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My husband had a cap put on a cracked tooth last week, and…

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My husband had a...

My husband had a cap put on a cracked tooth last week, and is still experiencing pain. It wakes him up at night. It isn't constant, but 3 or 4 times a day. Why would this be happening?

Doctor's Assistant: Is the pain consistent, or does it fluctuate?

Fluctuates

Doctor's Assistant: Please give me a bit more information, so the dentist can help you best.

He was experiencing pain in that molar. The dentist found a cavity and filled it. He was still experiencing pain so then the dentist told him he needed a crown, so he prepared the tooth for a crown. He told my husband the tooth was cracked. He put a temporary crown on, my husband was still experiencing pain during this time. The permanent crown was put on last week. He is still experiencing fluctuating pain

Submitted: 11 months ago.Category: Dental
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Answered in 12 minutes by:
9/17/2017
Dentist: Beth Dorian, Dentist (DDS or equivalent) replied 11 months ago
Beth Dorian
Beth Dorian, Dentist (DDS or equivalent)
Category: Dental
Satisfied Customers: 22
Experience: DMD/Owner at Platteville Family Dentistry
Verified

Hello, I'm Dr. Dorian, and I'm currently reviewing your question. I'll be back momentarily!

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Dentist: Beth Dorian, Dentist (DDS or equivalent) replied 11 months ago

Unfortunately, this situation is very common. Even if a tooth has NO symptoms prior to a crown preparation, it can become symptomatic afterwards. However, in your husband's case, the tooth was symptomatic BEFORE the crown was placed.

The key question about a tooth is the status of the pulp of the tooth. The pulp is the innermost part of the tooth and houses the nerves and blood vessels. It's the part that causes all the trouble! If we see an abscess definitively on an x-ray, we will KNOW that the pulp is infected. However, the absence of a definitive abscess on an x-ray does not mean that the pulp is NOT infected. So, if the pulp is compromised (and we dentists don't know that because there is no definitive abscess) and we work on it, the pulp might become inflamed afterwards. The pulp inflammation may cause the tooth to hurt for a while. The key question is:

-Is the inflammation reversible, or irreversible. (The conditions are called "reversible pulpitis" and "irreversible pulpitis" respectively).

Spoiler alert - my hunch is that your husband has irreversible pulpitis

If you have irreversible pulpitis, there are only two choices to resolve the problem:

1.) Root canal

2.) have tooth removed

The nature of pain for the two types of pulpitis are described below:

Irreversible pulpitis: spontaneous throbbing pain (you're sitting around doing nothing, and the tooth is hurting) High pain levels (7 out of 10 or above). Pain lingers after a painful stimulus - like cold or chewing. (However, in many cases the pulp no longer registers cold sensation because it's dying. So sometimes, it's just pressure or chewing that causes the pain and not temperature)

Reversible pulpitis: pain only occurs upon stimulus - cold, sweets, chewing, etc. and the pain subsides quickly after the stimulus is removed. (however, this is not totally cut and dry. Very soon after a tooth is worked on, you can get some spontaneous pain for the first week or so. But, it should diminish)

Sometimes, a crown or filling preparation will also introduce a lot of oxygen into the pulp. The bacteria that have been residing in the pulp didn't have the chance to REALLY thrive until the influx of oxygen (these types of bacteria are called "facultative anaerobes") That's why sometimes teeth that are totally asymptomatic BEFORE the tooth is prepared can sometimes get a bad toothache afterwards. (Patients hate us for that! But, the underlying reason is that the pulp was already mildly infected. Cracks or other defects in the tooth allowed for some bacteria to find their way in there. Just not enough to cause symptoms yet. Then, a dentist opens things up and allows a lot of oxygen/energy to get to those bacteria!) However, your husband's tooth was symptomatic beforehand, so we know that there was a problem with his pulp from the get go.

