Pain after crowns

[Why Me]

32 minutes ago, impulse said:

Who has 48 teeth?

Dentists numbering.

[DavisH]

1 hour ago, clivebaxter said:

How much was the impant?

About 65000 baht. I've had a lower molar done, and now an upper tooth that was lost ages ago. No bone graft needed (which adds to the cost). My molar implant is a removable one. One the second visit, the dentist removed and readjusted the placement. Seems to work fine. I'm more nervous about root canals than getting the implant done, which is a relatively painless procedure. The gum was sore for a night after the anaesthetic wore off. 

[DavisH]

2 hours ago, lopburi3 said:

The most expensive crown, high grade gold, is not more than about 25k in my experience.

https://www.bangkoknewsmile.com/fee-table.php

That's only the crown price 

 

56 minutes ago, Sheryl said:

A couple of possibilities come to mind:

 

1 - crack in the tooth itself, perhpas below the gum line and hard to see on Xray

 

2 -  pain from another tooth nearby (it can be hard to localize source of tooth pain)

 

3- failed root canal

 

In any case clearly you need a second opinion.  There is an older man at the Dental Hospital that I liked but unfortunately I don't have his name. http://www.dentalhospitalbangkok.com/about_us.php

add - bone less from a decayed tooth (under a crown, or otherwise) will give sensitivity on biting. But that should be visible on an xray. I had that. The tooth was a write-off and had to come out. 

[DavisH]

2 hours ago, kynikoi said:

All the research I did here in Bangkok to have a post and crown put in appears to be quite a bit more expensive than what I would pay in the United States.

 

My elderly mother was quoted us $1,7 00 for titanium post and crown the whole shot. This sort of work done in Thailand is now a scam for foreigners.

 

Prices range from 55,000 to 110,000 b does not include all of the scare tactics which drive the price up as well.

Posts, root canal, and crown should not cost more than about 30K in total. 

[Why Me]

2 hours ago, chalawaan said:

But Tylenol is way worse IMO as a short term moderate to severe pain management regime.

Yep, I am not happy about this situation at all. But the damned pain needs controlling. Well, hopefully I'll have the tooth sorted before liver cirrhosis sets in.

[Duke007]

As a retired dentist living in Thailand, I have seen and experienced a wide variety of expertise in multiple clinics. Maybe I can clear up a few questions.

1. There are obviously not 48 teeth- each quadrant has right teeth and they are counted from central incisor(1) to 3rd molar(8). So 48 is the lower right third molar.

2. Taking ibuprofen for dental pain is very common and occasionally even stronger pain med (opioid) is required.

3. A root canal can be performed through an existing crown depending upon the individual circumstances.

4. A root canal is not always indicated prior to placement of a crown.

5. As noted, continuing pain can be the result of a pulp irritation if the tooth is vital,  an incomplete or failing root canal, referred pain from another tooth, high occlusion, incomplete root fracture, periodontal abscess or even a sinus infection.

6. A post and core may be recommended after a root canal treatment depending upon the amount of remaining tooth structure.

 

I tried about 4 doctors before finding one who seemed competent, used adequate(if not proper) infection control, and spoke English well enough.

 

 

 

 

[Why Me]

1 hour ago, Sheryl said:

n any case clearly you need a second opinion.  There is an older man at the Dental Hospital that I liked but unfortunately I don't have his name. http://www.dentalhospitalbangkok.com/about_us.php

Thanks, Sheryl. A second opinion is what I have lined up for tomorrow at another clinic.

 

Problem is I like my current prosthodontist. Nice guy and clearly doing his best to solve the matter. He sits down each time and explains his thinking and it's obvious wants to proceed with minimum "aggression", in other words, RCT, extraction, etc. only after eliminating other causes.

 

But it's my life. So if I get some alternate advice tomorrow I'll pass it on (diplomatically) to my doc on Sat. when I meet him again. If all else fails I'll have to let him go and find help elsewhere.

 

[WhiteBuffaloATM]

had RCT performed poorly in UK which needed the best guy in London to fix it......

Any sensation at all .... get RCT properly done.....by experienced specialist.......

otherwise assume it never goes away & usually gets worse

see no problem having crowns removed & put back  ( basic quick job) before or after RCT .......

having non- diagnosed RCT before other work on same teeth is clearly ridiculous.......

[Why Me]

12 minutes ago, Duke007 said:

As a retired dentist living in Thailand, I have seen and experienced a wide variety of expertise in multiple clinics. Maybe I can clear up a few questions.

1. There are obviously not 48 teeth- each quadrant has right teeth and they are counted from central incisor(1) to 3rd molar(8). So 48 is the lower right third molar.

