Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

April 21, 2018

Water relieves the pain in my tooth


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Dr. Hall,
It’s been ten years since I got my two fillings. One fell out but doesn’t hurt. The other one is still in but is causing severe pain. It doesn’t bother any to bite on it, but it hurts most of the time. The only thing that relieves the pain is water and only for a few seconds. Any advice?
– Brandon from Oregon

Brandon,
I wish I had better news for you, Brandon, but your tooth, the one with the filling, is showing classic signs of a dying pulp and you’re going to need a root canal treatment on it. I’d get the other filling replaced before it’s too late.

Here’s what’s going on. There has been some decay get into the tooth, probably getting under the filling. That decay has grown until it has infected the pulp. As the infected pulp tissue dies, it can go into a state where it is called a gangrenous pulp. In that state, it gives off gasses that increase the pressure inside the tooth and cause a toothache. When you cool the tooth with water, it causes the gas to shrink somewhat and eases the pain.

This is a classic situation. When a patient reports that cold water or ice water is the only thing that relieves their toothache, you can be 100% guaranteed that they’re suffering from a gangrenous pulp in a tooth that has almost died. Relief can be obtained by simply creating an opening into the tooth to relieve the pressure, but then it needs to be followed up with a root canal treatment to fully remove all of the infected tissue inside the tooth and seal it against further problems.

It’s a similar situation when a tooth is sensitive to heat—it’s a nearly dead tooth.

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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

Do you have a comment or a question or anything else to add? 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 20, 2017

Tooth with a crown is sensitive to heat


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Dr. Hall,
I have several crowns, some on natural teeth some on implants. I have two crowns next to each other on top and front. The crowns are maybe 20 or 25 years old. 1 week ago I saw my dentist for a cleaning and today I woke with constant strong pain but much worse when sipping coffee warmer than room temperature. My dentist isn’t in for a few days and the pain seems to be growing to include the crown on the tooth next to it. Any ideas?
– Randy from Illinois

Randy,
I’m sorry to have to be the one to give you the bad news, but the pulp of your tooth is dying and it is going to need a root canal.

You have two of the classic symptoms of a dying tooth. Teeth can be sensitive to a number of things, and that sensitivity can sometimes come and go and may not indicate a dying tooth. But if you have strong pain that isn’t provoked, that’s an indication of a dying tooth. Adding to it, your pain is aggravated by heat–a doubly bad sign.

What happens is that an infected pulp will draw in body defenses including white blood cells. The tissue wants to swell, but being in a confined space, it chokes itself and then dies. As it dies, it can sometimes give off gasses. Any warming up of the tooth increases the pressure of those gasses and increases the pain. Cold will cause the gasses to contract and will generally provide relief in this situation.

So what do you do when you have a crown on the tooth that needs a root canal? It isn’t difficult to make an opening in the crown and do the treatment through the crown. However, if I were your dentist, I would want to remove that crown and find out what is going on under it. I would also want to replace the 20-year-old crown on the adjacent tooth, because something similar may be happening to that tooth.

Why is this happening? There are several possibilities. One is that decay has gotten in under the crown. This can happen through a leaky margin that your dentist didn’t catch or maybe did see but didn’t attach enough significance to it. Another could be that the tooth has become irritated through exposed root surface.

– Dr. Hall

Do you have a comment or a question or anything else to add? 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.

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