Dr. John Sorrentino D.M.D

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All Things Dental

When the Doctor is the Patient: Part I

I have been having a problem with a tooth on the lower right side since last fall.  All I know is that something hurt and I could not tell if it was an upper or lower.  I had a professional cleaning last October with radiographs and everything looked normal.  Over the winter it never went away but on a 1-10 pain scale it never registered more than a 1.  I knew something was up but did not know what it was.

As winter gave way to spring I concluded that it was my lower right second molar. While the sensation in the tooth never went away, it really did not hurt either and as we took another radiograph, it still looked fine.  That lasted until late June when I noticed the gum was swollen around the tooth and I could express some pus as well.  I immediately made an appointment with my dentist.

She noted the infection but as the radiograph at this time also appeared normal and there were no unusual probing depths or other symptoms it did not appear to be the tooth, but rather the gum that was infected.  She deep cleaned around the tooth and we figured that was the end of it.  Needless to say it was not.

As I was beginning to think this was something unusual, the next stop was to my physician who insisted it was bacterial, not viral and put me on a course of antibiotics.  After a week of no change, again insisting it was definitely bacterial he switched the antibiotic which also did nothing but screw up my microbiome.  This is when fate would intervene.

As it was summer and the very next week we were vacationing in South Carolina near my parents’ house I stopped in to see a dentist who had placed some implants for my mother.  She had always invited me to stop in if I was in the area and show me her office.  After a brief tour, I asked her about the problem I was having and would she give me her opinion.  After yet another radiograph, we could clearly see an abscess on the right lower second molar. She then probed it and had a reading of 10 mm (normal is 2-3 mm) in one spot.  She suspected a fracture but not what type of fracture. Now I was confused as there was no decay, only a small filling that had been there for years and it had taken 10 months to show up!  I thanked her very much but now at least I had a diagnosis and an answer.  Time to get some treatment.

Tooth # 31 Note the small filling and abscess on distal root.

Tooth # 31 Note the absence of decay, small filling and abscess on distal root.

Plan A would be a root canal then a gold crown.  If the tooth turned out to be unrestorable, Plan B would be an extraction, graft, implant and cemented (as opposed to screw retained) gold crown.  From South Carolina I called the office of Dr, Denise Assogna.  Her office has treated many of my patients and from experience it is my opinion that if God himself needed a root canal that is where he would go.  It took a few minutes as her receptionist was surprised that I was calling for myself and not one of my patients but they of course agreed to see me.  Now back from vacation I went in to see her.  After removing the old filling, bad news.  There was a vertical fracture in the tooth.  As every dentist knows a vertical fracture is not a restorable situation.  Looks like it was going to be plan B.

Filling removed, large crack across the floor.

Filling removed, large crack across the floor. Game over.

My next stop was the office of Dr. Michael Maltz, a periodontist who also happens to be an ace at placing implants.  Again when I walked in they were surprised that it was me and not one of my patients that I was there to talk about.  Long story short, he extracted the tooth and placed a bone graft.  Yes it was sore for a few days but it is healing nicely now. Having a tooth restored with an implant is a process.  Think of an implant as a new tooth root. While It takes 4-6 moths for the graft to heal before the implant may be placed; It takes an additional 4-6 months for the implant to integrate to the bone.  Then it is strong enough that it may be restored and put into function.

Some parting thoughts I have include why did this happen?  I can guess but I don’t know.  One time 25 years ago I came down on something hard enough to move that tooth.  It was sore for a week but I never had another issue.  Cracks in teeth can be just like cracks in windshields.  They can propagate over time, but 25 years?  That’s a stretch even for me.  Teeth are subject to thermal cycling, old style silver fillings expand at a different rate than natural tooth structure.  That can do it.  Should I have had it replaced years ago?  That filling is small but I have had that filling there since I was 16.  While we no longer do silver fillings, replacing otherwise functioning ones can also ignite problems.  No one has a crystal ball.  Perhaps a combination of the two. I guess I will never know.  Finally, and most importantly diagnosis of a problem can be tricky and take some time even for the best of professionals and the most modern of instruments.  It was 10 months from when I first noticed a problem to the time when it showed up on a radiograph. At least I know I am getting the best of care and soon enough this will be done.



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