Should a new crown hurt this much?
March 13, 2008 6:37 PM   Subscribe

My girlfriend's crown came off one of her molars, and it was damaged. She went to a dentist who reshaped the stump, made a new crown and replaced it. Since then (3 weeks) it came off once, she's been in excruciating pain the whole time, and now the dentist says she might need a root canal. Is this bad dentistry, or to be expected, and is there any recourse?

So, the issue is that before the new crown was put on, the technician drilled away at the old tooth for a while to reshape it -- reasons unknown -- and it's been nonstop pain since then. The theory as put forward by the dentist is that the tooth was shaved down too far and that the nerve is now too close to the new surface of the tooth. Right now we are wait-and-see if the pain gets any better. But if it doesn't, apparently the only recourse is to do a root canal.

To me this seems like really bad work -- replacing a crown should be an easy thing, right? At least, it shouldn't leave you in agony, right? I've never had to get one myself, so I dont know. If I am wrong, please correct me, but it sounds like it was bungled pretty bad.

Anyway, if it was in fact a massive cock-up by the dentist's office, what can we do? Should we expect the dentist's office to pay for the root canal? Should we expect the fee for the crown ($800 after insurance) back? I am retarded when it comes to doctors and dentists and health care etc., so I don't know what's normal. Thanks!
posted by sergeant sandwich to Health & Fitness (15 answers total) 1 user marked this as a favorite
Generally speaking roots in teeth die for seemingly random reasons, at least that's how it's been explained to me. I mean if a root is harassed and harried, it can drop dead, but realistically there's no simple and easy way to prevent that from happening once you're digging around in teeth. My experience has been similar to your gf's. I had a filling that turned into a dead/sore tooth which turned into a root canal. I asked the exact same questions that you are asking and my dentist at the time, who I otherwise respected and believed, told me that. I do not have reason to believe otherwise, personally, but others may have differing experiences.
posted by jessamyn at 6:55 PM on March 13, 2008

sorry, on re-reading the post i guess i should clarify: when i said "it was damaged" i mean the original crown was damaged, not the underlying tooth (stupid english!). the underlying tooth was fine and didn't hurt at all, until after it was shaved down more. it's not infected now, but apparently a root canal is what's required to make the pain stop over the long run.
posted by sergeant sandwich at 7:34 PM on March 13, 2008

Can you clarify... Did the crown come off a second time? (sorry I am having trouble comprehending that sentence)
Did this dentist do the original crown or only the second?
Can you get a second opinion?
posted by fogonlittlecatfeet at 7:38 PM on March 13, 2008

I had my wisdom teeth out in 2005. I had a tooth adjacent to one of the remove teeth die almost 2 years later. My oral surgeon (NOT the one who did the extraction, and in fact at a different practice) and my dentist both told me that there's usually not a clear explanation for why a tooth dies.
posted by Inspector.Gadget at 7:39 PM on March 13, 2008

gah, sorry fogonlittlecatfeet... okay, what happened was:

- original crown comes off, is damaged in the coming-off, and needs to be replaced

- dentist reshapes the tooth, makes a new crown in fancy crown-making machine, and puts it on

- 10 days of pain, and then the new crown comes off

- dentist puts temporary crown on, sends imprints to the lab to have a different new crown made

- 10 more days of pain (so far) while waiting for the permanent crown to come back

- meanwhile dentist says that if the pain doesn't stop on its own, a root canal may be required, because what's left of the tooth is now too short.

apologies for not being clear in the original post!
posted by sergeant sandwich at 7:45 PM on March 13, 2008

This is bad dentistry, I think. 10 days of pain should not be allowed-- let alone 20-- and she shouldn't be waiting for pain to go away. Most dental pain can be relieved in a visit if the source is addressed, at worst 2-3 days and those days should involve opioids.

Excruciating pain usually means that an infection has occurred and something is trying to expand into space it cannot expand into and is pressing on a nerve.

