is less room for error.

A dentist can avoid these issues by simply creating more taper in the crown. And some dentists do just that. They may not be intentionally taking shortcuts—they may just lack confidence in their ability to create a perfect crown, so they just shoot for acceptable, with the result that they have some crowns that end up falling off.

We dentists, when we talk among ourselves, will talk about this issue of crown retention, and we fully understand that we are in control. But many dentists, when they are talking to patients, don’t feel the inclination to be quite so honest, for fear it will tarnish the profession. That’s their mindset. But it’s not mine.

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

July 17, 2015

I had an awful experience getting this CEREC crown

Filed under: Dental crowns — Tags: , , — mesasmiles @ 2:42 pm

Dr. Hall

I recently had a CEREC crown put in. I was told how great the CEREC was going to be, and that this was supposed to fit perfectly. But it didn’t seem to go that way.

I ended up spending about three hours in the dental chair. My dentist said she had to take a generic image from the database because my tooth was in such bad shape. And then the crown didn’t fit when it was made. I was watching the screen on the machine when she was making it, and I noticed a lot of red area. And then when she tried to put it on, it didn’t fit. She had to hand grind the sides and a lot off the top. It looked like it was sitting up really high and she had to grind it a lot. And then now it looks like it’s a little lower than the teeth next to it and doesn’t look like a natural tooth. It doesn’t have the bumps on it like my other teeth have, and seems a little wider on the outside at the base. Also it seems a little sensitive. I don’t know if that’s normal for a period of time or not. Its been almost a week. It just don’t feel strong. I wonder if it is not seated in properly.

Now when I went to the CEREC site, it looks like this was supposed to be a near perfect fit and would only take a few minutes to put in. And only minor modification if any. I also sen the image of how it looks when they take the image. My tooth looked identical to this, so Im a little concerned why she is saying it was because the tooth was in bad shape as to why they couldn’t fit it right or get a proper model of it. It looks from the site that they could make a copy of the top tooth to know how it would fit. But my dentist only took a image of the prepared tooth, so that doesn’t seem right.

So I want to know if my dentist did something wrong and is she trying to cover it up? and what about the sensitivity – why is that?
– Chad from Texas

Dear Chad,
You’re correct that something isn’t right with this crown. I can’t pin down from your description exactly why you had this bad experience, but you’re right that it shouldn’t have been this way.

The initial comment that your dentist made about having to take a generic image from the database because your tooth was in such bad shape–I’m not sure what to make of that. The CEREC crown system is made to deal with teeth that are in bad shape. Teeth that are in good shape don’t need crowns. The CEREC software asks the dentist to input which tooth is being crowned. For example, the dentist would program in that you need a crown on your upper left first molar. CEREC is set up to recognize how that tooth is supposed to look and gives the dentist a starting point for designing the crown. Then the images of the surrounding teeth and the opposing teeth should give her the information the machine needs to fit the crown perfectly onto your tooth and into your bite. Clearly, from all the grinding she did and what you are telling me about the shape looking funny and the tooth looking low, that didn’t happen. Why? One possibility is that she didn’t really know what she was doing. Another is that there was some problem that she didn’t tell you about such as that your gums were bleeding so badly that she wasn’t able to get good pictures of your prepared tooth.

There are a lot of things that can go wrong with a crown. In dental school, the first operative procedure your dentist was taught was how to do fillings. Only after she mastered that was she taught how to do a crown, because a high level of skill is required to do a crown and there are a lot of things that can go wrong. If the crown doesn’t fit the tooth perfectly all the way around, for example, the crown will have what is called an open margin–a gap through which decay can enter. Decay that gets into a tooth under a crown can ruin a tooth. If the bite isn’t designed correctly, it can lead to soreness in the tooth or TMJ problems. If the sides aren’t contoured correctly, it can lead to gum inflammation and gum disease. From the sounds of what you described, it seems like your dentist may have just sculpted the crown freehand in your mouth, which is a recipe for all kinds of trouble.

