Persistently painful crown
December 29, 2015 7:36 AM Subscribe
I've had a crown on one of my molars for a couple years now, and it's never felt right. On my last visit to the dentist, they essentially told me I was SOL. Is this true?
I had a crown put on one of my back upper molars a couple of years ago. It was definitely too high/pronounced, and caused pain when I chewed. Me being me, I would not make special appointments to have it adjusted but would simply ask them to file it down whenever I went in for my six month cleanings.*
At the next-to-most-recent appointment, the dentist said they'd reached the limit of how far they could file it down, and if it continued to bother me they'd need to redo it. It continued to bother me in a low-level sense (feeling occasional pain there, a sensation of looseness of the molar right next to it), and so on my last visit I mentioned this again. The dentist told me that because of the way the molar next to to the crown was higher than the rest, this was causing my bite problems and there was nothing else they could do to help me.
I was pretty shocked at this but didn't know if it was reasonable to argue with them. I do know from talking with others that crowns can indeed create persistent, low-level bite problems. But is this really the end of the story?
A few more details:
The pain in the crown mainly comes on when I've been chewing gum and/or especially tough, fibrous foods like raw cabbage (I intend to stop both of these). I also have pain when I've had too much caffeine and so am unconsciously clenching my teeth, as well as sometimes when I wake up in the morning, suggesting nighttime tooth-grinding, which I also intend to address.
My teeth seem to be shifting throughout my mouth, especially the lower front teeth. This happened in the time following the crown, possibly due to me favoring the other side of my mouth. I've since made a conscious effort to start chewing on both sides.
The question(s):
Would it be worth it to go back to my current dentist and insist they do a new crown? I am guessing that it's been too long from the time they first put in the crown for them to redo it for free, and I guess I'd be willing to pay for it. Should I just go to a new dentist? Or is this sort of low-level pain a normal, acceptable and unresolvable result of having a crown? Is it truly sometimes impossible to create a perfect crown due to the placement of the surrounding teeth?
*I know I should have been more diligent about this. In addition to being lazy, I have a lot of dentist anxiety due to some pretty gory dental surgery experiences when I was younger. To be making it in for the cleanings on a regular basis is sort of a victory.
I had a crown put on one of my back upper molars a couple of years ago. It was definitely too high/pronounced, and caused pain when I chewed. Me being me, I would not make special appointments to have it adjusted but would simply ask them to file it down whenever I went in for my six month cleanings.*
At the next-to-most-recent appointment, the dentist said they'd reached the limit of how far they could file it down, and if it continued to bother me they'd need to redo it. It continued to bother me in a low-level sense (feeling occasional pain there, a sensation of looseness of the molar right next to it), and so on my last visit I mentioned this again. The dentist told me that because of the way the molar next to to the crown was higher than the rest, this was causing my bite problems and there was nothing else they could do to help me.
I was pretty shocked at this but didn't know if it was reasonable to argue with them. I do know from talking with others that crowns can indeed create persistent, low-level bite problems. But is this really the end of the story?
A few more details:
The pain in the crown mainly comes on when I've been chewing gum and/or especially tough, fibrous foods like raw cabbage (I intend to stop both of these). I also have pain when I've had too much caffeine and so am unconsciously clenching my teeth, as well as sometimes when I wake up in the morning, suggesting nighttime tooth-grinding, which I also intend to address.
My teeth seem to be shifting throughout my mouth, especially the lower front teeth. This happened in the time following the crown, possibly due to me favoring the other side of my mouth. I've since made a conscious effort to start chewing on both sides.
The question(s):
Would it be worth it to go back to my current dentist and insist they do a new crown? I am guessing that it's been too long from the time they first put in the crown for them to redo it for free, and I guess I'd be willing to pay for it. Should I just go to a new dentist? Or is this sort of low-level pain a normal, acceptable and unresolvable result of having a crown? Is it truly sometimes impossible to create a perfect crown due to the placement of the surrounding teeth?
*I know I should have been more diligent about this. In addition to being lazy, I have a lot of dentist anxiety due to some pretty gory dental surgery experiences when I was younger. To be making it in for the cleanings on a regular basis is sort of a victory.