2. Taking ibuprofen for dental pain is very common and occasionally even stronger pain med (opioid) is required.

3. A root canal can be performed through an existing crown depending upon the individual circumstances.

4. A root canal is not always indicated prior to placement of a crown.

5. As noted, continuing pain can be the result of a pulp irritation if the tooth is vital,  an incomplete or failing root canal, referred pain from another tooth, high occlusion, incomplete root fracture, periodontal abscess or even a sinus infection.

6. A post and core may be recommended after a root canal treatment depending upon the amount of remaining tooth structure.

 

I tried about 4 doctors before finding one who seemed competent, used adequate(if not proper) infection control, and spoke English well enough.

 

 

 

 

Thanks a lot, doc!

Got questions for you if you don't mind.

 

First, probably not a failed root canal on 46 as this was done after the initial crowns which was when the pain started. It just didn't alleviate the pain. 

 

However, the reason for deciding RCT for 46 was that tapping indicated pain there. Now, there's no pain tapping 46, but tapping 47 and to some extent 45. Incidentally, 48 has already been extracted.

Btw, the pain I feel at home has been pretty much the same for a month, no matter what the tapping points to.

 

So, what do you think of the following plan? Remove the crowns on both 45 and 47 and let the teeth "breathe" a bit (not sure this makes sense but crowns surely create pressure/impact inside), then RCT if need be (from Xrays).

 

What would you do?

[WhiteBuffaloATM]

 

somewhat regetting my correct but crude impirical layman post after reading Duke007 definitive expert complete subject response post......

[Why Me]

1 hour ago, Sheryl said:

In any case clearly you need a second opinion.  There is an older man at the Dental Hospital that I liked but unfortunately I don't have his name. http://www.dentalhospitalbangkok.com/about_us.php

The website doesn't have a list of docs. If you ever recollect the name please post.

[kynikoi]

2 hours ago, DavisH said:

Posts, root canal, and crown should not cost more than about 30K in total. 

They start around 65k in Bangkok.

[Why Me]

1 hour ago, kynikoi said:

They start around 65k in Bangkok.

My recent experience:

Zirconium crown 18k

RCT approx. 10k, depends on tooth

Post/core build up 6k

[stewart479]

Hi. In my experience; difficult dental problems can be identified by a 360 degree xray; providing that there is someone to read it thoroughly. Cheers

[Tracyb]

Has your prosthodontist checked the occlusion on that tooth?  When you bite down does that tooth meet the opposing tooth first before any others in your mouth touch each other?  Ask a dentist to check for occlusion issues first.  If the occlusion is ok, strongly consider a root canal.  There is no need to remove the crown before performing the root canal.

 

please do consider the root canal before you have the tooth extracted.  Bone loss really is an issue with extractions.  I also had a full mouth restoration with implants, crowns and bridges.  It’s a bitch and everything has to go well.  I’ve had pain after mounting permanent crowns but it subsided after a week or so.  I’ve also had pain that did not subside that surfaced a year or two later and got it resolved by root canal without crown removal.  
 

there’s also an outside, minimal possibility that nerve damage occurred in your jaw.  Although this is only a slight possibility, you should explore the possibility if you can’t get the pain under control.   
 

If you’re in Bangkok, consider going to the Bangkok Hospital Dental Clinic.  Excellent doctors there….from my experience.

 

Also, switch to Ibuprofen for the pain.  It will also address inflammation.  Just be watchful of the dosage.  You can also mix ibuprofen and Tylenol without major issues.  Again, be mindful of the length of time you take it.

 

best of luck!

Edited June 22, 2021 by Tracyb

[holymoly]

What worked well for me is salt water swooching in the effected area, Massage the

the flesh at the same time. Swooshing and massaging  every 1-2 hours for about three days

Sounds simple I know, but it worked. My best to you.........

[millymoopoo]

18 hours ago, Why Me said:

Anyone had a similar issue?

Once, with a dentist (I obviously never go back to) put a crown on a tooth that was abscessed....!

Crown had to be removed (by a better dentist) root canal treatment and a new crown fitted.

Not a fun time.

Hope your issue is not that but might be worth exploring if the issue is not resolved soon.!

[natway09]

I have had 5 crowns done here, but all with root canal (seesaw) treatment first

Any crack should have shown up on X ray.

Highlighting exactly where the pain is actually coming from can be difficult

but your lady has obviously banged your teeth for that.

I do not know where you are but the Dental School on Sukhumvit (46 I think)

have some really good people

Good Luck

It is becoming more evident that good oral hygiene plays a significant role in your overall wellbeing

[thvima]

I guess that you went to Bkk Pat hospital ?

