Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

April 11, 2016

I have an awful toothache, and my dentist is trying to tell me the tooth is fine!


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Dr. Hall,
Over a month ago, I had a toothache and ended up needing a root canal treatment on a lower molar. After that was done, the tooth felt somewhat better, but has never completely settled down. Now this last weekend the pain really flared up. It actually felt like it was the tooth next to this one. It started hurting so bad it scared me. So I went back to the endodontist who did the root canal. He took x-rays of all the bottom teeth on that side. He says that nothing is wrong and I could have all the teeth on that side pulled, including the new root canal and the pain would still be there. He told me to go to a neurologist.
Do you have any advice?
– Kendra from Oklahoma

Dear Kendra,
It’s tough for me to tell what is going on without a personal examination. But I think I can be helpful.

I can tell you that it isn’t uncommon at all for pain to feel like it is coming from a tooth and that tooth is fine. There are several possibilities for pain like this:

  • One is referred pain. I have seen where an upper tooth is infected and the pain feels like it is coming from a lower tooth. Or the pain can feel like it is coming from a tooth next to it. You don’t see referred pain crossing from one side of your mouth to the other, but you do see it from upper to lower, and you do see it from teeth that are in the same quadrant.
  • A second is some type of neuralgia. Yes, this happens, and it isn’t all that rare—a nerve problem that feels like a toothache. So yes, it is possible that your endodontist is right.
  • A third possibility is some other type of pain. A sinus infection, for example, can feel like a toothache. The maxillary sinus often is very close to the roots of upper teeth and infection there can press on those roots and feel for all the world like a toothache. Or that pain could be referred and feel like it is a lower tooth. Other health problems can feel like toothaches sometimes.

I can also tell you that it is possible, from a careful reading of x-rays, to determine that a tooth and its root are healthy. If a root canal isn’t healing properly, there will be x-ray evidence of that.

So I don’t know how to tell, from here, what the problem is. My advice would be to listen to the endodontist.

However, I would allow for the possibility that this endodontist isn’t very sensitive to patients or a good listener. You get some of that in the dental profession. If you have the feeling that he doesn’t really care that much and is trying to get rid of you, it might be smart to get a second opinion, just to be sure you’re getting correct information. Find another endodontist. If there isn’t one in your town, so much the better. It would be worth a drive to go get a good second opinion. But in getting that second opinion, make sure it is a blind second opinion. DO NOT tell the second endodontist the whole story, and especially don’t give the name of the endodontist who treated you or even give any clue that you went to an endodontist. Don’t say anything about the diagnosis you’ve been told. Just say that you had this root canal a month ago and now you have pain flaring up and ask if he or she can figure out where it is coming from. If they press you for more of the story, just be frank with them—tell them you want a blind second opinion and you’re not going to say anything more. They’ve got eyes and training—they don’t need anything more than the basics of the story, their eyes, and x-rays, to come to a diagnosis. You don’t want to complicate the second opinion by having this new endodontist call your old one. They probably know each other and there will be a strong inclination of the one to want to protect the other.

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.

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.

September 29, 2012

Can Ali trust this dentist?

Hi and thank you for taking my question!

For about 2 weeks I have been having jaw and tooth pain that comes and goes and seemed to move. I went to the dentist who I have not seen before. He did X-ray and found a large cavity in a tooth that already had a filling. He said he feels there is only a 10% chance he can save the tooth because there won’t be enough actual tooth to work with and it is probably going to be extracted the same day after he cleans it out and finds how deep it is. Then he suggests an implant or bridge but leans toward a implant and bone grafting.

I strongly dislike any dental work and am petrified of all this. The tooth is 4 from the back on my right side which still has wisdom teeth. Does this sound correct to you or should I seek a second opinion? He said there was no infection he saw at this time but put me on amoxicillin for precaution since I had some pain. I have the worst fear of having some type of allergic reaction to the local anesthesia or something going totally wrong and I am having constant anxiety over this. Thanks for any advice!
– Ali from Maryland

Ali,
I can’t say for certain without seeing your tooth, but I am skeptical of what you are saying your dentist is telling you, for a couple of reasons.

