To crown, or not to crown?

[StayPuft]

Hi everyone!

So, I originally went to the dentist because I had a toothache. The dentist said I might need a root canal, but put in a temporary sedative filling to see if the pain would calm down. The pain has progressively gotten better, but he keeps saying wait to put a crown on to make sure the pain has subsided. That's fine, but I'm not sure how long this temporary filling will last. What's a reasonable estimate so that it doesn't just wear out on me and I get that tooth reinfected again before I have a chance to get a crown done? FYI, the filling is the furthest back molar on my bottom left teeth.

Also, on the furthest back molar on my bottom right teeth, an old filling has apparently come out. You can see the big chip in my tooth in the picture. The dentist says I need a crown (instead of just a filling) for that, as well. What do you think? If I need a crown, will it be really bad if I wait a little while?

BTW, sorry for the HUGE pics. I couldn't figure out how to shrink them.

 

[Busybee]

Always best to try a filling to see if it works before cutting a whole load of natural tooth down for a crown. I would go elsewhere to a more conservative dentist.

 

[MattKW]

Busybee, you're absolutely incorrect, and you should keep your layperson anecdotal "knowledge" to less clinical problems; you are misleading the OP.
Most often decay occurs in these places when the extraction of impacted wisdom teeth has been delayed. Fillings on the distal of 2nd molars will often lead to mesio-distal cracks of the teeth despite fillings, and ultimately result in extractions. Both of these teeth will only continue to function with crowns, and I would suggest full gold or zirconia.

 

[Busybee]

Staypuft always seek a second opinion from a different dentist in the real world, rather than relying on internet advice from people who haven't seen your x rays.

 

[MattKW]

Staypuft always seek a second opinion from a different dentist in the real world, rather than relying on internet advice from people who haven't seen your x rays.

I don't need to see Xrays to know what's happening here; I've seen plenty like this case. The mere fact the OP has had distal caries in a lower left 2nd molar can only occur if there is (or was) a mesially impacted 3rd molar.
At least I'm a dentist with loads of experience, rather than a layperson with anecdotes. And second opinions are fine - from a dentist.

 

[StayPuft]

thank you for the responses! Sorry, just saw them. I still have a little while until I see the dentist again, so I'll do more research and make a decision.

Do you have any idea how long that temporary sedative filling might last in the first picture? I know it's not an exact science, but a rough estimate might be nice so I know how long I can hold off.

thank you!

 

[MattKW]

Impossible to say. Anywhere from a few weeks to a couple of years? But when they break, it's always too late.

 

[KVMCruces]

Always best to try a filling to see if it works before cutting a whole load of natural tooth down for a crown. I would go elsewhere to a more conservative dentist.

Busybee, you're not a dentist nor do you work in dentistry.
You're a person who isn't asking any questions about your own dental care, you just consistently give illegitimate advice to other patients who are actually seeking dental advice from actual dentists.
Just because you've had work done to your mouth does not make you a professional. This forum is for PATIENTS to ask DENTISTS questions. If you're not a dentist then please don't advise anyone to do anything because you're doing more harm than good.

As a dental tech who is married to a retired dentist, it is so frustrating seeing your replies where you speak on subjects you have no knowledge about and constantly bash dentists and accuse them of being "scammers". I also find it ironic that you'd give advice to a patient to seek dental advice from a dentist "in the real world" rather than online, yet 90% of your dentistry knowledge comes from the internet. Hopefully one of the forum admins can resolve this issue.

 

[MattKW]

Busybee, you're not a dentist nor do you work in dentistry...

Yo, kick ass!

 

[Ian]

I'm away for a few days, but when I return home I will be starting work on a site upgrade, as well as a set of guidelines and rules for the forum. I've been intending to do this for a couple of months now, but this will start ASAP.

We definitely need to address what happens when medical advice is provided on the site, and I suspect we'll need to tip the scales in a direction where only verified dentists can provide medical advice (but with a mechanism where others can still comment in plenty of areas).

Next week, I'll get the ball rolling with a discussion on how members would like to see things function going forward. I've got a few ideas to suggest, but will want to seek significant input from active members on the site.

 

[Busybee]

KVMcruises I am astonished by your post. If a patient needs treatment there is no substitute for a face to face examination.