You should not be accepting discomfort from a crown as normal and inevitable. If you can afford it, I would heartily recommend seeing a specialist dentist -- for a crown, I'd guess a prosthodontist. Regular dentists might be just fine for many ordinary dental exams and procedures, but in my experience the specialist guys have the best equipment and raise dentistry to a high art. The root canal I had done by an endodontist (which saved a tooth that might otherwise have been pulled by a run-of-the-mill dentist) was beautifully done, and was a much better experience than I've had with root canals done by general dentists. A specialist will fashion you a crown that will feel right -- will not say he/she is done until the most minute adjustments are made to make your bite feel excellent.
Also, you might consider having the crown done in a dental school clinic. The students are supervised every step of the way by professors (who are themselves specialists in their field), and not only are all procedures about half the price of private dentists, but the work is often actually better.
posted by RRgal at 8:08 AM on December 29, 2015
Also, you might consider having the crown done in a dental school clinic. The students are supervised every step of the way by professors (who are themselves specialists in their field), and not only are all procedures about half the price of private dentists, but the work is often actually better.
posted by RRgal at 8:08 AM on December 29, 2015
I would get it looked at again by someone else. When crowns fail they can really push the boat out and ruin what's left of that tooth, resulting in an endless array of dental horrors; when mine starting causing pain during chewing that radiated to other parts of my mouth, it was because the underlying bone was really badly abscessed and it was a huge grotesque nightmare. Find yourself a specialist rather than a general dentist.
posted by poffin boffin at 8:34 AM on December 29, 2015 [1 favorite]
posted by poffin boffin at 8:34 AM on December 29, 2015 [1 favorite]
One important thing I've noticed with my crown is that if I've not been really careful about flossing and get even a small piece of food wedged up there, it will start to ache and then eventually progress to pain. I, too, clench my teeth at night -- and recently realized that I also do it unconsciously during the day. This, alone, is causing my teeth to shift. I'm trying to be more aware of it and it's made a difference in how my teeth (and crown) feel.
As far as having the crown replaced, when is the last time your dentist has done an x-ray to check the integrity of the tooth underneath? Turns out that I had a crack in the seal on my crown, which allowed decay down in there and had to have the whole thing removed and replaced. Not particularly nice or cheap. But it made a HUGE world of difference. My dentist told me that in some scenarios, the crown can be popped off in one piece and be re-used. Unfortunately mine was too well cemented it and broke off in pieces. By the way, my dentist happened to specialize in crowns. Anyway, food for thought.
Also, while it may not be your situation, I didn't have enough room on top of my tooth for the crown to be sitting properly and that was something else that need to be rectified. Hope you feel better soon.
posted by dancinglamb at 8:38 AM on December 29, 2015
As far as having the crown replaced, when is the last time your dentist has done an x-ray to check the integrity of the tooth underneath? Turns out that I had a crack in the seal on my crown, which allowed decay down in there and had to have the whole thing removed and replaced. Not particularly nice or cheap. But it made a HUGE world of difference. My dentist told me that in some scenarios, the crown can be popped off in one piece and be re-used. Unfortunately mine was too well cemented it and broke off in pieces. By the way, my dentist happened to specialize in crowns. Anyway, food for thought.
Also, while it may not be your situation, I didn't have enough room on top of my tooth for the crown to be sitting properly and that was something else that need to be rectified. Hope you feel better soon.
posted by dancinglamb at 8:38 AM on December 29, 2015
Get a new dentist, an endodontist who does root canals. Get the crown off. Pain often indicates infection causing sensation in the nerve. If the crown is an upper you can get very ill from infection in the sinus or even the brain. Trust me on this an infection under a crown made me ill for two years before it finally just fell off, revealing its fetid state. The crown was supposed to be properly sculpted to begin with and adjusted by your dentist, or else it should have gone back to the maker.
posted by Oyéah at 10:02 AM on December 29, 2015 [2 favorites]
posted by Oyéah at 10:02 AM on December 29, 2015 [2 favorites]
I am a dentist, (but not your dentist of course), and if you were my patient I would certainly be willing to explore the reasons for your discomfort, and if it were the fault of the crown (ill-fitting, too high etc.) I would replace it at no cost (usually for the first 5 yrs is standard, but not universal, especially if you have been regular for check-ups and have followed through on needed treatment, indicating that you haven't simply let things go downhill due to neglect).
