root canal or wait?

[munkispank]

Hey there,

well, my husband had his root canala today- very quick and the numbness hasn't turned into pain yet. The tooth was filled and a temp filling on top. When my husband asked about diving, the dentist told him he could dive tomorrow if he wanted. I'm not so sure about that, but now we are faced with what to do about the crown.

I want to take Dr Stein's advice and wait until after the trip to get the crown done. We would have to wait one week before getting the process started, which would be the 28th- then it is usually 2 weeks before the permanent is ready- which is when we will be in Bonaire. Is is going to be OK to wait for the crown?

The hygenist said we should get it done " as soon as possible" but was that just the standard thing to say?

BTW, my husband had a slight infection at the base and has been given antibiotics for a week, and the tooth has no other filling in it- just the small temp from the root canal opening. I am assuming the reason they want to crown it is for strength.

Any advice?

 

[GreatInca]

My body is thick and dense boned. Maybe its the jawbone thing? My expeince is full tounge numb, little or no lip, and partial teeth. I rember my lip hurting alot when the oral surgeon was using it to leverage his scalpel.

 

[Laurence Stein DDS]

munkispank,

What? You want me to get started again?? Wasn't 2 1/2 feet of text about numbness enough?

Seriously, I appreciate you wanting my advice but I've never met or examined the patient. I can offer information, but your dentist should offer the advice--I mean this in a nice way.

Under most circumstances, and if there is no pain, diving should be possible immediately. If the temporary filling is in direct contact with the floor of the nerve chamber and root canal filling material, I would choose to wait to do the crown upon my return. There is a better chance of a temporary cap coming loose and possibly aspirated (inhaled into the lungs) than there is if the temporary comes out.

You can go to the drug store before your trip and ask for something like Dentemp. It is a temporary cement/filling material. You mix it thin, like sour cream, to recement a crown or thick, like playdough, and squash it into the opening if the temporary comes out (so you need a little tool like a nail file, tongue depressor, tiny screw driver to plaster it into the tooth. It probably comes with a mixing tool that works as a spatula.

Yes, the crown will be for strength. Following the root canal or even a dead nerve, the tooth structure is weakened and is more brittle. The crown, usually with a core or a post and core is placed into and around the tooth.

The hygienist is "right" because we cannot predict if you will accidently break the tooth. It is generally agreed that the single most common reason for root canal failure is the failure to get a good and proper final restoration.

The temporary will eventually wear away or wash out and the underlying root canal material is exposed to the mouth. The saliva and germs migrate down the root between the tooth structure and the filling material. This will intoduce new bacteria into the root tip and set off another infection. BTW, I gave you names of a couple of dentists in Bonaire, just in case.

Waiting too long can also allow for the accidental breakage of the tooth and that may then become unrestorable.

Personally, I actually like to wait a couple of weeks to see if the tooth is going to flare up. I feel really bad when a patient returns one day after final cementation of a crown because the root canal has become a problem again. It happens to all dentists and is not necessarily an indicator of poor technique.

So now I've given you information. You run it past your dentist and take HIS advice. Certainly, if the opinions differ greatly, then there may be a problem. You still shouldn't accept my information as gospel. Seek a second opinion. If you used a specialist for the root canal, ask the specialist. There are too many qualifier statements here and I am not familiar with all the treatment your husband has had.

Hope you have a great vacation. Most likely nothing will happen...well, maybe my fingers will heal!

Laurence Stein, DDS
:doctor: Disclaimer
(No representations are made that in any way offer a diagnosis, treatment or cure for any illness or condition, either discussed or implied. Answers to questions are offered as information only and should always be used in conjunction with advice from your personal diving physician/dentist. I take no responsibility for any conceivable consequence, which might be related to any visit to this site.)

 

[GreatInca]

Would me feeling the injection in three different locations in the same rear portion of the lower right quarter of the mouth while under the nitrous oxide provide any hint of nerve structure variation or is it just the nitrogen narcosis causing my brain not to be able to dicern pain sources corectly? I normally dont get multi-point (felt 3 pricks in the rear 2 malars when the needle went in) when not on the nitrous. Oh yeah that nitrous high is really cool

 

[Laurence Stein DDS]

Don't know...you could have had 3 injections. Two are usually needed for lower extractions on any one side and a third may have been used to supplement the other injections.

There is no telling what you really experienced under nitrous oxide so I won't speculate.

Laurence Stein DDS

 

[munkispank]

Thnakyou for your advice- I am sorry to have asked you to write again.
As the root canal dentist was not our regular-he was extremely brief and unwilling to talk. Our regular dentist said the referral would give us the info-this is why I was stuck.

I guess in order to make our own decision I will have to go to medical school.

happy drilling

 

[Laurence Stein DDS]

First, call me Larry,

I've given you some information...just run it by your dentist...he knows the case. I can see no reason to risk aspiration of a temporary crown if the temporary filling is durable for at least two weeks.

If there is any question about the temporary, simply have your dentist, who is going to cap the tooth, place the core or post and core into the tooth. This will be durable and would be the first part of capping the tooth. It won't come out.

I just don't want you to use information from a stranger (ME) as an opinion of how to properly treat any given patient. This runs afoul of both ethics and medical/legal issues.

The only people who seem to have no problem doing this are the dental insurance companies. In their review of a claim, should they change a code or allow for a lesser procedure, somebody, who probably is not licensed in your state has had to form an opinion about the necessity of a procedure without ever examining the patient. Then to "help" matters, they send YOU a letter that makes you wonder if your dentist is telling you the correct treatment and often infers that the fee he is submitting is too high. This ruins the doctor/patient relationship...eventhough nobody likes an insurance company.

Remember, they are the ones with the corporate jet not your dentist!

With some of the new privacy laws that have recently come into effect, many insurance companies are still asking for TOO much information rather than the "minimum necessary" information.

If you don't have an insurance company, then you don't run into this problem. If you have a good relationship with your dentist then take his advice and opinion.

Besides, I'm jealous of your trip Bonaire is a beautiful place to dive. You see...I'm biased!

Regards,


Larry Stein
:doctor: