Q: Three weeks ago I bit down on an ice cube and a terrific pain shot through my upper left molar. At first, I thought it was just the ice causing the sensitivity but then, after that, even cool water would set it off. I saw a dentist a few days later and he said it was a cracked tooth. He said that temperature could cause an expansion contraction movement inside the tooth and that would get to the nerve. He told me I needed a crown and got me in, right away. The next day the tooth hurt more, so I went back. I was a bit upset and more so when he said the tooth needed a root canal I said, “OK.” So, he did the root canal therapy. It seemed better but then, on day three, the tooth hurt like before. I decided to see a specialist. I’m waiting because they’re backed up. The pain has changed and only hurts when I bite down. The dentist said it might take a few days to two weeks to settle but it’s now three weeks and I’m still getting pain when I bite. What is the problem? Am I expecting too much? What if the tooth has to come out? I’m into this tooth for close to three grand. Do I just lose out? I’ll never bite down on ice again!
A: What set your tooth off is not uncommon. Molar teeth undergo enormous pressure. When fillings are placed, the teeth are weakened but if the filling and teeth are well adjusted many years of service can still be expected. Most people with old, moderate to large fillings have cracks in their teeth. Often these cracks are not sensitive.
However, an episode like yours or a period of grinding can cause the crack to propagate. When that happens, the tooth experiences a sharp pain. Ninety percent of the time crowning the tooth is all that’s needed. In the other ten percent, root canaling is required. In less than a half percent the crack goes all the way through the tooth and can’t be repaired or fixed – it must come out.
This is disturbing for you but also for your dentist. He want’s everything he does to work every time. This has happened to me about five or six times in my career. When it happens, I tell my patient, “I hear you.” “When I take this tooth out I’ll put bone in the socket and six months later, an implant.” I’ll credit your payments thus far to that procedure. Talk to your dentist, he wants the best outcome for you and has the expertise to conduct a safe root canal procedure. I’m sure you can strike a compromise satisfactory to the both of you.