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New composite filling hurts

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Hello Dr. Hall, I’ve had small fillings done with flowable resin based composites, and have had constant sharp pain when chewing certain hard crunchy foods that last a split second. The pain has not been getting worse, and I’ve had the fillings replaced with the same composite but have stayed the same or gotten slightly worse.

From your page Pain in my tooth after getting a new filling, your second to last bullet point, it matches my situation exactly. I can clench my teeth together without any discomfort at all, but when I chew hard crunchy foods I get a sharp pain in these teeth.

I’ve been trying to source a dentist that uses “self-etching primers” or a glass ionomer base, as you suggest on the page, but receptionists I’ve called seem not too familiar. Some will say they use Filtek (which I can look up and is a composite filling), but what exactly should I say to ask for your suggestions?

I am living in Birmingham, England currently, but honestly, I don’t care where it is, I wouldn’t mind traveling down to London if you know of some appropriate ones there, as it’s been bugging me seriously.

– Gilbert from Birmingham, England

Dear Gilbert,
Yes, it does sound like this strange sensitivity that curiously tends to occur much more often with small fillings than with large ones and seems to be related to the bonding of the filling to the dentin of the tooth. And I’m not surprised that the receptionist won’t know what you’re talking about when you ask if the dentist uses self-etching primers or glass ionomer bases. One of the dental assistants who helps in the procedure might know what a glass ionomer base is, but I couldn’t be sure of even that.

I can think of two possible solutions for you. One would be to make an appointment and then tell the dentist directly, before he or she starts working on you, that you insist that they use a glass ionomer base under the filling to protect the dentin, so that they don’t have to bond the composite to the dentin, and if they can’t agree to that, don’t let them work on you.

The second and more certain solution would be to go to London, as long as you’re willing to travel that far, and see our recommended cosmetic dentist there, Dr. Tim Bradstock-Smith. He would know all of these things.

Dr. Hall

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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.

Sensitivity after a small composite filling on a back tooth, and a dentist who won’t fix it

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Dr. Hall, I recently had a small composite filling done on tooth 14 [upper left first molar] and am experiencing the exact symptoms you describe as:

“With composite fillings, there is an unusual kind of sensitivity that sometimes occurs. With this sensitivity, the tooth is not sensitive when you clench your teeth together but will experience a sharp pain when food is chewed. . . . Curiously, it tends to occur most often in smaller fillings. When it occurs, replacing the filling with another composite filling can eliminate the sensitivity.”

My question is, can you point me towards any documentation or research concerning this unusual sensitivity? My dentist has checked for a cracked tooth, adjusted my bite twice and yet my extreme sharp sensitivity to chewing food still exists. He states he sees 5 or 6 patients a year with this type of sensitivity (all in small fillings he claims) but still insists that my bite is off and is suggesting a crown/root canal if the pain does not go away. I have searched the internet for more information about this unusual sensitivity but have not found much other than your website. When I suggested he redo the filling, he stated composite material bonds excellent and that could not be the cause. Can you help provide me with more information or a piece of your own knowledge regarding this?

Thanks for you time.
Matthew from Arkansas


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Matthew,
Do a root canal and a crown? You have to be kidding me! When all you need is a small composite filling?

You’re asking me about documentation for this. I’m guessing that what you want to do is take that documentation to your dentist and convince him that replacing the filling is the way to solve this. The problem is I have never seen this approach work where the patient tries to become the teacher. Plus, you already have documentation on this sensitivity—my web page you reference that explains tooth sensitivity after a composite filling. The page should have pretty good credibility with you and your dentist because it nails your problem exactly—small composite filling, pain when you chew, no pain when you bite, the bite adjustment didn’t solve it, checking for a cracked tooth doesn’t turn up anything. What more does your dentist need? Look up my CV and check my credentials. Not only have I heard other lecturers talk about this, I had a fair amount of experience with this. Replacing the filling does work, as I did that every time I saw this sensitivity and it worked every time.

The problem may actually be that your dentist doesn’t WANT to replace the filling. What he appears to want is to do a root canal and a crown. The crown and root canal will likely be near $2000, but he’d have to replace the filling for free. He’s leaving me wondering if that isn’t what he’s really concerned about.

No, I don’t think you’re going to persuade your dentist, no matter what you do. I think you need to get a little assertive with him. Here’s what I recommend doing: Take a printed copy of my web page (assuming he hasn’t seen it yet), and maybe a copy of my CV (you can find that on our infinitydentalweb.com website). Show that to him and then tell him you and he can fix this one of two ways. Either he can replace the filling himself, putting in a glass ionomer base that completely covers the dentin before the tooth is etched (that’s the best guarantee for eliminating the sensitivity). Or, if he won’t do that, you’ll go to another dentist to have that done, which will solve the problem and prove him wrong. And then you will demand that he pay for it or you will report him to the dental board and take your complaint public on Yelp or Google reviews.

And I’d love to know how this turns out.

Dr. Hall

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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.