I may not be a dentist (and if you check my posting history I have often stated that in my posts), .I am not here in a professional capacity but I do work in healthcare regulation, and this includes dental healthcare. So I do understand very well how the sector works in my country and the standards that they are expected to uphold.

Many patients come here seeking guidance on what to do next and I can certainly advise them on that. In most cases you will see from my posts (including the one above which was so objectionable to you and others) that I have advised them to seek a second opinion. That is always the correct advice where is there is a conflict between the patient's expectations and the outcome of treatment and this conflict is not being recognised by the care provider.

I have not made the assertions against dentists that you state. But I have confirmed that there is a great variability in the quality and approach to dental care between different professionals.

It's in fact a certified dentist here, Honestdoc who has mentioned several times that dentists in the US overtreat for financial gain.

I'm a firm believer that conservative dentistry is the best approach and have underlined that in my posts (including the one above). Many patients may not have heard of the benefits of minimally invasive techniques or that it can save them from having more aggressive treatment.

There is nothing contentious in my original post on this thread. The first sentence was an observation, the second sentence (to seek a second opinion) was my perfectly sensible advice.

Good luck with running this forum as "cilinician only" advice Ian. Don't forget that patients can also help each other as they are more objective about the profession. I hope your panel of clinical experts will post in a more professional manner in the newly upgraded forum than I've seen on this thread! Otherwise it will certainly put a few patients from going to the dentist.

 

[MattKW]

No, Busybee.

1. Your first post shows that you do not understand the clinical implications of this particular case.
   
2. Your second reply looks like you were miffed that I spoke against you, so you implied that my opinion was doubtful.
   
3. "Conservative treatment is the best approach" is a very broad statement that is misleading. What you were advocating in this case was obviously under-treatment, and those of us dentists with decades of clinical and teaching experience are way ahead of you.
   
4. The current British adherence to NICE Guidelines on wisdom teeth extractions is an excellent example of conservatism gone wrong as has been addressed by other British specialist colleagues. Work your way through the 56 pages if you can.
   
5. "Dentists in the US overtreat for financial gain". Sure, there are some that do it everywhere, including UK and Aust, but that doesn't put your misleading opinions ahead of those of me, honestdoc, or KVMCruces. We aren't getting paid for our advice, and you are extremely annoying at times with your (frankly) stupid and ill-informed advice.
   
6. As I said in an earlier post, you are welcome to give general advice of a supportive nature, but far too often you delve into clinical issues that are way beyond your knowledge base of Dr Google. I would be more than happy to see you go to another forum as you appear to "threaten" in your last sentence. Ooooh, I'm worried.

 

[Busybee]

MattKw I've no idea what you are referring to in my last sentence?! The newly upgraded forum will be this one. I am not talking about another forum. You will presumably be one of the clinicians. Perhaps the only clinician as I have seen you jump down the throats (no pun intended!) of fellow clinicians just as often as you've jumped down mine. Such that very few of your fellow dentists post here any more. From what I have seen your personal arrogance as an individual is as immense as your conviction that you are the only one that's right. You don't seem to have noticed that there are many patients posting on here daily whose concerns are being ignored by any dental professional registered here. Their posts take days to be answered (if they are answered at all). They are anxious and need to feel that they are understood. I've been taking the time to make them feel that they are heard in the hope that a dentist will turn up and give a more thorough clinical review. Instead I get this nonsense!

There is nothing wrong with my original post on this thread. The first part is an observation. The second part is very sensible advice, advice that you frequently give yourself after I have given it. That goes for most of my posts on here. You parrot what I say very often. Few are countered by you. When they are countered it is with incredible rudeness and immature insults e.g. above.

You may be gratifying your ego with such responses but you are not representing your colleagues in a way befitting to the profession . A profession that has many members who are sensitive, kind and capable.

There is no need to be so angry that someone is contradicting you. My point was perfectly valid - you absolutely cannot diagnose without a full set of information and the best exam is one that is in person. You do not have that in this case. You are not superman. I'm sure from what I've seen that you are technically a very good dentist. But your chairside manner is terrifying. Being a dentist is not just about good engineering skills. It's about being kind and really listening to patients. If you want to demonstrate those skills start with being kinder and more considerate in your posts. Otherwise it just seems as though you come here to offload after a bad day in your surgery.

 

[MattKW]

My chairside manner is quite fine in my postings to patients. But you are absolutely right that I am annoyed with you, and I make no apology.