She should go to another dentist for emergency root canal and/or antibiotics, whatever is needed as IANOD (but have had just about every dental procedure short of implants).

Also, some people-- like yours truly-- have extra nerves in their teeth. This means that they are there when the dentist thinks they are all gone. Once when a dentist hit one of these supposedly not existent nerves, I literally flew out of the chair before I was even conscious of having moved, the pain was so bad.

This is why I knew that James Frey was a liar immediately-- he claimed to have had root canal without anesthesia, and this would be physically impossible even with the patient tied down because it is delicate work and unless you had a skull immobilizer like those used for brain surgery (which no dentist would have and he doesn't mention), it would be physically impossible for him to sit still for it even if he wanted to do so.
posted by Maias at 7:53 PM on March 13, 2008

This is why I knew that James Frey was a liar immediately-- he claimed to have had root canal without anesthesia

Just as an aside, my Dad had a root canal without anaesthesia. And he's not a liar and wasn't mistaken. In his case the entire nerve was dead, right down to the bottom, and there was no infection and were no other nerves nearby. So they could drill into his jaw without him feeling it. I was surprised because my root canal done around the same time used a ton of local anaesthesia and was still uncomfortable (I have long fine nerves so they drilled a long way in) but apparently it is possible.

When I had mine done it was because a pre-existing filling was too close to the nerve, leading over time to the nerve dying. Because I don't get regular checkups (can't afford it) it was this way for who knows how long and eventually got infected so became very painful before I got the root canal done. A regular x-ray would have picked up the problem earlier and allowed it to be fixed before it became sore. Stuff doesn't even have to touch the nerve for it to die, my filling was just close by rather than on the nerve for example and it died anyway. Meanwhile the tooth next door has a filling pressing right into the nerve and it's happy and healthy. So yeah, it's possible for tooth nerves to up and die for various reasons, it seems somewhat random as to if it will happen, and once it happens there's nothing you can do except drill out the dead nerve.

In your girlfriends case I'd say that it was the scraping down of the tooth which damaged the nerve, assuming this is causing the pain (which seems likely). Whether this was done excessively or ineptly I don't know although I'm sure its possible. Maybe a second opinion or a good look at the x-rays would help answer this? This seems like the bit you guys should be looking into to see if there is a case for bad dentistry.

Now that the nerve is damaged the dentist is correct in that a root canal is the only way to fix it. It's pretty easy for them to test if the nerve is dead (putting ice on the tooth seemed to be the main test with mine) and her dentist should be following this up more aggressively. Mine said that the pain keeping me awake was enough to make it an emergency and I was scheduled two days later. The delay was only for me to find the money, he would have done the root canal that afternoon.

I know how much this hurts, both physically and financially, so I hope she gets a resolution quickly.
posted by shelleycat at 8:30 PM on March 13, 2008

Oh, and if the nerve isn't actually damaged than putting a well fitting crown over it will stop the pain. It will physically protect the nerve in the same way that the actual tooth once did. So there is still hope that this will come right once the crown is sorted.
posted by shelleycat at 8:33 PM on March 13, 2008

This is why I knew that James Frey was a liar immediately-- he claimed to have had root canal without anesthesia...

This is possible if the nerves in the tooth are already dead.
posted by hAndrew at 8:33 PM on March 13, 2008

I have the benefit of experience of tons (TONS) of horrible dentistry, mostly due to a childhood accident plus some genetically bad cards, tooth-wise - but this is still a layman's opinion. I'd say it was not necessarily bad treatment. When you lose a crown there can be damage and/or decay to the tooth base, and having to work on it is not abnormal. The tech could have been doing the best with what was left - the best dentist in the world might not have done any better. The only way to get a valid second opinion (as opposed to mine, for example) would be to have another dentist check it out, along with all the before/during info the original dentist can provide from the crown work.

