Crown belongs on my tooth, not in my hand

November 30, 2008 2:47 PM

Broken (dental) crown on a root-canaled tooth. I'm supposed to fly on Thursday and work is insane. Best courst of action?

You're not a dentist, you're not my dentist. I have a call in to my dentist but even their after hours number is useless at 5:45 pm on the Sunday of a holiday weekend and their solution for emergencies is the ER, which this doesn't require. I've read the related, none appear to address this.

I have awful teeth. However it's not for lack of dental care. In the latest dental saga, two root canals on the bottom right were being re-treated. In the case of the tooth whose crown is in my hand, the tooth was treated for a cavity in 2004 and then crowned. Pain persisted and I was referred to a specialist. Said specialist did a root canal through the existing silver crown and then the hole in the crown was filled. Pain never went away 100% and a current dentist was playing watch and see for about a year from April 2007 to this summer when they decided enough wait and see, the root canal had failed. The root canal was re-treated (again through the crown) and after that was done I was knock wood, pain free for the first time since 2003-2004. Alas, victory was short-lived and after eating three plain (no nuts) M&Ms, I feel something hard in my mouth. I spit it into my hand and recognize the crown. No pain whasoever but very jagged tooth nub in my mouth.

Chewing not an issue, I wasn't chewing on this side due to current dental work on the adjacent tooth (further to the rear) and a temp crown on the adjacent tooth to the front. However what is an issue is I'm due to fly to Cancun on Thursday. I'll be back in NYC Monday, can this be treated then? I have a call into my dentist but not expecting miracles of being able to be seen before then due to insane work schedule. Hoping that Weds may be an option.

Breaking a crown is not odd to me -- it happened 2x on the back tooth which is why I had silver on both of these. The back tooth's crown broke a third time when she began to re-treat the root canal and crown lenghtening was discussed although (I think) ultimately deemed not necessary.

So.... What do I do other than walk in with the crown in my hand? Cross my fingers and hope like hell that re-cemnting it is an option? I'm not certain but I believe the tooth broke below the crown and tht's why the crown is in my hand.

This may be over-information, however I want to avoid questions that I could have answered from the out set if I'd given all info.

Thanks!

posted by TravellingCari to health & fitness (11 comments total)

Get your work out of the way, and try to get into the dentist next Monday, following Cancun. The root canal should be plugged with epoxy, so you should be in little danger of getting food down in there to cause infection.

And maybe you should try a different dentist.
posted by KokuRyu at 3:05 PM on November 30, 2008

This is a dental emergency. The best course of action is to stop whatever it is you're doing and go to your dentist first thing tomorrow morning. He or she will probably put a temporary filling or cap on your broken tooth and make an appointment for you to return and have it fixed properly. The longer you delay, the greater your risk for infection which can lead to things much more unpleasant and inconvenient than missing work.

Whatever work you have can wait--see your dentist tomorrow morning when he or she opens.
posted by mattdidthat at 3:07 PM on November 30, 2008

First thing tomorrow morning, I probably could do but I'm not sure when they'll check messages and don't routinely answer the phone before they've cleared voice mail so calling when they open at 8am isn't an answer especially if the dentists aren't in yet.

I'm hoping Koku is correct in that it can wait a bit, or at least until Weds when our big event is over and I can actually get out of the office to see a dentist for a temporary solution. And yes, I'm familiar with Diamonte's story, sad. However the bone has been healing at the base of the root and I don't think I'm at risk for that because I've been undergoing regular treatment.

I do need a better dentist since I was using students while I was in grad school however this tooth is under the care of a specialist with one year follow up following the re-treatment so changing dentists for this tooth will probably be more expensive. I have no reason to think she didn't do this properly, but tend to suspect my awful teeth finally giving in.
posted by TravellingCari at 3:12 PM on November 30, 2008

Drilling through the crown -twice - may have compromised the crown's structure and/or weakened its cement. You'll need to find out via xrays if the tooth formerly beneath the crown remains intact or has been fractured. If it's fractured, you may have to consider bridgework or an implant.

