The Cosmetic Dentistry Blog

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.

March 20, 2009

Did my teeth really need root canal treatments?

Filed under: Pain in teeth — iowasmiles @ 6:35 pm

Dr. Hall,

I was having EXTREME pain and sensitivity all of sudden in my lower left side of my mouth and I went to the dentist. She evaluated the two possible teeth (both of which were somewhat painful to cold and tapping) and stated that one of them (if not both) needed a root canal. So I went and had two root canals (#18 & #20) at the recommendation of the endodontist. Everything went well except that even after a few days, I still experienced serious sensitivity and discomfort, but in a DIFFERENT tooth (#22). I went back to the endodontist for a checkup and he confirmed that #18 & #20 were fine and to go back to my regular dentist to check #22. I am very worried that I did not need the other root canals and that they were just sensitive because of the massive filings and previous work done a few years ago. The tooth that is still hurting me (#22) has had no work done except a superficial filling (white amalgram or whatever its called) a while back. Is it possible that this tooth was the actual problem and the others were only hurting when banged or touched with cold spray because of major fillings? This tooth (#22) hurts when I tap it with my toothbrush or drink anything cold or hot, and also if cold air rushes across it. The pain is not as bad as before the root canals, but now I have less nerves to feel the pain :(

PLEASE advise, as my insurance is maxed out and now I feel like I have been taken advantage of with no recourse. I am using a sensitive toothpaste in the meantime and trying to avoid anything too cold or hot.

Thank you.

Melissa,
It’s hard to tell, sometimes, which tooth is causing a problem. Your diagnosis from the start was iffy – “two possible teeth … that needed a root canal.”

It could be that they both needed root canals. Your teeth shouldn’t be sensitive after dental work for more than a couple of months. But then again, maybe they didn’t. But it sounded like even your dentist who actually examined the teeth wasn’t completely sure.

When teeth get to hurting and the pain is hard to localize, the more time that goes by the more clear it is which tooth is causing the problem, or what the problem is. Eventually they abscess and then it’s usually pretty clear on the x-ray where the problem is.

I’d advise getting another opinion from another dentist.

Dr. Hall

Related links:
Pain after root canal
Read more about toothaches

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March 16, 2009

Cracked root and other problems with root canal tooth

Filed under: Root canals — iowasmiles @ 6:00 pm

Dr. Hall,

I had a root canal and gold crown on tooth #14 (upper left molar) many years ago. A few years ago I began to feel pain and went to an endodontist. He discovered a fourth canal and treated it. A few years later, I developed an abscess and went back to the same endodontist who performed an apicoectomy. At the time he gave me the odds of success and mentioned problems could occur if among other things, there was a cracked root. I developed another abcess shortly afterwards and he sent me to a periodontist who discovered a cracked root. Since I did not want to lose the tooth and there was already considerable money invested in it, he amputated the cracked root and did a bone graft. Now, about 9 months later, I have developed another abscess and have severe tooth pain in the same tooth. And it is tooth pain, not tissue pain. The plan now is to take antibiotics and go back in a week to see if he can discover the cause of pain in this tooth. He says one possibility is to return to the endodontist for retreatment of the root canal. Both doctors are highly respected and recommended and I believe they are very competent and I have faith in both. I am wondering if it is possible to have yet another “undiscovered” root branch or other reasons why why retreatment might be needed on this tooth. I was under the impression that once a canal is cleared of its contents there should be no pain. And I’m wondering if there are other (maybe systemic) reasons for the recurrence of abscesses.

I’m interested in any insight you might have about this situation and thank you in advance for your thoughts.
- Stephanie from Nevada

Stephanie,
If it were my tooth, I wouldn’t go back to have the root canal re-treated. Again?

Now I am one of the biggest advocates of saving teeth that there is. I have saved teeth that were unsavable, and had three research articles published about saving teeth that over 95% of dentists think are unsavable. But I think you would be best off in this case with a dental implant. That’s my opinion.

It appears probable that when this tooth started hurting again several years after the original root canal, that no one ever discovered what was really wrong. A lot of times, with root canal treatments, the diagnosis is guesswork. It’s probability. You can’t see cracks in a root–even on x-rays. You can’t see leaky canals. And that’s why your endodontist gave you “odds of success.” You tried your odds, and the tooth didn’t make it. And what that means is that no one really knows where the problem is. It could be that every one of the roots is cracked.

Now if you’re fine with undergoing all this treatment when your chances of success are maybe one out of ten, then go for it. But dental implants are an excellent tooth replacement treatment with a much, much higher chance of success.

My opinion.
- Dr. Hall

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March 12, 2009

Does my tooth need to come out?

Filed under: Pain in teeth — iowasmiles @ 6:48 pm

Dr. Hall,
I had a checkup and was told that my back top left molar was half missing and would need to be capped. When I went back a week later to have my cavity filled in another tooth I was told that it would have to be removed. Well now I have a low pain that seems to radiate to my bottom teeth same side but when I drink something cold the pain goes away. 

