Do I really need 2 more crowns if I don't have any cavities? Please help.

[desperate_thing6628]

Hey all,

So, I have severe dental anxiety. I hadn't been to the dentist in 5+ years but decided that this was the year I needed to address things. I was also feeling some pain from impacted wisdom teeth and knew that those likely needed to be dealt with.

So, over the course of 2 months (starting in April), I had my wisdom teeth removed and on the recommendation of my dentist, had a filling (on 17) and a crown (on 18). The crown had quite a few complications and required many visits. I want to say about 6-8.

A couple days before they put in the permanent crown, I started feeling a slight pain when biting down on that area. At first I wasn't sure if it was the crowned tooth that was causing me pain or the tooth above it. I brought it up to my dentist and they thought it was likely just the pressure on the crown. So, once I had the permanent in, they adjusted my bite. I had to go back for a second bite adjustment and some cement removal a couple days later and was still experiencing the pain. So, I brought it up again. My dentist this time adjusted the bite in my upper tooth (as I also have a filling there). After this adjustment, the pain was much worse. Though it is only painful when I bite down in that area. And only when I bite on food or objects-- not when I clench my teeth together. No pain when I push on the area. And it seems to be very localized. I can bite down in some areas back there as long as it doesn't hit that one spot.

I waited a few weeks, hoping that maybe it was just pain from all the dental work that I had had over the past couple months. But after 3 weeks, the pain hadn't gone away. So, I went back to my dentist, who suggested that it might be the ligament around the tooth that was swollen from the dental work. They recommended that I take a few days of large doses of Ibuprofen and see if the pain subsided.

It didn't, so they referred me to an Endodontist. I just visited them yesterday morning. They did a couple tests and determined that the pain was present in both 14&15. From what I understand, they said they thought it was fluid shifting around in my teeth and causing pain. I don't understand this thoroughly-- I was also upset (because anxiety) and I wasn't in a great frame of mind to ask questions. They said the only 2 treatment options would be either getting both teeth crowned or jumping straight to a root canal. This seems crazy to me because there's nothing visibly wrong with these teeth--that why my dentist referred me to the endo in the first place. But I'm not an expert, which is why I decided to post here.

Is there really no other treatment option for this mysterious pain? Could it be something else that the dentist or endo didn't mention? Should I get a second opinion?

It just seems as though the endo wasn't super sure what the cause was and just wanted to try a treatment option. He said try getting them crowned, but if that doesn't work, come back and get a root canal. But it seems crazy to me to remove good portions of my molars just to hope it will stop the pain.

Any advice you can give would be appreciated. I also have x-rays if that would be helpful to share.

TLDR: After a lot of dental work, I'm now being told that I need 2 additional crowns (on 14&15) to treat a mystery pain. Do I really?

 

[MattKW]

Probably go to another dentist for an opinion, and take copies of your records and X-rays. Sure, put up your X-rays on this forum and we might be able to help. It would be very useful if you showed us X-rays taken pre-treatment as well as after the initial treatment.

 

[desperate_thing6628]

I only have copies of x-rays from after the first crown, unfortunately. But I have attached both below!

Thank you so much for your response!

 

[MattKW]

The upper teeth look fine and require no obvious treatment. DON'T start crowning them.

Based on the limited info, it sounds most likely that there is still a high spot on the lower crown at a certain biting position. I'm curious why the crown took so many appts; normally only 2 appts or 3 at most.

1. I would firstly recheck your "bite" and adjust the crown ONLY (not the opposing tooth).
2. It looks more like a large onlay covering the cusps than a full-encirclement crown. It appears as if you still have an older filling either on the outer side of the tooth or under the onlay. And at the lower edge of that tooth is an area of radiolucency - this may be decay that hasn't been removed (arrowed). Discuss with your dentist.
3. Next case scenario is to remove the crown and place a simple temporary plastic crown to see if it settles down again.
4. You don't mention what type of material the crown/onlay is made of. I suspect it may be zirconia - a very strong material that is a pain to adjust or remove. Once adjusted, it weakens them. My preference for a 2nd molar would be a high yellow gold-content (precious alloy). Much easier to adjust, and much gentler to the wear of the opposing teeth.
5. If the temp crown doesn't resolve the pain, only THEN would I consider a root anal therapy.

 

[desperate_thing6628]

That's extremely helpful thank you! It was the direction to crown the upper two teeth that was so concerning to me.
My only question is. if it's the lower crown that's causing the issue, then why do I seem to be feeling the acute pain in my upper teeth? Is it just hitting a bad spot? Or what?

To answer your question about the process of crowning the lower tooth, it took many appointments to get a permanent crown that fit the tooth below. The first permanent crown appointment I had, my dentist was concerned with a shadow underneath that turned out to be trapped debris-- but she had to drill the filling to get it. So, they had to re-scan for a permanent. The second appointment, the crown they sent just didn't fit. Same with the third. The fourth finally fit, but I had to have multiple adjustments to it.

I believe that my dentist is aware of the state of the crowned tooth-- they're waiting to see if it will heal before referring me for a root canal.

