The Cosmetic Dentistry Blog

August 12, 2010

Sinus infections, heart attacks, and toothaches.

Filed under: Pain in teeth — Tags: , , — iowasmiles @ 6:22 am

Dr. Hall,
I have pressure pain on the back bottom teeth, that started after my sinus infection started. Is it common for the bottom teeth to hurt also? There is no sensitivity to hot or cold and only really hurts from the top, the sides of the teeth do not hurt. My jaw and upper teeth hurt too.

- Ken from Arkansas

Ken,
It’s not common, but it’s not rare, either, to have a condition called “referred pain” in your teeth. You can have a problem in your upper teeth and it feels like the lower teeth hurt, too, or sometimes even just the lower teeth hurt when the problem is an upper one. Or to feel pain in your upper teeth from a sinus infection, or to have that pain referred to lower teeth.

One of your sinuses is very close to the roots of the upper back teeth, so it is fairly common for a sinus infection to cause a toothache. This pain might be aggravated by pressure, and wouldn’t usually involve sensitivity to cold.

One quirk of pain in the teeth is that one possible symptom of a heart attack can be pain in the lower jaw or pain in the left arm. So it’s a good idea, whenever you have pain that you don’t understand, to see a doctor.

I hope this is helpful,
Dr. Hall

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June 14, 2010

Do I need a root canal?

Filed under: Pain in teeth — iowasmiles @ 10:24 am

Dr. Hall,
okay i dont know if i have root canal yet or having it soon. i had a filling when i was in high school i can see the fillings in my teeth but can not see them very well. my top right and bottom right teethes hurt when i eat or drink something cold. i would sometimes put my head into the sink to put some Heat on it. it works for 5=10 seconds then pain again. i would brush my teeth trying to get the friction from my tooth brush to give it heat. and it does work. but how long is that going to last. first i thought it was cause i was chewing gum while i was smoking if thats the problem ill have to go to the dentists. if you can get back to be asap that would be great.
- Andrew from California

Andrew,
I’m not following all that you’re saying. But persistent pain in a tooth from cold is an indication that the tooth needs a root canal treatment.

If something cold touches the tooth and it hurts only while the cold is on the tooth, that indicates an irritated tooth that may or may not need treatment. If the pain lingers for more than a few seconds after the cold has been removed, that tooth won’t get better on its own, and it needs a root canal treatment.
Sometimes people are fooled because after a week or several weeks the pain goes away, so they think the tooth is better now. But what happens is that the living tissue inside the tooth dies, and that is usually the reason that the pain goes away.
- Dr. Hall

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May 3, 2010

Pain from teeth bleaching

Filed under: Teeth sensitivity, Tooth whitening — iowasmiles @ 2:07 pm

Hello, I have been using an at-home whitening system for about 2 weeks with no problems. Then yesterday, I used them and I felt a sharp pain that lasted for about 30 seconds The source of the pain was my front tooth which has a dental bond. It was chipped and repaired about 10 years ago. My question is – is my bond nearing the end of its life cycle, or is the whitening weakening the bond? I suspect it is both. Thank You, Kim from Texas

Kim,
I doubt that the tooth bleaching system would weaken the bond on this tooth. Bleaching gel hasn’t been known to weaken bonds like this. Plus, if the bond were weakened, the repair to the chip would probably fall off – it wouldn’t just be this pain.

The kind of pain you experienced can be caused by the bleaching gel on a sensitive part of the tooth. That’s what I would suspect. If this tooth was otherwise injured and repaired, there could be a sensitive place that used to be covered by some bonding agent and that has come off.

Your case is a good illustration of why, when you’re doing teeth bleaching, you need to be under a dentist’s supervision. I assume that you are. You should let the dentist know about this, and hopefully they can find the exact cause of your problem. If it is indeed a sensitive spot, it could be coated with something to take care of the sensitivity, and you can go on with your bleaching. But get this solved before you bleach any more.

- Dr. Hall

Read more about sensitive teeth.
Other links: Chicago porcelain veneers.

January 4, 2010

How could the dentist diagnose my sensitive tooth so fast?