So with that said would i need to get it capped or is it too late and do I need to get it removed completly?
- Jeremy from Rhode Island

Jeremy,
Sounds like your tooth needs a root canal treatment. When cold makes the pain go away, that’s a dead giveaway that the tooth is dying inside and needs a root canal.

If you want a tooth extraction, then that’s your choice. I believe in saving your teeth when you can. But your dentist should give you the option of saving it, and explain the pros and cons of doing that versus having it taken out. One of the problems in taking out one tooth is that it affects other teeth. For example, there’s a good chance that taking out your upper 2nd molar will cause you to eventually lose your lower second molar on that same side.
Dr. Hall

Related links:
Read about tooth pain after a filling.
Or tooth pain after root canal.

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March 10, 2009

What can I do about my discolored fillings in my front teeth?

Filed under: Lumineers, Tooth bonding — iowasmiles @ 8:32 pm

Dr. Hall,
Overall, I love my smile. The only issue I have is discolored fillings in my top front teeth.

They don’t respond to bleach. And when I brush them, they look worse, because you can see the difference in the color between the fillings and the teeth more clearly.

My dentist has talked to me about Lumineers, and I wonder if this would help or if the color of the fillings would show through. What is the best thing for me to do?

- Ana in New Jersey

Dear Ana,
The answer to your question is actually fairly simple. I think you’re making it too complicated. You have discolored fillings because the dentist that did them didn’t know how to make them match your teeth.

There are bonding materials that are used for fillings that have every tooth shade under the sun, and they can mimic your natural teeth in translucency, in gloss, and in texture. So you just need a dentist who knows how to do this. See our dental bonding page to see how beautiful these fillings can be.

Whatever you do, don’t do Lumineers. They will make your teeth longer, and they will be bulky. And if you’re happy with the shapes of your teeth, there is no point to doing Lumineers – that’s overtreatment that you don’t need. The problem is the fillings, so just get the fillings fixed.

Check our list of New Jersey cosmetic dentists. Any one of them that we list would be able to do your fillings so that your teeth will look beautiful. I screen these dentists carefully and am confident of their artistic abilities.

One caveat – if your fillings are so large that they cover maybe 1/3 or more of the surface of your teeth, it may be best to shave down the fillings a little and put regular porcelain veneers over them. But not Lumineers.

Good luck,
Dr. Hall

Related links:
Find a cosmetic dentist close to you.

March 4, 2009

Should I have an oral surgeon do this extraction?

Filed under: Extractions, Sedation dentistry — iowasmiles @ 6:26 pm

Dr. Hall,
A couple of years ago, a filling came out of my tooth, and the tooth later broke. When the pain finally became too much to bear, I went to a dentist and ended up having a root canal done, although I’m not sure it was successful. I’m ashamed to admit that my apprehension about dentists has kept me from proper routine check ups and maintenance. The dentist that did the root canal failed to follow up with me and I was in no rush to have more work done, as the pain was gone for the most part, so I did not follow up either and I did not have a cap put on. The temporary filling ultimately fell out, the tooth is about half gone as well and is now infected.

I’ve seen a new dentist that was recommended by a friend, he confirmed the infection, and has advised that the tooth needs to be extracted. He explained that it would be quite invasive due to the condition of the tooth, cutting gum and bone, and that I could have it done by an oral surgeon under anesthesia, or by him with a local. Because of cost considerations, I’ve elected to NOT use an oral surgeon/anesthesia.

I guess my question is this—Due to the invasive nature of the procedure, would it be advisable to use the oral surgeon, or is it safe to assume that a ‘regular’ dentist is qualified to handle to job safely and effectively?
- Amy in New Jersey

Amy,
Giving patients options like this can leave them in a quandary. You leave them with the impression that they might not be safe taking the cheaper route. I would suggest asking more questions to help get at the answer.

It’s possible that the extraction you’re dealing with is beyond the comfort level of your dentist and the dentist could end up in trouble during the appointment. And it’s possible that this appointment could be a traumatic experience for you. Those are the two issues.

Dental anxiety can be very expensive, as you are finding out. If you had the filling replaced when it first came out, you wouldn’t have needed a root canal treatment. If you had the crown done right after the root canal (which sounds like it was done properly), you wouldn’t need the tooth extracted and now a much more expensive tooth replacement to keep your bite from collapsing. So I wouldn’t dismiss the idea of having this appointment with the best anesthesia possible, to keep you from having a bad experience and the resulting lifetime of serious dental anxiety. The end result would be that your mouth would gradually fall apart.

So I would try to pin your dentist down with some specific questions about just how comfortable he feels with this appointment, if he has done extractions like this in the past, if there is nitrous oxide sedation available for you that would help it be more comfortable, and if it is likely to be traumatic for you. Are the roots straight and tapered, or are they twisted with knobs on the end?

Having answers to these questions would help. It sounds like your dentist is trying to be fair and honest with you, so I would give his expressed opinions considerable weight. My tendency would be to encourage you to see the oral surgeon if that option is being offered—it indicates a degree of discomfort on the part of your dentist.

- Dr. Hall

Related links:
Read about dental crowns and why they are needed. In particular, you may want to find out about porcelain fused to metal crowns.
Read more about sedation dentistry here.

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