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Dr. Katz
Dr. Katz, Dentist - DDS
Category: Dental
Satisfied Customers: 3344
Experience:  Dentist and Anesthesiologist for 37 years.Anesthesiology Fellow-Johns Hopkins School of Medicine.Evaluator for Maryland State Board of Dental Examiners.
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Following up on previous question regarding pain and

Customer Question

Following up on previous question regarding pain and sensitivity to the number two tooth having 11-12 days after temporary crown.I just returned from the dentist, and he made a comment regarding the temporary crown having a high spot to the best of my recollection. So he did some drilling on that tooth.He said sensitivity to cool liquids is normal if fleeting, and I seem to recall in most instances after drinking a cold liquid it was just a matter of seconds. However, over the weekend I did have some mild pain from the tooth/gum, and sometimes moderate whereupon I used a table or two of Advil plus Orajel. However, I never had a throbbing sensation, and the pain was intermittent, and never woke me from my sleep.He thought my sensations were within the realm of normality, but he again added that 6 to 8 or even 10% of teeth that are crowned will need a root canal, although when I asked him if my was more of a candidate from my procedures, he said no. However, at the same time, he noted that the cavity in the number two tooth was higher up on the tooth, and thereby closer to the nerve (perhaps the reason for the sensitivity/pain?). He said that the tooth had had two prior fillings (he is not my normal dentist who is on disability), so apparently he can tell from the X-ray. I know it had a moderate to large cavity more toward the bottom of the tooth that he would have had to remove it if he had decided to fill the current cavity rather than putting a crown on the tooth. Further, a gap (apparently recent) had developed between the number two and three tooth causing inflammation, and apparently a filling would not solve that problem. He made a comment that perhaps the tooth should have had crown even earlier.Then he said regarding my query of a root canal, that there is no way to know whether a root canal is needed other than the patient having continual pain/throbbing in the tooth. I told that to a colleague upon my return and he said that an X-ray should be used to diagnosis a root canal, and that you did not just precede with a root canal because the patient is feeling pain. He told me to see a new dentist.I have an appointment for the permanent crown on Monday, and he said that if I am experiencing symptoms at that time he would use a temporary adhesive.He also said that he used to use CEREC but that they do not anymore, that it is not the best material for molars, and added something about the necessary skill to use this type of treatment. My regular dentist does not use CEREC. He also said that using CEREC would necessitate cutting away more of the healthy tooth, but he also said that he prepped by tooth for a CEREC even though he is using a porcelain/ceramic substrate for the crown, and that by using that technique it required less taking out of the dentin or pulp (not exactly sure; I would not think he would have to take away any of the pulp for the crown, so he must have meant the dentin? He did say that when prepping for the crown he never had to touch the nerves. It just seems counterintuitive that on the once had he would say that CEREC would require cutting away more of the health tooth, but that prepping it as if for CEREC involved less of a cutting away of the health tooth.Finally, I do have some tenderness/mild pain after the drilling this morning (he did not take an X-ray; should he have?). Not bad pain, just checking if that is normal. My sensitivity to water is minimal and mostly fleeting, although when the hygienist used the air when the dentist was drilling, the pain was certainly present, but I believe he said that was normal because the nerves are exposed at this point.He said there was some blood due to not flossing, which I could not due because he cemented the number two tooth the number three tooth (something about closing or preventing a gap).If the dentist's comments do not make total sense, then I should clarify with him or seek a second opinion.I know this is a lot for one question. If you desire to address it partially, I could ask the remainder as a new question to give your more credit.Thank you!
Submitted: 1 year ago.
Category: Dental
Expert:  Dr. Katz replied 1 year ago.
Is it possible for you to upload an xray of this tooth or area in question?.That could help a lot in diagnosing your problem.
Customer: replied 1 year ago.
I don not have one available, and do not know if I could access one. Is this something I could ask my dentist to send me via e-mail? Thanks.
Customer: replied 1 year ago.
Should he have taken an X=Ray today, or not necessarily? Concerned about his comment that cannot tell if root canal needed unless patient complains of continual pain (as opposed to intermittent I believe). Maybe there is more, but he just did not tell me?Also, he said the crown would not be metal. I did receive my insurance claim, and it said the crown was porcelain/ceramic substrate. That requires a co-pay on my part, as opposed to a full cast noble metal. Money is not a concern regard this for me. He said that crown would be Zirconia, and that it is a type of ceramic. But in looking at the net, it seems to be a metal. Could you clarify or make suggestions? Thanks.Perhaps you could address some of these questions, and I could ask a new question for your diagnosis if I can get an X-Ray. I will leave that up to your judgment. Thanks.
Expert:  Dr. Katz replied 1 year ago.
There should have been a recent xray taken.Your dentist should be able to email you a copy.
Expert:  Dr. Katz replied 1 year ago.
Zirconia is not metal.It is a ceramic substrate.It is a hard substance that is difficult to adjust.My opinion is that in this area, an all gold or porcelain fused to metal crown is the best type of restoration in this scenario.You can insist on it no matter what the dentist says.If he he does not do them or is unskilled in prepping them,find a new dentist.
Expert:  Dr. Katz replied 1 year ago.
Signs that a tooth needs to be root canaled are ,pain to heat,pain to biting pressure, swelling in the gum,fistula formation and xray ray evidence showing bone loss around the root tip.If most of these signs are not evident,the tooth is not a candidate for root canal therapy.
Customer: replied 1 year ago.
I called my insurance company and told them the dentist was planning a Zirconia crown. The rep stated that the claim submitted was for all porcelain (text shows porcelain/ceramic substrate). The rep stated that Zirconia is partial metal (I think she said not visible part), and that the dentist had submitted the wrong claim code. When I specifically asked him this morning whether the crown had any metal, he said no. What am I to think?Regarding root canals, I take it a dentist would not give a patient a root canal based on subjective symptoms, but would need evidence via an X-Ray that problems existed with the pulp, and/or a pulp test? If so, why would he not tell me that?
Expert:  Dr. Katz replied 1 year ago.
I think that the dentist is doing what he wants to do and have you just go along with it.There is virtually no metal in zirconia.There are just tiny particles of what they call metal that are not visible with the human eye.The important part of a porcelain fused to metal crown or an all metal crown is the metal coping.This metal is what gives a better fit and allows the preparation of the crown to be below the gumline for a better seal.I cannot tell you why or why not your dentist says something.It could range from answers like he doesn't know any better or that he is incompetent.
Expert:  Dr. Katz replied 1 year ago.
If you have no further questions,please leave a rating so that we can maintain good quality control on this site.I have offered a phone call but it seems like you are not interested in any more specific information. Thanks for your cooperation.
Expert:  Dr. Katz replied 1 year ago.
Is there anything else that I can help you with?

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