Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

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.

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.

January 12, 2016

The tooth extraction site is sensitive to warm food

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Dr. Hall,
I had an oral surgeon remove a wisdom tooth. About 2 weeks later I shoveled snow in 20 degree temps for about 3 hours. The tooth site felt a bit achey. Now, a week later the site still seems achey and now seems very sensitive to warm-hot food. The extraction site appears very healthy. Is there anything I might need to attend to or check? Thank you so much for your time and attention.
– Tia from Michigan

Tia,
It’s normal for an extraction site to start to ache after physical exertion, if you’ve had a recent extraction, especially for a wisdom tooth. However, the sensitivity to heat is a different matter.

I get these reports of an tooth extraction site being sensitive to cold or air after an extraction and almost always it’s the adjacent tooth, and I suspect that’s what is happening in your case. Sometimes extractions will cause the root of an adjacent tooth to become exposed and that tooth with the exposed root will become sensitive. Sensitivity to cold wouldn’t be much concern especially if it’s mild, but sensitivity to heat could potentially be a serious problem in that tooth. I’d have it checked.

When a tooth becomes irritated, it will often become sensitive to cold. If that irritation persists without getting resolved, the tooth can become sensitive to heat. That happens when the pulp tissue inside the tooth begins to die. In the process of dying, it gives off gasses. Heat causes those gasses to want to expand, but since they’re confined inside the tooth, there is no where to expand and that causes pain.
– 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.

May 24, 2012

Tooth sensitive to cold after wisdom tooth extraction

Dr. Hall,

I had my wisdom teeth removed three weeks ago, and the gums appear to be healing well. However I have been experiencing increased tooth sensitivity to the cold. It began just at the sites where the extraction occurred but has now spread to most of my top teeth. I plan to buy some tooth sensitivity toothpaste, but was wondering if this is a normal side effect? Will it go away with time? And is it a concern that the sensitivity has spread through my mouth?

Regards,
Miffy from Australia.

Miffy,
Occasionally, after the extraction of a wisdom tooth, the tooth right in front of it will become more sensitive to cold or air. This happens rarely on the lower and a little more often on the upper. The reason is that, with the removal of the wisdom tooth and possibly some of the bone that was holding it in, part of the root surface of the adjacent tooth becomes exposed making the tooth sensitive. While this root can be treated to make it less sensitive, it is easier and less expensive to begin brushing with a toothpaste for sensitive teeth, such as Sensodyne. If that doesn’t work, then I would ask your dentist to see if he or she has any desensitizing treatments available in the office.

This sensitivity could increase with time as the tissue at the extraction site heals and shrinks, but it should not spread to other teeth. Sometimes one tooth can be sensitive and it can feel like the teeth around it are also sensitive. To be on the safe side, I would go back to your dentist to see if there is something else wrong. Perhaps there is some deep decay or something else is going on here.
– Dr. Hall

Link: When is a tooth sensitive to air?

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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.

August 16, 2011

A tricky diagnostic problem? Not really.

Filed under: Pain in teeth — Tags: , , — mesasmiles @ 10:04 pm

Good day Dr. Hall,
I am 24 years old and broke off at least 1/3 of my left front tooth when I was 21 or 22. I was in France at the time and had to have an emergency root canal as the nerve had been exposed. When I got back to England (where I lived then), I went straight to my dentist who drilled out the filling to check the work. He concluded it was good, refilled it and later put a crown on it. This was fine for a long time, with no pain.

In November 2010, after I moved to Georgia, the crowned tooth became excrutiatingly sensitive to hot and cold, and occasionally ached when not eating or drinking at all. So after a couple of months, the pain had become far less intense and only now sensitive to very cold. I decided I would still go and have it checked, after an x-ray and some wiggling of the tooth my dentist could not tell what was wrong, so referred me to an endodontic specialist. The specialist said he thought the symptoms were coming from the tooth next to it as I have been putting pressure on that tooth in my sleep.

