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Mark Bornfeld, DDS
Mark Bornfeld, DDS, Dentist
Category: Dental
Satisfied Customers: 6021
Experience:  Clinical instructor, NYU College of Dentistry; 37 years private practice experience in general dentistry, member Academy of General Dentistry, ADA, American Academy of Oral Medicine
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My crown hurts every time I chew on it.

Resolved Question:

My crown hurts every time I chew on it.
Submitted: 5 years ago.
Category: Dental
Expert:  Mark Bornfeld, DDS replied 5 years ago.
Welcome to JustAnswer, and thank you for putting your trust in me!

Please provide more information:

-Was the prior crown replaced under the assumption that there was something wrong with that crown that was the cause of your present pain?

-What was the assumed defect in the prior crown?

-Was this tooth previously diagnosed with either periodontal or pulpal disease, for which either root canal therapy or periodontal therapy was performed? Were these treatments provided by a general dentist, or were they done by a specialist? Please elaborate.

-Do you have any other symptoms besides tenderness in response to biting pressure, such as swelling, conspicuous pus/exudate, or sensitivity to cold or hot foods/beverages?

-Have you consulted with any other dentists/specialists for this problem? Please elaborate.

Answers to all these questions will allow me to provide a more accurate and relevant response...
Customer: replied 5 years ago.
Hi Mark,
The previous crown was misfit and caused food impaction and pain. After two years of trying to convince the dentist that the crown needed to be replaced, he did it. This new crown fixed the food impaction problem. He never conceded that the previous crown was defective. He imagined I was allergic to the metal in it, but the symptoms did not fit, so I am not sure if I was.
This new crown is porcelain. When the crown was being fit, the temporary fell off--twice. Then when this permanent crown was placed it too fell off two days after placement. They replaced it, and I have been having pain chewing on it ever since. Sometimes I think I can get my fingernail between the top of the crown and the gums. No root canals have been diagnosed as necessary.
It is also sometimes very sensitive to temperature. But not always.
I have not consulted another dentist regarding this second crown because insurance will not cover work done on the same tooth twice in a certain period of time.
Xrays do not show any problems. The dentist who put it in thinks it just needs to be adjusted, but he's adjusted it so many times that it is now even so low that it can't really hit the bottom teeth easily. It can if I grind my teeth around, but the pain also has to build. It's like it gets reinjured every time the tooth gets pressed on.
Expert:  replied 5 years ago.
Your symptom is non-specific, and could theoretically reflect a variety of different issues. One question that would be helpful to answer is whether the pain that you're currently experiencing is due to the same underlying cause as the pain you experienced with your previous crown, because the second crown eliminated the presumptive cause of the initial symptom (i.e., the food impaction). Although the food impaction is undoubtedly a potential etiology in dental pain, it does not logically follow that just because there is food impaction that it is the cause, or the sole cause, of the pain. This leaves open the possibility that there is an ongoing issue that has yet to be identified or managed.

It is tempting to suspect some deficiency in the new crown, especially considering the repeated loosening-- a crown that falls off just two days after being cemented would seem to have an insufficient amount of the quality we dentists call "retention"-- the ability to reliably stay attached to a tooth. A crown with poor retention can break free of and move on the tooth in response to chewing force, and this movement can irritate the gum tissue and the surface of the tooth. Therefore, the crown itself is certainly not above suspicion, and needs to be evaluated. It is also evident that your dentist has already done enough "adjusting" of the crown to have determined whether that strategy is beneficial, and it is time to move on to additional diagnostic inquiry.

So, what needs to be done is to re-assess the condition and quality of the crown, and the pulpal, periodontal, and structural condition of the tooth, because all these parameters have the potential for eliciting the symptom you describe. If your dentist is either incapable or unwilling to re-assess the fruits of his labor, you will have no choice but to continue the diagnostic inquiry elsewhere. As for your perception of the insurance "frequency limitation"-- you should know that it does not pertain to a particular tooth per se, but to a particular service on a particular tooth. In other words, although your insurance benefit for another crown on that tooth will have been exhausted (typically, for a period of 5 years), you would still have reserved benefits for other services that are different (e.g., periodontal, endodontic). And at the very least, you will want to move forward with diagnostic service so a clearer picture of the problem emerges.

Therefore, and based on a general truism that a considerable majority of complaints like yours are caused by pulp inflammation (a feasible assumption, given the potential for pulp injury following two consecutive crown preparations), your best first strategy would be to consult with an endodontist (root canal specialist). This type of clinician is particularly attuned to these types of symptoms, and with his training, experience, and intuition (not to mention his lack of personal culpability in your current situation), would be best able to provide an informed and candid diagnostic assessment. You can find contact information for an endodontist near you by consulting the online directory of the American Association of Endodontists.

Hope this helps...
Mark Bornfeld, DDS and other Dental Specialists are ready to help you
Customer: replied 5 years ago.
The only possible last thing I could want to know is whether you personally know an endodontist in Northern Utah that you can refer me to. If not, I will find one. I have no further questions.
Expert:  replied 5 years ago.
Unfortunately, I am personally unfamiliar with clinicians outside my location, and therefore cannot provide specific referrals to endodontists.

Your primary care dentist should be willing to provide you with a suitable referral, assuming his intent is to help in resolution of the problem. Given his lack of success to this point, he should be eager at this time to get a fresh pair of eyes to look at the problem.

Good luck!
Mark Bornfeld, DDS and other Dental Specialists are ready to help you
Customer: replied 5 years ago.
I have no idea why this is telling me I haven't accepted your answer.