OT: Any dentists in the house?

Submitted by blue95 on

Long story, but to summarize:

I had a root canal, went in a couple weeks ago to have it prepped for a crown. The dentist was worried at first cuz there is a crack in the tooth, but after working on it he figured it was salvageable and he put some kind of rubber stuff around the gum line and temporarily capped it to get the crown in a couple weeks.

I was chewing something a couple minutes ago and the entire top of my tooth came off. Now it's a nub about 1/4 inch (totally guesstimating that). No pain, and it's all sealed up.

Is there any salvaging this, or is it gone?

njv5352

January 29th, 2011 at 4:45 PM ^

So did you break it off clean at the gum line or did the temporary just come off? If it just the temporary don't panic and put some toothpaste in it and put it back on. If it broke off clean at the gum line then it may or may not be salvageable. After having a root canal is shouldn't be painful at all unless the gums are inflamed or the tooth is split.

Champ Kind

January 29th, 2011 at 4:53 PM ^

I've had a couple root canals as well.  When they prep it for the crown, they take a lot more of your tooth then you think.   I checked out my tooth when they took off the temporary and it was just a nub.   I was surprised by what a small piece of tooth I had left. 

So, hopefully just the temporary cap came off, and everything is still in place to have the crown put on. 

njv5352

January 29th, 2011 at 4:56 PM ^

A quarter inch nub doesn't seem like a lot, but in dental terms it can be a ton. You figure that most teeth are 1/2-5/8 inches tall about the gumline. Depending on where it is.....and I am going to venture a guess that it is one of the back teeth and possibly a top one, that might still be saved. Keep it clean and call first thing Monday unless you get into pain. Can you tell how much tooth is in the temp?

CB2009

January 29th, 2011 at 5:04 PM ^

First year dental student, so I can give my VERY unexperienced (yet very expensive) opinion. As long as you only broke the temporary crown, then it shouldn't change anything in the long run. I couldn't tell from your story, so I'm assuming the permanent crown hasn't gone in yet.  Since the root canal is done, there shouldn't be pain regardless. If what you broke was the real tooth, then worst case scenario you'll need to get an implant, which isn't all that bad, actually pretty bad ass in my opinion.

njv5352

January 29th, 2011 at 5:16 PM ^

Depending on how much tooth is actually broken off the crown may or may not fit. If it is just a little bit then the cement will usually be strong enough to fill it in and hold. If it is too much if a gap then there are a few other options including making a new crown. Hopefully your tooth can be saved and everything will go smoothly.

ColsBlue

January 29th, 2011 at 5:05 PM ^

With horizontal fractures, all you'd need is enough tooth stucture for the crown to surround the entire tooth above bone level. If it's a verical fracture below the bone level, it's a goner. This scenario is why extraction and implant have become such a strong alternative to traditional RCT/core/crown. Good luck!

pullin4blue

January 29th, 2011 at 5:11 PM ^

I am wondering who did the root canal. I don't want their name, I am just wondering if your dentist did the root canal or if a root canal specialist (endodontist) did. The reason I ask this is that if a specialist did the root canal they will use a microscope during the procedure to evaluate the soundness of the tooth prior to doing the root canal. In most cases, if a fracture of the tooth is noted, they will not do the root canal and will advise you to have the tooth removed.

There are a lot of dentists who do root canals themselves, and there is nothing wrong with that, but sometimes they complete root canals on teeth that have fractures that make the tooth either very difficult or impossible to restore (cap/crown). 

The hallmarks of a failing tooth are pain, swelling or discharge (pus). I would tell you that if you have any of these symptoms it is fairly unlikely that the tooth will have a good long-term prognosis. Antibiotic treatment may relieve symptoms temporarily, but the tooth would still need definitive treatment.

CVS sells temporary cement that you can use to re-cement the crown back on the tooth, providing there is still enough tooth to hold the crown. If your dentist feels the tooth is stable and can still be restored you will likely need what is called a post and core and then the crown. This will add to the expense of having the tooth restored, but will allow restoration of a tooth that has lost much of the structure above the gum line.

pullin4blue

January 29th, 2011 at 5:34 PM ^

CB2009,

The economy sucks right now so most people I know are not looking for associates or partners. However, you have the luxury of time. I'm seeing a lot of older docs, DDS and MD that are staying in practice longer only because the market isn't what they thought it would be when they hit their window for retirement. Having said that, in the next few years, as the economy continues to turn around, these guys will be retiring and looking for associates and partners. I would always recommend looking at specializing, but I understand that debt has to be paid off. You have plenty of time right now. Get good grades and try to develop good relationships with your instructors. They hire a lot of the grads.