Filed under: Teeth sensitivity — iowasmiles @ 2:33 pm

Dr. Hall,
I have a molar that has a large filling, it is sensitive to cold, heat and air. I went to see my dentist, he blew some air on it in a couple of different spots, asked if it hurt, and put some desensitizing something or other on it. He said if the pain stayed he would have to remove the nerve. My question is how does he know this in 2 seconds of blowing some air? I currently have braces, could this have something to do with it? I’ve also had another thought of the filling having a hole in it or maybe being thin, could this cause the sensitivity? My dentist is very impersonal, very quick no time for questions, he does what he thinks he needs to do and that’s it, he’s gone.
- Laurie in North Dakota

Dear Laurie,
Sometimes these pain issues are very clear and sometimes they are fuzzy and take time. From what you’re telling me, yours was fairly clear.

If you blow air on a tooth and it hurts, that indicates that there is some unprotected, sensitive spot on the tooth, which can be helped by coating the tooth with a desensitizing bonding agent. If the pain is transient—it hurts for a moment and the pain goes away immediately, that’s a sign that the nerve or the pulp of the tooth is irritated, but that it could potentially heal. If, on the other hand, the air provokes pain and the pain lingers for more than a few seconds, then the irritation of the pulp or nerve is irreversible—it will not heal on its own and will require root canal treatment.

The tooth can also be tested with cold, with heat, or with electrical impulses, depending on the situation.

I don’t know the situation in your mouth, so whether this has something to do with braces or not, I couldn’t tell. That would be unlikely, but possible.

I wouldn’t think that the filling being thin would cause this sensitivity. You said the filling is large, so it would be more likely that there could be some leaking around the filling, or decay under it. Again, I don’t know what your filling looks like other than your saying it is large, so there might be reasons your dentist didn’t think these were possibilities that should be checked.

As far as your dentist not staying around to answer your questions, if I were in your shoes I would call the office and say I needed to ask some questions, and if the doctor didn’t have time for my questions I would have to find another dentist. That would almost certainly get you some attention. I would actually probably say that while I was still in the office and the assistant was dismissing me. Health care is built on trust, and the two pillars of trust are the knowledge of the doctor and the caring of the doctor. One without the other doesn’t lead to good care.

- Dr. Hall

Other links:
Click here to read about tooth sensitivity from various causes.
Click here to read about why a tooth is sensitive to cold.

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November 21, 2009

Pain after a new filling

Filed under: Pain in teeth, White fillings — iowasmiles @ 8:03 am

Dr. Hall,
I had a composite filling with a ceramic cap done on tooth # 19 two weeks ago. Ever since I have been in severe pain in my jaw and often from the top of my head to the middle of my neck only on the left side. I have been living on Ibuprofen 3-4 times a day. The pain is about an 8 on a scale of 10 being the worst.

The dentist said was because I was grinding my teeth, so I bought a night guard and that was no help. So he proceeded to grind my tooth down to fix my bite, but I am still in a lot of pain! Is this normal? Should I get a second opinion? What specialist should I see? Thank you, Charlotte from Indiana

Charlotte,

I’m not sure what you mean by a composite filling with a ceramic cap. Cap is a lay term for a crown. A filling just replaces decayed or weak tooth structure. A cap or a crown covers the entire tooth.

It certainly doesn’t sound like your pain was from grinding your teeth. If your bite is adjusted properly, grinding your teeth won’t cause pain in a single tooth.

There are lots of kinds of pain that can occur in a tooth, and when we’re examining that, we try to find what provokes the pain or makes it worse. Constant, severe pain usually means that the tooth is infected. If cold brings on pain that goes away once the tooth warms up, the tooth is just irritated. Pain to biting could mean that the bite needs to be adjusted, or it could mean that the tooth is abscessed or that there is some infection in the ligament that holds the tooth in the bone.

Severe pain right after a filling is placed could mean that the tooth had a slight infection before the filling, which was aggravated by doing the filling. Or, if it is a bonded white filling, improper technique could also cause post-operative pain.

