Issues months after crown... loose tooth and swelling

[sohcsol]

Hi everyone, new to this forum but I don't know where else to look for opinions and advice. Sorry for the long first post, but thanks to anyone who reads it.

Back in early January I broke my lower right molar on a popcorn kernel. I had not seen a dentist since I moved from out of state, so I picked one close to my work that had good reviews and took my insurance and made an appointment.

All went well at first, they gave me a temporary filling so the broken tooth wouldn't cut into my tongue. Then I got a temp crown. At this point I had had no pain at all in this tooth and could chew with it just fine. But he told me that the break was deep enough that the nerve might die and I might need a root canal on this tooth eventually.

Then the day came in late January that I went for my permanent crown placement. When the dentist forced it down on the broken tooth it hurt a little. Then I noticed it felt too high. They said "that's weird, that never happens" and he went to work filing it down to where he thought it was OK, or until he couldn't afford to spend any more time on it that day. I figured it just felt funny because I would need to get used to it.

Well that wasn't the case. I have bruxism and after a couple nights of grinding on it, I had a terrible toothache. I thought maybe it had abscessed because my entire face and jawbone hurt on that side. The lymph node under my jaw was swollen like a golf ball. I went to an urgent care to get antibiotics and pain meds because it was the weekend, and the dentist couldn't get me back in until the following Wednesday. When I went back to the dentist, he adjusted the bite for about 5-10 minutes and sent me on my way.

After not chewing on that side for a few days it seemed to get better. Then as soon as I started chewing with it again on soft foods, it was like the tooth shifted and suddenly the bite was way too high again. So back to the dentist I went.

This cycle went on for a couple of months, I went back about every two weeks to get the bite adjusted. The dentist explained that the tooth could be moving because the bite wasn't right, I was grinding on it, or some other unknown reason. They actually seemed kind of stumped.

I looked up my symptoms online and they sounded like the result of tooth trauma, or periodontitis. I decided to wait for several weeks after the last bite adjustment, since it doesn't feel too terrible at the moment, and see if the tooth just needed to rest so it could heal. Well it's been four weeks now that I haven't been chewing on it or had any work done, and the tooth is not painful but it is still loose and wiggly if I push on it. I can't chew with it because it moves and starts to hurt. I also have had periods where the gum around it swells up quite a bit, probably after accidentally contacting it or grinding.

I called the dentist again and he said I need to come in for an xray, that I probably need a root canal because the nerve might be dying. We are now 4 months since the original crown placement. I am wanting to go to a different dentist for another opinion because I do not trust him at this point, especially if I need a root canal. I feel that the only reason that I am going through this is because they made the crown wrong in the first place, causing severe damage to the tooth ligaments and probably my jaw bone, which now has a big lump under it and feels sore if I press on it.

Any other opinions or advice I can get on what might be going on with my tooth would be appreciated. Does it seem like this dentist was negligent in giving my an ill-fitting crown and not replacing it, but instead trying to file it down to fit? The bite still doesn't seem perfect, if I bite down all the way it feels like it gets pushed out to the side.

I am especially fearful if I need more work done or a root canal, because no dentist has been able to get me fully numb in my lower molars before.

 

[Busybee]

You should definitely go for a second opinion. Particularly as your dentist doesn't understand what could be wrong. All teeth have a little bit of give to absorb shock but molars should not be "wiggly". A molar wouldn't shift position every two weeks. It could be that the crown is moving and from what you've said there was something not right when it was fitted. Your dentist's comments do not inspire me with much confidence.

 

[honestdoc]

Could you provide an x-ray image? Did the dentist perform any tests like percussion and cold response? The dentist appeared inexperienced..."That never happens."

 

[sohcsol]

Thanks for your responses. The dentist did not perform any tests that you mention, he has just inspected it visually and adjusted the bite. Now I am sure my gum is infected or abscessed. I am going back to him today for an xray to see what it shows. He seems convinced now I will need a root canal and that the nerve is dying. I will not be having him perform any more work on my teeth, but he is an experienced dentist of over 40 years so I thought he would be knowledgeable.