My dentist says the cavity is too deep for a white filling

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Dr. Hall,

I recently went to a dentist who wanted to give me amalgam fillings on the back bottom teeth. I would not let him. He claimed that the cavities were too deep for white fillings, so I walked out. I need to find a dentist who will give me white fillings in my area. My insurance is Denti-Cal. do you know of anyone?
-Marion from Los Angeles

Marion,

A couple of points in answer to your question.
First, that is a lame excuse, saying that the cavity is too deep for a white filling. The truth is that the deeper the filling, the greater the reason for doing a white filling. Amalgam makes a tooth more sensitive to hot and cold, and the deeper the filling, the deeper the heat or cold is conducted into the tooth. Plus a deep filling is likely also to be wide, leaving the walls of the cavity thinner than usual. A bonded white filling will strengthen those walls where an amalgam filling will leave the tooth more susceptible to breaking.
But your insurance is a problem. Denti-Cal is the government dental insurance plan in California, and that is what is screwing you. Not only does Denti-Cal not provide any benefits for white fillings (because amalgam fillings are cheaper), they actually prohibit you from paying the difference yourself. So the only way you’re going to be able to get a white filling is to pay for the whole thing yourself.

– Dr. Hall

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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.

Is a leaky filling an urgent matter?

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Hi Dr. Hall,

I tried out a new dentist this morning and have a question about his recommendation.

I have two composite fillings on two different back molars and he told me that they are leaky and have potential for failing. He recommended that I have them removed and replaced with newer, better materials. Is this an urgent situation? He said he may only have to remove part of one of them but it would probably be best to have them both redone to fix the seals.

– Jamie from Colorado

Jamie,
A leaky filling is a legitimate situation that needs treatment. A gap can form between the tooth and the filling and bacteria can get in there and decay can start then under the filling. That’s called recurrent decay, and the technical term for the process is microleakage.

A nice thing about composites is that it is easier to tell when decay starts to get around them. With amalgam, often the decay is hidden until it actually gets under the filling and has grown to some size, at which point it is fairly advanced. I can’t tell you how many amalgam fillings I removed that I thought were sound but the patients just wanted them out because they didn’t like them, and I was surprised to find decay under them. But these surprises don’t usually happen with composites.

Is it urgent to replace a leaky filling? That depends. With an amalgam, you often don’t know if there is decay under it or how much decay. Decay under a filling starts pretty deep into the tooth, so your tooth could be close to becoming infected. In that case, yes, it is possibly urgent. But with composite, which is what you have, it is easier to tell if there is decay. And, from the way you are phrasing what your dentist is saying, there isn’t decay yet, just the risk of decay.

And yes, if they are leaky, it would be best to replace the entire filling and get a better seal. If the old filling is leaking in one place, it may start leaking in another.
– Dr. Hall

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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.

Correct treatment for a dens in dente

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Dr. Hall,
I had a case called dent in denti (tooth within a tooth). This strange tooth got an abscess and wasn’t subsiding with antibiotics. I had a root canal done and then had the tooth extracted. Now what are my options?
Victoria, from Victoria, Australia

Victoria,
You refer to a condition called dens in dente, which in Latin means “tooth within a tooth”, and what happens is you have a deep pit, almost like an inverted small tooth, that grows within another tooth, almost always a lateral incisor. A dentist should pick this up on routine x-rays and fix it before it gets to be a problem, and if so, it will require a simple filling. In my practice, I would clean out the pit really well and then fill it and seal it over with a white composite filling, and the issue was done.

But if it isn’t caught preventively, the pit can decay, and since the pit goes very deep into the tooth, the cavity will progress quickly to an infected tooth, requiring a root canal treatment.

Anyway, this tooth has been extracted, and you need it replaced. That can be done with either a dental implant, a dental bridge, or a removable partial denture. The cheapest replacement would be with a dental flipper.
– Dr. Hall

We thank our advertisers who help fund this site.

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.

Do amalgam fillings stain your teeth?

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Dear Dr. Hall,
I have two amalgam fillings I would like removed completely and replaced with composite for two back teeth. However, my dentist mentioned to me these fillings may have stained the teeth and they may not be as aesthetic  after the work is done.

Is it true that amalgam fillings can stain teeth, and if so what does create the stain? And what option can exist to remove such stain? In addition, these two teeth have around 70% filling: Is white composite a good option for strength and durability vs amalgam?
– Stephan in Seattle

Stephan,
I have taken out a lot of old amalgam fillings and replaced them with composite and they always looked better. Yes, amalgam can discolor your tooth a little bit, but I never found that to be an issue that significantly detracted from the appearance of a back tooth.

It sounds to me like your dentist simply isn’t very comfortable with the composite fillings on back teeth. I would absolutely warn you about trying to press this matter. Placing composite fillings in back teeth is very different from placing amalgam fillings, and I have received e-mails of some horror stories of patients ending up needing root canal treatments because of the damage to their teeth from improper technique. If your dentist is indeed trying to tell you that he or she doesn’t want to do this, just drop the matter. If this is important to you, I would advise finding a different dentist who is trained to provide the kinds of services you want and whose values are more in line with yours.

