Why does my tooth hurt after the placement of a post and core?

The truth is that after a post and core is placed a tooth should not hurt. Occasionally patients can have pain after a post is placed. This pain can come from a number of causes. The most benign is that the bite has changed slightly after the placement of a post and core. This can be remedied with a simple bite adjustment.

A more disturbing possibility is that the root canal in the tooth is failing and placement of the post has somehow made the problem more symptomatic. This may happen because the drilling and placement of the post may have disturbed the guttapercha or just stirred up an already present 'hornet's nest'.

Endodontically treated teeth, that are not properly sealed with an interim restoration. can become contaminated in as little as thirty days. It has been my experience that when some of these teeth have a post placed, they can become symptomatic.

Still a third possibility is that the placement of the post has resulted in either a perforation of the root or caused possibly caused a crack to form .

Rarely, patients can even have pain stemming from a sensitization of an intermediate ganglion from a past trauma or infection, so it is possible to feel pain due to a previously cured endodontic infection.

If you are having prolonged pain in a tooth with a post it is advisable to visit your dentist or go for a consultation with an endodontist. They will take a radiograph and examine around the tooth to check for evidence of infection.

What is a rubber dam and why is it used?

A rubber dam is a latex sheet that dentists use to isolate a tooth or a group of teeth, either for sterility or to achieve moisture control. The dam has a hole or holes punched in it and is usually held in place by a clamp and stretched out with a rubber dam frame.

Rubber dams are extremely useful for root canals, since they hold the mouth open and protect the patient from accidental aspiration of any of the files or drills used during an endodontic procedure. It also acts like a surgical drape to help keep the canal system free from contamination and helps contain the irrigants used during root canal procedures.

Dentists can utilize rubber dams during operative procedures as well. If they are placed prior to removing a silver filling, they can minimize the amount of metal filings that the patient is exposed to. Instead, the assistant can easily suction them off and none are ingested.

Some dentists use rubber dams during bonding procedures, for which moisture control is extremely important. Although there are other good ways for dentists to achieve moisture control, rubber dam is one of the best!

Occasionally, patients do not like having the rubber dam placed in their mouths and some claim it makes them feel like they can not breathe. Usually cutting a small hole in the dam allows patients the option of either breathing through their nose or mouth and is helpful to patients whom the dam makes 'claustrophobic'.

How long should I brush my teeth for?

Two minutes is the time most often quoted by dentists, but that recommendation is somewhat arbitrary. Actually, I think the time needed differs for each person. I recommend that they be systematic and brush each surface adequately and see how long it takes them.

When I brush my teeth I start in the upper right quadrant on my back teeth and gradually work my way to the upper left. Then I do the upper insides in the same manner. After that, I usually do the same for my lower teeth. I use an electric and I allow about 3 seconds per tooth surface.Using a manual brush might take longer per surface area- lets estimate about 10 seconds per area.

You just want to be thorough and systematic job and not go over the same areas repeatedly during the same session. I do not believe that even using a manual brush it in necessary to spend more than 10 seconds on a particular area. Using the technique I have described above brush your entire mouth and see how long it takes. That is the average time you will need.

What should I do if my temporary crown breaks?

This is an easy one. Call your dentist! Temporary crowns function in multiple ways. They act as space maintainers, and protect the tooth from the effects of bacteria, sweets , and hot or cold liquids. Either a new temporary should be made or the old one should be repaired.

No real harm will come to a patient because they do not have an intact temporary crown for two or three days, but the longer a patient waits to have the temporary replaced, the more likely that shifting of the prepped tooth will occur. This may make it more difficult to fit the permanent crown.

Often times, when patients go for long periods of time without a temporary crown, the prepped tooth extrudes and lessens or eliminates the 'clearance' that the dentist had created between the preparation and the opposing teeth. Also the teeth on either side can start to shift which is undesirable.

Is it possible for a tooth's nerve to die without any symptoms.

It is not uncommon to take a full set of radiographs for a patient and find a tooth with a periapical radioluscency around to apex of a tooth. When I ask the patient if they have had any symptoms with that tooth, they sometimes report they have no discomfort.

When continue the discussion with these patients , some remember having some symptoms in the remote past, but at the tooth stopped bothering them(the pulp died?). Some do admit that the tooth does bother them from time to time.

Sometimes, when I percuss these teeth the patient does report that the do feel slightly different than the adjacent teeth and when I do open these teeth up to do a root canal procedure I invariably find that the pulp is non vital (dead).

Should I bleach before having porcelain veneers?

Yes , but it is better not to bleach the teeth that will receive veneers. Teeth that are bleached can slowly darken over time and if the veneers are translucent, then the veneers can appear darker with time. Translucency in veneered porcelain is usually considered a good thing, since the final result looks more 'natural'. If the teeth without veneers slowly darken, then the patient is instructed to use their trays to 'touch up' their bleaching. This usually takes only a few nights.

Another other minor problem with bleaching, prior to veneer placement, is that afterwards bleaching trays may not fit . Sometimes I have to fabricate new trays for the arch that received the veneers.

What does it mean if I have sensitivity to cold or sweets on a tooth after it has had a root canal?

Usually it means that the sensitivity is coming from an adjacent tooth and not the tooth that has had the root canal. For a tooth to experience these symptoms it must have vital pulp tissue and very few root canal teeth have any vital pulp tissue that remains. For that to be the case the tooth would need to have an extra root that was not compromised by the root canal treatment.

Usually the irrigants and medicament's that are used during a root canal will kill any vital pulp tissue. I have found that most people have a sensitivity that has a threshold of +or - one tooth, so that they often point to a tooth next to the one causing the symptom.

The best way for a dentist to pinpoint which tooth is causing cold sensitivity is to use an ice cube pr0be and place it on each tooth in a quadrant and see which tooth is the most sensitive to cold application.