Dr. Hall,
I went to my dentist recently and he filled a front tooth. While in the chair he stated that he saw a small crack on the rear molar on the left side, and he said it needed to be repaired. He drilled the tooth out, banded it, and filled it with composite. I called him the next day because the tooth was extremely painful. Two days after he did the procedure I was back in his office, and after a cold test he said that I needed a crown and a root canal. I had him pull the tooth. Should I pay him for the extraction when there was no issue with the tooth, before he removed half of it, other than a small crack?
– Mark from Georgia

Mark,

Nothing you told me indicates to me that your dentist did anything wrong. Yes, it’s possible, because I don’t know the whole story. But I’ve seen this sort of thing many times, and it sounds to me like your dentist did the right thing.

When you say that there was nothing wrong with this molar but a small crack, that’s not the complete story. A crack is almost always a symptom of a major underlying problem with the tooth. A tooth that is otherwise healthy will not have a small crack in it. From subsequent events, it seems clear to me that this tooth was already infected. Yes, working on it irritated it a little more and placing a well-sealed filling over the infected pulp of the tooth caused an immediate painful reaction. Had your tooth been healthy before your dentist worked on it and had merely had some accident during the procedure, your tooth would have started to get diseased and it would have taken some time for it to flare up. The fact that it was immediately painful indicates that this disease process was probably already pretty advanced.

The reason your dentist was concerned when he saw this “small crack” was that the tooth probably had a large filling in it. You didn’t say what type of filling, but almost all teeth with cracks have large fillings in them, usually amalgam fillings. The crack would probably indicate that there is some leakage around the filling, meaning that decay will be able to leak through and get under the filling.

Not being able to see the x-ray, and not having looked over the shoulder of your dentist while he was working on your tooth, I can’t say with certainty what happened, but let me tell you what probably happened, based on my experience with many of these situations. Your dentist removed the old, leaky filling, likely with some decay underneath it. The dentin that was left between the bottom of your cavity and the pulp of the tooth was thin but intact. However, dentin is porous, and because of how the tooth reacted it appears to be clear that bacteria from the decay had been able to penetrate that porous dentin to infect the pulp of the tooth, causing it to be slightly inflamed. Working on the tooth irritated it somewhat, as it always does. Your dentist then replaced the old leaky filling with a new composite resin filling, bonded to the tooth and tightly sealed. The well-sealed filling now caused the internal pressure of the inflamed pulp to increase, which is what caused your immediate painful reaction.

I’m sorry for your sake that you had the tooth pulled when it could have been saved, but that is water under the bridge now. If it was the tooth furthest back in your arch, that shouldn’t have a serious impact on your bite, but you might eventually end up also losing the opposing tooth because it now may have no tooth to chew against and will hyper-erupt.

My recommendation to you would be to have your dentist look at your entire mouth and all your old dental work with a new set of eyes, and replace any old, suspicious fillings with new, well-sealed composite fillings, to help prevent this from happening again.

– Dr. Hall

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