In your situation, I would get a second opinion. It doesn’t sound like your dentist is on the right track. I don’t think you need a specialist, just a good, thorough, careful general dentist who understands tooth pain.

Dr. Hall

Related links:
Read about tooth pain after a new filling.
Read more about toothache – the various types of tooth pain and what cause them.

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November 4, 2009

A mysterious case of tooth pain

Filed under: Pain in teeth — iowasmiles @ 5:27 pm

Hi Dr. Hall,
I am writing because I could use some expert advice and I am impressed with your posts. 

I just finished a two month course of treatment where #14 was a retreated root canal and #15 was first time root canal. Anyway – there had been a sizeable black area in the bone above 14 before the RC but 14 had been asymptomatic for years. It was only when 15 needed a root canal due to a large filling that 14 “woke up”. 14 had no pain until 15 had the RC. After the two root canals, 15 resolved pain but #14 didn’t. Both teeth were re-medicated 4 times over a two month period before root canals were finally completed today. #14 is still tender and painful just to rub my tongue on it. Endodontist is highly skilled with excellent reputation and says the #15 looks great and #14 has no signs of fracture visible using microscope from inside and no sign of fracture on xray. The gutta percha did not ‘ooze’ out of filling on xray so Dr. says this bolsters evidence of no fracture. He did say the ho! les at bottom of root were larger than normal but he said that was from original root canal 20 years ago. He said that he ostensibly ‘corked’ the holes by pushing the filling material through the root openings past the tooth (which I can see on post treatment xrays). He said any excess will be reabsorbed over time. The dark shaded area above #14 appears a slight bit reduced as compared to xrays one month ago but the Dr. says that may just be angle of xray. The black area is like an 8mm pocket in the jaw (it is not surrounding the tooth’s root as would be the case with an abscessed tooth root.)

Question: My endodontist can not offer any explanation for pain in #14 other than effects of bone loss over the years due to that slow growing pocket of infection. Should I request an antibiotic to try to see if this pain is possibly from infected ligaments around the tooth now that the inside of tooth has been treated and retreated and remedicated for two months? Will the dark area on the x-ray – if it is bone loss – eventually regenerate into bone? If the black area is infection, will it reinfect the teeth? What to do? The endodontist said if it really bothers me then extract the tooth but if it were his mouth – he’d said he’d try to save the tooth. My problem is the pain is wearing me down and I have lost almost 20 lbs in 2 months from not being able to properly eat. I fear that unless we know the problem – extraction might not even be the solution. What do to? At! my wit’s end. Should I get antibiotics? Dr said to delay seeking restorative crowns till pain is resolved but not sure how long to wait. Any thoughts would be greatly appreciated.
Thank you
Nan from New Jersey

Dear Nan,
I’m not going to be able to tell what’s wrong with your tooth from here, but from what you’ve told me it sounds like your endodontist is careful and caring. Too many of them give up on a tooth too early as a way to protect themselves, and it impresses me that he’s willing to stick this through and try to save your tooth. Everything you’re saying he is telling you makes sense to me.

The black area on the x-ray, once everything is healed, will fill in with bone over a period of months. And it appears that the infection isn’t spreading. Even if it does spread, it is highly unlikely that it would infect other teeth.

If an antibiotic makes the pain go away, then, yes, that’s a great indication that the pain is from an infection and not, say, from a nerve that is acting strange, or from stress on the tooth, so that could be worth trying.

If there is pain when you chew, you can have your dentist reduce the tooth so you don’t hit it at all and this should help.

And I would agree with your dentist. While he is in favor of trying to save this tooth, if you get to a point where you just don’t want to monkey with it any more, then you can have it extracted. But you would definitely want to know that it is this particular tooth that is causing your problem. Sometimes pain can feel like it is from one tooth but it is really referred pain and the source is somewhere else. I have had patients swear that a lower tooth, for example, was the source of their toothache, when it was actually an upper tooth.

Dr. Hall

related links:
Read more about root canal treatment and failed root canals.
Read more about pain after root canal treatment.

