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cracked tooth treatment options
Old 04-05-2009, 06:02 PM   #1
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cracked tooth treatment options

Hi all,

I have a tooth (2nd one from the back on the bottom) which I have been told is cracked.

I had a root canal done on it about 5 or 6 years ago, followed by placement of a crown. It was less painful afterwards, but never became completely painfree. I got used to it and just dealt with the intermittent pain when I bit down the wrong way.

Well, over the past few months it is becoming more sensitive. It now is becoming sensitive to cold for the first time. This is quite painful. I find myself chewing more and more on the other side of my mouth, and I know this is risky (i.e. could develop TMJ).

I'm going to go back to the dentist, but I wanted to to a little more research myself first.

First of all, since I had a root canal done, why does it still hurt? Did they not get the entire nerve?

Secondly, a friend of mine told me she would just have it pulled and be done with it. If you have a tooth pulled, will this cause any other problems with alignment, etc.?

Third, if i decide to get a root canal done, how do I find a GOOD endodontist? I live in a really small town, and I'm worried about how good the medical specialty care might be here.

It's not a money issue. It's an issue of just getting this fixed once and for all. I'm tired of dealing with it.

Thanks all.
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Old 04-05-2009, 07:13 PM   #2
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Quote:
Originally Posted by simple girl View Post
Hi all,

I have a tooth (2nd one from the back on the bottom) which I have been told is cracked.

I had a root canal done on it about 5 or 6 years ago, followed by placement of a crown. It was less painful afterwards, but never became completely painfree. I got used to it and just dealt with the intermittent pain when I bit down the wrong way.

Well, over the past few months it is becoming more sensitive. It now is becoming sensitive to cold for the first time. This is quite painful. I find myself chewing more and more on the other side of my mouth, and I know this is risky (i.e. could develop TMJ).

I'm going to go back to the dentist, but I wanted to to a little more research myself first.

First of all, since I had a root canal done, why does it still hurt? Did they not get the entire nerve?

Secondly, a friend of mine told me she would just have it pulled and be done with it. If you have a tooth pulled, will this cause any other problems with alignment, etc.?

Third, if i decide to get a root canal done, how do I find a GOOD endodontist? I live in a really small town, and I'm worried about how good the medical specialty care might be here.

It's not a money issue. It's an issue of just getting this fixed once and for all. I'm tired of dealing with it.

Thanks all.
Which tooth is it? I cracked a molar several years ago and decided if the crown didn't work I would have it pulled.

I am not a dentist: it might be simpler to just pull the darn thing.
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Old 04-05-2009, 07:28 PM   #3
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Which tooth is it? I cracked a molar several years ago and decided if the crown didn't work I would have it pulled.

I am not a dentist: it might be simpler to just pull the darn thing.

It's the second one from the back on the bottom.

I've never had a tooth pulled, but I'm really considering it. Not sure what the ramifications are of having a tooth pulled, though. Does it cause alignment problems?

These are questions I will ask the dentist, but I also wanted to hear some real life stories for additional feedback.
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Old 04-05-2009, 08:01 PM   #4
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I'm not a dentist either, but I had a molar pulled on the top (the one next to the wisdom tooth). It was cracked and the endodontist said the crack went too deep and that the root canal would probably fail. The best option for me would be an implant (since they don't seem to like to hook a bridge to a wisdom tooth). Either the implant or a bridge would cost about the same, roughly $2,000. The oral surgeon who pulled the tooth recommended to try doing nothing since he said that it was not an important tooth for chewing, which is what I ended up doing since the prospect of drilling into my jaw bone to do an implant didn't seem to be something I was ready to face (although implants have been successful for many people). In any case, I don't miss the tooth, and I haven't had a problem with the adjacent teeth shifting into the empty space.

