A Vicious Cycle
Q: Dr. Crapo: In the past eighteen months, I've had three of my back teeth go bad. I was told they needed crowns because the big fillings were breaking down.
A filling fell out of a top molar and a corner broke off two of my lower molars, one after the other. I got crowns on all three teeth but after that they all seemed to hurt more than they had before.
The top one hurt the most. I was taking pain pills and couldn't even touch it with my tongue. I was told I needed a root canal so I had one, and that made it a bit better, but then my lower teeth needed root canals so I had them done.
The bottom ones settled down but the top one that had the root canal got bad and I had to have it out. Three weeks ago I had a gum boil come up around the lower teeth that had root canals and after an x- ray I was told they needed to be re-root canaled.
I'm sick of this. I don't want to lose more teeth but I can't have this infection in me either. How can I know if redoing the root canal will succeed? What started the problem in the first place? What made them hurt and then get infected after they were crowned? Is it my body or was it the dentist? I'm afraid to go back. How would you handle the problem? Do I just need to get implants?
A: Your experience isn't completely unique and there are many variables that are explainable. When I hear of lost fillings, I think firstly of a powerful bite, then inadequate filling technique, and then both. When I hear of “corners of teeth” breaking off, I think firstly of a powerful and unbalanced bite, coupled with grinding or clenching, or both.
When crowns are put on teeth that have experienced what your teeth experienced, it is meant to hold the teeth together and prevent future breakage. Decay, a bad bite, grinding/clenching habits, fillings, crowns – all these put stress on teeth and their nervous systems.
Too much stress leads to nerve death, leading to abscesses and pain. Because each tooth has an inner and outer nervous system, it is not always easy to know which one or if both are infected.
In your case it will be necessary to identify all causative factors, bad bite, infected gums, grinding habits etc., and correct them. I wouldn't go much further in the short run until I knew what was causing these problems. Once that is done, treatment can be made with confidence in the outcome.
Implants may be the answer but not if you've got a badly unbalanced bite and unchecked grinding. Implants can to fail if powerful grinding forces put too much stress on them.
Based on actual patient cases
Calvin Ross Crapo