 

[Paul DS]

20 hours ago, Why Me said:

Glad to hear of your improvement. Yes every visit, once a week past month, he's been grinding and doing this and that to me as well. Did some electric surgery on the gum too. But the damned pain is not improving which pi**es me off. It can't be anything crazy serious but just not being diagnosed accurately. 

I would suggest a sensitize teeth / gum toothpaste plus a good flouride mouthwash, it is possible your teeth /gum are too sensitive at the moment. 

 

Clean your teeth after every time eating. with a soft brush.

[sead]

21 hours ago, Why Me said:

Interesting you say that because the original treatment plan had 45 and 46 slated for root canal but then when he took a closer look the prosthodontist decided against it.

 

So when they ended up taking off the 46 crown and doing an RCT anyway I asked the endodontist wouldn't it have been better to have done it first like the original plan. She said an aggressive treatment like RCT is advised only when it is absolutely necessary. It would be "immoral" (her words) to do it otherwise. She said sometimes can happen that it's needed later and we have to deal with it.

I guess thats what happens when they give a price for all work. They will try to save time and money.

[SunsetT]

On 6/21/2021 at 11:13 AM, Why Me said:

Yep, got a big lecture about extraction as the last resort, "too aggressive", bone loss, blah blah. But, hey, how about severe tooth ache that won't go away freakin' 24 hrs day in day out? I am popping 4-5 Tylenols a day which brings its own set of problems.

Have you tried antibiotics just in case you have a bacterial infection somewhere and/or an absyss brewing. 500mg amoxycillin twice a day for 7 days or 3 times a day for 5 days. They can be bought over the pharmacy counter. It might help.

[Surelynot]

Just now, SunsetT said:

Have you tried antibiotics just in case you have a bacterial infection somewhere and/or an absyss brewing. 500mg amoxycillin twice a day for 7 days or 3 times a day for 5 days. They can be bought over the pharmacy counter. It might help.

Good point........some powerful antibiotics to at least eliminate that as a potential problem.

[SunsetT]

5 minutes ago, Surelynot said:

Good point........some powerful antibiotics to at least eliminate that as a potential problem.

Worth a try.

[DavisH]

7 hours ago, natway09 said:

I have had 5 crowns done here, but all with root canal (seesaw) treatment first

Any crack should have shown up on X ray.

Highlighting exactly where the pain is actually coming from can be difficult

but your lady has obviously banged your teeth for that.

I do not know where you are but the Dental School on Sukhumvit (46 I think)

have some really good people

Good Luck

It is becoming more evident that good oral hygiene plays a significant role in your overall wellbeing

Unfortunately, cracks don't always show up on x-rays. Having a post can also contribute to a tooth cracking later. 

[DavisH]

32 minutes ago, SunsetT said:

Have you tried antibiotics just in case you have a bacterial infection somewhere and/or an absyss brewing. 500mg amoxycillin twice a day for 7 days or 3 times a day for 5 days. They can be bought over the pharmacy counter. It might help.

Some antibiotics target the mouth area, so it would be worth for the OP to ask the dentist about it. I was given some after my implant surgery, but don't recall the name. 

[clivebaxter]

2 minutes ago, DavisH said:

Unfortunately, cracks don't always show up on x-rays. Having a post can also contribute to a tooth cracking later. 

Very true, had x rays done at my dentist, then back home, then at Mahidol- none of them could find a crack. Went back to my local dentist again and eventually he did spot it.

[Why Me]

52 minutes ago, SunsetT said:

Have you tried antibiotics just in case you have a bacterial infection somewhere and/or an absyss brewing. 500mg amoxycillin twice a day for 7 days or 3 times a day for 5 days. They can be bought over the pharmacy counter. It might help.

Thanks for the suggestion. Matter of fact did. Two rounds of antibiotics. Amoxiclav full course and then Augmentin about 2 weeks later. Did not help.

[Letseng]

On 6/21/2021 at 11:41 AM, clivebaxter said:

They can't always do root canal work, mine had closed up, happens sometimes in older people. I had similar last year when temp crown was on it never hurt but started to hurt a few days after the real one was fitted. Eventually it wore off but not until after I almost went in and asked him to take the tooth out. Took about a month to wear off. Oh I did have him grind it a bit lower as well.

Your bite might be too high or all is not aligned properly. Therefore, you constantly irritate it. Don't know where you are or who has done it. Try Asavanant Dental, Thonglor.

[clivebaxter]

21 minutes ago, Letseng said:

Your bite might be too high or all is not aligned properly. Therefore, you constantly irritate it. Don't know where you are or who has done it. Try Asavanant Dental, Thonglor.

 

I have been there as well as dental centre in Amarin Plaza, Mahidol also Nakorton and Bumrungrad hospitals as well as the Bkk dental hospital. I prefer my local one at Rama 2.