Archive for July, 2010

My tooth doesn’t hurt – why did it need a pulpotomy?

Wednesday, July 28th, 2010

Several months ago I had an abcess at one of my premolars. After taking antibiotics it went away. I was pregnant at the time and did not want any work done. It never hurt. A few weeks ago, the abcess came back, so I finally went to see a dentist (within two weeks from the recurence). The tooth did not hurt this time either. The dentist performed a “pulpotomy” (I am not sure I nedeed that procedure).

I went home and the tooth start hurting. He could see me only two days later and at that time he “cleaned up” some more. This time he gave me some antibiotics – for 7 days. 7 days later still hurts. More antibiotics for another 7. I am now 5 days later and still have pain – I don’t know if the infecton cleared up yet. Tomorrow I am scheduled to get a root canal. Should I get it while my tooth still hurts? Did I needed the “pulpotomy” in the first place? Thank you.
- Emily from Texas

Emily,
With dental work, it’s especially important to be able to trust your dentist. The reason is that often you cannot tell when anything is wrong, and then problems that are put off are always more expensive to fix later, and can result in irreversible damage to your teeth. So far, from what you’ve told me, your dentist is treating you right. So hopefully you feel you can trust him. If not, find a dentist you feel you can trust.

Let me explain what is happening in your mouth. If a tooth is abscessed, antibiotics alone will not clear up the problem, they only help put off the symptoms. You see, infections are caused by dead or infected tissue inside the tooth. Antibiotics don’t get to the inside of your tooth when it is filled with dead tissue, because there is no blood circulation there. The abscess is caused by the tooth spewing bacteria out the end of the root. So the antibiotics will fight those bacteria but can’t ever eliminate the source because it’s protected inside the tooth.

And to answer your questions, yes, you did need the pulpotomy and yes you need the root canal treatment. Your tooth may continue to hurt until you get this done. The root canal treatment is to solve the pain, the abscess, by getting rid of the source of the infection. The tooth is carefully and thoroughly cleaned out and then is sealed.

I would have actually strongly recommended that you have the root canal treatment when you first discovered the abscess. While you want to avoid dental work during the first and third trimesters of a pregnancy, it’s worse for the baby if you have an infection in your body when you are pregnant. Now, after having waited this long, you are more likely to have complications from the deeply entrenched infection as your dentist tries to remove its source by doing a root canal. That’s probably why the infection seems now to be so resistant to the antibiotics. But get it done – the sooner, the better.

Follow-up: Read Emily’s response a week later.

Repairing my gold onlay: amalgam or composite?

Friday, July 9th, 2010

Hello. I have a gold onlay on a molar. I have had it for 28 years and the gold on the top surface of the tooth is worn out. My dentist says he can cut the top off and fill in with amalgam, keeping the gold around the sides of the tooth. I was wondering if composite filling could be used for this to improve the look. I also don’t like amalgam.
Thank you
- Penny from New York

Penny,
Part of your question is simple, and part is a little complicated.

A gold onlay is like a crown that covers the entire tooth, except that it covers just the chewing surface and goes down the sides partway. They can last a long time if they’re done well, and it looks like yours was done well.

Yes, I would much prefer in my own tooth or in a patient’s tooth, to have the hole repaired with white composite rather than amalgam.

Another issue with plugging the hole with amalgam is that you would then have two dissimilar metals in the same tooth. This creates a slight electric current, which would accelerate the corrosion of the amalgam. Plus, a little of the mercury gets absorbed in the surface of the gold.

The complication is that, if your dentist prefers using amalgam here, he is not one I would ask to do the composite repair. Dentists who know how to do the composite repair well almost universally prefer that technique. It is very risky to try to nudge a dentist out of his or her comfort zone. They will not want to reveal their discomfort with a procedure, and it’s a recipe for disaster. These composite fillings are very technique sensitive, and many dentists don’t know how to do them well.

Bottom line – if you want to have your dentist do this, let him do it the way he wants. If you have a problem with that, seek out a dentist who does composites on back teeth routinely. A good way to find such a dentist is to call the office and ask if the dentist does very many silver fillings (as if that is what you wanted). If they tell you the dentist doesn’t do many silver fillings or doesn’t recommend silver fillings, then you can be fairly sure he or she is very comfortable doing composites on back teeth.

Link: See our page explaining that Dr. Kagan is a mercury-free Boca Raton dentist.