Best possible plan of action: visit a dentist prior to your trip for an evaluation and treatment plan. Best case scenario: the tooth is intact and the crown is re-cemented.

I agree with KoKoRyu that, when you are able, you should consider consulting a new dentist and endodontist. Two re-retreated root canals, three broken crowns, and a one-year "watch and wait" raise concern. Before you visit a new dentist, ask your current dentist why the two root canals "failed." Did both have extra canals? Can these be seen on xrays? Have a new dentist review your records and evaluate the work done.

When a tooth is not properly reduced (sometimes through the lengthening procedure you mention), there is not enough above-gumline tooth left for a proper-sized crown. The subsequent "mini-crown" is unstable and more prone to breakage.

When you return from your trip, visit a new practitioner who has an excellent reputation in your community for a full dental examination and treatment recommendations. The exam is cheap and may save you hundreds of dollars... and perhaps a few crowns and teeth.
posted by terranova at 3:42 PM on November 30, 2008

I agree with KoKoRyu that, when you are able, you should consider consulting a new dentist and endodontist. Two re-retreated root canals, three broken crowns, and a one-year "watch and wait" raise concern. Before you visit a new dentist, ask your current dentist why the two root canals "failed." Did both have extra canals? Can these be seen on xrays? Have a new dentist review your records and evaluate the work done.

Whoops I wasn't clear. The specialist currently re-treating the failed root canals is not the one who did the initial treatment in 2002 (back tooth) or 2004 (current broken crown). She is a supervisiing dentist/faculty member where I'm currently going. The first time she saw me this summer (on a consult) he said more-or-less "We watched and saw, now time for a re-treatment." She showed me on the x-ray how the root bent and how the previous dentist chose/was not able to go further. Unable to read his mind and he won't release the records (I know I'm legally entitled but lacking a magic wand, I can't make them appear) so I don't know why he didn't finish the job. I could see the problem on the x-ray and can see the now healing (re-ossification? sp?) of the bone below the root now that the first tooth had been re treated. I also could feel being pain free for the first time.

When a tooth is not properly reduced (sometimes through the lengthening procedure you mention), there is not enough above-gumline tooth left for a proper-sized crown. The subsequent "mini-crown" is unstable and more prone to breakage.

Yes, that was her explanation of the problem with the back molar that has had two broken crowns and now the silver one breaking when she drilled. That and the dentist had left some gauze and it hadn't properly adhered.

Thanks for the input! I really hope to avoid a bridge or anything but like I said, my teeth are awful and at one point I enterained having them all yanked.
posted by TravellingCari at 3:51 PM on November 30, 2008

just show up the minute the office opens. a few minutes before, even.

no, seriously, just show up. anyone who shows up first thing in the morning is going to get care and attention.
posted by micawber at 6:13 PM on November 30, 2008

Does the crown fit back onto the tooth? Is it in one piece?

If so, drugstores sell temporary crown cement for just these sorts of occasions, it could hold it on for a few days while you wait for the dentist.

But I'd show up at their office if possible too.
posted by mmoncur at 7:38 PM on November 30, 2008

Crown is in one piece, I'm not sure whether it would fit back on the tooth.

Showed up, no one was there at opening. Have called again.
posted by TravellingCari at 8:05 AM on December 1, 2008

Update: While I have yet to get a call back, I might have some time tomorrow to go. However if they can't see me, I might try one of the recommendations from this thread. Although I don't have Cigna DMO, there were some recommendations for good dentists and I'm happy for one who can solve the problem for a week, if possible, I'll submit the claim to my dentist.

We'll see...
posted by TravellingCari at 4:48 AM on December 2, 2008

Finally got in to the dentist. Fill in dentist who sorted it out temporarily. He was the first to raise the issue that there could be a reason why my back teeth are awful since I "appear to blush and floss fine" so we'll see. Thanks all!
posted by TravellingCari at 5:20 PM on December 9, 2008

Update --- crown came off again but has been re-cemented pending an appointment in early January to get a new permanent crown. This will be the first of thre three neighbours to earn its new crown.
posted by TravellingCari at 6:11 PM on December 21, 2008