Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

June 29, 2016

Just a filling, but it’s getting really complicated now


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Dr. Hall
I am 34, never had a cavity, and had been with the same dentist for 10 years. Our insurance changed so I had to change dentists about 2.5 years ago.

At the first appointment with the new dentist she said I had a cavity needing filled. I was shocked, had had no symptoms, but due to childcare complications had her fill it right then. It hurt for weeks, she adjusted and it continued to hurt.

I waited out the year and switched insurance back to my old dentist, He said I had had that shadow on my x-rays for 10 years with no change and it was likely I didn’t need the filling. He adjusted it and within days the pain stopped! However, the filling kept tearing floss and pocketing food under my gums. He recommended I have it fixed so the pocketing food wouldn’t cause an issue.

He did the repair in January. As soon as the numbness wore off, I had pain where the numbing medication had been injected and my tooth was very sore. This remained and then progressed to heat and cold sensitivity over the next few hours. I called him a week later and he had me come in. He gave me options and we decided to try steroids orally for any inflammation. I have had bad reactions to steroids in the past, but thought I would be okay to try.

It really isn’t any better, and now I am scared to go back. He said worst case scenario is removing the tooth. I am devastated but also in almost continual pain for 6 months now, especially to anything not body temperature. My appointment is tomorrow to try to brave him fixing it again. I don’t know what to do or even if I can trust him anymore. HELP ME PLEASE.

– Erin from Texas

Erin,
Boy, there’s a lot to say about your saga with this tooth.

I’d love to be able to see your tooth and see exactly what happened here. Not seeing that, I have to make some assumptions. I will tell you that it doesn’t sound to me like either of these dentists is doing good for you, but there are more problems and more serious problems with your current dentist than with the one who originally did the filling.
Let me address several of the points you bring up:

1. One dentist seeing a cavity or feeling like a tooth needs to be filled and another dentist disagreeing with that–we see that kind of professional disagreement often and there is no ill intent with either dentist. My inclination is to be more partial to the dentist who called it a cavity. As an additional point, your dentist’s explanation seems suspect to me. A shadow on your x-rays for 10 years and he never even told you about it? That sounds to me like an excuse. A dentist doing one filling–because of the overhead involved there is little to no profit in that and it is more an annoyance to the dentist, so I don’t think there was any dishonesty in the dentist who filled it. It’s more likely there was sloppiness in the dentist who let it go for ten years.

2. The tooth becoming sensitive to hot and cold after repairing the filling–that’s bad. I would assume (because the problem was the filling catching floss and catching food and because of the post-operative sensitivity) that the “repair” involved replacing the filling. For it to become sensitive to hot and cold after a simple filling replacement something had to go wrong that he didn’t tell you about. Especially since the sensitivity wasn’t immediate. Temperature sensitivity after a new filling isn’t uncommon and doesn’t mean that anything went wrong. But this wasn’t a new filling. To simply take a filling out and replace it shouldn’t be that irritating to a tooth, and based on the problems you were having, he wouldn’t have even needed to replace the entire filling.

3. Steroids? Really? Wrong treatment! The hot and cold sensitivity in your tooth indicates a possible low-grade infection in the tooth. Steroids would make that worse. Steroids block your body’s response to inflammation, but also block its response to infection. Not good.

4. Removing the tooth? Bad again. I would be scared, too, if my dentist started talking to me about extraction at this point. Things are cascading out of control quickly here. There is quite a list of steps, every one of which has to go wrong, before he should be talking about extraction.

Bottom line–I think you should find a new dentist. Between the two you’ve seen, I think you would be better off in the hands of the dentist who did the filling. Though she didn’t do great for you, you just had the one mishap, not this series of problems. But the better thing would be to get a different dentist entirely.

I don’t know what the deal is with your insurance, but I wouldn’t let your insurance hold you hostage here and prevent you from getting adequate care. Losing this tooth over this simple cavity that was apparently just a slight shadow on your x-ray, that’s too much.

I’m wondering how you ended up with two dentists, neither of which has done very well for you. Maybe the problem is that you have really cheap insurance and no really good dentists want to participate in that plan. That occurs to me. If that is the case then maybe, to get this done right, you need to go outside your insurance company’s list of “preferred providers.” From the point of view of the patient, if your insurance company is using that term, “preferred provider,” I would translate that as “cheap dentist.” That’s what insurance companies mean by preferred.