First, if this is the first time you have had a toothache in this tooth, then the tooth has just recently become infected. I am having a hard time believing that this tooth is as far gone as your dentist is saying, if that is the situation. A hopeless tooth would have most likely begun hurting months ago.

Second, a tooth that has been so extensively destroyed that it isn’t savable, this would not require an x-ray to see it. It would have an obvious, big, gaping hole in it, and the filling would have fallen out long ago. Usually.

So yes, a second opinion would be smart.

A word of advice about getting a second opinion – make sure it is a BLIND second opinion. Don’t let the second dentist know what the first dentist said. You are entitled too be able to get a copy of the x-ray to take to the second dentist, but you need to conceal the diagnosis because that knowledge can possibly prejudice the second opinion.

And another point. You say you are having a lot of anxiety about facing this work and are worried you may be allergic to the anesthetic. In all my years of practice and the thousands of people I treated, I never had a genuine case of allergic reaction to any local anesthetic. I had people claim they were allergic, but upon administering the anesthetic, there was no allergic reaction. But I saw a lot of anxiety like yours. In fact, I myself am an anxious patient. You need to find a dentist who practices sedation dentistry who can give you something to take care of your anxiety. For me, if I just have nitrous oxide, that works and I’m fine. For others, they may need conscious sedation. When you have a certain level of anxiety, your body actually fights off the local anesthetic and it may be impossible to get you completely numb. And that just perpetuates this vicious cycle.

So, yes, get your second opinion, and I would recommend finding a dentist who could offer you sedation.

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 4, 2011

I don’t really think I had five cavities.

Dr. Hall,
I recently went to a new dentist to get my teeth cleaned. I floss every day and I brush my teeth in the morning and most nights also, I dont drink alot of sodas either. I take really good care of my teeth. My old dentist told me I had great teeth. I found it weird that the dentist I went to the other day told me i have 5 cavities. All of them were in my back teeth. I went and had them filled, which he filled them with the white ones.

Since then I’ve had alot of problems with pain. I’ve had him adjust my bite but it still hurts. I really dont think I had cavities at all though. Should I get an xray from before and bring it to another dentist to see if I even needed the fillings? I looked at the xray after he took it, I didn’t see anything, but of course I’m not a dentist either. I just never had pain before and now I do, plus with the care I take with my teeth I dont see how I could have had 5 after just going to the dentist last year and had none. Just wanting another opinion.
– Alicia in Tennessee

Alicia,
It is possible that you had cavities that the first dentist missed. I had an experience after I got out of dental school where I had a large cavity in my own mouth that had been there for quite some time and the x-rays taken at dental school missed it because they were taken at the wrong angles. But I think you’re reasonable to be suspicious. Yes, if you have reason, like you do, to be suspicious, I would ask for a copy of the x-rays and get a second opinion. But tell the second opinion dentist as little as possible, and don’t let the second dentist know the name of the first. I would just present the x-rays and show up and say, “I’d like a second opinion on this dental work” without planting any ideas like that you thought the work was unnecessary. A dentist who is hungry for patients will sometimes try to agree with a patient in order to convince a patient to quit the other dentist and become a patient. And a dentist who is personally acquainted with another dentist will sometimes hold back and feel a strong obligation not to criticize. To get the very best second opinion, you could visit a dentist in a distant city while you’re on vacation or something.

The post-operative pain you’re feeling also makes me suspicious. It sounds like the white fillings may not have been done correctly – not bonded correctly. Do you have pain when you clench your teeth together? Or is it just pain when you’re actually chewing something? If it doesn’t hurt to clench, but it hurts to chew, that’s an indication that something went wrong in the bonding process. If that pain persists, it may be necessary to replace the fillings to alleviate it. If it hurts to clench, then it’s probably that the bite just needs to be adjusted.

– Dr. Hall

Links: read more about pain after new fillings.
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We thank our advertisers who help fund this site.

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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