If I saw your husband, and saw the original cavity, first, I'd like to understand the nature of the pain he had then:

1.) When does pain occur? Only after stimulus? OR spontaneously? (just sitting around doing nothing)

2.) After any offending stimulus hits the tooth, does the pain linger?

3.) On a scale of 1-10 what is the pain level at its WORST.

Those are the types of questions I'd ask (plus, I'd probably tap on his teeth, and do a couple of tests) to determine whether he likely had reversible pulpitis or irreversible pulpitis to begin with.

If the pain seemed like it could be reversible pulpitis, (for example, just a little sensitive to cold, but as soon as the cold went away, the pain went away) then, it's possible that the filling will resolve the problem. But, it's also possible that it won't.

If he was still having pain after the filling, I would not have done the crown. First, I would have tried to distinguish the symptoms once again, between reversible and irreversible pulpitis. If it seemed more like the reversible pulpitis, I would have advised some cautious waiting. If the symptoms sounded like irreversible pulpitis, I would have referred to a root canal specialist. (endodontist) to have the tooth evaluated. (and probably do a root canal). Placing a crown on a tooth NEVER solves the pain issue except in very specific circumstances. (for example, the tooth ONLY hurts when he bites on it in a certain way. Those are the symptoms of a more benign "cracked tooth syndrome" which would benefit from a crown).

Of course, once you have a root canal done on a molar, you need a crown. I know your husband has already had a crown. The good news is that he won't need to get a new crown. The root canal can be done straight through the crown. Then, the dentist puts a filling through the access hole.

ONE OTHER POSSIBILITY: the bite is too high on the crown. He's hitting the tooth too heavily when he bites. "Heavy occlusion" can also cause a lot of postoperative, and even spontaneous pain. That's always what I check first! But, I tend to doubt that's the issue because he STARTED OUT in pain. But, it's a possibility.

My educated guess is that your husband needs a root canal on the tooth. (unless he elects to have it removed instead)

I recommend going to an "Endodontist" (root canal specialist) for a root canal on a molar. Most general dentists don't do molar root canals (or should NOT be doing molar root canals, unless they devote a lot of their time and energy to root canals!) Endodontists see abscessed teeth with recent crowns ALL THE TIME, so nothing new to them!

I know that was a long answer to your question. I have two videos that I made about cavities, and toothaches. Both might be useful to you to fill in some of the understanding gaps. They were made for specific audiences, and your husband's situation doesn't fit either situation perfectly, but I think you'll still get the gist if you watch them. I'll forward the links to them momentarily.

Bot***** *****ne, very, very high chance that your husband needs a root canal. :(

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Dentist: Beth Dorian, Dentist (DDS or equivalent) replied 11 months ago

Here are the links to the two videos I mentioned:

https://screencast-o-matic.com/watch/cDlockQ0jp

https://screencast-o-matic.com/watch/cDX02wQ1jx

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Dentist: Beth Dorian, Dentist (DDS or equivalent) replied 11 months ago

After reading my answer, I noticed a possible area of confusion.

Irreversible pulpitis also means abscessed tooth (whether or not we can see the abscess on the x-ray). If we can see an abscess, then we don't bother doing anything until it's taken care of with a root canal. While not a fun finding to see an abscess, it sure makes the diagnostic process easier!

But, sometimes the tooth:

"is abscessed" "is infected" "has irreversible pulpitis" (all of those terms are synonymous) but we don't know that because the x-ray isn't showing it. We figure it out by asking questions about the symptoms, and doing a few tests. Again, guessing that your husband's tooth is infected (a.k.a. "abscessed"/"stricken with irreversible pulpitis" :) ).

But, there is the remote possibility that the bite is too high.

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Dentist: Beth Dorian, Dentist (DDS or equivalent) replied 11 months ago

Please let me know if there is anything else I can do for you. I am happy to answer more questions. If not, please be sure to offer a rating. That's the only way this service will work and the only way for experts to receive any compensation for their time. :) Thank you!

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