Dr. Hall

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

February 5, 2016

Diagnosing a sensitive tooth after a new filling

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Dr. Hall,
I wanted to get your opinion on a pain I am having after the filling on my molar was replaced two weeks ago (a silver filling was replaced with composite filling)

Here are my symptoms:
*moderate pain when chewing
*very mild sensitivity to cold
continuous moderate pain starting up in the evenings after dinner…
*I started taking 400mg Ibuprofen around midnight if I couldn’t sleep from the discomfort, and that really helps.
*In the mornings I have no pain.
(My wife, who is a doctor, suggested I take ibuprofen continuously to reduce possible inflammation. Started that today.)
*In the evenings, continuous mild pain and discomfort around my left jaw and tonsil.
*very slight tingling and numbness in my lower left jaw and chin, kind of like when anesthesia is almost completely worn off

So my question:

Do you think I should have the new filling replaced to address these symptoms? Or should I wait?
– Sergio from California

Sergio,
As thorough as you have been in describing your symptoms, I still haven’t got enough information to diagnose your pain. I don’t know how big your filling is. I don’t have an x-ray. I don’t know how deep the dentist had to go in doing your filling. Nevertheless, I think I can be helpful. Let’s examine your symptoms, point by point.
• Moderate pain when chewing. A sharp pain when chewing when there are no other symptoms indicates this peculiar sensitivity that seems to come because of a bonding failure. If that happens then yes, you want to have the filling replaced with some changes in the bonding procedure. But that’s not the case with your filling. The pain is moderate and there are other symptoms. I would attribute your sensitivity to one of two possible causes. Either this is a larger filling that has changed your bite somewhat, or the ligament attaching your tooth to the jawbone has been traumatized slightly. I would expect this to get better over time.
• Very mild sensitivity to cold. This would also happen if you had a large filling, or even one that was deep, where the pulp of the tooth was irritated because the dentist had to go close to the pulp to get the decay out. This type of sensitivity is routine for silver amalgam fillings but also happens with composite fillings when they are deep. As long as it gets gradually better, it is no cause for concern.
• Continuous moderate pain in the evenings. This is a little puzzling and is of more concern. Spontaneous pain in a tooth can indicate an irreversible pulpitis, especially if it is more intense when you lie down. Again, this could have been a deep filling. But if there is spontaneous pain, it would tend to indicate that some bacteria have gotten into the pulp. This doesn’t mean that the dentist did anything wrong. The dentin of your tooth is porous, and in the process of removing deep decay, some bacteria are going to be pushed into the dentinal tubules of your tooth. If the pulp is close to the floor of the cavity, those bacteria will end up in the pulp. If it’s not too many bacteria, your tooth can recover. But if your tooth isn’t getting better by now, it’s not recovering.
• Pain in the jaw and tonsil. This wouldn’t have anything to do with the tooth. It might be related to stress on your jaw or mouth from the procedure.
• Tingling and a sense of numbness in your lower left jaw. You had an injection to numb the lower left jaw. Residual tingling would indicate that the dentist hit the bullseye with the injection – a direct hit on the nerve he or she was targeting to numb. He or she may have even nicked it slightly with the needle. The target nerve here goes to the teeth on that side of your lower jaw and also to the lip and chin. This is of no concern and will completely go away in time.
Anyway, I hope this is helpful. You have an interesting mix of symptoms, and I’m hoping it makes an interesting and helpful blog post for others. Bottom line–most of this is not of any concern. But the spontaneous pain in the evenings worries me. Pain intense enough that you have to take ibuprofen to sleep is a concern. If it has been two to four weeks and there is no improvement, I would have the tooth x-rayed by a dentist who has a high level of expertise in radiographic diagnosis–possibly an endodontist (root canal specialist)–who should look for a widened periodontal ligament space around the root tip of this tooth. If that is present, the tooth may need a root canal treatment, and it would be better to have that done before the pain gets unbearable.

– Dr. Hall

Do you have a comment? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

August 21, 2015

What is this amalgam glass ionomer filling I got?

Dr. Hall,

A substantial amount of tooth structure was removed during the procedure of 3 fillings in my molars. Those teeth were not painful, so I do not understand why it was necessary. The edge of one tooth was removed with the filling overflowing on that part to replace it. A little bit disintegrated, thus a bit of gum is exposed. Food gets stuck there fairly easily.
I am curious as to what type of filling material was used. I think it might be amalgam glass ionomer. It is a lighter colour than traditional amalgam fillings, and different in texture.
Also, how long should those fillings approximately last before they need to be replaced? I am only 20 years old, so I don’t know how what options I have to make those teeth more functional and aesthetically pleasing. I am distraught.

