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Original poster

Dentists, gather here, i have to make a quick (before tomorrow 8.00) decision.

38 replies

minkymuskyslyoldstoaty · 09/12/2014 09:04

I have bruxism, and something upsetting happened last week which set off the anxiety.
Upper right tooth root filled many yrs ago, and was mostly a filling, well half of it fell out in May, so it's been covered with some type of filling. Yet it is half a tooth. Now it's been hurting since i started clenching my jaw.

Dentist took an xray yesterday and said no sign of infection and it looks the same as it did 6 months ago. Thinks it could be gum/muscle pain from the bruxism? She tapped all the teeth and nothing made me jump, but the half tooth was a bit painful.

I could have the tooth removed tomorrow, there is an emergency slot. I could leave it a week and go to my appt next tuesday and have it removed if no improvement.

My question is, i guess, can an xray show no infection but there is still something brewing. She wouldn't prescribe antibiotics. Fair enough.

I had another tooth out, it's equivalent on the other upper side in July and the recovery was slow.

If i took it out tomorrow at least i might have some sort of comfortable mouth at xmas.

thankyou dentists, and anyone with thoughts.

OP posts:
Original poster
minkymuskyslyoldstoaty · 09/12/2014 09:18

bump

OP posts:
StillinShockAhhhhhhh · 09/12/2014 12:44

Have you been given a treatment plan to deal with the bruxism?

Original poster
minkymuskyslyoldstoaty · 09/12/2014 15:22

hi i have a custom made lower jaw guard which i wore for about a month.
i had a big upset last week and suddenly woke knowing i had been clenching. so have worn the guard again the past three nights.

OP posts:
Original poster
minkymuskyslyoldstoaty · 09/12/2014 18:33

wimpers, any evening dentists around.

i don't even know if there is anything wrong with this tooth, can there be pain and no sign of abscess or infection?

OP posts:
StillinShockAhhhhhhh · 09/12/2014 19:12

The pain could be caused by the bruxism and may settle down, if I was you I would wait until your appointment next week and reevaluate, the ligaments around teeth can become 'bruised' which would not show up on an X-ray. as the tooth was heavily filled you could ask your dentist to adjust the filling to take it out of occlusion (bite) temporarily to see if this aids healing. You can always have the tooth extracted at a later date but can't have it put back x

Original poster
minkymuskyslyoldstoaty · 09/12/2014 19:50

i am national health and i don't think i get to choose many options.

i have a front tooth that was crowned years ago and the metal bit is showing more and more but she said she can't do it. she has both private and national health patients.

my tooth has been a half tooth for about six months. previously it had a tooth shaped post of cement over it.

the current filling on it slants diagonally with what is left and when i bite the tooth part doesn't touch my bottom teeth.
have read that am abcess can start and not be seen.
is this true.
dentist wouldn't give antibiotic.

OP posts:
Original poster
minkymuskyslyoldstoaty · 09/12/2014 19:52

not post, a tooth shaped piece of cement

OP posts:
StillinShockAhhhhhhh · 09/12/2014 20:01

Very early stages of infection sometimes don't show up on X-rays to begin with but will over time, what was the dentists reason to not fully repair the tooth? Is it loose atall or compromised in some other way?

Original poster
minkymuskyslyoldstoaty · 09/12/2014 20:09

it's not loose at all no. root filled many years ago.
i get the feeling if i were a paying customer i might have been given more options.

OP posts:
bonzo77 · 09/12/2014 20:09

Dentist here place marking on phone till I get my laptop.

Original poster
minkymuskyslyoldstoaty · 09/12/2014 20:09

are you a dentistSmile ?

OP posts:
Original poster
minkymuskyslyoldstoaty · 09/12/2014 20:10

oh Bonzo, crossed postsSmile

OP posts:
StillinShockAhhhhhhh · 09/12/2014 20:11

Is the broken tooth the one with the crown and metal showing?

Iheartautumn · 09/12/2014 20:13

I'd just get it out tomorrow and rinse well with salt water and don't do anything your not meant to

beautyfades · 09/12/2014 20:14

.

Mrsmorton · 09/12/2014 20:16

I'm a dentist too (and I??Bonzo).

I'm in two minds. How long have you been wearing the guard?

You say the broken tooth doesn't touch the other tooth when you bite? Are you absolutely sure? Not in any way shape or form no matter how you move your jaw?

