> I recently went to a dentist to have a suspected fractured tooth
examined
> (#19?), as I have had two of these previously. The dentist confirmed
this
> and proceeded to prepare the tooth, for what I thought would be a
> traditional crown. When she was finished I was told the crown would
be ready
> the following day?! And informed it would be a CEREC restoration. She
> explained that this type of restoration allowed her to retained a
larger
> portion of the tooth (note: she retaine the side closest to my
tongue, which
> is where the sensistivity was localized). With the temproary crown
(which
> only covered half the tooth, since it had not been completely ground)
I felt
> no improvement -- the tooth (on the offending side) was still very
sensitive
> to pressure and to hot/cold. When I returned I informed the destist
that the
> tooth was not improved with the temporary crown and she stated that
that was
> normal given the type of procedure that was being done. I was
suspicious,
> but had no idea what to do, so she proceeded to do the procedure --
numbing
> me and applying the CEREC restoration. Of course the restoration
looked very
> pretty and the dentist seemed quite proud, but, the following day, the
> sensistivity to hot/cold and pressure remained. Due to the holidays, I
> waited about 2 weeks to return, and the tooth was the same (I am
taking
> advil regularly). She believed the pain was do to misadjustment in
the bite
> and proceeded to adjust my bite (which hurt alot). But prior to
adjustment
> she took another x-ray and indicated that the problem might be an
abscess in
> the tooth directly behind the sensistive tooth (I have never had a
problem
> with that tooth, it has been filled). She said there was a shadow on
the
> xray. She then did a tap test on the tooth and there was no pain on
either
> the sensistive tooth or the tooth which she said might have an
abscess. Then
> she did a vitality test on the suspected abscess and it didn't hurt
all that
> badly, and so she concluded that there probably is an abscess in that
tooth,
> which must be causing the sensitivity on the tooth in front of it.

> Is it possible that I would have so much localized sensistivty on the
tooth
> with the CEREC restoration from an abscess on the tooth behind it? Of
course
> I do not want an unecessary root canal, but do not want to leave an
> abscessed tooth untreated either. I still feel that the tooth that
had the
> CEREC restoration should have been given a full crown, but I am not a
> dentist -- what do I know. Any ideas, suggestions or words of wisdom
would
> be appreciated.

> Regards

> There is no way to tell from here what the best course of treatment for
your
> tooth may be.

> In general terms, a tooth with a crack or fracture is best treated with a
> metal or porcelain fused to metal full coverage crown (in my opinion).
> Often (that means not always) a cracked tooth is detected by the patient
> feeling pain not when they bite down on the tooth, but when they release
the
> pressure.

> In general terms, (again with lots of exceptions) a tooth which hurts when
> pressure is applied to it will have:  a) a high spot on a filling,  b) a
> bruised socket from clenching or hitting something hard imbedded in food,
> or  c) a abscess beneath the root.

> Sensitivity to sweets is generally a sign of the restoration leaking, but
> could be due to some "gum tissue" recession.

> Molar teeth are sometimes very difficult to determine the vitality of the
> pulp tissue due to the number of roots and the number of canals inside
these
> roots.  Establishing a diagnosis is something which will require gathering
> lots of information and trying to put it together in a fashion which seems
> logical.  Remember that diagnosing your tooth problem is a lot like a
> birthday present.  You can take a present, lift it, feel its weight, shake
> it and listen for noises, check its size, feel the stiffness of the box,
> etc.  You gather all these facts and guess that you have a new transistor
> radio in the package.  You open it up and sometimes find that you got a
new
> punching bag shaped like a clown instead.  Sometimes, we can only take our
> best guess at what is going on, then act on it.  Most often we are right,
> sometimes we are fooled by the signs and symptoms.

> Your dentist should discuss any uncertainties with you, so you both make
the
> decision to treat further or not together.

> Best wishes to you,

> Dr. Steve

> |
> |
> | I recently went to a dentist to have a suspected fractured tooth
examined
> | (#19?), as I have had two of these previously. The dentist confirmed
this
> | and proceeded to prepare the tooth, for what I thought would be a
> | traditional crown. When she was finished I was told the crown would be
> ready
> | the following day?! And informed it would be a CEREC restoration. She
> | explained that this type of restoration allowed her to retained a larger
> | portion of the tooth (note: she retaine the side closest to my tongue,
> which
> | is where the sensistivity was localized). With the temproary crown
(which
> | only covered half the tooth, since it had not been completely ground) I
> felt
> | no improvement -- the tooth (on the offending side) was still very
> sensitive
> | to pressure and to hot/cold. When I returned I informed the destist that
> the
> | tooth was not improved with the temporary crown and she stated that that
> was
> | normal given the type of procedure that was being done. I was
suspicious,
> | but had no idea what to do, so she proceeded to do the procedure --
> numbing
> | me and applying the CEREC restoration. Of course the restoration looked
> very
> | pretty and the dentist seemed quite proud, but, the following day, the
> | sensistivity to hot/cold and pressure remained. Due to the holidays, I
> | waited about 2 weeks to return, and the tooth was the same (I am taking
> | advil regularly). She believed the pain was do to misadjustment in the
> bite
> | and proceeded to adjust my bite (which hurt alot). But prior to
adjustment
> | she took another x-ray and indicated that the problem might be an
abscess
> in
> | the tooth directly behind the sensistive tooth (I have never had a
problem
> | with that tooth, it has been filled). She said there was a shadow on the
> | xray. She then did a tap test on the tooth and there was no pain on
either
> | the sensistive tooth or the tooth which she said might have an abscess.
> Then
> | she did a vitality test on the suspected abscess and it didn't hurt all
> that
> | badly, and so she concluded that there probably is an abscess in that
> tooth,
> | which must be causing the sensitivity on the tooth in front of it.
> |
> | Is it possible that I would have so much localized sensistivty on the
> tooth
> | with the CEREC restoration from an abscess on the tooth behind it? Of
> course
> | I do not want an unecessary root canal, but do not want to leave an
> | abscessed tooth untreated either. I still feel that the tooth that had
the
> | CEREC restoration should have been given a full crown, but I am not a
> | dentist -- what do I know. Any ideas, suggestions or words of wisdom
would
> | be appreciated.