And I have two additional points about these fillings, which you say cover about 70% of the teeth. If that’s true, the teeth really should have crowns, if the fillings are that large. So you’ve given me another reason to question your dentist. But if they do have fillings, the white composite fillings bond to the tooth and strengthen it where the amalgam fillings just sit in the tooth and make it easier for the tooth to fracture. The amalgam material itself is stronger than the composite, but the combination of the filling plus the tooth is much stronger if the filling is composite.

Dr. Hall

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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.

I don’t really think I had five cavities.

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Dr. Hall,
I recently went to a new dentist to get my teeth cleaned. I floss every day and I brush my teeth in the morning and most nights also, I dont drink alot of sodas either. I take really good care of my teeth. My old dentist told me I had great teeth. I found it weird that the dentist I went to the other day told me i have 5 cavities. All of them were in my back teeth. I went and had them filled, which he filled them with the white ones.

Since then I’ve had alot of problems with pain. I’ve had him adjust my bite but it still hurts. I really dont think I had cavities at all though. Should I get an xray from before and bring it to another dentist to see if I even needed the fillings? I looked at the xray after he took it, I didn’t see anything, but of course I’m not a dentist either. I just never had pain before and now I do, plus with the care I take with my teeth I dont see how I could have had 5 after just going to the dentist last year and had none. Just wanting another opinion.
– Alicia in Tennessee

Alicia,
It is possible that you had cavities that the first dentist missed. I had an experience after I got out of dental school where I had a large cavity in my own mouth that had been there for quite some time and the x-rays taken at dental school missed it because they were taken at the wrong angles. But I think you’re reasonable to be suspicious. Yes, if you have reason, like you do, to be suspicious, I would ask for a copy of the x-rays and get a second opinion. But tell the second opinion dentist as little as possible, and don’t let the second dentist know the name of the first. I would just present the x-rays and show up and say, “I’d like a second opinion on this dental work” without planting any ideas like that you thought the work was unnecessary. A dentist who is hungry for patients will sometimes try to agree with a patient in order to convince a patient to quit the other dentist and become a patient. And a dentist who is personally acquainted with another dentist will sometimes hold back and feel a strong obligation not to criticize. To get the very best second opinion, you could visit a dentist in a distant city while you’re on vacation or something.

The post-operative pain you’re feeling also makes me suspicious. It sounds like the white fillings may not have been done correctly – not bonded correctly. Do you have pain when you clench your teeth together? Or is it just pain when you’re actually chewing something? If it doesn’t hurt to clench, but it hurts to chew, that’s an indication that something went wrong in the bonding process. If that pain persists, it may be necessary to replace the fillings to alleviate it. If it hurts to clench, then it’s probably that the bite just needs to be adjusted.

– Dr. Hall

Links: read more about pain after new fillings.
Click here to find a cosmetic dentist.

We thank our advertisers who help fund this site.

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.

Pain after a new filling

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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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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.

My tooth is still sensitive after a white filling.

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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.

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.

Pain after a white filling

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Dr. Hall,
Six months ago I had a front tooth filled with a white filling. Almost two months ago, I went back to complain how floss gets stuck in a notch between my teeth and to buff the surface of the tooth where leftover filling material was a nuisance. So my dentist smoothed it out. But then I got shocking pain when I took a bite into pizza. I gave it two weeks, went back in to have the tooth x-rayed. My dentist says the tooth is still sensitive to the filling procedure and take Advil and wait it out. But for the past two weeks the pain level is such that I can’t chew bread or drink room temperature liquids.

I am now constantly on pain medicine. My choices?? If I go back in, he will probably want to redo the filling. But can the dentist tell from the x-ray if the tooth really needs the root canal or do you think the porcelain did not get bonded or filled correctly? It is my front tooth so I don’t want to make a bad decision about whether to see an endodontist or let this dentist experiment around and redo the filling.

Any help or advice is greatly appreciated.
– Lisa in Colorado

Lisa,
If the pain is as intense as you seem to say, then you probably do need to see the endodontist. A dentist should be able to diagnose this by testing the tooth, and, if they’re good, they should be able to see it on the x-ray at this point. The endodontist should be able to tell.

This isn’t just irritation from being filled, because you are telling me that it’s been six months and the pain is getting worse. When a tooth is just irritated, it hurts, but then the pain will get better–sometimes very slowly, but always getting better. When the pain progresses, it’s a sign that there is some type of infection going on.

While it’s possible the dentist did something wrong, usually when this happens it’s just an indication that there was decay under the old filling or something like that. This would cause some bacteria to get into the pulp of the tooth. Then, with the added irritation of being worked on, it’s enough to push the tooth over the edge and start to show signs of infection.

And here’s an important tip for a root canal filling on a front tooth that a lot of dentists don’t know. Ask that they leave no gutta percha (root canal filling material) inside the crown, but to trim that filling material to below the tooth attachment. This will help keep the front tooth from discoloring. You may end up needing a crown on this tooth, in which case the discoloration won’t matter. But if there isn’t a large filling in the tooth, you may not need a crown and trimming the gutta percha will help keep the tooth from turning dark.
– Dr. Hall

Related links:
Read about dental implants
Tooth pain after filling
Tooth infection
Root canal

We thank our advertisers who help fund this site.

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.

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