Although I wish that this was not so, sometimes patients do experience discomfort after having a filling done. Sometimes the pain is associated with a bite that needs to be adjusted. If the filling that was placed hits just slightly before the other teeth hit it can cause pain and sensitivity.
If a patient calls with pain after a filling is placed, I always ask if they bring their teeth together does that provoke the pain. If it does I ask them to return for a bite adjustment. Often this 30 second adjustment is all that is needed. The tooth becomes comfortable within 24-48 hrs.
Infrequently, the bite adjustment doesn't work and in that case if the pain is not severe, I will suggest giving the tooth some time to calm down(one week to one month). If the patient is still bothered at that point and there has not been an improvement I suggest taking the filling so that I may have a chance to reexamine the tooth without the filling.
After removing the filling, I study the tooth with a bright light and magnification and look for either internal cracks or for possible microscopic exposures of the nerve. If none are found I place a sedative 'temporary' filling to see whether that helps. If I do find an internal crack in the tooth that may be responsible for the patients sensitivity, I often recommend making a crown for the tooth and having it placed temporarily in the mouth to see if the tooth becomes 'happy'.
A small percentage of teeth even when all is said an done remain 'unhappy' and do require a root canal to remove the pulpal tissue. Root canals, when performed properly, have a very high rate of success and will give these patients back their 'happy' tooth.
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2 comments:
Dear Dr. Spindel,
It has been over 6 weeks since I had 5 smaller cavities filled and a Dentist I had never been to prior. Something I should tell you is that I do not numb easily and Im extremely sensitive. I let the D. know and indeed it took several 3-4 shots to numb me -the last shot was intense -the D said it was into my muscle, but it worked... A week later and still in pain, I went back to D. My gums were not looking good around the area where i had pain. In addition to throbbing pain around tooth #29, the last filling I had done (also the site of the deep muscle injection), and where the gums had been damaged, my entire lower jaw ached and was so sore... He thought it was a Viral gum disease and referred me to a Periodontist- and he gave me corticosteroids and an antiviral drug. I went to the P. and he said, no disease, simply my gums had been damaged during the filling and it would take awhile to regenerate the cells- a few weeks maybe. 2 weeks later the pain was much worse and I was unable to eat or sleep without tons of pain meds. It was H#@* for me. I went back to my D. and had x-rays and nothing showed up-again, so he referred me to an Oral surgeon, by this time my gums are looking great-but feeling so much pain. Mind you the D. kept checking my bite with those little pieces of paper you bite and grind on. At the oral surgeon, panoramic xray shows my back molar has a failing root canal. He said it was probably failing for some time and having had this recent work done, it stirred up the pot-so to speak. It made sense to me because i was having the pain there,and he sent me home with antibiotics and time to think...3 days later, the pain was unbearable, and for reasons that include past cracked teeth on failing root canals, I opted to have the tooth (#31) removed- it was an emergency surgery- very painful- he said it was "hot" (and not able to have general anesthesia) This did relieve some of my pain once this healed, but the original pain on my one tooth where I had the last filling (#29), still is hurting. Some days I think it is getting better, but at such a slow rate..i cannot go without advil at least 10 per day...vicadin at night. it is a throbbing pain. I have gone back to the D again, about a week after having the extraction on #31, asking him to check bite, and see what he can do...he suggested a root canal...I did not like that idea, as I seem to have bad luck with those. So, one week ago, i went to an Endodontist for a 2nd opinion, who did more x-rays and probing and said I do NOT need root canal...and suggested my bite is off!! During the last 6 weeks I've had 5 cavity filled, 2 doses of antibiotics, one tooth extraction, visits to 3 different specialists, at least 3 visits back to the original Dentist- who has checked my bite, and I am still in pain. I do not want a Root canal, and I do not want my current D to re-do my filling, because of lack of trust (it was my first and last time going to him)Do you have any suggestions? I feel that I will need a D to remove the filling and look at it closely, like you suggest, but I am nervous and hope I can find a D that will do this, as I am NOT going back to the other D. Have you had this happen or know what I should do? I am tired of living in pain and feeling rather desperate.
thank you so much,
Dear Janna,
If your tooth is still hurting and the bite has been adequately adjusted, then possibly removing the filling and having a sedative or interim filling is a good idea. Why not find another dentist who can help you?
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