It sounds like yours is in a position where you could either have a bridge or an implant, if you decided to have the tooth pulled, or maybe do nothing and leave the space.
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Old 04-05-2009, 08:05 PM   #5
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I'm not a dentist either, but I had a molar pulled on the top (the one next to the wisdom tooth). It was cracked and the endodontist said the crack went too deep and that the root canal would probably fail. The best option for me would be an implant (since they don't seem to like to hook a bridge to a wisdom tooth). Either the implant or a bridge would cost about the same, roughly $2,000. The oral surgeon who pulled the tooth recommended to try doing nothing since he said that it was not an important tooth for chewing, which is what I ended up doing since the prospect of drilling into my jaw bone to do an implant didn't seem to be something I was ready to face (although implants have been successful for many people). In any case, I don't miss the tooth, and I haven't had a problem with the adjacent teeth shifting into the empty space.

It sounds like yours is in a position where you could either have a bridge or an implant, if you decided to have the tooth pulled, or maybe do nothing and leave the space.
Very interesting. If I do have it pulled, I will either opt to do nothing or have a bridge placed (not too keen on the bridge, either). My brother had an implant and when they drilled into his jaw to place it, the drill went through the jaw into the sinus cavity <shudder>. I have a major fear of implants now!
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Old 04-05-2009, 08:25 PM   #6
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It's the second one from the back on the bottom.

I've never had a tooth pulled, but I'm really considering it. Not sure what the ramifications are of having a tooth pulled, though. Does it cause alignment problems?

These are questions I will ask the dentist, but I also wanted to hear some real life stories for additional feedback.
My tooth was the last one on the side(#31) and pulling would not have caused any problem. Don't think a missing molar would cause much in the way of alignment problems.
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Old 04-05-2009, 08:39 PM   #7
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I wouldn't worry about it, and I wouldn't assume that it needs to be pulled.

I would go to the dentist and find out what's going on. It might not be that big a deal.

These days, a lot of dentists do root canals in their offices instead of sending patients off to endodontists. Root canals can be done in one sitting now. I had my last one done by my dentist (who had the training to do it) and it was much less of an ordeal, and has been just fine. But if you already had a root canal done on that tooth, it doesn't sound like that is going to be required.

It isn't unusual for a tooth to be sensitive to temperature after a root canal. It might just be something that you have to live with.
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Old 04-05-2009, 09:11 PM   #8
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I think that if it is just a redo of a root-canal, a good dentist can 'go through' the old crown and fill it. Real dentists can correct me, feel free.
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Old 04-05-2009, 11:36 PM   #9
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I cracked a crown and they redid the crown..pay about what you'd pay for the first one around, just a pain in the butt.

I also have a root canal - and it failed - but that was extreme pain so you'd know if that was the case. Also, mine still is bothersome and I've been told it is vulnerable still so those can just be problematic, even if you think it's been taken care of!

I have heard something about how the health of your mouth and number of teeth are strong determinants of other health factors...your mouth is a pathway to other parts of your body so keeping it free from infection after the extraction is probably really important.

I really wish I'd had better oral health education growing up (supervision!) ...
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Old 04-06-2009, 02:19 AM   #10
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I've had dentists yell at me for not treating cracked teeth and popped out crowns as emergencies. Sometimes I complain of a bad toothache, dentist looks around and treats a tooth on the other side, pain goes away. I still can't bring myself to calling the dentist's emergency number on a weekend. I've only had one tooth pulled and that was because there were too many, and the doc. put a brace on to re-arrange the others. My series of dentists want to preserve teeth at all costs, and those costs are mine. Good luck, and as always, YMMV.