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October 31, 2009

Sensitivity to Cerec Crown

Filed under: Dental crowns, Teeth sensitivity — Tags: — iowasmiles @ 9:24 am

Dr. Hall,
Some months ago I went to my dentist with sensitivity in one of my molars to hot, cold, and pressure. It was agreed that a Cerec crown would be sculpted to replace the offending tooth. An appointment was made for several months later. The appointment was for middle of July. I was very impressed. Several days later I was still experiencing a high degree of discomfort still with hot and cold and pressure. I came in so he could “ease the crown”. It was better but still very sensitive to everything. He assured me that a root canal was not necessary. (This dentist was awarded the young dentist of the year in the UK two years ago.) I was called two weeks later and advised that I should give it another 8 weeks. By now I was going on holidays. During my holiday the pain became excruciating spreading to my entire jaw and creating radiating pain in the adjoining tooth. So much so that I had to buy pain killers. I took these for the duration of the holiday! I am now back 2 weeks, have stopped taking the painkillers and gradually the discomfort has disappeared. Lately, last few days, I can chew hard foods again, toast, nuts etc with the afflicted tooth. Hot and cold is not a problem anymore but I cannot understand it. I have had an ordinary crown applied before with no such problems, it was instant relief. it leads me to suspect that there is something else about “Cerec” crowns that I have not been told. Now it is still slightly sensitive but improving everyday and it would seem that the 8 weeks was an accurate prognosis. Hve you an explanation or clarification. Thank you for taking the time to read nd reply. Yours sincerely,
Erick in Ireland

Erick,

I would have the tooth x-rayed by a different dentist. It’s worth checking to see if the tooth is okay or not.

A Cerec crown is an excellent option. I have one myself. That isn’t the issue here. I’m just not sure why a crown would be prescribed for a tooth that is sensitive to hot and cold. That kind of sensitivity occurs because a tooth is irritated, and a crown preparation is additional irritation. Generally, if I saw a sensitive tooth and it also needed a crown, I would first remove the old filling and any possible decay, and then put some bonded buildup material or glass ionomer and wait to see if the tooth settled down. That buildup would serve as a core for the crown once the tooth settled down. If the pain persisted or got worse, the tooth would need a root canal treatment.

It could be that the pulp tissue in the tooth has died, and this is why it is now feeling better. When a tooth is sensitive to hot and cold, it is irritated. When the tooth starts hurting with intensity all on its own, it’s a reliable indication that it is infected and needs a root canal treatment. It will then get better only when the pulp tissue dies. After that, it may be sensitive off and on to biting, or may not be sensitive at all.

I am not impressed with awards like “dentist of the year” unless I know the integrity of the awarding organization and then maybe the selection process.

Dr. Hall

September 3, 2009

Dental treatment for someone in addiction recovery

Filed under: Dental fear, Pain in teeth — iowasmiles @ 12:48 pm

I am currently on methadone maintenance for opiate addiction and I am in desperate need for extensive repair on my teeth. The last time I needed dental work the dentist refused to give me any pain medication after I had informed him that I was on Methadone. I even gave him the name and number of the clinic I attend and permission to speak to the clinic’s doctor and my counselor. I was in need of dental care and in quite a bit of pain and concerned about pain after the procedure. I already have anxiety issues about going to the dentist and my teeth are in great need of dental care. What would be the best way to go about talking to the dentist about my needs. I do not want to continue to suffer with the pain I have been nor do I want to suffer through pain after. If you could offer me any suggestions or know of a compassionate dentist in my area that would be willing to work with me, I would greatly appreciate it.
- Cheryl from California

Cheryl,
Dentists and medical doctors are afraid of the Drug Enforcement Administration, and many of them simply prefer not to deal with any issue that could raise questions from the DEA. Some dentists have gotten in trouble simply because they were trying to be compassionate, and as these stories circulate, it’s the patient that suffers.