You mention sensitivity but you don’t say whether it is steady, increasing, or decreasing and whether that is sensitivity to cold, to sweets, to biting, or to something else. If it is steady and caused by either cold or food or air, my guess would be that is from an open margin. An open margin would probably mean the crown needs to be re-done.

You definitely want to get another dentist to look at this. And, assuming the crown has to be re-done, your dentist should pay for that. Don’t demand just a refund, but you want her to pay for the replacement crown and anything else that may be required to fix this, which may be more than what she charged you for this defective crown.

A couple of little tips on getting this second opinion–do not tell the second dentist any of this that you told me. Just tell the dentist you were questioning the crown and say that you don’t really want to say any more than that, and you want his or her opinion on the crown based alone on what he or she sees, not based on your story. Don’t give the name of your dentist. You want a blind second opinion. The more you say, the more you telegraph about the answer you’re expecting, and that can color the opinion you get. And you don’t want the dentist influenced by any friendship or animosity they may feel toward your dentist. If they press you for more information, say that you’ll be happy to share that after they tell you their opinion about what they see but not before. Oh, and be willing to pay for an x-ray so that the dentist can fully evaluate this.

Good luck,
Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

October 12, 2011

My temporary crowns hurt

Hi Dr Hall,
I recently had two crowns replaced on the upper right side. The gap between the old crowns was too big and too much food getting trapped there. I had temp crowns for a total of three weeks, while I waited for my permanent ones to be ready. Unfortunately, the last week the temp crowns smelled, tasted horrible and I started to feel some pain. My dentist assured me that the pain would disappear once the new crowns where cemented in. The pain did not disappear and it only increased in the days after the permanent crowns where put in. I went back to the dentist and he explained the maybe the bite was off. He did a little drilling to fix the bite and now it hurts only in that one area but pain is still there. The pain comes and goes but it hurst to chew on that side or bite down on that side. Is this common? He assured me that I did not need a root canal. Thanks
– Larissa from New York

Larissa,
There are various types of pain that you can have when you are wearing temporary crowns, or when you have a new crown. Some are serious, and others aren’t.

Three weeks is a little long to be wearing temporary crowns. The last week you were wearing them and they smelled and then started to hurt, what was happening there is that they were beginning to leak, and microscopic particles were getting in between the temporary crowns and the teeth. Those trapped particles started to smell, and since they were in direct contact with the porous dentin of your teeth, they would also irritate the teeth.

I have had that kind of pain while wearing a temporary crown, and it was very uncomfortable. I do think your dentist should have explained better what would happen once the crowns were cemented. The cement is an additional irritant of the tooth, and the sensitivity could increase right after they are cemented, but then it would gradually subside and disappear. If it didn’t subside and go away, it would mean that the irritation was too much for the tooth, and it may end up needing root canal treatment.

The pain to biting is probably a separate issue. I would assume that the bite just needs to be adjusted until it is comfortable. There is a chance, however, that everything – all the irritation from being worked on, etc., has caused the pulp in one or both of the teeth to die, which would then begin to irritate the ligament that holds the tooth in. It would be prudent, at your next checkup, to ask that the roots of these teeth be x-rayed, just to make sure everything is okay. Especially if the sensitivity to biting or chewing never really completely goes away.

Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

July 21, 2011

Cement left around my new crown

Filed under: Dental crowns — Tags: , , , — mesasmiles @ 2:40 pm

Dr. Hall
Is it common for a dentist to leave cement in a mouth that had a crown? My gums were hurting from the temporary crown. After the permanent crown was put on he said in a few weeks my gums would heal. They didn’t. I finally took tweezers and anything else I could find and pulled out a piece of cement under my gums. NOW my gums are healing. I felt instant relief after extacting this piece of cement. A 7 week ordeal.
– Mona from Texas

Mona,
This is a “no-no”, for a dentist to leave cement around a crown, and it will cause gum inflammation until it is removed.

I wouldn’t assume that you got all the cement but would make an appointment with the dentist, explain what happened, and say you want it checked carefully for any residual cement. If cement is left in there long-term, it can contribute to irreversible gum disease.
– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

July 14, 2011

How should my crowns come together?