I'll see what he says today then go to a different dentist for another opinion. It bothers me now looking back that he has not already done another xray or any other tests to find out what was actually going on with my tooth. He has given no definite explanation. Now I fear that the damage has already been done and I will either need a root canal or lose the tooth. I also fear that I may have bone damage from allowing the infection to linger for so long. I had felt a hard lump under my jaw bone for a while, it seems to be going away now but not sure if it was a cyst from pus trying to escape or just a hard swollen lymph node.

My hope is that the xray looks good and its just a periodontal infection, then should antibiotics clear it up and my tooth be okay?

 

[sohcsol]

Here are the xrays. Image R6 is from January 22, right after the crown was placed (the taller crown). Image R7 is from today.

He says there is a 50/50 chance I will lose the tooth. The bone around it has deteriorated causing it to be loose. He says most likely the nerve is dead causing the infection and bone loss. It probably died back in February when I was having severe pain and swelling in my lymph node. We both just thought the pain was because the crown was too high.

He wants to do a root canal to see if the tooth will tighten back up once it is cleared out, and I am starting antibiotics today.

But, if it doesn't tighten up after the root canal, the only option will be extraction.

 

[honestdoc]

You said this dentist has been practicing over 40 years. I see a lot of problems both in x-rays and his discussions with you. You mentioned he "forced" the crown in and quick to do a root canal without performing diagnostic tests. The R6 xray showed the "taller" tooth with bad margins under the crown with the shorter crown with recurrent decay under the crown. In the R7 x-ray, the taller tooth bone deteriorated unusually fast indicating a root fracture. The "taller" tooth cannot be saved unfortunately.

 

[Busybee]

Honestdoc I am glad that you posted with your expert opinion. I am not a dentist and was shocked when I saw the profound change in such a short time. Sochsol you should not go back to this dentist. You should take legal action because this is shoddy work.

Good online reviews are unfortunately very misleading these days. There are no longer any online sites where you can find out the whole truth about clinical work. You have to go by recommendation. Are you in the US?

 

[sohcsol]

Thanks for your responses guys. I will take these xrays to another dentist then. Are you saying that there is no hope for saving the tooth even with a root canal? He offered to do the root canal for free saying there was a 50% chance it could save the tooth.

I also did forget to mention that he did a cold sensitivity test on the tooth, I could not feel anything on the one in question but could feel it when he applied cold to the crown in front of it. Also the reason for the height of the crown is because when the tooth broke, the break went down below the gum line. If it is a root fracture, I don't think it occured at the time it broke though. I would guess it happened when the bite on the crown was initially way too high.

What do you suggest my course of action should be? Should I not bother going through with the root canal he offered? Just go somewhere else and see what they say?

Thanks again.

 

[Busybee]

If you have a crack that is below the gum then you cannot save a tooth with a root canal. I'm sure that some try but you're then going down the experimental route. The dentist offering to do the root treatment for free realises he has messed up. He thinks that legally it would look better if he offers to make amends. I think you should get legal advice. This dentist should not be in practice.

You should get two to three second opinions. That is the best course of action right now. Don't give them too much background information upfront. That way they will be more objective.

 

[sohcsol]

Thanks Busybee. I did schedule a visit with another larger office in our area for an exam, and I sent them the xrays with a brief explanation. I am trying to understand better what "should" have been done, since apparently this tooth should not have been crowned in the first place? Was it never saveable because the break went below the gum line? And finally, if it is root fracture, what would cause this and is it not possible to save such a tooth then?

It is looking like my only option now is extraction, just trying to better understand how I got to this point and what the appropriate response would have been by the dentist. I am new to all of this lingo

 

[sohcsol]

Additionally, if I were to decide to take legal action, is there a good method for locating a competent dental malpractice lawyer?

 

[Busybee]

Teeth break because they have been under stress for years and suddenly that one popcorn kernel is the last straw. But if it is broken below the gum a dentist should realise this based on symptoms and tests. Then they should realise it because they start to prepare for a crown and they can see there is a problem.

