Dear Dr. Hall:
On June 26, my dentist prepared my cracked tooth number 30 (lower right first molar) for a crown. I had several problems with the temporary crown including very sore gum and pain with biting and cold sensitivity. However, since the pain was not lingering, my dentist placed my permanent crown on July 12. But it didn’t subside and in fact, it got worse. After one week, I visited him again and he took X-ray and did cold test and pressure test. He also knocked at my tooth which was not painful. My tooth was very sensitive to cold but it went away in less than 30 seconds. Also, I didn’t feel pain with pressure test although I felt pain when I bit on hard things. So my dentist said I had to wait and I had high chances to get better. He said sensitivity to pressure is normal even for 30 to 90 days. Now 10 days has passed and from my permanent crown placement, but I don’t see any improvement. Also, today I discovered my tooth is sensitive to hot food too although it doesn’t linger for a long time after the hot food is removed. I think once I realized this sensitivity with that temporary crown but didn’t care about it.
Are these reversible pulpitis symptoms? Does that heat sensitivity show my tooth nerve is dying? How long do you think I must wait before I see an endodontist?
Thanks a lot.
– Bita from Iowa

Bita,
Thanks for the clear description of your symptoms! You told me what kind of pain, what provokes it, and gave me a clear history, which makes it much easier to figure out what is going on with your tooth.
I would call the endodontist today. There are a couple of red flags here and I’d get an expert diagnosis before this tooth gets any worse. It doesn’t look good.
I don’t want to be too critical of your dentist, because I don’t know the whole story of your tooth—just what you’ve told me. But just taking what you’ve told me, some additional caution in your case seems like it would have been wise, and I’ll explain why. It also isn’t normal for a tooth with a new crown to be sensitive to pressure for more than a few days, if the occlusion is adjusted correctly.
First, you had a cracked tooth. A crack can easily involve the pulp of a tooth and by itself can cause a tooth to become infected and the pulp to die.
On top of this, you had significant cold sensitivity after the crown preparation. This could have been due to an incompletely sealed temporary crown, or it could have been due to the extra irritation to which the tooth was subjected from the crown preparation, or a combination of the two. It would have been wise to have coated the tooth with some type of desensitizing product at this point. Maybe that was done.
Also, given those two things, it would have been prudent to have temporarily cemented the crown. This is a lower first molar, so the crown would have to be made out of some strong material that could have been cemented with a soothing type of cement in hopes that it would settle down, or, if it didn’t, to allow easy removal of the crown for root canal treatment. Permanently cementing a crown is usually an additional irritation which can push a borderline tooth over the edge to needing root canal treatment.
So your dentist permanently cemented the crown and the pain got worse. Your sensitivity is headed in the wrong direction and appears that it will end up in irreversible pulpitis, requiring root canal treatment.
And now it is getting sensitive to heat. I wouldn’t go quite so far as to say that it’s absolutely certainly suffering from irreversible pulpitis at this point, but if not, it’s awfully close. The endodontist should be able to tell you for certain. There would be subtle changes in the ligament of the tooth around the end of the root that most general dentists wouldn’t see but the endodontist should.

– Dr. Hall

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