Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

February 19, 2018

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 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 27, 2017

This is too much sensitivity – you need a root canal


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Dear Dr. Hall:
On June 26, my dentist prepared my cracked tooth number 30 (lower right first molar) for a crown. I had several problems with the temporary crown including very sore gum and pain with biting and cold sensitivity. However, since the pain was not lingering, my dentist placed my permanent crown on July 12. But it didn’t subside and in fact, it got worse. After one week, I visited him again and he took X-ray and did cold test and pressure test. He also knocked at my tooth which was not painful. My tooth was very sensitive to cold but it went away in less than 30 seconds. Also, I didn’t feel pain with pressure test although I felt pain when I bit on hard things. So my dentist said I had to wait and I had high chances to get better. He said sensitivity to pressure is normal even for 30 to 90 days. Now 10 days has passed and from my permanent crown placement, but I don’t see any improvement. Also, today I discovered my tooth is sensitive to hot food too although it doesn’t linger for a long time after the hot food is removed. I think once I realized this sensitivity with that temporary crown but didn’t care about it.
Are these reversible pulpitis symptoms? Does that heat sensitivity show my tooth nerve is dying? How long do you think I must wait before I see an endodontist?
Thanks a lot.
– Bita from Iowa

Bita,
Thanks for the clear description of your symptoms! You told me what kind of pain, what provokes it, and gave me a clear history, which makes it much easier to figure out what is going on with your tooth.
I would call the endodontist today. There are a couple of red flags here and I’d get an expert diagnosis before this tooth gets any worse. It doesn’t look good.
I don’t want to be too critical of your dentist, because I don’t know the whole story of your tooth—just what you’ve told me. But just taking what you’ve told me, some additional caution in your case seems like it would have been wise, and I’ll explain why. It also isn’t normal for a tooth with a new crown to be sensitive to pressure for more than a few days, if the occlusion is adjusted correctly.
First, you had a cracked tooth. A crack can easily involve the pulp of a tooth and by itself can cause a tooth to become infected and the pulp to die.
On top of this, you had significant cold sensitivity after the crown preparation. This could have been due to an incompletely sealed temporary crown, or it could have been due to the extra irritation to which the tooth was subjected from the crown preparation, or a combination of the two. It would have been wise to have coated the tooth with some type of desensitizing product at this point. Maybe that was done.
Also, given those two things, it would have been prudent to have temporarily cemented the crown. This is a lower first molar, so the crown would have to be made out of some strong material that could have been cemented with a soothing type of cement in hopes that it would settle down, or, if it didn’t, to allow easy removal of the crown for root canal treatment. Permanently cementing a crown is usually an additional irritation which can push a borderline tooth over the edge to needing root canal treatment.
So your dentist permanently cemented the crown and the pain got worse. Your sensitivity is headed in the wrong direction and appears that it will end up in irreversible pulpitis, requiring root canal treatment.
And now it is getting sensitive to heat. I wouldn’t go quite so far as to say that it’s absolutely certainly suffering from irreversible pulpitis at this point, but if not, it’s awfully close. The endodontist should be able to tell you for certain. There would be subtle changes in the ligament of the tooth around the end of the root that most general dentists wouldn’t see but the endodontist should.

– 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.

December 21, 2015

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

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

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.

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