Dental Issues: Pain and Concerns with Dentures

Issues with dentures?

Hello Dr.
Chang,
I would like to ask you a few questions: I have a connected dental crown on my upper left teeth #5 and #6 (meaning there are no individual crowns).
The dental pulp has been bonded, but the crown has not been permanently cemented yet; it is only temporarily attached for adaptation.
However, for the past five months, I have felt something unusual with the crown, a sensation that is neither pain nor discomfort, but I can feel it whenever I bite down on something.
Each time I visit, I only receive a dental cleaning and observation.

Two weeks ago, I suddenly experienced pain so severe that I was afraid to bite down on anything, and I even had some bleeding.
My dentist has always believed it to be a periodontal issue, so he removed the crown and prescribed me periodontal medication, but there has been no improvement.
I have noticed that the pain is actually in the gum tissue above the original tooth; it hurts significantly when I touch that area with my hand or brush my teeth.
Even touching that tooth with my tongue causes discomfort.

I have been suspicious that it might be due to inadequate cleaning during the procedure, but my dentist believes that since the nerve has been removed, it should not cause pain or issues.
He suspects that the silver filling in my upper left tooth #7, which has not had a root canal, might be the problem, but X-rays show no abnormalities.
However, I do not feel any pain from that silver filling.
I am quite confused and would like to ask Dr.
Chang:
Q1.
Once the dental nerve is removed, is it guaranteed that there will be no issues?
Q2.
Could the issue with my upper left tooth #7 be affecting the adjacent teeth #5 and #6, even though I do not feel any pain from tooth #7?
I would greatly appreciate your clarification and advice.
Thank you!

SAN, 40~49 year old female. Ask Date: 2011/11/16

Dr. Zhang Xiangyuan reply Dentistry

Dear online user,
Based on your description, here are the responses:
1.
It is possible to experience pain after completing root canal treatment.
However, you should consult your dentist for an X-ray and further examination to determine the potential source of the pain.

2.
The pain associated with the new crown on your upper left tooth may be related to the original seventh metal crown.
A thorough intraoral examination and X-ray are necessary for an accurate diagnosis.
Therefore, I recommend that you have your dentist conduct a detailed examination again or consult an endodontist (you can check with major dental institutions) for further diagnosis and treatment.

Thank you!
Dr.
Chang Hsiang-Yuan, Dentistry

Reply Date: 2011/11/16

More Info

Hello! Thank you for reaching out with your concerns regarding your dental issues. It sounds like you are experiencing a complex situation with your dental health, particularly with the connection between your dental crowns and the surrounding teeth and gums. Let’s address your questions and provide some insights into your situation.

Q1: After a tooth nerve is removed, can there still be problems?
Yes, even after a tooth nerve (pulp) has been removed through a procedure known as root canal therapy, there can still be issues. The removal of the nerve alleviates the pain associated with an infected or inflamed pulp, but it does not guarantee that the tooth will be free of problems in the future. The surrounding structures, such as the periodontal ligament and the bone, can still be affected by infection, inflammation, or other dental issues. Additionally, the tooth can still be sensitive to pressure or temperature changes due to the surrounding tissues reacting to the dental work or the condition of the tooth itself.

Q2: Could the issue with the left upper 7th tooth affect the adjacent 5th and 6th crowns?
Yes, it is possible for issues with one tooth to affect adjacent teeth, even if the adjacent teeth do not exhibit pain themselves. This can happen due to several reasons:
1. Shared Structures: Teeth share the same supporting structures, including the gums and bone. If there is an infection or inflammation in one tooth, it can lead to discomfort or sensitivity in neighboring teeth.

2. Occlusion: The way your teeth come together (occlusion) can also play a role. If the 7th tooth is misaligned or has a problem, it may cause undue pressure on the 5th and 6th teeth when biting or chewing.

3. Referred Pain: Sometimes, pain can be referred from one area to another. This means that even if the 7th tooth is not painful, it could still be contributing to discomfort in the 5th and 6th teeth.

Recommendations:
Given your situation, here are some steps you might consider:
1. Seek a Second Opinion: If your current dentist is unable to resolve your concerns, it may be beneficial to seek a second opinion from another dental professional. A fresh perspective can sometimes uncover issues that were previously overlooked.

2. Comprehensive Evaluation: Request a thorough evaluation, including X-rays, to assess the health of the surrounding teeth and bone. This can help identify any underlying issues that may not be immediately apparent.

3. Periodontal Assessment: Since your dentist suspects a periodontal issue, it may be worthwhile to consult a periodontist. They specialize in gum health and can provide targeted treatment if there are underlying gum problems.

4. Discuss Your Concerns Openly: When visiting your dentist, be open about your concerns and symptoms. This can help them better understand your situation and tailor their approach to your needs.

5. Pain Management: If you are experiencing significant pain, discuss pain management options with your dentist. They may recommend specific medications or treatments to help alleviate your discomfort.

6. Follow-Up Care: Ensure that you have regular follow-up appointments to monitor the situation. Dental issues can sometimes evolve, and ongoing evaluation is key to maintaining oral health.

In conclusion, dental health can be complex, and it’s important to address any discomfort or concerns promptly. By seeking further evaluation and being proactive about your dental care, you can work towards finding a solution that alleviates your pain and improves your overall oral health. Take care, and I wish you the best in your journey towards better dental health!

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