blue95

January 29th, 2011 at 5:18 PM ^

I had the root canal (by the dentist) about 2 1/2 years ago and my dental insurance was maxed for the year, so we decided we'd put off the crown until the next January and go with the temp cap until then. Then I got laid off and lost insurance, so I've had the temp for all this time. Last November I bit into a peppercorn or something and felt the temp break. I've had a hole in the tooth for the last 3 months until they finally filled it and re-prepped it 2 weeks ago. Thanks Jeebus we don't have universal health care in this country! Goddamn mooches always trying to take care of themselves in a timely manner!

njv5352

January 29th, 2011 at 5:32 PM ^

Not here to judge and definitely without seeing your mouth. I can tell you that I have successfully restored teeth that have horizontal fractures in the coronal 1/3 often. If it drops below that the success rate begins to fall. Vertical fractures are a whole new ball game. Depends where the vertical fracture terminates and history of the tooth. I have had several patients in temporaries for long periods of time with nothing bad happening. You just have to understand the word temporary and often........they are just that, temporary and need to be followed often. Most of these patients were cancer patients who were entering treatment and did not want extractions. As for losing insurance.....unfortunately it happens all the time. That is a risk lots of people take. Go see YOUR dentist and let him/her look at it. If you don't trust them go get a second opinion.

blue95

January 29th, 2011 at 5:41 PM ^

I guess sometimes one worries more about how they are going to eat and pay rent next month than when they will get their tooth crowned. Unfortunately, I see dentistry as a luxury expense compared to other basic necessities. I know that's not the best thought process, but it's reality. I have a good job and get paid well, but I've been mostly consulting over the last few years and have just recently gotten new, reasonable insurance.

njv5352

January 29th, 2011 at 5:48 PM ^

I completely understand. I have plenty of patients in the same boat and it is just part of the industry. Seems as though you are getting back into it so hopefully this tooth can be saved and with no additional cost. I grew up with dentistry as a luxury too. We were more worried about paying the rent and eating than getting our teeth fixed. That is just part of life for some. I was extremely lucky to not have many problems. Hopefully things start looking up for you. Glad I could help.

blue95

January 29th, 2011 at 5:55 PM ^

I guess this is the true problem with medicine in this country. Most people only go to see a professional when there is an emergency — not as a preventative measure — because they can't afford either the expense or to take time off work. I've always had really good teeth so I hope it will work out well. Cheers, all!

M-Fan97

January 29th, 2011 at 5:33 PM ^

I cracked the top off of a tooth once, playing baseball. I took a line drive to the face. They were able to glue the tip of the tooth back on after the root canal.....

gerst521

January 29th, 2011 at 6:05 PM ^

as a soon to be graduating dental student it sounds like (without reading every comment on here) that the crown that is being made now will not fit and you should let your dentist know in case it has not been processed at the lab yet.  Depending on what it looks like, the dentist may be able to salvage it by placing a post into one of the roots and attaching a core to that to build up tooth structure.  Then a new impression would need to be taken in order to make the final crown.  

periotrainer

January 29th, 2011 at 6:24 PM ^

Hey.....if there is enough tooth/root we might be able to cut away a little tissue and bone. The tooth may still be restorable. (I'm a periodontist......give me a call). If not we can slick it out and stick in a little titanium. 

bluebyyou

January 29th, 2011 at 6:40 PM ^

Enough of this already...this site is supposed to keep our minds off of real life things like dentists, not my favorite people at the moment.

I had an implant and graft done a week ago, with the damned implant placed 16 mm into my jaw, or so I think the oral surgeon said to me as I was coming out of the conscious sedation haze.  Great stuff but still no fun.  Still aches a week later.

Out of curiosity does Dante have a place in hell for people who bore into your mouth with drills spinning at a couple of trillion RPM's?  And that's after they stick a needle into your gum that seems long enough to exit through the side of your neck. If not, we need to establish such a place.

Steve in PA

January 29th, 2011 at 7:47 PM ^

Dentists her are advertising one visit crowns.  They do the grinding, take some pictures and have a milling machine produce your crown in the same visit.  Seems to be the way to go.

I had a root canal and crown after splitting my tooth.  I used to grind my teeth while sleeping and now just chew the hell out of my mouthguard.  About 3 years after I got my crown it came off.  It looked almost exactly like what you describe.  They reglued it and explained that it would come off every 5-7 years when the adhesive wears out.

I wouldn't worry, but just get to your guy/gal asap