How to approach a dental problem
November 18, 2023 7:14 AM   Subscribe

I recently discovered I've had a dead tooth in my head for ages. My old dentist retired pre-COVID and the window to make a professional complaint about him has passed. How do I approach this problem with the new dentist?

My old dentist, Dr. O, retired pre-COVID, but he put a crown on a rear molar in 2016.

Prior to 2016, I had swelling that came and went in the area prior to 2016. Dr. O shrugged it off when I brought up my concern with him around 2012-2013. Dr. O was not very good at listening to my concerns and towards the end of his practice I began to feel a little sus about his skills.

Anyway--this tooth died rather quietly and an endodontist recently confirmed it was dead and there was no blood flow to the tooth.

I have had regular x-rays and dental hygiene appointments for years, but the dentist who took over Dr. O's practice didn't detect the problem either. I asked the endodontist about the x-rays I had and he said that the dentist's panoramic x-ray equipment isn't as sensitive as his 3D panoramic equipment.

The window has passed to formally complain about Dr. O because the dental college only takes complaints within two years of a dentist halting their registration.

It's on me that I didn't bring up my concerns about the swelling with the new dentist in the few years I've been seeing him. However, the swelling only happened occasionally and until this month, was never present at my dental appointments.

So, after all that, I want to know:

* Is it a good idea to approach the dentist about Dr. O's lack of curiosity about my problem?

* Is it possible to put a crown on a dead tooth?

* Would Dr. O have noticed when he was doing the crown that the tooth was dead?

Is there anything else I'm not thinking about or considering, or am I just overthinking it? I'm not angry about it, but I want to understand the above questions better because I'm not a dentist. TIA!
posted by Calzephyr to Health & Fitness (14 answers total)
I think this is not necessarily a problem unless it is giving you trouble? One of my two top front teeth has been dead since I was a kid, probably from getting a hard knock at some point. Aside from minor discolouration it's never been a problem (and it's been decades).
posted by Rhedyn at 7:53 AM on November 18 [7 favorites]

Seconding Rhedyn - at my most recent cleaning the dentist pointed out that one of my lower teeth was a little discolored, and suggested that maybe it was dead. He asked if I'd had any kind of pain there ever or had some kind of injury and I said no, not that I recalled. I'd noticed that it was colored a little different, but the way it looked was all that I'd noticed. I also wasn't having any pain from it as well. So he and I both just shrugged, and he said that if it ever DID give me trouble to let them know.

But that addresses the current state of the tooth. I don't think you need to put a crown on that tooth, as I don't think it would do anything. What would concern me, though, is that you said you noticed a swelling there at one point, and that you brought it up with Dr. O and he waved it off. I would speak to your current dentist just about that, to see if there is any other underlying situation you may want to worry about now. I don't know that there IS anything, mind you, I'm just covering all bases here.

It sounds to me like there was some kind of mild infection that later went away; you probably aren't going to be able to do anything about your tooth now, but it may be a good idea to have it on record that something happened then just in case.
posted by EmpressCallipygos at 8:01 AM on November 18 [3 favorites]

My understanding is that any tooth that has had a root canal is in effect dead, so I have a mouthful of dead teeth. A few of those teeth eventually were weakened and broke - but this was after more than fifty years. I have many crowns on teeth that have had root canals, so yes, you can put a crown on a dead tooth. A lot of dentists recommend a crown after a root canal. IANAD.

If I were you, I would ask about the swelling, but try to avoid directly criticizing Dr. O. Your new dentist doesn't know you and might not want to side with you against another dentist.
posted by FencingGal at 8:41 AM on November 18 [4 favorites]

Response by poster: Not to threadsit, but I forgot to mention that I will be probably having the tooth extracted. The endodontist doesn't extract teeth, so the next conversation I'll be having is with the new dentist.

The endodontist reassuringly said "It's going to be a monster when it wakes up" and the dead tooth has caused me to lose bone in the area, so it's going to be a problem eventually, erf! The endodontist said the success of a root canal is 50/50 with extraction being the most predictable route.

It is interesting to me from your replies that people do live with dead teeth. The area isn't causing me pain at all.

I don't think you need to put a crown on that tooth

The tooth already has a crown :-P

Your new dentist doesn't know you and might not want to side with you against another dentist.

Yeah! That's why I'm asking here--the new dentist wouldn't know Dr. O's work, just that I'd been a patient there for a long time, and I don't know if dentists critique each other's work.

