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In This Article
About This Series
April 2013 Decision day. I went in to have the filling removed to see what was left of the tooth. Even this...See more standard procedure is one that separates excellent dentists from just okay dentists. Unfortunately, this dentist is "just okay." After the decision was made, I learned that there were several things she might have been able to do to better stabilize this tooth. But none of these things were on the table. Take another look at the X-ray. [And, by the way, take a look at the bitewing to note the occlusion.] Note that there is a good amount of natural tooth surrounding the filling. From her perspective, replacing the filling didn't seem like an option. There was some decay underneath; my fault for letting things slide so long. Should she have more adeptly and promptly been able to assess the source of my pain? Should she have been able to see this decay before removing the filling? Should she have been more assertive with me when I deferred taking action by letting me know what I might be in for if I didn't address the problem right away? Did she know? After she removed the filling and the decay, I asked: "Is there enough tooth structure for an adequate prep?" THE moment of truth: "Oh yes, plenty," she said. I had to trust her assessment. I told you at the outset that I made a poor decision; trusting her assessment was it. I could have, and certainly SHOULD have, asked her to a) take a photo of the prep so I could show it to Rob and b) asked her to give me a few days before moving forward with treatment so I could get a second opinion. Besides which, Rob pointed out to me after the fact, it would have been wise to wait so the traumatized tooth could settle down. I didn't realize the ramifications I faced as a result of this one simple poor decision to trust. Instead, I compounded my error by choosing to be a guinea pig in the name of original—and personal—research for LMT. As I said, I was greatly curious to know, first-hand, how a CEREC crown would compare in the hands of what I considered to be "your friendly neighborhood dentist." Again, and this is so critical, I did not think about questioning her prep work. My jaw was numb from the drilling so I couldn't tell what the surface of the remaining tooth felt like. I watched her work the CEREC software. "Hmm," I said, "that looks kind of bulky on the lingual side; can you make it thinner? Otherwise, I'll be running my tongue against it all the time." I watched her slice off some of the bulk on the monitor. "Also, that anatomy looks very round; my teeth are pretty angular. Shouldn't it match the anatomy of my other teeth?" "It's an anatomically correct tooth," she replied, and left it round. After she did all this, she said it is possible there was more decay or damage to my tooth and it might very well need a root canal treatment in the near future. That appeased me regarding the round and quite unappealing tooth she designed. The reason for that appeasement is that I truly believed I'd have to have the crown removed for the endodontic procedure and then have the crown replaced anyway. So I accepted the blob that looked like someone else's temp and left, glad that I would now be able to chew on both sides of my mouth. And that was true. Until the night of June 6. (However, this is not the night the crown fell on the very, very old linoleum floor.) That's in the next installment. Tune in August 16th.
The Night of June 6 A bunch of us were sitting around the fire pit on my patio, protected from the rain by a...See more covered pergola. It was a Thursday night. We—LMT staff members, Andy and I—were enjoying our visitors from the Chicago LAB DAY setup team. Without warning, my laughter was replaced with a yelp; what started as a low-grade ache suddenly turned into a searing pain in my mouth. I knew in that instant that #14 was saying it's time for that root canal procedure. But we still had another day of scheduled activities with our visitors, so ibuprofen and I coexisted until Monday morning when I made a beeline to the endodontist, a friend I trust implicitly. He attached the rubber dam and tackled part one of the pulpectomy. I was really surprised he drilled right through the crown. He was really surprised the crown itself wasn't fully polished and was such a "lump." "What were you thinking?" he asked, wondering why I accepted "the lump." I told him I assumed I'd have had to have it removed in order to do the endodontic procedure. Hmm. We scheduled Part Two of the procedure for the following week. June 14: Flag Day [for me, Red Flag Day] Part Two of the pulpectomy began with the attempted insertion of the rubber dam. Clamp on #15, bring it across #14 and . . . out pops the crown and bounces across his floor. (No, not that floor; I'm in Connecticut, not yet in New Hampshire.) "Judy, Judy, Judy!" my endo-friend exclaimed. "You know better! This dentist drilled your tooth flat against the gingival. How could you let this happen to you? Look at this!" he motioned to his assistant. "There's no shoulder or bevel here to speak of to hold a crown!" We're both Jewish so there were a lot of "Oy, yoy, yoy's." He made some peer-to-peer phone calls. He described to them what he saw. I heard the word "implant" tossed around a number of times. He came back into the room. "There is no 'ideal' solution here," he said. "No matter what, you are looking at a long-term process to fix this problem and there are no guarantees." "I really would like to save the tooth if that's possible," I said. He agreed that the conservative—but more costly—approach is the way to go. You will need a periodontist to do a crown lengthening procedure and you'll need a post placed in one of the roots to help with retention. "You have short teeth," he said. "That makes it all the more essential to have had an adequately prepped area." "I want to level with you, Judy, this is a tricky case. There's no guarantee any of this will hold up long term. We don't know how much trauma the tooth has suffered. When the post is placed, the root can crack; it's a risk you should know about. If that happens, you'll need an implant, but if you want to go the conservative route, it's worth trying to save your tooth first." He filled the center of the crown (where he drilled for the pulpectomy) with cement, hoping it would hold until my appointment with the prosthodontist. Why is it I didn't get smart until after the damage was done? Now I called upon the big guns: I made two appointments, one with a renown and quite excellent periodontist (I'm lucky to live 35 minutes from his office) and one with another highly recommended prosthodontist (who helped LMT with our earliest crown experiments) only 45 minutes away. You're probably wondering why I didn't go to the prosthodontist for the problem with #14 in the first place. I am certainly upset with myself for not doing that as well. That distance seems minute when you consider the damage done by the dentist who is only 15 minutes away. My 'Where's Waldo' Moment After leaving the endodontist's office, our family headed up to New Hampshire for the weekend where we have a summer cottage. Even though I'd been chewing only on the right, Sunday morning after breakfast I also forgot I wasn't supposed to floss by #14. That's when the crown popped out again; this time on the very, very old linoleum floor. Look at that floor! A comedian couldn't have conjured up a more perfect floor on which to lose a tooth! This pattern looks like it could house thousands of crowns, right out of a Vita shade guide! It was absurd; it took me over an hour to find it. I swept, I dusted, I was down on hands and knees patting whole sections at a time. I removed the bottom part of the stove and swept under there. I couldn't imagine where it had landed. Then, when I began putting the stove drawer back, Andy arrived and spotted what he thought was a Cheerio but didn't pick it up. Then Eric [my son] walked in and with his young eyes, spotted it too, and actually did. That Cheerio was, indeed, the crown. Look again. I've enlarged it for you. Click here to see it: http://lmtmag.com/static/images/artwork/Circled_Tooth.jpeg Yes, it's a sorry-looking lump. _____________________________________________________________________ A note about the photo of my prepped tooth: the white in the center is cement to protect the open canals. There's a story behind how it got there, coming in the next installment. What do you surmise by looking at this tooth? What have you got to say about the crown? Watch for the next installment in the middle of next week.