Thursday, February 23, 2012

What Happens When You Go to Get A Dental Crown?

This is the day for Crown #3. My memories of crowns #1 and #2 were somewhat fuzzy as I typed, but I was rested and not high on pain medication for this one. This tooth did not have a root canal filling.

Total time: 2 hours
Total cost (AFTER insurance): $881.50 That was $140 for the buildup, the rest for the "noble" white gold crown, and this is the entire cost to me from anaesthesia to final fitment and a 1-year guarantee.

I showed up early and they had me go over the patient consent and disclosure forms, because it's a new year. Then I went pee (very important, the next hours will be busy) and was escorted right back to a waiting chair.

The assistant took my blood pressure and pulse, then put some numbing gel on between the cheek and the gum by the tooth in question (#19) and left a gauze pad to cover/hold it in place. We went back to the operating suite.

The doctor came and looked at my mouth, and injected some pain killers. I was left for the medicine to numb my jaw for a few minutes. Then the assistant did a "cold test" where they spray some super-duper-duper-cold liquid on a q-tip and touch the tooth they will be working on with the cold stuff. If it hurts, you're not numb. It wasn't (it NEVER is, for me) so they left me a few more minutes. After I failed another cold sensitivity test, the doctor gave me a BUNCH more injected anaesthetic. The very worst of these was only a slight pinch, because she makes it her business to not hurt people. At one point, as she was using both hands and a lot of arm strength to inject the stuff, I felt one of my nerves go all fuzzy and that was the one that was not going numb before. A few minutes later, I was ready to go.

They took some pictures with a little digital camera the size of a toothbrush. It has little LED lights on it that are very bright, and is no-kidding shaped like an electric toothbrush.

I was made to bite down on a tray of goo that took a minute to set up. The tray was as long as all my molars and wrapped around to the incisors, and the goo was smeared liberally inside. This was the first mold, to capture the shape of my tooth before they took any of it away. It also captures a faithful mold of all the other teeth, but we just needed a mold of the one tooth. This comes in handy, later.

The assistant placed a clamp around the tooth to hold a dental dam (a rubber sheet to keep bits of teeth out of your mouth and your tongue off the dentist's fingers). The clamp pinched something and stung, so she repositioned it. The dam was installed by stretching a sheet of rubber around the clamp, then putting the corners of the sheet on a metal "U" shaped frame to hold it open. She didn't like the way it set, so she pulled it off and tried again, this time leaving the dam off. She told me "close your mouth" and put something between my teeth. I held it there for a few minutes.

The doctor came and had me open "wide, big-big wide" and the thing between my teeth turned out to be a couple of "bite this with your mouth wide open and it will stay wide open" spacers. The doctor put one on the other side of my mouth, and the mouth was comfortably held wide-open until they were pretty well done with me.

The doctor re-installed the dam and gave me some wraparound sunglasses to keep bits of old filling and whatnot from getting in my eyes, and got out The Drill. She drilled out the (big) old filling and all the cooling water spray and bits of filling were sucked into a suction tube held near the tooth by the assistante. The doctor made some clucking noises to herself and they put a marker dye in there to see if there was any decay and she drilled some more. This was the only spot of decay in my mouth at the last checkup, right beside a "leaky" old filling. The filling in this tooth was pretty deep. The doctor said she could see the pink of my nerves through a thin section of tooth at the bottom of the now-open cavity. They packed the cavity with "buildup" material and used another toothbrush shaped instrument. This was an ultraviolet curing lamp. The filling was cured and the tooth was strong enough to proceed to cut off the remnants of the natural crown.

This was a full-coverage crown instead of a partial or a filling or inlay, because the tooth had vertical fractures on all four faces. When they were getting the tooth ready to receive the crown, they had to grind down the top of the tooth to get rid of the cracked areas. One of the walls of the cavity was "eggshell thin" and it felt like dull, heavy pressure on my tooth as they ground down that fracture line. This lasted less than a minute and got better as they got past the more heavily damaged part. The spacer, dam and clamp were removed.

The crown will be a gold part, and less tooth has to be destroyed/removed for a gold crown than for a porcelain crown. They didn't have to take the margins way down, so they didn't have to cut my gums. This meant no seeping gums and no need for a followup visit to take a final impression.

The final impression is a higher-resolution goo that gets better detail on the mold. You bite down hard on what feels like silly putty. For five minutes. Your jaws get tired, then they come in and pull the stuff out. The doctor examined the mold made of my teeth, pronounced it good, and something amazing and magical happened. The first impression has come back into importance.

The assistant squeezed some tooth-colored paste out of an applicator syringe into the hole my tooth made in the first-impression mold. The mold was then put back into my mouth and I bit down on it. The paste was soon-to-be-solid temporary crown plastic material, and it was formed perfectly to what was left of my tooth by this procedure. The plastic set up, and the mold was removed. Excess plastic was picked out by the fingers and metal picks of the dentist's assistant. She then removed from my mouth and ground the excess plastic off the temporary crown (for this is what had just been made). She had me tap-tap my teeth together and listened, then put the crown on the tooth with no glue. The sound was different. Tap-tap on some marking paper, and then she pulled the crown off. A bit was ground off the crown, and she put it back on the tooth stub. Better. Some temporary adhesive was applied and the crown was glued onto the tooth.

They gave me a do-it-yourself kit to reglue the crown on in case it comes loose. They set up another appointment, I made another head call, and I went to work.

I had taken ibuprofen before I went, and it wore off while I was at work. I took more. The worst pain is where the needles were poked into the gums for the anaesthesia, and there is a general soreness on that tooth as well as the teeth that were pushing for an hour against the mouth holder-opener thing that kept my mouth open. These are very slight pains, compared to a proper toothache.

The scary part, and the painful part: none. I trust these people after having dealt with them several times now, and they didn't let me down. There were a few "pinchy" moments but nothing that actually hurt.

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