 

[KVMCruces]

BusyBee, obviously an exam with a dentist is best in person. I said nothing stating otherwise so I'm not quite sure why you're so "astonished", it must be the shock from being called out on the forum...yet again.

"I may not be a dentist .I am not here in a professional capacity" - THIS EXACTLY. You're not a dentist nor do you work in dentistry. I don't think anyone here is saying its a "clinical only advice lan" but there certainly needs to be boundaries for when its appropriate for you to insert your advice & you've overstepped those boundaries plenty of times. Not to mention the constant bashing of dentists only causes more stress & anxiety to patients who already have Odontophobia. There are $h!tty money hungry dentists EVERYWHERE. As an American myself, I can agree that we have our fair share but not every single doc that isn't "conservative" is out to get you. I think this paranoia you seem to have might possibly be coming from your own traumatic dental experience(s) & I would strongly advise you to find someone to talk to. Any dentist/dental assistants/technicians that are in the field for the right reasons still continue their dental education even after receiving their degrees/licenses/certifications. We attend educational seminars & take additional courses so that we stay informed. So please try to understand why MattKW or myself is quite irritated with you constantly dishing out illegitimate advice or even arguing with dental professionals.
As for patients having to wait a few days for advice... as MattKW stated previously, nobody gets paid to be on here. The dentists on here are probably busy seeing patients throughout the day & the dentists that usually do help can only answer so many questions in a day. However, that doesn't mean you start giving out mediocre advice. You can simply say that it usually takes a couple days for a response so if it's a big concern advise the patient to see a dentist "in the real world" like you said so yourself.

I don't care to go back n' forth with you & I most definitely will not. An admin has already addressed it so I'll be looking out for updates on upcoming changes.

MattKW - The forum is very dependent on dentists such as yourself and others like Honestdoc. If you guys weren't here it would literally be the blind leading the blind so thanks for not only sticking around but also putting up with... you know LOL.

 

[Busybee]

KVMcruices if you "don't care to go back 'n forth" (sic.) then do not post your impertinent opinions in the first place! You're no dentist yourself. You have in the past posted clinical advice which is outside the boundaries of your professional knowledge. You've pretty much diagnosed conditions on here. I've been far more careful in my own posts yet you call me out?! Most of my knowledge comes from dental professionals and not the internet.

But that's all good because this forum currenly has no rules to say that advice has to be given by a dentist or that patients can only post questions. If the forum rules here change then I will of course adhere to the new rules.

As for dental professionals - it's two dental professionals = three opinions! So you need an MDT to really be confident of a diagnosis and treatment plan. That's why they now sway towards conservative dentistry in the UK. You can always go forward slowly but you cannot go back. Just as those UK citizens who were subjected to the antipodean "dental trench" in the late last century cannot go back to dental health...

 

[MattKW]

BusyBee, obviously an exam with a dentist is best in person. I said nothing stating otherwise so I'm not quite sure why you're so "astonished", it must be the shock from being called out on the forum...yet again.

Thanks for your kind support, and rebuttal to BusyBee (what an appropriate name). I think it's ironic that Bb complains that dentists don't reply sooner on this forum - my own reluctance is to avoid getting into pointless discussions with an uninformed and troublesome person like Bb. I only step in when she starts giving incorrect clinical advice. If she continues to interfere and doesn't recognise when to back out then she'll be the only person left and it can be renamed the "Bb ranting forum". Cheers.

 

[KVMCruces]

"KVMcruices if you "don't care to go back 'n forth" (sic.) then do not post your impertinent opinions in the first place! You're no dentist yourself. You have in the past posted clinical advice which is outside the boundaries of your professional knowledge. You've pretty much diagnosed conditions on here. I've been far more careful in my own posts yet you call me out?! Most of my knowledge comes from dental professionals and not the internet."

It's veryyyy apparent that you're delusional. You cannot delete anything on here so if you actually looked at my past postings & you would clearly see that I've never diagnosed any conditions nor have I ever given clinical advice that was "outside of my boundaries". I also didn't post an opinion, I advised you to mind what you're saying to patients because you're in the habit of giving out mediocre advice. I was trying to be nice but you can't seem to take a hint.
You're not a dentist, RDA/RDH or CDT. STAY IN YOUR LANE little Busy Gnat.

The forum rules will be changed very soon & then you'll have no choice but to go find a hobby (one that you so desperately need). Toodle-loo 'till then