You just need to find a dentist for whom the compassion will be a ruling factor and not fear of the DEA. I would start by looking for dentists who do sedation dentistry, and then ask them up front if they can help you with your treatment and post-operative pain control, given that you are in addiction recovery. My advice would be to just keep asking around until you find a dentist willing to help you. Dentists tend to be compassionate, but they also tend to be timid. But I’m confident you could find someone who would be a match for you.
- Dr. Hall

Related links:
Read about toothache pain

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June 22, 2009

My tooth has a really sensitive spot at the gumline

Filed under: Teeth sensitivity — iowasmiles @ 10:18 pm

Dr. Hall,
Very recently for the past few weeks one of my teeth has grown rather sensitive. Not to cold or hot, but if I scrape it with my fingernail near the gum line it almost feels like touching a nerve. The funny thing is, eating, drinking, brushing and flossing are all painless; its only sensitive to pressure with something hard, like a toothpick or fingernail. I was wondering what this might be.

I see the dentist about 2-3 times a year, and they always tell me my teeth are extraordinarily clean. I’m just very paranoid about my teeth. I hate getting dental work, and I don’t want to find out it requires a painful procedure to get it fixed. Help!
- Brandon from Ontario

Brandon,
It’s important to pay attention whenever a tooth is sensitive for an extended period of time like yours is. Even if the cause isn’t serious, the constant irritation of your tooth isn’t good and can lead to nerve damage inside the tooth, requiring root canal treatment.

I’m encouraged to know that the tooth isn’t sensitive to heat or cold or anything other than touching it in this one spot. Teeth can have sensitive spots like this, and usually those spots can be sealed over with something to alleviate the sensitivity. It’s kind of like a tiny filling.

Teeth tend to flex a little bit right where the crown meets the root. A lot of dentists aren’t familiar with this phenomenon, and it was only recently that it was discovered. But the tooth flexes at this spot, and causes tiny particles of tooth structure to break off, sometimes causing a sensitive spot, and sometimes continuing to progress until a significant groove develops. The trouble with treating them is that dentists have a hard time getting fillings to stick in this location – they tend to pop out. The way to get fillings to stick in this position is to use a flexible filling material, like a microfill composite.

So ask your dentist to seal over this sensitive spot, and if there is enough room for a filling, to place a small amount of microfill over the spot, and I believe the sensitivity will go away.
- Dr. Hall

Related links:
Read more about teeth that are sensitive to touch.
Read about a toothpaste for sensitive teeth.

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March 27, 2009

My tooth is still sensitive after a white filling.

Filed under: Pain in teeth, White fillings — iowasmiles @ 11:56 am

About eight months ago I had a cavity filled with a white filling. Shortly afterward this tooth became sensitive to cold temperatures. I returned to the dentist regarding the new sensitivity. The dentist stated this tooth initially had a deep cavity and recommended placing a crown over it using temporary cement. If the tooth was still sensitive a root canal would be recommended. It has been eight months and my tooth is still sensitive. During this time I have been saving for my portion of the total crown cost, if I should undergo this procedure. Currently, I am seeking a second opinion regarding my sensitive tooth. Would replacing the filling resolve the problem? What is your opinion regarding the crown? Is there a way to avoid a root canal?

Thank you!
- Cassie in Washington

Cassie,
Does your tooth need a root canal treatment? You may just have to wait and see. The key thing you want to watch for is whether the sensitivity is getting worse at this point or better. If it’s getting worse, you probably need a root canal.

Even though I don’t understand what your dentist did, I wouldn’t recommend a second opinion. What I don’t understand is why he or she did a temporary crown after the tooth was sensitive. Was there evidence the tooth was cracked? That is the only way I can make sense of that treatment. If a tooth is sensitive just to cold after placing a white filling, it’s generally best to leave it alone and hope it recovers. The more you do to it, the more you could aggravate it. That’s why I wouldn’t recommend replacing the filling–just wait it out.

When a tooth feels fine immediately after a new filling, whether it is a composite filling or a silver filling, and then there is a delayed sensitivity reaction, that usually means that there are bacteria from the original decay that had penetrated into the pulp of the tooth, and you just have to hope that the normal body defenses can take care of them, because the only way to clean it out is to do a root canal treatment.

But I wouldn’t fear a root canal. These days, they are generally relatively painless.

- Dr. Hall

Related links: click here to find a cosmetic dentist.

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