So nothing has been done to the crowned tooth and the wiggling of the tooth which they both did actually made the pain come back again. It is still bothersome and I am very worried. The pain is starting to get a little worse again, now. With both dentist and specialist saying they can’t see anything wrong on x-rays, and I have no pain when they tap the tooth, I am at a loss. I fear that I will eventually lose the tooth if nothing is done to solve whatever is wrong. What do you think this could be? I find it strange that the tooth gave me no trouble for over a year and then all of a sudden became unbearably sensitive. I very much look forward to your reply, and thank you in advance for your advice.

Kindest regards,
Danielle from Georgia

Danielle,
I’m not sure why there is so much puzzling about this tooth. This isn’t that difficult a diagnostic situation.

Let me clarify a couple of points to bring some sense to what has happened to you..

First, I’m understanding you had a root canal treatment on your left front tooth 2 or 3 years ago. That removed the nerve from the tooth, so there is no way it could have any sensation to hot or cold, unless the root canal treatment wasn’t really done. It is very rare for this upper front tooth to have any extra canals or other strange anatomical features that a dentist might miss in doing a root canal treatment.

Second, not seeing anything on the x-ray is no great mystery. When the pulp of a tooth is inflamed, it doesn’t show up on the x-ray until the inflammation progresses to infection and the infection begins to leak out the end of the tooth into the bone. It also isn’t sensitive to tapping until that happens.

Going back to the original accident that caused your left front tooth to fracture. As large as the fracture was, there had to be some trauma to the teeth next to it. So for one of these teeth to be acting up at this point is not the least unexpected. I have seen that before where a tooth has been traumatized and it is fine for several years and then begins to act up.

If the pain is pretty much gone now, it could mean one of two things. Either the tooth has recovered, or the tissue inside the tooth is dying. If it is dying, that will show up on the x-ray in time, plus the tooth will turn darker. So as long as it is not hurting, there is no great urgency and I would leave it alone and get an x-ray at your next regular check-up and see what it shows. If it shows nothing, count your blessings, but have the tooth x-rayed again every few years, just to be sure. If the tissue does die, which is what will probably end up happening, it means that you’ll need another root canal treatment and a crown – it’s not that difficult to fix.

Dr. Hall

Links to related pages:
Why is a tooth sensitive to biting?
Why is a tooth sensitive to heat?
Sensodyne is a toothpaste for sensitive teeth.

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.

June 16, 2011

How can I tell if a tooth is infected?

A week ago, I answered a question from a woman named Cortney who had a sensitive tooth, was pregnant, and her dentist, who had originally told her that the tooth had only a small cavity which he then filled, now told her that she needed a root canal treatment. I heard back from Cortney with a follow-up question.

Click here to read the original post, “It was a small cavity, now he says I need a root canal!”

Here’s the new question:
Thank you Dr Hall. That was very helpful 🙂 I will “like” you on facebook. I totally agree with your assessment of this dentist. Lastly, how will I know if the tooth has become infected and not just cold/air sensitive? Will I have fever/swelling to the area? Can they tell only on xray? Just want to make sure that if I wait, unknown infection won’t spread to my unborn child. Thank you so much!
– Cortney from Maryland

Cortney,
You won’t have to worry about any infection spreading if it is cold and/or air sensitive. The sensitivity indicates that the tooth is still alive, and thus any infection that there may be would be slight and thus confined to the tooth.

There are ways to tell if a tooth will recover from sensitivity or not. If the sensitivity is gradually getting better or staying the same, that is a good sign. If the sensitivity is such that the tooth hurts only while it is cold and as soon as the tooth warms up it feels better, that’s a good sign. If the pain lingers for, say, 30 seconds after a cold stimulus or air, that’s a bad sign and indicates that the sensitivity is irreversible. If the tooth gets so that it begins to hurt without any cold or air stimulus, in other words the sensitivity is spontaneous, that’s also an indication that the tooth will probably not get better, and that would be the point where you would say that it needs a root canal treatment.

Congratulations on your pregnancy, and good luck,
Dr. Hall

Read Cortney’s thank you.

 

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.

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