I would also investigate whether or not your symptoms are being referred from muscle attachments (since they are most pronounced when you are chewing or grinding) or from your bite issues.
Sometimes, the reason that the tooth needed a crown in the first place is the reason it continues to bother, which is to say, deep decay that might have made the nerve unhappy, but wasn't deep enough to warrant a root canal, or a traumatic injury to the tooth that may have done long-term damage to that same nerve. So occasionally we think we're in the clear without a root canal, but later the tooth goes south and we have no choice but to go back and do one.
A second opinion is not a bad option, but the second doc who looks at it won't know what led to the crown in the first place, so will probably just cut the crown off and eval the tooth beneath (since an x-ray can't see through the crown).
posted by OHenryPacey at 10:12 AM on December 29, 2015 [2 favorites]
I would also investigate whether or not your symptoms are being referred from muscle attachments (since they are most pronounced when you are chewing or grinding) or from your bite issues.
Sometimes, the reason that the tooth needed a crown in the first place is the reason it continues to bother, which is to say, deep decay that might have made the nerve unhappy, but wasn't deep enough to warrant a root canal, or a traumatic injury to the tooth that may have done long-term damage to that same nerve. So occasionally we think we're in the clear without a root canal, but later the tooth goes south and we have no choice but to go back and do one.
A second opinion is not a bad option, but the second doc who looks at it won't know what led to the crown in the first place, so will probably just cut the crown off and eval the tooth beneath (since an x-ray can't see through the crown).
posted by OHenryPacey at 10:12 AM on December 29, 2015 [2 favorites]
Getting the crown off is essential; another dentist; start again basically. I had this a couple of years back and the good news was that the dentist did the whole job with CEREC computer-milled crowns - hopefully that's standard in the US.
posted by colie at 10:15 AM on December 29, 2015
posted by colie at 10:15 AM on December 29, 2015
I have eight crowns (maybe more; I've lost count) and I have had this problem. High crowns can sometimes be lowered with a procedure called crown lengthening. Basically, the dentist (or possibly an oral surgeon--they might refer you) removes a bit of gum to expose more tooth, so that the crown can be cemented on in a lower position (after the tooth nubbin underneath is filed down some more).
Also, crown pain should at least be checked out! The least your dentist could have done is pried the crown off to look underneath. I'd start looking for a new dentist if I were you.
posted by the_blizz at 10:16 AM on December 29, 2015
Also, crown pain should at least be checked out! The least your dentist could have done is pried the crown off to look underneath. I'd start looking for a new dentist if I were you.
posted by the_blizz at 10:16 AM on December 29, 2015
What Dr. Pacey said. But also consider: If your doctor said that they've done all the bite adjustment that they can do on the crown, because of crown becoming too thin, have they done any reduction on the tooth that bites against your crown? Sometimes because of a high "plunging" cusp that continually bangs into a new restoration or crown, the new dental work can continue to be sensitive. Many times all it takes is just the slightest sanding down of a portion of the opposing tooth to bring your bite back into normalcy.
I would continue to explore treatment options with your current dentist, they do have a responsibility to see your treatment through. They may suggest a specialist: Endodontic or Prosthodontic if they feel they have reached the end of their treatment options.
posted by Jazz Hands at 10:40 AM on December 29, 2015
I would continue to explore treatment options with your current dentist, they do have a responsibility to see your treatment through. They may suggest a specialist: Endodontic or Prosthodontic if they feel they have reached the end of their treatment options.
posted by Jazz Hands at 10:40 AM on December 29, 2015
All I can add is that the dental practice I go to, and trust, would never have been so fatalistic. Get recommendations for a second opinion.
posted by zadcat at 12:01 PM on December 29, 2015 [1 favorite]
posted by zadcat at 12:01 PM on December 29, 2015 [1 favorite]
FWIW when I had a similar problem with my root canal, my regular dentist futzed around interminably and was never able to actually solve the problem. He took more & more material off the crown, too, until he said he didn't dare to remove any more.
