Get a Crown

One of my teeth has been the bane of my existence for some time. A few years ago an incisor on my upper right side abscessed. It was an exceedingly painful infection for which I got a Tylenol 3 prescription and a root canal referral from my then dentist. Left untreated, abscesses can be very dangerous. This story is in part cautionary tale.

Root Canal Fail

While the root canal brought the desired relief the tooth was never quite right, and not knowing what I didn’t know, I wasn’t armed with the questions I should have asked my dentist at the time. While the nerves were gone and the tooth was essentially a dead placeholder, it always felt a bit weak and remained prone to minor infection symptoms. An odd thing I thought, since it had no pain receptors any more.

Needing a dentist when we moved to Victoria anyway, I arranged my first visit when I had another bout of pain in April. I went over my history with the tooth, and initial 3D scans and x-rays revealed there was probably some persistent infection around the dead root. My ongoing problems, he suggested, were likely the result of my previous dentist not crowning the tooth after its root canal. This is apparently standard practice for strengthening the weakened tooth and preserving it for the long term.

A porcelain or ceramic cap ‘crowns’ the weakened tooth to strengthen and preserve it.

I was referred to an orthodontic specialist and had my appointment in early May. Upon gutting the tooth of its previous filling material, he couldn’t complete the refill and sealing due to the discovery of a very large crack running the entire length of the tooth. A crack, no doubt, due in large part to my dentist not crowning the tooth. A temporary patch good for up to a few months was all he could do, with a recommendation to do an extraction and implant.

Extraction

I was then booked in last Thursday for an implant consult, but very nearly went in early to have the tooth yanked due to more pain associated with the same tooth. After another bloody flossing, it calmed down as quickly as it had flared up so I simply kept my consult appointment. After quickly going over the procedure I was booked in for the extraction this past Monday. The implant actually happens several months after the extraction so the bone can fully heal and provide a solid place to anchor the implant screw to which the new crown is attached.

The extraction itself seemed to go well and all appeared good until Wednesday. As the day progressed I experienced more swelling with some extreme pain and sensitivity around the extraction site and other symptoms consistent with, yet another, infection. I followed all the post-extraction recommendations and still ran into my umpteenth infection associated with this one tooth (or its ghost as is now the case).

Another Infection?

Wednesday night was largely sleepless, as I tossed and turned for about three hours, got up for some ibuprofen, ice and TV-watching for another while and returned to bed for two additional hours awake. After leaving a somewhat pathetic-sounding middle-of-the-night voicemail, my dentist came in on his day off and saw me first thing in the morning. He found the sutures and bone graft filling to be holding well, and didn’t want to disturb it by flushing things out. I was prescribed Amoxicillin and high doses of acetaminophen and ibuprofen and sent on my way with his personal number, in case the infection doesn’t abate in due course.

As of this writing Thursday night, after less than a full day on the antibiotics, it feels like there is already some reduction in symptoms. Given my history with this thing, I cannot state strongly enough how over all this I am. Aside from two wisdom tooth extractions several years ago and a handful of pretty typical childhood fillings, I’ve had very few dental problems in my life. I’d like to get back to that place.

Sunday update: Things have substantially improved and it really feels like this thing is under control. The infection appears to be completely gone, despite having another four plus days of antibiotics. Even the pain associated with the incision sutures and gums really seems to have calmed down. Extractions are supposed to fully heal in one to two weeks in most cases. I’d say I’m 90+% there now.

The moral of this story, if there is one, is to get a crown after a root canal.

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