Also, I am happy to provide any other detail that might be helpful-- just not sure what that would be.

Thank you so much for responding! I really appreciate your advice! Definitely makes me feel like I'm not crazy for questioning the advice of crowning what appear to be healthy teeth.

 

[MattKW]

The pain may feel like it's coming from the top teeth, but may be referred from the lower. I may be wrong, of course, but everything seemed OK for you until you got this crown. It is not impossible that the uneven bite of the crown has caused a crack in one of the upper teeth, but I'd prefer not to start tampering with other teeth; just concentrate on the one that's been treated recently (the crowned tooth) or you risk "muddying the waters" and start causing pain for other reasons.
I would persist in having the crown adjusted more heavily, or removed and temporised, and possibly replaced with gold. I wouldn't be starting an RCT unless the pain was continuous, woke you whilst sleeping, and was not relieved by painkillers.

 

[desperate_thing6628]

Okay, thank you so much! And just to clarify, you're talking about the RCT related to the lower tooth, right?

 

[MattKW]

Yes. You don't have the correct signs and symptoms to start an RCT in any of your teeth until simpler (for you!) procedures have been attempted. The dentist may not want to do what I outlined earlier because he's looking to fix your problem with least time and money on his part, but I think that if you start an RCT (lower tooth) at this stage, it risks not addressing the real problem (prob poor occlusion) and starts to make other problems appear.

 

[desperate_thing6628]

Thank you so much! I've discussed your recommendations with my dentist and we are starting with another adjustment to the crown this week. I'm also going to start using a night guard.

 

[Hopefulgirl]

Hey all,

So, I have severe dental anxiety. I hadn't been to the dentist in 5+ years but decided that this was the year I needed to address things. I was also feeling some pain from impacted wisdom teeth and knew that those likely needed to be dealt with.

So, over the course of 2 months (starting in April), I had my wisdom teeth removed and on the recommendation of my dentist, had a filling (on 17) and a crown (on 18). The crown had quite a few complications and required many visits. I want to say about 6-8.

A couple days before they put in the permanent crown, I started feeling a slight pain when biting down on that area. At first I wasn't sure if it was the crowned tooth that was causing me pain or the tooth above it. I brought it up to my dentist and they thought it was likely just the pressure on the crown. So, once I had the permanent in, they adjusted my bite. I had to go back for a second bite adjustment and some cement removal a couple days later and was still experiencing the pain. So, I brought it up again. My dentist this time adjusted the bite in my upper tooth (as I also have a filling there). After this adjustment, the pain was much worse. Though it is only painful when I bite down in that area. And only when I bite on food or objects-- not when I clench my teeth together. No pain when I push on the area. And it seems to be very localized. I can bite down in some areas back there as long as it doesn't hit that one spot.

I waited a few weeks, hoping that maybe it was just pain from all the dental work that I had had over the past couple months. But after 3 weeks, the pain hadn't gone away. So, I went back to my dentist, who suggested that it might be the ligament around the tooth that was swollen from the dental work. They recommended that I take a few days of large doses of Ibuprofen and see if the pain subsided.

It didn't, so they referred me to an Endodontist. I just visited them yesterday morning. They did a couple tests and determined that the pain was present in both 14&15. From what I understand, they said they thought it was fluid shifting around in my teeth and causing pain. I don't understand this thoroughly-- I was also upset (because anxiety) and I wasn't in a great frame of mind to ask questions. They said the only 2 treatment options would be either getting both teeth crowned or jumping straight to a root canal. This seems crazy to me because there's nothing visibly wrong with these teeth--that why my dentist referred me to the endo in the first place. But I'm not an expert, which is why I decided to post here.

Is there really no other treatment option for this mysterious pain? Could it be something else that the dentist or endo didn't mention? Should I get a second opinion?

It just seems as though the endo wasn't super sure what the cause was and just wanted to try a treatment option. He said try getting them crowned, but if that doesn't work, come back and get a root canal. But it seems crazy to me to remove good portions of my molars just to hope it will stop the pain.

Any advice you can give would be appreciated. I also have x-rays if that would be helpful to share.

TLDR: After a lot of dental work, I'm now being told that I need 2 additional crowns (on 14&15) to treat a mystery pain. Do I really?

In my opinion, not a dentist, but I have studied some dentistry for a while and I believe the pain is in 14 and 15 because 18 and 17 is hitting them. (And is 17 a wisdom?) I believe something is wrong with your bite because of those new crowns. They most likely don’t fit we’ll. What does your gut say?

 

[desperate_thing6628]

Thanks for your response!

To give an update, I have not had more crowns put in. After reviewing the advice from this thread with my dentist, we re-adjusted the existing crown and I started using a night guard. This has significantly reduced my pain.

I am starting to believe that the pain may indeed be from a cracked tooth, but with it being minimal currently (depending on my bite), I'm okay living with it unless/until the pain gets worse.

I do notice that when I forget to use my night guard, the pain is worse the following day. So, I'm hopeful that with continued use of that, I can avoid any further treatment.