Ulcer slow healing after crown placement

[RtdTwo]

Sorry i believe i posted this in the wrong sub earlier. Hello I’m glad to find this community in hopes of getting another opinion on my situation. I had a permanent crown place back in mid October and for a few days every was fine until I bit my tongue while eating and the next day I woke up with this ulcer area along my tongue.

I’ve been back to the dentist 3 times to have the crown polished down however the ulcer remains. It has diminished in size however I can feel my tongue hitting the crown while eating and sometimes while talking or swallowing. It’s only painful when it’s rubbing - or sometimes when chewing if food hits it . I’ve been very careful to avoid hard crunchy foods however 3 days ago I bit that area again while eating and it seem to set any healing back.

My dentist said last week after polishing the crown again that these type trauma ulcers could take as long as another 30-45 days to fully heal and to do salt water rinses several times a day And avoid irritating it. I’m beginning to wonder if extraction is ultimately the only option. Attached is different pictures several weeks apart. I greatly appreciate any advice or suggestions if any . Thanks

 

[Dr M]

It seems like the disto-lingual cusp is the culprit here. I think you can try and adjust it a bit more, but keep in mind, every bit that you take of the crown, compromises the integrity of the crown. An ulcer usually takes about 14 days to disappear. That being said, I don't know the size of the original lesion. I would not recommend extraction.

 

[RtdTwo]

Thank you so much for the advice! I’ve called my dentist and waiting on a callback to work me in. my apologies for not being more clear on a timeline. the bottom 2 pictures are the original ulcer just a few days after crown placement. Top pictures are more recent. Thank you again

 

[RtdTwo]

Update… Dentist called back and requested me to Text pictures of the area for the dentist to look at. Received a callback shortly afterwards saying everything was ok continue the saltwater rinses daily and give it more time. We are going on 2 months now since crown was placed

 

[Dr M]

If the ulcer is not healing and the dentist is not addressing your concerns, then perhaps consider seeing another dentist for a second opinion.

 

[RtdTwo]

If the ulcer is not healing and the dentist is not addressing your concerns, then perhaps consider seeing another dentist for a second opinion.

I’m going too as soon as Christmas holidays pass and I can get into another dentist.also My dental insurance switches to a different company on January 1st. Thankfully it’s not hurting anymore at all and I’ve been very careful not to bit the area while eating. Now if the gash would fill in that’s missing from my tongue I’d feel much better about it. Thanks Dr M for taking the time to listen and advise! I truly appreciate it!

 

[MattKW]

I have to disagree here. A usual guide is remove any likely sources of trauma or localised allergy (sometimes amalgams) and apply a corticosteroid paste e.g. Kenalog in Orabase, for 2 weeks and then review. If it hasn't healed, then treat as suspicious and get a biopsy by an oral surgeon.
I had a case similar to this but less ulceration. A woman in her 30s, no risk factors (smoking, alcohol). There was an adjacent amalgam, so I replaced with GIC and prescribed Kenalog. Made no change at all, so referred for biopsy and turned out to be squamous cell carcinoma (SCC). The surgeon thanked me for being proactive and saving her from a worse outcome. Tongue cancer requires quite a lot of removal and the sooner something is assessed properly, the better. I'd rather be wrong 100x than miss 1x.