Mrsmorton · 09/12/2014 20:18

Antibiotics are not the right treatment for this. Last month was antibiotic awareness month, patients expect antibiotics for every ache and pain in their mouth and they are very rarely the correct treatment.

on a mission to educate MN

Mrsmorton · 09/12/2014 20:20

You need to wear the grinding guard as much as possible. (Just read all your posts)

I have bad bruxism and my jaw joint is very badly affected, sometimes I get awful toothache nearly bad enough to find an emergency dentist. It can mask a lot of symptoms.

Original poster
minkymuskyslyoldstoaty · 09/12/2014 20:21

no sorry the crown tooth with metal showing is a front next to big tooth tooth.Smile

the half tooth is the one at the back. upper. my last molar so nearing the side of my smile.

it is root filled. then a few years ago part of the top came off. one lady put a lump of composite on it. i think she thought it might not hold a post and crown.
this lasted about three years.
this year that fell off. new dentist pasted over it. so now its a slanty tooth.

OP posts:
gamerchick · 09/12/2014 20:24

You don't need anti biotics you need to wear your guard at night.

Original poster
minkymuskyslyoldstoaty · 09/12/2014 20:29

hello MrsmortonSmile

i would say that the slant tooth does touch bottom teeth if i move my jaw diagonally and with alot of pressure.
i hadn't had any bruxism for about four months till last week. it came back very quickly after my world was rocked last week. literally over night.
i totally agree with antibiotic misuse. clutching at straws after googling.

OP posts:
Original poster
minkymuskyslyoldstoaty · 09/12/2014 20:33

gamer yes i am now wearing it since this started up.

my dentist it quite happy to just remove this tooth tomorrow. though as an afterthought said ok give it a week and if no better i can give you an appointment next Wednesday. this is i guess wanting me out of pain before xmas.

OP posts:
bonzo77 · 09/12/2014 20:35

I'm Back...

My question is, i guess, can an xray show no infection but there is still something brewing.

Absolutely. Xrays show changes in bone / tooth that take time to develop. It is totally possible (in fact very likely) to have pain and nothing showing on the xray.

Now, I don't give diagnoses without seeing a person in, well, person. But I'm pretty good at making a guess at what is going on based on what you are telling me. Here goes...

  1. A root filling is as good as the seal on top. The best seal on a back tooth is provided by a crown, except for in a tiny number of situations. This is because root filled teeth are brittle, and prone to fracture. Once part of the original tooth or filling breaks, saliva and therefore bacteria can get in, and thus the root canal gets infected, which can cause pain and / or changes on the xray. A molar tooth with a root canal and no crown is vulnerable. More so in a bruxer as they work their teeth so hard.
  1. If you are really lucky you just crack the top of the tooth, you get it attended to quickly (crowned) and all is well. If you are unlucky (and especially if the filling is a big one), the crack extends onto the root surface beneath the gum line. Then most of the time the tooth needs to come out. Because it will be impossible to ever seal the tooth properly against bacteria. Sometimes the crack will be so deep that it splits the roots apart. These are catastrophic, and painful at the time. But usually make for easy extractions in my experience.

IME, once you know exactly what to look for, it's usually pretty easy to diagnose and find a crack. However, using xrays is rarely useful as they don't often show up.

  1. As a PP said, the pain could be caused by the bruxing. However, it is highly likely that even if it is, the tooth will have sustained a crack, and if you are to keep the tooth long term .... well see below.

Some cracked root filled teeth are salvagable. Yes, even on the NHS. My selection criteria are:

  1. does the patient want to go through all the proceedures and time involved. on the NHS I will be pretty much doing it at my own expense. I need comittment! Any missed or cancelled-at-short-notice appointments and I will not be offering any more.
  2. is there enough tooth left to crown? If not it's a straight out no.
  3. Is there a crack below the gum line? If so, it's a straight out no.
  4. If i need to re-do the root canal, will I be able to do it the same or better standard than what is currently there? If no, you guessed it, it's a no.

If the dentist is feels the tooth is not salvagable (do ask), or you do just want it out, then I would say get it done sooner rather than later to reduce the chances of wrecking christmas.

MargaretRiver · 09/12/2014 20:38

It is possible that it's an early infection not yet visible on XR but with the timing it seems much more likely to be related to the bruxism

Wear your guard every night for a week and reassess

And ask your dentist what your options are for having the tooth properly restored

Mrsmorton · 09/12/2014 20:39

If it's the last tooth then you don't need it to chew on, really you won't miss it.

Tough call op, it may be that the bruxism has led to the tooth fracturing which has now led to this. So, wear the guard! Tooth out or not... Impossible to say without the benefit of seeing you. Do you trust your dentist?