Hi, Dr. Hall,
I’ve had a bridge on tooth#s 18, 19, 20 for 7 yrs now. I haven’t had any pain with it.
Now, 2 weeks back, I went to the dentist. He told me to replace the bridge. I got the treatment, he removed the old bridge, and put a temporary bridge on. Since then I am having continous pain on that side; I am on motrin every 8hrs, pain is consistent and it is spread to the whole side, even the jaw. Sometimes it feels more when I speak or open my mouth, so he checked and said x-rays are ok. Gums are mildly inflamed, everything looks ok, he doesnot know why pain is so severe and continous.
So he refered for 2nd opinion to an endodontist, whom i have to see yet. Please give your suggestion what it could be?
Thanks a lot.
– Sami from California
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Dear Sami,
It’s not unusual for teeth to be sensitive after they’ve been prepared for crowns or bridgework or while you’re wearing a temporary crown or a temporary bridge, and there are several possible sources of this sensitivity.
The teeth can be sensitive merely from having been worked on. A bridge generally consists of two teeth with crowns on them and one or two false teeth suspended between them. And to place a crown requires shaving those two teeth down one to two millimeters on each side and on the top. It can been fairly traumatic for a tooth, and can cause it to ache or to be quite sensitive to hot and cold foods, air, or other potentially painful stimuli. Now your teeth were initially prepared for bridges seven years ago. Removing the old bridge and preparing for a new bridge would be traumatic to the teeth, but the trauma is much less than what happened seven years ago.
The teeth could be irritated by bacteria. You didn’t tell me the reason for needing the new bridge. If there was decay underneath either or both of the abutment teeth, the bacteria could have been pushed down into the teeth through the porous dentin, and these could be causing irritation.
The temporary bridge could be not covering the prepared teeth completely. If there is an area of dentin exposed and not covered, your saliva, air, or substances in the food you eat could be irritating the teeth.
The temporary bridge could be not fitting into your bite well. If this is the case, you could be hitting extra hard on these teeth when you move your jaw, which will make them ache.
The temporary bridge could be irritating the gums around the prepared teeth.
If the teeth are extremely sensitive to hot and cold stimuli but not too much to biting on them, the cause is likely to be one of the first three I listed. If they are more sensitive to biting, but not so sensitive to hot and cold, it is more likely to be one of the latter two reasons.
None of these sensitivities would likely show up on an x-ray in the early stages. And there could be multiple sources of the sensitivity. all adding up.
If your dentist was unable to figure out the cause, referring you to an endodontist (root canal specialist) is appropriate. The teeth could be examined closely, and possibly tested with hot and cold stimuli and tapping tests to get more information about the cause of the sensitivity and to pin down if it is coming from one particular tooth or both of them.
There might be a temptation to delay making the permanent bridge because of this. I would advise, however, to have the permanent bridge made right away and then having it placed with a temporary cement. This could solve the problem, and there is little chance that this would aggravate the teeth more. And the reason for using temporary cement would be to take time to observe the teeth and see if the sensitivity has died down. When and if it does, a careful x-ray examination should show whether or not the sensitivity was too much for the tooth and the living tissue inside the tooth has died. If that has happened, the affected tooth or teeth would required a root canal treatment, which would be much easier to do with the bridge temporarily removed. But I have seen cases of fairly extreme sensitivity completely go away with no lingering effects once the permanent restoration is placed. I had a case like that in my own mouth. It took the tooth a couple of months to settle down, but now it is fine.
Dr. Hall
Links:
Read more about various types of teeth sensitivity: sensitivity to cold, sensitivity to heat, sensitivity to biting, sensitivity to sweets, sensitivity to air. And read about a toothpaste for sensitive teeth.
About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
Michelle says
The pain without Motrin round the clock is crazy! My first temp bridge already replaced and I had been saying it feels like shards of glass and the resin dried was in my gums! They pulled them out when making my second temp, week 2. I thought it would be better and it is smoother but without Motrin the pain brings me to tears. Perm delayed to do hand work to assure fit by another week. 12 days more, but appreciate knowing perm bridge should bring relief!