Let us know how it goes.
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Old 04-06-2009, 07:27 AM   #11
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It sounds like you are over the five year mark. My insurance company has a five year life on crowns. They will not pay for a new crown on the same tooth unless the five years have expired.
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Old 04-06-2009, 08:31 AM   #12
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I have a tooth (2nd one from the back on the bottom) which I have been told is cracked.
Had this happen many years ago, same tooth position, and the dentist opted to pull the tooth since he did not think there would be alignment issues. That was over 25 years ago, and I have not missed the tooth at all. The dentist did say that extraction could cause problems in some cases but it is dependent upon an individual's tooth alignment (how the upper and lowers make contact). Might be worth discussing this option with the dentist.
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Old 04-06-2009, 09:06 AM   #13
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I think that if it is just a redo of a root-canal, a good dentist can 'go through' the old crown and fill it. Real dentists can correct me, feel free.
Not sure about a redo of a root canal, but I had this done on a tooth that was crowned and subsequently developed the need for a root canal. The endodontist drilled a small hole (~ 3mm in diameter) through the biting surface of the crown and did the root canal using a telescopic/microscopic device so he could see clearly what he was doing. After the root canal, my regular dentist put a small filling in the hole. Cosmetically, the filling shows, but it's not a front tooth (I believe it's the same location as SG has described), and I didn't have to have a new crown. The endodontist said this works about 85% of the time. If it's a porcelain-covered gold crown (which mine was), he said there's about a 15% chance that the porcelain will crack when he drills the hole, in which case he can still do the root canal, but a new crown will likely be required.
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Old 04-06-2009, 10:24 AM   #14
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About a month ago I had a toothache from a tooth that had a root canal. This all happened over a weekend and my regular dentist was not available. To make a long story short, over the course of the weekend, the pain shifted to another tooth (from a bottom tooth to a upper tooth). By Monday, when I was able to finally see my regular dentist, it was discovered that there was nothing wrong with the root canal tooth, but, that I needed a new root canal done on one of my upper teeth. Tooth pain can be deceiving...not always the tooth you think is the problem.
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Old 04-06-2009, 10:34 PM   #15
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You should discuss it and have it checked/watched. I have the same problem and the endodontist said I could end up with bone deterioration under the tooth. Which would be bad. I do feel ... not quite pain ... but it's not right. My regular dentist asks me about it everytime I go in. Not sure when we'll decide I need to go back to the endodontist.
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Old 04-07-2009, 07:04 PM   #16
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I did an implant and have had good luck so far. DW did one too. Trouble with bridges is that they destroy the teeth to the side when they get used as anchor points.

My first implant post had to be removed as it got infected. Second was successful and now has a crown on it. First wasn't painful that much at all, but the second was as the dentist wanted to really get it in there good and folded back a good chunk of my gum. That hurt more than the bone drilling!

I'd consider an implant before a bridge. DW is a dental assistant and really spent a lot of time with implants and attending implant info sessions/trade shows.
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Old 04-07-2009, 07:59 PM   #17
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simple girl,

You mentioned the lack of options in the small town. I know that you visit western PA. One option is that you can find good dental people in the Pgh area and arrange the dental work next time you visit.

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Old 04-07-2009, 09:07 PM   #18
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I am a practicing dentist, and here is my advice.

From the sounds of it, you have a failing root canal, and the tooth is probably not cracked. The reason I say this is because of the cold sensitivity, which means that you likely have a canal that was missed or incompletely filled during the root canal.

If the tooth/root was cracked, you would most likely have symptoms of pain to chewing and/or swelling in the area, but not temperature sensitivity.

You should go see an endodontist. They can simply drill right through the crown and retreat the root canal.
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Old 04-07-2009, 09:09 PM   #19
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simple girl,

You mentioned the lack of options in the small town. I know that you visit western PA. One option is that you can find good dental people in the Pgh area and arrange the dental work next time you visit.

Free

I have thought about that, but wouldn't you need to have follow-up visits (especially if there were problems)? I'm considering going to someone in Birmingham, AL. It's about a 2 hour drive. I guess I could take a couple Friday afternoons off, and we could make a fun weekend out of it. Now that I think about it, that is probably my best option.

I appreciate the stories everyone has shared. I now at least have an idea of the options I can consider and investigate further.
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Old 04-07-2009, 09:14 PM   #20
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I am a practicing dentist, and here is my advice.

From the sounds of it, you have a failing root canal, and the tooth is probably not cracked. The reason I say this is because of the cold sensitivity, which means that you likely have a canal that was missed or incompletely filled during the root canal.

If the tooth/root was cracked, you would most likely have symptoms of pain to chewing and/or swelling in the area, but not temperature sensitivity.

You should go see an endodontist. They can simply drill right through the crown and retreat the root canal.
Wow, I just caught this post. Thank you so much - this gives me hope! I will get in with an endodontist ASAP. I am more than willing to go through another root canal if there is a reasonable chance of success. I really appreciate your input.
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