– anonrocker in the U.K.

Dear anonrocker,

I can only guess at the type of fillings you got. It would help to know on what basis you are saying these were amalgam glass ionomers. Kind of sounds like they told you something about it for you to use this term “glass ionomer.” And you don’t say what was different about the texture.
I’ll take your word that it was indeed a glass ionomer restorative and guess from there. There is a product called Miracle Mix that is a glass ionomer mixed with a silver alloy, so it has a grayish color to it. It is used usually as a buildup material for a large cavity when the tooth needs a crown, and the crown is then done over this restorative. I also used it as temporary fillings when a person had a lot of decay that needed to be arrested quickly and economically. Then we would either go back and drill off the surface of the Miracle Mix and do a composite filling on top of it, or we would do a crown over it.
Miracle Mix comes packaged in little capsules similar to the way amalgam is packaged, and it mixes in an amalgamator, also the same as amalgam. It is very quick and easy to use (i.e. cheap). There is no mercury in it
A nice feature of this restorative is that it has a high fluoride release, so it resists any recurrent decay on the tooth. Another nice feature is that it has a moderate chemical bond to tooth structure, so the tooth is unlikely to break around it. A not-so-nice feature is that it isn’t very wear resistant. It has kind of a gritty texture to the surface, and it will both wear off and dissolve over time, so that it will likely last only 2-3 years.
The good news is that your teeth are probably just fine for right now, except for the place where the food gets stuck. That should really be fixed because it will promote decay and gum disease in that spot. The bad news is that you’re going to have to have all these fillings fixed later. You shouldn’t need to have the fillings replaced–just re-surfaced with something more wear resistant. Go back to the dentist and ask if this was indeed Miracle Mix or some other similar glass ionomer restorative, and then go from there.
About the amount of drilling. While it could be that the dentist drilled away too much, a tooth with a large cavity can easily be asymptomatic. In fact they usually don’t hurt. So it’s also entirely possible that the dentist didn’t drill away too much.
If you want quality dental care in the UK, my advice would be to get away from the government program. It’s nice that so many people are getting dental care. But there is little incentive in your government-covered dental care for excellence in treatment–all the incentive is to run the patients through and take care of what they need in the easiest, quickest way possible.

– Dr. Hall

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

October 2, 2010

Probably a simple bite adjustment

Filed under: Fillings,Teeth sensitivity — Tags: , — mesasmiles @ 12:22 am

Dr. Hall,
Hi, I got a tooth filling because of cavities yesterday… Today when I bite down, one tooth at the back of my jaw seems to hit the tooth at the top, (second tooth after the bottom left canine tooth)…I can eat because of this without pain… Whats the problem? Help would be appreciated.
– Zim from California

Zim,
You’re not giving me a lot to go on. I don’t know if this is a white filling or an amalgam filling, a large filling or a small filling. The most like cause, though, of a tooth with a new filling hurting when you bite down, is that the filling is high. I’d call your dentist, tell him or her what you’re experiencing, and hopefully a simple bite adjustment will take care of it.

There are other possibilities, but that’s the most likely.
Dr. Hall

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We thank our advertisers who help fund this site.

About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

July 2, 2008

My new composite filling is a little sensitive

Filed under: Fillings — mesasmiles @ 7:22 am

Dr. Hall,
I have recently had tooth whitening and front composite fillings replaced. I am experiencing no pain or sensitivity to hot and cold. However one of my front composite fillings when pressed in the corner gives a slight sensitive pain. The filling was removed and replaced and problem still exists. Do I need to see a dentist again?
– Jeremy from Los Angeles

Dear Jeremy,
I don’t think I could tell you why your tooth is sensitive without seeing it, but I’m reasonably confident it’s nothing you need to worry about.
Sometimes with the white fillings a patient will experience strange slight sensitivities. There could have been some irritation with some of the bonding process. It’s also possible that in polishing the filling the enamel of the tooth was irritated. A sensitivity to just touch, especially if it’s slight, sounds pretty benign.
– Dr. Hall

Related links:
Pain or hurt after new fillings
Why is a tooth sensitive to sweets?
Dental bonding

About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

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