LOL I may be overthinking it, but isn't that what MeFites do best? :-)
posted by Calzephyr at 8:46 AM on November 18

Best answer: I'd look at it as the past is the past, you're coming into the new dentist with a few issues (which is extremely common) and just figure out the best way to move forward, probably extraction. The past is the past, there's nothing you can really do about it at this point. For a single anecdote, I have a mouthful of work, some good, some less good, done by multiple dentists over the years, and not one has commented on the previous's work - it's always just been a new set of xrays and figuring out next steps from there.
posted by cgg at 9:27 AM on November 18 [5 favorites]

A dead tooth is more vulnerable to cracking or even breaking off. I'd guess that infection of the remaining non-bony tissue is the concern. Implant should still be an option. New dentist has no need to know about retired dentist's shortcomings; complain on reddit or otherwise shout into the void.
posted by theora55 at 10:19 AM on November 18 [1 favorite]

My first crown went over a molar that I thought had been root-canaled. But later it hurt the worst ever, and a better dentist (with endodontist skills) suggested the pain was from that tooth dying. He took off that crown (with a hammer and chisel, one effective tap, true story) and the room filled with a bad smell, to which the dentist said "Yep, dead tooth". He didn't like the first crown because it had a 'ledge' so he installed a new one. Don't recall if he did any more root-canaling on that tooth (because he also did the same for another) and it hurt again, periodically, until many years later when that crowned-molar was finally extracted, and now I have an implant there.
posted by Rash at 10:59 AM on November 18 [1 favorite]

I was kicked by a horse thirty year ago, and it eventually resulted in a dead tooth. This was discovered immediately prior to covid, so I didn't have anything done to it and it abscessed. Never did hurt, so I sort of ignored it. When I went in after covid, turned out there were three dead teeth and the abscess had gone into a fistula, which caused bone erosion. You don't want that! There was a lot of screwing around with failed root canals, miscommunication, general fuckery, etc., and I ended up changing dentists, having all three teeth pulled, and I am currently having a fixture made.
The whole thing was expensive, and I will never have any procedure done without asking how long it was likely to last. I understand nothing can be guaranteed forever, but my expectation was that the root canals that were done would at least last 5 years--I've had one that's now twenty years old and still in good shape! Prior dentist never bothered to communicate to me that it was doubtful that the root canals would last more than a year. Unacceptable in my opinion.
posted by BlueHorse at 11:45 AM on November 18 [1 favorite]

Geez, the idea of complaining to your new dentist's dental college about not detecting a problem which occured under and was dismissed by your old dentist, which you didn't advocate for under the old nor mention to the new, whose underlying issue wouldn't be reliably detectable by either given their imaging limitations and which wasn't actively presenting when you saw either seems way too aggro out of the gate.
posted by DeepSeaHaggis at 8:05 PM on November 18

Response by poster: Oh man, I'm sorry to hear that you had such a time with your tooth BlueHorse! Everyone's experiences are making me feel less alone and now I feel I can have a better conversation with my dentist too. My first root canal from 2009 is still going well as far as I know.

Rash--I never thought of getting an implant, thanks for mentioning that too!

Thanks everyone for your answers and helping me think out my next steps. Much appreciated!
posted by Calzephyr at 9:48 PM on November 18

“The endodontist says the odds of a root canal are 50/50 with extraction being the most likely route.”

So if it’s me, I’m just going for the extraction. That’s probably where this is going anyway, and why spend the time and money on a root canal if that’s likely to do no good?
posted by azpenguin at 12:35 PM on November 19 [1 favorite]

Response by poster: Extraction appointment has been made :-D I have to wait until the area has healed before considering an implant.
posted by Calzephyr at 1:08 PM on November 20

If there's any possibility of getting that implant make sure your extracting dentist knows, because if that's the case, they do something to make the area implant-ready, during the extraction.

my expectation was that the root canals that were done would at least last 5 years

Mine too, I've never heard of anything less. Because the tooth is dead, especially after a root canal, the tooth can become brittle with age, and you may eventually lose it. But certainly not next year, hopefully not even next decade. Of course, that depends on you. Biting down hard with that tooth on the wrong piece of food, like a mouthful of crab or a pecan retaining a bit of shell, can crack the tooth, leading to intermittent pains that only more dental work will cure.
posted by Rash at 3:50 PM on November 22

Response by poster: If anyone's curious, I had the tooth removed today. The abscess actually left a small hole in my sinus, which now needs to heal. Don't delay with those dead teeth--you never know what they could be getting up to in your head :-D
posted by Calzephyr at 9:04 PM on December 7

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