How do I resolve my new crown's issues with my dentist

December 30, 2012 10:21 AM

Did my dentist botch my new crown? It seems low to me and doesn't seem to make proper contact with its above counterpart. What should I do next?

My rearmost lower molar was crowned recently (wisdom tooth is already removed). While I was waiting for the permanent crown I had a temporary cap that was very comfortable--I barely noticed the difference from my old tooth. When the permanent crown was put on however, once I started eating I realized it was making little contact with the tooth above and all the strain of chewing was on the two molars in front, which were starting to hurt.

I gave it a week or so and when back to my dentist. She said that dentists deliberately put new crowns a little lower, which seems strange because my only other crown, at another dentist, was a little high and had to be filed down.

To resolve the problem, the dentist filed down the upper tooth of the next pair, to distribute the load more evenly. I questioned this solution several times because it seemed to me that it would just move the pressure point onto the next pair of teeth but she convinced me it would work.

I've given it a couple of weeks for me to get used to it. It turns out I was right. When I close my mouth, the back two pairs of molars on that side no long make contact and instead the front pairs take the load, which is an uncomfortable default state for my mouth. Furthermore, when I chew, they don't make close enough contact so I can chew food but not reduce it sufficiently finely and so I then transfer it over to the other side of my mouth. (The new crown also has a little pain if I push it down or sideways but I gather this will disappear over time?)

I think I really need the crown removing and reset higher. Can this be done? Is this a standard approach and can the crown be saved or does it need a new one to be created? It's a difficult discussion to have with the dentist (I suggested it last time) since she just disagrees and will no doubt suggest filing down more healthy teeth, which seems crazy to me and didn't work out so well last time. So I'd like to be prepared for that discussion.

If she flat out refuses I guess I can go to another dentist, but I don't think my insurance (US) would be happy with that. Should I be contacting them to let them know that I am not happy with things so far?

I have a attempted a very poor diagram of my teeth below, if it helps. Front of mouth is to left, back is to right i.e. I am facing to the left. Bold indicates a crown.

Before new crown:

UUU
NNN

After new crown, lower rear tooth doesn't make proper contact:

UUU
NNn

After filing down actual tooth, the main contact is now the next set toward the front

U^uU
NNn

Thanks

posted by NailsTheCat to health & fitness (10 answers total)

Keep in mind that size differences that are essentially microscopic can feel HUGE when you feel around in your mouth with your tongue or fingers. I had this discussion with my dentist when she was fitting my crown - to me the differences during fitting felt huge and unmissable, but she showed me how microscopically little she was filing off the crown and I understood that I had to really express myself and be really finicky about what felt big and ungainly during the fitting.
posted by kalessin at 10:31 AM on December 30, 2012

that happened a little to me, i went back and he used some paper that would darken when i bit up and down, and then he ground the tooth a bit so that I could bite properly and not get a headache.
posted by misspony at 11:03 AM on December 30, 2012

and then he ground the tooth a bit so that I could bite properly and not get a headache

Did he grind your new crown because it was too high, which is what happened with my first crown and makes sense to me? Or did he grind down your healthy non-crowned teeth to accommodate a low set crown, which is what is happening to me now?
posted by NailsTheCat at 11:30 AM on December 30, 2012

I just went through something similar where basically the crown was far too high and I needed it grounded down a bit. It's absolutely incredible how small a difference makes itself known. We're talking millimeters here, but they can hurt like nothing else.

My dentist uses ink sheets that he has me grind my teeth on so he can see where no contact's being made... I would imagine yours is doing the same? (Like misspony's experience.)

In my case, he ground down the crown to match my real teeth, since it felt like too much uneven contact. I don't know if he would've ground down the other real tooth at all. When I had some cavities filled, I had a ton of other work done as well so I couldn't provide feedback on the grinding job (I was put under, basically). I ended up having to come back a day later because eating was agony.

He should work with you to get it right in any event, without any other charge. And use the damn ink sheets to help.
posted by disillusioned at 1:03 PM on December 30, 2012

Yeah - we used ink sheets etc. Just as with my previous crown. The nub of the issue is that if a crown is too low, you can't grind up (of course). So that easy fix of grinding a high crown down just can't work. My guess is the only possible solutions are to redo the crown or grind down the rest of my teeth to match.
posted by NailsTheCat at 2:41 PM on December 30, 2012

You can ask your dentist to add a "filling" on top of your crown as if there were a cavity there. This is just like grinding "up." I've had this done, and I encourage you to keep going back to the dentist until your biting and chewing feels normal. It may take a while, but it can be done.
posted by danceswithlight at 4:35 PM on December 30, 2012

Once upon a time, I was a dental assistant. I think your dentist messed up and doesn't want to pay for a new crown. I've not seen the "filling" on top of a crown, but my career in dentistry was brief. It was my experience that the crown was always made a little high, then filed down based on the ink.
posted by kamikazegopher at 8:11 PM on December 30, 2012

I agree that even the smallest change in the size or shape of a tooth can have a huge effect on the comfort of your bite. I went through a similar situation with an implant. Dentists can have egos and unfortunitely they can become irratated by patients who seem dissaatified with their work. But the bottem line is you don't feel good about the crown. It's the dentist's job to make it right. That being said I would encourage do be direct with your dentist but be polite. It's a fine line between "My crown feels off and it's causing problems with my bite. Lets work together to solve this problem." and "you totally messed up my tooth! You better fix it!" At the end of day you want the dentist to be on your side. Of course you always have the option of going to another dentist but that could get costly. Stay pesistant with your dentist. If the dentist is good and values her reputation she'll make it right.
posted by ljs30 at 9:31 PM on December 30, 2012

Agreeing with the last two comments. The dentist ought to make this right.
posted by jander03 at 9:37 AM on December 31, 2012

Thanks for your answers all. I shall of course be polite--as always. But this time I shall be polite and firm. Last time I was too trusting and went along with the healthy tooth grind which was definitely a mistake. Thanks again!
posted by NailsTheCat at 8:25 PM on December 31, 2012