Sometimes a dentist who has been practising for 40 years no longer has good eyesight or doesn't have the most up to date training or equipment because they have not invested in their business. It's a very physical job and although some dentists carry on way into their 70s that's not always wise given the physical and mental changes that the body goes through during the ageing process. Instruments slip and damage dental tissue or surrounding teeth, hands shake, judgement is impaired. Along with other professionals dentists don't always realise they have limitations. It becomes complex to correct long sight and that might make it harder to spot faults. Just generally the brain slows down.

Anyway I hope you do find some redress and that you are back to dental health soon. Hopefully your insurers will pay for any implant you need. Do update on the second or third opinions.

 

[Busybee]

Additionally, if I were to decide to take legal action, is there a good method for locating a competent dental malpractice lawyer?

I can't advise you because I am in the UK and I think you are in the US. But to find a good lawyer I suppose the best way would be to research recent cases that have been successful. In the Uk that is information that is usually available to the public. We have regulatory authorities that strike dentists off when they are found guilty of misconduct. Case histories are the way to go. Then look to who was the winning lawyer.

 

[honestdoc]

This is just opinion since I have no law degree/license other than knowing a few attorneys. I don't think you have a legal case. Most lawyers in the US will not touch dental cases unless they know they will collect more than $100,000 because it is a waste of their time. You may get an unqualified, new graduate, starving attorney that will take your case. In the US, if you win $100,000, the plaintiff lawyer gets around $40 k, you pay about $47-48K in taxes and keep the remainder. There is no proof he caused the root fracture. You did mention of grinding your teeth which can cause root fracture.

 

[Busybee]

In the UK they focus on negligence. It would not be about the dentist causing the fracture, but his failure to spot it via symptoms and treat it accordingly. The trauma that ensued through poor diagnosis and treatment. The financial loss. The loss of bone through failure to diagnose, which may make implants less successful. There are so many angles. Here you don't pay if the lawyer does not win the case. They take on a case only if they think they have a good chance of winning. If you were in the UK they would take this case. The US has certainly changed.

 

[sohcsol]

Thanks for the information. I have been thinking about whether I would have a legal case or not. There are quite a few unknowns where, depending on the competency of lawyers on either side it could go either way as to who is at fault. I think that the dentist should have done more thorough tests to see what was going on, but at the same time he might blame me for not describing my symptoms or complaining about the pain I was in as much as maybe I should have? I don't know. I imagine they would want to settle it out of court, but yeah probably wouldn't be enough in it for an attorney.

That said, I am a week into taking my antibiotic and the gum around the tooth is still very inflamed, and I still cannot bite all the way together without that tooth getting pushed sideways in a way that is painful. I am seeing a different dentist Wednesday and hope they can shed some more light on what could happen. I know it is possible that jaw bone can regenerate but at this point I don't want to go through any more trouble with this tooth, would almost rather it just be removed.

 

[Busybee]

In terms of liability you have pretty clear clinical evidence with those x rays that the dentist missed something important here. They do not blame you for not complaining enough about pain. The fact that he knew something wasn't right just after fitting, having to keep filing down what should have been made properly by the lab. Surely he should have seen some alarm bells right away and should not have fitted it but sent it back. It's possible the impression he sent the lab were wrong and he was not alert enough to check them. Or the lab made a faulty fitting crown, but again that is down to the dentist to check and return if it's not a good fit. Try to get your medical records including any models and take these to another dentist to examine. If you lose the tooth because of this then you should take action. Let us know how you get on with the new dentist.

 

[Busybee]

Take action before he retires!

 

[sohcsol]

Lol thanks. I have contacted an attorneys office who deals with medical and dental malpractice and they are giving me a free consult to see if we may have a case. If anything it would be nice to help prevent anyone else from having to suffer due to his negligence.

And yeah I didn't go into much detail about the process when they made the crown initially. They used some 3D scanning device to scan my upper and lower teeth. It took them quite a while and they started to get frustrated with the equipment, not sure why. Also not sure how this works since A) my original tooth was already broken and B) they never had me bite together when using the device, so how would it know where the limit should be for my bite? But anyway, yeah the crown was a total failure. From everything I've read, he should have redone the crown completely once they saw that it wasn't right. I've had several other crown in the past and never had a problem, though they were all made by using a bite impression and mold.

 

[Busybee]

sounds like you have a good case. Make sure you act while the evidence is still in situ.