Troublesome Front Teeth

I thought it was high time I blew the dust off my keyboard and posted up another interesting case which I saw recently. There are two issues which I had to deal with here, so I thought it would be best to treat each ‘challenge’ as a separate blog article. Sooooo, this is the first of the two pieces which I hope you’ll find interesting.

This lady (let’s call her ‘Mary’)  called the clinic early one morning in a lot of pain and wanted to know if we would see her. Like most dentists, I never like turning away dental emergencies, so we told her to come straight down and I would “squeeze her in”.

So Mary arrived and shortly afterwards we had her on the chair to find out how we could help her. Ok, here goes…

One week previously Mary tripped on the kerb and fell, breaking half her front tooth off (tooth with the blue dot in the photo below). This tooth was extremely sore to touch. She went to her nearest dentist who told her the nerve in the tooth was damaged beyond repair and would have to be removed (this is called ‘Root Canal Treatment’ ).

Toothache from upper right central incisor (blue dot) tooth.

Luckily the dentist had enough time to carry out the entire root canal treatment there and then and also had enough time to repair the broken tip of her tooth. Mary was out of trouble…. or so she thought.

Digital x-ray of Mary’s front teeth showing the root canal treatment

Here is the x-ray which I took when Mary came into us that first morning.

Mary said that as soon as the anaesthetic had worn off after treatment, the pain came back, and got worse. She thought this was normal and might take a few days to settle. Unfortunately the pain continued.

She returned to this dentist two days later who gave her antibiotics and told her it should settle down. The pain however remained. She also noticed a ‘hard lump’ on her gum above the root canal treated tooth. This was very sore to touch. And all the time the pain was becoming more unbearable. Enough was enough… time to get a second opinion – and our phone starts ringing.

Fast forward to Mary’s appointment with me. She is in the chair and two things concern me about her front teeth:
1 – the appearance of the root canal treatment on the x-ray and
2 – the colour of her other front tooth – notice it looks a ‘weird grey-ish pink’ colour here.

Check out my x-ray with the flashing dots on it. I’ve placed red dots to show where the tip of the root is. We like to fill the root canal to this tip or just short of it. The blue arrows show where some root canal filling material is squashed out way beyond the tip of the root and into the surrounding bone.

Root Canal material extruded

Sometimes this filling may go out beyond the root tip and never cause problems. Here however, the material is well beyond the tip and is undoubtedly the cause of Mary’s discomfort.

The other cause of her dental pain is the other front tooth – the grey-ish pink colour is a big warning sign here. I tested this tooth and unfortunately the nerve is dead – it will need root canal treatment too. 🙁

So, what did I do here? Simple really – I had to remove the less-than-ideal root canal filling from the ‘blue dot’ tooth, clean the canal properly and replace it with a more satisfactory one. (And also root canal treat the other tooth beside it!) Thankfully we were able to get Mary out of pain!

See my final digital x-ray below.

Left Image: Before Treatment. Right Image: After Treatment

In my next blog, I will describe how we improved the appearance of Mary’s dark upper front teeth and get her back smiling again. Stay tuned….

Written by Dr. Mark Kelly.
Do you have a troublesome front tooth? Would you like our help? If you’re looking for a dentist in Dublin, we’re always happy to accept new patients. You can book an appointment online or call our reception team at 01-6655900. And as always, you can email us at info@shelbourneclinic.ie – during office hours we always aim to respond to queries within 30 minutes.