I want to vehemently second that serious pain that goes more than a day or two without diminishing is not normal and never acceptable. If you were communicating this status to the dentist and not having it taken seriously, you need a different dentist. If you were just waiting and seeing, or not being clear that the pain was very serious, it may have been a communication failure. But seriously - if I told a dentist I was having serious, unexpected pain that was not diminishing after a couple days and they were not working their asses off to get me in for an emergency visit within 48 hours I would fire that dentist.

Finally - it would likely be really hard to force compensation. But dentistry is a profession of relationships, in my opinion, and I think it would be perfectly reasonable to communicate that the crown procedure was not effective, and that it, according to the dentist's own opinion, led to the problem requiring a root canal, and so you think they should absorb some of the cost. You can come up with a figure or see what's offered, though I'd call expecting them to pay for the root canal or the full $800 from the crown to be a long shot.
posted by nanojath at 9:14 PM on March 13, 2008

I can't say for sure whether or not this was bad dentistry that caused the pain. But it is bad dentistry allowing it to continue unabated like this. A second opinion is in order. Unfortunately, I doubt you'll be able to get this compensated without more trouble than the money is worth, unless the dental office is reasonable. The number one issue, though, is to do what you can to get the pain stopped ASAP.

I can offer a little comfort, though - I've had two root canals, and while a little uncomfortable, they were not nearly as painful as you would think by the way people talk about them. Not only that, but the underlying pain that necessitated the work was gone for good by the time the novocaine wore off. That quick. Your (OK, her) mileage may vary, but it's typically not an evil procedure.
posted by azpenguin at 12:38 AM on March 14, 2008

I've recently received treatment for a similar problem. I had a crown put on a molar about 2 years ago that was sensitive to pressure and temperature. I finally got sick enough of it to get it checked out by an endodontist. When the crown was placed, they had to remove a significant portion of the tooth, which led to the crown being quite close to the nerve. As a result, the nerve became "irreversibly inflamed", necessitating a root canal.

Anyway, my input is this:
1. It's not necessarily bad dentistry; sometimes you take a chance on a simpler procedure that doesn't work out. However, I think the dentist should credit you for the ineffective treatment. I succeeded in having a crown redone at no cost via this rationale.

2. If at all possible, I recommend having your root canal done by an endodontist. Regular dentists can do root canals, but endodontists specialize in them. I've had two root canals, one by a dentist and one by an endodontist. The first took about 3-4 hours. The second (by the endo) was done in about 90 minutes, despite the fact that I have exceedingly long, thin, and curved roots. In both cases, the root canal was painless after the lidocaine injection.

3. Despite the fact that root canals are more "serious" than crown work, lots of dental insurance covers a larger percentage of the cost of a root canal than crowns. My co-pay for the root canal was 10% of the total cost, which was about $110.

Good luck!
posted by EKStickland at 1:16 AM on March 14, 2008

I've had a root canal (in a front tooth) without anasthesia.

The nerve was completely dead, so no pain from the drilling although the extra pressure on the abscess which the dentist was drilling into wasn't fun -- it was a huge relief when the drill bit entered the cavity. I even got to see all the gunge :)
posted by pharm at 5:20 AM on March 14, 2008

Yes, it is common (and IMO advisable) to have a root canal in conjunction with a crown.

Because later, when the root dies (which has happened to me once, and was the most excruciating pain I've ever known) most dentists are uncomfortable with knocking off the crown, and then he'll end up drilling through the crown and patching it, which just sounds wrong, to me.
posted by Rash at 11:52 AM on March 14, 2008

The possibly needing a root canal is not bad dentistry. However, having a patient be in pain for 20 days could be the sign of a not so good dentist. Every time a dentist preps a tooth for a crown, there is the possibility it could lead to the need of a root canal. (Even if the tooth was fine prior, and there was no pain.) Such is the nature of crown preps. The dentist should have explained this at the get go. The dentist might be letting her ride it out in the hopes that she could avoid having a root canal, but it would be nice if he/she offered your girlfriend some meds to keep her comfortable.
posted by jildelicious at 1:27 PM on March 14, 2008

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