What should be done if my tooth is sensitive after a new crown has been cemented?
Fortunately, not a high percentage of my patients ask me this, but It does happen, probably less than 5% of the time When they have this complaint I have them come in and I check their bite, both in normal closure position (centric occlusion) and in excursions ( moving their jaw side to side in a tooth touching position). If I see marks from articulating paper I adjust the crowns occlusal surface with a fine diamond. If this makes the crowned tooth feel better that's often the solution.
Unfortunately, the bite isn't always the problem. Other possible causes, are: A pulpitis, a necrotic pulp, a leaky crown, or a crown that does cover all the prepared surfaces of the tooth.
A pulpitiis is a term that means inflammation of the pulp and usually involves a hyperemia of the capillaries inside a tooth. Sometimes its reversible and sometimes not. It can slowly resolve itself but when it doesn't a patient and their dentist may opt to perform a root canal on the tooth involved. I should add that a high percentage of teeth that get crowned have had a pre-existing history of having sensitivity which could have been caused by a crack or extensive decay. These teeth may eventually require a root canal treatment whether they are crowned or not. That being the case most patients in my practice seem to prefer a wait an see approach. I try and remove all decay and place some sort of intermediate restoration to see if I can make their tooth comfortable. This may be a interim filling or a temporary crown. If the tooth becomes more comfortable I then place a more permanent restoration; either a filling , inlay or crown.
Some crowned teeth have a sensitivity associated with cementation. This is especially obvious when a patient was comfortable prior to cementation when wearing their temporary crown and only after their permanent crown was cemented did they develop sensitivity to cold or hot. This sort of cementation can pose a dilemma for the dentist. What should be done? Although some dentists recommend endodontics immediately, that's not usually my first preferred option. I cement my Porcelain fused to metal crowns with either Durelon or Glass ionomer cements. Durelon tends not to cause "cement sensitivity" since it is not acidic. Glass ionomer cements can sometimes cause this (they can dry out the tooth if they have acetone in their formulation). In general teeth do not like being over desiccated or don't do well if exposed to acidic environments for long periods of time.
Some Zinc Phosphate cements , especially when mixed improperly, are said to be responsible for causing an acid shock to teeth when used for crown cemenation. One way to avoid this symptom is to mix this cement slowly with sufficient powder to slowly incorporate the acidic liquid. Also if I am concerned about this, I place Glumma over the tooth prior to cementation. This is said to seal the tubules so they aren't as affected by the cement used.
What about bonded all ceramic crowns that are sensitive? This is another matter entirely. Each case has to be evaluated individually. Sometimes the sensitivity can be from the bite, sometimes from poor bonding to the under lying tooth. If the bond to the tooth fails it can definitely cause sensitivity. If one of my patients with a bonded comes in with symptoms after a recent cementation, I first check and adjust the bite if needed and then often suggesting waiting a month or two to see if symptoms subside.
What about crowns that were initially fine but later become sensitive. This is ominous. If the crown is a pfm cemented with a normal dental cement, I usually eventually opt for an endodontic solution. If my patient has a all ceramic bonded crown I sometimes remove it and place a temporary to see if the symptom goes away. When I do, often the symptoms improve ( around 50% of the time I believe). If this is the case, the sensitivity was caused by a debonding of the cement against the tooth which can occur if tooth experiences repeated strong biting pressures. Essentially the crown is "loose" but it hasn't come off due the good fit of the crown.
I should add that each dentist has there own way of handling sensitive crowns and this post documents how I deal with this issue in my practice. As far as I know there is no standard way that dentists are taught to deal with sensitive crowns but instead each uses their best judgement on how to proceed. I welcome feed back from other dentists on this topic.
from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2018/01/what-should-be-done-if-my-tooth-is.html - http://lspindelnycdds.blogspot.com/
Unfortunately, the bite isn't always the problem. Other possible causes, are: A pulpitis, a necrotic pulp, a leaky crown, or a crown that does cover all the prepared surfaces of the tooth.
A pulpitiis is a term that means inflammation of the pulp and usually involves a hyperemia of the capillaries inside a tooth. Sometimes its reversible and sometimes not. It can slowly resolve itself but when it doesn't a patient and their dentist may opt to perform a root canal on the tooth involved. I should add that a high percentage of teeth that get crowned have had a pre-existing history of having sensitivity which could have been caused by a crack or extensive decay. These teeth may eventually require a root canal treatment whether they are crowned or not. That being the case most patients in my practice seem to prefer a wait an see approach. I try and remove all decay and place some sort of intermediate restoration to see if I can make their tooth comfortable. This may be a interim filling or a temporary crown. If the tooth becomes more comfortable I then place a more permanent restoration; either a filling , inlay or crown.
Some crowned teeth have a sensitivity associated with cementation. This is especially obvious when a patient was comfortable prior to cementation when wearing their temporary crown and only after their permanent crown was cemented did they develop sensitivity to cold or hot. This sort of cementation can pose a dilemma for the dentist. What should be done? Although some dentists recommend endodontics immediately, that's not usually my first preferred option. I cement my Porcelain fused to metal crowns with either Durelon or Glass ionomer cements. Durelon tends not to cause "cement sensitivity" since it is not acidic. Glass ionomer cements can sometimes cause this (they can dry out the tooth if they have acetone in their formulation). In general teeth do not like being over desiccated or don't do well if exposed to acidic environments for long periods of time.
Some Zinc Phosphate cements , especially when mixed improperly, are said to be responsible for causing an acid shock to teeth when used for crown cemenation. One way to avoid this symptom is to mix this cement slowly with sufficient powder to slowly incorporate the acidic liquid. Also if I am concerned about this, I place Glumma over the tooth prior to cementation. This is said to seal the tubules so they aren't as affected by the cement used.
What about bonded all ceramic crowns that are sensitive? This is another matter entirely. Each case has to be evaluated individually. Sometimes the sensitivity can be from the bite, sometimes from poor bonding to the under lying tooth. If the bond to the tooth fails it can definitely cause sensitivity. If one of my patients with a bonded comes in with symptoms after a recent cementation, I first check and adjust the bite if needed and then often suggesting waiting a month or two to see if symptoms subside.
What about crowns that were initially fine but later become sensitive. This is ominous. If the crown is a pfm cemented with a normal dental cement, I usually eventually opt for an endodontic solution. If my patient has a all ceramic bonded crown I sometimes remove it and place a temporary to see if the symptom goes away. When I do, often the symptoms improve ( around 50% of the time I believe). If this is the case, the sensitivity was caused by a debonding of the cement against the tooth which can occur if tooth experiences repeated strong biting pressures. Essentially the crown is "loose" but it hasn't come off due the good fit of the crown.
I should add that each dentist has there own way of handling sensitive crowns and this post documents how I deal with this issue in my practice. As far as I know there is no standard way that dentists are taught to deal with sensitive crowns but instead each uses their best judgement on how to proceed. I welcome feed back from other dentists on this topic.
from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2018/01/what-should-be-done-if-my-tooth-is.html - http://lspindelnycdds.blogspot.com/
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