Filed under: Dental crowns,TMJ — Tags: , , — mesasmiles @ 9:30 pm

Dr. Hall,
I am 59 years old, and have had 8 previous crowns. 2 weeks ago a new dentist fitted 2 new crowns (one porcelain and one gold) to my upper rear left adjacent molars.These are the permanent crowns, not temporaries. These new crowns are at least one mm or more distant from touching the opposing lower teeth (which are also crowned). I read that crowns should slightly touch opposing teeth. I also need another crown on the other side of my mouth, but need to know if my dentist made a mistake. Thank You very much!
– Mark from Colorado

Mark,
Yes, dental crowns should touch their opposing teeth. But, if they are made correctly, there are more rigorous demands than that. It matters where they touch. The study of how your teeth come together is called “occlusion,” and there are textbooks and entire courses that study occlusion.

How your upper teeth meet your lower teeth is important for proper jaw function. If your jaw is properly aligned, you should be able to clench together and all your teeth will meet at the same time. Then, when you slide your teeth from side to side, there are two acceptable patterns of occlusion. One is called canine-protected occlusion. In that type, when you grind your teeth to the side, only your canine teeth touch. These teeth have especially long and sturdy roots and are equipped to take this sideways stress.

The other acceptable pattern is called group function. In group function, all of the posterior teeth have the same slope and when you grind your teeth to the side, they all touch evenly.

One way some dentists use to check the bite is to put a thin strip of plastic between your back teeth, about 0.05 mm thick and about the width of one tooth. No matter where you put it on the back teeth, you should be able to clench your teeth together and prevent the strip from being withdrawn.

When you have back teeth that don’t come together all the way, over time they may drift together and touch. But even though they may touch, there is a strong chance that they won’t touch correctly, and they could throw your bite out of alignment. A poorly aligned bite is one of the contributing factors in TMJ disorder.

I hope this is helpful.
Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

March 26, 2011

Is this a case of gorilla bite?

Filed under: Dental crowns,Root canals,TMJ — Tags: , , , — mesasmiles @ 11:17 am

A little over three months ago I had a root canal and crown done. Tonight not only did the crown come out it broke off the post also. What do you reccomend doing to fix this? And since it didn’t even last four months should my dentist be responsible?
– Gerrard from California

Gerrard,
It sounds like a nasty situation, this tooth of yours. I suspect that the crown didn’t just come loose but broke off at the gumline. I’m guessing here somewhat, and answering based on what I’m visualizing of your situation, based on the few details you’ve given me. Not being able to see what has actually happened, I want to try to be helpful based on what is probably going on here. Anyway, if the post broke off, I’m guessing the tooth also broke off. It creates kind of a tough situation because there probably wasn’t a lot left of the tooth to start with. And if the post and crown have failed, it may be that the tooth really can’t be saved.

If not, then maybe the post was just weak and this can be re-done so that it works.

I want to be careful here, because I don’t want to make it sound like your dentist was anything other than well-intentioned and appears to have been trying to save a tooth that is proving pretty tough to save, which to me is admirable. And there could be extenuating circumstances. There are some patients that have what some dentists call a “gorilla bite” that generates a tremendous amount of force, and once they hit a certain age and their teeth start breaking down, they tend to break anything a dentist puts in their mouth. Having said that, if this post and crown only lasted three months, yes, if I were the dentist, I would eat some of the cost. What I would do when I tried what ended up being heroics to try to save a tooth, and I didn’t adequately warn the patient that this treatment might not work, I credited to the patient the cost of what I did do against the more aggressive treatment that I should have done in the first place. You are very likely going to need more aggressive treatment here – possibly a bridge or an implant to replace this tooth. So I think that credit would be fair. But whether the dentist is legally responsible to do that for you would depend on if he or she actually did something wrong, and it’s not clear that this is the case.

If you are one of these people with the “gorilla bite”, then your dentist may have to make you a night guard to help protect you against breaking off more teeth. You can tell the person with the “gorilla bite” by looking at the profile. If the bottom of the lower jaw is parallel to the upper jaw, that’s the “gorilla bite.” If that’s you, get a hard plastic night guard fitten to your upper teeth and wear it faithfully every night. I had three or four patients like that, and that was the only way to keep them from breaking off teeth. If you’re not, then count your blessings and just address this one tooth that may be unrestorable.