When I went to visit the specialist dentist in complicated root canals, he solved the entire problem in literally 5 seconds. (Filed down the exact small 'high spot' that was causing the problem.)
Also FYI, even if they have removed all they can from the crown, often the problem can still be solved by removing a bit from the other tooth (the one it matches with). It's often just a small bit in one spot the needs to be removed.
Point is, it's very well worth getting another opinion or two, and particularly from a specialist in difficult problems relating to root canals & crowns.
posted by flug at 1:42 PM on December 29, 2015
When I went to visit the specialist dentist in complicated root canals, he solved the entire problem in literally 5 seconds. (Filed down the exact small 'high spot' that was causing the problem.)
Also FYI, even if they have removed all they can from the crown, often the problem can still be solved by removing a bit from the other tooth (the one it matches with). It's often just a small bit in one spot the needs to be removed.
Point is, it's very well worth getting another opinion or two, and particularly from a specialist in difficult problems relating to root canals & crowns.
posted by flug at 1:42 PM on December 29, 2015
Your symptoms sounds similar to mine.
I had an uncomfortable crown for about two years. I posted an AskMe about my initial problems. Before she could attempt to fix it my dentist went on maternity leave. Her partner wasn't comfortable trying to address it. I learned to live with it during that time--basically I chewed on the other side of my mouth.
By the time she returned, not only was it uncomfortable but it chewing was a little painful on the crowned tooth--it seemed loose. I discussed the topic at length on the next couple of visits but she couldn't see anything wrong with it. When I eventually insisted she fix it she agreed and started to try and work on mouth. I asked her what she was planning to do and she said grind it down. I explained that it was already too low--she'd forgotten the whole back story. She was adamant it was fine and grinding would fix it so I walked out.
One month later I was eating, nothing particularly chewy, and it fell out. I went to another dentist. He fitted a new crown and I've never looked back. But it cost me $2,000 because insurance wouldn't pay for a new crown on the same tooth.
posted by NailsTheCat at 7:50 PM on December 29, 2015
I had an uncomfortable crown for about two years. I posted an AskMe about my initial problems. Before she could attempt to fix it my dentist went on maternity leave. Her partner wasn't comfortable trying to address it. I learned to live with it during that time--basically I chewed on the other side of my mouth.
By the time she returned, not only was it uncomfortable but it chewing was a little painful on the crowned tooth--it seemed loose. I discussed the topic at length on the next couple of visits but she couldn't see anything wrong with it. When I eventually insisted she fix it she agreed and started to try and work on mouth. I asked her what she was planning to do and she said grind it down. I explained that it was already too low--she'd forgotten the whole back story. She was adamant it was fine and grinding would fix it so I walked out.
One month later I was eating, nothing particularly chewy, and it fell out. I went to another dentist. He fitted a new crown and I've never looked back. But it cost me $2,000 because insurance wouldn't pay for a new crown on the same tooth.
posted by NailsTheCat at 7:50 PM on December 29, 2015
Response by poster: Thanks for your suggestions, everyone! I'm glad to hear I have more options than "deal with it." I will definitely be pursuing these further.
posted by whistle pig at 8:04 PM on December 29, 2015
posted by whistle pig at 8:04 PM on December 29, 2015
Definitely get a second opinion. While everyone's mouth is different, my crown is next to a molar and I have no pain like you describe.
posted by Aleyn at 9:41 PM on December 29, 2015
posted by Aleyn at 9:41 PM on December 29, 2015
This thread is closed to new comments.
I also think you're missing another worst-case option: having the tooth pulled. I would probably not do this first -- better to have teeth than not! -- but if you're sinking tons of money into a tooth without any guarantee that it will feel better, consider extraction. It's inexpensive, and will feel better fast. Downsides are that the gum will be tender for a while, and that getting a bridge or implant eventually can also be a painful and expensive hassle.
posted by chesty_a_arthur at 7:56 AM on December 29, 2015