Question:
Due to my difficult travel schedule and I'm also in the process of
moving, I would like to know the advisability of either "getting it
over with quickly" (root canal) or else, waiting about 3 months with
the temp crown before deciding to get either a permanent crown or a
root canal + crown (as long as symptoms don't get worse).
So, first, is it significantly worse for the tooth to just get the root
canal now, assuming maybe about 50% chance that it's the real solution.
(I know it would be worse on the wallet, but...i'll ignore that for
now)
Second, if its a bad idea, then is it OK to have a temp crown for about
3 months or more (I guess strong glue would have to be used...I'm an
avid flosser.
Third, I really don't know anything about how crowns are made, so: If
a temp crown is made by dentist #1, can a different dentist install the
permanent crown later, or would he have to start from scratch? I would
guess the latter (?), unfortunately.
Answer:
Problem with doing root canal pre-emptively is that if there is an
undetected fracture it could be for naught and you could wind up losing
the tooth.
Assuming the offending tooth can be isolated, I would probably choose
to remove any restorations in the tooth and examine it for signs of
fracture under high magnification. If nothing can be seen, I would
place a sedative dressing for a few weeks and see if there is any change
(possibly relieving the bite to lessen pressure on the tooth). If the
sensitivity to direct pressure on the tooth remains, I would place a
temporary crown, and use a cement strong enough to last as long as you
need it to.
The dentist who removed the filling (restoration)
and put in a new one, did not use a microscope...just the eye. I had
never thought about that as a problem. That was a few months ago.
Oooh, taking out the filling again to have another look...ugh.
(p.s. How many (what %)dentists have microscopes; I guess I have to ask
before making appointment. I guess I'm wondering: If someone were to
go to randomly selected dentist with a problem like mine, how likely is
it a microscope will be used/available...and what kinds of dentists
have them.).
I guess I'm also under the misconception that a crown can be useful if
there's a crack/fracture, whether it can be seen or not. I thought
that that the dentist who suggested a temp crown thought there might be
an unseen crack and the crown might solve the problem...???
Usually I agree with you Bornfeld, however in this instance
with regard to the symptoms RCT is advisable followed quickly
with a perm crown.
Can be done in the same appt.
Lingering pain to thermal stimulus is indicative of
irreversible pulpitis. Get RCT done by an endodontist.
Quickly.
Get a crown done ASAP after the endo.
The crown MAY solve the problem if the crack has not extended under the
gumline.
Most general dentists (myself included) don't have operating
microscopes as such, but many who don't have telescopes or intraoral
cameras which do a good job. Most endodontists at this point probably
have microscopes.