Dr. Hall

Links: Read about another patient who kept breaking teeth off, so had his whole mouth rebuilt with 28 crowns and has continued to break off teeth. This is likely a true case of gorilla bite.

 

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

January 5, 2011

Persistent pain to biting on a new CEREC crown

Filed under: Dental crowns — Tags: , — mesasmiles @ 8:31 am

Dr. Hall,
I recently received my first cerec dental work done on 3 back teeth. One of the teeth hurts when I chew as if a nerve is exposed. I cringe if I chew something just slightly crunchy e.g. popcorn. I have gone back 2 times had the tooth shaved done. My dentist explained to me that I have a cow chewing effect when I eat and that the pain was more than likely from my chew. I disagree because I have never had this problem. Do you agree with her? Or can you give me a brief explanation without seeing me as to what you think may be happening. I do not enjoy eating for fear I may hit the nerve in the tooth.
– Leigh from Oklahoma

Dear Leigh,
I don’t think your problem of pain when you chew has anything to do with the fact that this is a CEREC crown. Fitting the crown to the bite is usually easier with CEREC, because this work is done by the computer that mills the crown.

There are two likely reasons for a tooth with a new crown to hurt from biting. One is that the bite is high – you hit this tooth harder than the other teeth, which makes it sensitive. The other is that the tooth is infected. The infection can cause an inflammation of the ligament that connects your tooth to the jawbone, which makes the tooth tender when you’re biting on it, or it can even cause a constant toothache.

With two trips back to the dentist to reduce the bite, I would guess that the problem is probably not that this cown is high. So it would be time to investigate if it is infected. An x-ray of the tooth would show whether or not this is the case. However, sometimes the signs of infection are rather subtle on an x-ray, so you may need the opinion of a root canal specialist if your dentist’s diagnostic skills aren’t that sharp. The intensity of your pain as you are describing it along with the amount of time that I’m guessing has passed since this crown was done make me very suspicious that this is the case.
– Dr. Hall

Links:
Read more about pain from biting on a tooth.
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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

April 7, 2010

A putrid smell in my mouth, after getting 28 crowns.

Sir i got all my 28 teeth replaced with crowns for the purpose of teeth lengthening. Upper & lower molars(8) of Porcelain fused to Metal. Premolars of Zirconia(8). Incisors & canine (12)of Empress. And now after 2 months from the procedure done am having very much bad breath that its very much difficult to live with and even to breathe, and it tastes like vomit. Still after using mouthwash and brushing twice a day its not helpful and the smell is as it is. even i got done scaling but still the smell and taste of the teeth remains. Please tell me some solution that can be done now to get rid of this as its too much difficult to live like this. i am really helpless. And also tell me is it was right for the teeth lengthening??
– Ogas in India

Dear Ogas,
There is something very wrong with your dental work. It my days of practice, I had several occasions to replace dental work done in other countries, and I frequently found poor dentistry with overhangs that would catch food or other basic defects.

The materials your dentist used sound first class. But if there are overhangs on all the crowns, that could produce the putrid smell that you’re experiencing. I can’t tell if that’s the case. There are other possibilities.

If this problem is allowed to remain, it will likely lead to gum disease and early loss of your teeth.

There are excellent dentists throughout the world. But I believe the consensus among the world’s dentists is that there is no place that has as high standards for dental care as the United States. So what I would look for would be a dentist in India with some credentials from an international organization based in the United States. A couple examples of that would be accreditation or some other credential from the American Academy of Cosmetic Dentistry (There are two accredited members of the AACD in Mumbai, India, and several accreditation candidates in the country), or fellowship or diplomate status with the International Congress of Oral Implantologists. There may be other credentials. I would track down a dentist with a credential like that and go there for an opinion on your case. Go to the website of the specific organization and they usually have a search tool for finding a credentialed member.
– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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