MY TOOTH HURTS BUT MY DENTIST CAN'T FIND THE PROBLEM

 This is a repost of a blog I wrote in 2012.  I am reposting this because it happens so often I just want to refresh your memories or to just sharpen the point. So please have a good read:

A patient comes into the office and says that he is having discomfort on one side. He has hasn't eaten on that side for months if not years.  The culprit tooth has a small filling in it or no filling at all.  In the x-ray the tooth looks perfectly normal.

I am most definetly starting to think CRACKED TOOTH!!

I place pressure on each cusp separately.  On one of the cusps, as the patient opens from pressing, then the tooth starts to hurt.  Yes it is a cracked tooth.

Can you see it on the x-ray?  No you can't since the tooth is fractured and not broken.  When it is fractured the two sides are close together and an X-ray will not pick up the fracture.

Why is it hurting if the sides are still together?  This is because, as you bite down on the tooth, the sides of the tooth are flexing.  At that point fluid moves in and out of the tooth causing pain.

So how do you fix it?  This is the easy or hard part.  It all depends where and how far down the root the tooth is fractured.  To fix this problem you need a crown on the tooth.  By shaving the tooth down and then covering it with a crown (or cap) all the forces of biting will be directed internally and the fractured parts will be held together thus stopping the pain.  To test this, we place a temporary crown on the tooth first.  If the symptoms disappear then we can go ahead with the permanent crown and have reasonable confidence in the outcome.  If the fracture goes further down the root and beyond the crown then the symptoms may persist.  We may need to do a root canal and the symptoms may then disappear.  But overall the prognosis is now guarded.  When the crown does not encompass the entire fracture the tooth may still be flexing and the long term prognosis is questionable.

Does this happen a lot?  Actually it happens quite a bit, even teeth that have never had a filling in them get fractures.  This is called wear and tear.  If you never use your teeth this will never happen to you.  Since most people use their teeth quite a bit and of course many of us also grind our teeth which makes this worse, quite a few of us will experience this throughout our lifetimes.

If you have any questions, you can always send me a note.

All the best

Dr. Ron Barzilay
Hamilton Ontario

www.rondentist.com

Do I need a Crown after Root Canal Treatment

Do I need a Crown after Root Canal Treatment

This is not the first time I have written on this subject and I keep getting asked this same question.
I understand the question.  People have had their root canal treatment and their tooth no longer hurts so why should they have this expensive treatment called a crown.  I mean they have just paid enough for the root canal. and the filling.
Well, this past week, another patient of mine came in who had his root canal done a few months ago and the tooth was cracked.  Nothing I could do and I had to extract the tooth.  Only problem was that this tooth was his last molar on one side and it held his partial denture.  Now that the tooth is gone he has a real issue holding that denture.  We have repaired the denture to have it hold better but a solution that will let him hold the denture at least the way it was is going to be expensive.
Yes you need the crown after the root canal treatment.  It will save you money in the long run.

Enjoying dentistry in Hamilton Ontario Canada

All the best

Dr Ron Barzilay

www.rondentist.com

PS. any questions, just send them as a comment

I HAD A ROOT CANAL - WHY DOES MY TOOTH STILL HURT?

I HAD A ROOT CANAL - WHY DOES MY TOOTH STILL HURT?

I have heard this question many times from new patients coming into the practise or from emergency patients having problems with a tooth.  Of course the answer is never simple and always depends on the circumstances.
When someone has had a root canal treatment the tooth is now altered and may not feel exactly the way it did before.  The questions we must ask:  Is the tooth functional?  Can you eat on it without discomfort?  If you answer yes to both then there is no problem.  If the answer is no then there is a problem and that is what we will deal with in this blog.
Lets start with the simple.  If you just had a root canal yesterday and your tooth is hurting it is most likely some post op discomfort and it will most likely resolve shortly.  You can even get some swelling after the treatment which may need an antibiotic but then will resolve.
What we really want to discuss here is the tooth that had root canal treatment a while ago and you still can't eat on it.  General success of root canal treatment is in the very high range.  If a root canal treatment does not succeed there can be a number of reasons which in general amounts to bacteria still being in the root canal system.  This can happen because there may be an extra canal (or two) which we didn't find.  It can also be because the root canal system is so convoluted that we couldn't clean out the entire root canal system well enough.  Another reason that a root canal may fail is due to a fracture in the tooth which may never have been noticed.
So probably the more important question in all this is what can be done?
This question usually involves a discussion with your dentist because the answer is not always black and white.  If the root canal looks like it was done poorly then you would consider redoing it.  The results could be very good.  If the root canal looks like it was done well then you have to consider the cost benefit of redoing the root canal or apical surgery (all in an attempt to stop bacterial leakage into the surrounding tissues) versus extraction and implant placement. I have simplified things but as I said earlier this will involve a discussion between you and your dentist as to the proper course of action depending on your individual circumstances.

Having fun doing Dentistry in Hamilton Ontario

All the best
Dr. Ron Barzilay
www.rondentist.com

PS you are welcome to follow the blog and leave comments